Women’s Health

Question 1

What is the MOA for progestins?

Answer 1

Produced during the luteal phase by the ovaries & placenta
Anterior pituitary releases LH to synthesize progestin within the corpus luteum.
If implantation doesn’t occur, levels decline stimulating menses.
Rise during pregnancy to suppress contractions and sustain pregnancy.

Question 2

What are indications for progestins?

Answer 2

Dysfunctional uterine bleeding (causes the uterine lining to relax). Insufficient excretion of progesterone to balance estrogen levels. Progesterone 10-14 days

Amenorrhea. Inadequate endogenous estrogen levels. Supplementation of both maybe needed to induce cycle

SPECIALTY CARE: used for endometrial hyperplasia and CA, and pregnancy or history of preterm labor

Question 3

What do you need to monitor for with progesterone use?

Answer 3

Monitor for fluid retention, BP, weight.
Baseline- HR, BP, weight, and r/o undiagnosed abnormal vaginal bleeding (transnational U/S if needed).

CONTRAINDICATED IN HTN (can use with close monitoring)

Question 4

What are adverse effects of progesterone?

Answer 4

Increased risk for breast CA in post-menopausal women if used with estrogen, breast tenderness, headache, abdominal discomfort, depression, arthralgias, contributes to neonatal jaundice in breastfeeding.

When used as contraception can decrease production of cervical mucous, spotting, break through bleeding, and irregular menses

Question 5

What are indications for HRT?

Answer 5

Treatment of moderate/severe vasomotor symptoms of menopause, genitourinary syndrome of menopause, prevention of osteoporosis

Question 6

When is estrogen alone HRT typically used?

Answer 6

Women with hysterectomy

Question 7

What are benefits of HRT?

Answer 7

Vasomotor symptoms, improved sleep, improved libido, mood, prevents urogenital atrophy, prevents osteoporosis/fractures

Question 8

What are risks associated with HRT?

Answer 8

Ages 50-59 should use short term. >60 increased risk for DVTs, thromboembolic events, stroke, breast CA with EPT therapy.

Assess for personal or family hx of breast CA, cardiovascular disease

Question 9

How should HRT be initiated?

Answer 9

Start with the lowest effective dose. Start with topical in area closest to symptoms (vaginal cream for vaginal symptoms). Oral therapy is the least favorable d/t more systemic effects and increased adverse cardiovascular side effects