Podcast
Questions and Answers
Which of the following is a potential side effect of estrogen therapy?
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?
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?
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?
Which of the following is a synthetic estrogen?
What is a key difference between natural and synthetic estrogens?
What is a key difference between natural and synthetic estrogens?
Which of the conditions listed is a contraindication for hormone replacement therapy?
Which of the conditions listed is a contraindication for hormone replacement therapy?
Tamoxifen is used to treat estrogen-positive breast cancer because it:
Tamoxifen is used to treat estrogen-positive breast cancer because it:
How does Clomifene stimulate ovulation?
How does Clomifene stimulate ovulation?
Which of the following is a characteristic of naturally occurring progesterone when administered orally?
Which of the following is a characteristic of naturally occurring progesterone when administered orally?
What effect do progestogens have on body temperature?
What effect do progestogens have on body temperature?
What is a primary mechanism of action for mifepristone (RU486) when progesterone is present?
What is a primary mechanism of action for mifepristone (RU486) when progesterone is present?
What is the approximate time frame after ovulation during which fertilization can occur?
What is the approximate time frame after ovulation during which fertilization can occur?
A patient with endometriosis could potentially benefit from which of the following treatments?
A patient with endometriosis could potentially benefit from which of the following treatments?
Which of the following best describes the function of gemeprost or misoprostol when used with mifepristone?
Which of the following best describes the function of gemeprost or misoprostol when used with mifepristone?
Which of the following contraceptive methods contains both an oestrogen and a progestogen?
Which of the following contraceptive methods contains both an oestrogen and a progestogen?
What is the primary mechanism of action of progestogen-only injectables like Medroxyprogesterone acetate (DepoProvera)?
What is the primary mechanism of action of progestogen-only injectables like Medroxyprogesterone acetate (DepoProvera)?
Why is long-term use (over 2 years) of Medroxyprogesterone acetate (DepoProvera) generally not recommended?
Why is long-term use (over 2 years) of Medroxyprogesterone acetate (DepoProvera) generally not recommended?
What is a common side effect associated with the use of the Etonogestrel subdermal implant (Implanon NXT/Nexplanon)?
What is a common side effect associated with the use of the Etonogestrel subdermal implant (Implanon NXT/Nexplanon)?
Within what timeframe should Levonorgestrel be taken as an emergency contraceptive pill to maintain maximum efficacy?
Within what timeframe should Levonorgestrel be taken as an emergency contraceptive pill to maintain maximum efficacy?
What is the therapeutic mechanism of emergency contraceptive pills if ovulation has already occurred?
What is the therapeutic mechanism of emergency contraceptive pills if ovulation has already occurred?
What is the primary mechanism of action of the progestogen component in combined oral contraceptives?
What is the primary mechanism of action of the progestogen component in combined oral contraceptives?
Which of the following is a potential side effect associated with combined oral contraceptives?
Which of the following is a potential side effect associated with combined oral contraceptives?
What is a key difference between the combined oral contraceptive pill and the progestogen-only pill (mini-pill) regarding administration?
What is a key difference between the combined oral contraceptive pill and the progestogen-only pill (mini-pill) regarding administration?
Which of the following best describes the mechanism of action of progestogen-only pills?
Which of the following best describes the mechanism of action of progestogen-only pills?
Why might a progestogen-only pill be prescribed instead of a combined oral contraceptive?
Why might a progestogen-only pill be prescribed instead of a combined oral contraceptive?
What is the potential consequence of drug interactions with oral contraceptive pills (OCPs) that affect hepatic cytochrome P450 enzymes?
What is the potential consequence of drug interactions with oral contraceptive pills (OCPs) that affect hepatic cytochrome P450 enzymes?
When an individual is prescribed an antibiotic that causes vomiting or diarrhea, what is the recommended advice regarding oral contraceptive pills?
When an individual is prescribed an antibiotic that causes vomiting or diarrhea, what is the recommended advice regarding oral contraceptive pills?
Which of the following medications, known to enhance CYP450 activity, may interfere with the efficacy of oral contraceptives?
Which of the following medications, known to enhance CYP450 activity, may interfere with the efficacy of oral contraceptives?
Which mechanism of action does ulipristal acetate employ to prevent pregnancy?
Which mechanism of action does ulipristal acetate employ to prevent pregnancy?
What is the primary mechanism of action of mifepristone (RU486)?
