female reproductive physiology Flashcards by Evie withington

main female reproductive organs

ovaries containing ovarian follicles
fallopian tube 
uterus - body
cervix - opening of the uterus into the vagina
vagina

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structure of ovaries

surface

cortex and medulla

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describe the surface structure of the ovary

connective tissue capsule covered with layer of simple cuboidal epithelium

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describe the cortex of the ovary

peripheral part

connective tissue containing ovarian follicles

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what is an ovarian follicle

one oocyte surrounded by single layer of cells

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describe the medulla of the ovary

central part

connective tissue with blood vessels supplying the ovary

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what are the 2 main functions of the ovary

oocyte production

steroid hormone production

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oocyte production in the ovaries

one mature egg per menstrual cycle
~400 ovulated during entire reproductive lifespan
majority of eggs perish during the cycle
finite number, decreases with increasing age - starts at ~30y/o

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steroid hormone production in the ovaries

oestrogen develops and maintains female 2y sexual characteristics
progesterone prepares endometrium for implantation
50% of testosterone produced by ovaries before menopause

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when does primordial germ cell mitosis occur

fetal life only

primordial follicles arrested in the stage of 1st meiotic division until puberty

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meiotic division of germ cells

1st meiotic division complete and 2nd division starts after puberty and leads to release of 1 2y oocyte in a menstrual cycle which is capable of fertilisation

2nd meiotic division completes after fertilisation of oocyte with sperm

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describe the process of oogenesis

mitosis before birth
FSH, LH secretion at sexual maturity
early 1y follicle –> 1y follicle –> 2y follicle
1st meiotic division now completed
2y meiotic division starts 2y follicle –> graafian follicle containing 2y oocyte
corpus luteum
if no fertilisation –> corpus albicans

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follicular development stages

primordial follicles
primary follicle
2y follicle
3y/graddian follicle

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what is a primordial follicle

1y oocyte arrested in 1st meiotic division surrounded by 1 layer of squamous pre granulosa cells

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what is a 1y follicle

oocyte surrounded by zona and cuboidal granulosa cells

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what is a 2y follicle

increased oocyte diameter and multiple layer of granulosa cells
resumption of 1st meiotic division

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what is a 3y/graffian follicle

follicular fluid between the cells which coalesce to form antrum (fluid filled space)
completion of first meiotic division to form 2y oocyte and start of 2nd meiotic division

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chromosomal division during oogenesis

oogonium - 2n (46)
mitosis
primary oocyte - 2n

PUBERTY 
meiosis continues
2y oocyte - 1n larger (arrests in metaphase 2), 1n polar body smaller (no use)
ovulation, sperm entry - 1n 
meiosis, fertilisation
fertilised egg - 2n

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endocrine control of female reproductive axis

hypothalamic-pituitary-ovarian axis

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hypothalamic-pituitary-ovarian axis

hypothalamus releases GnRH
GnRH acts of anterior pituitary which releases FSH and LH
FSH and LH act on the ovary
ovary releases oestrogen and progesterone which both act on the uterus to coordinate the menstrual cycle

positive and negative feedback in the hypothalamic-pituitary-ovarian axis

oestrogen released by the ovary has +ve feedback on anterior pituitary and hypothalamus during day 12-14 to increase GnRH and FSH+LH release

oestrogen and progesterone have -ve feedback on hypothalamus and anterior pituitary for most of the cycle to reduce GnRH and FSH+LH release

what is the purpose of the +ve feedback in the hypothalamic-pituitary-ovarian axis

aids with mid-cycle ovulation

the ovarian cycle

first 1/2 (follicular stage) - FSH and LH released and levels increased
follicular development starts - 2y follicle to antral follicle stage
FSH levels stays relatively static, small peak mid cycle
during the 1st 1/2 oestrogen is produced which causes follicular development

