Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.
Dr. V.SATHYANARAYANAN M.D
PROFESSOR OF PHARMACOLOGY
SRM MCH & RC
CHENNAI, INDIA
DRUG THERAPY IN
GYNECOLOGY
SEX AND HORMONES
 The sex hormones are a special kind of
steroids,
 released mostly by the gonads
 and to a lesser degr...
ESTROGENS AND PROGESTINS
 Estrogens include estradiol and others
 and are referred to as “female hormones”
 because wom...
STEROIDS BASICS
 Steroid hormones are all derived from cholesterol
 Cholesterol contains cyclopentanophenanthrene
ring
...
Actions of estrogens
 Development and maintenance of internal
(fallopian tubes, uterus, vagina), and external
genitalia
...
 oral contraception;
 replacement therapy.
MAIN USES OF OESTROGEN
Oral contraception;
• the treatment of symptoms of menopause;
• the prevention of osteoporosis•
the treatment of vaginal a...
OESTROGEN FORMULATIONS
 Oral
 Transdermal patches, gels
 Subcutaneous implants
 Vaginal ( ring, cream, tablet or pessa...
Progestins - Physiological Effects:
 Development of the endometrium.
 Development of the mammary gland during
pregnancy....
PROGESTERONE - Secretion
 By the ovary
 mainly the corpus luteum
 during the second half of the menstrual cycle.
PROGESTERONE AND PROGESTINS
 Drugs which mimic the action of
 progesterone
 complement the action of estrogen on
primar...
to control anovulatory bleeding;
 to prepare the uterine lining in infertility
therapy and
to support early pregnancy;
...
PROGESTINS
 norgestrel,
 levonorgestrel,
 norethindrone,
 norethindrone acetate,
 norethynodrel,
 ethynodiol diaceta...
 as part of the combined oral contraceptive
 and in the progestogen-only pill.
 Medroxyprogesterone acetate administere...
ABNORMAL UTERINE BLEEDING
 Primary Dysfunctional uterine bleeding
(ovular)
Uterine fibroids
Uterine endometriosis(adenomyosis) – painful
periods
...
 Primary Dysfunctional uterine bleeding –
 [anovular or ovular] – common
Uterine fibroids
Uterine endometriosis
Secon...
 Tt of choice  Trenexamic acid during menses ( reduce
bleeding 50%)
 Associated pain  mefenamic acid
 Combined oral c...
 DUB
 Endometrial pathology
 Climacteric
 Fibroids/ adenomyosis
 Ovarian pathology
IRREGULAR AND BUT HEAVY PERIODS
 anemia  iron supplements
 In the climacteric combined HRT
 high doses of progestogens in the second half of
menstrua...
 Cervical ectropion
 Cervical polyp
 Cervicitis
 Cervical carcinoma
 Medical  appropriate antibiotics for infection ...
long-term suppression of ovarian estrogen
production
(eg in endometriosis, uterine fibroids)
PROGESTINS
AMENORRHOEA & MENOPAUSE
Find out the cause
(secondary amenorrhoea –
 pregnancy
 stress
 PCOS ( infertility & oligomenorrhoea)
 Hyperprolacti...
 PCOS  combined OCP (patient wishes for regular
periods )
 induce ovulation ( wishes pregnancy)
surgery (ovarian drilli...
 Premenstrual syndrome – around 35 yrs, resolved by menses,
during the week before menses, tension, aggression,
depressio...
JUST FOR JOKE
 Supportive –reassurance cognitive and relaxation therapy
 Medical-
 COC
 Evening primrose oil
 Vitamin B6
 SSRIs
 ...
Menopause
 Transition period in a woman's life when
her ovaries stop producing eggs,
her body produces less estrogen and ...
Combined estrogens and progestins
 Currently very popular forms for HRT
 combine an estrogen (natural or semi-synthetic)...
Hormone Replacement Therapy
(HRT)
 Estrogen + progestins or either!
 Medical treatment for menopausal or post-menopausal...
Modes of HRT
 Combination:
- Pills and patch
 Estrogen:
- Pills, patch, cream
 Progestins
- Pills, vaginal gels,
IUDs
Patches vs. Pills
 Different routes of administration = different side
effects
 Pills 2 times likely to cause blood clot...
INCONTINENCE & PROLAPSE
 PRE-TREATMENT – BP measurement,
 Weight,
 breast examination,
 cervical smear,
 pelvic examination
 6 monthly – Wt,...
 Short-term HRT for menopausal symptoms – beneficial,
outweigh risks
 Decision for HRT – individual
 Lowest dose, short...
 Sphincter incontinence ( GSI ) – multiparity, prolonged labour,
H/O uterovaginal prolapse
 Urodynamics normal
 Detruso...
 Detrusor instability
 GSI
 Mixed incontinence
 Neurological disorder ( uncommon )
 Detrusor instability
 H/O urgenc...
 Cystocele
 Uterine prolapse – primary, secondary, tertiary
 Rectocele
 Enterocele
I FEEL SOMETHING COMING DOWN
NEOPLASIA
 Infection or inflammation – vaginal discharge
