Please click on the required question.
- 1 What might I need to know about drugs frequently used in gynaecology?
- 2 How do hormone treatments work?
- 3 In what situations may hormone treatments be indicated?
- 4 What are the sources of hormone treatments?
- 5 What determines the effect of a hormone treatment?
- 6 When are hormones used in combination?
- 7 Why do hormone treatments sometimes cause side effects?
- 8 When are oestrogens prescribed?
- 9 What are the possible side effects and risks of oestrogen therapy?
- 10 When are progestogens prescribed?
- 11 What are the possible side effects and risks of progestogen therapy?
- 12 How is the relative potency (strength) of progestogens measured?
- 13 When is danazol prescribed?
- 14 When are androgens prescribed?
- 15 What are the possible side effects of androgens?
- 16 What are gonadotrophin releasing hormone analogues and gonadotrophins?
- 17 When are GnRH analogues prescribed?
- 18 What are anti-hormones?
- 19 By which routes can drugs be given and why are they chosen?
- 20 Why do I seem to be given a medication with a different name but my doctor says it is the same as before?
- 21 I am worried about the possible side effects of a medication. What should I do?
- 22 How are new treatments developed?
- 23 What is a meta-analysis?
- 24 What is meant by the term evidence based medicine information?
- 25 What is a clinical trial?
- 26 What is a placebo?
- 27 What is meant by relative risk?
- 28 What is informed consent?
- 29 What is the current opinion of the medical profession on alternative or complementary medicine?
- 30 Support Groups.
You may be interested to learn:
- how these drugs are thought to work.
- about the possible indications (uses).
- how they may be administered (taken).
- their possible side effects and risks.
- the dose of the medication that you can take.
To answer these questions fully even for the more frequently used drugs in gynaecology would require a book dedicated to the subject. The objective of this chapter is to provide a brief explanation of some of the basic issues. It should be emphasised that when prescribing for women during their reproductive years, great care is taken to avoid medication that could have an adverse effect on a possible pregnancy.
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.
