Womens Health Drugs

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Female Reproductive Functions

Female sex steroid hormones

Estrogens
Progestins

Pituitary gonadotropin hormones

Follicle stimulating hormone (FSH)

Luteinizing hormone (LH)

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Female Reproductive
Functions (contd)

Female sex steroid hormones and pituitary

gonadotropin hormones promote:

Development of primary and secondary sex

characteristics
Start of menses and regulation of menstrual cycle

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Estrogens

Three major endogenous estrogens

Estradiol (principal and most active)

Estrone
Estriol

Synthesized from cholesterol in ovarian

follicles
Basic chemical structure of a steroid

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Exogenous Estrogenic Drugs

Synthetic

Steroidal

Conjugated estrogens, estradiol transdermal,

many others

Nonsteroidal

Diethylstilbestrol
No longer available in the United States

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Estrogens
Responsible for :
Development and maintenance of the female
reproductive system
Development of female secondary sex
characteristics

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Estrogens: Indications

Treatment or prevention of disorders that

result from estrogen deficiency

Atrophic vaginitis
Hypogonadism
Oral contraception (given with a progestin)
Dysmenorrhea
Hot flashes of menopause

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Estrogens: Indications (contd)

Treatment or prevention of disorders that

result from estrogen deficiency (contd)

Uterine bleeding
Palliative treatment of advanced breast and
prostate cancer
Osteoporosis treatment and prophylaxis
Many other indications

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Estrogens: Contraindications

Any estrogen-dependent cancer

Undiagnosed abnormal vaginal bleeding
Pregnancy
Active thromboembolic disorder or history

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Estrogens: Adverse Effects

Thrombolytic eventsmost serious

Nauseamost common
Hypertension, thrombophlebitis, edema
Vomiting, diarrhea, constipation, abdominal
pain
May cause photosensitivity, chloasma

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Estrogens:
Adverse Effects (contd)

Amenorrhea, breakthrough uterine bleeding

Tender breasts, fluid retention, headaches
Others

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Estrogens and HRT

Currently there is controversy about whether

or not hormone replacement therapy (HRT) is
safe
Ongoing studies

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Progestins

Synthetic derivatives of progesterone

hydroxyprogesterone (Hylutin)
medroxyprogesterone (Provera)
megestrol (Megace)
etonogestrel implant (Implanon)
Many others

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Progestins: Indications

Treatment of functional uterine bleeding

caused by:

Hormonal imbalance, fibroids, or uterine cancer

Treatment of primary and secondary

amenorrhea

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Progestins: Indications (contd)

Palliative treatment of some cancers and

endometriosis
Prevention of threatened miscarriage
Alleviation of PMS symptoms

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Progestins: Indications (contd)

megestrol (Megace)

Adjunct therapy for treatment of breast and

endometrial cancers
Management of anorexia, cachexia, or
unexplained weight loss in AIDS patients
To stimulate appetite and promote weight gain in
cancer patients

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Progestins: Adverse Effects

Liver dysfunctioncholestatic jaundice

Thrombophlebitis, thromboembolic disorders
Nausea, vomiting
Amenorrhea, breakthrough uterine bleeding,
spotting
Edema, weight gain or loss
Others

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Contraceptive Drugs

Medications used to prevent pregnancy

Oral medications

Monophasic, biphasic, and triphasic forms

Triphasic form most closely duplicates the normal
hormonal levels of the female cycle

Newer extended cycle products

Most contain estrogen-progestin combinations

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Contraceptive Drugs (contd)

Other contraceptive forms available

Long-acting injectable form of

medroxyprogesterone (Depo-Provera)
Transdermal contraceptive patch
Intravaginal contraceptive ring

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Contraceptive Drugs:
Mechanism of Action

Prevent ovulation by inhibiting the release of

gonadotropins and increasing uterine mucous
viscosity, resulting in:

Decreased sperm movement and fertilization of

the ovum
Possible inhibition of implantation of a fertilized
egg (zygote)

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20

Contraceptive Drugs:
Other Drug Effects

Improve menstrual cycle regularity

Decrease blood loss during menstruation
Decrease incidence of functional ovarian
cysts and ectopic pregnancies

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Contraceptive Drugs: Indications

Primarily used to prevent pregnancy

Other uses:

Treatment of endometriosis and hypermenorrhea

Production of cyclic withdrawal bleeding
Postcoital emergency contraception

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Contraceptive Drugs:
Adverse Effects

Drawbacks to the use of these drugs include:

Hypertension
Thromboembolism, possible PE, MI, stroke
Alterations in lipid and carbohydrate metabolism
Increases in serum hormone concentrations