 Dyskaryosis
 Malignancy – early sex, multiple partners, HPV, HSV-2
Infe...
 Pelvic mass ( ovary, fallopian tube, uterus)
 Ascites
 Bladder distension
 Bowel problems
DISTENDED ABDOMEN
megestrol acetate:
 a progesterone derivative,
 used in treatment of endometrial cancer
 Atrophic vaginitis
 Endometrial polyp, hyperplasia, cancer
 Cervical polyp, cancer
 DM, Obesity, HTN  risk factors f...
SERMs
 Selective Estrogen Receptor Modulators
 Because Estrogen receptors differ slightly
in different organs,
 SERMs c...
Uses of SERMs..
 Used before or after menopause
 Can help in slowing metastasis of cancer breast
 Can treat osteoporosi...
Tamoxifen
 Non streoidal competetive estrogen antagonist
 Partial-agonist antagonist in breast cancer, hypothalamus,
ant...
ANTIESTROGENS - SERD
 Fulvestrant
 Antagonist at all tissues with estrogen receptors
 250 mg I.M depot injection, once ...
AROMATASE INHIBITORS
 Aromatase catalyses the final step
 In estrogen synthesis
 Letrozole, anostrozole, vorozole, fadr...
DISCHARGE & PAIN
 Infection – candida, trichomanas vaginitis, etc
 Inflammation
 Foreign body
 Candida – ass with itching, OCP, antibio...
 Advice on Personal hygiene and clothing
 Candida - clotrimazole cream, oral fluconazole
 trichomanas vaginitis - metro...
 Acute PID – fever, pelvic pain, foul smelling vaginal discharge
 STI or STDs
 IUCD
 Secondary PID
 ACUTE ABDOMEN –
...
 Antibiotics based on C/S report
 O2, IV fluids, IV antibiotics septic shock
TREATMENT OF PID
 Endometriosis
 Chronic PID
 Primary dysmenorrhoea
PAINFUL PERIODS & PAIN DURING
INTERCOURSE
 AIM 
 relief of pain
 To induce amenorrhoea
 NSAIDs
 COC pills for 6 months then till pregnancy is desired
 Proges...
INFERTILITY
Male causes – 25%
Anovular – 25%
Tubal blockade – 25%
Unknown – 25%
With Irregular periods  primary infertility
( PC...
Clomiphene citrate
 : is a partial agonist of estrogen
 (so binds receptors
but doesn’t act as a full agonist,
thus get ...
ADVERSE EFFECTS
 Multiple pregnancy
 Ovarian carcinoma
 Hot flushes
 Headache
FERTILITY CONTROL
 Nearly 50% of all women in their twenties in the UK
use this form of contraception.
 It is the most consistently effect...
• thrombo-embolic disease;
• increased blood pressure;
• jaundice;
• migraine – precipitates attacks or aggravates
previou...
• pregnancy;
• thrombo-embolism;
• multiple risk factors for arterial disease;
• ischaemic heart disease;
• severe hyperte...
Levonorgestrel 1.5 mg
as a single dose as soon as possible,
preferably within 12 hours of,
 and no later than 72 hours...
 (e.g. norethisterone, norgestrel)
 are associated with a high incidence of menstrual
disturbances, but are useful if oe...
• pregnancy;
• undiagnosed vaginal bleeding;
• severe arterial disease;
• liver adenoma;
• porphyria.
PROGESTOGEN-ONLY CON...
 are more effective than oral preparations.
 A single intramuscular injection of medroxy
progesterone acetate provides c...
Progestin Antagonists: Mifepristone
 Compete with the progestin receptors.
 Uses:
 Contraceptive.
 Abortifacient.
Mifepristone (RU-486)
 effectiveness: is 95% effective during first 7 wks
following conception
A 26-year-old woman consults you in your GP
regarding advice about starting the combined
oral contraceptive pill.
Questio...
 It is very important to take a careful history
 in order to exclude any risk factors
 which would contraindicate the c...
 The combined oral contraceptive is probably an appropriate
form of contraception in a woman of this age,
 who would pos...
 control and weighing
 the beneficial effects on plasma lipids offered by
 the newer progestogens, such as
 desogestre...
 The majority of women achieve good cycle control
with combined oral contraceptives
 containing oestrogen at a dose of
...
 A 50-year-old woman consults you about her
symptoms of flushing and vaginal discomfort.
 She is thin and is a smoker.
...
 This woman is probably menopausal
 and is suffering the consequences of
 the vasomotor effects of the menopause,
 as ...
 However, in view of her other symptoms,
 a better option would be to start her
 on hormone replacement therapy.
 If s...
 In this woman,
 who has risk factors for osteoporosis,
 such as smoking and thinness,
 it may be of benefit to contin...
THANK YOU..
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Pharmacology of  gynecology satya
Prochain SlideShare
Chargement dans…5
×

