Clinical uses of oestrogens
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Clinical uses of Oestrogens. 1. Hormone Replacement Therapy [ HRT ] For Menopause [OE alone or with a Prog] 2. Oral Contraception [OE with a Prog] 3. Dysmenorrhoea [OE with Prog - most OCs effective]

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Clinical uses of Oestrogens

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Clinical uses of oestrogens

Clinical uses of Oestrogens

1. Hormone Replacement Therapy [ HRT ] For Menopause [OE alone or with a Prog]

2. Oral Contraception [OE with a Prog]

3. Dysmenorrhoea [OE with Prog - most OCs effective]

4. Dysfunctional Uterine Bleeding [DUB][OE with a Prog -cyclically]

5. Acne[OE with a Prog - cyclically]

6. Evaluation of ovarian function [OE with a Prog - cyclically]

7. Failure Of Ovarian Development /Turner’s Syndrome [OE alone or with a Prog]

Other use

8. Prostate Carcinoma [To inhibit Gn Release ] [OE alone]


OE = Oestrogen

Prog = Progestogen

Gn = Gonadotrophin

Clinical uses of progestogens

Clinical uses of Progestogens

1 HRT / OCs / Dysmenorrhoea[With OE]

2.Endometriosis [Medroxyprogesterone 2.5 -10 mg or Norethisterone 5-10 mg / day for 6-9months.

Long acting medroxyprogesterone injection [effective for 12 wk] also used.

3.Threatened / Habitual abortion [Doubtful efficacy]

4.Evaluation of ovarian function[Used in the past]

5.Pregnancy diagnosis[Used in the past]

6.Inhibition of lactation[Bromocriptine preferred]

Hrt for menopause

HRT for Menopause

Indications:(a) To relieve:

Symptoms of hot flushes,

Atrophic vaginitis

Pruritis/Kraurosis vulvae


(b) To prevent:

Atherosclerosis [Doubtful]

Osteoporosis / Early Bone loss

Hysterectomized [Treatment may be started on any day of MC] - OE alone Continuously

Intact uterus[4 wk cycle]

[a]OE aloneFirst 14 days

OE + ProgNext 14 days

[b]OE + Prog.[Low doses] continuously

-If not menstruating Treatment may be started on any day.

-If Menstruating Treatment may be started on day 1 (or 5) of the cycle.

[OE alone increases Risk of Endometrial Carcinoma

With Prog. Risk but of Breast Carcinoma ]


OE= Oestrogen

Prog= Progestogen

MC= Menstrual cycle

-Hormones taken orally /skin patch but treatment must be started with minimum effective dose.

-Treatment given from a few months to few years.

-OE or OE+ Prog combined patch is effective for 3- 4 days.

Steroids for hrt of menopause

Steroids for HRT of Menopause



Natural Oestradiol -17ß,


Oestrone + Equilin

[Conjugated Oestrogens]



(2)Non-SteroidsDehydrostilboestrol [Dienoestrol]

Diethylstilboestrol [Stilboestrol]

Given orally / skin patch/ vaginal cream


Progestogens [ All Steroids]



(a)1st Generation*Dehydroprogesterone [Dydrogesterone]


(b) 2nd Generation**Norethisterone



*Selective but week progestogens ; week androgens

**Non-selective but potent ; moderate androgens

Hrt side effects of oestrogens progestogens

HRT- Side Effects of Oestrogens/ Progestogens

GID, Induce or enhance symptoms of Diabetes mellitus

Risk of :

-Intravascular coagulation

-Endometrial carcinoma [with OE alone]

-Breast / Liver carcinoma [with prolonged use]

-Carcinoma in children of mothers given OE in pregnancy [Breast, uterus, testis, kidney]



Undiagnosed Vaginal Bleeding

Thromboembolic disease

Severe cardiac / hepatic / renal disease

Genital tact Malignancy


History of Thromboembolism

Inherited Liver disorders [Dubin Johnson / Rotor-Syn.]


GID = Gastrointestinal disturbances- [nausea, vomiting, epigastric distress /pain]

Other agents for hrt osteoporosis

Other agents for HRT/Osteoporosis

  • Gonadomimetic agents

    (1) Tibolone

    A steroid with Prog / OE & weak androgenic activity

    GnRH Release by Stabilising Hypothalamus / Pituitary axis [Helps to reduce menopause related GnRH increase]

    SE: GID / dizziness / vaginal bleeding / rarely thromboembolism.

Other agents for hrt osteoporosis contd

Other agents for HRT / Osteoporosis [contd.]

