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21 Cards in this Set
- Front
- Back
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What are the benefits of hormone replacement therapy in menopause?
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- Improves problems like hot flushes, sweating, mood alterations- Improves genital atrophy- Prevents osteoporosis
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What are the bad effects of hormone replacement therapy in menopause?
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Increases risk of:- Coronary artery disease (even with progestins)- Ovarian cancer- Breast cancer- Venous thrombus- Stroke- Gallstones- Cardiovascular disease- Endometrial cancer (if given without progestin)
Therefore there is few indications for systemic treatment. |
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Indications of postmenopausal hormone therapy?
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- Vaginal atrophy, treated topically.
- Systemic therapy to relieve hot flashes, mood alterations etc. Should not be given to those with history of breast cancer, coronary heart disease, thrombus, acute liver disease. Should be lowest dose as possible and last for a short time. |
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Who would receive therapy with both estrogen and progestin, and who would only receive estrogen monotherapy?
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Women who have not performed hysterectomy should receive estrogen together with progestin to prevent the increased risk for endometrial cancer.
Those without uterus can receive monotherapy with estrogen |
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Which estrogen and progestin is preferred in postmenopausal hormone therapy?
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Estradiol which micronized is taken orally or it can be as a transdermal patch.
Progesterone is preferred, but other progestins can be used as well. |
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What are the two ways of dosing estrogen and progestin in postmenopausal therapy?
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1. Estrogen can be given alone for 15 days, and combined with progestin for 10 days, followed by a 5-day pause. Period bleeding will occur during the pause, as an artificial menstrual cycle.
2. Estrogen and progestin is given together everyday without any pause. This causes atrophy of endometrium and therefore no menstrual bleedings. |
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What is tibolone?
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A synthetic steroid with estrogen, progestin and androgen effects. It has estrogenic effect on vaginal mucosa and skeleton, progestin effect on endometrium and positive effect on libido and mental wellness.
But it increases the risk of breast and endometrial cancer. |
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What is the Pearl Index?
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Efficacy of hormonal contraception. It shows the number of unwanted pregnancies per 100 women pr year.
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Which estrogen and progestin components are often found in the combination pill?
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Ethinyl estradiol and levonorgestrel/desogestrel.
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Which progestin components are usually used in the minipill?
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Desogestrel, norethindrone or levonorgestrel.
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Mechanism of action of the combined pill?
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The contraceptive effect is mainly mediated by negative feedback to the hypothalamus. This leads to reduced levels of GnRH, which decreases FSH and LH. There will be no ovulation without the surge in LH and decreased FSH inhibits ovarian folliculogenesis.
Progestins also inhibit endometrial proliferation, increases viscosity of cervical mucus and impairs fallopian tube peristalsis. The sperm will not reach the egg, and if it does, the egg will not be able to implant. |
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Mechanism of the progestin-only contraceptives?
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The local effects in the uterus are more important than the negative feedback to the hypothalamus.
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How is the classical dosing schedule for the combined pill? How is the newer schedules?
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Classical: the drug is taken for 21 days followed by a 7 day drug-free period where withdrawal bleeding occurs. The patients often have a blister pack with 28 pills, but the 7 last ones are placebo.
Newer schedules involves taking the drug for longer than 21 days, like 26 days with and 2 days with placebo. This reduces the inconveniences with menstuation without causing any harmful effects. |
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What is a monophasic preparation? (combined pills)
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In a monophasic preparation, all pills in the cycle contains the same amount of active ingredients.
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What is a biphasic preparation? (combined pill)
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In a biphasic preparation, the pills in the first half of the cycle contain less estrogen than in the latter half. This reduces the total amount of taken hormone.
Triphasic also exist. |
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Contraindication for estrogen-containing oral contraceptives?
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- Cardiovascular like thromboembolism, coronary heart disease or hypertension
- Significant hypertriglyceridemia - Diabetes mellitus - Hepatic tumors - Estrogen-dependent tumors - Smoking and over 35 years - Undiagnosed abnormal uterine bleedings |
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What does emergy contraceptic contain?
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- Ulipristal 30 mg
or - Levonorgestrel 0,75 mg twice in 12 hours or 1,5 mg once. |
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What is the Yuzpe regimen?
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It refers to taking additional doses of oral combination contraceptive pills containing levonorgestrel and ethinyl estradiol as emergency contraceptive. It is less reliable than taking dedicated emergency pills.
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What is the most effacacios and the only non-hormonal emergency contraceptive and when is it indicated?
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Copper IUD.
It is indicated in obese women with BMI over 30 because levonorgestrel- or ulipristal-containing are 50 % less efficacious in these populations. |
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Mechanism of action of emergency contraceptives? How long are they effective?
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They act like normal hormonal contraceptives by inhibiting ovulation and preventing fertilization and implantation.
Levonorgestrel is effective up to 3 days after intercourse, and ulipristal 5 days after intercourse |
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Side effects of emergency contraceptives?
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Nausea and vomiting. New dose should be taken if vomiting occurs.
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