Hormone Therapy and Estrogen Use
72 Questions
3 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is a potential side effect of estrogen therapy?

  • Decreased risk of ovarian cancer
  • Increased risk of uterine cancer (correct)
  • Decreased blood pressure and increased sodium excretion
  • Reduced risk of thromboembolism
  • Which statement best describes the clinical use of estrogen?

  • To decrease blood pressure
  • Exclusively for treating estrogen-dependent tumors
  • Solely for contraception in all individuals
  • For replacement therapy in primary ovarian failure (correct)
  • Why is estrogen often administered with a progestogen?

  • To increase the risk of thromboembolism.
  • To minimize side effects and reduce the risk of endometrial cancer. (correct)
  • To treat oestrogen dependent tumours.
  • To enhance feminization in males.
  • Which of the following is a synthetic estrogen?

    <p>Mestranol (D)</p> Signup and view all the answers

    What is a key difference between natural and synthetic estrogens?

    <p>Natural estrogens are rapidly metabolised in the liver. (A)</p> Signup and view all the answers

    Which of the conditions listed is a contraindication for hormone replacement therapy?

    <p>High risk of breast cancer (D)</p> Signup and view all the answers

    Tamoxifen is used to treat estrogen-positive breast cancer because it:

    <p>Competes with natural estrogens for receptors in target organs (C)</p> Signup and view all the answers

    How does Clomifene stimulate ovulation?

    <p>By preventing normal negative feedback in the anterior pituitary, causing increased FSH and LH release (A)</p> Signup and view all the answers

    Which of the following is a characteristic of naturally occurring progesterone when administered orally?

    <p>Virtually inactive due to metabolism by the liver (A)</p> Signup and view all the answers

    What effect do progestogens have on body temperature?

    <p>Increase body temperature (C)</p> Signup and view all the answers

    What is a primary mechanism of action for mifepristone (RU486) when progesterone is present?

    <p>Functions as a competitive receptor antagonist at the progesterone receptor. (D)</p> Signup and view all the answers

    What is the approximate time frame after ovulation during which fertilization can occur?

    <p>12-24 hours (C)</p> Signup and view all the answers

    A patient with endometriosis could potentially benefit from which of the following treatments?

    <p>Progestogens (D)</p> Signup and view all the answers

    Which of the following best describes the function of gemeprost or misoprostol when used with mifepristone?

    <p>Inducing uterine contractions to facilitate the termination of pregnancy. (C)</p> Signup and view all the answers

    Which of the following contraceptive methods contains both an oestrogen and a progestogen?

    <p>Combined pill (A)</p> Signup and view all the answers

    What is the primary mechanism of action of progestogen-only injectables like Medroxyprogesterone acetate (DepoProvera)?

    <p>Suppressing ovulation and thickening cervical mucus to prevent sperm penetration. (A)</p> Signup and view all the answers

    Why is long-term use (over 2 years) of Medroxyprogesterone acetate (DepoProvera) generally not recommended?

    <p>It is associated with a reduction in bone mineral density and, in rare cases, osteoporosis. (D)</p> Signup and view all the answers

    What is a common side effect associated with the use of the Etonogestrel subdermal implant (Implanon NXT/Nexplanon)?

    <p>Irregular bleeding and headaches. (D)</p> Signup and view all the answers

    Within what timeframe should Levonorgestrel be taken as an emergency contraceptive pill to maintain maximum efficacy?

    <p>Within 72 hours of unprotected intercourse because efficacy decreases with time. (B)</p> Signup and view all the answers

    What is the therapeutic mechanism of emergency contraceptive pills if ovulation has already occurred?

    <p>They delay the movement of the egg in the fallopian tube and thicken cervical mucus. (D)</p> Signup and view all the answers

    What is the primary mechanism of action of the progestogen component in combined oral contraceptives?

    <p>Inhibiting LH release and preventing ovulation, and altering cervical mucus. (B)</p> Signup and view all the answers

    Which of the following is a potential side effect associated with combined oral contraceptives?

    <p>Weight gain, nausea, mood changes, and skin pigmentation. (B)</p> Signup and view all the answers

    What is a key difference between the combined oral contraceptive pill and the progestogen-only pill (mini-pill) regarding administration?

