Hellekant Female Repro Flashcards
Primary oocytes complete meiosis I under the influence of what hormone?
FSH
What is the priordial follicle?
Primary oocyte surrounded by follicular cells (granulosa and theca cells)
Cyclic recruitment in the female cycle refers to what?
Antral follicles that are rescued from atresia by FSH
In the mature hypothalamic pituitary ovarian axis, FSH promotes development and synthesis of what?
Development of the follicle, and synthesis of LHR
Why do we get an LH surge, but not FSH surge?
Inhibit released from the granulosa cell has a neg feedback on FSH but not LH
After ovulation, what happens to the granulosa and theca cells?
The become the corpus luteum
What hormones are produced by the corpus luteum?
Estrogen and progesterone
During the luteal phase, what hormone is predominant?
Progesterone
During the follicular phase, what hormones are predominant?
Estrogen
Where is GnRH produced?
Arcuate nucleus of the hypothalamus
What type of receptor does GnRH bind?
Gq
What hormone is critical for inducing ovulation?
LH
During the first trimester what is secreting progesterone and estrogen? What is maintaining this?
Corpus luteum secretes progesterone and estrogen; hCG maintains the corpus luteum
What receptor does hCG stimulate in order to maintain the corpus luteum?
LH receptor
What subunit is identical in FSH, LH, TSH, and hCG?
Alpha subunit
LHR binds what?
LH and hCG
What type of receptors are LHR and FSHR?
Gs protein coupled
What cell does LH act on in the ovary?
Theca cell
When LH acts on the theca cell, what is produced?
Progesterone, androstenedione, testosterone (androgens)
What happens to the androgens made in the theca cell due to LH response?
They diffuse across the basement membrane to granulosa cells
What happens to the androgens that diffuse across into the granulosa cells?
Under the action of FSH, the are aromatized to 17 beta estradiol
What cell does FSH act on in the ovary?
Granulosa cell
When FSH acts on the granulosa cell, what is the response?
Androgens from the theca cell are aromatized to 17 beta estradiol
What type of estrogen receptor mediates the HPO axis responses to estrogen?
ER alpha
What effect does estrogen have on the endometrium?
Thickening and proliferation; glands develop, stromal and vessel growth occurs, uterine lining increases
What effects does progesterone have on the endometrium?
Causes secretion from glads, rather than proliferation
What produces hCG in early pregnancy?
The chorion - specifically the syncitotrophoblast
What hormones does the placenta produce?
Progesterone, estriol, hPL, and inhibin
What are the different types of estrogen produced during pregnancy? Where do they come from?
17 beta estradiol from the corpus luteum; estriol from the placenta
What hormone is required for the maintenance of pregnancy?
Progesterone
When is the greatest likelihood for miscarriage? Why?
End of 1st trimester; when pregnancy transitions from being dependent on ovarian hormones to placental hormones
What hormones are responsible for development of the epithelial ductal tree in breasts?
Etrogen, glucocorticoids, GH
What hormones are responsible for lobular-alveolar growth in breasts?
Estradiol, glucocorticoids, Progesterone and prolactin, placental lactogen
What is Lactogenesis II? What hormones are responsible?
Post-partum onset of copious milk secretion; comes with fall in progesterone; prolactin dependent
What hormone is required for maintenance of lactation? Milk let down? Involution?
Prolactin for maintenance; oxytocin for let down; involution due to lack of prolactin
What causes the degradation of the corpus luteum?
If no pregnancy, prostaglandin F alpha causes corpus luteum to degrade
What can be used to promote folliculogenesis or stimulate follicles?
FSH +/- LH;estrogen antagonists
What can be used to induce ovulation?
Human chorionic gonadotropin
What can be used to control the timing of ovulation?
GnRH agonists/antagonists
What can be used for the treatment of uterine fibroids?
GnRH agonists/antagonists
What can be used to maintain pregnancy?
Progestins
How is folliculogenesis promoted in women with hypothalamic anovulatory function?
Administer both FSH and LH
How is folliculogenesis promoted in women with endogenous estrogen activity and normal hypothalamic-pituitary-ovarian function?
Clomiphene citrate - estrogen antagonist; induces FSH secretion
What is clomiphene citrate?
Estrogen antagonist
What is menotropin?
(Also called pergonal); FSH and LH activity
Wht is urofolitropin?
Also called metrodin; only has FSH activity
What are the urinary derived human gonadotropins?
Menotropin (LH and FSH activity) and urofolitropin (FSH activity only)
What are the recombinant human gonadotropins?
Follitropin a and follitropin b; both FSH analogs
What is ovarian hyperstimulation syndrome?
Shift of vascular fluids to abdominal and thoracic cavity; due to SE of folliculogenesis stimulation
What is clomiphene citrate?
Estrogen antagonist
Where does clomiphene act?
Blocks ER signaling in hypothalamus and anterior pituitary
What effect does clomiphene have on HPO axis?
Blocks ER signaling, resulting in release of GnRH and gonadotropins
What is used to mimic LH surge and induce ovulation?
HCG
What is leuprolide?
Synthetic GnRH
What is Goserelin?
Synthetic GnRH
The drugs that end in -relin are synthetic analogs of what?
GnRH
What are the uses for GnRH agonists?
Shut down HPO axis; reduce symptoms from uterine fibroids; control hormone dependent prostate and breast cancers
What are the GnRH antagonists?
Ganirelix, Cetrorelix
When are GnRH antagonists used?
Fertility to prevent endogenous LH surge; prostate and breast cancer; benign uterine disease (fibroids)
What is Ganirelix?
GnRH antagonist
What is cetrorelix?
GnRH antagonist
What is ethinyl estradiol?
Hormonal contraceptive estrogen with addition at C-17 to reduce metabolism and make orally available
What effects do estrogen and androgens have on the synthesis of SHBG?
Estrogens increase synthesis; androgens decrease synthesis
What is added to oral progestins to decrease 1st pass metabolism?
17 alpha substitution
Progesterone binds to what binding globulin? 19-nor progestins bind to what binding globulin?
Progesterone binds cortisol binding globulin; 19-nor progestins bind SHBG
What is medroxyprogesterone acetate?
C21 progestin
What is norethindrone?
Progestin that is a 19 nor testosterones; estrane
What is levonorgestrel?
Progestin in 19-nor testosterone class; gonane
What is desogestrel?
Progestin in the 19-nor testosterone class; gonane
Of the synthetic progestins, which are in hte progestanes class?
Medroxyprogesterone acetate
In the synthetic progestins, what drugs are in the estranes class?
Norethindrone
In the synthetic progestins, which drugs are in the gonanes?
Levonorgestrel, desogestrel
What synthetic progestins are more potent and able to be used at lower doses?
Gonanes
What is mifepristone?
Progesterone antagonist; but also an analog to 19-nortestosterone
What is ulipristal acetate?
Progesterone antagonist or agonist; not sure how it works, can be used to prevent pregnancy
What emergency contraception works up to 5d after intercourse?
Ulipristal acetate
What is mifepristone used for?
Small doses - emergency contraception by preventing/delaying ovulation; larger doses - terminate early pregnancy (< 49 days), used with misoprostol
To terminate a pregnancy at < 49 days, what drugs are used?
Mifeprisonte (large dose) and misoprostol (prostaglandin)
