Female Reproductive Flashcards
Oogenesis
Oogonium (one 2N) --> Primary oocyte (one 2N) arrested in prophase I until ovulation
OVULATION Secondary oocyte (one 1N, one polar body) arrested in Metaphase II until fertilization
FERTILIZATION
Ovum (one 1N and one polar body)
Draw Two cell theory of estradiol production
page 272
Pulsatile GnRH –> FSH and LH secretion
LH stimulates theca cells… Cholesterol converted by desmolase to androstenedione
Androstenedione crosses basement membrane, enters granulosa cell
Granulosa cell is stimulated by FSH
Aromatase converts androstenedione to estrone
Estrone –> estradiol
Steps of female reproductive cycle
- increased FSH
- follicle maturation
- increased estrogen
- negative feedback –> positive feedback
- LH surge triggers ovulation
- Formation of corpus luteum
- increases progesterone (and estrogen) –> negative feedback
- decreased FSH and LH
- Degeneration of corpus luteum
- decreased progesterone and estrogen
- Menstruation, decreased inhibition of FSH
- increased FSH - starts over
Draw reproductive cycle
page 273
Pregnancy steps
Fertilization w/in 1 day of ovulation in ampulla of tube
Implantation 6 days after fertilization
Syncytiotrophoblasts secrete hCG
- corpus luteum maintained
- hCG has same alpha subunit as LH, FSH, TSH - acts like LH on follicle
- hCG in blood 1 week after fertilization, in urine 2 weeks after
Location steps
alveoli –> lobule –> ducts
Suckling stimulates release of:
Prolactin - anterior pituitary –> milk production (secretion)
Oxytocin - posterior pituitary –> milk ejection - alveoli –> ducts
Estrogen and progesterone inhibit milk production
Average age of menarche
just under 12.5 years
Treatment of anovulatory cycles
OCPs
Menorrhagia
heavy, prolonged periods
Metrorrhagia
Frequent, irregular periods
menometrohhagia
heavy, frequent, irregular periods
Oligomenorrhea
more than 35 day cycle, infrequent periods
polymenorrhea
less than 21 day cycles, frequent periods
primary dysmenorrhea
no cause
tx: NSAIDs +/- hormone contraceptives
Progestins
birth control
abnormal uterine bleeding
oppose proliferative effect of estrogen on endometrium
adverse effect - irregular bleeding, wt gain, mood changes
decreased bone mineral density
Estrogens side effects
endometrial hyperplasia
growth of estrogen-responsive cancers
increased risk of DVT, PE
metabolized by P450 - caution with inducers
Side effects of combined estrogen-progestin contraceptives
venous thromboembolism
HTN
MI and stroke
Hepatic adenoma
Risks of paraguard (copper IUD)
uterine perforation
increased risk of PID w/in 3 weeks of insertion
Menopause
avg 51.4 years
under 40 yo = primary ovarian insufficiency
cause: depletion of ovarian follicles
12 mo amenorrhea
Ovaries stop: decreased estradiol, decreased inhibin
no negative feedback: increased GnRH, FSH, LH
Estrone becomes main estrogen
Symptoms of low estrogen levels
“Menopausal Symptoms wreak HAVOC”
Mood change - depression Sleep disturbances Hot flashes - vasomotor sx Atrophy of vagina Vaginal dryness Osteoporosis Coronary artery dz
Menopausal hot flashes
Occur in 75% of menopausal women
Starts in face/chest then generalizes
associated w/ diaphoresis and palpitations, followed by chills and shivering
lasts 2-4 minutes
May cause sleep disturbances
Tx: estrogen replacement > SSRI, SNRI, gabapentin
Herbal tx: soy isoflavones, red clover, black cohosh, vitamin E
Hormone replacement therapy for menopause
Use estrogen + progesterone if uterus present
-unopposed estrogen increases risk of endometrial cancer
For relief of sx, not to prevent chronic dz (CAD, osteoporosis)
Use for only shortest about of time and at lowest dose needed
Avoid if:
Coronary heart dz
active liver dz
Hx of breast cancer, stroke, venous thromboembolism
Vulva cell type
stratified squamous
Labia majora - keratinized
labia minora - nonkeratinized
Vagina cell type
stratified squamous, non keratinized
Ectocervix cell type
nonkeratinized stratified squamous
Endocervix cell type
simple columnar epithelium - mucus secreting
Transformation zone
squamo-columnar junction
metaplastic cells transform columnar –> squamous depending on age and hormonal status
immature squamous cells vulnerable to HPV
majority of cervical cancers arise at squamocolumnar junction
Body of uterus cell type
simple columnar ciliated, secretory
