PDA 1 exam 2 (contraception)

What happens to estrogen, LH and FSH during menopause

• Decrease in estrogen

• increase in LH and FHS

average age is 52

Hormone replacement therapy

natural or synthetic estrogens

ethinyl estradiol

• estrogen receptor agonist

• 0.005-0.02 mg

micronized estradiol

• estrogen receptor agonist

• 1-2 mg

what do conjugates, esterified or mixed estrogenic substances come in

• oral- 0.3-1.23 mg

• Injection- 0.2-2 mg

• transdermal patch

estrogenic chemical compounds

BPA

what are the therapeutic uses for estrogens

• combination oral contraceptives

• primary hypogonadism (target organs ie ovaries)

• postmenopausal HRT

adverse effects of estrogens

• uterine bleeding

• increased risk of breast cancer

• endometrial carcinoma

contraindication of estrogens

• endometrium or breast carcinoma

• genital bleeding, liver disease, thromboembolic disorder

• heavy smoker

fulvestrant

• estrogen receptor antagonist

• estrogen receptor positive breast cancer

elacestrant

• estrogen receptor antagonist

• estrogen receptor positive breast cancer

what does an aromatase inhibitor do

blocks androgen to estrogen

anastrozole

• aromatse inhibitor

• tx of metastatic breast cancer

• prevention of recurrences of breast cancer

letrozole

• aromatse inhibitor

• tx of metastatic breast cancer

• prevention of recurrences of breast cancer

exemestane

• aromatase inhibitor

• tx of metastatic breast cancer

• Prevention of recurrences of breast cancer

nafarelin

• long acting GnRH agonist

• tx of endometriosis and breast cancer

goserelin

• long acting GnRH agonist

• tx of endometriosis and breast cancer

leuprolide

• long acting GnRH agonist

• tx of endometriosis and breast cancer

mifepristone

• progesterone receptor antagonist

• terminate early pregnancy (abortifacient)

ulipristal

• selective progesterone receptor modulator

• used in emergency contraception

progesterone receptor agonist therapeutic uses

• contraceptives

• HRT (protective to uterus and decrease risk of endometriosis)

Androgenic progesterones

• Medroxyprogesterone

• norethindrone

• norethindrone acetate

• ethynodiol diacetate

• norgestrel

HRT effects associated with estrogen

• increase stroke and thromboembolism

• decreased osteoporosis

Estrogen and progesterone effects

• increased cardiovascular, breast cancer, stroke

• decreased osteoporosis

current recommendation in HRT

postmenopausal women should use HRT only to treat bothersome symptoms and the lowest dose and shortest duration

what is the major mechanism of hormonal contraception

prevent ovulation

what is the minor mechanism of hormonal contraception

changes in cervical secretion that retard sperm

what does hypothalamic and pituitary suppression do

abolish mid cycle LH surge

effects of estrogen on cervical mucus during cycle

before ovulation - thinner, more alkaline mucus

effects of progesterone on cervical mucus during cycle

after ovulation and during pregnancy- thicker more viscous mucus

what drugs increase estrogen metabolism

• barbiturates

• phenytoin

• rifampicin

emergency contraception

• L-norgestrel- 1.5 mg once

• Ulipristal acetate- one 30 mg dose

• Levonorgestrel prevents ovulation and fertilization