54

Partager

Pharmacology of gynecology satya

This interesting ppt deals with pharmacological aspects of Gynecology highlighting various aspects of it...it'll be very useful for the beginners in Gynecology...

Livres associés

Gratuit avec un essai de 30 jours de Scribd

Tout voir

Livres audio associés

Gratuit avec un essai de 30 jours de Scribd

Tout voir

Pharmacology of gynecology satya

  1. 1. Dr. V.SATHYANARAYANAN M.D PROFESSOR OF PHARMACOLOGY SRM MCH & RC CHENNAI, INDIA DRUG THERAPY IN GYNECOLOGY
  2. 2. SEX AND HORMONES  The sex hormones are a special kind of steroids,  released mostly by the gonads  and to a lesser degree by the adrenal glands.  affect the brain, genital and other organs  Two types 1. Androgens 2. Estrogens  Both sexes have both hormones.
  3. 3. ESTROGENS AND PROGESTINS  Estrogens include estradiol and others  and are referred to as “female hormones”  because women have higher levels.  Progesterone is a type of hormone that  prepares the uterus  for the implantation of a fertilized ovum  and promotes the maintenance of pregnancy.
  4. 4. STEROIDS BASICS  Steroid hormones are all derived from cholesterol  Cholesterol contains cyclopentanophenanthrene ring Estrogen and progestins are just two of the many steroids found in the human body  Mechanism: - Modulate gene expression inside cell Cholesterol
  5. 5. Actions of estrogens  Development and maintenance of internal (fallopian tubes, uterus, vagina), and external genitalia  skin: increase in vascularization,  development of soft, textured and smooth skin  bone: increase osteoblastic activity, decreases resorption  electrolytes: retention of Na+, Cl- and water by the kidney  cholesterol: Increases HDL, decrease LDL  Enhance coagulability of blood
  6. 6.  oral contraception;  replacement therapy. MAIN USES OF OESTROGEN
  7. 7. Oral contraception; • the treatment of symptoms of menopause; • the prevention of osteoporosis• the treatment of vaginal atrophy; • the treatment of hypo-oestrogenism (as a result of hypogonadism, castration or primary ovarian failure); • treatment of primary amenorrhoea; • treatment of dysmenorrhoea; • treatment of oligomenorrhoea; • treatment of certain neoplastic diseases; • treatment of hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu syndrome); • palliative treatment of prostate canceR USES OF OESTROGENS
  8. 8. OESTROGEN FORMULATIONS  Oral  Transdermal patches, gels  Subcutaneous implants  Vaginal ( ring, cream, tablet or pessary )  Nasal spray
  9. 9. Progestins - Physiological Effects:  Development of the endometrium.  Development of the mammary gland during pregnancy.  Milk secretion starts when its level decrease with birth.  Thermogenic action.
  10. 10. PROGESTERONE - Secretion  By the ovary  mainly the corpus luteum  during the second half of the menstrual cycle.
  11. 11. PROGESTERONE AND PROGESTINS  Drugs which mimic the action of  progesterone  complement the action of estrogen on primary and secondary sex characteristics
  12. 12. to control anovulatory bleeding;  to prepare the uterine lining in infertility therapy and to support early pregnancy;  for recurrent pregnancy loss due to inadequate progesterone production;  in the treatment of intersex disorders,  to promote breast development. USES OF PROGESTERONE
  13. 13. PROGESTINS  norgestrel,  levonorgestrel,  norethindrone,  norethindrone acetate,  norethynodrel,  ethynodiol diacetate,  Desogestrel and norgestimate
  14. 14.  as part of the combined oral contraceptive  and in the progestogen-only pill.  Medroxyprogesterone acetate administered by depot injection is used when parenteral contraception is indicated.  as an anti-androgen in prostate cancer, e.g. cyproterone acetate;  as part of hormone replacement therapy  endometriosis;  in menstrual disorders, such as premenstrual tension,  dysmenorrhoea and  menorrhagia; USES OF PROGESTOGENS
  15. 15. ABNORMAL UTERINE BLEEDING
