Sex hormones Flashcards
Oestrogen therapy is given cyclically or continuously for a number of gynaecological conditions. If long-term therapy is required in women with a uterus, what should normally be added to the regimen and why is this added?
A progestogen to reduce the risk of cystic hyperplasia of the endometrium and possible transformation to cancer.
Why are oestrogens no longer used to suppress lactation?
Because of their association with thromboembolism.
Menopausal atrophic vaginitis may respond to what?
A short course of a topical vaginal oestrogen preparation used for a few weeks and repeated if necessary.
HRT using small doses of an oestrogen, together with a progestogen in women with a uterus, is appropriate for alleviating menopausal symptoms such as what?
Vaginal atrophy or vasomotor instability.
What is tibolone used for? [2]
Used for short-term treatment of symptoms of oestrogen deficiency (including women being treated with gonadotrophin releasing hormone analogues).
Also used for osteoporosis prophylaxis in women at high risk of fractures when other prophylaxis contra-indicated or not tolerated.
2.5mg daily.
Unsuitable for use within 12 months of last menstrual period (may cause irregular bleeding).
What is clonidine hydrochloride used for? [3]
- Reduction of vasomotor symptoms in women who cannot take an oestrogen but may cause unacceptable side effects.
- Hypertension: 10-100 micrograms 3 times a day, increase dose every second or third day, usual maximum dose 1.2mg daily.
- Prevention of recurrent migraine: prevention of vascular headache: 50 micrograms twice daily for 2 weeks, then increased if necessary to 75 micrograms twice daily.
What are the risks of HRT that patients should be aware of?
Increased risk of venous thromboembolism.
Stroke.
Endometrial cancer (reduced by a progestogen).
Breast Cancer.
Ovarian Cancer.
CHD in women who start HRT more than 10 years after menopause.
WRT to HRT, oestrogen alone is suitable for continous use in which patient group?
Women without a uterus, however, in endometriosis, endometrial foci may remain despite hysterectomy and the addition of a progestogen should be considered in these circumstances.
What is ethinylestradiol licensed for the treatment of? [4]
- Short-term treatment of the symptoms of oestrogen deficiency.
- Osteoporosis prophylaxis if other drugs cannot be used.
- Treatment of female hypogonadism and menstrual disorders.
- VERY OCCASSIONALY: under specialist supervision, for the management of hereditary haemorrhagic telangiectasia and the pallative treatment of prostate cancer.
What is raloxifene hydrochloride licensed to treat?
- Treatment AND prevention of postmenopausal oseoporosis; unlike HRT, raloxifene hydrochloride does not reduce menopausal vasomotor symptoms [hot flashes and night sweats]
Dose of 60mg once daily.
Levonorgestrel is the active isomer of what?
Norgestrel (a testosterone analogue), levonorgestrel has twice the potency of norgestrel.
Where endometriosis requires drug treatment, it may respond to what?
A progestogen such as norethisterone, administered on a continuous basis. Danazol and gonadorelin analogues are also available.
What can ethinylestradiol be occasionally used to treat?
VERY OCCASSIONALY: under specialist supervision, for the management of hereditary haemorrhagic telangiectasia and the pallative treatment of prostate cancer.
Although oral progestogens have been used widely for menorrhagia they are relatively ineffective compared with what?
Tranexamic acid or, particularly where dysmenorrhoea is also a factor, mefenamic acid; the levonorgestrel-releasing intrauterine system may be particularly useful for women also requiring contraception.
In women with antiphospholipid antibody syndrome who have suffered recurrent miscarriage, administration of low-dose what and a prophylactic dose of what may decrease the risk of fetal loss?
low dose aspirin and low dose LMWH under specialist supervision.
