reproduction Flashcards
endometriosis
Presences of endometrial epithelial cells outside of uterine cavity (stomach, lungs, intestine, spleen)
etiology poorly understood
Responds to hormone cycles Causes pain Infertility Increased risk of ovarian ca Common gyne problem.
endometriosis interventions
Treatment led by patient’s wishes: Influenced by : Patient’s age Desire for pregnancy Symptom severity Extent and location of disease
*** If infertility issues have brought the patient in for assessment, treatment proceeds more rapidly
endometriosis drug and hormone therapy
Drug therapy:
Pain meds: NSAIDs and diclofenac (Voltaren)
Endometriosis is controlled, not cured by hormone therapy
Inhibit estrogen production (shrinks endometrial tissue)
Ovulation is suppressed by progestin (medroxyprogesterone)
Danazol (Cyclomen: synthetic androgen (atrophies ectopic endometrial tissue)
Adverse effects: weight gain, acne, hot flashes, hirsutism, expensive
endometriosis hormonal contraceptives
Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they’re using a hormonal contraceptive. Using hormonal contraceptives — especially continuous cycle regimens — may reduce or eliminate the pain of mild to moderate endometriosis.
lighter periods – may reduce or eliminate pain of mild to moderate endometriosis
endometriosis gonadotropin releasing hormone agonist and antagonists
These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness and bone loss. Your periods and the ability to get pregnant return when you stop taking the medication. (Lupron)
Gonadotropin releasing hormone agonist - i.e. leuprolide or nafarelin – result in amenorrhea, - adverse effects similar to menopause – hot flashes, vaginal dryness, emotional lability. Stop taking – can become pregnant again
endometriosis progestin therapy
A progestin-only contraceptive, such as an intrauterine device (Mirena), contraceptive implant or contraceptive injection (Depo-Provera), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.
Progestin therapy – can suppress menstrual periods and suppress growth of endometrial tissue
Mirena – is an IUD that releases small amounts of progestine. Can be placed in GP’s office . 5 years. Also for menorrhagia and of course as contraceptive.
endometriosis danzol
This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis. However, danazol may not be the first choice because it can cause serious side effects and can be harmful to the baby if you become pregnant while taking this medication.
Danazol - an androgen that inhibits anterior pitutiary and thereby blocking ovarian stimulating hormones – end result atrophy of ectopic endometrial tissue.
Caution – can be harmful to baby
endometriosis surgery
Diagnostic laparoscopy:
Required for definitive diagnosis
Lesions may also be removed
Surgery: Removal of uterus (hysterectomy), Fallopian tubes (Salpingectomy), Ovaries (oophorectomy) Endometrial implants
Only cure is surgery
Can be conservative or definitive
- Conservative – to confirm diagnosis or remove endometrial implants
Gonadotropin releasing hormone agonist therapy leuprolide can be given 4-6/12 prior to reduce size of endometrial tissue - Definitive Sx – removal of uterus, fallopian tubes, ovaries and endometrial implants
three stages of menopause
Peri- first sign of change in menstrual cycle to cessation of menses
Menopause – the time when there have been no periods for consecutive period of 12 months
Post – menopause – the time in a woman’s life after menopause
symptoms of menopause
Hot flashes
- Sleep disturbance
- Depression
- Vaginal dryness
- Sexual dysfunction
- Cognitive changes
menopause drug therapy
Hormone therapy was the standard therapy and included estrogen for women without ovaries or estrogen and progesterone for women with a uterus
Women who took estrogen plus progestin were at an increased risk for breast cancer, stroke, heart disease, and emboli yet these women had fewer hip fractures and lower risk of developing colorectal cancer
Women who took only estrogen (Premarin) had increased risk for stroke and emboli and less risk for hip fractures and no risk heart disease or breast or colorectal cancer
If women want symptom management for less than 5 years: consider HT therapy
Lowest effective dose for the shortest amount of time
Used to be the standard of care to give drug therapy for menopause. No longer the case.
Estrogen: for women with without ovaries
Estrogen + progesterone: women with ovaries
findings from WHI for menopause drug therapy
Estrogen + progestin
- —Incr risk breast ca, stroke, Heart disease, and emboli Decreased risk of hip # and colorectal ca
2. Only estrogen (Premarin) - –Incr risk of stroke and emboli Decr risk of hip fractures
- –No incr in risk for HD, breast ca or colorectal ca
Also consider individual risk factors – family HX breast ca, HD
Discuss pros and cons with prescriber NP/GP
And also biposponates – Fossamax (alendronate)
adverse effects of drug therapy for menopause
Adverse Effects of Estrogen:
Nausea, fluid retention, headache, and breast enlargement
Adverse Effects of Progesterone
Increased appetite, weight gain, irritability, depression, spotting, and breast tenderness
Common estrogen regime is a daily dose and dose increased for symptom relief
Common progesterone regime would be indicated for 12 days of each month on a cyclical regiment or a continuous regime
more drugs for menopause
SSRI paroxetine (Paxil), fluoxetine (Prozac), venlafaxine (Effexor XR) or gabapentin (Neurontin)
May decrease hot flashes
Mechanism of action unknown
SERMs may also be used –raloxifene (Evista) to prevent bone loss
Biposponates – decreases osteoporosis risk
Fossamax (alendronate)
Risedronate (Actonel)
SSRI (Paxil) and (Prozac): depression, OCD, anxiety, PTSD, menopause
Gabapentin: seizures, restless leg syndrome, neuropathic pain, headache, bipolar, anxiety, menopause
Specific SERMS: tamoxifen, evista and fareston
menopause collaborative care
Avoid situations that fluctuate body temperature:
A cool environment
Limiting caffeine and alcohol
Loose clothing that doesn’t retain heat
Relaxation techniques
Vitamin E may reduce hot flashes
cessation of smoking
bone = Bone loss and CVD risk counteracted by:
-diet with calcium & vit D
-diet with complex carbohydrates and vitamin B complex
herb = Also: herb black cohash help with menopause symptoms
Libido does not go away with menopause
Vaginal epithelium may have atrophic changes: water soluble lubricant may help that
Active sex life helps to increase lubrication and maintains the pliability of vaginal tissue