  16. 16.  Primary Dysfunctional uterine bleeding (ovular) Uterine fibroids Uterine endometriosis(adenomyosis) – painful periods Secondary DUB REGULAR, BUT HEAVY PERIODS
  17. 17.  Primary Dysfunctional uterine bleeding –  [anovular or ovular] – common Uterine fibroids Uterine endometriosis Secondary DUB - caused by bleeding disorders {eg ITP} ABNORMAL UTERINE BLEEDING
  18. 18.  Tt of choice  Trenexamic acid during menses ( reduce bleeding 50%)  Associated pain  mefenamic acid  Combined oral contraceptive pill  Levonorgestrel IUCD ( warn of irregular menstrual cycle upto 9 months)  Danazol ( but ADR like acne, weight gain, voice changes)  Iron supplements  Progestogens are not indicated  SURGICAL Tt endometrial ablation, hysterectomy(definitive) TREATMENT OF PRIMARY DUB (DYSFUNCTIONAL UTERINE BLEEDING)
  19. 19.  DUB  Endometrial pathology  Climacteric  Fibroids/ adenomyosis  Ovarian pathology IRREGULAR AND BUT HEAVY PERIODS
  20. 20.  anemia  iron supplements  In the climacteric combined HRT  high doses of progestogens in the second half of menstrual cycle  With anovular DUB resulted in endometrial hyperplasia  progestogens in high doses  Consider Levonorgestrel IUCD  release continuous progestogens locally for upto 5 years  SURGICAL  Hysterectomy is definitive TREATMENT OF HEAVY IRREGULAR PERIODS
  21. 21.  Cervical ectropion  Cervical polyp  Cervicitis  Cervical carcinoma  Medical  appropriate antibiotics for infection ( based on C/S reports ) VAGINAL BLEEDING AFTER INTERCOURSE
  22. 22. long-term suppression of ovarian estrogen production (eg in endometriosis, uterine fibroids) PROGESTINS
  23. 23. AMENORRHOEA & MENOPAUSE
  24. 24. Find out the cause (secondary amenorrhoea –  pregnancy  stress  PCOS ( infertility & oligomenorrhoea)  Hyperprolactinemia – prolactinoma ( headache & visual disturbances)  Hypo/hyperthyroidism  premature menopause(associated with hot flushes & night sweats)  Drugs – phenothiazines, progestogens INFREQUENT PERIODS, NOT HAD ANY FOR 7 MONTHS…
  25. 25.  PCOS  combined OCP (patient wishes for regular periods )  induce ovulation ( wishes pregnancy) surgery (ovarian drilling)  Menopause  combined OCP  combined HRT  Hyperprolactinaemia  dopamine agonists  ( bromocriptine, cabergoline)  TREATMENT OPTIONS
  26. 26.  Premenstrual syndrome – around 35 yrs, resolved by menses, during the week before menses, tension, aggression, depression  Secondary Dysmenorrhoea –  endometriosis ( adenomyosis ) – heavy periods  PID  Pelvic venous congestion INTOLERABLE MENSTRUAL PERIODS
  27. 27. JUST FOR JOKE
  28. 28.  Supportive –reassurance cognitive and relaxation therapy  Medical-  COC  Evening primrose oil  Vitamin B6  SSRIs  High dose estrogens + progestins  GnRH agonists  to stop ovarian function temporarily TREATMENT FOR PMS
  29. 29. Menopause  Transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent  Symptoms are  mood swings,  hot flashes and  vaginal dryness
  30. 30. Combined estrogens and progestins  Currently very popular forms for HRT  combine an estrogen (natural or semi-synthetic) with an orally effective progestin  Prempro and Premphase  FemHRT  Combipatch
  31. 31. Hormone Replacement Therapy (HRT)  Estrogen + progestins or either!  Medical treatment for menopausal or post-menopausal women  Progestins keep weight off and stop cell proliferation  Benefits of estrogen:  Reduction in loss of bone mass (osteoporosis)  Decreased risk of cardiovascular disease  Positive effect on cognitive function
  32. 32. Modes of HRT  Combination: - Pills and patch  Estrogen: - Pills, patch, cream  Progestins - Pills, vaginal gels, IUDs
  33. 33. Patches vs. Pills  Different routes of administration = different side effects  Pills 2 times likely to cause blood clots than patches
  34. 34. INCONTINENCE & PROLAPSE
  35. 35.  PRE-TREATMENT – BP measurement,  Weight,  breast examination,  cervical smear,  pelvic examination  6 monthly – Wt,  BP  Yearly – breast examination  3-yearly – mammography, cervical smear SCREENING PROGRAM FOR HRT
