Obat-obat Gangguan HaidObat-obat Gangguan Haid

Kepustakaan

• Goodman and Gilman’s, The Pharmacological Basis Of Theurapeutics, Eleventh Ed, 2006

• Farmakologi Dan Terapi, Edisi 5, 2007

Gangguan Haid

AmenorrheaDysmenorrheaMenorrhagia

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 24-48 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 (19 nortestosterone), senyawa gonane (norgestrel).

b. Steroid : medroxyprogesterone acetate (MPA), megestrol acetate., norethindrone acetate.

2. Antiprogestin: mifepristone, onapriston, (kombinasi antiprogestin‑prostaglandin: 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 diseaseOthers: 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 boneDecrease total cholesterol, LDL and

lipoprotein, but does not increase HDL and TG

Therapeutic Uses: breast cancer (tamoxifen), Osteroporosis (raloxifene), infertility (clomiphene)