Sex Hormones & HRT

Question 1

Describe the action of the combined OCP

Answer 1

contains synthetic oestrogens
Act via:
Endocrine function to prevent ovulation
Physical action of reproductive tract to increase cervical
mucus thickening and encourage endometrial thickening

Question 2

Describe the risks/ADRs associated with the combined COCP

Answer 2

Overall risks are minor
However, do increase risk of
• DVT
• Hypertension
• Gall stones
• Reduced glucose tolerence
• Stroke

Question 3

Describe a DDI of the combined OCP

Answer 3

Broad spectrum antibiotics reduce effectiveness of
COCP:

Undergo Phase I and II hepatic pathways
Thus affected by CYP Inducers to reduce effectiveness
of COCP

Effect on intestinal flora reduces their ability to be
re-uptaken into the circulation

Question 4

What assessments should be carried out prior to commencing on combined OCP

What advice should be given once commenced on combined OCP

Answer 4

Risk factors must be evaluated:
BMI
Blood pressure 
Migraines 
Smoking History

Advice is required:
Any missed pill requires alternative contraception for
following 7 days
V4D make COCP ineffective
Check BP every 3-6 months

Question 5

What is HRT used for

Answer 5

acts to prevent the symptoms of menopause or limit effects
of osteoporosis
Not used to prevent any CVD

Question 6

What are the risks in using HRT

Answer 6

Increased risk of endometrial cancer and ovarian cancer
Increased risk of breast cancer
Increased risk of stroke
Increased risk of DVT

Question 7

Describe the overall mechanism of action of Selective oestrogen receptor modulators (SERMs)

Answer 7

a mixed agonist and antagonist profile, depending on
the receptor target tissue
Act on oestrogen receptors to modify transcription factors

Question 8

Give 2 examples of SERMs and their specific mechanism of action

Answer 8

Clomiphene: acts on pituitary gland to induce ovulation by
negative feedback

Tamoxifen: acts as anti-oestrogenic in breast tissue but pro-oestrogenic in endometrium

Question 9

What are the sex hormones
What are they derived from
What is their mechanism of action

Answer 9

progesterone, oestrogen, and testosterone
They are all derived from cholesterol
They act on intracellular receptors, which when bound act on gene expression
High levels of receptor expression found in the reproductive organs