  36. 36.  Short-term HRT for menopausal symptoms – beneficial, outweigh risks  Decision for HRT – individual  Lowest dose, shortest period, review annually  Inc risk of fractures, > 50  use HRT only when other therapies C/I  Healthy woman without menopausal symptoms – advised against HRT  NO BENEFITS  for CHD, cognition  C/I  past H/O breast cancer  Oestrogen alone  woman without uterus HRT ADVICE FOR PRESCRIBERS
  37. 37.  Sphincter incontinence ( GSI ) – multiparity, prolonged labour, H/O uterovaginal prolapse  Urodynamics normal  Detrusor instability – urgency, urge incontinence  Mixed incontinence  Tt- pelvic floor exercises + physiotherapy  Drugs alpha agonists ( phenylproponalamine)  surgery EVERY TIME I COUGH, I LEAK URINE
  38. 38.  Detrusor instability  GSI  Mixed incontinence  Neurological disorder ( uncommon )  Detrusor instability  H/O urgency, frequency, nocturia with or without UTI  Tt – alter fluid intake habits,  Anticholinergic drugs  flavoxate, oxybutinin  detrusor relaxation ( S/E – dry mouth. Constipation, blurring of vision)  No surgery I HAVE TO RUSH TO THE TOILET, OTHERWISE I LEAK URINE
  39. 39.  Cystocele  Uterine prolapse – primary, secondary, tertiary  Rectocele  Enterocele I FEEL SOMETHING COMING DOWN
  40. 40. NEOPLASIA
  41. 41.  Infection or inflammation – vaginal discharge  Dyskaryosis  Malignancy – early sex, multiple partners, HPV, HSV-2 Infection, smoking, low socioeconomic status CERVICAL SMEAR IS ABNORMAL
  42. 42.  Pelvic mass ( ovary, fallopian tube, uterus)  Ascites  Bladder distension  Bowel problems DISTENDED ABDOMEN
  43. 43. megestrol acetate:  a progesterone derivative,  used in treatment of endometrial cancer
  44. 44.  Atrophic vaginitis  Endometrial polyp, hyperplasia, cancer  Cervical polyp, cancer  DM, Obesity, HTN  risk factors for endometrial cancer  tt - surgery POSTMENOPAUSAL BLEEDING
  45. 45. SERMs  Selective Estrogen Receptor Modulators  Because Estrogen receptors differ slightly in different organs,  SERMs can target receptors of a certain organ  So a SERM that blocks estrogen’s effects in breast cells won’t impact estrogen binding in the uterus! Tamoxifen
  46. 46. Uses of SERMs..  Used before or after menopause  Can help in slowing metastasis of cancer breast  Can treat osteoporosis  Advantage: specificity  Yet to find a SERM that has no negative side effect ( both mentioned cause colon cancer)
  47. 47. Tamoxifen  Non streoidal competetive estrogen antagonist  Partial-agonist antagonist in breast cancer, hypothalamus, anterior pituitary;  agonist in endometrium, bone, and liver.  Effective orally  palliative or adjuvant treatment for ER + metastatic ( hormone dependent) breast cancer.  Use for longer than five years = 3-5x ↑risk of endometrial cancer,  S/E : Amenorrhoea, hot flushes, N, V, Bleeding  also may increase risk venous thrombosis and cataracts.
  48. 48. ANTIESTROGENS - SERD  Fulvestrant  Antagonist at all tissues with estrogen receptors  250 mg I.M depot injection, once a month  Uses  breast cancer resistant to tamoxifen  Side effects  headache, hot flushes, nausea
  49. 49. AROMATASE INHIBITORS  Aromatase catalyses the final step  In estrogen synthesis  Letrozole, anostrozole, vorozole, fadrozole  Not steroids  Reversible inhibition  Preferred drugs in breast cancer  No risk of thromboembolism or endometrial cancer
  50. 50. DISCHARGE & PAIN
  51. 51.  Infection – candida, trichomanas vaginitis, etc  Inflammation  Foreign body  Candida – ass with itching, OCP, antibiotics, DM  thick white discharge,  premenstrual,  intense itching worsening at night  TV – grey frothy discharge, pain, dyspareunia, burning  Bacterial vaginosis  green discharge  Gonococci, chlamydia  yellow mucopurulent, postmenstrual, pain, burning ( gono) I HAVE CONSTANT IRRITATING VAGINAL DISCHARGE…
