reproductive 1 Flashcards
What type of hormone are the sex hormones
Steroid based fat soluble so they pass through cell membranes easily
Three types of estrogen
Estradiol E2 - the most powerful, Estriol E3, Estrone E1
How do the estrogens compare
Estradiol E2 is 10 times more potent than Estriol and Estrone
are naturally occurying or synthetic estrogens more bioavailable?
Synthetic estrogens are more bioavailable because they are less subject to first pass hepatic metabolism
Why what HRT originally used
Postmenopausal: Reduce vasoactive response, tissue atrophy, improvesleep, blunts osteoporosis
concerns with exogenous estrogen replacement (without progestin)
increases risk of stroke, clots, ovarian endometrial and breast cancer
why is progestin added to those with uterus
because unopposed estrogen can increase risk of endometrial cancer
Differences between estrogen and estrogen with progestin trials
both had reduced risk of fracture, and increased risk of stroke, but in addition the progestin plus estrogen had increase risk of MI, DVT and breast cancer
bioidentical hormone options
BiEst: E3:E2 or TriEst: E3:E2:E1 both oral or topical
Compare Bi and Triest
E3:E2 80:20 / E3:E2:E1 - 80:10:10
what is the conjugated estrogens
Premarin ; estrone with equillin so it undergoes less hepatic metabolism
what is premarin used for
prevent and treat osteoporosis and post menopausal sx
how does premarin and all the hormones work?
MOA is altering gene transcripton
what is importain to know when using premari
you must add progesteron if you still have your uterus
category of premarin
Cat X, they also are contraindicated with hx of DVT, breast, ovarian or uterine cancer
what is synthetic progestogen
progestin, similar effect of progesterone
why are progestins used?
Hormonal contraception and prevention of endometrial hyperplasia in HRT
name a synthetic progesterone/progestogen
Medroxyprogesterone/Provera
indication for medroxyprogesterone/provera
contraceptive, HRT, dysfunctional uterine bleeding, endometriosis
how is medroxyprogestrone administered
PO or DEPO iv
side effects of medroxyprogestrone/provera
increase LDL/HDL ratio, facial hair, weight gain,
when is medroxyprogesterone contraindicated
Hx of female cancers, or DVT hx, and will cause birth defects if taken while pregnant
the pill
combo of estrogen and progestin
what does the estrogen of birth control doo
supresses ovulation
what does the progestin of birth control do
prevents implantation and makes mucus impenetrable to sperm
how effective are BCPs
97-98%
most commonly used estrogen fir BCP
ethinyl estradiol
combination pills
contstant estrogen with changeingamount of progestin
what are benefits of the OCP
reduce risk of colorectal cancer, improves PID, dysmeorrrhea, PMA and acne, PCOS sx and anemia
side effects of OCP
increase CVD, DVT, HTN, Stroke,
what should you not do while on the pill
Smoke, or be over 35
what is mini pill
consistent progestin with no estrogen for 21 days
why would someone want mini pill
it cant tolerate estrogenic, but its not as effective
what can reduce the efficacy of the pill
antibiotics, sulfa drugs and st johns wart
how much does pill reduce ovarian and endometrial cancer risk
about 50% in 5 and 80% in 10 years
Drospirenone
yaz, it has a way higher risk of thromboembolism
how often for Medroxyprogesteron acetate /depo proveria IM
four times each year, immediate protection
how does depo provera work
inhibit folicular development to revent ovulation
what does medroxyprogesteron acetate/provera also prevent
reduce risk of endometrial cancer by upt to 80%
how long to get pregnant after depo
9-10 months after last injection
risks of depo/medroxyprogesterone acetat
increase osteoporosis, has a black box warning, it shouldn’t be used for more than 2 years
what are the current implantable contraceptives
Implanon - can last 3 years
transtermal patches
Ortho evara - applied withing first 5 days of cycle , never apply over breasts
what happens if patch falls off
if you replace it in 48 hours no backup contraception is needed
concerns with patch ortho evara
higher estrogen than pills, twice the risk of clotting
what is in nuva ring
combined progestin and estrogen, 3 weeks, per ring, increased risk of blood clots
if ring falls out what then
if out more than 3 hours back up method for 7 days
IUD brand names
Copper: ParaGard, Hormone: mirena, liletta and skyla
whats in homonal iud
levonorgestrel and progestin
how does hormonal IUD work
Levonorgestrel : deminish ovulation, mucus consistency, make implation less likely, inflammatory response
Mirena duration
levonorgestrel : 5 years / 20 mcg day
liletta
levonorgestrel: 5 years / 20mcg day
Skyla
levonorgestrel: 3 years/14mcg day
Progestin only contraceptives
Levonorgestrel: Plan B, Next choide: 750 ug 12 hours apart
what is Ulipristal acetate/Ella
SERM, selective progesterone receptor modulator for emergency contracepton given within 5 days.
moa of ulipristal acetate /ella
delay or inhibit ovulation and inhibit folicular rupture
what are combo mornin after pills?
estrogen and progestin, 2 doses, same effect as stacking reglular pills
what are the 4 types of emergency contraceptive
progestin only, SPRM, combo, abortifacient
First 2 months of pregnancy abortifacient
Mifepristone: synthetic steroid,
moa of Mifepristone:
progenstin antagonist partial agonist so off and part on. 85% effective in first trimester
side effects of mifepristone
crampin, bleeding 9-16 days., emergency if incomplete
contraindications of mifepristone
in presence of IUD, ectopic pregnancy, hemorrhagic disorders, prednisone
SERMs
Clomiphene/Clomid
MOA of clomiphene/clomid
bind estrogen receptor sites in brain interfering with negative feedback on GnRH to resuld in increase secretion of GnRH, increasing LH and FSH stimulationg ovulation.
what are these SERMS clomphine/Clomid used for
infertility or amenorrhea.