These effects are caused by the estrogen

component

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Contraceptive Drugs:
Adverse Effects (contd)

May also cause:

Edema, dizziness, headache, depression, nausea,

vomiting, diarrhea, increased appetite, increased
weight, breast changes, many others

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Contraceptive Drugs:
Interactions

Drugs that decrease effectiveness of oral

contraceptive drugs

Antibiotics, barbiturates, isoniazid, rifampin

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Contraceptive Drugs:
Interactions (contd)

Drugs that may have reduced effectiveness if

given with oral contraceptive drugs

Anticonvulsants, beta-blockers, hypoglycemic

drugs, oral anticoagulants, theophylline, TCAs,
vitamins, hypnotics

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Osteoporosis

Low bone mass

Increased risk of fractures
Primarily affects women
20% with this condition are men

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Osteoporosis: Risk Factors

Caucasian/Asian
descent
Slender body build
Early estrogen
deficiency
Smoking
Alcohol consumption

Low-calcium diet
Sedentary lifestyle
Family history

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Drug Therapy for Osteoporosis

Calcium supplements and vitamin D may be

recommended for women at high risk for
osteoporosis

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Drug Therapy for

Osteoporosis (contd)

Bisphosphonates

Selective estrogen receptor modifier (SERM)

alendronate (Fosamax), ibandronate (Boniva),

risedronate (Actonel), zoledronic acid (Reclast)
raloxifene (Evista)

Hormone

calcitonin
teriparatide (Forteo)

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Drug Therapy for

Osteoporosis (contd)

Bisphosphonates

Work by inhibiting osteoclast-mediated bone

resorption, thus preventing bone loss

SERMs

Stimulate estrogen receptors on bone and

increase bone density

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Drug Therapy for

Osteoporosis (contd)

calcitonin (Calcimar)

Directly inhibits osteoclastic bone resorption

teriparatide (Forteo)

Only drug that stimulates bone formation

Derivative of parathyroid hormone
Action similar to natural parathyroid hormone

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Drug Therapy for Osteoporosis:

Indications

Bisphosphonates

Both prevention and treatment of osteoporosis

Bisphosphonates also used for glucocorticoidinduced osteoporosis and Pagets disease

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Drug Therapy for Osteoporosis:

Indications (contd)

calcitonin (Calcimar)

raloxifene (Evista)

Treatment of osteoporosis
Nasal spray (Miacalcin) most commonly used
Prevention of postmenopausal osteoporosis

teriparatide (Forteo)

Treatment for those with highest risk of fracture

(prior history of fractures)

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Drug Therapy for Osteoporosis:

Adverse Effects

SERMs

Hot flashes, leg cramps

Increased risk of venous thromboembolism
Contraindicated if patient is near age of menopause
because of possible hot flashes
Leukopenia

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Drug Therapy for Osteoporosis

Adverse Effects (contd)

Bisphosphonates

Headache, GI upset, joint pain

Risk of esophageal burns if medication lodges in
esophagus before reaching the stomach
Risk of osteonecrosis of the jaw

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Fertility Drugs

Various medical techniques used to treat

infertility

Includes in vitro fertilization and medication

therapy (ovulation stimulation)

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Fertility Drugs (contd)

clomiphene (Clomid, others)

Nonsteroidal ovulation stimulant

Blocks estrogen receptors in the uterus and
brain, resulting in a false signal of low estrogen
levels

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Fertility Drugs (contd)

clomiphene (Clomid, others) (contd)

Increases production of Gn-RH, FSH, and LH

As a result, maturation of ovarian follicles is
stimulated, leading to ovulation and increased
chance of conception

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Fertility Drugs (contd)

mentropins (Pergonal)

Standardized mixture of FSH and LH

Stimulates development of ovarian follicles,
leading to ovulation
May also be given to men to stimulate
spermatogenesis

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Fertility Drugs (contd)

chorionic gonadotropin alfa (Ovidrel)

Recombinant form of human chorionic

gonadotropin
Causes rupture and ovulation of mature ovarian
follicles, and maintenance of corpus luteum
Used to stimulate ovulation

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Fertility Drugs: Indications

Used primarily to induce ovulation in

anovulatory patients
Also may be used to promote
spermatogenesis in infertile men

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Fertility Drugs: Adverse Effects

Tachycardia, phlebitis
Dizziness, headache, flushing, depression,
anxiety, nervousness, fatigue
Nausea, bloating, constipation, others
Ovarian hyperstimulation, multiple
pregnancies, blurred vision, breast pain,
others

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Uterine-Active Medications

Medications used to alter uterine contractions

Used to:

Promote labor
Prevent the start or progression of labor
Postpartum use: reduce the risk of postpartum
hemorrhage