What is the primary mechanism of action of mifepristone (RU486)?
Which of the following is a characteristic of long-acting progestogen-only contraception?
Which of the following is a characteristic of long-acting progestogen-only contraception?
How does Clomifene exert its effects?
How does Clomifene exert its effects?
Which of the following best describes the mechanism by which combined oral contraceptives prevent pregnancy?
Which of the following best describes the mechanism by which combined oral contraceptives prevent pregnancy?
What is a key difference between levonorgestrel and ulipristal acetate when used for emergency contraception?
What is a key difference between levonorgestrel and ulipristal acetate when used for emergency contraception?
Why is misoprostol often administered alongside mifepristone?
Why is misoprostol often administered alongside mifepristone?
Which best describes the function of etonogestrel in long-acting contraception?
Which best describes the function of etonogestrel in long-acting contraception?
Which of the following is a potential consequence of estrogen's impact on salt and water retention?
Which of the following is a potential consequence of estrogen's impact on salt and water retention?
Which of the following statements is most accurate regarding the administration of estrogens?
Which of the following statements is most accurate regarding the administration of estrogens?
Why are synthetic estrogens like ethinylestradiol considered more potent compared to natural estrogens such as estradiol?
Why are synthetic estrogens like ethinylestradiol considered more potent compared to natural estrogens such as estradiol?
In which of the following scenarios would estrogen therapy be contraindicated?
In which of the following scenarios would estrogen therapy be contraindicated?
What is the primary reason for the cyclical administration of estrogen in contraception?
What is the primary reason for the cyclical administration of estrogen in contraception?
Which of the following accurately describes the role of estrogen ($E_2$) in preparing the uterus for implantation?
Which of the following accurately describes the role of estrogen ($E_2$) in preparing the uterus for implantation?
How do synthetic estrogens impact the release of follicle-stimulating hormone (FSH) from the anterior pituitary (AP)?
How do synthetic estrogens impact the release of follicle-stimulating hormone (FSH) from the anterior pituitary (AP)?
Which of the following mechanisms best describes how estrogens influence bone density?
Which of the following mechanisms best describes how estrogens influence bone density?
Which mechanism describes the genomic action of estrogens?
Which mechanism describes the genomic action of estrogens?
How do estrogens affect lipid profiles in plasma?
How do estrogens affect lipid profiles in plasma?
The mechanism by which oestrogens modulate vascular function involves:
The mechanism by which oestrogens modulate vascular function involves:
The effect of oestrogens on blood coagulability is best described as:
The effect of oestrogens on blood coagulability is best described as:
Which of the following is a non-genomic mechanism of estrogen signaling?
Which of the following is a non-genomic mechanism of estrogen signaling?
What is a major concern associated with the use of desogestrel as a contraceptive?
What is a major concern associated with the use of desogestrel as a contraceptive?
Which condition could potentially be treated with the administration of mifepristone?
Which condition could potentially be treated with the administration of mifepristone?
What is the primary action of progestogens in contraceptive methods?
What is the primary action of progestogens in contraceptive methods?
What should be considered regarding sperm viability in relation to ovulation?
What should be considered regarding sperm viability in relation to ovulation?
Which of the following is a method of emergency contraception?
Which of the following is a method of emergency contraception?
What is a significant side effect of anti-oestrogens like Tamoxifen?
What is a significant side effect of anti-oestrogens like Tamoxifen?
Which of the following best describes the role of progestogens during pregnancy?
Which of the following best describes the role of progestogens during pregnancy?
Which mechanism is primarily responsible for Clomifene's ability to induce ovulation?
Which mechanism is primarily responsible for Clomifene's ability to induce ovulation?
What is one reason that progestogen preparations derived from testosterone can be given orally?
What is one reason that progestogen preparations derived from testosterone can be given orally?
What is a potential consequence of using anti-oestrogens for breast cancer treatment?
What is a potential consequence of using anti-oestrogens for breast cancer treatment?
What is a significant concern associated with the long-term use of Medroxyprogesterone acetate?
What is a significant concern associated with the long-term use of Medroxyprogesterone acetate?
Which of the following describes a common side effect of the Etonogestrel subdermal implant?
Which of the following describes a common side effect of the Etonogestrel subdermal implant?
How does Levonorgestrel function as an emergency contraceptive if taken during the second half of the menstrual cycle?
How does Levonorgestrel function as an emergency contraceptive if taken during the second half of the menstrual cycle?