  52. 52.  Advice on Personal hygiene and clothing  Candida - clotrimazole cream, oral fluconazole  trichomanas vaginitis - metronidazole  Bacterial vaginosis - metronidazole  Gonococci – penicillins + probenecid or erythromycin  chlamydia – doxycycline  Herpes – acyclovir  Treat the partner simultaneously TREATMENT
  53. 53.  Acute PID – fever, pelvic pain, foul smelling vaginal discharge  STI or STDs  IUCD  Secondary PID  ACUTE ABDOMEN –  ectopic pregnancy,  ovarian cyst,  Related to bowel problems I AM UNWELL AND HAVE ABDOMINAL PAIN & DISCHARGE
  54. 54.  Antibiotics based on C/S report  O2, IV fluids, IV antibiotics septic shock TREATMENT OF PID
  55. 55.  Endometriosis  Chronic PID  Primary dysmenorrhoea PAINFUL PERIODS & PAIN DURING INTERCOURSE
  56. 56.  AIM   relief of pain  To induce amenorrhoea  NSAIDs  COC pills for 6 months then till pregnancy is desired  Progestogens – oral, injectable, IUD  Danazol  GnRH agonists TREATMENT
  57. 57. INFERTILITY
  58. 58. Male causes – 25% Anovular – 25% Tubal blockade – 25% Unknown – 25% With Irregular periods  primary infertility ( PCOs, prolactinemia (anovulation))  unexplained CAUSES OF INFERTILITY
  59. 59. Clomiphene citrate  : is a partial agonist of estrogen  (so binds receptors but doesn’t act as a full agonist, thus get less activity),  hypothalamus therefore thinks there’s not enough estrogen around →  ↑FSH/LH →stimulate follicle   and induce ovulation.  Give clomiphene 50 mg daily ( day 2-6 ) for 5 days to get follicle stimulation  Ovarian hyper stimulation may occur.
  60. 60. ADVERSE EFFECTS  Multiple pregnancy  Ovarian carcinoma  Hot flushes  Headache
  61. 61. FERTILITY CONTROL
  62. 62.  Nearly 50% of all women in their twenties in the UK use this form of contraception.  It is the most consistently effective contraceptive method  and allows sexual relations to proceed without interruption  but it lacks the advantage of protection against sexually transmitted disease that is afforded by condoms.  The most commonly used oestrogen is ethinylestradiol. THE COMBINED ORAL CONTRACEPTIVE
  63. 63. • thrombo-embolic disease; • increased blood pressure; • jaundice; • migraine – precipitates attacks or aggravates previously existing migraine; • increased incidence of gallstones; • associated with increased risk of liver cancer. COMBINED ORAL CONTRACEPTION (COC) – ADVERSE EFFECTS
  64. 64. • pregnancy; • thrombo-embolism; • multiple risk factors for arterial disease; • ischaemic heart disease; • severe hypertension; • otosclerosis; • breast or genital carcinoma; • undiagnosed vaginal bleeding; • breast-feeding; • porphyria. COMBINED ORAL CONTRACEPTIVE (COC) – ABSOLUTE CONTRAINDICATIONS
  65. 65. Levonorgestrel 1.5 mg as a single dose as soon as possible, preferably within 12 hours of,  and no later than 72 hours after, unprotected sexual intercourse. POST-COITAL CONTRACEPTION
  66. 66.  (e.g. norethisterone, norgestrel)  are associated with a high incidence of menstrual disturbances, but are useful if oestrogen-containing pills are poorly tolerated or contraindicated  (e.g. in women with risk factors for vascular disease such as older smokers, diabetics or those with valvular heart disease or migraine) or during breast-feeding.  Contraceptive effectiveness is less than with the combined pill,  as ovulation is suppressed in only  approximately 40% of women and  the major contraceptive effect is on the cervical mucus  and endometrium. PROGESTOGEN-ONLY CONTRACEPTIVE PILLS
  67. 67. • pregnancy; • undiagnosed vaginal bleeding; • severe arterial disease; • liver adenoma; • porphyria. PROGESTOGEN-ONLY CONTRACEPTIVE ABSOLUTE CONTRAINDICATIONS
  68. 68.  are more effective than oral preparations.  A single intramuscular injection of medroxy progesterone acetate provides contraception for ten weeks  with a failure rate of 0.25 per 100 women per year.  It is mainly used as a temporary method  (e.g. while waiting for vasectomy to become effective),  but is occasionally indicated for long-term use in women for whom other methods are unacceptable.  The side effects are essentially similar  After two years of treatment up to 40% of women develop amenorrhoea and infertility,  so that pregnancy is unlikely for 9–12 months after the last injection DEPOT PROGESTOGEN INJECTIONS
