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sex hormones 1-2 Flashcards

1
Q

What type of hormones are all sex hormones?

A

steroid hormones

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2
Q

What are sex hormones synthesised from?

A

cholesterol

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3
Q

What are the male sex hormones called?

A

androgens

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4
Q

main male sex hormone

A

testosterone

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5
Q

What produces testosterone and other androgens?

A

Leydig cells of the testes

adrenal gland (lesser extent)

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6
Q

What are male sex hormones responsible for?

A

foetal differentiation
development of male urogenetial system
some effects on the brain

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7
Q

What happens to Leydig cells after birth?

A

they become inactive until activated by gonadotropins during puberty

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8
Q

What happens during male puberty?

A

androgens cause the sex organs to grow and secondary sex characteristics to develop

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9
Q

explain the release of male sex hormones

A
  • hypothalamus secretes GnRH
  • GnRH causes the anterior pituitary to release FSH and LH
  • FSH acts on sertoli cells and stimulates spermatogenesis and releases inhibin
  • LH acts on Leydig cells and stimulates testosterone secretion
  • testosterone also acts on sertoli cells
  • T acts on hypothalamus and anterior pituitary to inhibit LH and GnRH release
  • Inhibin acts on the anterior pituitary to inhibit FSH release
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10
Q

effects of testosterone

A
  • initiation and maintenance of spermatogenesis
  • decreased GnRH secretion via hypothalamus
  • inhibits LH secretion (anterior pituitary)
  • differentiation of male accessory reproductive organs and maintains their function
  • induces male secondary sex characteristics (opposes oestrogen)
  • protein anabolism, bone growth, cessation of bone growth
  • sex drive
  • aggressive behaviour
  • stimulates erythropoietin secretion by kidneys
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11
Q

2 female sex hormones

A

oestrogen

progesterone

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12
Q

What produces oestrogen and progesterone?

A

ovaries

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13
Q

actions of female sex hormones

A

sexual maturtion at puberty, secondary sex characteristics
control menstrual cycle
higher level during pregnancy by placenta (inhibit ovulation)

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14
Q

How often are female hormones produced?

A

cyclically

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15
Q

effects of oestrogen

A
  • growth of ovary and follicles
  • growth of SM
  • proliferation of epithelial lining of reproductive tract
  • external genitalia growth (puberty)
  • breast growth
  • body configuration (fat distribution)
  • fluid secretion from lipid skin glands
  • bone growth and cessation of bone growth (protects against OP)
  • vascular effects (hot flushes)
  • feedback on hypothalamus and anterior pituitary
  • prolactin secretion
  • protects against atherosclerosis
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16
Q

effects of progesterone

A
  • converts endometrium to secreting tissue suitable for implantation
  • induces thick, sticky cervical mucus
  • decreases contraction of fallopian tubes and myometrium
  • decreases proliferation of vaginal epitheliel cells
  • stimulates breast growth
  • inhibits milk inducing effects of prolactin
  • feedback on hypothalamus and anterior pituitary
  • inc body temperature (after ovulation)
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17
Q

mechanism of release of female hormones

A
  • hypothalamus secretes GnRH
  • causes anterior pituitary to release FSH and LH
  • FSH causes ovarian follicle to mature and secretes oestrogen
  • this causes the uterine lining to thicken
  • LH triggers ovulation
  • it causes the follicular cells to become corpus luteum which secrete progesterone
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18
Q

What is the menstrual cycle?

A

regular changes in the uterine lining resulting in monthly bleeding

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19
Q

What is menarche?

A

first menstrul peroid

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20
Q

What is menopause?

A

termination of cycle due to normal aging of the ovaries

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21
Q

3 phases of the menstrual cycle

A
  1. menses day 0-7
  2. proliferative phase 7-14
    - increase in oestrogen
    - LH rise before ovulation
  3. secretory phase day 14-28
    - ovulation day 14
    - oestrogen drops just before ovulation
    - progesterone increases
    - temparature increases from day 14: 36.4-36.7 (progesterone inc)

day 28 - O and P fall and endometrium sheds again, new cycle

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22
Q

11 contraception methods

A
  1. coitus interrupts
  2. rhythm method
  3. mechanical barriers
  4. chemical barriers
  5. oral contraceptives
  6. injectable contraceptives
  7. insertable contraceptives
  8. contraceptive implants
  9. transdermal contraceptives
  10. IUD
  11. surgical methods
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23
Q

advantages of COC

A
  • reliable and reversible
  • reduced dysmenorrhoea and menorrhagia
  • reduced PMT
  • less symptomatic fibroids/cysts
  • less benign breast disease
  • reduced risk of ovarian/endometrial cancer
  • reduced risk of pelvic inflammatory disease
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24
Q

