oral contraceptives, menopause, HRT

Question 1

what are the forms of oestrogen contraceptives/HRT?

Answer 1

• oestrone sulphate
• oestriol
• ethinyl oestradiol (ethinyl groups protects from first pass metabolism)

Question 2

what is the issue with oestradiol?

Answer 2

• well absorbed but LOW bioavaliability

- extensive first pass metabolism

Question 3

what does a lack of oestrogen result in?

Answer 3

inc. chance of osteoporosis and fracture

Question 4

what does oestrogen contribute to?

Answer 4

• breast growth

- CVS problems

Question 5

describe the absoprtion and metabolism of progesterone

Answer 5

• poorly absorbed

- rapidly metabolized in liver

Question 6

what is the combined oral contraceptive?

Answer 6

• combination of an oestrogen and a progestogen

- synthetic combo supresses ovulation

Question 7

what are the mechanisms that it supresses ovulation by?

Answer 7

• feedback of oestrogen and progestogens on hypothalamus and piuitary
• progestogens thicken cervical mucus
• oestrogen counteracts androgenic effects of synthetic progestogens

Question 8

what are some side effects of oestrogens?

Answer 8

• nausea
• headache
• inc. weight
• CVS problems
• breast (oestrogen-dependant cancers)
• endometrium (proliferative effects)

Question 9

when are progesterone only contraceptives used?

Answer 9

when oestrogens are not a good idea i.e.. CVS problems, history of thrombosis

Question 10

what are the 3 forms of emergency contraception?

Answer 10

• 1. levonorgestrel (2 doses 12 hours apart being within 72 hours of intercourse)
     
     2. copper IUD
     3. ulipristal (up to 120 hours after intercourse)

Question 11

what is menopause?

Answer 11

permanent cessation of menstruation resulting resulting from loss of ovarian follicular activity

Question 12

what is climacteric?

Answer 12

period of transition from predictable ovarian function through the postmenopausal years

Question 13

what is premature ovarian failure?

Answer 13

menopause occuring before age of 40

may be autoimmune, secondary to surgery, chemotherapy or radiation

Question 14

compare the GnRH, LH/FSH and oestradiol levels in normal women and in menopause

Answer 14

Normal women:
GnRH - high
LH/FSH - high
oestradiol - high
Menopause:
GnRH - high
LH/FSH - high
oestradiol - low

Question 15

what are the symptoms of menopause?

Answer 15

• hot flushes
• sleep disturbance
• depression
• urogential atrophy
• dec. libido
• joint pain

Question 16

what are the 2 complications of menopause?

Answer 16

• osteoporosis

- CVD

Question 17

what is the treatment of menopause?

Answer 17

• HRT
• oestrogen and progestrone
• prevent endometrial hyperplasia
• reduces risk of cancer

Question 18

what does HRT inc. the risk of?

Answer 18

• breast cancer
• VTE
• stroke
• gall stones
• HRT to older women has much more inc. risk than in younger postmenopausal women

Question 19

what is tibolone?

Answer 19

• synthetic prohormone

- has oesteogenic, progestogenic and weal androgenic actions

Question 20

when is HRT-oestrogen only used?

Answer 20

only for women that have had hysterectomies

Question 21

what are SERMs? give 2 examples

Answer 21

Selective Oestrogen Receptor Modulators

e.g. Raloxifene, Tamoxifen

Question 22

describe raloxifene

Answer 22

• tissue selective (oestrogenic in bone, anti-oestrogenic in breast/uterus)
• used in treatment and prevention of postmenopausal osteoporosis

Question 23

what does raloxifene inc./ dec. risk of?

Answer 23

inc risk of fatal stroke, VTE

dec. risk of vertebral fractures and breast cancer

Question 24

describe tamoxifen

Answer 24

• anti-cancer drug
• anti-oestrogenic in breat tissue
• used to treat oestrogen-dependant breast tumours and metastatic breast cancers