Estrogens and Progestins
Which patient may be given progestin therapy during pregnancy? A. A woman who is 8 weeks pregnant and diagnosed with corpus luteum deficiency syndrome B. A woman pregnant with triplets during her first pregnancy C. A woman experiencing severe nausea and vomiting during pregnancy D. A woman who is trying to achieve pregnancy through planned intercourse
A. A woman who is 8 weeks pregnant and diagnosed with corpus luteum deficiency syndrome Progestins are used to support an early pregnancy in women with corpus luteum deficiency syndrome and in women undergoing in vitro fertilization (IVF). Progestin therapy is also used for prematurity prevention. One progestin—hydroxyprogesterone acetate [Makena]—is approved for preventing preterm birth in women with a singleton pregnancy and a history of preterm delivery. It is not used for nausea or for pregnancy achievement through planned intercourse.
Progestins may be used to treat which conditions? (Select all that apply.) A. Endometrial hyperplasia B. Dysfunctional uterine bleeding C. Endometriosis D. Breast cancer E. Amenorrhea
A. Endometrial hyperplasia B. Dysfunctional uterine bleeding C. Endometriosis E. Amenorrhea Progestins are used for contraception (see Chapter 62) and to counteract endometrial hyperplasia that could be caused by unopposed estrogen during HT. Other uses include dysfunctional uterine bleeding, amenorrhea, endometriosis, and support of pregnancy in women with corpus luteum deficiency. Progestins are contraindicated in carcinoma of the breast.
Which beneficial metabolic effects does estrogen have in nonreproductive tissues? (Select all that apply.) A. It promotes and suppresses coagulation. B. It improves glomerular filtration rates. C. It reduces low-density lipoproteins (LDLs). D. It suppresses bone resorption. E. It reduces fat deposits in the liver.
A. It promotes and suppresses coagulation C. It reduces low-density lipoproteins (LDLs). D. It suppresses bone resorption. Estrogens have a positive effect on bone mass, blocking bone resorption. It also has favorable effects on cholesterol levels in that LDL levels are reduced, and the levels of high-density lipoprotein (HDL) are elevated. Estrogens promote coagulation by increasing factors II, VII, and others; they also suppress coagulation, increasing the activity of factors that promote the breakdown of fibrin. Estrogens do not improve the glomerular filtration rate or reduce fatty deposits in the liver.
The Women's Health Initiative (WHI) landmark trial data led to which recommendations about hormone replacement therapy? (Select all that apply.) A. There are benefits to using HRT short term to reduce vasomotor symptoms. B. Postmenopausal women should avoid smoking, exercise regularly, and control hypertension. C. Estrogen/progestin therapy (EPT) is preferred as the primary treatment to prevent loss of bone mass. D. Estrogen and progesterone should be used only to prevent cardiovascular events. E. Treatment with HRT for longer than 5 years increases the risk for pulmonary embolus and stroke.
A. There are benefits to using HRT short term to reduce vasomotor symptoms. B. Postmenopausal women should avoid smoking, exercise regularly, and control hypertension. E. Treatment with HRT for longer than 5 years increases the risk for pulmonary embolus and stroke. The WHI trial has yielded the most current, statistically valid data on the benefits and risks of HRT. The use of HRT short term to reduce vasomotor symptoms generally outweighs the risks if the dose is kept low for the shortest time needed. HRT should not be used to prevent cardiovascular disease; postmenopausal women should avoid smoking, perform regular exercise, and manage hypertension and diabetes with medications as needed. There are preferred alternative therapies to HRT to preserve bone mass. The major risks of HRT taken for longer than 5 years are myocardial infarction, dementia, stroke, deep vein thrombosis, and breast cancer.
Selective Estrogen Receptor Modulators (SERMs)
Activate in some tissues and.block estrogen receptors selectively in others Developed to provide benefit of estrogen while avoiding the drawbacks Four available (classified as hazardous drugs, so you want to wear gloves) 1. Tamoxifen 2. Raloxifene 3. Toremifene 4. Bazedoxifene Tamoxifen Uses: Breast cancer treatment and prevention (it can inhibit cell growth in breast) Protects against osteoporosis BBW: -Serious life-threatening events -Risk for endometrial cancer and thromboembolism Raloxifene -Different from tamoxifen because it DOES not activate estrogen receptors in endometrium (thus not posing risk for uterine cancer) Uses: -Post menopause osteoporosis treatment and prevention -Breast cancer prevention BBW: Venous thromboembolism (VTE) & Fatal Stroke Risk
A nurse is teaching a postmenopausal patient taking estrogen/progestin therapy (EPT) about breast self-examination (BSE). Which of these instructions should the nurse give? A. "There are no risks for breast cancer, so BSE is not necessary." B. "Do your breast self-examination the first day of each month." C. "Examine your breasts by looking at them in the mirror." D. "Feel each breast while lying on the opposite side."
B. "Do your breast self-examination the first day of each month." All women should perform regular breast self-examinations, preferably 1 week after the menstrual cycle ends. It is especially important for postmenopausal women taking a progestin combined with an estrogen, because this treatment is associated with an increased risk of breast cancer. Recent data suggest that estrogen alone does not increase the risk of breast cancer. For postmenopausal women without monthly cycles, the breasts should be examined once a month on the same day; the first day of the month is suggested.
