DRUGS AFFECTING THE REPRODUCTIVE SYSTEM

(PICTURES/VIDEOS – ANATOMY OF THE FEMALE AND MALE REPRODUCTIVE

SYSTEM)

FEMALE REPRODUCTIVE PROCESSES

• The uterus – a pear shaped, hollow, very muscular organ located in the
pelvic cavity between the rectum and the bladder; it is connected to
the vagina by the cervix

• Three distinct layers compose the uterine wall: the outer layer
(perimetrium), the muscular middle layer (myometrium), and the
inner mucosal layer (endometrium).

• The myometrium – a network of involuntary (smooth) muscles divided

in to 3 layers, with the muscles of each layer configured in different
patterns.

• The outer muscles are arranged longitudinally to assist with cervical

effacement (thinning and shortening) and to expel the fetus at the
time of delivery.

• Muscles in the middle layer are arranged in a figure-8-design. These

muscles are extremely important in the control of bleeding
(hemostasis).

• Blood vessels are threaded throughout these muscles, and when a

contraction occurs, the vessels are compressed, creating a hemostatic
effect.

• Circular muscle fibers are found in the area of the intestinal os and
help control its sphincter. These circular muscles keep the fetus
contained in the uterus for the normal gestational period. It is these
muscles that stretch (dilate) the cervix to a diameter of 10 cm during
labor.

• When all three muscles layers work together during labor, contractions
cause cervical dilatation and descent and delivery of the infant.

• The Menstrual Cycle

 The reproductive cycle is hormonally controlled by
interactions between the endocrine and reproductive
systems.

 Hypothalamus – secretes gonadotropin-releasing hormone

(Gn-RH), which stimulates the anterior pituitary to
synthesize and release follicle-stimulating hormone (FSH)
and luteinizing hormone (LH). These gonadotropins
stimulate the ovaries to produce estrogen and
progesterone, respectively.

 In most women the menstrual cycle lasts 28 days (ranges

of 22 to 34 days).

 The ovarian hormone estrogen and progesterone regulate

the cycle, which had 3 ovaries phases: follicular, ovulatory,
and luteal. Endometrial phases occur stimultaneously with
these ovarian phases.

 The follicular phase occurs during the days 1 of 14 of the

cycle.

 Days 1 to 6 of this period constitute the menstrual phase

and days 7 to 14, the proliferative phase.

 During the total 14-day period, FSH increases and follicles

begin to mature within the ovary. One graafian from the
group matures and swells by days 10 to 13, ruptures on
day 14, and releases the ovum to the fallopian tube.

 The ovulatory phase occurs on day 14 when the ovum is

released.

 The luteal phase occurs from days 15 to 28 and includes

the secretory phase of the endometrial cycle.

 During this period, estrogen and progesterone are

produced by the ovarian corpus luteum (the ruptured
graafian follicle), reaching peak levels 8 days into the
phase.

 Changes occur in the endometrium for optimal

implantation of a fertilized ovum.
  FSH and LH levels decrease, mediated by dopamine,
norepinephrine, and serotonin.

 Estrogen and progesterone are withdrawn immediately

before menstruation, and the endometrial prostaglandin
level increase.

 The cycle begins a new with the follicular phase.

 In cycles that are nonovulatory, hormonal secretion of

estrogen, FSH, and LH is erratic; there is also an alteration
in the usual amount of progesterone. These physiologic
alterations become the basis for planning and
implementing pharmacologic interventions.

I. Female Reproductive Cycle I: Pregnancy and Preterm Labor

A. Therapeutic Drug and Herbal Use in Pregnancy

- The most common indications for use of drugs and herbs

during pregnancy are nutrional supplementation with iron,
vitamins, and minerals and treatment of nausea and vomiting,
gastric acidity, and mild discomforts.

B. Drugs for Minor Discomforts of Pregnancy

- The average prenatal client uses three drugs during

pregnancy, two of which are vitamin and mineral
supplements. Drug ingestion is most likely during the first and
the third trimesters, when the minor discomforts of pregnancy
tend to be most bothersome. Many of the complaints
associated with pregnancy will be related to the
gastrointestinal (GI) tract (nausea, vomiting, heartburn,
constipation). The etiology of nausea and vomiting is unclear.
Physiologically, nausea is purported to be related to increased
human chorionic gonadotropin (hCG) levels of pregnancy. The
increased progesterone of pregnancy, which relaxes smooth
muscle, contributes to the discomforts of heartburn and
constipation. The physiologic reason is that the elevated
female sex hormones during pregnancy change the motility of
 the GI tract. Additionally, the enlarging uterus displaces the
bowel.

C. Drugs that Decrease Uterine Muscle Contractility

- Preterm labor (PTL) is labor that occurs between 20 and 37

weeks or pregnancy involving a fetus with an estimated
weight between 500 and 2499 g. Regular contractions occur
at less than 10-minute intervals over 30 to 60 minutes and
are strong enough to result in 2-cm cervical dilation and 80%
effacement. PTL occurs in approximately 8% to 10 % of all
pregnancies.

D. Corticosteroid Therapy in Preterm Labor

- Administration of corticosteroids accelerates lung maturation

with resultant surfactant development in the fetus in utero,
thereby decreasing the incidence and severity of respiratory
distress syndrome.

E. Drugs for Pregnancy-Induced Hypertension (PIH)

- Pregnancy-induced Hypertension (PIH), the most serious

complication of preganancy, can have devastating maternal
and fetal effects. The condition is most often observed after
20 weeks’ gestation intrapartum and during the 72 hours
postpartum. The cause of PIH remains unknown, although
there numerous hypotheses exist. The pathophysiology of
preeclampsia-eclampsia is believed to be related to decreased
levels of vasodilating prostaglandins with resulting
vasospasm.