Sex Hormones Flashcards
(25 cards)
Examples of natural oestrogens
Estradiol
Estrone
Estriol
Examples of synthetic oestrogens
Ethinylestradiol
Mestranol
What activity does Tibolone have?
Oestrogenic
Progestogenic
Weak androgenic
When would oestrogen and progestogen be given to a patient? Why?
If a woman has a uterus
Reduce the risk of cystic hyperplasia of the endometrium and cancer
Symptoms of menopause
Vaginal atrophy
Vasomotor instability
How to treat each menopausal symptom
Vaginal atrophy - short course of topical vaginal oestrogen preparation (repeated if necessary)
Vasomotor instability - systemic oestrogens or tibolone or clonidine
How is Tibolone administered? (e.g., continuously or cyclic)
Continuously, without cyclical progestogen
Why isn’t clonidine widely used?
Large side effect profile
Risks associated with HRT
VTE - Increased risk with both oestrogens-only and combined HRT and with prolonged bed rest, obesity, trauma, family history
Stroke - Slight increase with both oestrogen-only and combine HRT. Tibolone increases risk by 2-3 times in first year of treatment
Endometrial cancer - reduced by a progestogen. Tibolone increased risk
Breast cancer - Increased risk after 1 year – longer use = higher risk. Risk higher in combined HRT over oestrogens only. Excess risk persists for more than 10 years
Ovarian cancer - Small increase which disappears a few years after stopping
Increased risk of coronary heart disease in women who start combined HRT more than 10 years after menopause
MHRA advise on initiating HRT
Should only be prescribed to relieve post-menopausal symptoms that are adversely affecting quality of life and treatment should be reviewed regularly to ensure the minimum effective dose is used for the shortest duration
Benefits of HRT
Reduces risk of osteoporosis associated with menopause
MHRA advise regarding breast cancer risk
Encourage current and past HRT users to be vigilant for signs of breast cancer and to attend routine breast screening.
Which HRT regimen would be recommended to women with a uterus?
Oestrogen with cyclical progestogen for the last 12 to 14 days of the cycle
Continuous administration of an oestrogen and a progestogen
Which HRT regimen/medication is avoided in perimenopausal phase and within 12 months of the last menstrual period?
Continuous combined and tibolone
Which HRT regimen in recommended to women without a uterus? And how to manage if endometriosis occurs?
Continuous oestrogen use
Endometriosis - consider an addition of progesterone
How to manage HRT if the patient is undergoing elective surgery?
Stop HRT 4-6 weeks before surgery
Reinitiate when fully mobile
How to manage HRT if the patient is undergoing emergency surgery?
Prophylactic with unfractionated heparin or LMWH
Graduated compression stockings
When to stop HRT?
If pending investigation and treatment
Sudden severe chest pain/breathlessness (PE)
Unexplained swelling or severe pain in calf of one leg (DVT)
Severe stomach pain (hepatotoxicity)
Serious neurological effects: unusual severe, prolonged headache, fainting, first unexplained epileptic seizure, motor disturbances, numbness
Hepatitis / jaundice
BP >160mmHg systolic or 95 mmHg diastolic
Prolonged immobility – increased risk of VTE
What can occur if a woman with a uterus takes combined preparations of HRT or tibolone in the perimenopasual phase or within 12 months of the last menstrual period? How to manage this?
Irregular bleeding can occur
If this continues = endometrial abnormality should be ruled out and consideration given to changing to cyclical HRT
When would ethinylestradiol be used?
Licensed for
1) Short-term treatment of symptoms of oestrogen deficiency
2) Osteoporosis prophylaxis if other drugs cannot be used
3) Treatment of female hypogonadism and menstrual disorders.
Specialist
1) Management of hereditary haemorrhagic telangiectasia
When would raloxifene be used? Which symptoms is it ineffective at treating/managing?
Licensed for
1) Treatment and prevention of postmenopausal osteoporosis
Does not reduce menopausal vasomotor symptoms.
Why is progestogen added to HRT regimen for women with a uterus?
To prevent cystic hyperplasia of the endometrium and possible transformation to cancer
Examples of progestogen, progesterone and its analogues?
Progesterone, desogestrel, norgestimate, dydrogesterone and medroxyprogesterone acetate
Examples of testosterone analogues
Norethisterone and norgestrel
