Used for hypogonadism/ovarian fail, menstrual abnormalities, men w/androgen-dependent prostate cancer (just like you use testosterone for women w/estrogen-receptor-pos breast cancer!). SE's: endometrial cancer, post-menopausal bleeding, clear cell adenocarcinoma of vagina in female fetuses exposed to DES, inc'd thrombus risk, ER-positive breast cancer.
OC's, treat endometrial cancer/abnormal bleeding
Estrogen partial agonists. Clomiphene = opposite of OC's: inc'd release of FSH & LH from pituitary. Tx: polycystic ovarian syndrome (b/c that condition has high LH, but not FSH, so hirsutism -- you aren't making any estrogen, too much testosterone!). SE's: hot flashes, visual disturbances, multiple simultaneous pregnancies, enlarged ovaries.
5-alpha reductase inhibitor --> dec'd DHT. Used for male-pattern baldness & BPH.
Testosterone receptor antagonist (competitive). Tx of prostate cancer -- could also give estrogen for androgen-dependent prostate cancer.
SERM -- antagonizes ER's on breast tissue (for ER-pos breast cancer)
Ketoconazole & spironolactone
Ketoconazole inhibits steroid synthesis (i.e. inhibits CYP450 making testosterone & androstenedione). Spironolactone inhibits steroid binding to its receptor, including aldosterone. Used for polycystic ovarian syndrome, so the woman doesn't develop hirsutism (her high LH but lack of FSH is causing her to pump out lots of testosterone). SE's: gynecomastia, amenorrhea.
SERM -- agonist on bone's ER's --> dec'd resorption, to treat osteoporosis. (Because estrogen is good for bone.)
Pulses: GnRH agonist (to treat infertility). Constant: GnRH antagonist (prostate cancer). Also used for uterine fibroids. SE's: nausea, vom, anti-androgen.
Fill the penis (inc cGMP --> vasodilation). Used for ED. SE's: life-threatening hypotension if taken w/nitrates; impaired blue-green color vision; HA.
Abortion drug -- competitively inhibits progestins. SE's: GI (nausea, vom, anorexia), heavy bleeding & pain.
Dec risk of endometrial & ovarian cancer, plus pelvic infections. Bad: Inc triglycerides, HTN, hypercoagulability, depression, weight gain, nausea. Histo: endometrium stroma is decidualized, but glands are inactive.
Inhibit premature labor contractions: B2 agonists that relax uterus.
Aromatase inhibitors: for post-menopausal women w/breast cancer (you don't need any more estrogen!)
Obv, it's an agonist at androgen receptors. Used for hypogonadism, stimulation of anabolism (rebuilding) after burn/injury; tx of estrogen-receptor-positive breast cancer. SE's: masculinization in females, gonadal atrophy in males (b/c Leydig cells inhibited). Inc'd LDL & dec'd HDL.
Aggressive, only 40% 5-year survival. Higher incidence in blacks just like leiomyoma (benign fibroids), but 1 doesn't progress into the other.
GYN tumors: most common & most deadly
Common = endometrial; deadly = ovarian.
Chlamydia: the bacterial stains that work
It's intracellular, so no Gram stain. Use Giemsa, iodine, or fluorescent Ab's.
Placenta invades myometrium, so lots of bleeding after delivery. Previous C-section predisposes.