The nurse is providing teaching regarding Duavee (conjugated estrogens/bazedoxifene). Which statement by the patient indicates that the teaching was effective? A. "I know I am at an additional risk for increased growth of my uterus lining." B. "I understand that the combination product should help protect me from the side effects of the estrogen." C. "I will have to set an alarm to take my medication four times per day." D. "I am prepared to take this medication for the rest of my life."
B. "I understand that the combination product should help protect me from the side effects of the estrogen." Duavee is the first drug to combine estrogen with an estrogen agonist/antagonist (bazedoxifene). The bazedoxifene component of Duavee reduces the risk of excessive growth of the lining of the uterus that can occur with the estrogen component. The dose is one tablet orally twice daily for the prevention of vasomotor symptoms and osteoporosis in postmenopausal women with a uterus. Contraindications to taking Duavee are the same as for other estrogen-containing products, and as with other products, this drug should be used for the shortest duration possible.
Which therapeutic effect is the purpose of a progestin medication in menopausal hormone therapy (HT)? A. To reduce urogenital atrophy B. To suppress endometrial proliferation C. To relieve vasomotor symptoms D. To prevent adverse cardiac events
B. To suppress endometrial proliferation Progestin is prescribed in HT to provide a counterbalance to estrogen-mediated stimulation of the endometrium, which can lead to endometrial hyperplasia and cancer. However, it is omitted in women who do not have a uterus. Progestins appear to increase the risk of adverse cardiac events. Estrogens relieve the vasomotor symptoms of menopause and prevent urogenital atrophy (manifesting as vaginal dryness and itching).
During the follicular phase of the menstrual cycle, estrogen has which effects on the female reproductive organs? A. Maturation of a corpus luteum B. Ripening of an ovarian follicle C. Proliferation of the endometrium D. Monthly menstrual bleeding
C. Proliferation of the endometrium During the first half of the menstrual cycle, called the follicular phase, estrogen released from maturing ovarian follicles causes the endometrial lining to proliferate. Follicle-stimulating hormone (FSH) acts on the developing ovarian follicles, causing them to ripen and release estrogens in the first half of the cycle. Luteinizing hormone (LH) levels rise at midcycle, causing rupture of the follicle, which evolves into a corpus luteum. At the end of the cycle, without fertilization, the corpus luteum atrophies, leading to menstrual bleeding as the endometrial lining is shed.
What is the primary difference between the selective estrogen receptor modulators tamoxifen and raloxifene? A. Raloxifene does not protect against breast cancer. B. Raloxifene does not produce hot flashes. C. Raloxifene does not increase the risk for uterine cancer. D. Raloxifene does not increase the risk for thromboembolism.
C. Raloxifene does not increase the risk for uterine cancer. Raloxifene is very similar to tamoxifen. The principal difference is that raloxifene does not activate estrogen receptors in the endometrium and hence does not pose a risk of uterine cancer. Like tamoxifen, raloxifene protects against breast cancer and osteoporosis, promotes thromboembolism, and induces hot flushes. Raloxifene is approved only for prevention and treatment of osteoporosis, and for prevention of breast cancer in high-risk women.
A patient takes fluoxetine [Prozac] for premenstrual disorder (PMD). Which priority assessment allows the nurse to evaluate the effectiveness of this treatment? A. Decreased craving for carbohydrates B. Reduction in breast tenderness C. Less abdominal bloating D. Reports of mood improvement
D. Reports of mood improvement Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are considered first-line therapy for the psychologic symptoms of PMD. They are most effective for reducing the affective symptoms (mood improvement) of PMD; however, they also can reduce physical symptoms, such as breast tenderness, bloating, and headaches.
Estrogens and Progestins
Hormones with multiple actions -Promote female maturation -Regulate ongoing activity of female reproductive organs -Affect bone mineralization and lipid metabolism Principal estrogen = estradiol Principal progestin = progesterone
Menopausal Hormone Therapy
Low doses of estrogen with or without progesterone taken to compensate for low levels of estrogen Approved indications: 1. Treatment of moderate to severe vasomotor symptoms associated with menopause 2. Treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause 3. Prevention of postmenopausal osteoporosis
Estrogens
Physiologic actions -Female reproductive tract and secondary sex characteristics -Physiologic processes related to reproduction Metabolic actions -Positive effect on bone mass -Favorable effects on cholesterol levels -Blood coagulation (alter levels by increasing or decreasing levels of coagulation factors in blood) Adverse effects -Endometrial hyperplasia and carcinoma (cells are growing rapidly) -Promotes growth of existing breast cancer -Ovarian cancer -Cardiovascular events -Nausea Therapeutic uses -Menopausal HRT -Female hypogonadism (used to promote puberty) -Acne Administration routes -Oral -Transdermal -Intravaginal -Parenteral
Progesterone
Produced by ovaries and placenta Adverse effects -Teratogenic effects -Gynecologic effects -Breast cancer -Depression -Breast tenderness -Bloating Therapeutic uses -Postmenopausal HRT -Dysfunctional uterine bleeding -Amenorrhea (absence of menstruation) -Infertility -Prematurity prevention -Endometrial carcinoma and hyperplasia
