Female Reproductive Drugs

Question 0

Contraindications for OCP and HRT

Answer 0

Smoking, hx of blood clots, hx or fam hx of breast CA, fam hx of osteoporosis, current or unstable HTN.

Question 1

HRT

Answer 1

Benefits: menopausal sxs such as hot flashes and night sweats, and prevents/treats post-menopausal tissue atrophy in genital tract. Estrogens also PREVENT THE RESORPTION OF BONE to help prevent osteoporosis.
Risks: Increased liklihood of stroke, blood clots, ovarian CA, endometrial CA, and BRCA.

Question 2

OCPs

Answer 2

Various hormonal contraception pills. Combo pills contain a steady dose of estrogen over a 21 day cycle with a low but increasing dose of progestin. The 21 day cycle is followed by 7 placebo pills and pts experience a bleed during this time.
OCPs reduce the risk of colorectal CA, improves dysmennorhea and PMS, improves endometriosis and PCOS as well, and can help manage anemia due to menorrhagia. Reduces lifetime risk of ovarian CA significantly.
SFx - increased risk of CVD, DVT, HTN and stroke (especially in smokers). Low-grade sfx include depression, HA, breast tenderness, edema, and nausea.

Question 3

Drug interactions with OCPs.

Answer 3

Multiple drugs can reduce OCP efficacy, including:

penicillins, amoxcillin, tetracyclines, cephalosporins, sulfas, anticonvulsant drugs, antidepressants, and Hypericum.

Question 4

Drospirenone (Yaz/Yasmin)

Answer 4

Synthetic progestin-only OCP. Used for contraception, especially in pts who do not tolerate estrogens well. Notable that drospirenone has anti-mineralocorticoid effects, and a 6-7 fold increase in stroke risk. This is twice the risk increase seen in pts on a levonorgestrel OCP.

Question 5

Medroxyprogesterone acetate (Depo-Provera IM)

Answer 5

Injection containing 150mg of medroprogesterone. Administered every 3 months to maintain effectiveness. Has been shown to reduce risk of ovarian CA by 80%.
SFx - menstrual irregularities, abdominal discomfort, wt changes, HA, hair loss, fatigue, depression and anxiety. Fertility returns 9-10 months after last depo shot.
BLACK BOX WARNING for bone loss and osteoporosis. Should not be used longer than 2 years unless there is NO other viable method for contraception.