1 / 16

D- CONTRACEPTIVE AND PRO-FERTILITY AGENTS

D- CONTRACEPTIVE AND PRO-FERTILITY AGENTS. 1. Oral Contraceptives. Combined – contain both estrogenic and progestogenic agents Monophasic Multiphasic Biphasic Triphasic Continuous use of progestin only “minipill” – Progesterone only New Generation

sahara
Download Presentation

D- CONTRACEPTIVE AND PRO-FERTILITY AGENTS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. D-CONTRACEPTIVE AND PRO-FERTILITY AGENTS 1

  2. Oral Contraceptives Combined – contain both estrogenic and progestogenic agents • Monophasic • Multiphasic • Biphasic • Triphasic Continuous use of progestin only “minipill” – Progesterone only New Generation • Yasmin – oral - new progestin component • Ortho Evra – transdermal • Etonogestrel - implantable • Nuvaring – hormone-releasing vaginal ring 2

  3. Oral and Implantable Contraceptive Agents 3

  4. Oral and Implantable Contraceptive Agents 4

  5. Benefits of Oral Contraceptives • Reduction of Pregnancies • Reductions of menstrual disorders • Reduction of premenopausal/menopausal symptoms • Reduction of reproductive organ neoplasms • Reduction of reproductive disorders (Pelvic Inflammatory Disease & endometriosis • Reduced incidence of ectopic pregnancies • Other: reduction of acne, anemia, ulcers, rheumatoid arthritis 5

  6. Pharmacologic effect of Contraceptive Agents 6

  7. Severe Adverse Effects 7

  8. Contraindications Relative Contraindications • Migraine • Hypertension • Varicose veins • Cardiac/renal dysfunction • Diabetes w/o insulin • Hepatitis • Hypercholesterolemia • Clotting disorders • Known cancer • Hepatic disorders • Diabetes - insulin • Pregnancy • Age older than 35 years and smoker 8

  9. Postcoital Contraceptives 9

  10. Pro-fertility agents:Estrogen Inhibitors and Antagonists • tamoxifen, a competitive partial agonist inhibitor of estradiol at the estrogen receptor, • is used in the palliative treatment of breast cancer in postmenopausal women and for chemoprevention of breast cancer in high-risk women; • may increase the risk of endometrial cancer • raloxifene ,estrogen agonist-antagonist, is approved for the prevention of postmenopausal osteoporosis and prophylaxis of breast cancer in women with risk factors. • clomiphene, partial agonist, is used as an ovulation-inducing agent cyclophenanthrene structure triphenylethylene structure benzothiophene structure triphenylethylene structure 10

  11. Multiple Outcomes of Raloxifene Evaluation (MORE) Double Blind Placebo-Controlled Trial 7705 PMP women aged 31 to 80 Raloxifene 60 mg/d or 120 mg/d or placebo Follow-up for 36 months for efficacy and 40 months for adverse events Increased bone mineral density (BMD) in femoral neck by 2.1% (60 mg) and by 2.4% (120 mg) Increased BMD in spine by 2.6% (60 mg) and by 2.7% (120 mg) Increased risk of venous thromboembolism Conclusions: Raloxifene increases BMD in spine and femoral neck and reduces risk of vertebral fracture – but increases risk of venous thromboembolism 11

  12. Clomiphene • Clomiphene is used in the treatment of ovulation disorders in patients who wish to become pregnant. It stimulates ovulation in 70% of women. The compound is of no value in patients with ovarian or pituitary failure. • Clomiphene is also used in men to stimulate gonadotropin release and enhance spermatogenesis • Clomiphene increases the amplitude of LH and FSH pulses, without a change in pulse frequency, acting largely at the pituitary level to block inhibitory actions of estrofene on gonadotropin release from the gland • Adverse Effects • hot flushes, occasionally, headache, constipation, allergic skin reactions, and reversible hair loss have been reported • multiple pregnancy is approximately 10%. • Contraindications • special precautions should be observed in patients with enlarged ovaries. • treatment with clomiphene for more than a year may be associated with an increased risk of low-grade ovarian cancer 12

  13. Selective Estrogen Receptor Modulators (SERMs) 13

  14. Other Therapies for Induction of Ovulation • Gonadotropins: • Follicle-stimulating hormone analog: follitropin-α • Human chorionic gonadotropin (hCG) • Synthetic GnRH Agonists • Gonadorelin (short-acting GnRH) 14

  15. Side effects of synthetic fertility drugs • headache • flushing • abdominal discomfort • hot flashes, osteoporosis • vaginal dryness • altered lipid metabolism • multiple births • emotional lability • acne • weight gain • hirsituism 15

  16. Progesterone Inhibitors and Antagonists • Mifepristone, a "19-norsteroid“, that binds strongly to the progesterone receptor and inhibits the activity of progesterone • is used as postcoital contraceptive • limited clinical studies suggest that mifepristone may be useful in the treatment of endometriosis, Cushing's syndrome, breast cancer • Danazol, an isoxazole derivative of ethisterone (17 -ethinyltestosterone) with weak progestational, androgenic, and glucocorticoid activities • binds to androgen, progesterone, and glucocorticoid receptors, and to sex hormone-binding and corticosteroid-binding globulins • is use in the treatment of endometriosis; it can be given in a dosage of 600 mg/d. The dosage is reduced to 400 mg/d after 1 month and to 200 mg/d in 2 months. About 85% of patients show marked improvement in 3–12 months. • is used in the treatment of fibrocystic disease of the breast and hematologic or allergic disorders 16

More Related