6a. Sex Hormones and HRT

Question 1

What are the three main sex hormones?

Answer 1

Progesterone, oestrogen, and testosterone.

Question 2

Where do progesterone and oestrogen bind?

Answer 2

Intracellularly.

Question 3

What are the actions of progesterones around the body?

Answer 3

Secretory endometrium, anabolic, increased bone density, fluid retention, mood changes.

Question 4

What are the side effects of progesterones around the body?

Answer 4

Weight gain, fluid retention, acne, nausea and vomiting, irritability, lack of concentration.

Question 5

What are the actions of oestrogen around the body?

Answer 5

Mild anabolic, sodium and water retention, raised HDL and lowered LDL, decreased bone reabsorption, improve blood coagulability.

Question 6

What are the side effect of oestrogen around the body?

Answer 6

Nausea and vomiting, water retention, risk of thromboembolism, impaired glucose tolerance, endometrial hyperplasia and cancer.

Question 7

What makes up the combined oral contraceptive pill?

Answer 7

Synthetic oestrogens and 1st-4th generation progesterone.

Question 8

How does COCP work?

Answer 8

Acts on endocrine system and reproductive tract to prevent ovulation and cause cervical mucus and endometrial thickening.

Question 9

What are the ADRs of COCP?

Answer 9

Generally minor although increased risk of DVT, raising blood pressure, increased risk of gall stones, decreased glucose tolerance, and increased risk of stroke.

Question 10

How is COCP metabolised?

Answer 10

In phase I and II hepatic pathways.

Question 11

How do broad-spectrum antibiotics reduce efficacy of COCP?

Answer 11

Intestinal flora cleared so reduced re-uptake into circulation.

Question 12

Which drugs impact COCP metabolised via CYP?

Answer 12

Inducers - PCBRAS - phenytoin, carbamazapine, barbiturates, rifampicin, alcohol, and sulphonylureas.

Question 13

Which risk factors should be assessed before starting a patient on the COCP?

Answer 13

BMI, blood pressure, migraines, smoking history.

Question 14

What advice should be given about taking COCP?

Answer 14

Take it every day, any vomiting or diarrhoea may make the drug ineffective, and blood pressure needs to be checked every 3-6 months.

Question 15

What is are the actions of the progesterone only pill?

Answer 15

Main: cause cervical mucus thickening. Secondary: endometrial thickening, endocrinological effects.

Question 16

What are the negatives of using POP rather than COCP?

Answer 16

Narrower window of use, less reliable, more side effects.

Question 17

Who should be given the POP?

Answer 17

Women who have contra-indications for COCP.

Question 18

How can long term contraception be given using progesterone?

Answer 18

Implants - IM, SC, IUD. These last from 3 months to 5 years.

Question 19

What is the purpose of hormone replacement therapy?

Answer 19

Prevent the symptoms of the menopause and limit the effects of osteoporosis.

Question 20

What are the risks of HRT?

Answer 20

Increased risk of endometrial cancer and ovarian cancer, increased risk of breast cancer, increased risk of stroke, increased risk of DVT.

Question 21

What does the action of selective oestrogen receptor modulators depend on?

Answer 21

Tissue specific expression of oestrogen receptors, genes associated with these receptors, or presence of transcription factors.

Question 22

What is the action and site of action of clomiphene?

Answer 22

Oestrogen antagonist acting on pituitary, induces ovulation by inhibiting negative feedback.

Question 23

What is the agonist/anatagonist actions of tamoxifen and raloxifene?

Answer 23

Anti-oestrogenic in breast tissue, oestrogenic in endometrium, protects against osteoporosis.