Estrogen & Progesterone
ESTROGEN & PROGESTERONE
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Introduction
· Estrogen and progesterone
are the primary female sex hormones, playing critical roles in reproductive
health, menstrual cycle regulation, and overall bodily functions.
· Estrogen is involved
in the development of female secondary sexual characteristics and reproductive
system maintenance, while progesterone is crucial for regulating the menstrual
cycle and maintaining pregnancy.
Definition
·
Estrogen: A group of steroid hormones
responsible for the development and regulation of the female reproductive
system and secondary sexual characteristics.
·
Progesterone: A steroid hormone released by the
corpus luteum that stimulates the uterus to prepare for pregnancy.
Classification
Estrogens:
1.
Natural Estrogens:
o
Estradiol (E2)
o
Estrone (E1)
o
Estriol (E3)
2.
Synthetic Estrogens:
o
Ethinyl estradiol
o
Diethylstilbestrol (DES)
Progestogens:
1.
Natural Progestogens:
o
Progesterone
2.
Synthetic Progestogens:
o
Medroxyprogesterone acetate
o
Norethindrone
o
Levonorgestrel
Pharmacokinetics
Estrogen:
·
Absorption: Estrogens are well absorbed from the
gastrointestinal tract, skin, and mucous membranes.
·
Distribution: Estrogens bind extensively to plasma
proteins, including albumin and sex hormone-binding globulin (SHBG).
·
Metabolism: Metabolized in the liver to various
hydroxylated metabolites.
·
Excretion: Excreted in urine and feces as
glucuronide and sulfate conjugates.
Progesterone:
·
Absorption: Progesterone is well absorbed from
the gastrointestinal tract, skin, and mucous membranes.
·
Distribution: Binds extensively to plasma proteins,
primarily albumin and corticosteroid-binding globulin (CBG).
·
Metabolism: Metabolized in the liver to
pregnanediol and other metabolites.
·
Excretion: Excreted in urine as glucuronide and
sulfate conjugates.
Mechanism of Action
Estrogen:
·
Estrogens bind to estrogen receptors (ERs) in the cytoplasm, which then
translocate to the nucleus.
·
They interact with estrogen response elements (EREs) in DNA, modulating
the transcription of specific genes.
·
This influences the development and function of reproductive tissues and
other organs.
Progesterone:
·
Progesterone binds to progesterone receptors (PRs) in the cytoplasm.
·
The hormone-receptor complex translocates to the nucleus, interacting
with progesterone response elements (PREs) in DNA.
·
This modulates the transcription of genes involved in the menstrual
cycle, pregnancy maintenance, and other bodily functions.
Uses
Estrogen:
·
Hormone replacement therapy (HRT) in menopausal women
·
Contraception (in combination with progestins)
·
Treatment of hypogonadism in females
·
Osteoporosis prevention and treatment
·
Palliative treatment of advanced prostate and breast cancer
Progesterone:
·
Contraception (alone or in combination with estrogens)
·
Hormone replacement therapy (HRT) in menopausal women
·
Treatment of menstrual disorders (e.g., amenorrhea, dysmenorrhea)
·
Support of early pregnancy in women with luteal phase defects
·
Management of endometrial hyperplasia
Adverse Effects
Estrogen:
·
Nausea and vomiting
·
Breast tenderness and enlargement
·
Headaches and migraines
·
Increased risk of thromboembolic events (e.g., DVT, PE)
·
Increased risk of breast and endometrial cancer
Progesterone:
·
Weight gain
·
Mood changes and depression
·
Bloating and abdominal pain
·
Breast tenderness
·
Irregular bleeding or spotting
·
Increased risk of thromboembolic events
Contraindications
Estrogen:
·
Known or suspected pregnancy
·
Active or history of breast or endometrial cancer
·
Active or history of thromboembolic disease
·
Liver dysfunction or disease
·
Undiagnosed abnormal genital bleeding
Progesterone:
·
Known or suspected pregnancy (for certain formulations)
·
Active or history of breast cancer
·
Active or history of thromboembolic disease
·
Liver dysfunction or disease
·
Undiagnosed abnormal genital bleeding
Role of the Nurse
·
Assessment: Monitor patients for signs of hormone
imbalance, adverse effects, and contraindications.
·
Education: Educate patients on the purpose,
benefits, and potential side effects of hormone therapy. Emphasize the
importance of adherence to prescribed regimens.
·
Administration: Administer hormone therapy as
prescribed and monitor for immediate reactions.
·
Support: Provide emotional support to patients
experiencing side effects or adjusting to hormonal changes.
·
Monitoring: Regularly monitor patients' health
status, including blood pressure, weight, and laboratory values as necessary.
·
Communication: Collaborate with the healthcare team
to adjust treatment plans based on patient responses and side effects.
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