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Pathophys > Female Repro Phys > Flashcards

Female Repro Phys Flashcards

1
Q

where is the germinal epithelium located? what develops from this layer

A

the outer surface of the ovary where the primordial ova develope

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2
Q

What is the function of the granulosa cells

A

1-keep the ova nourished

2-secrete oocyte maturation inhib factor to prevent egg from further development

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3
Q

how do granulosa cells form

A

they form when a ovum colleccts a layer of spindle cells from the ovarian stroma

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4
Q

what is a primordial follicle

A

ovum surrounded by a single layer of granulosa cells

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5
Q

what is adrenarche

A

activation of the adrenal cortex

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6
Q

what is gonadarche

A

activation of the gonads by FSH and LH

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7
Q

what is pubarche

A

appearance of pubic hair

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8
Q

what is thelarche

A

appearance of breast tissue

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9
Q

what is menarche

A

onset of first menstrual period

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10
Q

what are the 5 tanner stages

A

Stage 1: prepuberty, no palpable breast tissue, no pubic hair

Stage 2: development of a breast bud, enlargement of areolar diameter, sparse, straight hair along lateral vulva

Stage 3: enlargement of the breast without separation of areolar contour from the breast, hair darker, coarser and curlier

Stage 4: areola and papilla project above the breast, pubic hair is adult like

Stage 5: recession of the areola to match contour of the breast, pubic hair is adult like

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11
Q

when does menarche begin

A

Menarche begins approx 2.6 years after onset of puberty

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12
Q

what causes the initiation of puberty

A

inc leptin production from adipocytes= pulsatile GnRH release from hypothalamus= FSH/LH release from ant pit= estrogen/progesterone from ovaries

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13
Q

What is theorized to have a effect on pulsatile GnRH

A

dec GABA

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14
Q

how does nutrition affect age of puberty

A

anemia will delay start

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15
Q

what is the typical age of 1st menstrual cycle

A

11-15yo

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16
Q

what occurs bt spikes of GnRH release?

A

slight GNRH levels= slightly elevated estrogen and inhibin levels= inhibition of ant pit release of FSH/LH

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17
Q

what occurs at the spikes of GnRH release?

A

High GnRH levels= high estrogen levels(bc ovum releases it)= stimulates ant pit to cause LH/FSH surge=ovulation

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18
Q

what is the corpus luteum

A

the remainder of the follicle after ovulation. It has granulosa cells that produce estrogen and progesterone to inhibit GnRH release

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19
Q

how long does the corpus luteum last

A

several days

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20
Q

what is the typical duration of the menstrual cycle

A

28 days (20 to 45 days)

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21
Q

what occurs during the follicular phase and when does it occur

A

The follicle is developing (ie proliferative phase). It begins with onset of menses, ends on day of LH surge(ovulation). ave= day1-15

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22
Q

what occurs during the luteal phase and when does the luteal phase occur

A

Luteal phase= formation of corpus luteum. It begins on the day of LH surge and ends at onset of next menses. (the secretory phase). ave=13 days

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23
Q

when does menstration occur

A

during the follicular phase

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24
Q

what is the typical length/volume of flow during menstration

A

2-6days, <60ml

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25
Q

what phase is typically affected if abnormality in length of menstrual cycle

A

the luteal phase length has less variation so the follicular phase is affected more.
short cycle= dec growth
long cycle= overgrowth

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26
Q

what hormones drive the follicular phase? what is their effect?

A

mainly FSH, small LH effect
FSH accelerates follicle growth(6-12 primary follicles) by
1) increasing layers of granulosa cells= inc estrogen in the antrum
2) formation of the theca cells

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27
Q

what is the role of the theca interna

A

important in hormone production. produces androgens which are converted to estrogens

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28
Q

what is the role of the theca externa

A

it is the capsule of the follicle to give structure/strength

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29
Q

why is it important that estrogen is fat soluable

A

it allows it to leave the ovum’s antrum to inc estrogen levels= stimulate ant pit LH surge

30
Q

what causes the accelerated growth of the follicular phase

A

Estrogen: secreted into follicle causes granulosa cells to increase number of FSH receptors on granulosa cells
Causes positive feedback effect making granulosa cells more sensitive
FSH + Estrogen: Increases LH receptors on granulosa cells allowing LH stimulation to occur in addition to FSH
Estrogen and LH: Proliferation of Theca cells

31
Q

why do only 1-2 eggs develope and release each cycle out of the 6-12 primary follicles

A

high levels of estrogen(from theca and granulosa working together)=suppression of FSH=atresia

32
Q

when does the LH surge occur

A

2 days prior to ovulation

33
Q

how does the LH surge cause ovulation

A

1)prostaglandin endoperoxide synthase causes a pseudoinflammatory response causing rapid swelling of the follicle
2)Prostaglandins E and F release proteolytic enzymes cause weakening of the follicle wall
=formation of stigma(nipple like protrusion of follicle)= bursts

34
Q

how do low dose progesterone BCP work

A

thickening of the cervical mucous to prevent sperm motility

35
Q

how do high dose progesterone BCP work

A

suppress ovulation in addition to cervical mucous thickening

36
Q

what is Mittelschmerz

A

pain w/ ovulation

37
Q

what do the granulosa and theca interna cells produce in the luteal phase

A 
Granulosa cells produce
-Progesterone and Estrogen
Theca interna cells produce
-Androgens
-Androstenedione
-Testosterone
Androgens converted to estrogens by granulosa cells by aromatase
38
Q

what enzyme is in granulosa cells that convert androgens to estrogens? What activates it?