  69. 69. Progestin Antagonists: Mifepristone  Compete with the progestin receptors.  Uses:  Contraceptive.  Abortifacient.
  70. 70. Mifepristone (RU-486)  effectiveness: is 95% effective during first 7 wks following conception
  71. 71. A 26-year-old woman consults you in your GP regarding advice about starting the combined oral contraceptive pill. Question Outline your management of this patient. CASE HISTORY
  72. 72.  It is very important to take a careful history  in order to exclude any risk factors  which would contraindicate the combined oral contraceptive,  such as  a past history of thrombo-embolic disease  or risk factors for thrombo-embolic disease.  In addition, it is important to ascertain whether  the patient is a smoker and  when she last had a cervical smear.  It is important to exclude  a history of migraine and  to check her blood pressure. ANSWER
  73. 73.  The combined oral contraceptive is probably an appropriate form of contraception in a woman of this age,  who would possibly be highly fertile,  as it is the most reliable form of contraception available,  provided that there are no risk factors to contraindicate the combined oral contraceptive  There are many COCs on the market and  selection for this individual would be  dependent on  a balance of achieving good cycle CHOICE OF OCP FOR THIS PATIENT
  74. 74.  control and weighing  the beneficial effects on plasma lipids offered by  the newer progestogens, such as  desogestrel, gestadine and norgestimate,  against the recently reported  two-fold increased risk of venous thrombo-embolism noted with desogestrel and gestadine.  In a woman of this age, the beneficial effects on plasma lipids are probably of minor importance and  in view of the increased risk of venous thrombo-embolism  it would probably be appropriate to choose a pill containing  norethisterone, levonorgestrel or norgestimate. CHOICE OF PROGESTIN FOR THIS PATIENT
  75. 75.  The majority of women achieve good cycle control with combined oral contraceptives  containing oestrogen at a dose of about 30–35 μg;  pills containing the higher dose of oestrogen  would only be required  if the individual was on  long-term enzyme-inducing therapy (e.g. rifampicin) or anticonvulsant medication. THE DOSE OF ESTROGEN FOR THIS PATIENT
  76. 76.  A 50-year-old woman consults you about her symptoms of flushing and vaginal discomfort.  She is thin and is a smoker. Question  Outline the therapy most likely to be of benefit, including the reasons for this. CASE HISTORY 3
  77. 77.  This woman is probably menopausal  and is suffering the consequences of  the vasomotor effects of the menopause,  as well as vaginal dryness.  The vaginal dryness could be treated  locally with short periods of treatment with topical oestrogens. ANSWER
  78. 78.  However, in view of her other symptoms,  a better option would be to start her  on hormone replacement therapy.  If she still has an intact uterus then  it is important to give  both oestrogen and cyclical progestogen  to protect the endometrium from hyperplasia.  Depending on preference, life-style and  the likelihood of compliance,  either oral therapy or  patches may be appropriate. WHY HRT ?
  79. 79.  In this woman,  who has risk factors for osteoporosis,  such as smoking and thinness,  it may be of benefit to continue the hormone replacement Therapy  for a period of at least five years  and possibly longer,  although it is important to exercise caution  with regard to her risk for breast cancer  and cardiovascular disease DURATION OF HRT IN THIS WOMAN
  80. 80. THANK YOU..
  • sarasmeenasubramanian