+ve feedback of oestrogen as it reaches its peak results in LH surge mid cycle –> ovulation

luteal phase (2nd 1/2)
if a pregnancy doesn’t occur the follicle –> corpus luteum
rise in progesterone to prepare the lining for pregnancy after ovulation and oestrogen drops
w/o pregnancy the corpus luteum dies, oestrogen and progesteone drop and the lining is shed

follicular phase of the ovarian cycle

FSH causes follicle to mature and produce oestrogen - inhibits development of other follicles

ovulation phase of ovarian cycle

LH surge causes ovulation | follicle ruptures and releases 2y oocyte

luteal phase of ovarian cycle

ruptured follicle forms a corpus luteum and secretes progesterone and some oestrogen

menstruation phase of the ovarian cycle

if a pregnancy hasn't resulted the corpus luteum degenerates and forms a corpus albicans new ovarian cycle can begin

menstrual cycle - endometrial development

day 1 - thin endometrium due to bleeding cycle progresses with increasing oestrogen, endometrium starts to thicken reaches a certain thickness mid cycle progesterone secretion causes changes in the blood vessels day 28 - max thickness, if no pregnancy, lining is shed

what does oestrogen cause in relation to the endometrial lining

thickening of the lining

what does progesterone cause in relation to the endometrial lining

changes in the vasculature | also adds to the thickness

what is the name given to the changes in the endometrial lining caused by oestrogen and progesterone

decidualisation - changes to the endometrium in preparation for pregnancy

ovarian and menstrual cycle together

1. pituitary releases LH and FSH causes ovarian cycle - divided into follicular and luteal phase 2. ovary produces oestrogen and progesterone - oestrogen dominant in first 1/2 for the follicular phase and progesterone dominant in the luteal phase 3. these cause resulting changes to the endometrium during the menstrual cycle 4. at the end if there is no pregnancy, the endometrium is shed and a new cycle begins

which part of the pituitary releases LH and FSH

define amenorrhoea

no periods 1y or 2y 2y is where they have started then stopped for 6mths or more

reasons for amenorrhoea

problem with regulating hormones - low FSH/LH, high prolactin (hypogonadotropic hypogonadism) problem with ovarian function problem with uterus or outflow tract

causes for problems with regulating hormones

``` functional chronic medical conditions intracranial space occupying lesion infection or trauma drugs genetic ```

functional causes for problems with regulating hormones

XS weight loss/gain over exercising stress

chronic medical conditions - causes for problems with regulating hormones

DM sarcoidosis renal disease TB

intrancranial space occupying lesions - causes for problems with regulating hormones

prolactinoma tumours cysts

infection/trauma causes for problems with regulating hormones

meningitis intracranial bleed Sheehan's

drug causes for problems with regulating hormones

glucocorticoids anabolic steroids opioids

genetic causes for problems with regulating hormones

Kallmann's syndrome

causes for problems with ovarian function

hypergonadic hypogonadism - high/normal FSH/LH ``` genetic ageing POI/POF chronic illness - AI radio/chemotherapy infection - TB, mumps oophoritis ```

genetic causes for problems with ovarian function

Turner's syndrome | 46X, fragile X

ageing causes for problems with ovarian function

steep decline in ovarian function past 35y/o

problems with uterus or outflow tract

congenital | iatrogenic

congenital causes for problems with uterus or outflow tract

absent uterus, vagina - lack of mullerian duct development (MRKH syndrome) transverse vaginal septum or imperforate hymen - Mullerian duct fail to canalise androgen insensitivity syndrome

iatrogenic causes for problems with uterus or outflow tract

uterine adhesions or synechiae (Asherman syndrome) | Radiotherapy - pelvic/cervical

management of amenorrhoea

life style changes optimise control of medical illness stop drugs or switch to alternatives prolactinoma - medical treatment intracranial SOL - surgical treatment vaginal anomalies (septum/hymen) - surgical treatment uterine adhesions - surgical division hysteroscopic fertility preservation before radio/chemotherapy fertility treatment - IVF w/ own or donor eggs