Contraceptive, HRT and SREMs Flashcards
How does menopause affect the oestradiol/LH/FSH levels?
Drop in oestradiol because not being produced anymore-no more inhbin B too
loss of negative feedback on LH and FSH-expect them to be high
Define menopause?
Permanent interuption of menstruation
Loss of ovarian follicular activity
Average age: 51
Climacteric-transition period
What are the main symptoms of menopause?
Hot flushes (head neck and upper chest Urogenital atrophy-causes dysperunia (painful sex)
also : sleep issue, depression, decreased libido, joint pain
tend to disapear with time but can be distressing at fisrst
What are the main complications of menopause?
Osteoporosis-oestrogen deficiency-loss of bone matrix-high fracture risk
Increase of CVD-actually before menopause, risk of CVD lower-when menopause-reach same levels at men (around 70)
What is the purpose of HRT?
Treat vasomotor symptoms (hot flushes)-can be very debilitating (have to weigh breast cancer/stroke chance)
What do you prescribe in HRT? (which hormones) Which are the 2 dosage/ways to take it? How can you give them?
Oestrogen is the lost one-but if only give that-endomitrial growth can cause cancer -so give Oestrogen AND progesterone
EXCEPT if they dont have a uterus-then only oestrgen
Can be taken cyclical: E-everyday and P-12 days (like period) OR continuously-E+P
How can you give HRT hormones?
Oral, transdermal, transvaginal (need much higher dose oral)
because low bioavailability-is absorbed well but quickly 1st phase metabolised
Can give conjugated forms to reduce dose
But in the end most prefer transdermal
What are the main side effects of HRT? How risky are there?
BCD (breast cancer, CHD, DVT) and then stroke and gallstones
The risk though, if you take it for 5 years after 50-VERY low risk overall -nearly no excess risk in “young” women
How do the risks of oestrogen vs E+P change side effects of HRT?
Oestrogen alone is protective of CHD, DVT, diabetes (still v small risks)
Oestrogen in beneficial to lipid profile and endothelial function BUT if person has artheroslerosis (older)-increase prothrombosis and inflammation
So good in younger women, and worse in people with already arther
synthetic Progesterone negates these effects of oestrogen
What is tibolone ?
Synthetic pro-hormone -oetrogenic, progestrenic + androgenic
but increase stroke, and breast cancer
What is Raloxifene?
Selective oestrogen receptor modulator (SERM)
In bone: oetrogenic effects (good)
In breast and uterus-anti oestrogenic - (reduce cancer(
BUT risk of VTE/STROKE
and does not help with vasomotor symptoms (flushes)
What is tamixofen?
Anti-oestrogenic in breast tissue-use to treat oestrogen dependent metastatic breast cancer
What is premature ovarian insuficency? Why would you get it?
Loss of ovarian follicular activity before 40-rare
due to AID, radiation, surgery, chemotherapy
What are combined oral contraceptive pills?
Oestrogen (semi synthetic) +progesterone
Taken orally 21 days then stop 7 days
supress ovulation with E+P negative feedback + progesterone thickens cervical mucus
What are Progesterone only oral contraceptive pills? when use it?
When oestrogen is contra indicated (smoker over 35-CHD chances high)
MUST be taken same time each day (short half life+duration of action
long acting exist via intrauterine
