Reproductive System Meds

What topics are covered in Week 10/11 reproductive pharmacology?

Female hormones (estrogen and progesterone), pregnancy-related drugs (vitamins, corticosteroids, antiemetics, antihypertensives, uterine stimulants and relaxants), oral contraceptives, male hormone (testosterone), infection-related medications (antibiotics, antifungals, antivirals), and drugs for erectile dysfunction and low libido including PDE5 inhibitors and certain antidepressants.

Which female hormones are the focus of this lecture?

Estrogen and progesterone (progestins).

Which pregnancy-related medications should students know?

Prenatal vitamins, corticosteroids, antiemetics, antihypertensives, uterine stimulants, uterine relaxants, and oral contraceptives.

Which male hormone is discussed?

Testosterone.

Which medication classes are associated with erectile dysfunction treatment?

Phosphodiesterase type 5 (PDE5) inhibitors and selected antidepressants.

At what age does female puberty normally begin?

Approximately 9–16 years of age.

Which hormones are released by the anterior pituitary to stimulate ovarian function?

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

What is the function of FSH?

Stimulates ovarian follicle development and estrogen production.

What is the function of LH?

Triggers ovulation and stimulates progesterone production by the corpus luteum.

What do the ovaries produce?

Estrogen, progesterone, and ova (eggs).

What are the primary phases of the menstrual cycle?

Menstrual phase, follicular (proliferative) phase, ovulation, and luteal (secretory) phase.

What drug class is estrogen?

Estrogenic hormone.

What is the generic name of Premarin®?

Conjugated estrogens.

What is the generic name of Estragyn®?

Esterified estrogens.

Which estrogen is available as a transdermal patch?

Estradiol transdermal (Climara®).

Which estrogen formulation is administered intramuscularly?

Estradiol valerate IM.

Which estrogen is available as a vaginal ring?

Estradiol vaginal ring.

Which estrogen is available as a vaginal cream?

Estrone vaginal cream.

What is the brand name of estropipate?

Ogen®.

Which oral contraceptive contains ethinyl estradiol?

Alesse®.

What is Estrace®?

Micronized estradiol.

What routes can estrogen be administered?

Oral, vaginal ring, vaginal preparations, transdermal patch, topical gel, and injection.

Which estrogen drugs are highlighted as exam-important?

Those highlighted in blue on the lecture slides, particularly Premarin®, Estradiol, and Ethinyl Estradiol.

What are common therapeutic uses of estrogen?

Endometriosis, peri-menopause symptoms, menopause symptoms, oral contraception, hormone replacement therapy, and other estrogen deficiency disorders.

What is atrophic vaginitis?

Thinning, drying, and inflammation of the vaginal tissues due to estrogen deficiency.

What is hypogonadism?

A condition in which the gonads produce insufficient sex hormones.

What reproductive condition is estrogen commonly prescribed for?

Oral contraception.

Why might estrogen be prescribed after ovarian failure or castration?

To replace deficient estrogen and relieve symptoms of hormone deficiency.

How can estrogen help treat uterine bleeding?

It stabilizes the endometrium and helps regulate bleeding.

How is estrogen used in breast or prostate cancer?

Only as hormone therapy in advanced, palliative-stage cancer.

Why is estrogen generally contraindicated in breast cancer despite being used in advanced breast cancer?

Routine estrogen therapy can stimulate estrogen-dependent tumors, but in rare advanced palliative situations, hormonal manipulation may inhibit tumor progression under specialist supervision.

How does estrogen help prevent osteoporosis?

It decreases bone resorption and helps maintain bone density.

How is estrogen used in transgender care?

As part of cross-gender hormone therapy for male-to-female transgender individuals.

What menopausal symptoms does estrogen improve?

Vasomotor symptoms such as hot flashes and night sweats.

Can estrogen be used to treat severe acne?

Yes, in selected patients.

What cancers are considered estrogen-dependent?

Breast cancer, ovarian cancer, and endometrial cancer.

What is the most important contraindication before giving estrogen?

Pregnancy.

Why should pregnancy always be ruled out before starting estrogen therapy?

Estrogen can harm the developing fetus.

Why is undiagnosed vaginal bleeding a contraindication to estrogen therapy?

The underlying cause must first be determined because bleeding may indicate malignancy or another serious condition.

What thromboembolic disorders contraindicate estrogen therapy?

Deep vein thrombosis (DVT), pulmonary embolism (PE), or active clotting disorders.

Which cancers contraindicate estrogen therapy?

Any estrogen-dependent cancer including breast, ovarian, and endometrial cancers.

What is another contraindication to estrogen therapy?

Drug allergy or hypersensitivity.

Which cardiovascular adverse effects are associated with estrogen?

Hypertension, edema, thrombophlebitis, and thrombosis.

Which gastrointestinal adverse effects are associated with estrogen?

Nausea, vomiting, diarrhea, and constipation.

Which genitourinary adverse effects occur with estrogen?

Amenorrhea, breakthrough uterine bleeding, and enlarged uterine fibroids.

What dermatologic adverse effects may occur with estrogen?

Chloasma (melasma), hirsutism, and alopecia.

What is chloasma?

Facial skin discoloration (also called melasma) associated with estrogen therapy.

Which endocrine/metabolic adverse effects occur with estrogen?

Fluid retention, weight gain, decreased carbohydrate tolerance, and headaches.

Which breast-related adverse effect commonly occurs with estrogen?

Breast tenderness.

How do the dose and route of estrogen influence adverse effects?

Higher doses and certain administration routes increase the risk of adverse effects, especially thromboembolic events.