Reproductive System Flashcards
How is testosterone replaced?
Testosterone Replacement: Daily Gel (eg Tostran). Care not to contaminate partner. 3 weekly intramuscular injection (eg Sustanon) 3 monthly intramuscular injection (eg Nebido) Less Common (Implants, oral preparations)
What are the symptoms of low tstesterone - hypogonadism?
loss of early morning erections, libido, decreased energy, shaving
What is easier to treat primary or secondary hypogonadism?
Secondary ( deficiency of gonadotrophins so can give LH FSH to induce spermatogenesis
What does LH and FSH do in men? when it is given as treatment
LH :stimulates Leydig cells to increases intratesticular testosterone to much higher levels than in circulation (x100).
FSH : stimulates seminiferous tubule development and spermatogenesis
Would you give a man with Low Testosterone and low LH/FSH testosterone if they are trying to concieve?
No, would lower LH/FSH
Not given to men wanting to conceive
What is hypothalamic Amenorrhoea?
Insufficient energy for fertility so Amenohhrea:
Low body weight
Excessive excersize
Genetic susceptibility
Stress
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What is Ovulation induction?
Aim to develop one ovarian follicle
If >1 follicle develops this risks multiple pregnancy e.g. twins / triplets which can have risks on mum and baby
Ovulation induction aims to cause a small increase in FSH
- used in PCOS
How to restore ovulation in PCOS?
. Lifestyle / Weight Loss / Metformin
2. Letrozole (Aromatase inhibitor) 3. Clomiphene (Oestradiol receptor modulator) 4. FSH stimulation
How does clomiphene work?
Antagonist = reducing negative feedback from estradiol increasing GnRH –> LH/FSH
How does IVF treatment work?
Ooctye retrivel after giving FSH for multiple follicles
- Fertilisation in vitro
Embryo incubation
Embryo transfer
- Can to in vitro fertilisation or intra-cytoplasmic sperm injection
Describe the hormones involved in IVF?
- understand agonist methodology and desensitization
- Superovulation through FSH
- prevent premature rise in LH that would cause ovulation too soon with GnRH antagonist OR GnRH agonist which causes desensitization and acts as antagonist
- Use HCG to trigger LH release to turn diploids into haploid to become a mature egg
4.
What types of contraception are there?
- Methods:
Barrier: male / female condom / diaphragm or cap with spermicide
Combined Oral Contraceptive Pill (OCP)
Progestogen-only Pill (POP)
Long Acting Reversible Contraception (LARC)
Emergency Contraception - Permanent methods:
Vasectomy
Female sterilisation
Pros of Condoms?
Protect against STI’s
Easy to obtain – free from clinics
/ No need to see a healthcare professional
No contra-indications as with some hormonal methods
Cons of Condoms?
Can interrupt sex Can reduce sensation Can interfere with erections Some skill to use eg correct fit. Two are not better than one
How does the oral contraceptive pill work?
Oestogen and progesterone causing negative feedback
Decreased LH FSH
+ thickening of cervical mucus
Thinning of endometrial lining to reduce implantation
What are the pros of OCP?
- One pill a day - easy
Effective - Doesn’t interrupt sex
- Can take several packets back to back and avoid withdrawal bleeds
- Reduce endometrial and ovarian cancer
- Weight Neutral in 80%
(10% gain, 10% lose)
What are the cons of OCP?
- difficult to remember to take
- No protection against STIs
- P450 Enzyme Inducers may reduce efficacy
- Not the best choice during breast feeding
Possible side effects: - Spotting (bleeding in between periods) - Nausea - Sore breasts - Changes in mood or libido Feeling more hungry (try different OCPs to see which suits best)
Extremely rare side effects:
Blood clots in the legs or lungs (2 in 10,000)
What are the non-contraceptive use of OCP?
Helps make periods lighter and less painful
(eg endometriosis or period pain or menorrhagia)
Withdrawal bleeds will usually be very regular
PCOS: help reduce LH and hyperandrogenism
What are the pros of Progesterone only pill?
Works as OCP but less reliably inhibits ovulation
Often suitable if can’ttake oestrogen
Easy to take – one pill a day, every day with no break It doesn’t interrupt sex Can help heavy or painful periods Periods may stop (temporarily) Can be usedwhen breastfeeding
What are the cons of POP?
Can be difficult to remember
No protection against STIs
Shorter acting – needs to be taken at the same time each day
Possible side effects Irregular bleeding Headaches Sore breasts Changes in mood Changes in sex drive
What are LARCs?
Long-Acting Reversible Contraceptives
e.g. Coils / IUD. IUS
Progesterone only injectable contraceptives or subdermal implants
What are Coils?
