reproductive Flashcards
bio-identical hormone options
BiEst- estriol + estradiol, 80:20
TriEst- estriol + eatradiol + estrone, 80:10:10
-both are available as topical preparations or oral
progestin
synthetic progesterone
used as contraception(alone or with an estrogen) and to prevent endometrial hyperplasia in unopposed estrogen tx
conjugated estrogens(CEE)/ premarin
conjugated estrogens- estrone & equillin- fron the urine of pregnant horses
-undergo less first pass hepatic metabolism
for the prevention of osteoporosis & post-menopausal sxs- hot flashes, vag dryness & itching
MOA-**ALTERS GENE TRANSCRIPTION
-oral or topical
SE- vag bleeding, breast tenderness, inc risk for DVT, artherosclerosis & CAD & uterine & breast CA
CI for premarin
- prior hx of DVT or breast, ovarian or uterine CA
- smoking
- CATEGORY X
- risks vs benefits must be discussed
medroxyprogesterone/ provera
medroxypregesterone acetate isa synthetic variant of progesterone
-for contraception, HRT, DUB, endometriosis
MOA- **alters gene transcription
PO, depo-form is IM
SE- acne, wt gain or loss, edema, breast tenderness, increased facial hair, insomnia, anxiety, inc ratio of LDL:HDL, inc risk for DVT
CI- prior DVT, hx of breast, ovarian or uterine CA, may cause birth defects if used durign pregnancy
combined oral contraceptive pill (COCP)
includes both estrogen & progestin
estrogen suppress ovulation
progestin prevents implantation & increases cervical mucus
-98% effective
-ethinyl estradiol is the most commonly used estrogen
-several different progestins are used
-appears to decrease the risk of colorectal CA, imporves PID, dysmenorrhea, PMS, acne. may reduce sxs of endometriosis & PCOS, anemia
SE- inc risk for CAD< DVT, HTN, stroke- esp in those who smoke, >35yo. depression, HA, edema, nausea, breast fullness, acne
mini pill
progestin only- no estrogenic agent for 21 days
- used if the pt cannot tolerate estrogenic effect or if its contraindicated
- not as effective as combo pill, generally causes irregular menses
drugs that interact with OCP
- amoxil, cephalosporins, penicillin, seizure drugs, sulfa drugs, tetracycline
- st. john’s wort
- must PARQ pt on potential interaction with other drugs
drospirenone
YAZ or Yasmin
- synthetic progesterone that is closer in pharmacological profile to natural progesterone
- inc risk of developing thromboembolism by 6-7 times those who take no hormones, 2 times those who take pill with levonorgestrel
- potassium testing for contaminant K sparing drugs
medroxyprogesterone acetate/ depo-provera IM
MOA- inhibit follicular development to prevent ovulation. decrease GnRH release by hypothalamus- decreases FSH & LH from the anterior pituitary
- dec risk of endometrial CA by 80%
- SE- menstrual irregularities, wt changes, fatigue, HA, hair loss, epression, nervousness, abd discomfort
- bone loss & increased risk for osteoporosis is major concern- shoudl not be used for longer than 2 yrs
implantables
progestin levonorgestrel(norplant)- no longer on the market in US- replaced by Implanon- must be removed by the end of 3 yrs
transdermals
ortho evra- contains norelgestromin & ethinyl estradiol
nuva ring
progestin & estrogen(etonogestrel)
SE- BV, HA, leucorrhea, nausea, wt gain
mirena
levonorgestrel
morning after pill
plan B, next choice
progestin only- levonorgestrel, 1.5mg- either 2 750micrograms doses 12 hrs apart, or a single dose
ulipristal acetate/ ella- Selective Progesterone Receptor Modulator(SPRM)
delays or inhibits ovulation by inhibiting follicle rupture
large doses of both estroen & progestin- 2 doses 12 hrs apart
less effective & less tolerated
