Hormones-used for OBG.pptx

7/28/2019 Hormones-used for OBG.pptx

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Hormones-used for OBG


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Progesterone and Progestins

The actions of progesterone are as follows, majority of them

requiring concurrent or prior administration of estrogen.

Endometrial glandular epithelium: reduction in mitotic

activity, increase in glandular secretion, suppression of

estrogenic stimulation.

Endometrial stroma :increase in mitotic activity in response toestrogen, vascular tortuosity to oxytocin.

Myometrium ; reduced myometrial activity, decrease in

myometial sensitivity to oxytocin.

Cervix : decrease in glandular secreations, inhibition of ferningof cervical mucus, decrease in elasticity of mucus.

Vagina : increase in intermediate cell count, decrease in

glycogen content of epithelial cells


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Indications :

Child hood :

Medroxyprogesterone for precocious pubery

Adolescence :

Progesterone challenge test for evaluation of primary

amenorrhoea.

Primary dysmenorrhoea

Menorrhagia

Regulation of menstrual cycles : treatment between 16th and

25th days of the cycle.

Contraception : combined pill, minipill

With estrogen in estrogen deficiency state : during last 10days

of the therapy with estrogen.

Polycystic ovarian disease


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Reproductive age group :

Progesterone challenge teat for evaluation of secondary

amenorrhoea

Corpus luteum insufficiency,Irregular ripening

Dysfunctional uterine bleeding

Threatened abortion

Anovulation : pregnancy not desired Contraception : combined pills, progesterone only

contraception.

Polycystic ovarian disease

Prevention of preterm labour

Endometriosis

Endometrial hyperplasia

To achieve withdrawal bleeding prior to administration of

clomiphene citrate for induction of ovulation


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post menopausal years :

carcinoma in situ of the endometrium

endometrial hyperplasia

with estrogen to prevent endometrial hyperplasia induced byestrogen.

Metastatic or recurrent endometrial carcinoma


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Estrogens

Comparative doses of various estroges (mg)

Ethinyl estradiol 0.015

Mestranol 0.02

Conjugated estrogens 0.625 Diethylstilbesterol 0.25


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Action of estrogens :

Stimulation of endometrial glandular and stromal growth

Stimulation of myometrium Proliferation of vaginal and urethral epithelium

Increase in blood flow to the genital tract

Increase in cervical gland secretion

Stimulation of production of receptors for progesterone andLH

Increase in RNA and alkaline phosphatase content of the

endometrium.

Deposition of glycogen in vaginal mucosal cells.

Increase in height with growth and prominence of ciliated

cells as well as enlargement of secretory cells of tubal

epithelium.

Increase in sensitivity of the ovary to LH


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Indications

Childhood :

Gonococcal vulvovaginitis , if the patient is sensitive3 to

antibiotics or if the bactgieria are resistant to treatment.

Adolescence : Primary dysmenorrhoea

Menorrhagia

Contraception

Hypogonadal states : to stimulate sexual development .


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Tall stature : to stimulate epiphyseal closure. The indication is

controversial and the benefit obtained is disputed. Dose

equivalents of 2.5 to 20mg/dl conjugated estrogens havebeen used. Treatment is started at 11years of bone age, and is

discontinued after achieving a bone age of 15 to 16 years.

Long term effects of such treatment are not known.

Acne vulgaris Hirsutism

Stimulation of breast growth :success after prolonged therapy

is moderate. Steroid causes the dark pigmentations of the

nipples and areolae. Investigation of primary and secondary amenorrhoea by

estrogen challenge test.

Reproductive age group :

Contraception: as a part of combination type of contraceptive


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Dysfunctional uterine bleeding : control of active bleeding as

well as ling term management.

Dysmenorrhea Replacement therapy: hypogonadism prostogladectomy.

Regulation of irregular menstrual cycles.

Estrogen challenge test.

Estrogen provocation test : with a competenthypothalamopitutaty axis is a positive LH response on

intramuscular administration of estrogen but not in presence

of hyperprolactinemia.

Improvement of cervical mucus.

Corpus lutem insufficientcy due to follicular phase defect

Irregular shedding of the endometrium

Ovulation induction by causing LH release: not very

successful. ,Premature ovarian failure,Endometriosis


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Menopause

Menopausal syndrome

Osteoporosis

Vulvocaginitis not responding to treatment In postmenopausal patients, estrogen therapy is best

combined with progesterone during the last 10days of

treatment in each cycle,


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Gonadotropins

Indications for the use of human menopausal gonadotropins (

FSH & LH )

Induction of ovulation

Luteal phase defect

In vitro fertilization and embryo transfer

Timing ovulation for artificial insemination

Unexplained infertility

Testing ovarian function


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hCG

Indications for the use of hCG

Induction of ovulation

Corpus luteum insufficiency

In vitro fertilization and embryo transfer Undescended testes in male

Cryptorchidism in male


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AndrogensIndications :

Menopausal syndrome : when estrogens are contraindicted. Itmay be combined with estrogen for its anabolic action on

osteoporosis .

Dyspareunia due to atrophic vaginitis :

Postmenopausal frigidity Suppression of lactation

Dysfunctional uterine bleeding : action on the pituitary and

antiestrogenic effect on the endometrium control active

bleeding. Uterine leiomyoma : when surgery is not possible.

Mastodynai associated with extensive fibrocystic disease of

the breast: methyl testosterone is given in a dose of 5 to

10mg/d orally.

Hormones-used for OBG.pptx

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