What is the maximum duration for which an Etonogestrel implant should remain in place?
What is the maximum duration for which an Etonogestrel implant should remain in place?
What influence does body weight have on the efficacy of the progestin-only emergency contraceptive Levonorgestrel?
What influence does body weight have on the efficacy of the progestin-only emergency contraceptive Levonorgestrel?
What is the primary use of ulipristal acetate (ellaOne)?
What is the primary use of ulipristal acetate (ellaOne)?
What type of medication is ulipristal acetate classified as?
What type of medication is ulipristal acetate classified as?
Which of the following statements best describes the role of anti-oestrogens?
Which of the following statements best describes the role of anti-oestrogens?
What is mifepristone primarily used for?
What is mifepristone primarily used for?
How long can ulipristal acetate be effective for preventing pregnancy after unprotected intercourse?
How long can ulipristal acetate be effective for preventing pregnancy after unprotected intercourse?
Which hormone is primarily combined with a progestogen in the combined oral contraceptive pill?
Which hormone is primarily combined with a progestogen in the combined oral contraceptive pill?
What is the effect of progestogen-only injectables typically used for contraception?
What is the effect of progestogen-only injectables typically used for contraception?
Which clinical application is associated with the medication Tamoxifen?
Which clinical application is associated with the medication Tamoxifen?
Flashcards
Acute Vasodilation
Acute Vasodilation
Rapid widening of blood vessels, increasing blood flow.
Therapeutic Oestrogen
Therapeutic Oestrogen
Hormonal treatments using oestrogens, natural or synthetic.
Oestrogen Clinical Uses
Oestrogen Clinical Uses
Utilized for contraception and hormone replacement therapy.
Side Effects of Oestrogen
Side Effects of Oestrogen
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Oestrogen Contraindications
Oestrogen Contraindications
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Carcinoma of the endometrium
Carcinoma of the endometrium
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Anti-oestrogens
Anti-oestrogens
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Tamoxifen
Tamoxifen
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Clomifene
Clomifene
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Progestogens
Progestogens
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Progestogen-only injectables
Progestogen-only injectables
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Medroxyprogesterone acetate
Medroxyprogesterone acetate
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Etonogestrel implant
Etonogestrel implant
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Emergency contraception mechanism
Emergency contraception mechanism
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Levonorgestrel
Levonorgestrel
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Desogestrel
Desogestrel
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Mifepristone
Mifepristone
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Contraception Methods
Contraception Methods
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Combined Pill
Combined Pill
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Combined Oral Contraceptive
Combined Oral Contraceptive
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Mechanism of Action (MOA) - Combined Pill
Mechanism of Action (MOA) - Combined Pill
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Effectiveness of Combined Pill
Effectiveness of Combined Pill
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Progestogen-only Pill (Mini-pill)
Progestogen-only Pill (Mini-pill)
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MOA - Progestogen-only Pill
MOA - Progestogen-only Pill
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Drug Interactions with OCP
Drug Interactions with OCP
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Seven Day Rule
Seven Day Rule
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Side Effects of Oral Contraceptives
Side Effects of Oral Contraceptives
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Ulipristal acetate
Ulipristal acetate
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Emergency contraception
Emergency contraception
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Progestin-only method
Progestin-only method
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Anti-progestogen
Anti-progestogen
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Progestogen-only pill
Progestogen-only pill
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Long acting progestogen
Long acting progestogen
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Natural Oestrogen Preparations
Natural Oestrogen Preparations
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Synthetic Oestrogens
Synthetic Oestrogens
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Oestrogen Side Effects
Oestrogen Side Effects
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Contraindications for Oestrogen
Contraindications for Oestrogen
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Progestins
Progestins
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Combined Contraceptive
Combined Contraceptive
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Progesterone-only Contraceptive
Progesterone-only Contraceptive
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Mechanism of Action - Oestrogens
Mechanism of Action - Oestrogens
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Adverse Effects of Oestrogens
Adverse Effects of Oestrogens
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Contraception
Contraception
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Emergency contraception time frame
Emergency contraception time frame
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High Risk Breast Cancer
High Risk Breast Cancer
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Anti-oestrogens Mechanism
Anti-oestrogens Mechanism
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Progestogens Actions
Progestogens Actions
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Clomifene Function
Clomifene Function
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Progestogen Preparations
Progestogen Preparations
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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.
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