Medications That Affect the Reproductive System UNIT 28 Medications That Affect the Reproductive System

Key Terms Amenorrhea Cryptorchidism Hirsutism Hypogonadism Menopause Osteoporosis

Female Hormones Onset of puberty: ages 9–16 FSH and LH released from pituitary stimulates ovarian activity Ovaries produce Estrogen and progesterone Ova

Phases of Menstrual Cycle Proliferation Luteal Premenstrual Menstruation

Estrogen: Uses Amenorrhea DUB Hirsutism Menopause Atrophic vaginitis Osteoporosis Palliation for breast cancer

Estrogen: Contraindications Pregnancy Breast cancer Undiagnosed genital bleeding Blood clots Estrogen-dependent neoplasia Discussion Question: How can estrogen be used for palliation in breast cancer if breast cancer is listed as a contraindication?

Estrogen: Adverse Reactions Breakthrough bleeding Breast tenderness Alopecia Headache Weight gain (continues)

Estrogen Adverse Reactions Warning! Estrogen use may increase risk of Breast cancer Gallbladder disease Hypertension MI in men Hypercalcemia (patients with breast cancer and bone metastasis)

Estrogen: Patient Teaching Record weight daily Report weight gain of 5 lb or more Watch for signs of thrombosis or bleeding Perform BSE

Progesterone Produced by ovaries and adrenal cortex Prepares uterus for pregnancy Suppresses ovulation during pregnancy Stimulates milk secretion (continues)

Progesterone: Uses Secondary amenorrhea DUB Infertility Threatened or habitual miscarriage

Progesterone: Contraindications Blood clots Cerebral apoplexy Liver disease Any reproductive cancer Missed abortion Undiagnosed genital bleeding

Progesterone: Adverse Reactions Breast tenderness Galactorrhea Breakthrough bleeding Weight gain Depression Insomnia

Progesterone: Patient Teaching Record weight daily Report weight gain of 5 lb or more Watch for signs of thrombosis or bleeding Perform BSE (continues)

Progesterone: Patient Teaching Warning! Progesterone may cause Fluid retention Depression Increased glucose intolerance Progesterone should be discontinued if mental depression become severe.

Menopause Decrease in female hormones Cessation of menstrual activity May be surgically induced May be relieved with HRT Alternative treatment available (continues)

Menopause Symptoms Hot flashes Vaginal dryness Insomnia Headaches Mood swings Depression Osteoporosis

Hormone Replacement Therapy: Benefits Most effective treatment for menopausal symptoms Short-term use of hormone therapy for relief of menopausal symptoms protects against the following conditions Osteoporosis Colorectal cancer Heart disease

Hormone Replacement Therapy: Risks Increased risk for blood clots Small increase in breast cancer risk Greater risk of endometrial cancer Increased risk of heart disease in some women (continues)

Hormone Replacement Therapy: Risks DVT and PT are more common in women taking oral estrogen Increased risk for stroke Increased risk of developing gallstones

Alternative Treatments for Menopause Natural biodentical hormones Exercise and diet Vaginal moisturizers Herbal treatments (continues)

Alternative Treatments for Menopause Dietary supplements Weight reduction Smoking cessation

Methods of Birth Control Hormonal OCPs DEPO-PROVERA NuvaRing Ortho Evra IUD (continues)

Methods of Birth Control Nonhormonal Condoms Sterilization Spermicides IUD Diaphragm Natural planning

NuvaRing Inserted vaginally Left in place for 3 weeks 98–99% effective Side effects and contraindications are same as with OCPs

Ortho Evra Birth control patch Replaced weekly 99% effective Same adverse effects and contraindications as OCPs

DEPO-PROVERA Given every 3 months May take some time for effects to wear off after discontinued 99% effective

Oral Contraceptives Monophasic Biphasic Triphasic Progesterone only (minipill) Nearly 100% effective Most contain mixture of estrogen and progestins 21 active pills per cycle for most OCPs

Oral Contraceptives: Contraindications Blood clots Angina pectoris Reproductive cancer Undiagnosed genital bleeding CVA or MI Pregnancy (continues)

Oral Contraceptives: Contraindications Warning! Cigarette smoking increases risk of serious adverse effects from OCP use. Women older than 35 who smoke more than 15 cigarettes per day should find alternative contraception.

Testosterone Onset of puberty: ages 13–15 Gradual decline in production after age 40 Maintains male sex characteristics, libido, sexual potency, and sperm production Rapidly inactivated by liver

Testosterone: Uses Hypogonadism Stimulate puberty Impotence Select breast cancer patients (continues)

Testosterone: Uses Did you know? Testosterone is frequently abused by individuals who wish to increase muscle mass and athletic skill. Be aware of signs of abuse.

Testosterone: Contraindications Pregnancy or lactation Male breast or prostate cancer Pituitary insufficiency History of MI Hypercalcemia (continues)

Testosterone: Contraindications BPH Impaired liver or kidney function Infants Young children

Testosterone: Adverse Reactions, Male Gynecomastia Oligospermia Excess penile erection Fluid and electrolyte imbalance Suppression of clotting factors

Testosterone: Adverse Reactions, Male Altered liver function Peliosis hepatitis Headache Baldness Libido changes Increased cholesterol

Testosterone: Adverse Reactions, Female Amenorrhea Menstrual irregularities Inhibition of gonadotropin secretion Virilization

Testosterone: Patient Teaching Record weight daily Report weight gain of 5 lb or more Monitor BP Watch for signs of bleeding (continues)

Testosterone: Patient Teaching Discussion Question: Testosterone transdermal systems are listed as schedule III controlled substances. Why do you think this is, when other forms are not?

Erectile Dysfunction Affects up to 20 million U.S. men 80% have a physical cause: Vascular disease – Neurologic diseases Diabetes – Surgery Prescription drugs – Spinal injury Substance abuse – Hormonal imbalance, reduced testosterone (continues)

Erectile Dysfunction May be treated with Viagra Cialis Levitra Warning! Medications for erectile dysfunction (ED) are not recommended for use in men with preexisting cardiovascular disease, due to increased cardiac risk.

Labor and Delivery Drugs Uterine relaxants Delay preterm labor Uterine stimulants (oxytocic agents) Induce labor Induce abortion Control bleeding

Sexuality and the Older Adult Sexual interest remains into 70s and beyond At all ages, more men than women say sex is important Nine in ten say that companionship is most important in a relationship Medications and health problems cause decline in sexual activity

Sexuality and Children STDs seen beginning as early as age 10 STDs may be contracted with first intercourse Most are treatable Risk of teen pregnancy (continues)

Sexuality and Children Discussion Questions: What are the consequences of untreated STDs? What are some ways to prevent STDs and teen pregnancy?