SEX HORMONE THERAPY Anti-progestogens Mifiproston RU 486 : 19 nor testosterone derivative with different side chains. It has strong affinity for progestogen receptor inducing antagonistic effect mostly with some agonistic effect.

Indications of RU 486 Mostly used as efficient abortificient in combination with PGs in 1 st trimester. Emergency contraception. Induction of labour. In combination with antiestrogen of better control of breast Cancer metastasis.

*Gonadotrophins ( Gn )* Pituitary Gonadotrophins : Chorionic Gonadotrophins ( HCG ) Recombinant FSH IM or SC

Indications Indication of ovulation when infertility is the complaint. After failure of clomiphene treatment. For superovulation induction in IVF and other assisted reprotactive technique (ART) with or without GnRH. HCG : to mimic LH surge and release ovum. HCG is used in luteal phase defect to produce luteal support in the 2 nd half of cycle and 1 st trimester of pregnancy.

Side Effects Local reaction at the site of injection, anaphylaxis. Multiple ovulation multiple pregnancy. Ovation hyperstimulation syndrome.

Contraindications Tumors of ovary, breast, uterus, pitutery Gland, and hypothalamus. Pregnancy except HCG. Lactation. Undiagnosed uterine bleeding. Primary ovarian failure. Ovarian cyst.

*Anti-Gonadotrophins * * Danazol : 17α ethinyl testosterone. It lowers the levels of FSH and LH and can suppress ovulation and menstruation, endometriosis,dysfunctional uterine bleeding( DUB) ( as a 3 rd line therapy). Its dose 200 – 800 mg / day. * Gestrinone : 19 nortestosterone

GnRH agonist and antagonist * Buserlin, Goserlin, Triptolin, Leuprolin, Nafarelin Routes : IM, IV, SC injection, daily or monthly Nasal snuff 2 – 5 times/day. - Various protocol used ; long, short and ultrashort.

Indications : Precocious puberty. Endometriosis. Leiomyoma. Used reoperative DUB. Infertility : Hypooestrogenic state. Induction of ovulation. Hirsutism. Breast Cancer and tamoxifen. premenstrual syndrome(PMS). Infertility Males used in : Cryptorchidism Benign prostatic Hyperplasia. Cancer of prostate.

Side effect: Local allergic reaction. Menopausal symptoms ( 3 – 4 weeks ) Osteoporosis if > 6 months and it is not totally reversible so require add back treatment.

II. GnRH antagonist Ganirelix. Cetrorelix. Recently they are used in programs of induction of ovulation instead of GnRH agonist It acts immediately to suppress gonadotrophin secretion it is expensive therapy. Their side effect are mainly because of mast cell degranulation

*Androgen * There is very little place for androgen therapy in female, it is limited to castrated menopausal woman to libido & promote feeling of wellbeing.

*Anti-androgen * - Cyproterone acetate It is a powerful anti-androgen, combined with ethinylestradiol (Dian) to treat : Severe acne. Mild to moderate hirsutism. PCOS. Contraception for female with androgen dependant skin conditions ( pcos + hirsute + acne + doesn’t need baby ). - Spironolactone : It is a mixture of agonistic / antagonistic action treatment of hirsutism. - Flutamide and finistride treatment of hirsutism.