OESTROGEN

Secretion starts from the graffian follicle under the influence of FSH and concentration in blood rises gradually during follicular phase. Due to the modest FSH surge, estrogens further rise transiently. After ovulation, corpus luteum continues to secrete estrogens till about two days before menstruation. Estrogens exercise feed back inhibition of FSH (also LH at higher concentrations) by direct action on pituitary as well as through hypothalamus. In postmenopausal women, there is a sharp decline in oestrogen. Thus synthetic compounds of oestrogen are useful in the treatment of post menopausal deficiency states particularly when active ovaries have been removed surgically & the abrupt hormonal withdrawl is there.

Indications : Menopausal syndrome, senile vaginitis, delayed puberty in gils. Postmenopausal osteoporosis. Contraceptive. Dysmenorrhoea. Acne, hirsutism. Functional uterine bleeding. Suppression of lactation. Carcinoma prostate, carcinoma breast.

Contra indications : Pregnancy, lactation, undiagonosed vaginal bleeding. Cardiovascular or cerebrovascular disorders e.g. thrombophlebitis, thrombo-embolic processes. Severe hepatic impairment. Hypertension. Herpes gestationis. Rotor syndrome, Dubin-Johnson syndrome. Porphyria. Endometrial hyperplasia. Hyperlipoproteinaemia. Suspected estrogen dependent neoplasia tumours.

Special Precautions : Epilepsy, migraine, asthma, cardiac or renal disease. Discontinue if cancer progression or hypercalcaemia occur. May cause salt & fluid retention, chronic mastitis, abnormal mammograms. Impending major surgery.

Side-effects: Suppression of libido, gynaecomastia & feminization in males. Endometrial carcinoma. Breast cancer. Benign hepatomas. Fusion of epiphyses & reduction of adult stature when given to children.

Drug Interaction : Rifampicin, barbiturates and phenytoin increase rate of metabolism. Enhance toxic effects of impramine reduce effectiveness of anticoagulants and enhance activity of phenytoin.