Obat-obat Gangguan Haid

Kepustakaan
Goodman and Gilmans, The Pharmacological Basis Of Theurapeutics, Eleventh Ed, 2006 Farmakologi Dan Terapi, Edisi 5, 2007

Gangguan Haid
Amenorrhea Dysmenorrhea Menorrhagia

Gangguan Haid
Amenorrhea Treatment depends on etiology. Direct therapy to the underlying cause.

Amenorrhea If normal physical examination with secondary amenorrhea, consider administering medroxyprogesterone 10 mg daily for 5-10 days

Dysmenorrhea Provide symptomatic relief with nonsteroidal anti-inflammatory drugs (eg, naproxen, ibuprofen) at the first sign.

Dysmenorrhea If nonsteroidal anti-inflammatory therapy fails, consider oral contraceptive pills for 3-6 months. If this fails as well, look for secondary causes of dysmenorrhea.

Dysmenorrhea Short-term use of selective estrogen receptor modulators (SERMs), such as tamoxifen

Menorrhagia Most cases of menorrhagia fall under the category of disfungsional uterine bleeding (DUB). Treatment of the underlying cause is necessary.

Menorrhagia For patients with mild DUB, provide reassurance and observation. Instruct the patient to keep a menstrual calendar. Consider iron supplementation and antiprostaglandin

Menorrhagia For patients with moderate DUB, prescribe combination oral contraceptive pills beginning with 4 monophasic 35-microgram pills a day and tapering down. Pills are usually continued for 6 months. Medroxyprogesterone alone may also be used. Oral iron and folic acid supplements are usefull

Menorrhagia If DUB is severe, consider an undiagnosed underlying disorder, such as von Willebrand disease (VWD) or factor VII deficiency.

Menorrhagia IV Premarin every 4 hours until the bleeding stops, up to 4 doses. Simultaneously administer a monophasic 35-microgram oral contraceptive pill every 6 hours for 2448 hours and then twice daily to complete a 28-day course.

Menorrhagia If Premarin does not stop the bleeding after 4 doses, consider pelvic pathology. Examination under anesthesia and dilatation and curettage may be necessary.

Menorrhagia An international expert of obstetrician/gynecologists and hematologists has issued guidelines such as von Willebrand disease as a cause of menorrhagia and postpartum hemorrhage

Menorrhagia An underlying bleeding disorder should be considered when a patient has any of the following:

 Menorrhagia since menarche Family history of bleeding disorders Personal history of one or more of the following: (1) notable bruising without known injury, (2) bleeding of oral cavity or GI tract without obvious lesion, or (3) epistaxis that persists more than 10 minutes

Menorrhagia Recent literature (including information from the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice) favors the use of levonorgestrel intrauterine devices (eg, Progestasert, Mirena coil)

Menorrhagia Surgical options for the management of severe menorrhagia include thermal balloon endometrial ablation, transcervical resection of the endometrium (TCRE), and hysterectomy.

Hormon kelamin dan antagonisnya

Estrogen dan antiestrogen : 1. a. Estrogen: estradiol, estradiol valerate, estradiol cypionate, ethinyl estradiol, mestranol, quinestrol, estrone, estrone sulfate, equilin, b, Senyawa nonsteroid dengan aktivitas estrogenik: diethylstilbesterol,

p,p' DDT, bisphenol A, genistein. 2. Selective estrogen receptor modulators (SERMS) : tamoxifen, raloxifene, toremifene. 3. Antiestrogen: clomiphene, fulvestrant 4. Estrogen syntesis inhibitors: fortnestane, exemestane, anastrozole, letrozole, vorozole

 Progestin dan antiprogestin : 1.a. Progestin: progesterone, senyawa pregnane (17 alfa acetoxy progesterone), senyawa estranes (19nortestosterone), senyawa gonane (norgestrel). b. Steroid : medroxyprogesterone acetate (MPA), megestrol acetate., norethindrone acetate.

2. Antiprogestin: mifepristone, onapriston, (kombinasi antiprogestinprostaglandin: sulprostone, gemeprost, misoprostol)

 Kontrasepsi : a. Kombinasi oral (progestin-estrogen): monofasik, bifasik, trifasik. b. Progestin only : oral, parenteral: MPA, implants: norethinrone

Estrogen-progestin
Endogenous hormon produce physiological actions: - Developmental - Neuroendocrine for ovulation - Fertilitation - Mineral, carbohydrate, protein, lipid

Estrogen
Two major uses: - combination oral contraceptive - MHT (menopausal hormone therapy)

MHT
Vasomotor: hot flashes, inapropriate sweating, paresthesias Osteoporosis: estrogens reduce bone resorption Vaginal dryness and urogenital atrophy Cardiovascular disease Others: thinning of the skin etc

Menopausal Hormone Regiment

1960-1970 Estrogen Replacement Therapy (estrogen alone) increasing endometrial carcinoma 1980 Hormon Replacement Therapy (include progestin), now referred as Menopausal Hormon Therapy

Selective Estrogen Receptor Modulators and Anti-Estrogen

Antiresoptive effect on bone Decrease total cholesterol, LDL and lipoprotein, but does not increase HDL and TG Therapeutic Uses: breast cancer (tamoxifen), Osteroporosis (raloxifene), infertility (clomiphene)