The action of one hormone treatment may be altered by that of another:

  • A course of progestogen will not result in a withdrawal bleed in a patient with amenorrhoea and low oestrogen levels after the menopause. The same woman, however, would have a positive result if she were given oestrogen before the progestogen.

A drug may act by blocking a receptor.

  • clomifene (clomiphene citrate) blocks the oestrogen feedback mechanism. Gonadotrophin releasing hormone agonists may initially have a positive action with a temporary increased output of the gonadotrophins FSH and LH (flare response) from the pituitary. They then block the receptor sites suppressing FSH and LH levels (down-regulation); this action is used in IVF regimens (24), as one possible treatment of endometriosis (endometriosis) and as pre-surgical preparation for removing fibroids (17).

Some drugs have actions on different receptor sites and these combined actions can be utilised therapeutically.

  • Tibolone (Livial) activates both oestrogen and progesterone receptors so that it has the benefits of providing hormone replacement therapy whilst conferring endometrial protection. It may also have some beneficial androgenic activity.
  • Tamoxifen has anti-oestrogenic activity, which enhances the treatment of patients with breast cancer. Its anti-oestrogenic action is also used in the treatment of anovulatory infertility (tamoxifen infertility). Tamoxifen also has some oestrogenic activity so that it may relieve some menopausal symptoms. Its oestrogenic activity may adversely affect the endometrium (uterine lining) leading to hyperplasia (thickening) and rarely malignancy.


women's health



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