A

aromatase

activated by FSH binding to granulosa cell

39
Q

why is there a spike of progesterone in the luteal phase

A

the LH surge causes the theca and granulosa cells to both produce so much progesterone that the aromatase cant convert it all (some does get converted so estrogen also spikes post ovulation)
(Almost all progesterone is converted to estrogen during the follicular phase)

40
Q

what is the effect of lutein cells(corpus luteum) also secreting inhibin inaddition to estrogen and progesterone

A

Estrogen/ progesterone/ inhibin secreted by corpus luteum all have feedback on AP to maintain low secretory levels of FSH and LH. Low FSH and LH cause corpus luteum to degenerate.

41
Q

what causes the corpus luteum to keep producing estrogen and progesterone during pregnancy instead of dying off

A

Hcg (acts like FSH)

42
Q

how is estrogen removed from the body?

A

Liver conjugates estrogens and 1/5th is excreted in bile and remainder in urine. Decreased liver function —–increases estrogen levels.

43
Q

how is estrogen transported in the body

A

transported in the blood either freely or bound to plasma proteins

44
Q

what occurs if females lack granulosa cells

A

androgens cannot be converted to estrogens

45
Q

what occurs if females lack granulosa cells

A

progesterone cannot be converted to androgens (so granulosa cells cannot convert androgens to estrogen)

46
Q

what are the 3 types of estrogen? what is the most potent?

A

Beta estradiol
estrone (1/12 potency)
estriol (1/80 potency)

47
Q

how is progesterone degraded

A

liver

48
Q

what happens to hormone levels during luteal phase

A

Progesterone & Estrogen (neg. FB)
Decrease FSH & LH from anterior pituitary
Inhibin also inhibits FSH

Decrease FSH & LH
Cause corpus luteum to degenerate
Decreases production of Estrogen and Progesterone

Decrease Estrogen and Progesterone
Increase FSH & LH

49
Q

what is inhibins effect on FSH

A

inhibin inhibits FSH

50
Q

why does the corpus luteum degenerate during the luteal phase?

A

dec FSH and LH from ant pit causes corpus luteum to degenerate

51
Q

what is the generalized organ response to estrogen? what organs?

A

estrogen is a proliferative hormone= organs inc in size(Ovaries, fallopian tubes, uterus, and vagina)

52
Q

what is estrogens effect on the uterus

A

Within 2 years: uterus increases 2-3 fold

Proliferation of stromal tissue and glands.

53
Q

what is estrogens effect on fallopian tubes

A

Proliferation of glandular tissues

Proliferation of ciliated epithelial cells (with increased activity

54
Q

what is estrogens effect on the external genitalia

A

deposition of fat in mons pubis and labia majora with enlargement of labia minora

55
Q

what is estrogens effect on vaginal epithelium

A

Vaginal epithelium changes from a cuboidal into a stratified epithelium (more resistant to trauma and infections)

56
Q

how can you cure vaginal infections in children

A

give estrogen therapy bc Vaginal epithelium changes from a cuboidal into a stratified epithelium (more resistant to trauma and infections)

57
Q

what is estrogens effect on breasts

A

Development of stromal tissues of breast
Growth of extensive ductile system
Deposition of fat in breast tissue
Lobules and alveoli of breast develop a little under estrogens but progesterone and prolactin ultimately determines growth and function of these structures

58
Q

what is estrogens effect on the skeleton

A

Inhibits osteoclastic(=inhibit bone break down) activity

Unites the epiphyses with the shafts of long bones= stops growth

59
Q

how does estrogen affect osteoprotegerin(osteoclastogenesis inhibitory factor)

A

it stimulates it to inhibit bone resorption

60
Q

what is the generalized organ response to progesterone

A

promotes secretory changes

61
Q

how does progesterone effect the uterus

A

Increase secretory changes preparing uterus for implantation.
Decreases the frequency and intensity of uterine contractions (prevents expulsion of the implanted ovum.

62
Q

how does progesterone effect the fallopian tube

A

Promotes secretion (thick mucous)

63
Q

how does progesterone effect the breast tissue

A

Promotes development of the lobules and alveoli

64
Q

what is the uterine response in the follicular phase

A 
(estrogen Phase)
Endometrium proliferates
Growth of endometrial glands
New blood vessels
Cervical mucus is thin/stringy to help sperm motility
65
Q

what is the uterine response in the luteal phase

A 
(Progesterone and estrogen phase)
Estrogen increases proliferation
Progesterone stimulates glands in the uterus.
-Nutrients
-“uterine milk”
66
Q

what occurs during the luteal phase if implantation occurs

A

Trophoblastic cells digest endometrium and absorb nutrients.

67
Q

what prevents blood from clotting during menses

A

fibrinolysin(plasmin) is released from necrotic endometrium

68
Q

what is the definition of menopause

A

1-obsolescence of ovaries
2- no estradiol production,
3-ova only occasional secondary follicle
4-few primary follicles

69
Q

what is the average age of menopause

A

51

70
Q

what blood test can confirm menopause

A

high LH and FSH levels

71
Q

how does menopause affect estrogen, inhibin, LH, FSH

A

reduction in estrogen, low levels of inhibin,
no negative feedback of LH and FSH; therefore, high levels
LH and FSH

72
Q

can estrogen be given for bone health

A

yes but it should not be use if cardio/Ca risk

Pathophys (15 decks)

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