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PHYS - REPRO > 7. UTERUS, UTERINE TUBES & LUTEAL PHASE > Flashcards

7. UTERUS, UTERINE TUBES & LUTEAL PHASE Flashcards

1
Q

What are the three layers of the uterus lining?

A
  1. Perimetrium - outer layer
  2. Myometrium - muscular layer involved in contractions
  3. Endometrium - shed during menstruation
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2
Q

Describe the changes in the uterus & cervix with age?

A
  • The uterus & cervix grow with height during infancy
  • The uterus of a newborn can be larger than that of a toddler, because the foetus would have been exposed to the high levels of oestrogen in utero, causing proliferation
  • Myometrial growth is dependent on E2 (estradiol)
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3
Q

Describe the growth of the myometrium

A
  • The outer muscular myometrium grows gradually throughout childhood/infancy
  • It grows rapidly during puberty & responds to oestrogen specifically E2
  • The myometrium size changes throughout the menstrual cycle & can grow substantially during pregnancy
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4
Q

What are the three fibres of the myometrium?

A
  1. Inner circular fibres - arranged concentrically
  2. Middle figure 8 or spiral fibres
  3. Outer layer longitudinal fibres
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5
Q

What are the properties of the endometrium?

A
  • Endometrium is very thin in childhood but begins to thicken during puberty
  • Dependent on sex steroids & responds to cyclical hormone changes
  • Most of endometrium is shed during menstruation
  • But the basal layer of the endometrium remains & is covered by an extension of glandular epithelium
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6
Q

What are the two endometrial phases of the menstrual cycle?

A
  1. ENDOMETRIAL PROLIFERATIVE PHASE
  2. ENDOMETRIAL LUTEAL PHASE
    - The two phases are divided by ovulation
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7
Q

What happens during the endometrial proliferative phase?

A
  • The proliferative phase of the endometrium is also the follicular phase of the ovary
  • The endometrium thickens in response to oestrogen in the proliferative phase. The oestrogen is produced by the granulosa cells of the growing follicle
  • When the endometrium is larger than 4mm, progesterone receptors are induced and small muscular contractions of the myometrium occur
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8
Q

What are the 3 changes during the proliferative phase?

A
  1. Stromal cell division occurs producing small, columnar epithelial cells
  2. Glands become tortuous & length
  3. Increased vascularity - formation of new blood vessels (neoangiogenesis)
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9
Q

What happens during the endometrial secretory phase?

A
  • The secretory phase of the endometrium is also the luteal phase of the ovary
  • Progesterone dominates the endometrial phase
  • The gradual rise in progesterone results in decreased cell division but increased differentiation
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10
Q

What 4 changes occur during the secretory phase?

A
  1. Glands increase in size & swell
  2. Glands secrete lipids & glycoproteins
  3. Oedema occurs, increased vascular permeability due to arterioles contracting & becoming tighlty coiled
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11
Q

How does regression of the corpus luteum trigger menstruation?

A
  • The corpus luteum produces progesterone & has LH receptors, so LH is needed to maintain the corpus luteum
  • If fertilisation occurs, the oocyte will form a blastocyst & the blastocyst will produce human chorionic gonadotrophin which binds to the LH receptors, maintaining CL.
  • Maintaining CL, maintains progesterone & the endometrium
  • But if fertilisation doesn’t occur, the high levels of progesterone produced will cause negative feedback causing LH levels to decline
  • The drop in LH will cause the corpus luteum to regress forming the corpus ablicans
  • Progesterone will no longer be produced & progesterone will decline triggering menstruation
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12
Q

Describe the process of menstrual bleeding?

A
  • The decline in progesterone (due to corpus luteum degradation) levels will trigger menstruation
  • As the endothelial cells of the uterus break down, they release inflammatory prostaglandins
  • The prostaglandins cause constriction of the spiral arterioles, leading to hypoxia. The hypoxia leads to necrosis of endothelial cells. The blood vessels then dilate causing bleeding
  • The dying tissue releases proteolytic enzymes
  • Outer layer of endometrium is shed (functional layer), 50% lost in first 24 hours
  • Oestrogen produced by follicles in the next follicular phase will start the cycle again
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13
Q

What are three segments of the uterine tube?

