There are sometimes predictable side effects. GnRH agonists, for example, may be used to lower oestrogen as part of treatment of fibroids or endometriosis; low oestrogen levels are associated with menopausal symptoms.

Progesterone is a precursor (precedes in the chemical pathway) of the glucocorticoids and mineralocorticoids (adrenal gland steroid hormones) as well as of the sex steroid hormones. There is a great deal of chemical similarity (Figure 2.5) between the adrenal steroids, and the sex hormones - progesterone, androgens (male hormones e.g. testosterone) and the oestrogens (female hormones e.g. oestradiol). The adrenal steroids play a critical part in body protection and fluid balance. Hormones prescribed in anticipation of their action on one set of receptors, may also activate other receptors leading to side effects. Progestogens, for example, and particularly norethisterone, may have androgenic side effects. Fluid retention (an adrenal steroid effect), may be a side-effect of sex hormone (oestrogen and progesterone/progestogen) administration.

One Sunday morning, in the early hours, I received a telephone call from a distressed patient. She was infertile due to anovulation (infertility cause) and I had prescribed an appropriate drug to help her. She had been terrified to read in the patient information leaflet accompanying the tablets that the drug should not be taken within six weeks of trying for a pregnancy. I reassured her that the medication was licensed for the treatment of infertility. The following day, I confirmed that she had correctly read the information leaflet and I wrote to the company concerned re questing an explanation. They kindly forwarded summaries of many medical papers, including one of my own, demonstrating that it was a safe and effective drug in the management of infertility cases.

Following my second letter, they agreed that the information leaflet was misleading to patients and they would consider altering it. It is surprising how misleading pharmaceutical data sheets supplied by the companies manufacturing medications can be (Q 28.27) .

 

The list of  Warnings, precautions and side effects? relating to most drugs is such that many patients who read them become understandably anxious. When compiling these lists, the pharmaceutical companies are indicating problems that have been reported by patients whilst taking the medication. The fact that a patient reports a problem whilst taking a medicine does not necessarily mean that the drug was the cause of the problem; it may have been incidental. Both weight gain and weight loss have been reported by patients taking hormone replacement therapy (Q 28.22). Of course some patients lose weight and others gain but this is unlikely to be related to this treatment everyone's weight fluctuates. Some complications may be extremely rare but for the sake of completeness the company concerned may feel obliged to include them as potential problems. Information which the company provides for patients can occasionally be incorrect or misleading (Q 28.27).






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