long tubular glands
Fallopian tube cell type
simple columnar, ciliated, secretory
peg cells - resting
ovary cell type
simple cuboidal
Sarcoma botryoides
aka embryonal rhabdomyosarcoma
infants and kids under 5
grape like mass out of vagina
Clear cell adenocarcinoma
rare
DES exposure in utero
mullerian duct anomalies - T shaped uterus
Vaginal adenomas - patches of columnar epithelium in vagina
Squamous cell carcinoma of vagina
HPV 16, 18, 31
Lichen sclerosus
Prepuberty/postmenopausal
Inflammatory condition of vulva - thinning of epidermis
smooth white plaques
lead to shrinking of introits, fusion of labia majora and minora
Sx: pain, pruitis, dyspareunia
dx via bx
Tx: topical corticosteroids
assoc w/ increased risk of squamous cell carcinoma of vulva
Squamous cell carcinoma of vulva
chronic inflammatory condition
HPV infection 16*, 18, 31 –> koilocytosis
coexist w/ cervical cancer
Paget dz of vulva
intraepithelial cancer
adenocarcinoma
10-20% underlying malignancy (100% in breast Pagets)
Cervical dysplasia
can lead to cancer Risk: persistent high risk HPV 16, 18 early coitarche multiple sex partners immunosuppression smoking -impairs immune system OCP use - not protecting against STDs Hx of STDs
Sx: abnormal bleeding esp postcoital vaginal discharge pelvic or LBP bowel and bladder sx ureteral obstruction --> pyelo, uremia, renal failure
HPV mechanisms –> cancer
E6 binds p53 - degrades it
E7 binds Rb, inactivates it
Most squamous cell but some adenocarcinoma
Screening for cervical cancer
Pap - transformation zone
HPV - koilocytes
darkening of cell
HPV DNA testing
CIN 1
mild dysplasia
low grade SIL
bottom 1/3 epithelium
CIN2
Moderate dysplasia
high grade SIL
precancerous
bottom 2/3 epithelium
CIN3
severe dysplasia
high grade SIL
precancerous
throughout epithelium
CIS
full thickness of epithelium involved
next step invasion
Risk of endometrial hyperplasia
Too much estrogen
anovulation - stuck in estrogen dominant phase - PCOS
increaed estrogen production - obesity, granulosa cell tumor
–> endometrial carcinoma
Endometrial carcinoma
MC in US
post menopausal 55-65 yo
prognosis stage 1 80-90%
Present: irregular bleeding or post menopausal bleeding
dx: endometrial bx
Endometritis
inflammation of endometrium
ascending infection
acute: postpartum
Chronic: PID, retained FB
**Plasma cells in endometrium
TX: broad spectrum Abx - gentamycin, clindamycin
Adenomyosis
endometrium extends into myometrium
-enlarged globular uterus tender to palpation
Sx: menorrhagia, dysmenorrhea, dysparenia, pelvic pain
Tx: hysterectomy
Endometriosis
Endometrial tissue found outside uterus
- functional
- -> fibrosis and adhesions
- pain
Sx: dysmenorrhea, pelvic pain, dyspareunia, infertility, dysuria, dyschezia - bowel involved
MC site: ovaries - ovarian cysts filled with old blood - Chocolate cyst
Uterine ligaments bowel bladder lungs bone heart
powder burn implants
Treatment of Endometriosis
NSAIDs, OCPs, progestine
leuprolide - continuous GnRH agonist
Danazol - synthetic androgen –> negative feedback
- Use in endometriosis, fibrocystic breast dz, hereditary angioedema
- SE: acne, hirutism, deepening of voice, wt gain, hot flashes, decreased HDL, hepatotoxicity
Leiomyosarcoma
rare malignant tumor arising de novo from myometrium
rapidly enlarging uterus
Uses of leuprolide
GnRH analog binds GnRH receptors
initial release of FSH, LH, estrogen
Continuous administration down regs GnRH receptors –> decreased FSH, LH, estrogen
–> hypogonadotrophic state
Leiomyomas - shrink prior to surgery
-short term
Endometriosis
Central precocious puberty
Advanced prostate cancer
Infertility
- continuously to suppress intrinsic hormone production during IVF
- given once to induce ovulation
SE: amenorrhea, hot flashes, decreased libido, depression, bone loss
Leiomyomas (Leiomyomata uteri)
MC - 70-80%
Benign tumor of sm.m. of myometrium
Monoclonal
hormonally sensitive - shrink after menopause
Multiple well circumscribed tumors
Histo: whorled pattern of sm.m.
Sx: most asx
- menorrhagia
- dysmenorrhea
- pelvic pressure/discomfort
- acute pelvic pain - twisted on stalk or outgrow blood supply –> degeneration
- infertility
- miscarriage
- urinary frequency
Dx: PE followed by US
-nontender enlarged uterus w/ irregular contours
Tx: hysterectomy or myomectomy
Leuprolide pre-op to shrink
