FARMAKOLOGI

HORMON REPRODUKSI &

KONTRASEPSI HORMONAL

dr. Rahma Triliana, S.Ked., M.Kes., PhD (Candidate)

Reproduction I Block
March 2016
REPRODUCTIVE
HORMONE
PHYSIOLOGY
HORMONES DURING PREGNANCY
 PRINCIPLES OF USING
HORMONES FOR TREATMENT &/
PREVENTION
 Understand the concepts of Drug/Hormone Receptor  Lock &
key, affinity, saturation, Bound/unbound, synthesis/degradation
 Know their molecular mechanism
 Understand the concepts
 Agonis  Hormone Hypo-function
 Antagonist  Hormone hyper-function
 Sensitizer  Receptor induction
 Understand the basic pharmacology from Drug (hormone) delivery
until effects occurs
 Remember Forward Regulation and feedback mechanism
HORMONE – RECEPTOR LOCK
& KEY MECHANISM

AFFINITY SATURATION
HORMONES ACTIONS
IN CELLs IS STRONG
- Regulation Of
Control (+)
- Binding Protein (+)
For Transfer
- Degradation
mechanism (+) 
Fast & Slow
(for EXAMPLE)
GRE, glucocorticoid response element; AP1, activating protein 1;
MRE, mineralocorticoid response element; PRE, progesterone response element;
ERE, estrogen response element; ARE, androgen response element.
Drug/Hormones Movement In Body
Forward
Regulation
&
Negative
Feedback
of
Hormones
 HORMONAL TREATMENT
in REPRODUCTIVE SYSTEM
 Hormonal contraceptives
 Oral contraceptive
 Injectibles
 Implants
 IUD with Hormones
 Treatment of hormonal disorders
 Agonis hormones
 Estradiol, estriol, estrone
 Medroxyprogesterone, Norethisterone
 Testosterone
 Narelin, gonadorelin,
 Antagonis Hormones
 anti-esterogen  Tamoxifen, Chlomiphene, Raloxifene
 Anti-progesterone  Misoprestone, gameprost
 Anti-androgen  flutamide, cyproterone, finasteride
 H/P bloker  Danazol
 HORMONAL TREATMENT
in REPRODUCTIVE SYSTEM
 Myometrial Stimulants
 Oxytocin
 Ergometrine
 Carboprost, gemeprost
 Mifepristone
 Myometrium relaxant
 Ritodrine
 Atosiban
 Hormon replacement therapy
 Agonis Esterogen & progesteron
 Phytoesterogen
 Erectile disfunction
 Yohimbine
 Apomorphine
 Phenilephrene
 Sidenafil, tadalafil, vardefi
 Anastrazole

Finasteride
VARIOUS CONTRACEPTIVE
METHODS
BRANDS NAME
FOR ORAL
CONTRACEPTIVES
(USA)
Benefits of Combined Estrogen &
Progestin Oral Contraceptives
  bone density
  menstrual blood loss and anemia
  risk of ectopic pregnancy
 Improved dysmenorrhea from endometriosis
 Fewer premenstrual complaints
  risk of endometrial and ovarian cancer
  in various benign breast diseases
 Inhibition of hirsutism progression
 Improvement of acne
 Prevention of atherogenesis
  incidence and severity of acute salpingitis
  activity of rheumatoid arthritis
 WHO Eligibility Criteria for Contraceptive Use
Condition Combined Progestin- DMPA/ Norplant TCu-
Ocs only OCs NET EN implants 380A
IUD
Pregnant NA NA NA NA 4
Age
Less than 18 (<20 for IUD) 1 1 2 1 2
18-39 1 1 1 1 1
40-45 2 1 1 1 1
Over 45 2 1 2 1 1
Smoking
Less than age 35 2 1 1 1 1
Age 35 and over
Light smoker (fewer than 15 cigarettes per 3 1 1 1 1
day)
Heavy smoker (15 or more cigarettes per day) 4 1 1 1 1
High blood pressure (hypertension)
Systolic 140-159 or diastolic 90-99 3 1 2 1 1
Systolic >160 or diastolic >100 4 2 3 2 1
Controlled hypertension With BP monitored 3 1 2 1 1
Past hypertension when BP not evaluated 3 2 2 2 1
Diabetes
History of gestational disease 1 1 1 1 1
Diabetes without vascular disease
Not treated with insulin 2 2 2 2 1
Treated with insulin 2 2 2 2 1
DM with vascular disease or diabetes > 20 yrs 3-4 2 3 2 1
Multiple cardiovascular risksb 3-4 2 3 2 1
 Vaginal bleeding patterns
Irregular without heavy bleeding 1 2 2 2 1
Irregular with heavy or prolonged bleeding 1 2 2 2 2
Unexplained abnormal vaginal bleeding 2 2 3 3 4
Pelvic inflammatory disease (RID)
Past PID (no known current risk of STDs)
Became pregnant since PID 1 1 1 1 1
Has not become pregnant since PID 1 1 1 1 2
Current PSD or in last 3 months j 1 1 1 1 4
Current STD (including purulent cervicitis)l 1 1 1 1 4
STD in last 3 months (asymptoms after Tx) 1 1 1 1 4
Vaginitis without purulent cervicitisl,m 1 1 1 1 2
Increased risk of STDs n 1 1 1 1 3
Parity
Nulliparous (has no children) 1 1 1 1 2
Parous (has children) 1 1 1 1 1
Severe dysmenorrhea) 1 1 1 1 2
Breast-feeding
Less than 6 weeks after childbirth 4 3 3 3 V
6 w - 6 mo after childbirth (full breastfeed) 3 1 1 1 V
6 months or more after childbirth 2 1 1 1 V
Postpartumu (non-breast-feeding women)
Less than 21 days after childbirth 3 1 1 1 V
21 or more days after childbirth 1 1 1 1 V
Postabortion
First trimester 1 1 1 1 1
Second trimester 1 1 1 1 2
After septic abortionv 1 1 1 1 4