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Uterine Stimulants

Also called oxytocics

Oxytocin (hormonal drug)

Prostaglandins
Ergot derivatives
Progesterone antagonist

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Uterine Stimulants (contd)

Oxytocin (Pitocin)synthetic form

Used to induce labor at or near full-term gestation,

and to enhance labor when contractions are weak
and ineffective

Other uses

Prevent or control postpartum uterine bleeding

Complete an incomplete abortion (after miscarriage)
Promote milk ejection during lactation

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Uterine Stimulants (contd)

Prostaglandins

Natural hormones
Cause potent contraction of myometrium, smooth
muscle fibers of the uterus
Used to induce labor by softening the cervix and
enhancing uterine muscle tone
dinoprostone (Prostin E2) and misoprostol
(Cytotec)

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Uterine Stimulants (contd)

Ergot alkaloids

Increase force and frequency of uterine

contractions
Used after delivery of the infant and placenta to
prevent postpartum uterine atony and hemorrhage
methylergonovine (Methergine)

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Uterine Stimulants (contd)

Progesterone antagonist

mifepristone (Mifeprex)
Stimulates uterine contractions to induce abortion
Given with a prostaglandin drug for elective
abortions

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Uterine Stimulants:
Adverse Effects

Hypotension or hypertension, chest pain

Headache, dizziness, fainting
Nausea, vomiting, diarrhea
Vaginal pain, cramping
Leg cramps, joint swelling, chills, fever,
weakness, blurred vision

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Uterine Relaxants:
Tocolytics

Used to stop labor that begins before term to

prevent premature birth
Generally used after the 20th week of
gestation

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Uterine Relaxants:
Tocolytics (contd)

Uterine contractions that occur between the

20th and 37th weeks of gestation are
considered premature labor
Nonpharmacologic measures

Bed rest, sedation, hydration

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Uterine Relaxants

terbutaline (Brethine)

Beta-adrenergic drug
Stimulation of beta2-adrenergic receptors on the
uterine smooth muscle
Results in relaxation of the uterus, thus stopping
premature contractions
Off-label use

Magnesium sulfate IV also used to stop labor

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Uterine Relaxants:
Adverse Effects

Palpitations, tachycardia, hypertension,

others
Tremors, anxiety, insomnia, headache,
dizziness, others
Nausea, vomiting, anorexia, bloating,
diarrhea, constipation
Hyperglycemia, hypokalemia
Dyspnea, hyperventilation, others

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Herbal Products: Soy

Relief of menopausal symptoms,

osteoporosis prevention
Estrasorb, applied as a lotion
Adverse Effects

Nausea
Diarrhea
Abdominal pain
Estrasorb remains on skin for 8 hours

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Nursing Implications

Assess baseline vital signs, weight, blood

glucose levels, renal and liver function
studies
Assess whether the patient smokes
Assess history and medication history
Assess contraindications, including potential
pregnancy

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Nursing Implications (contd)

Before giving any uterine stimulants, assess

the mothers vital signs and fetal heart rate
Uterine relaxants are used when premature
labor occurs between the 20th and 37th
weeks of gestation

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Nursing Implications (contd)

For bisphosphonates, ensure that patients

have no esophageal abnormalities and can
remain upright or in a sitting position for
30 minutes after the dose

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Nursing Implications (contd)

Estrogens and progestins

Take the smallest dose needed

Give IM doses deep in large muscle masses, and
rotate sites
Give oral doses with meals to reduce GI problems
Teach patients about correct self-administration
and what to do if a dose is missed

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Nursing Implications (contd)

Estrogens and progestins (contd)

Increased susceptibility to sunburn may occur

advise patients to wear sunscreen or avoid
sunlight
Instruct patients to report weight gain
Advise patients to complete annual follow-up
exams, including PAP smear and breast exam

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Nursing Implications (contd)

Follow specific administration guidelines

carefully for IV administration of uterine
relaxants or stimulants
Monitor patients vital signs and fetal
condition during therapy

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Nursing Implications (contd)

Instruct patients taking fertility drugs to take

the medication as ordered
Advise patients to keep a journal while on
fertility drugs

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Nursing Implications (contd)

Bisphosphonates

Instruct patients to take medication upon rising in

the morning, with a full glass of water, and
30 minutes before eating
Emphasize that patients should sit upright for at
least 30 minutes after taking the medication

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Nursing Implications (contd)

SERMs

Instruct patients that the medication will need to

be discontinued 72 hours before and during any
prolonged immobility (such as surgery or a long
trip)

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Nursing Implications (contd)

Monitor for therapeutic responses

Monitor for adverse effects

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