    <p>The combined pill involves a 21-day cycle with 7 hormone-free days, while mini-pills are taken daily without interruption. (B)</p> Signup and view all the answers

    Which of the following best describes the mechanism of action of progestogen-only pills?

    <p>Inhibition of LH release, altering cervical mucus, and hindering implantation. (B)</p> Signup and view all the answers

    Why might a progestogen-only pill be prescribed instead of a combined oral contraceptive?

    <p>When estrogen is contraindicated, such as in women with a history of venous thromboembolism. (C)</p> Signup and view all the answers

    What is the potential consequence of drug interactions with oral contraceptive pills (OCPs) that affect hepatic cytochrome P450 enzymes?

    <p>Decreased absorption or increased clearance of hormones, potentially causing contraceptive failure. (D)</p> Signup and view all the answers

    When an individual is prescribed an antibiotic that causes vomiting or diarrhea, what is the recommended advice regarding oral contraceptive pills?

    <p>Follow the 'seven day rule'; use other methods of contraception during the illness and until seven active pills have been taken. (D)</p> Signup and view all the answers

    Which of the following medications, known to enhance CYP450 activity, may interfere with the efficacy of oral contraceptives?

    <p>Phenytoin (C)</p> Signup and view all the answers

    Which mechanism of action does ulipristal acetate employ to prevent pregnancy?

    <p>Modulates the progesterone receptor, impacting its normal function. (B)</p> Signup and view all the answers

    What is the primary mechanism of action of mifepristone (RU486)?

    <p>It competitively binds to and antagonizes the progesterone receptor. (A)</p> Signup and view all the answers

    Which of the following is a characteristic of long-acting progestogen-only contraception?

    <p>Includes options such as medroxyprogesterone acetate injections. (B)</p> Signup and view all the answers

    How does Clomifene exert its effects?

    <p>By competing with natural estrogens for receptors in target organs. (A)</p> Signup and view all the answers

    Which of the following best describes the mechanism by which combined oral contraceptives prevent pregnancy?

    <p>They act by suppressing ovulation through the combined action of estrogen and progestogen. (A)</p> Signup and view all the answers

    What is a key difference between levonorgestrel and ulipristal acetate when used for emergency contraception?

    <p>Ulipristal acetate has a broader mechanism of action, working even after the LH surge has started. (B)</p> Signup and view all the answers

    Why is misoprostol often administered alongside mifepristone?

    <p>To enhance cervical dilation and facilitate the expulsion of uterine contents. (B)</p> Signup and view all the answers

    Which best describes the function of etonogestrel in long-acting contraception?

    <p>Provides a steady release of progestogen to prevent ovulation. (C)</p> Signup and view all the answers

    Which of the following is a potential consequence of estrogen's impact on salt and water retention?

    <p>Edema and increased blood pressure (C)</p> Signup and view all the answers

    Which of the following statements is most accurate regarding the administration of estrogens?

    <p>Estrogens are almost always administered with a progestogen. (A)</p> Signup and view all the answers

    Why are synthetic estrogens like ethinylestradiol considered more potent compared to natural estrogens such as estradiol?

    <p>Synthetic estrogens are degraded less rapidly, leading to higher systemic concentrations (A)</p> Signup and view all the answers

    In which of the following scenarios would estrogen therapy be contraindicated?

    <p>In a patient with known estrogen-dependent tumors (A)</p> Signup and view all the answers

    What is the primary reason for the cyclical administration of estrogen in contraception?

    <p>To mimic the natural hormonal cycle. (C)</p> Signup and view all the answers

    Which of the following accurately describes the role of estrogen ($E_2$) in preparing the uterus for implantation?

    <p>Proliferation and vascularization of endometrial cells, along with the induction of progesterone receptors. (A)</p> Signup and view all the answers

    How do synthetic estrogens impact the release of follicle-stimulating hormone (FSH) from the anterior pituitary (AP)?

    <p>Synthetic estrogens inhibit FSH release via negative feedback on the AP, suppressing follicular development. (C)</p> Signup and view all the answers

    Which of the following mechanisms best describes how estrogens influence bone density?

