ENDO + REPRO: OESTROGENS + PROGESTOGENS

Question 1

O+Ps: INDICATIONS

Answer 1

• Hormonal contraception, reversible contraception and improving chronic acne
• HRT for women in early menopause (when it is given until 50 years of age)
• Women with distressing menopausal symptoms

Question 2

O+Ps: MOA

Answer 2

• Luteinising hormone (LH) and follicle-stimulating hormone (FSH) control ovulation and ovarian production of oestrogen and progesterone. In turn, oestrogen and progesterone exert predominantly negative feedback on LH and FSH release
• In hormonal contraception, an oestrogen (e.g. ethinylestradiol) and/or a progestogen (e.g. desogestrel) are given to suppress LH/FSH release and hence ovulation
• Others offer additional benefits, e.g. reduced menstrual pain and bleeding, and improvements in acne
• At the menopause, a fall in oestrogen and progesterone levels may generate a variety of symptoms, including vaginal dryness and vasomotor instability (‘hot flushes’)
• Oestrogen replacement (usually with a progestogen) alleviates these

Question 3

O+Ps: ADVERSE EFFECTS

Answer 3

• Irregular bleeding and mood changes
• Double the risk of VTE
• Increase risk of cardiovascular dx and stroke
• Associated with an increased risk of cervical and breast cancer

Question 4

O+Ps: WARNINGS

Answer 4

• CI in all forms of breast cancer
• Avoid in patients with an increased risk for VTE
• CVDx

Question 5

O+Ps: INTERACTIONS

Answer 5

• Concurrent use of cytochrome P450 inducers (e.g. rifampicin) may reduce the efficacy of hormonal contraception, particularly progestogen only forms
• Most other antibiotics are safe to use with hormonal contraception

Question 6

O+Ps: EXAMPLES

Answer 6

• Combined ethinylestradiol products

- Desogestrel