Oral contraceptives, Menopause and HRT Flashcards
What is the medical terms for painful sex?
dysparunia
What is menopause?
The permanent cessation of menstruation. Loss of ovarian follicular activity which usually happens at an average age of 51 (range 45-55)
Running up to menopause women will be having a climacteric period = transition period (there will be irregular periods)
What are the symptoms of menopause?
Hot flushes (head, neck, upper chest) Urogenital atrophy and dysparunia
Sleep disturbance
Depression
Decreased libido
Joint pain
Symptoms usually diminish/disappear with time
Draw the normal HPG axis
See diagram
What are the complications of menopause?
Osteoporosis - oestrogen deficiency = loss of bone matrix –> 10 fold increased risk of fracture
Cardiovascular disease - Oestrogen has a protective against CVD so women are protected before menopause. Women have the same risk as men by the age of 70
What would you always prescribe HRT for?
To deal with the hot flushes. It controls the vasomotor control symptoms
Prescribe O+P
Oestrogen alone causes endometrial proliferation which puts the person at a risk of endometrial carcinoma.
Progestogens prevents endometrial hyperplasia
What are the HRT formulations?
Cyclical: E (everyday) then P(12-14 days)
Continuous combined
What are the forms in which oestrogen is administered?
Oral oestradiol (1mg)
Oral conjugated equine oestrogen (0.625mg)
Transdermal (patch) oestradiol (50 microgram/day)
Intravaginal
Estradiol - well absorbed. You need to give a high dose since there is a high level of first pass metabolism = low bioavailability
Estrone sulphate - conjugated oestrogen
Ethinyl estradiol - a semi-synthetic oestrogen. The ethinyl group protects the molecule from first pass metabolism.
Most oestrogens can be administered via transdermal skin patches
What are the side effects of HRT?
Breast cancer Coronary heart disease Deep vein thrombosis Stroke Gallstones
The absolute risk of complications for healthy symptomatic postmenopausal women in their 50s taking HRT for five years is very low. Although it has protective effects however at older years e.g >60 you have risks for CHD.
Timing of exposure of HRT is important. 50-59 these women are not as risk. Don’t prescribe to those with CVD or over the age of 60.
What effects does oestrogen have on younger and older women?
Younger women: Beneficial effect on lipid profile & endothelial function however if you add progestins it negates these positive effects
Older women: It causes atherosclerosis and they are susceptible to the prothrombotic and proinflammatory effects of oestrogen
Describe Tibolone
Synthetic prohormone
Oestrogenic, progestogenic and weak androgenic actions
Reduces fracture risk
Increased risk of stroke and maybe breast cancer
Describe Raloxifene
SERM - Selective oestrogen receptor modulator
Oestrogenic in bone - reduces risk of vertebraal factures
Anti-oestrogenic in breast & uterus - reduces breast cancer risk
Does not reduce vasomotor symptoms and has an increased risk of VTE and stroke
Describe Tamoxifen
Anti-oestrogenic on breast tissue
Used to treat oestrogenic-dependent breast tumours & metastatic breast cancers
What is premature ovarian insufficiency?
Menopause occurring before the age of 40. This happens to 1% of women.
Can be due to: Autoimmune Surgery Chemotherapy Radiation
Describe the combined oral contraceptive pill
Oestrogen (ethinyl oestradiol) + progestogen (levonorgestrel or norethisterone)
Suppress ovulation:
E&P: negative feedback actions at the hypothalamus/pituitary
P thickens cervical mucus
Take for 21 days then stop for 7
