Female Reproductive System

The hypothalamus secrets what

gonadotropin-releasing hormone (GnRH)

What does gonadotropin- releasing hormone (GnRH) stimulate

Pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

What do LH and FSH stimulate

The ovaries to produce estrogen and immature ovarian follicles begin to develop 

Maturing follicles secrete what 

estrogen and progesterone

What will cause one follicle to release an oocyte (egg)

A surge in luteinizing hormone (LH) called ovulation

What “shuts off” FSH and LH

High levels of estrogen and progestin

What happens is the egg isn’t fertilized 

Estrogen and progestin levels drop and menses begins (day 1)

Which of the following is an important function of luteinizing hormone?

Ovulation

3 different compounds of estrogen

estradiol, estrone, and estriol

Physiological effects of estrogen 

Maturation of the female reproductive organs and appearance of all secondary sex characteristics

What else does estrogen do

• Decreases LDL

• increases HDL

• strengthens bones by blocking bone resorption
  

Estrogen stimulates what parts of the body

Brain, kidneys, skin, and blood vessels

All estrogens have what 

Thromboembolic potential and will stimulate the growth of estrogen sensitive tumors 

Progesterone promotes what

Breast development and supports the endometrium

When estrogen and progestin are used pharmacologically what happens 

Prevent pregnant, treat uterine bleeding, treat the symptoms of menopause and treat certain cancers 

What else can hormones do

Terminate a pregnancy, stimulate uterine contractions, and promote breast milk

Which of the following is an important function of progesterone?

Maintenance of the endometrium

When used pharmaceutically, how do estrogen and progesterone prevent pregnancy?

By preventing surges in FSH and LH

Hormonal contraceptives mechanism of action

Provide low, steady doses of estrogen (ethinyl estradiol) and progesterone (norethindrone) which “turn off” FSH and LH preventing ovulation

Other progestins

desogestrel, norgestimate, drospironone, levonorgestrel

Combined oral contraceptives contain estrogen and progesterone are classified as followed

Monophasic

Biphasic

Triphasic

Quadphasic

Monophasic

same dose of each over 21 days

Types: Loestrin, Orthocyclen

Biphasic

same dose of estrogen for 21 days, progestin varies last 2 weeks

Triphasic

Estrogen and progestin doses vary each week of the 21-day cycle
Types: Ortho-Tricyclen, Ortho-Novum 7/7/7

Quadriphasic

contains ethinyl valerate and dienogest; dose of each varies over 4 weeks

Which of the following is the rationale for oral contraceptives with variations in hormone dose throughout the cycle?

Risks of combined oral contraceptives

• Reduced breast milk production

• cancer

• elevated blood glucose and blood pressure

• may exacerbate SLE and migraine HA, teratogenic, and thrombosis

Benefits of combined oral contraceptives

• Decreased incidence of ovarian cancer

• lighter/regular menstrual periods

• decreased incidence of bone fractures and

• decreased incidence of heart disease

Common side effects of contraceptives

• Breast pain/tenderness

• Weight gain

• Irregular menstrual bleeding

Adverse events of contraceptives

Hypertension and thrombosis

Which of the following thromboembolic risks are most likely related to combined oral contraceptive use?

Progestin only contraceptives

• Pills

• Subdermal implants

• Depot injections

• Intrauterine devices

Progestin pill types

Micronor and Nor- Q.D

Progestin subdermal implants

Nexplanon

Progestin depot injections

Depo-Provera

Progestin intrauterine devices

IUD- Mirena

Which ones are known as long-acting reversible contraceptives

Nexplanon, Depo-Provera, and IUDs

Side effects of Progestin Only Contraceptives

Breakthrough bleeding, and weight gain

Adverse events: bone loss

Which of the following pharmacologic principles best explains drug-drug interactions with combined oral contraceptives and decreased effectiveness of oral progestin only contraceptives?