Oral contraceptives, menopause and HRT Flashcards
What are the benefits of oestrogen treatment in menopause?
Benefits for lipid profile and endothelial function
Recall the most common combinations for combined oral contraceptives
Oestrogen component = ethinyl oestradiol
Progesterone component = levonorgesterel or norethisterone
What are the 2 main mechanisms of action of the combined oral contraceptive pill
- O+P have negative feedback effect on hypothalamoadenohypophysial axis
- P = thickens cervical mucus
Recall 2 indications for progesterone-only contraceptive therapy
= CONTRA-indications for oestrogen therapy (which is better)
- Smoking (reduce CV risk)
- Old (>35!)
Why does oestrogen-only contraceptive have to be taken at the same time each day?
Short half life
Recall 3 possible drugs that can be used as an emergency post-coital pill?
- Copper IUD
- Levonogesterel
- Ulipristal
Recall the mechanism of action of a copper IUD as a EPCP
IUD = intrauterine device = exclude pregnancy and decrease viability of sperm fx
How long post-coitally will levonogesterel still be effective?
72 hours
How long post-coitally will ulipristal still be effective?
120 hours
Define menopause
Permanent cessation of menstruation
What is the term given to the transition period before menopause?
Climacteric
What is the average age at which menopause occurs?
51
Recall 6 symptoms of climacteric
- Sleep disturbance
- Vasomotor action (hot flushes)
- Dyspareunia due to urogenital atrophy
- Depression
- Decreased libido
- Dysarthria
What are the 3 most commonly cited complications of menopause?
Vasomotor symptoms, CVD, osteoperosis
Why are post-menopausal women at so much higher risk of osteoperosis?
Loss of bone matrix –> 10 x higher fracture risk
Oestrogen inhibits PTH-stimulated osteoclast activity
By what age do men and women have equal risk of CVD
70
Why is oestrogen not usually prescribed alone?
Carries risk of endometrial hyperplasia
In what case might you give an oestrogen-only HRT?
Hysterectomy
What are the 2 different options for O and P combination in HRT?
- Cyclical - O with P for last 2 days of each fortnight
2. Daily combined
Recall 3 methods of administration of HRT and reasons for each choice
- Oral (patient preference)
- Transdermal patch (patient preference)
- Intravaginal (dyspareunia = main complaint)
What is premature ovarian insufficiency?
Menopause before age of 40
What is the prevalence of premature ovarian insufficiency?
1%
Recall 4 possible causes of premature ovarian insufficiency
- AI
- Surgery
- Chemotherapy
- Radiation
Describe the bioavailability of HRT
Oestradiol has high first-pass metabolism therefore bioavailability = low
