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Endocrine > Sex Hormones > Flashcards

Sex Hormones Flashcards

1
Q

Examples of natural oestrogens

A

Estradiol
Estrone
Estriol

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2
Q

Examples of synthetic oestrogens

A

Ethinylestradiol
Mestranol

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3
Q

What activity does Tibolone have?

A

Oestrogenic
Progestogenic
Weak androgenic

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4
Q

When would oestrogen and progestogen be given to a patient? Why?

A

If a woman has a uterus
Reduce the risk of cystic hyperplasia of the endometrium and cancer

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5
Q

Symptoms of menopause

A

Vaginal atrophy
Vasomotor instability

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6
Q

How to treat each menopausal symptom

A

Vaginal atrophy - short course of topical vaginal oestrogen preparation (repeated if necessary)

Vasomotor instability - systemic oestrogens or tibolone or clonidine

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7
Q

How is Tibolone administered? (e.g., continuously or cyclic)

A

Continuously, without cyclical progestogen

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8
Q

Why isn’t clonidine widely used?

A

Large side effect profile

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9
Q

Risks associated with HRT

A

VTE - Increased risk with both oestrogens-only and combined HRT and with prolonged bed rest, obesity, trauma, family history

Stroke - Slight increase with both oestrogen-only and combine HRT. Tibolone increases risk by 2-3 times in first year of treatment

Endometrial cancer - reduced by a progestogen. Tibolone increased risk

Breast cancer - Increased risk after 1 year – longer use = higher risk. Risk higher in combined HRT over oestrogens only. Excess risk persists for more than 10 years

Ovarian cancer - Small increase which disappears a few years after stopping

Increased risk of coronary heart disease in women who start combined HRT more than 10 years after menopause

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10
Q

MHRA advise on initiating HRT

A

Should only be prescribed to relieve post-menopausal symptoms that are adversely affecting quality of life and treatment should be reviewed regularly to ensure the minimum effective dose is used for the shortest duration

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11
Q

Benefits of HRT

A

Reduces risk of osteoporosis associated with menopause

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12
Q

MHRA advise regarding breast cancer risk

A

Encourage current and past HRT users to be vigilant for signs of breast cancer and to attend routine breast screening.

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13
Q

Which HRT regimen would be recommended to women with a uterus?

A

Oestrogen with cyclical progestogen for the last 12 to 14 days of the cycle

Continuous administration of an oestrogen and a progestogen

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14
Q

Which HRT regimen/medication is avoided in perimenopausal phase and within 12 months of the last menstrual period?

A

Continuous combined and tibolone

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15
Q

Which HRT regimen in recommended to women without a uterus? And how to manage if endometriosis occurs?

A

Continuous oestrogen use

Endometriosis - consider an addition of progesterone

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16
Q

How to manage HRT if the patient is undergoing elective surgery?

A

Stop HRT 4-6 weeks before surgery
Reinitiate when fully mobile

17
Q

How to manage HRT if the patient is undergoing emergency surgery?

A

Prophylactic with unfractionated heparin or LMWH
Graduated compression stockings

18
Q

When to stop HRT?

A

If pending investigation and treatment

Sudden severe chest pain/breathlessness (PE)

Unexplained swelling or severe pain in calf of one leg (DVT)

Severe stomach pain (hepatotoxicity)

Serious neurological effects: unusual severe, prolonged headache, fainting, first unexplained epileptic seizure, motor disturbances, numbness

Hepatitis / jaundice

BP >160mmHg systolic or 95 mmHg diastolic

Prolonged immobility – increased risk of VTE

19
Q

What can occur if a woman with a uterus takes combined preparations of HRT or tibolone in the perimenopasual phase or within 12 months of the last menstrual period? How to manage this?

A

Irregular bleeding can occur

If this continues = endometrial abnormality should be ruled out and consideration given to changing to cyclical HRT

20
Q

When would ethinylestradiol be used?

A

Licensed for

1) Short-term treatment of symptoms of oestrogen deficiency
2) Osteoporosis prophylaxis if other drugs cannot be used
3) Treatment of female hypogonadism and menstrual disorders.

Specialist

1) Management of hereditary haemorrhagic telangiectasia

21
Q

When would raloxifene be used? Which symptoms is it ineffective at treating/managing?

A

Licensed for

1) Treatment and prevention of postmenopausal osteoporosis

Does not reduce menopausal vasomotor symptoms.

22
Q

Why is progestogen added to HRT regimen for women with a uterus?

A

To prevent cystic hyperplasia of the endometrium and possible transformation to cancer

23
Q

Examples of progestogen, progesterone and its analogues?

A

Progesterone, desogestrel, norgestimate, dydrogesterone and medroxyprogesterone acetate

24
Q

Examples of testosterone analogues

A

Norethisterone and norgestrel

25
Q

Which progestogen is most potent?

A

Levonorgestrel

Endocrine (4 decks)

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