What are stages of menstrual cycle? - ANS ✓o Follicular phase
o Luteal phase
o Full cycle about 28 days
What are estrogen effects on primary and secondary sex characteristics? -
ANS ✓o Influence the physiologic processes related to reproduction
o Affects the ductal growth in the breasts, the thickening and cornification of the
vaginal
epithelium, the proliferation of the uterine epithelium, and the copious secretion
of
thickened mucus form the endocervical glands
Metabolic effects of Estrogen? - ANS ✓o Positive effect on bone mass—block
bone resorption
o Favorable effects on cholesterol levels
Decrease LDL, raise HDL
o Effect on blood coagulation
Increasing the levels of the coagulation factors
o Affect glucose homeostasis
Increase insulin sensitivity and promote glucose uptake
Adverse effects of estrogen? - ANS ✓o Endometrial hyperplasia and carcinoma
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, 2
NUR
o Increase cardiovascular events, N/V, gallbladder disease, jaundice, headache
and
chloasma
Therapeutic uses of Estrogen? - ANS ✓o Menopausal hormone
o Female hypogonadism
o Acne
SERMS—Selective estrogen receptor modulators - ANS ✓o drugs that activate
estrogen receptors in some tissues and block them in others
Why were these developed? - ANS ✓Provide the benefits of estrogen
protection against vaginal atrophy
Reduction of LDL cholesterol, but avoiding the drawbacks
What is Duavee? - ANS ✓Conjugated estrogens with bazedoxifene
Combine estrogen with an estrogen agonist or antagonist
Used for treatment of vasomotor symptoms and osteoporosis in
postmenopausal women
Bazedoxifene—reduces the risk of excessive growth of the uterine lining that is
posed by the estrogen component
What are noncontraceptive uses for progesterone? - ANS ✓o
Postmenopausal hormone therapy
o Dysfunctional uterine bleeding
o Amenorrhea
o Infertility
o Prematurity prevention
o Endometrial carcinoma and hyperplasia
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, 3
NUR
When is estrogen therapy (ET) alone indicated? Estrogen/Progesterone
(EPT)? - ANS ✓o Estrogen alone—women who have had a hysterectomy
o EPT—all other women
What are benefits? Risks? - ANS ✓o Benefits
Relief of vasomotor symptoms
Management of urogenital atrophy
Prevention of osteoporosis and related fractures
Cardioprotection
Prevention of colorectal cancer
Positive effect on wound healing
Tooth retention
Glycemic control
Physiologic doses of estrogen (with or without progestin)
Taken to manage symptoms caused by loss of estrogen in menopause
Hot flashes, sleep disturbances, urogenital atrophy, bone loss, altered
lipid metabolism
Use of hormone replacement therapy (HRT) has declined sharply
o Risks
Cardiovascular events: Myocardial infarction, stroke, pulmonary embolism, and
deep vein thrombosis
Endometrial cancer
Breast cancer
Ovarian cancer
Gallbladder disease
Dementia
Urinary incontinence
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NUR
What are 3 approved indications? - ANS ✓o Treatment of moderate to severe
vasomotor symptoms associated with menopause
o Treatment of moderate to severe symptoms of vulvar and vaginal atrophy
associated
with menopause
o Prevention of postmenopausal osteoporosis
Birth Control
o What are pharmacologic and nonpharmacologic methods of birth
control? - ANS ✓Pharmacologic methods of contraception
Oral contraceptives
Etonogestrel implants
Injectable medroxyprogesterone acetate
Intrauterine devices
Vaginal rings
Transdermal patches
Nonpharmacologic methods of contraception
Surgical sterilization (tubal ligation, vasectomy)
Mechanical devices (condom, diaphragm, cervical cap)
Avoiding intercourse during periods of fertility (calendar method,
temperature method, cervical mucus method)
How should you select a method? - ANS ✓Consider effectiveness, safety,
personal preference
Oral contraceptives
o MOA—inhibit ovulation
o What are categories? Subgroups? - ANS ✓Classification (two main
categories)
Combination oral contraceptives (OCs)
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