    <p>Estrogens inhibit osteoclast activity and promote osteoblast activity, maintaining bone density. (A)</p> Signup and view all the answers

    Which mechanism describes the genomic action of estrogens?

    <p>Estrogens bind to intracellular receptors, influencing gene transcription through induction or repression. (A)</p> Signup and view all the answers

    How do estrogens affect lipid profiles in plasma?

    <p>Increase HDL, decrease LDL and cholesterol. (B)</p> Signup and view all the answers

    The mechanism by which oestrogens modulate vascular function involves:

    <p>Maintaining elasticity of skin &amp; blood vessels. (D)</p> Signup and view all the answers

    The effect of oestrogens on blood coagulability is best described as:

    <p>Increased coagulability of blood via increased clotting factors. (A)</p> Signup and view all the answers

    Which of the following is a non-genomic mechanism of estrogen signaling?

    <p>Rapid effects mediated via membrane receptors. (D)</p> Signup and view all the answers

    What is a major concern associated with the use of desogestrel as a contraceptive?

    <p>Higher risk of thromboembolism (C)</p> Signup and view all the answers

    Which condition could potentially be treated with the administration of mifepristone?

    <p>Medical termination of intrauterine pregnancies (D)</p> Signup and view all the answers

    What is the primary action of progestogens in contraceptive methods?

    <p>Thicken cervical mucus (D)</p> Signup and view all the answers

    What should be considered regarding sperm viability in relation to ovulation?

    <p>Sperm can survive in the female reproductive tract for up to 5 days. (A)</p> Signup and view all the answers

    Which of the following is a method of emergency contraception?

    <p>IUD insertion (A)</p> Signup and view all the answers

    What is a significant side effect of anti-oestrogens like Tamoxifen?

    <p>Increased risk of thromboembolic events (D)</p> Signup and view all the answers

    Which of the following best describes the role of progestogens during pregnancy?

    <p>Mature the endometrium and support embryogenesis (B)</p> Signup and view all the answers

    Which mechanism is primarily responsible for Clomifene's ability to induce ovulation?

    <p>Antagonism of oestrogen binding in the pituitary (D)</p> Signup and view all the answers

    What is one reason that progestogen preparations derived from testosterone can be given orally?

    <p>They are less rapidly metabolized by the liver (A)</p> Signup and view all the answers

    What is a potential consequence of using anti-oestrogens for breast cancer treatment?

    <p>Increased risk of developing uterine cancer (B)</p> Signup and view all the answers

    What is a significant concern associated with the long-term use of Medroxyprogesterone acetate?

    <p>Reduction in bone mineral density (A)</p> Signup and view all the answers

    Which of the following describes a common side effect of the Etonogestrel subdermal implant?

    <p>Irregular bleeding (B)</p> Signup and view all the answers

    How does Levonorgestrel function as an emergency contraceptive if taken during the second half of the menstrual cycle?

    <p>Thickens cervical mucus (D)</p> Signup and view all the answers

    What is the maximum duration for which an Etonogestrel implant should remain in place?

    <p>3 years (A)</p> Signup and view all the answers

    What influence does body weight have on the efficacy of the progestin-only emergency contraceptive Levonorgestrel?

    <p>Heavier weight decreases efficacy (D)</p> Signup and view all the answers

    What is the primary use of ulipristal acetate (ellaOne)?

    <p>To prevent pregnancy up to 120 hours after unprotected intercourse (D)</p> Signup and view all the answers

    What type of medication is ulipristal acetate classified as?

    <p>A progesterone receptor modulator (C)</p> Signup and view all the answers

    Which of the following statements best describes the role of anti-oestrogens?

    <p>They act as antagonists by competing with natural oestrogens for receptors. (B)</p> Signup and view all the answers

    What is mifepristone primarily used for?

    <p>As a competitive receptor antagonist at the progesterone receptor (B)</p> Signup and view all the answers

    How long can ulipristal acetate be effective for preventing pregnancy after unprotected intercourse?

    <p>120 hours (D)</p> Signup and view all the answers

    Which hormone is primarily combined with a progestogen in the combined oral contraceptive pill?

