Professional Documents
Culture Documents
Sistem Reproduksi
DR. RAHMA TRILIANA, S.KED. M.KES, PHD 13 DESEMBER 2016
BAHASAN
• KONTRASEPSI
• UTEROTONIK
• TOKOLITIK
• HORMONE REPLACEMENT THERAPY
• FERTILITY TREATMENT
• SEXUAL MATURITY INDUCTION
• ENDOMETRIOSIS
CONTRACEPTION
• Planned Contraception
• Oral Contraceptive Pills
• Patches, & Implants
• Vaginal Or Intrauterine Devices
• Barrier Foams, & Spermicides,
• Tubal Ligation, & Vasectomy
• Unplanned Contraception Emergency Contraception/Post Coital
• High-dose Estrogen-containing Oral Contraceptive Pills,
• High-dose Progestin Pills,
• A Progesterone Antagonist also for pregnancy termination
• Intrauterine Devices
ORAL CONTRACEPTION
• Mechanism:
• Primarily : suppressing the luteinizing hormone (LH) surge &
preventing ovulation.
• Estrogen Sensitize hypothalamus & pituitary gonadotropes
feedback inhibitory effects of the progestin and to
minimize breakthrough bleeding.
• Progestin negative feedback suppresses LH surge, prevents
ovulation, protects against uterine cancer by opposing the
proliferative effects of the estrogen on the uterine
endometrium.
PREPARATION
• Monophasic, biphasic, triphasic, estrophasic, &
Extended cycle (longer period & decrease duration of
menstrual bleeding)
• Constant amount of the hormone = monophasic
• Multiphasic preparation to prevent breakthrough
bleeding, minimizing total exposure to the hormones
• Most contain Ethinyl estradiol (estrogen) & 17-alkyl-19-
nortestosterone derivative (progestin)
• Newer preps designed to mimic hormone level,
minimize adverse effects, + iron to diminish the risk of
Fe-deficiency anemia
Antagonist
of Mineralo-
corticoid
Receptor
ADVERSE EFFECTS
• Menstrual bleed ( + / -)
• Thromboembolic disease estrogenic component
• Increased risk of breast cancer (still in debates)
• Hypertension
• Edema
• gallbladder disease
• Elevations in serum triglycerides.
• Hyperkalemia (in drospirenone due to K+-sparing
mechanism)
CONTRA-
INDICATION
• Women with history of
• Thromboembolic disease
• Cerebrovascular disease
• Migraine headaches with aura
• Estrogen-dependent cancer
• Impaired hepatic function or active
liver disease
• Undiagnosed uterine bleeding
• Suspected pregnancy.
• Gestational diabetes venous
thromboembolism (e.g., elective
surgery).
PROGESTIN-ONLY CONTRACEPTIVES
• NO estrogen Alternative if estrogen-containing formulations are
contraindicated.
• Mechanism
• Inhibit ovulation
• Changes of cervical mucus inhibit fertilization
• Endometrial changes fo implantation.
• Less effective if doses are missed, taken at different times
• Long-acting progestin only medroxyprogesterone (DEPO-PROVERA)
IM 3 months
• Subdermal implants inserted into inert matrix & slow release 3 y
• Adverse effect
• Decreased BMD Not for teenagers & younger women
• Intermittent breakthrough bleeding
• Acne & Weight gain
EMERGENCY CONTRACEPTION
• = Postcoital contraception
• Indication
• Mechanical failure of barrier devices
• Circumstances of unprotected intercourse
• NOT a regular method of contraception.
• Mechanisms of action not fully understood
• Mostly inhibition of ovulation.
• Effects on gamete function and survival
• Inhibit implantation.
• Taken first dose within 72 hours post coital 2nd dose 12 hours
later or SD 1.5 mg within 72 hours.
PREGNANCY TERMINATION
• Surgical Intervention (D/C)
• Drugs Complete abortion > 90%, if fails surgical intervention
• Mifepristone Competitive antagonist of progesterone
receptor Mechanism unclear
• Focal hemorrhage beware in anemic patients OR patient receiving
anticoagulants
• Breakdown of the stromal extracellular matrix & uterine endometrium
• Inhibition of expression of stromal cell "tissue factor," hemostasis
• Activation of extracellular matrix proteases
• Increases sensitivity to the uterotonic effects of prostaglandins.
• Methotrexate potent abortifacient
• Inhibit placenta to concentrate FH2Glun (dihydrofolate polyglutamate) and its
analogs.
• Prostaglandin analog stimulate uterine contractions & expel the detached
conceptus
• PGE2 analog, dinoprostone, sulprostone
• PGE1 analog (misoprostol, gemeprost)
ADVERSE EFFECT
• Prolonged Vaginal bleeding (> 1-2 weeks)
• Abdominal pain
• Uterine cramps
• Nausea and vomiting
• Diarrhea secondary to the prostaglandin.
• Myocardial ischemia & infarction sulprostone &
gemeprost.
• Infections septic shock
Drugs For Nonmalignant
Gynecological Disorders
• Treat the various symptoms and signs of menopause (e.g.,
hot flashes, dyspareunia, mood disorders, osteoporosis)
• Sexual differentiation in females with impaired sex steroid
hormones synthesis
• Assisted reproduction technology in infertile women
• Estrogen-dependent disorders (endometriosis, uterine
fibroids)
• Androgen-dependent conditions (acne & hirsutism)
• Gynecological malignancies Oncology drugs.
TREATMENT
MENOPAUSE
• Estrogen replacement therapy
Conjugated estrogen +
medroxyprogesterone (uterus +) or
estrogen alone (uterus -)
• Effect
• improved BMD decreased the risk
of fractures
• Decreased risk of colorectal cancer.
• Increased DVT & stroke, breast
cancer & coronary heart disease
cognitive impairment, or dementia.
• Oral, transdermal (patch, gel, spray),
and vaginal (cream, ring, and tablets).
• Start low go slow
• Other regimen:
• Phytoestrogens (e.g., soy products),
• Herbal extracts (e.g., black cohosh),
• Selective serotonin reuptake inhibitors
(e.g., fluoxetine, controlled-release
paroxetine, sertraline), clonidine, and
gabapentin.
• Androgen Therapy
UTEROTONIK
• Uterotonik adalah obat yang merangsang kontraksi uterus
• Ergot dan alkaloid ergot metyl ergometrin
• Oksitosin
• Prostaglandin
• Indikasi:
• Induksi partus aterm dan mempercepat persalinan pada kasus-kasus
tertentu
• Mengontrol perdarahan dan atoniuteri pasca persalinan
• Merangsang kontraksi uterus setelah operasi caesar maupun operasi
uterus lainnya
• Induksi abortus terapeutik
• Menghilangkan pembengkakan payudara
PENGOBATAN
PADA IBU HAMIL
DAN MENYUSUI
Drug ADME.