Drugs in Gynaecology😍

Uterotonics

• Recommended by WHO:
• Oxytocin:
• t 1/2 = 3 mins
• DOC for AMTSL
• DOC for PPH
• No IV Bolus
• Hypotension on IV bolus
• S/E:
• Water Intoxication
• ADH like action

• If Oxytocin is unavailable, the following can be given:
• Methylergometrine (Methergine):
• 0.2 mg IM
• Never given IV (can lead to hypertension)
• Used in AMTSL, PPH
• NOT IOL
• Avoid in
• Cardiac and hypertensive patients,
• Twins, Rh negative, HIV positive mother on PIs, PVD
• NOTE: After delivery of 1st twin → Methergine can be given
• Mnemonic: Methyl kidathath are? → Rich people, tension people, cardiac patients, twins ne
• For IOL
• Misoprost (PGE 1):
• Can be given in asthma

Uses	Doses	ㅤ
MTP T1	800 mcg	ㅤ
MTP T2	400 mcg every 3 - 4 hrly (max: 6 doses)	ㅤ
IOL	Tab. 25 mcg Q4H P/V (max: 6 doses)	Not given in Prev CS for IOL
AMTSL	600 mcg Oral	ㅤ
PPH	800 - 1000 SL or PR	ㅤ

• Misoprost
• Baby miss (Abortion) avumbo misoprost
• Baby Miss avumbo Fever and hypotension
• WHO recommends misoprostol distribution to pregnant females
• To prevent PPH.
• S/E: Fever with chills

• Dinoprostone (PGE2):
• Only for IOL
• Time gap with Oxytocin = 6 hrs
• Maximum does: 3
• Cerviprime: Gel 0.5 mg Q6H (max: 4 doses).
• Cervidil: 10mg dinoprostone placed in posterior vaginal fornix (Slow release).
• NOTE: Dinoprost (Carboprost/ Hemabate): PGF2α
• S/E: Hyperstimulation
• Only as gel

• Syntometrine:
• Fixed dose combination of
• 5 IU oxytocin and 0.5 mg methyl ergometrine
• NOT GIVEN FOR PPH
• Carbetocin:
• Synthetic oxytocin with longer T½
• 100 mcg slow IV
• NOT GIVEN FOR PPH
• C/I: Asthma

• Note: 
• Dinoprost/Carboprost/ Hemabate
• PGF2α is used for management of PPH
• Not for AMTSL
• C/I: Asthma
• S/E: Diarrhea
• MgSO4

Drugs for Endometriosis/Dysmenorrhea

• Hyperestrogenic condition:
• Rx aims to decrease estrogen

• Minimal–mild:
• 1st line: NSAIDs/OCPs.
• 2nd line: Progesterone (downregulates estrogen receptor).
• 3rd line: GnRH continuous.
• If no relief: Laparoscopic management.

• Moderate–Severe:
• 1st line: Continuous GnRH.
• If no relief: Laparoscopic management.

Estrogen

• Synthetic
• EE
• CEE

• Physiological
• E1, E2, E3

Potency

• Ethinyl Estradiol (EE) >

• Conjugated Equine Estrogen (CEE) >

• Estradiol (E2) >

• Estrone (E1) >

• Estriol (E3)

Common Estrogen Types

Low Estrogen

• POI

• Menopause

• Gonadal dysgenesis

• Sheehan’s Syndrome

• Kallman’s syndrome

Progesterone challenge test is Negative

• If Low Estrogen
• Progesterone can only act on Estrogen primed endometrium

• Normal Estrogen
• Ascherman syndrome
• d/t no endometrium

• [Positive in PCOS]

• Tocolytics
• Nifedipine
• Indomethacin if < 32 weeks
• ≥ 32 weeks → PDA closure
• Atosiban
• Oxytocin Receptor antagonist
• Preferred with heart diseases
• Ritodrine
• β₂ agonist (tocolytic drug)
• → Inhibits uterine contractions
• Avoided in Diabetic Pregnancy
• they cause hyperglycemia, hypokalemia
• Terbutaline
• Only 1 dose
• Preferred for ECV

• C/I for Tocolysis
• Preferred method is Vaginal delivery
• Abruption
• Eclampsia
• Chorioamnionitis

• Hair growth in male pattern + Alopecia + Acne.

• Excessive hair growth in androgen-dependent areas in females.

• Conversion of vellus hair to terminal hair (opposite of AGA).

• Seen in: Increased Androgen.
• PCOS
• Congenital adrenal hyperplasias
• Virilizing tumors
• SAHA syndrome
• Idiopathic

• Androgens in Females
• Mild increase: Hirsutism.
• Excessive increase: Virilisation.

• Score: Ferriman-Gallwey scoring. ( ≥8 ).

• Rule out hyperandrogenism

• 1st line: 
• OCP: DOC.
• leading to ↓↓ Androgen,
• Use for 6 months
• If not relieved →
• Anti-androgens 
• Add Spironolactone + OCPs
• spironolactone is antiandrogenic → can affect external genitalia of a male fetus in case of conception → Hence OCPs are added in reproductive age group.

• Alternative:
• Flutamide.
• Finasteride.
• Ketoconazole.
• Cyproterone acetate.

• Topical: Eflornithine.

• Last resort: Continuous GnRH (decreased LH & FSH).

• Most important: 
• Laser hair reduction.
• Lasers:
• Diode
• long pulsed Nd:YAG laser.

• Mnemonic: Ocinu Ferriyil (Ferriman gellaway score) keetti → Spiral (Spironolactone) shape il odich → Flooril (Eflornithine) kidathi → Fine (Finasteride) Flute (Flutamide) keetti → Last continuous (Continuous GnRH) cheythu

Note

• Drug not used for hirsutism: Danazol (Causes hirsutism).

Female with Hirsutism:

• Check testosterone levels (Next step)



1. Normal: Idiopathic.
2. 70 - 200:
• PCOS.
• Late onset CAH.
3. ≥ 200:
• CAH.
• Androgen secreting tumour in ovaries.

• M/C cause of hirsutism in young:
• PCOS.

• M/C cause of rapid onset hirsutism in young females:
• Androgen secreting tumour of ovaries.

• 1st line D's which decrease bleeding but NOT size of fibroid:
1. Tranexamic acid.
2. OCP → Cause anovulatory cycles → So ↓↓ estrogen
3. Progesterone.
• Size of fibroid is dependent on both estrogen and progesterone
• So size of fibroid doesn't ↓↓

• 2nd line D's which decrease size of fibroid & bleeding:
• Drugs Decrease Estrogen
1. Letrozole (Androgen to Estrogen).
2. Danazole (S/E: Hirsutism).
3. GnRH analogues (Continuous).
4. GnRH antagonist.
• Drugs Decrease Progesterone
1. SPRM: Selective Progesterone Re-uptake modulator.
• Ulipristal
• Most effective hormonal emergency contraception
• Order: CuT > Ulipristal
• 30mg SD upto 5 days
2. Progesterone antagonist:
• Mifepristone (RU 486: medical abortion).
• Mnemonic: Fibroid → bleeding olla female → Let (Letrozole) the girl (GnRh continuous, antagonist) dance (Danazole) Pristine (Ullipristal, Mifepristone)