female reproduction Flashcards
what is the hormone:
development of breast + ductal system
stimulate ENDOMETRIAL PROLIFERATION
growth of female internal genitalia: ovaries, fallopian tubes, uterus, vagina
growth of female external genitalia
stimulate bone growth (inhibit osteoclast activity)
↑HDL, ↓LDL
estrogen
types of estrogen in body
estradiol (ovary, most potent)
estrone (converted from androgens in adrenal cortex to estrone via aromatase in adipose tissue, males/females)
estriol (placenta, least potent)
what is the hormone:
inhibit endometrial proliferation
promotes SECRETORY CHANGES in endometrium (prepare for implantation)
produces thick cervical mucus (inhibit sperm entry into uterus)
smooth muscle relaxation (incl uterus - prevent ctx + miscarriage)
secretory changes in breast (prepare for milk production)
progesterone
what is made by the syncytiotrophoblast of placenta
bHCG
most common location of fertilization
ampulla of fallopian tube
bHCG (from synctiotrophoblasts) is detectable after a pregnancy when:
blood: 1 week after conception
urine: 2 weeks after conception
implantation occurs
6 days after fertilization
fertilization must occur within
1 day after ovulation
role of syncytiotrophoblast and its bHCG secretion
prevent CL degeneration → maintain estrogen + progesterone levels
when does the placenta become the main source of estrogen (estriol) + progesterone
6 wks (no longer CL)
what inhibits lactation during pregnancy
↑ progesterone + estrogen from the placenta
once placenta removed: ↓ estrogen + progesterone → lactation
prolactin + oxytocin are both stimulated by
suckling
made by anterior pituitary
induces milk production
prolactin
released by posterior pituitary
induces milk let down (into the ducts)
oxytocin
α subunit of HCG is similar to
LH, FSH, TSH
protective against enodmetrial cancer
progesterone
primary oocyte is arrested in
prOphase I (until Ovulation)
secondary oocyte is arrested in
metaphase II (until fertiization)
> 35 day cycle
oligomenorrhea
polymenorrhea
frequent, irregular periods
metrorhagia
heavy or prolonged (>7 days) periods
menorrhagia
heavy, frequent, irregular periods
menometrorrhagia
painful periods with unknown cause
1° dysmenorrhea
painful periods due to endometriosis or fibroid
2° dysmenorrhea
sexual development of female
breast buds form → pubic hair → menarche → may have anovulatory cycles within first few years (irregular periods)
tx of anovulation few years after menarche
OCP
check pregnancy test first!
treatment of 1° dysmenorrhea
NSAIDs
+/- hormonal contraceptive
use of hormonal contraceptives
dysmenorrhea
dysfunctional retinue bleeding
PCOS
MOA of hormonal birth control
progestin +/- estrogen → negative feedback to pituitary + hypothalamus →↓ FSH/LH release → no LH surge → prevent ovulation
SE of estrogen
endometrial hyperplasia → can progress to endometrial cancer
growth of ER+ cancer (breast cancer)
↑ risk of venous thromboembolism (DVT, PE)
metabolism of estrogen (in birth control pill, HRT) is by
cyp450 potential for drug-drug interactions - drugs that induce P450 and enhance estrogen metabolism (ineffective birth control, HRT): Guinness, Coronas, PBRS, induce chronic alcoholism Griseofulvin Carbamazepine Phenytoin Barbiturates Rifampin - tx for latent TB St. John's wart chronic alcoholism
use of progestin
birth control (alone or with estrogen) abnormal uterine bleeding oppose estrogen proliferative effect on endometrium - used in women receiving estrogen replacement who still have a UTERUS (protect uterus from endometrial cancer)
SE of progestin
irregular bleeding (esp when used alone)
contraceptive that can cause hepatic adenoma
OCP
contraceptive that can cause ↓ bone mineral density
DMPA injection - depo provera
menopausal symptoms
↓ estradiol production in ovaries produce S/S: Menopausal Symptoms wreak HAVOC Mood changes - depression Sleep disturbances Hot flashes Atrophy of vagina → Vaginal dryness Osteoporosis Coronary artery disease (↑ risk)
diagnosis of menopause
12 months of amenorrhea
labs once in menopause
ovaries stop producing: estradiol, inhibin →↑ GnRH, FSH, LH
permanent cessation of menstruation due to decline in number of ovarian follicles
onset: 51 yrs
menopause
menopause before 40 yo
premature ovarian failure
predominant estrogen in post-menopausal women
estrone: androgen (from adrenal cortex) converted to estrone by aromatase in adipose tissue
sudden onset of heat in face/chest → periphery
associated with diaphoresis, palpatations
followed by chills, shivering
lasts 2-4 minutes
may disturb sleep
hot flashes
treatment of hot flashes
HRT (estrogen) better than SSRI, SNRI, gabapentin
herbal: contain estrogen (avoid in breast cancer)
use of HRT
relieve menopausal symptoms - not to prevent CAD, osteoporosis
use for shortest time possible, lowest dose (
contraindications for HRT
CAD
active liver disease
history of breast cancer, stroke, VTE
using HRT in women with a uterus
estrogen + PROGESTERONE (protective)
unopposed estrogen increases risk of endometrial cancer
differential diagnosis of 1° amenorrhea
turner syndrome (most common) imperforate hymen androgen insensitivity syndrome mullerian duct agenesis delayed puberty