    <p>Oestrogen (B)</p> Signup and view all the answers

    What is the effect of progestogen-only injectables typically used for contraception?

    <p>They primarily prevent ovulation and thicken cervical mucus. (B)</p> Signup and view all the answers

    Which clinical application is associated with the medication Tamoxifen?

    <p>As an anti-oestrogen in breast cancer treatment (C)</p> Signup and view all the answers

    Flashcards

    Acute Vasodilation

    Rapid widening of blood vessels, increasing blood flow.

    Therapeutic Oestrogen

    Hormonal treatments using oestrogens, natural or synthetic.

    Oestrogen Clinical Uses

    Utilized for contraception and hormone replacement therapy.

    Side Effects of Oestrogen

    Common effects include nausea, edema, and increased cancer risk.

    Signup and view all the flashcards

    Oestrogen Contraindications

    Conditions where oestrogen use is not recommended, like oestrogen-dependent tumors.

    Signup and view all the flashcards

    Carcinoma of the endometrium

    A type of cancer that originates in the lining of the uterus, often linked to hormonal influences.

    Signup and view all the flashcards

    Anti-oestrogens

    Substances that compete with oestrogen for receptor binding in target organs, blocking its effects.

    Signup and view all the flashcards

    Tamoxifen

    An oestrogen antagonist used to treat oestrogen-positive breast cancer; has mild oestrogen-like side effects.

    Signup and view all the flashcards

    Clomifene

    An oestrogen antagonist that induces ovulation in infertility treatment by blocking negative feedback.

    Signup and view all the flashcards

    Progestogens

    Hormones that mature the endometrium, support pregnancy, and have multiple bodily effects including insulin response.

    Signup and view all the flashcards

    Progestogen-only injectables

    Hormonal contraceptives like Medroxyprogesterone acetate that suppress ovulation and thicken cervical mucus.

    Signup and view all the flashcards

    Medroxyprogesterone acetate

    150 mg injectable contraceptive that reduces ovulation and changes cervical mucus, effective for 3 months.

    Signup and view all the flashcards

    Etonogestrel implant

    A subdermal contraceptive that releases hormones for 3 years; requires removal after this period.

    Signup and view all the flashcards

    Emergency contraception mechanism

    Works by delaying ovulation and modifying cervical mucus to prevent fertilization post-intercourse.

    Signup and view all the flashcards

    Levonorgestrel

    A progestin-only emergency contraceptive pill to be taken within 72 hours after unprotected sex.

    Signup and view all the flashcards

    Desogestrel

    A progestogen used in contraception with fewer side effects but a higher risk of thromboembolism.

    Signup and view all the flashcards

    Mifepristone

    An anti-progestogen used for medical termination of intrauterine pregnancies, functioning as a receptor antagonist.

    Signup and view all the flashcards

    Contraception Methods

    Techniques to prevent fertilization, including barrier methods, hormones, and intrauterine devices.

    Signup and view all the flashcards

    Combined Pill

    An oral contraceptive consisting of estrogen and a progestogen, used to prevent pregnancy.

    Signup and view all the flashcards

    Combined Oral Contraceptive

    Contains Ethinylestradiol + Progestogen, taken for 21 days with 7 days off.

    Signup and view all the flashcards

    Mechanism of Action (MOA) - Combined Pill

    Oestrogen inhibits FSH; Progestogen inhibits LH and thickens cervical mucus.

    Signup and view all the flashcards

    Effectiveness of Combined Pill

    99.5% effective if taken as directed.

    Signup and view all the flashcards

    Progestogen-only Pill (Mini-pill)

    Contains only progestogen; taken daily without breaks.

    Signup and view all the flashcards

    MOA - Progestogen-only Pill

    Thickens cervical mucus and inhibits LH, preventing ovulation.

    Signup and view all the flashcards

    Drug Interactions with OCP

    Certain drugs can decrease absorption, leading to contraceptive failure.

    Signup and view all the flashcards

    Seven Day Rule

    Use backup contraception if antibiotics cause vomiting/diarrhea.

    Signup and view all the flashcards

    Side Effects of Oral Contraceptives

    Commonly include weight gain, mood changes, and nausea.

