FEMALE ENDOCRINOLOGY

Question 1

CASE - HOW DOES THE PILL PREVENT PREGNANCY (COMBINED ORAL CONTRACEPTIVE)

Answer 1

the combined oral contraceptive pill will contain oestrogen and progestogen

oestrogen inhibits FSH secretion via NEGATIVE feedback of the anterior pituitary and suppresses the growth of the ovarian follicle (and the maturation)

progestogen inhibits the secretion of LH (leutinising hormone) which prevents ovulation and this makes the cervical mucus less suitable for the passage of sperm

Oestrogen and progestogen therefore work in concert to alter the endometrium in such a way that implantation is discouraged

Question 2

WHAT ARE LIMITATIONS OF THE COMBINED ORAL CONTRACEPTIVE (5 MARKS)

Answer 2

Weight gain, owing to fluid retention or an anabolic effect, or both
Mild nausea, flushing, dizziness, depression or irritability
Skin changes (e.g. acne and/or an increase in pigmentation)
Amenorrhoea of variable duration on cessation of taking the pill
Venous thromboembolism
Increase in blood pressure

Question 3

HOW DO HERBS AND SOME DRUGS INTERACT WITH COC’S

Answer 3

Combined and progestogen-only oral contraceptives are metabolised by hepatic cytochrome P450 enzymes.
Increase in clearance of oestrogen may result in contraceptive failure.
Enzyme-inducing drugs can increase clearance of combined and progestogen-only pills.
Rifampicin
Rifabutin
Carbamazepine
Phenytoin
Griseofulvin

HERBS - you can’t take st johns wort because ST JOHNS WORT WILL INCREASE THE METABOLISM OF THESE CYP450 ENZYMES AND ACTIVITY SO ORAL CONTRACEPTOVE WILL RAPIDLY BE CLEARED FROM THE BODY AND THIS IS NOT WHAT IT WAS DESIGNED TO DO

Question 4

Progestogen only pill what are some examples

Answer 4

norethisterone
levonorgestrel
ethynodiol

Question 5

Why do we use progestogen only pill in which patients?

Answer 5

if oestrogen is contraindicated and suitable for women who’s blood pressure increases unacceptably during the treatment of oestrogen

Question 6

How does progestogen only pill work

Answer 6

Makes the cervical mucus inhospitable to sperm
inhibits the secretion of LH and prevents ovulation

Question 7

Disadvantages of progestogen only pill

Answer 7

its less reliable and mainly due to alteration of cervical mucus

irregular bleeding is common

Question 8

Clinical uses of oestrogens

Answer 8

1) primary hypogonadism
(so oestrogen is used in the primary failure of development of ovaries, premature menopause or menopause)

2) postmenopausal hormonal therapy
(HORMONAL REPLACEMENT THERAPY - will improve symptoms, hot flushes and vaginal dryness) (also prevention and treatment of osteoporosis)

3) contraception