Reproductive Health Flashcards
What is the major effect of oestrogen?
Stimulates growth of endometrium and breast
Stimulates production of progesterone receptors
What is the major effect of progesterone?
Stimulates growth of endometrium and breast
Maintains pregnancy
Inhibits production of oestrogen receptors
What is the major effect of testosterone?
Stimulates secondary male characteristics
What actions does oestrogen have?
Mild anabolic Sodium and water retention Raise HDL, lowers LDL Decrease bone resorption Impairs glucose tolerance Increase blood coagulability
What are the side effects of oestrogen?
Breast tenderness Nausea, vomiting Increased blood coagulability => VTE Impaired glucose tolerance Endometrial hyperplasia, ovarian metaplasia, breast hyperplasia => cancer
What are the actions of progesterone?
Secretory endometrium Anabolic Increases bone mineral density Fluid retention Mood changes Maintains pregnancy
What are the side effects of progesterone?
Weight gain Fluid retention Anabolic Acne Nausea/vomiting Irritability, PMS Lack of concentration
What are actions/side effects of testosterone?
Male secondary sec characteristics
Acne
Voice changes
Aggression
Increased LDL - therefore males have increased risk of atherosclerosis disease
How does hormonal contraception affect menstruation/HPO axis?
Interruption of physiological control go the menstrual cycle
Effect on endometrial and cervical mucus
Inhibition of ovulation
How does the COCP act as contraception?
Prevent ovulation
Reduce endometrial receptivity => inhibit implantation
Thicken cervical mucus
How does the progesterone depot act as contraception?
High dose of progesterone =>
Prevents ovulation
Thickens cervical mucus
Prevents endometrial proliferation
How does the progesterone implant act as contraception?
High dose of progesterone:
Inhibition of ovulation
Thickens cervical mucus
Prevents endometrial proliferation
How does the progesterone only pill act as contraception?
Low dose progesterone:
Thickens cervical mucus
Not enough progesterone to inhibit ovulation
What is an adverse effect of the COCP?
VTE
However this risk is v small
Increased with smoking and high BMI
What are COCP and POP metabolised by?
CYP 450 enzymes in the liver
What can reduce efficacy of COCP and POP?
Enzyme inducing drugs
Increase production of CYP 450 => increase in metabolism of the drugs
Anti-epileptics; carbamazepine
Antibiotics; rifampicin
Natural products; St John’s wort
Why is HRT prescribed?
Management of symptoms such as hot flushes and dyspareunia
Osteoporosis
What are some risks of HRT?
Unopposed oestrogen: increases risk of endometrial and ovarian cancers
Opposed oestrogen: increases risk of breast cancer
Increase risk of VTE
Increase risk of stroke
What is a potential benefit of HRT?
Increase HDL, decrease LDL
However this isn’t an effect if the patient is already overweight
Also must not prescribe HRT for treatment of CVS disease
How does mifepristone act, and when is it used?
Progesterone receptor antagonist
Myometrium is made sensitive to prostaglandin induced contractions
Used for termination of pregnancy
How does clomiphene act, and what is it used for?
Competes with oestrogen
Used in treatment of anovulation in women of reproductive age
Leads to ovulation by increased production of anterior pituitary enzymes
How does tamoxifen act, and what is it used for?
Used as a treatment for breast cancer
In the breast: ER antagonist => cells arrest in the cell cycle
In the endometrium: ER agonist => endometrial hyperplasia
Therefore can lead to endometrial cancer
How does ulipristal acetate act, and what is it used for?
Selective progesterone receptor modulator
Used as emergency contraception as it delays or inhibits ovulation
Can also be used as treatment for fibroids
