hormonal cycle and cycle control

Question 1

Menarche to menopause

how many oocytes at birth?
how many at menarche?

Answer 1

Menarche: 12.5
Menopause: 51.4

Birth: 1 million primordial follicles – oocyte arrested in prophase of first meiotic division
Menarche: 300,000-400,000 oocytes due to atresia

Question 2

Hypothalamus

Answer 2

GnRH (pulsatile release; 70-90 min intervals–>drives cycle)
-produced by Arcuate nucleus
Pulsatile
70-90 minute intervals

Question 3

Pituitary

Answer 3

Gonadotropins: FSH and LH
Anterior pituitary gland
Negative feedback

Question 4

ovary has ??

Answer 4

Follicles
Estradiol:
Negative feedback effect on FSH
Positive feedback LH days 12-14 (otherwise negative feedback)
High level Estrogen
Progesterone: Negative feedback on FSH and LH

Question 5

ovarian cells

Answer 5

FSH–>Granulosa cells–>Estradiol

LH–>Theca cells–>Androgen

Question 6

Menstrual cycle

Answer 6

Follicular phase
Ovulation
Luteal phase

Question 7

Menstrual cycle: follicular phase: Day 1

Answer 7

Day 1: first day of bleeding
Progesterone withdrawal
Prostaglandins released  contractions  ischemic pain (“cramping”)

Question 8

Menstrual cycle: follicular phase

Answer 8

Hormones are all at their lowest point
Decrease in negative feedback-->FSH production
New follicles mature
Dominant follicle selected
Granulosa cells increase-->  estradiol

Question 9

Menstrual cycle: follicular phase

Answer 9

Estradiol–> LH receptors on theca cells–> androgens  aromatase–> estradiol

Rising estradiol–> increase in negative feedback–> decrease in FSH/increase in LH

Question 10

Dominant follicle

Answer 10

FSH binds to receptors on granulosa cells–>proliferation–>increased binding FSH–>estradiol

Follicle with the greatest # granulosa cells = dominant follicle = ovulation (the rest don’t ovulate)

Question 11

Menstrual cycle: ovulation

Answer 11

Estradiol  positive feedback  LH
LH surge day 11-13
Ovulation occurs 30-36 hours after
Oocyte is expelled from follicle
Follicle becomes corpus luteum (no egg)

Question 12

Menstrual cycle: luteal phase

Answer 12

Progesterone dominant (from corpus luteum)
Maximum production 3-4 days after ovulation, lasts 11 days
If no implantation–>involution of CL (13-14 days)–>decline in progesterone
If + implantation–>hCG secreted–>maintains CL  continued progesterone secretion

Progesterone negative feedback for FSH and LH

Question 13

cycle duration

Answer 13

Cycle typically 28 days
Follicular phase can vary
Luteal phase ALWAYS 14 days

Question 14

changes due to hormones

Answer 14

Endometrium
Endocervix
Breasts
Vagina
Hypothalamic thermoregulating center

Question 15

Menstruation: endometrium

Answer 15

-sloughed to basal level
Compact stroma cells
Short, narrow endometrial glands

Question 16

Estrogen: cell growth

Answer 16

Follicular phase
Stroma thickens
Glands elongate (straight and tubular)
“proliferative” endometrium

Question 17

Progesterone: differentiation

Answer 17

Luteal phase
Stroma becomes loose and edematous
Blood vessels twist and thicken
Glands become tortuous
“secretory” endometrium

Question 18

Endocervix changes

Answer 18

Cervical mucus

Estradiol: *sperm capture, storage, transport
Thin
Clear
Watery

Progesterone:
Thick
Opaque
Tenacious (prevents sperm from being transferred)

Question 19

Breast changes

Answer 19

in luteal phase after ovulation:
Progesterone 
Stimulates acinar glands
Rounded configuration
Breast tenderness

Question 20

Thermogenesis changes

Answer 20

Progesterone:

Increases body temp by .6 – 1 degree fahrenheit

Question 21

Hypothalamus: hormonal control via meds

Answer 21

Leuoprolide
Ganirelix
Clomiphene citrate
(all deal with GnRH)

Question 22

Leuoprolide

Answer 22

GnRH agonist
When continuous – decreases pulsatile release
Decreases FSH/LH (initial surge)

Question 23

Ganirelix

Answer 23

GnRH antagonst

Decreases FSH/LH

Question 24

Clomiphene citrate

Answer 24

Antagonist of estrogen at hypothalamus
Increases LH/FSH release
Causes ovulation (can cause multiple births)

Question 25

Hormonal control: Ovary

Answer 25

Combination oral contraceptives

Progestins

Question 26

Combination oral contraceptives

Answer 26

Estrogen and Progestin
-Progestin: suppression of LH secretion–>no ovulation
Thicken cervical mucus
Altered fallopian tube peristalsis
-Estrogen: suppression of FHS secretion–>no dominant follicle

Question 27

Progestins

Answer 27

Thicken cervical mucus
Alters endometrial proliferation (“hostile” environment)
Some suppress ovulation (if high enough dose)
-Depo-Provera, Nexplanon

Question 28

OMM

Answer 28

Viscerosomatics:
Ovaries: T10-T11 (lateralized)
Uterus: T9-L2
Fallopian tubes: T10-L2 (lateralized)
Parasympathetics:
Pelvic splanchnic nerves S2-S4
Lateral fallopian tubes: vagus nerve
Somatic dysfunction: related to pelvic pain

Question 29

Middlemertz?

Answer 29

pain that happens mid-cycle