- suitable for most women incl Nulliparous (no previous children).
- Exclude STI’s and cervical screening up to date before insertion
- Prevent implantation of conceptus – important for some religions
- Rarely can cause ectopic pregnancy
- Can be used as emergency contraception
What is the intra-uterine decide / copper coil?
- Intra-Uterine Device (IUD) ie Copper Coil- mechanically prevent implantation,
decrease sperm egg survival. Lasts 5-10yrs.
Can cause heavy periods, and 5% can come out especially during first 3months with periods.
What is the intra uterine systems which secretes progesterone / mirena coil?
to thin lining of the womb and thicken cervical mucus (can be used to help with heavy bleeding). Last 3-5yrs.
What is the intra uterine systems which secretes progesterone / mirena coil?
to thin lining of the womb and thicken cervical mucus (can be used to help with heavy bleeding). Last 3-5yrs.
How can IUD be used as emergency contraception?
Can be fitted up to 5 days after <1% chance of pregnancy
How does emergency contraceptive pill work?
Ulipristal acetate 30mg (ellaOne)
Ulipristal acetate stops progesterone working normally and prevents ovulation.
Must be taken within 5 days of unprotected intercourse (earlier better).
Which is the least effective emergency contraceptive pill work?
. Levonorgestrel 1.5mg (Levonelle) least effective
(esp if BMI >27 kg/m2)
Synthetic Progesterone prevents ovulation (don’t cause abortion).
Must be taken within 3 days of unprotected intercourse.
Side effects of oral emergency contraception?
headache, abdominal pain, nausea.
Liver P450 Enzyme inducer medications make it less effective.
If vomit within 2-3hrs of taking it, need to take another.
What to consider when choosing contraception?
- Risk of Venous Thromboembolism (VTE) / CVD / Stroke
Comorbidities- Avoid OCP if:
- Migraine with aura (risk of stroke)
- Smoking (>15/day) + age >35yrs
- Stroke or CVD history
- Current Breast cancer
- Liver Cirrhosis
- Diabetes with complications eg retinopathy/nephropathy/neuropathy
- Other conditions that may benefit from OCP eg Menorrhagia / Endometriosis / Fibroids
- Need for prevention of Sexually Transmitted Infections (STI’s)
4. Concurrent medication — P450 liver enzyme-inducing drugs (eg anti-epileptics,some antibiotics) Teratogenic drugs (eg lithium or warfarin), more effective methods of contraception needed (eg progestogen-only implant, or intrauterine contraception).
What are the risks of HRT *hormone replacement therapy?
Risks of HRT
1. Venous Thrombo-embolism: Deep Vein Thrombosis or Pulmonary Embolism
Oral oestrogens undergo first pass metabolism in liver
Oral»_space; Increase SHBG, Triglycerides, CRP
Transdermal estrogens are safer
Avoid oral oestrogens in BMI > 30 kg/m2
How does HRT effect hormone sensitive cancers?
- Breast cancer : slight increase in women taking the combined HRT depending on duration of treatment
- continuous use of HRT is worse than sequential
- Ovarian cancer : small increase in risk after long term use
What must be prescribed to women with HRT risked endometrial cancer?
Progesterone
- post menopausal bleeding could indicate endometrial cancer although bleeding is common within the first 3 months
In which patients may there be more benefits to oestrogen supplementation
Premature ovarian insufficiency
in younger women
Which type of HRT oestrogen increased the risk of cerebrovascular disease?
Oral>transdermal Oestrogen
Combined> Oestrogen only
What are the symptoms of low oestrogen due to menopause?
Flushing, disturbed sleep, decreased libido, low mood
So HRT will decrease these symptoms
In prepubertal young people who want to gender reassign?
GnRH agonist to pubertal suppression and then sex steroids
Gender reassignment surgery is after 1-2 years of hormonal treatment
Testosterone can be given to masculinise trans men, what are the side effects of this?
Polycythaemia
Lower HDL
Obstructive sleep apnoea
What physical changes can occur between 1-6 months of hormone therapy for trans men?
Balding Deeper voice change in body fat redistribution Enlargement of clit No periods Increased muscle and strength
What dosage of Estrogen is given to trans women for feminising?
Transfermal or oral or intramascular
4-5mg high dosage to aim for levels of 734 pmol/L
What are the side effects of using oestrogen as a feminising hormone?
High BP High triglycerides Hormone sensitive cancers abnormal LFTs Venous thromboembolism
What will not change by undergoing feminising estrogen therapy?
Adams apple
Voice
Height
