Oral Contraceptive, HRT And SERM

Question 1

Define menopause and its symptoms

Answer 1

Permanent cessation of mensuration, loss of ovarian follicular activity, average age (45-55). Climacteric: period of transition > you have normal regular cycles every month and then becomes a little irregular and then progresses to amenorrhea

Symptoms: hot flushes, urogenital atrophy and dyspareunia, sleep disturbances, depression, decreased libido and joint pain.

Question 2

Describe the normal HPG axis and hormonal changes during menopause

Answer 2

HPG axis: GnRH from the hypothalamus stimulates the anterior pituitary to produce LH and FSH, this makes ovaries make oestradiol and inhibin B (negative feedback - decrease LH and FSH)

Hormonal changes: low levels of oestradiol and inhibin B because of the follicular astresia, this means that there is less negative feedback so gonadotrophin levels go up (so LH and FSH go up)

Question 3

Describe complications of Menopause

Answer 3

1. Osteoporosis - caused by oestrogen deficiency (anabolic)

2. Cardiovascular disease - protected against CVD before menopause and have the same risk as men after the age of 70

Question 4

Describe the role of hormone replacement therapy

Answer 4

Control vasomotor symptoms (hot flushes)

Question 5

Describe the different formulations of HRT and side effects

Answer 5

Cyclical: take oestradiol everyday and for the last 12-14 days you take some progesterone, in continuous combined you take E+P

Oestrogen: estradiol (well absorbed and low bioavailability). Estrone sulphate (conjugated oestrogen). Ethinyl estradiol: semi synthetic oestrogen

Side effects: breast cancer, coronary heart disease, DVT, stroke, thrombosis and gallstones

Tibolone: synthetic pro hormone, oestrogenic and progestogenic, increased risk of stroke

Ralixofene: selective oestrogen receptor modulator (SERM), oestrogenic in bone (reduces risk of fracture), anti oestrogenic in breast and uterus, does not reduce vasomotor symptoms.

Tamoxifen: anti oestrogenic on breast tissue, used to treat oestrogen breast cancer.

Question 6

Explain what premature ovarian insufficiency

Answer 6

Menopause happening before the age of 40, autoimmune surgery, chemotherapy and radiation.

Question 7

Describe the difference oral contraceptive available

Answer 7

1. Combined: Ethinly oestradiol and progesterone

2. Progesterone only for less risk of thrombosis

Question 8

Describe the differences in emergency contraceptives

Answer 8

1. Copper IUD
2. Levonorgesterel
3. Ulipristal