TeacherOfMedicine: Oestrogens and progestogens

For hormonal contraception in women who require highly effective and reversible contraception, particularly if they may also benefit from its other effects, such as improved acne symptoms with oestrogens.
For hormone replacement therapy (HRT) in women with early menopause (when it is given until 50 years of age) and those who have distressing menopausal symptoms.

Luteinising hormone (LH) and follicle-stimulating hormone (FSH) control ovulation and ovarian production of oestrogen and progesterone. In turn, oestrogen and progesterone exert predominantly negative feedback on LH and FSH release. In hormonal contraception, an oestrogen (e.g. ethinylestradiol) and/or a progestogen (e.g. desogestrel) are given to suppress LH/FSH release and hence ovulation.
Oestrogens and progestogens also have many effects outside the ovary. Some, such as those on the cervix and endometrium, may contribute to their contraceptive effect (this is especially important in progestogen-only contraception).
Others offer additional benefits, e.g. reduced menstrual pain and bleeding, and improvements in acne. At the menopause, a fall in oestrogen and progesterone levels may generate a variety of symptoms, including vaginal dryness and vasomotor instability (‘hot flushes’). Oestrogen replacement (usually with a progestogen) alleviates these.

Hormonal contraception may cause irregular bleeding and mood changes. It does not appear to cause weight gain. The oestrogens in combined hormonal contraception (CHC) products double the risk of venous thromboembolism (VTE), but the absolute risk is low.
They also increase the risk of cardiovascular disease and stroke, but this is probably relevant only in women with other risk factors.
They may be associated with increased risk of breast and cervical cancer. In both cases the effect is small, and for breast cancer, it gradually resolves after stopping the pill. Used alone (in progestogen-only pills), progestogens do not increase the risk of VTE or cardiovascular disease. The adverse effects of hormone replacement therapy are similar to those of CHC but, as the baseline rates are higher, the relative risks have more significant implications.

All forms of oestrogens and progestogens are contraindicated in patients with breast cancer.
Combined hormonal contraception should be avoided in patients at increased risk for VTE (past VTE; known thrombogenic mutation) or cardiovascular disease (age >35 years; cardiovascular risk factors; migraine with aura; heavy smoking history).

Concurrent use of cytochrome P450 inducers (e.g. rifampicin) may reduce the efficacy of hormonal contraception, particularly progestogen-only forms.
Most other antibiotics are safe to use with hormonal contraception.

TeacherOfMedicine