During clinical rounds, I often encounter patients who are terrified of hormones. One second they can be having a pleasant conversation, and the next second, when hormones are mentioned, they ask pitifully if there are any other options. Although hormones have many side effects, they still need to be used when necessary!
I remember a painful lesson from a few years ago. A little girl had ANCA-associated vasculitis. Her parents, considering the side effects of hormones, refused to use glucocorticoids. Faced with such patients, doctors could only try their best to persuade them, but they were also helpless!
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Estrogen drugs are divided into two categories
▎Estrogen medications:
It is used to treat estrogen deficiency such as menopausal syndrome and ovarian insufficiency, as well as menstrual cycle disorders, amenorrhea, infertility, osteoporosis, and prostate cancer. It is also used for contraception.
Anti-estrogenic drugs:
Used to treat breast cancer.
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Specific drugs
▎Estrogen-based drugs (estradiol, estradiol benzoate, ethinylestradiol, ethinylestradiol, diethylstilbestrol)
Indications:
Menopausal syndrome [1]: Estrogen replacement therapy can alleviate menopausal symptoms such as hot flashes, sweating, insomnia, obesity and mood swings; for postmenopausal and senile osteoporosis, appropriate estrogen supplementation can reduce bone loss and prevent fractures. For senile vaginitis and vulvar dryness caused by estrogen deficiency, topical preparations such as estradiol benzoate ointment can be used.
Prostate cancer[1]: High doses of estrogen can inhibit the secretion of pituitary gonadotropins, causing testicular atrophy and reduced androgen secretion. Estrogen also has anti-androgenic effects, thus it can treat prostate cancer. Diethylstilbestrol[2] and phosphatidylcholine[3] can be used to treat prostate cancer.
Contraception: Contraceptive pills are a combination of estrogen and progestin used for birth control. Although birth control pills are hormonal, don't wait until you're unexpectedly pregnant and have to end your life to regret it!
Breast engorgement and milk suppression[1]: Some women continue to secrete milk after stopping breastfeeding, causing breast engorgement. High doses of estrogen can interfere with the stimulating effect of prolactin on the breast, reducing milk secretion and relieving pain.
Ovarian insufficiency and amenorrhea: For those with low ovarian function, estrogen replacement therapy can promote the development of the uterus, external genitalia and secondary sexual characteristics. Therefore, minors must stay away from drugs and foods containing sex hormones.
Adverse reactions and precautions:
Estrogen has therapeutic effects on prostate cancer and postmenopausal breast cancer, but it is contraindicated in patients with other cancers.
Central nervous system: Estrogen can aggravate migraines and induce depression[1].
Estrogen should not be used during pregnancy to avoid causing fetal developmental abnormalities.
Estrogen is mainly metabolized in the liver. Abnormal liver function can cause cholestasis, so it should be used with caution in people with poor liver function.
Anti-estrogenic drugs:
Tamoxifen[4]: It is a competitive estradiol antagonist that can bind to the estrogen receptors of breast cancer cells and inhibit the growth of tumor cells that require estrogen to suppress. It is used to treat breast cancer that is progressively developing after menopause. It is contraindicated in patients with fundus diseases.
Raloxifene: a selective estrogen receptor modulator, primarily used to treat osteoporosis.
Progestins and related drugs
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Drug Classification
Natural progesterone: progesterone
Synthetic derivatives: medroxyprogesterone acetate, medroxyprogesterone acetate, norethindrone
Anti-progestin drugs: mifepristone
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Indications
Progesterone: threatened abortion, habitual abortion, menstrual disorders. Progesterone injection is now also used for renal colic caused by stones[5].
Medroxyprogesterone acetate: It has no estrogenic activity and is used for dysmenorrhea, dysfunctional uterine bleeding, threatened abortion, and endometriosis.
Chlorpheniramine acetate: A potent oral progestin, combined with the long-acting estrogen ethinylestradiol to form compound ethinylestradiol tablets, which can provide contraception for 25 days with a single dose.
Mifepristone[6]: also known as an anti-progestin, used to terminate early pregnancy. It has a significant first-pass effect, and its main metabolite, N-demethylmifepristone, retains its activity. It competitively acts on progesterone and corticosteroid receptors, thus having anti-progestin and anti-corticosteroid effects. As a non-surgical anti-early pregnancy drug, it is used to terminate pregnancy within 49 days of amenorrhea, and is also used for labor induction, gynecological surgery, and emergency contraception.
androgen and related drugs
01
Drugs are divided into three categories
Androgen drugs: maintain the development of male reproductive organs and promote the development of secondary sexual characteristics, and also have protein anabolic activity.
Anabolic steroids: These drugs promote protein synthesis and bone formation, leading to muscle growth and stronger bones. Therefore, in addition to being used as a replacement therapy for insufficient endogenous androgen secretion, androgen drugs are also used as nutritional supplements.
Anti-androgen drugs: used to treat androgen-dependent diseases.
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Specific drugs
Methyltestosterone: The first oral androgen drug. Clinical uses: Men suffering from testosterone deficiency, and women experiencing dysfunctional uterine bleeding. Toxicity: Causes hepatotoxicity and jaundice; high doses in women can have masculinizing side effects.
Testosterone propionate: After intramuscular injection, it is slowly absorbed in the body, gradually hydrolyzing to release the original testosterone. It is a long-acting derivative of testosterone. Clinical uses: Treatment of male hypogonadism, dysfunctional uterine bleeding in women, fibroids, osteoporosis in the elderly, and aplastic anemia. Side effects: Masculinization in women, feminization in men (androgens are converted into estrogens in extragonadal tissues), water and sodium retention, leading to benign prostatic hyperplasia in men and accelerating the growth of prostate cancer.
Friendly reminder: All medications have certain side effects. Hormones are naturally present in our bodies and should be used when necessary. There's no need to feel like you have a deep-seated hatred just because you hear the word "hormone".
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