Hormonal regulation of the

reproductive cycle and associated

drugs

Ns. Frengki Apryanto, S.Kep.,

M.Kep.

 Kontrasepsi hormonal (pil) mulai diperkenalkan

pada th 1960 an, revolusi dalam sexual habits
dan perubahan sosial.
Untuk pertama kalinya dilegalkan
penggunaannya pada perempuan sebagai
terapi kesuburan dan pencegahan kehamilan.
Kontrasepsi pill terbukti aman 99% methode
efektif dalam kontrasepsi.
Obat tsb mempunyai fungsi lain disamping sbg
kontrasepsi, yaitu membantu mengurangi nyeri
dan pada bbrp gejala post-menopausal.

 Selama 28 hari siklus reproduksi pada perempuan

terjadi perubahan sbg persiapan konsepsi.
mendekati akhir siklus, endometrium (yg melapisi
uterus), siap menerima ovum yag dikeluarkan ovarium.
Ketika fertilisasi terjadi, ovum yg mengalami
pembuahan mnempel pada dinding uterus dan proses
embriologi (wonderful process) dimulai, dalam waktu 9
bulan, dan terjadi proses kelahiran.
Apabila perempuan tsb tdk mengalami konsepsi selama
waktu tsb, endometrium melepaskan melalui aliran
darah mestruasi. Dan terjadi proses (siklus) berikutnya.

cont
Sklus tsb di kontrol oleh 2 hormon yg
saling berkaitan, yg dikeluarkan oleh
pituitari anterior:
Follicle-simulating hormone (FSH)
Luteinising hormone (LH)
Dan dua hormon yg dikeluarkan oleh
ovarium:
Estrogen
progesteron

Figure. Simplified graph showing changing levels of hormones during

the 28-day
reproductive cycle

Keterangan gambar
1. The menstrual phase fase ini dimulai pada hari pertama menstruasi dan
berakhir 4-6 hari. Selama fase ini jaringan yang melapisi uterus terlepas melalui
aliran darah.
2. The follicular phase 8-10 hari kemudian, FSH membantu perkembangan dari
salah satu folikel yang terdapat pada ovarium yg mengandung sel ovum yg sudah
mature. Selama folikel tersebut berkembang, produksi estrogen dimulai, dan
jumlah estrogen dengan signifikan bertambah, folikel sendiri menjadi melebar.
Peningkatan estrogen dan berakhirnya fase folikuler menstimulasi pergerakan dari
Luteinising hormone (LH) dan menyebabkan folikel melepaskan ovum ke dalam
proses selanjutnya, yaitu ovulasi. Ovum berjalan dari ovarium menuju uterus,
dimana pd tmpt tsb berpotensi tjd fertilisasi (akibat pertemuan sperma dan ovum
3. The luteal fase ini adalah akhir fase , pada ovum fertilisasi terjadi atau tidak.
Apabila terjadi fertilisasi, embrio tertanam pada endometrium dan juga
mengirimkan sinyal kepada ovariis. Hal ini untuk mempertahankan kadar
progesteron tetap tinggi setelah terjadi ovulasi. Progesteron berfungsi
mempertahankan kekuatan struktur dari endometrium dan mencegah
menstruasi. Apabila fertilisasi tidak terjadi, progesteron akan menurun dan akan
menghentikan support dari endometrium melalui aliran menstruasi.

Hormone replacement therapy

(HRT)
As post-menopausal problems are caused as a result of falling
hormone levels, the pharmacological solution is to replace
these hormones artificially.
Restoring hormones to pre-menopausal levels brings
significant relief to many women for whom problems such as
hot flushes can cause considerable distress
Pengobatan yang diberikan pada wanita pra dan post
menopause sindrom (gejala, panas, kemerahan pd kulit, dan
distress).
Obat:
Estradiol (estrogen), norethisterone (progesterone)
Sediaan: oral, injeksi
Efek samping: mual, muntah, risiko terjadi kanker payudara,
stroke, dan trombosis

Oral contraceptives
Kontrasepsi oral sering digunakan pada pencegahan
kehamilan.
Prinsip kerja Kontrasepsi oral adalah dengan
mensupresi pengeluaran dua hormon pituitari yaitu
LH dan FSH.
menghambat perkembangan folikel ovarium dan
mencegah ovulasi.
Essentially, the body is responding to levels of
oestrogens and progestogens that normally equate
to pregnancy (where ovulation is suppressed), and if
the ovum is not released, fertilisation and
conception cannot occur.

 Combined hormonal contraceptives contain an

oestrogen and a progestogen.
The oestrogen is commonly ethinyloestradiol
and the progestogen may be norethisterone,
levonorgestrel, gestodene, norgestimate or
desogestrel.
There is typically a 5:1 ratio progestogen to
oestrogen.
The course of oral contraceptives normally lasts
for 21 days and after the final pill in the course,
the circulating levels of oestrogen and
progesterone fall and withdrawal bleeding occurs,
mimicking a menstrual period.

 the progestogen thickens the

cervical mucus making it inhospitable to sperm,
and preventing them from reaching the uterus.
Efek samping kontrasepsi kombinasi: fluid
retention, weight gain, nausea, vomiting,
headache, etc.
Interaksi dengan obat lain yang dapat
mengurangi efektivitas kontrasepsi : rifampicin,
rifabutin, carbamazepine, griseofulvin,
phenytoin and the herbal antidepressant

 Emergency or post-coital
contraception
This is a single high dose of
levonorgestrel taken as soon as
possible within the
three days after unprotected sexual
intercourse.

The thyroid gland: associated drugs

 The thyroid releases various hormones,

the most pharmacologically important ones
being thyroxine (T4) and the more active
triiodothyronine (T3).
The thyroid hormones are important regulators of
metabolism. They increase the bodys usage of
carbohydrates and lipids to make energy and this
maintainsbody temperature.
Thyroid hormones are important promoters of protein
synthesis which is why they are essential for normal
growth in children.

Disorders of thyroid function

These can basically be divided into two groups,
those that increase and those that
inhibit thyroid hormone production.
Hyperthyroidism is a condition where the
thyroid gland releases abnormally high
quantities of thyroid hormones into the blood.
There are various types, the most common
being Graves disease, an auto-immune
condition, and also benign adenomas.
Pembesaran kelenjar gondok (goiter) dan
exophthalmia

 Hypothyroidism is another auto-immune

problem of the thyroid that causes a reduction
in the release of thyroid hormones.
Patients have a reduced metabolism, are
lethargic and often speak very slowly.
Hypothyroidism can also be caused by a diet
severely deficient in iodine

Drugs used to treat disorders of

thyroid function
Hyperthyroidism : carbimazole and
propylthiouracil.
These drugs inhibit the release of thyroid
hormones and can return levels to near normal in
around four to eight weeks.
Iodine/iodide, also known a Lugols solution, is
another drug available for the treatment of
thyrotoxicosis.
Tindakan bedah thyroidectomy (removal of
part of the thyroid gland)

 Hypothyroidism is treated with

synthetic thyroid hormone in the form of
levothyroxine sodium.
This is basically thyroxine (T4) which
simply increases serum thyroxine levels.
that stimulate the body to increase its
own production of thyroid hormones.