WOMENS HEALTH.docx

[WOMENS HEALTH] - Estrogen - Uses: menopausal hormone therapy, female hypogonadism, acne, cancer palliation, gender affirmation - AE: endometrial cancer, breast cancer, CV/thromboembolic events, gallbladder di, chloasma - Contra: PE, stroke, DVT, MI, pregnant...

[WOMENS HEALTH] - Estrogen - Uses: menopausal hormone therapy, female hypogonadism, acne, cancer palliation, gender affirmation - AE: endometrial cancer, breast cancer, CV/thromboembolic events, gallbladder di, chloasma - Contra: PE, stroke, DVT, MI, pregnant women or who have vaginal bleeding w/out known cause, hx of liver disease, estrogen-dependen tumors, or breast cancer (except when indicated for management). +-----------------------------------------------------------------------+ | **Estradiol**- oral | | | | - IV emergency control of heavy uterine bleeding | | | | - Intravaginal: insert, creams, and rings | | | | - Estring for vaginal atrophy ass w/menopause | | | | - Femring hot flashes, night sweats, vaginal atrophy | | | | - Transdermal- emulsion, patches, gel, and spray | | | | - Transdermal advantages: total dose of estrogen is reduced | | (bypasses liver), less nausea and vomiting, less fluctuation | | of blood levels, lower risk for DVT, PE and stroke | +=======================================================================+ | **Selective Estrogen Receptor Modulators** | | | | Provide benefits of estrogen while avoid its drawbacks, but not all | | have total benefits/avoid drawbacks | | | | - Tamoxifen | | | | - Inhibits cell growth in breast used to prevent and tx breast | | cx | | | | - s/e: hot flashes | | | | - receptor activation inc risk for endometrial cx and | | thromboembolism | | | | - raloxifene | | | | - similar but does not cause receptor activation in endometrium | | less risk for uterine cx | | | | - otherwise same s/e. | | | | - approved ONLY for prevention/tx of osteoporosis and | | prevention of breast cx | | | | - bazedoxifene | | | | - prevention of vasomotor symp and osteoporosis in | | postmenopausal women WITH A UTERUS. | +-----------------------------------------------------------------------+ - Progesterone - Uses: hormone therapy to counteract thickening of the endometrial lining caused by estrogen, dysfunctional uterine bleeding, amenorrhea, endometrial hyperplasia and carcinoma. Support early pregnancy in women undergoing IVF, and preterm birth - AE: breast tenderness, HA, abd discomfort, arthralgias, and depression - Progestins: oral, IM, SubQ, intravaginal, intrauterine, and transdermal formulations MENOPAUSAL HT Consists of low doses of estrogen (w/ or w/out progestin) taken to compensate for the loss of estrogen that occurs during menopause. Two regimens: 1. Estrogen alone 2. Estrogen + progestin a. Estrogen in both cases is to control menopausal symptoms (vasomotor sym) b. Progestin is present for one reason counterbalance estrogen-mediated stimulation of the endometrium which can lead to hyperplasia and cancer i. Progestins SHOULD NOT be given to women who have undergone a hysterectomy - Estrogen is the most effective tx for genitourinary syndrome of menopause: dryness, irritation, and uncomfortable intercourse. Utilize topical if solely using for management of vulvar and vaginal sym - HT most effective tx for vasomotor symp. Use lowest effective dose. Vasomotor symp subside over time so the need for continue HT should be reassessed at regular intervals. - For high risk women other options are available: SSRI, SNRI, clonidine - HT reduces postmenopausal bone loss decreases risk for osteoporosis. - When HT is stopped bone mass rapidly decreases tx is lifelong BUT increases risks for harm. SO! If solely using to prevent postmenopausal osteoporosis approved nonestrogen tx should be considered. - Furthermore, HT should be considered only for women w/significant risk for osteoporosis and only when benefits outweigh risks Female sexual interest/arousal disorder (FSIAD) - Flibanserin BUT not for postmenopausal women - Bremelanotide - AE: transient rise in bp can occur lasting up to 12hr, permanent darkening of gums and portions of skin BIRTH CONTROL OCs should be avoided by women w/certain CV disorders as well as women \>35yrs who smoke - They can reduce effects of warfarin and hypoglycemic agents - Use secondary form of contraceptive when starting an antibiotic - Penicillin, amoxicillin, sulfa/trimethoprim, minocycline, metronidazole, and nitrofurantoin Two main categories for OCs 1. Estrogen + progestin (combination) a. Reduce fertility by inhibiting ovulation b. The estrogen suppresses release of FSH from the pituitary inhibits follicular maturation c. The progestin acts in the hypothalamus and pituitary to suppress the midcycle luteinizing hormone surge which normally triggers ovulation d. Estrogens employed: ethinyl estradiol, mestranol, and estradiol valerate e. Cyclic: 28 day cycle IF A DOSE IS MISSED 2. if 1 or more pills are missed in the first week, take one pill ASAP and then continue the pack. Use an additional form of contraception for 7 days 3. if 1 or more pills are missed during the second or third wk, take one pill ASAP and then continue with the active pills in the back BUT skip the placebo pills and go straight to a new pack 4. if 3 or more are missed during the second or third wk, follow the same instructions as above BUT use an additional form of contraception for 7 days. f. 5. Progestin only ("minipills") g. No estrogen do not cause thromboembolic disorders, n/ha or most other AE associated with combination OCs h. Less effective and are more likely to cause irregular bleeding i. Take the pill at the same time every day! j. Continuous EMERGENCY CONTRACEPTIVE Progestin-only pills are most widely used Plan B, Next Choice One Dose, and Next Choice. All contain levonorgestrel Take w/in 72s of unprotected sex Mifepristone- a synthetic steroid that blocks receptors for progesterone and glucocorticoids. One approved indication: termination of early intrauterine pregnancy