Module 3-Clin Pharm Lab

• Gynecologic diseases involve the female reproductive tract and include benign and malignant tumors, pregnancy-related diseases, infections, and endocrine diseases
• Physicians practicing in Obstetrics and Gynecology are called gynecologists or specialists in women's reproductive health
• Obstetrics and Gynecology is a branch of medicine that specializes in the care of women especially during pregnancy and childbirth
• Human papillomavirus (HPV) infection is a major etiological factor associated with cervical cancer
• Estrogen-only medicines are usually taken with progestin-only medicines to lower the chance of getting endometrial cancer in women who still have their uterus
• During menopause, a woman's body makes less of the hormones estrogen and progesterone, leading to symptoms like night sweats, hot flashes, vaginal dryness, and thin bones
• Common Gynecological disorders

  • Ovarian cysts
  • Pelvic pain
  • Endometriosis
  • Uterine fibroids
  • Polycystic ovarian syndrome (PCOS)
  • Acne and abnormal female hair distribution
  • Genital tract infections
  • Vulva and vagina skin disorders
• Menopause is the cessation of menstruation due to the loss of ovarian follicular tissue and the sex steroid estrogen, with 35% of a woman's life spent in the perimenopausal/postmenopausal state
• Malignant tumors are the most common cause of death in gynecologic diseases
• Practitioners in Obstetrics and Gynecology diagnose and treat diseases of the female reproductive organs, specializing in women's health issues like menopause, hormone problems, contraception, and infertility
• Inactivation of the BRCA1 tumor suppressor gene is implicated in hereditary ovarian cancer
• Obstetricians care for women during pregnancy and just after the baby is born, including delivering babies
• Menopause is a normal time in a woman's life when her period stops
• Some women opt for Hormone Replacement Therapy to treat menopausal symptoms
• With perfect use, oral contraceptives have an efficacy of more than 99%, but with typical use, up to 8% of women may experience unintended pregnancy
• The peri-menopausal period typically lasts 4-5 years
• Alternative treatments for menopause

  • Tibolone, raloxifene, biphosphonates
• Biphasic and triphasic pills contain variable amounts of estrogen and progestin for 21 days and are followed by a 7-day placebo phase
• Rotor Syndrome is a chronic familial non-hemolytic jaundice that lacks liver pigmentation
• 35-year-old women who had a hysterectomy & oophorectomy have an 8x risk of non-fatal Myocardial infarction
• Progestogen Therapy

  1. Used for patients with an intact uterus to protect the endometrium from hyperplasia & neoplasia

  2. List of progestogens: medroxyprogesterone, dydrogesterone, 19-nortestosterone

  3. Progestogen preparation: progesterone, micronised preparation, suppository, or implant
• Psychological problems during menopause

  • Mood changes, irritability, sleep disturbance, depression, decreased libido
• Contraindications for HRT include undiagnosed vaginal bleeding, liver disease, VTE, active thrombophlebitis, Dubin Johnson syndrome, Rotor syndrome
• Raloxifene


  1. Non-steroidal benzothiophene belonging to SERM (selective estrogen receptor modulator)

  2. Increases bone mineral density, antagonizes estrogen-dependent defects

  3. Increases risk of thromboembolism, hot flushes

  4. Preventive against breast cancer
• Contraception aims to prevent pregnancy by inhibiting sperm from reaching a mature ovum or preventing a fertilized ovum from implanting in the endometrium
• HRT is contraindicated for post-menopausal women and those with estrogen-dependent tumors
• Menopause results in the loss of the sex steroid estrogen
• Menopausal symptoms


  • Vasomotor, localized atrophy of the genitalia, psychological problems, osteoporosis, coronary heart disease
• Tibolone

  1. Synthetic steroid with estrogenic, progestogenic, and androgenic effects

  2. Protective against osteoporosis, increases libido, fewer breast-related adverse effects

  3. Side effect: bleeding
• Women with an intact uterus must take estrogen + progesterone
• Vasomotor symptoms


  • Hot flushes, night sweats, palpitations
• Menopause before age 40 is considered premature
• Factors to consider in menopausal management

  • Age, individual differences in hormone metabolism, BMI
• Dubin Johnson syndrome is a familial chronic form of non-hemolytic jaundice due to a defect in bilirubin excretion
• The goal of oral contraceptives is the prevention of pregnancy following sexual intercourse
• Estrogen Therapy


  1. Can be administered orally, transdermally, subcutaneously, or vaginally

  2. Best estradiol; estrone ratio is achieved through implants (6 months)

  3. List of estrogen types: estradiol, estriol, estrone, estropipate, estradiol valerate, conjugated equine estrogen

  4. Estrogen alone may be used if the patient had undergone hysterectomy
• Approximately 35% of a woman's life is spent in the per/post menopausal state
• Menopause is the cessation of menstruation due to loss of ovarian follicular tissue
• Other symptoms of menopause


  • Dyspareunia, dysuria, loss of libido
• Monophasic oral contraceptives contain a constant amount of estrogen and progestin for 21 days, followed by 7 days of placebo