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DO YOU KNOW?-3

DO YOU KNOW?-3
CREATININE CHEMISTRY

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Thursday, 12 May 2016

WOMEN GYNACOLOGY-PART-VI-PROGESTINS

PROGESTINS-THE HORMONES OF PREGNANCY

Progestins are a group of steroidal female sex hormones mostly synthetic.The only naturally occuring progestin is the Progesterone which is the base for these synthetic progestins.Unlike estrogens this progesterone is  secreted during the gestational periods only that means the period from which a fully developed ovum detached from the overy and waiting for a sperm to fertilize it and upto the end of either the menstural cycle if no fertilization happen or upto the end of the pregnancy period if fertilization happened.The hormone progesterone is secreted from the yellow gland Corpus Luteum the gland which is temporarily formed at the gap from which the matured ovum detached from the ovary.
Progesterone the hormone of the pregnancy is controlling both the anterior pituitary-ovary axis and as well as the hypothalamus- anterior pituitary axis during the gestational period by a feed back mechanism to protect the fetus by preventing further maturing of the ovarian follicles.At the domination of progesterone at the set plasma limit during the gestational period there are no further secretions of FSH but, increases the LH pulsative sectretions from the anterior pituitary.The GRH secretions from the hypothalamus also decreased similar to FSH by progesterone While estradiol the main estrogen is controlling only the hypothalamus- anterior pituitary- axis and thus prevent the secretions of FSH and not of LH from the anterior pituitary by feed backchanism for all the times if its plasma level is raised to certain limits.
Once the ovum is fertilized the implantation takes place in one week.A hormone called human chorionic gonadotropin (HCG) is secreted from the a special layer within the uterus known as  trophoblast to keep the carpus luteum to be sustained and functional for some time upto the trophoblast itself becomes a fully developed placenta..This hormone is largely excreted by the kidneys mostly in the morning hours.Detection of this hormone in the urine by a specialised home kit test can confirm Pregnancy.
After several weeks of implantation placenta begins to develop.As a fully developed placenta can sufficiently produce progesteron and estrogen with collaberation of fetal adrenal glands and thereafter the corpus luteum begins to fade as its function is not further required and the secretion of CGH too will fade to be secreted further.
The amount of secretions of progesterone is varying as a few milligram per day at the beginning of follicular phase of the cycle followed by increasing upto 10 to 20 milligram during the luteal phase and further increases to several hundred milligrams during the later parts of the pregnancy period.
In the luteal phase progesterone act on the endometrium produced by the estrogens and decrease its further proliferation by estrogen,and develop a secondary endometrium as a luxury cusion for the convenience of the fertilized egg.
In case if there is no fertilization happened the secretions of progesterone and its domination decreased and the corpus luteum begins to fade at the end of the cycle and the domination of estrogen cause shedding of the secondary endometrium as a waste and excreted as menses at the end of the cycle.
At normal pregnancy period progesterone also act on the cervix and make it into thick and secretions to be more viscid inorder to prevent further entry of sperms through.This mechanism is more beneficiary for the use of synthetic progesterone like Norgestrel as a best oral contraceptives used alone or in combinations with estrogens.This we will discuss later in detail by the following posts.
Progeserone also modify the estrogen controlled matured vaginal epithelium in order to make it convenient and more elastic for delivering the baby 
Progeserone is very important in maintaining pregnancy.During pregnancy it protect the fetus by preventing contractions of the uterus and further mensturation.
During the pregnancy period progesterone along with estrogen acting on the mammary glands and proliferate it for milk production.But at the beginning of the lactating period the actions and secretions of progesterone and estrogen becomes nill.

WOMEN GYNACOLOGY-PART-IV-ESTROGEN OVER ACTIVITY-TREATMENTS

ANTIESTROGEN DRUGS

When secretions of estrogens are above the normal by the over activities of the ovaries the condition is known as hypergonadism of women.This condition may be natural or induced by careless administration of estrogens.In natural or provided hypergonadism the cause may be due to the active overstimulation of the ovaries by pituitary FSH and LH or passively by the hypothalamus stimulation of anterior pituitary by its hormone Gonadoropins releasing Hormones.
Either the conditions the over activities of estrogens cause so many problems in women.

Symptoms

1.Over secretions of estrogen will stop further secretions of FSH and LH by feed back mechanism which inturn block the development and maturity of the follicles leads to infertility.
2.Breast tenderness and cancer
3.Endomerial tenderness and cancer
4.Androgenic defeciency
5.Deep Venous Thrombosis(DVT)
6.Pulmonary Embolism (PE)
7.Changes in lipid and carbohydrate metabolism can cause or enhance hypertriglyceridemia and Diabetes Mellitus
8.Hypertension
9.Gall bladder disease
10.GI distress
11.Migrain
12.Mood disturbances 
Over activities of estrogens are 90% by misuse of estrogen intake mostly by contraceptives or other estrogen therapies like post 
menopausal hormone replacement therapies.
Estrogens are highly carcinogenic and can cause cancers in kidney bone and male sex organs.
Intake of estrogen like Diethyl Stibestreol(DE S) by a pregnant women during the first trmester can cause viginal and cervical cancer.This is is because the fetus cannot metabolize the DES and send it back to mother through the placenta which leads to the accumulation of the drug on her parts.Hence esrogens should be discouraged to take during pregnancy.
Administration of estrogens to post menopausal women as a hormonal replacement therapy may cause endometrial cancer in uterus.But the carcinoma can be cured by discontinuation of the therapy for several years.Hence estrogens should be administered to these patients in low dosages and in cyclic manners.
Although estrogens are having some favourable effects .on lipid metabolism such as lowering LDL,and elevating HDL but they may increase triglyceride levels
On gallbladder estrogens will increase cholesterol level dangerously to cause gallstones and other defects.
Fortunately in modern technics dose deviced for the hormon replacement therapy for post menopausal women are highly safe and in these dosages the incidences of hypertension,heart disease,stroke and thrombosis like DVT and PE are minimised.
Nausea and vomiting can be minimised by taking estrogens with food just before sleep. 

Treatments By Antiestrogens

1.Tamoxifen (Nolvadex)
It is a nonsteroidal anti estrogenic drug that competitively inhibit estrogens by binding to its receptors.
It is used for the treatment of breast cancers in postmenopausal women who receives hormonal replacement therapy.
Side Effects are hotflashes,nausea and vomiting
2.Chlomiphene (Clomid)
Its main action is by partially stimulating the estrogen receptors and thereby preventing the normal estrogenic feed back inhibition of anterior pituitary.There are sufficient secretions of FSH and LH by the pituitary which subsquently stimulates ovulation.
Its main use is to treat infertility.
Side effects are hot flashes,ovarian hyperplasia,Multiple simultaneous births,sight defects.


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