    Sep. 4, 2021
  • khainguyen69

    May. 23, 2021
  • BhuvneshKumari

    Apr. 16, 2021
  • RaviVarahalu

    Apr. 3, 2021
  • IndhuSoura

    Dec. 24, 2020
  • anjum_1963

    Dec. 21, 2020
  • VISHALWANI

    Dec. 21, 2020
  • MoulyaAppannaKodira

    Dec. 20, 2020
  • bijeshshakya10

    Dec. 12, 2020
  • SumayyaNilambur

    Dec. 6, 2020
  • ApilanathMk

    Sep. 27, 2020
  • MadhuriVinay

    Aug. 13, 2020
  • SabirKhan31

    Jul. 29, 2020
  • KevinAntonyGeorge

    Jul. 26, 2020
  • ramiosman3

    Jul. 24, 2020
  • umaram9

    Jul. 7, 2020
  • MikhailGuiomala1

    Jun. 23, 2020
  • zahramosallanezhad

    May. 29, 2020
  • alphonsajibin

    Apr. 30, 2020
  • ShikhaToshniwal2

    Apr. 27, 2020

This interesting ppt deals with pharmacological aspects of Gynecology highlighting various aspects of it...it'll be very useful for the beginners in Gynecology...

Vues

Nombre de vues

10 840

Sur Slideshare

0

À partir des intégrations

0

Nombre d'intégrations

5

Actions

Téléchargements

0

Partages

0

Commentaires

0

Mentions J'aime

54

×