    Signup and view all the flashcards

    Ulipristal acetate

    A progesterone receptor modulator used for emergency contraception.

    Signup and view all the flashcards

    Emergency contraception

    Methods to prevent pregnancy after sex, effective within a specific time frame.

    Signup and view all the flashcards

    Progestin-only method

    Emergency contraception using only a progestin, such as Levonorgestrel.

    Signup and view all the flashcards

    Anti-progestogen

    Substances that block the effects of progesterone, such as Mifepristone.

    Signup and view all the flashcards

    Progestogen-only pill

    Oral contraceptive containing only progestogen, e.g., Norethisterone.

    Signup and view all the flashcards

    Long acting progestogen

    Extended-release contraceptives like injectables or implants, providing long-term pregnancy prevention.

    Signup and view all the flashcards

    Natural Oestrogen Preparations

    Forms of oestrogen derived from natural sources like estradiol and estriol, administered orally or transdermally.

    Signup and view all the flashcards

    Synthetic Oestrogens

    Lab-made hormones including Mestranol and Ethinylestradiol, used for contraceptives and therapies.

    Signup and view all the flashcards

    Oestrogen Side Effects

    Adverse effects from oestrogen use; common ones include nausea, edema, and increased cancer risk.

    Signup and view all the flashcards

    Contraindications for Oestrogen

    Conditions in which oestrogen should not be used, particularly with oestrogen-dependent tumors.

    Signup and view all the flashcards

    Progestins

    Synthetic hormones that support pregnancy and are used in various contraceptives.

    Signup and view all the flashcards

    Combined Contraceptive

    Birth control containing both estrogens and progestins to prevent ovulation.

    Signup and view all the flashcards

    Progesterone-only Contraceptive

    Contraceptives containing only progestin, suitable for some women.

    Signup and view all the flashcards

    Mechanism of Action - Oestrogens

    Oestrogens inhibit FSH and promote development of follicles and endometrium.

    Signup and view all the flashcards

    Adverse Effects of Oestrogens

    Potential side effects include nausea, weight gain, and possible blood clots.

    Signup and view all the flashcards

    Contraception

    Techniques to prevent fertilization, including barrier and hormonal methods.

    Signup and view all the flashcards

    Emergency contraception time frame

    Emergency contraception methods are effective up to 120 hours (5 days) after unprotected intercourse.

    Signup and view all the flashcards

    High Risk Breast Cancer

    Increased likelihood of developing breast cancer, often linked to genetic or hormonal factors.

    Signup and view all the flashcards

    Anti-oestrogens Mechanism

    Compete with oestrogens for receptors, inhibiting their effects in tissues.

    Signup and view all the flashcards

    Progestogens Actions

    Hormones that mature the endometrium and support pregnancy, also affecting insulin and body temperature.

    Signup and view all the flashcards

    Clomifene Function

    An anti-oestrogen that induces ovulation for fertility treatment by blocking feedback mechanisms.

    Signup and view all the flashcards

    Progestogen Preparations

    Includes natural hormones and testosterone derivatives used for various hormonal therapies.

    Signup and view all the flashcards

    Study Notes

    Reproductive Pharmacology

    • Class: Year 2 Medicine
    • Module: Endocrine & Breast
    • Title: Reproductive Pharmacology including contraception
    • Lecturer: Prof. Maria Morgan ([email protected]), Prof. Will Ford ([email protected])

    Learning Outcomes

    • Outcome 1: Describe the mechanism of action, clinical uses, common adverse effects, and contraindications of synthetic estrogens and progestins commonly used in contraception.
    • Outcome 2: Describe the mechanism of action and clinical use of anti-oestrogens and anti-progestogens using specific examples.
    • Outcome 3: Differentiate between the combined and progesterone-only contraceptives in terms of clinical applications and pharmacology.

    Hormone Control of Female Reproductive System (Hypothalamic-Pituitary-Gonadal Axis)

    • The diagram shows the hypothalamic-pituitary-gonadal (HPG) axis, the key hormone system controlling female reproductive function.
    • GnRH (gonadotropin-releasing hormone) is released from the hypothalamus and stimulates the anterior pituitary gland.
    • The anterior pituitary releases FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
    • FSH and LH act on the ovaries, promoting maturation of the graafian follicle (GF).
    • The ovaries produce estrogens and progesterone.

