Female Repro Anatomy and Physiology

Question 1

Describe Uterine and Ovarian Blood supply.

Describe the location of the ureter in relation to these vessels.

What is the MC positioning of the female reproductive system?

Answer 1

Ovarian artery branches off the abd aorta just below the renal arteries.

Uterine, vaginal, rectal, and internal pudendal arteries branch from the internal iliac artery.

Ureter is under the uterine artery.

MC is Anteverted

Question 2

What is DES? whats special about it?

Answer 2

DES is synthetic estrogen. It was one of the first transplacental carcinogens. May increase pregnancy complications and infertility as well as increased risk of cervical and breast CA. In sons have increased risk of cryptorchidism, hypogonadism, and epididymal cysts.

Question 3

What type of cells make up the mature follicle?

How does LH and FSH act upon these cells(the ones in the last question)?

Answer 3

Theca cells: secrete androgens

Granulosa cells: estrogen producers

LH stimulates secretion of androgens from the theca cells. These androgens are converted to estrogen in the granulosa cells.

FSH stimulates secretion of estrogen by the granulosa cells.

Question 4

How are hormones transmitted from the hypothalamus to the anterior pituitary?

Which menstrual cycle hormone is secreted from the hypothalamus?

Which hormones are secreted from the anterior and posterior pituitary?

Answer 4

The hypophyseal portal circulation (blood vessels)

GnRH is secreted from the hypothalamus

Posterior: oxytocin and vasopressin

Anterior: LH, FSH, Prolactin*, TSH, GH, ACTH, MSH

Question 5

describe the menstrual cycle

Answer 5

initially estrogen creates a negative feedback to pituitray to decrease LH and FSH. In late follicular stage, peak estradiol levels from the dominant follicle trigger a mid cycle surge of LH needed for ovulation and preparing ovary to make progesterone.

WIth ovulation, the dominant follicle becomes a progesterone secreting cyst called the corpus luteum and the luteal phase begins.

Progesterones negative feedback on pituitary secretion of LH and FSH causes decreassing estradiol and progesterone

If no conception, the lifespan of the corpus luteum is 9-11days, after this the progesterone levels fall and the menstrual period and sloughing of the endometrium is triggered. Since progesterone levels are falling the negative feedback for FSH secretion stops and FSH levels start to rise before onset of menses.

if implantation occurs HCG (human chorionic gonadotropin) from the zygote sustains the corpus luteum for 6-7wks until the placenta takes over.

Question 6

Estrogen effects of each of the following:

• breast
• endometrium
• cervix
• vagina
• bone
• brain

Answer 6

Breast: pubertal development

Endometrium: stimulates cell growth

Cervix: stimulates abundant clear mucus at mid cycle

Vagina: growth and maturation of epithelium, lubrication

Bone: helps maintain bone density (estrogen receptors in osteoblast)

Brain: estrogen receptors on the brain….

Question 7

WHat are the effects of Progesterone on the female reproductive system?

Answer 7

Thermogenic effects

Cervical mucus thickens and decreases in amount

Breast: stimulation of ducts, nipple and areola contributes to fullness and tenderness

Fallopian tubes: decrease mucus and cause relaxation to speed transport of ovum.

Question 8

WHat are some ways you can determine if you have ovulated?

Answer 8

Track length of mestrual cycles ( if your menstrual period started today you could count backwards 12-14 days and that’s when you would have ovulated in a classic 28d cycle.)

serial transvaginal US to follow follicular development from dominant follicle to corpus luteum

Measure LH surge: ovulation 36hrs after LH surge, LH will show up in urine 12hrs after surge (so you know you will ovulate in the next 24hrs)

Basal body temp rises 0.5-1.0 degree F

Measure serum progesterone at mid luteal phase (expect greater than 6ng/ml)

Question 9

What is Thelarche?

Breast composition

Which hormones cause breast development when pregnant?

What inhibits milk production during pregnancy?

Answer 9

Thelarche = onset of breast development, MC at 12.5YO

Breast composition:
-nipple, areola, milk glands, ducts, CT, fat

estrogen, progesterone, prolactin

Progesterone inhibits milk production.

Question 10

What hormones stimulates Milk production? ejection?

Answer 10

production = prolactin 
ejection = oxytocin

Question 11

Menstrual cycle:

• duration
• what are the 2 phases?
• what is considered to be day 1?
• age of menarche

Answer 11

duration 24-35d

2 phases = follicular and luteal phase

Day 1 = first day of menses AND the date of LMP.

Menarche 12.5YO

Question 12

Puberty;

• what is the predictable sequence of events?
• onset can be influenced by?

Answer 12

growth acceleration

breast development

pubic hair development

maximal growth rate

menarche

ovulation

ONSET:

• ethnic background (African then mexican then white then asain)
• BMI: higher = earlier onset of puberty
• genetics
• environmental toxins acting as endocrine disruptors

Question 13

What is considered delayed puberty?

Answer 13

absent or incomplete sexual maturation by age at which 95% of girls started pubertal development:

• absence of 2ndry sexual characteristics by age 13
• absence of menarche by age 15-16
• no menarche 5yrs after onset of thelarche

Question 14

What is precocious puberty?

-cause

Answer 14

onset of 2ndry sexual characteristics before age 6 in black girls and prior to age 7 in white girls.

Cause: early sex hormone production.

GnRH dependent: early activation of the HPO with both breast and pubic hair development

GnRH independent:

Question 15

Menopause:

• def
• dx
• median age
• SE

Answer 15

def: permanent cessation of menses. Depletion of follicles, oocytes resistant to FSH.

Dx:
-no period for 12mo without other explanation.

Median age is 51.4YO

*Can never declare menopause based upon 1 FSH level.

SE: d/t estrogen loss.

• urogenital atrophy
• increase in LDL and decrease in HDL
• decreased bone density
• vasomotor sx (hotflashes)