Female reproduction- pharm

• - suppressing ovulation- main mechanism
• -thickening the cervical mucus, preventing sperm from getting through
• - changing the lining of the uterus, making implantation of a fertilized egg less likely
• -reducing sperm access to the fallopian tubes, where eggs are fertilized

• - Prevent the LH surge needed for release of  the ovum·        
•                Prior to ovulation, there is a big LH surge. Progestins prevent that from happening
• -Thicken cervical mucus, hindering sperm entry into the uterus
• - Decrease tubal motility,  impeding sperm transit through fallopian tubes
• -Thin the endometrium, reducing implantation probability

• -Stabilize the endometrium, minimizing irregular bleeding                
• - Inhibit the release of FSH, preventing the development of the dominant follicle
• -Potentiate progestin’s inhibition of the LH surge

Block LH and FSH to inhibit ovulation

produced by gonadotroph cells in the anterior pituitary gland. Acute rise of LH triggersovulation & dev of the corpus luteum

temporary endocrine structure in XX mammals that is involved in the production of relatively high levels of progesterone & moderate levels of estradiol and inhibin A

regulates dev, growth, pubertal maturation, & reproductive processes of the body. Acts synergistically in reproduction c/ LH.

to prevent preg

• -less acne
• -less menstrual flow and cramping
• -less iron deficiency anemia that results from heavy menses
• -fewer premenstrual symptoms, as well as related headaches and depression
• -May help peri-menopausal women to smooth the transition

ethinyl estradiol

35 mcg

if women had spotting and needed more cycle control, if enzyme induced

Norethindrone

Desogestrel, levonorgestrel, & norgestrel

• Desogestrel & norgestimate
• least likely to cause acne & hirtusim

• Norgesterel
• increased libido

Norethindrone & ethynodiol

Drospirenone

Potassium, for hyperkalemia

• -20–50 mcg ethinyl estradiol
•         —newer formulations rarely contain >35 mcg
• -0.1–1.5 mg progestin

• - As progestin only 
• -As a combination of estrogen and progestin (Most preparations are a combination of an estrogen plus a progestin)
• -And in many options:  a vaginal ring, a patch, IM, an IUD, a subdermal rod, and a large variety of oral choices

20 mcg

Start c/ 10 mcg if you are worried about SE

• Tweak the dose
• Increase the estrogen if the XX is taking less than 30 mcg, or change progestin if she on 30 mcg or higher

• migraines c/ aura (consider progestin only)
• smoker

Nausea, breast tenderness, increased blood pressure, melisma (darkening of the skin), headache

 Early or mid-cycle breakthrough bleeding, increased spotting, hypomenorrhea

Breast tenderness, headache, fatigue, changes in mood

Late breakthrough bleeding

Increased appetite, weight gain, acne, oily skin, hirsutism, increased LDL cholesterol, decreased HDL cholesterol

• hormone levels remain constant
• ortho-Novum
• Demfun
• Lo-ovral
• ortho-cyclen
• Loestrin
• Alesse
• Ortho-cept

• Its a change of one hormone level of either estrogen or progestin
• one will change and one stays the same
• Ortho-Novum

• 3 diff doses of hormones changing q 5-10 days in 1st 3 weeks
• Ortho-Novum
• Ortho-Tricyclen
• Ortho-Tricyclen lo
• Tri-Norinyl

• 4 diff doses of hormones changing thru out 28 day cycle
• Natazia

Natazia

heavy menstrual bleeding

• 4 estrogen-only tabs plus 2 inert tabs.
• Idea behind it was decreased breakthrough bleeding.
• But they don’t really know what causes this

• Prostaglandin levels are higher in women who have heavy bleeding.
• NSAIDs block the prostaglandins    
• Go to a contraceptive if an NSAID isn't enough for bleeding. 

• Progestin only
• Mirena (levonorgestrelIUD) 

50%

Natazia