2-Selective Oestrogen Receptor Modulator [SERM] - Raloxifene

-Selective agonist of OE receptors [ERa] [in bone tissue]

-Non-Significant effect on OE receptors in other body tissues [uterus / breast / hypothalamus]

Use Prevention and treatment of osteoporosis in Post menopausal women. [given orally ]

SEHot flushes / Leg cramps / Oedema [Not recommended in women of child bearing age]


Other OE receptors

[ERb]Ovaries, Prostate, Lungs, CNS, Blood vessels

[ERg]Various tissues: Role unknown

Methods for oral long term contraception

Methods for oral / long term contraception

(a) Oral Contraceptives

1.Combined Pill [Combination Pill / OE + Prog]

Monophasic[ same preparation for 21 days]

Diphasic[ Prog content Doubled after 1wk and maintained

Triphasic [ Prog content increased by 50-60% after 5-7 days and maintained

In some preparations OE content is also slightly varied.

2.Sequential OE1-14 days of M.C [ up to 16 days]

OE + Prog15-21 days of M.C [ up to 20days]

3.Progestogen only [Mini pill]

Low dose Prog

4.Post-coital [Vacation Pill] on day 1 of M.C & continued without break.



OE + Prog


5.Once a month combined pill [Quinesterol 3 mg + Norethynodrel 12 mg]


(b) Long Term Parenteral Contraceptives

Deep I.MMedroxyprogesterone

S.C. Implant Etonogestrel



M.C= Menstrual cycle

S.C =Subcutaneous

Other agents for menopausal osteoporosis agents preventing bone loss

Other Agents For Menopausal Osteoporosis [Agents Preventing Bone Loss]

[a] - Bisphonates[Etidronate / Clodronate / Pamidronate/ Risedronate]

Act by Oteoclast activity

SE GID / Paraesthesia

Ca++ PTH in blood

Liver function -with Clodronate

Lymphocyte Count-with Pamidronate

Flue-like symptoms-with Risedronate

[b] - Salcatonin [Synthetic Calcitonin]

Act by Bone Resorption [Counteracts PTH effect & reduces osteoclastic activity]

SE GID / Paraesthesia

[c] -Calcium salts / Vitamin D


GID = Gastrointestinal disturbances [nausea, vomiting, epigastric distress/pain]

Commonly used steroids for oral contraception

Commonly used Steroids for Oral Contraception





I Generation [Selective but week receptor action] Now mainly used for HRT]



II Generation [Non-selective but potent receptor action: Moderate androgens]




III Generation* [Non-selective but potent receptor action: week androgens]





*Risk of androgen SE reduced but of venous thromboembolism & MI are somewhat increased

Ocs possible modes of action

OCs Possible modes of action

OE + Prog Gn Release  Ovulation (99%)

Interference in Ovum / Blastocyst transport

 Implantation [Endometrium hypoplastic / out of phase]

OE alone Corpus Luteum degeneration

FSH secretion

Prog. Alone Cervical mucus hostility towards spermatozoa

 Uterine pH and  sperm motility

 Sperm Capicitation

 Ovarian endothelial cell activity.

Minor side effects of oral contraceptives

Minor Side Effects of Oral Contraceptives

(a)High OE / Low Prog

GID, Dysmenorrhoea, Menorrhagia,

Enlargement of uterus / Breast

Chloasma, Telangiectasia

Oedema, Visual disturbances

Redistribution of Fat

(b) Low OE / High Prog

Redistribution of fat

Irritability, headache, depressed mood, fatigue

Dry vagina, Moniliasis / Breakthrough bleeding

Breast tenderness,

Carbohydrate intolerance

Increased appetite / weight

Acne, oily scalp, alopecia / CHO- intolerance

Cholestatic hepatitis / Increased BP

Contraindications precautions risk factors for ocs

Contraindications / Precautions / Risk factors for OCs

Absolute contraindications


Thromboembolism, Cerebrovascular /Coronary artery Disease

Impaired liver function, Hepatic adenoma

Undiagnosed vaginal bleeding

Breast or other malignancies

Relative contraindications

Within 2 wk of pregnancy termination

Diastolic pressure >110 / vascular or migraine headaches

Cardiac or renal disease / Diabetes mellitus

Gall Bladder disease


Fibrocytic disease

Heavy smokers

Planned operation in next 6 wk / patients in leg casts

Risk of side effects increased in


>35 Yr


History of Preeclampsia



Stop pill 6 weeks prior to major surgery.

Prevention of pregnancy after missing a combined pill

Prevention Of Pregnancy After Missing A combined Pill

< 12 hrTake the missed pill immediately and further pills as normal

> 12 hrTake the most recent pill but discard other missed pills

If the number of pills [after the most recent pills] is < 7

Start the next packet without break

If the number of pills [after the most recent pills] is > 7

Start the next packet after 1 wk break


Use extra precautions for the next 7 days

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