A
  1. AMPULLA - where fertilisation occurs
  2. ISTHMUS
  3. INTRAMURAL PORTION - closest to the uterus
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14
Q

What three histological layers comprise the uterine tube?

A
  1. MUCOSA
  2. MSUCLARIS
  3. SEROSA
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15
Q

What three cell types are found in the mucosa layer of uterine tubes?

A
  1. Secretory cells - secrete growth factors, nutrients & signalling molecules for embryo development
  2. Columnar ciliated epithelial cells - beat to help move oocyte along uterine tube
  3. Non-ciliated peg cells - release a secretion which lubricates tube to protect oocyte
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16
Q

What are the characteristics of the muscularis layer of eth uterine tube?

A
  • Arranged into two layers: inner circular fibres & outer longitudinal fibres
  • Consists of blood vessels & lymphatics
17
Q

What are the characteristics of the serosa layer of the uterine tube?

A
  • Serosa layer is the outer layer containing mesothelial cells
18
Q

What changes occur to the cells of the uterine tube during the follicular phase & ovulation?

A
  • Oestrogen dominates in the follicular phase. Epithelial cells express many oestrogen receptors & undergo differentiation in response to oestrogen
  • When ovulation occurs, the ciliated & secretory cells will have differentiated, so that they can carry out their functions when the oocyte is released
19
Q

What changes occur to the cells of the uterine tube during the luteal phase?

A
  • Progesterone dominates in the luteal phase
  • Progesterone counter-acts the effects of oestrogen such as ciliation
  • After a few days of progesterone exposure, the oestrogen receptors are suppressed
  • The cells decrease in height so that they don’t come in to contact with the oocyte, this helps to prevent late fertilisation
20
Q

What are the consequences of damage to the uterus tube lining?

A
  • Damage to the uterus uterus lining can occur due to infection, surgery, adhesions or endometriosis
  • Consequences:
    1. Pain
    2. Infertility
    3. Ectopic pregnancy
21
Q

Give two ways tubal patency can be tested

A
  • Tubal patency is when the uterine tubes are not blocked
    1. Laparascopy & dye
    2. HyCoSY - Hystero Salpingo contrast sonography
22
Q

Describe the principles of a laparoscopy & dye

A
  • Uterine canula inserted into vagina & a blue dye is inserted.
  • If there are no blockages in the uterine tube, the blue dye will emerge near the fimbriae. But if it’s blocked it won’t show up
  • The blue dye can be visualised with a laparascopy
23
Q

Describe the principles of Hystero-Salpingo contrast sonography

A
  • HyCOSy can be injected into the cervix via the vagina

- It is an opaque dye that can be visualised with ultrasound, so it’s less invasive than a laparoscopy

24
Q

What are the properties of the ectocervix?

A
  • Contains squamous epithelial cells

- Covered with non-keratinised stratified squamous epithelial

25
Q

What physiological changes occur in the cervix during the follicular phase?

A
  • Oestrogen produced in the follicular phase causes changes in the vascularity of the cervix & oedema
26
Q

What physiological changes occur in the cervix during ovulation?

A
  • Oestrogen in the mid-cycle makes the cervical mucus less viscous & permeable to sperm
  • The mucus contains glycoproteins which forms microscopic channels allowing sperm to swim up
27
Q

What physiological changes occur in the cervix luteal phase?

A
  • Progesterone in the luteal phase causes mucus to become viscous & less permeable to sperm
  • The glycoproteins in the mucus from a mesh like structure acting as a barrier to sperm
28
Q

What are the properties of the vagina?

A
  • Thick walled tube approximately 10cm

- Lined with squamous epithelial cells, also contains glycoproteins

29
Q

What are bartholins glands?

A
  • Bartholins glands secrete mucus to lubricate the vagina. They are the equivalent of the bulbo-urethral glands in males
  • Located posterior to & left & right to vaginal opening

PHYS - REPRO (10 decks)

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