    Estrogens: Actions

    • Estrogens (E2) control ovum maturation and follicular development.
    • They prepare the uterus for implantation by promoting endometrial cell proliferation and vascularization, inducing progesterone receptors to allow progesterone response during the luteal phase.
    • Estrogens inhibit FSH release, providing negative feedback to the anterior pituitary.
    • Estrogens have metabolic actions, including a mineralocorticoid-like effect, leading to sodium and water retention.
    • Estrogens influence lipid regulation, increasing HDL and decreasing LDL cholesterol.
    • They enhance blood clotting factors and maintain bone density and skin/blood vessel elasticity.

    Mechanism of Action

    • Estrogens primarily act intracellularly, via estrogen receptors (ERα and ERβ), influencing gene transcription.
    • Some rapid estrogen effects are mediated by membrane receptors, contributing to a non-genomic signaling mechanism (e.g., acute vasodilation).

    Therapeutic Estrogens

    • Natural: Oestradiol and Oestriol are rapidly metabolized in the liver.
    • Synthetic: Mestranol, Stilbestrol, and Ethinylestradiol are less rapidly degraded.
    • Preparations include oral, transdermal, intramuscular, implantable, and topical formulations.
    • Administration is almost always combined with a progestogen.

    Clinical Uses of Estrogen

    • Contraception: Cyclic administration is common.
    • Replacement therapy: Used in cases of primary (e.g., Turner's syndrome) or secondary ovarian failure (e.g., menopause), often in combination with HRT.

    Side Effects of Estrogen

    • Nausea, vomiting, sodium and water retention (leading to edema and increased BP).
    • Increased risk of thromboembolism
    • Increased risk of uterine, ovarian, and breast cancers
    • Feminization in males.

    Contraindications of Estrogen

    • Estrogen-dependent tumors (e.g., endometrial carcinoma or high risk of breast cancer)
    • Undiagnosed genital bleeding
    • Liver disease
    • History of thromboembolic disorder
    • Heavy smoking

    Anti-oestrogens

    • Tamoxifen: An estrogen antagonist (SERM) used to treat estrogen-positive breast cancer.
    • Clomifene: An estrogen antagonist (SERM) used in infertility treatments; induces ovulation.
    • Mild estrogenic effects are possible, affecting plasma lipids, endometrium and bone.

    Anti-progestogens

    • Mifepristone (RU486): A competitive progesterone receptor antagonist used in the medical termination of intrauterine pregnancies; used with prostaglandins (e.g., gemeprost or misoprostol) to induce uterine contractions.

    Contraception

    • Techniques and methods to prevent human fertilization, including barrier methods (e.g., condoms, diaphragms), intrauterine systems, and hormonal methods.
    • The life of an egg after ovulation is approximately 12-24 hours.
    • Fertilization can occur up to 24 hours after ovulation
    • Sperm can live in the female reproductive tract for 3-5 days.
    • Sexual intercourse within the 5 days prior to ovulation can result in fertilization.
    • Common hormonal methods include oral (combined and progestogen-only), long-acting (injectables, implants), and emergency contraception.

    Hormonal Contraceptives

    • Types: Oral contraceptives (combined pills, progestogen-only pills); long-acting progestogen-only (injectables, implants); emergency contraception.
    • Details of mechanism of action, drug interactions, and side effects for these contraceptive types are outlined in the slides.
    • Specific examples of oral contraceptives (e.g., Ethinylestradiol + Norethisterone, Norethisterone or desogestrel, etc) types and dosages are included.

    Further Reading (for more in-depth information)

    • Several online resources are mentioned for more advanced study including specific URLs for relevant articles and videos.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Description

    Test your knowledge on the clinical uses, side effects, and mechanisms of hormone therapy, specifically focusing on estrogen. This quiz covers various aspects of hormone replacement therapy, synthetic estrogens, and related medications. Ideal for students in the medical field or anyone interested in reproductive health.

    More Like This

    Use Quizgecko on...
    Browser
    Browser