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

2. Key Terms Amenorrhea Cryptorchidism Hirsutism Hypogonadism Menopause
Osteoporosis

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

4. Phases of Menstrual Cycle
Proliferation
Luteal
Premenstrual
Menstruation

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

6. 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?

7. Estrogen: Adverse Reactions
Breakthrough bleeding
Breast tenderness
Alopecia
Headache
Weight gain
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8. 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)

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

10. Progesterone Produced by ovaries and adrenal cortex
Prepares uterus for pregnancy
Suppresses ovulation during pregnancy
Stimulates milk secretion
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11. Progesterone: Uses Secondary amenorrhea DUB Infertility
Threatened or habitual miscarriage

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

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

14. Progesterone: Patient Teaching
Record weight daily
Report weight gain of 5 lb or more
Watch for signs of thrombosis or bleeding
Perform BSE
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15. Progesterone: Patient Teaching
Warning!
Progesterone may cause
Fluid retention
Depression
Increased glucose intolerance
Progesterone should be discontinued if mental depression become severe.

16. Menopause Decrease in female hormones Cessation of menstrual activity
May be surgically induced
May be relieved with HRT
Alternative treatment available
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17. Menopause Symptoms Hot flashes Vaginal dryness Insomnia Headaches
Mood swings
Depression
Osteoporosis

18. 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

19. 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
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20. Hormone Replacement Therapy: Risks
DVT and PT are more common in women taking oral estrogen
Increased risk for stroke
Increased risk of developing gallstones

21. Alternative Treatments for Menopause
Natural biodentical hormones
Exercise and diet
Vaginal moisturizers
Herbal treatments
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22. Alternative Treatments for Menopause
Dietary supplements
Weight reduction
Smoking cessation

23. Methods of Birth Control
Hormonal
OCPs
DEPO-PROVERA
NuvaRing
Ortho Evra
IUD
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24. Methods of Birth Control
Nonhormonal
Condoms
Sterilization
Spermicides
IUD
Diaphragm
Natural planning

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

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

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

28. 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

29. Oral Contraceptives: Contraindications
Blood clots
Angina pectoris
Reproductive cancer
Undiagnosed genital bleeding
CVA or MI
Pregnancy
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30. 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.

31. 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

32. Testosterone: Uses Hypogonadism Stimulate puberty Impotence
Select breast cancer patients
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33. 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.

34. Testosterone: Contraindications
Pregnancy or lactation
Male breast or prostate cancer
Pituitary insufficiency
History of MI
Hypercalcemia
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35. Testosterone: Contraindications
BPH
Impaired liver or kidney function
Infants
Young children

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

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

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

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

40. 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?

41. 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
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42. 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.

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

44. 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

45. 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
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46. Sexuality and Children
Discussion Questions:
What are the consequences of untreated STDs?
What are some ways to prevent STDs and teen pregnancy?