different types of COC

A

monophasic
biphasic
triphasic
quadraphasic

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25
monophasic COC
fixed amount of oeatrogen and progesterogen in each active tablet
26
biphasic/triphasic/quadraphasic COC
varying amounts of oestrogen and progesterone according to the stage of the cycle
27
What do the first 7 pills of COC do?
inhibit ovulation
28
What do the 14 pills in the 2nd and 3rd week do in COC?
maintain anovulation
29
2 types of oestrogen
ethinyl estradion | mestranol
30
What is mestranol?
a prodrug converted in vivo to ethinylestradiol
31
equivalent EE to mestranol
50 microg mestranol = 35 microg EE
32
active metabolite of desogestrel
etonogestrel
33
1st gen progesterone
norethisterone (NET)
34
2nd gen progesterone
levonorgestrel (LNG)
35
3rd gen progesterone
desogestrel gestodene norgestimate
36
MOA of COCs
- oestrogen inhibits secretion of FSH via negative feedback on the anterior pituitary and suppresses developmet of the ovarian follicle - progesterone inhibits secretion of LH and prevents ovulation - it makes cervical mucus less suitable for sperm passage - O and P can alter the endometrium to discorurage implantation
37
How does COCs affect fallopian tube?
P inhibits motility | O enhances motility causing abnormal rates of ovum transport
38
common adverse effects of COCs
- weight gain (fluid retention or anabolic effect) - mild nausea - flushing - dizziness - depression/irritability - skin changes (acne/inc pigmentation) - amenorrhoea when stopped - Oestrogen COCs dec breast milk production (not during BF)
39
contraindications for COCs
- VTE (or risk) - prolonges immobilisation - ATE (or risk) - stroke/TIA - Hx migraine with aura - DM with vascular symptoms, severe hypertension (risk of arterial TE) - Hx severe hepatic disease - Hx liver tumours - sex steroid malignancies - undiagnosed vaginal bleeding - hypersensitivity to API/excipients
40
seroiud COCs side effects
abdominal pain - gallstones/clot/pancreatitis chest pain/SOB/blood - lung clot/MI headaches - stroke/hpt/migraine eye problems - stroke/hpt/vascular occlusion severe leg pain - clot
41
When are POPs advantageous?
- pt can't take oestrogens (COCs/patch/ring) - any age - smoker and > 35 premenstraual symptoms and painful periods - can be used in BF
42
MOA of POP
- primarily on cervical mucus, in-hospitable to sperm | - P stops implantation through effect on endometrium and on motility/secretions of fallopian tubes
43
contraindications for POPs
- VTE - Hx hepatic disease - sex steroid malignancies - undiagnosed vaginal bleeding - hypersensitivity to API/excipitnts - allergy to penut/soya
44
What is ulipristal?
orally acive synthetic selective progesterone receptor modulator acts via high affinity binding to the human progesterone receptor
45
MOA of ulipristal
inhibition/delay of ovulation via suppression of the LH surge
46
How does ulipristal work after the LH surge?
it delays follicular rupture
47
indications for EHC
``` UPSI reduced efficacy of contraception - torn/leaky condom - missed pills - late implant/injection - detached patch ```
48
What is menopause?
- when a woman stops menstruating and reached the end of her natural reproductive life - when not had period for 12 consecutive months - ovaries stop maturing eggs and secreting oestrogen and progesterone
49
definition ofmenopausal women
includes women in perimenopause and postmenpause
50
perimanopause
time where a woman has irregular cycles of oculation and menstruation leading up to menopause and continuing until 12months after her final period aka manopausal transition/climacteric
51
postmenopause
time after menopause has occurred starting when a woman hasn't had a period for 12 consecutive months
52
age of manupause
between 45 and 55 years
53
manopause symptoms
``` hot flushes vaginal dryness atrophy of breasts depression loss of libido loss of self esteem weight gain ```
54
vasomotor symptoms of menopause
hot flushes night sweats formication
55
urogenital menopause symptoms
``` dry vagina atrophic vaginitis dyspareunia local microtrauma incontinence ```
56
physical changes with menopause
decreased fitness and flexibility changes in distribution of body fat changes in sleep patterns
57
What causes hot flushes?
oestrogen withdrawal affects the central adrenergic system causes release of catecholamines and prostaglandins that produce hot flushes
58
hot flush triggers
``` cigarette smoking alcohol caffeine stress heat (temp change) hot spicy foods exercise (release of catecholamines) ```
59
lifestyle advice for menopause
diet - reduce caffeine, spicy foods, alcohol exercise stop smoking stress relief and relaxation (dec catecholamines and PGs)- yoga holistic approach
60
When is HRT given for menopause?
women who have an intact uterus
61
routes of admin for HRT
orally - conjugated oeatrogens, oestradiol, oestriol vaginally - prssary/cream - oestradiol transdermal patches - oestradiol subcutaneous implant - oestradiol
62
metabolism of oral oestrogens
undergo first pass metabolism
63
contraception and HRT
HRT doesn't provide contraceptive cover woman potentially fertile for 2 years if under 50 and for 1 year if over 50
64
risks of HRT
increases risk of endometrial/breast/ovarian cancer oestrogen stimulation causes proliferation of the endometrium inc risk of malignancy breast cancer - related to duration of therapy, only inc over age 50, higher in women taking combined HRT compared to O only
65
What should be given with oestrogen HRT?
progesterone for 14 days of the cycle only
66
hysterectomy
removal of uterus
67
What is mirena in situ?
LNG-IUS
68
HRT for hysterectomy or mirena in situ
oestrogen only | - oral or transdermal gel/patch
69
HRT for NO hysterectomy or mirena in situ
oestrogen and progesterone perimenopausal - sequential therapy postmenopausal - continuous combined
70
indications for transdermal therapy
- porr symptom control with oral - GI disorder affecting oral - PMH/FH of VTE - BMI > 30 - variable BP control - migraine - gall bladder disease - hepatic inducing enxyme meds
71
When should testosterone therapy be considered?
after bilateral oophorectomy | surgical removal of ovaries

PHA223 (43 decks)

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