C H A P T E R 4 0
Drugs affecting the female reproductive system
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T
he female reproductive system functions in a cyclical
fashion, not in the steady-state fashion seen with much
of the rest of the endocrine system. Altering any compon
ent of this cycle or the system can have a wide variety of
effects on the entire body. Drugs that affect the female
reproductive system typically include hormones and
hormonal-like agents. Figure 40.1 reviews the female
reproductive system and sites of action of the drugs used
to affect the system. Box 40.1 highlights considerations
related to the use of drugs discussed in this chapter as
they affect the female reproductive system throughout
the lifespan.
SEX HORMONES AND OESTROGEN
RECEPTOR MODULATORS
The female sex hormones can be used to replace
hormones that are missing or to act on the control
mechanisms of the endocrine system to decrease the
release of endogenous hormones. Drugs that act like
oestrogen, particularly at specific oestrogen receptors,
are also used to stimulate the effects of oestrogen in the
body with fewer of the adverse effects. See Table 40.1
for information on these agents.
S
ex hormones
Female sex hormones include oestrogens and the
proges-
togens
(the endogenous female hormone progesterone
and its various derivatives). Oestrogens that are availa-
ble for use include oestradiol (
Estraderm
,
Climara
and
others) and conjugated oestrogens (
Premarin
).
Progestogens include desogestrel (
Marvelon
), dros-
pirenone (
Yasmin
,
YAZ
), etonogestrel (
Implanon
),
levonorgestrel (
Microlut
,
Mirena
), medroxyprogester-
one (
Provera
), and nomegestrol (
Zoely
), norethisterone
(
Brevinor
) and progesterone (
Crinone, Pro-Feme
).
Hypothalamus
Ovary
Ovary
Rectum
Bladder
Fallopian
tube
Uterus
Vagina
Ovum
GnRH
Pituitary
Oestrogen
receptors
bone resorption
Progesterone
Primary
follicle
Mature
follicle
Corpus
albicans
Labia
FSH/LH
Prostaglandins:
gemeprost,
dinoprostone
work here
Fertility drugs:
ganirelix, cetrorelix
and lutropin work here
Raloxifene and
toremifene work here
Progestins:
desogestrol,
drospirenone,
levonorgestrel,
medroxy-
progesterone
and progesterone
work here
Fertility drugs:
clomiphene, follitropins,
chorionogonadotropin alfa
work here
Oxytocics:
ergometrine
and oxytocin
work here
Corpus
albicans
Oral contraceptives
work here
Oestrogens:
oestradiol and
oestrogens
work here
FIGURE 40.1
Sites of action of drugs affecting the female reproductive system.
