Module 1 (a) Female Reproductive A&P & Menstrual Cycle

Question 1

Pelvic Girdle

-Constitutes?

Answer 1

1. Innominate (hip) bones (pubis, ischium, ilium)
2. Sacrum
3. Coccyx
4. The sacrum and Coccyx shape posterior of pelvis ** Allows fetus to pass through in childbirth
5. Pelvic outlet = TRUE pelvis -Bony passage in which childbirth occurs

Gyencoid Pelvis — Larger space so that childbirth can occur

Question 2

Pelvic Floor/Support

-2 muscles

Answer 2

1. Levator ani and coccygeus muscles form pelvic floor
   - Support urethra, vagina, uterus, and posterior portion of the rectum
2. Fascia form supportive sling for

Question 3

Vagina

-Anatomy

Answer 3

1. Thin-walled tube that extends from external vulva to cervix
2. Walls of vagina are AP positioned (lay on top of each other) and are flattened
3. RUGAE = folds of epithelial tissue; allow for expansion during intercourse and childbirth
4. Vaginal wall layers: Mucosa, muscle, adventitia
   - Adventitia is elastic; providing structural support and expansion during intercourse and childbirth

Estrogen and collagen — maintain elasticity of tissue

Question 4

Uterus

-Anatomy

Answer 4

1. Muscular, inverted, pear-shaped, hollow, thick-walled organ — Opens to vagina at cervix
2. Anatomical regions: Fundus, body, and cervix
3. Uterine wall layers: endometrium (inner most layer - shed during menses), myometrium, and serosa
4. Double blood supply to endometrium is important to cyclic shedding

Question 5

Fallopian Tubes

-Anatomy

Answer 5

1. Paired narrow muscular tubes that extend from the body of the uterus, outward to openings near ovaries
2. Inside of tubes are covered by fine hairlike structures (CILIA) that help move ova from ovaries to uterine body
3. Ovarian and uterine arteries supply blood — No specific blood supply

Question 6

Ovaries

-Anatomy

Answer 6

1. Paired ovaries resemble large almonds — Approx 1.5cm x 2.5 cm x 4cm each
2. Located near lateral walls of the pelvic cavity
3. Produce gametes (ova) and sex hormones estrogen and progesterone
4. Sensitive to pain and pressure
5. HAVE their own blood supply **

Question 7

Cervical Anatomy

Answer 7

1. Endocervical cells are columnar cells (Have ability to secrete mucus
2. Ectocervical cells are squamous cells
3. Squamocolumnar junction — Rapid cellular division — Aka Transformation Zone**
4. Transformation Zone is MOST vulnerable to HPV — This zone needs to be tested during PAP

Question 8

Squamocolumnar junction

-Location through Lifespan

Answer 8

1. Adolescents and early adulthood — the squamocolumnar junction is located in the cervical canal and extends onto face of ectocervix
2. With again, the suamocolumnar junction recedes into the cervical canal
   - Location is influenced by hormones

Question 9

Nabothian Cyst

Answer 9

1. Benign “pimple” that forms on the surface of the cervix and is caused by a clogged mucous duct — Transient throughout menstrual cycle

Question 10

Puberty Process

Answer 10

1. Breast budding — Driven by Estrogen
2. Growth of pubic hair — Adrenal Glands
3. Growth spurt peak
4. Change in body shape
5. Growth of underarm hair
6. First period (Menarche)
7. Adult breast size

-Missed sequence can be caused by endocrine pathology

Onset of puberty is driven by pulsitile secretion of Gonadotropin releasing hormone (GNRH) from Pituitary gland

• Influenced by BMI and genetics
• Influenced by light exposure

Question 11

Adolescent Development Terms

Answer 11

1. Thelarche — Breast development
2. Adrenarche — Pubic Hair development
3. Pubic hair before breast buds — Consider adrenal tumor **

Question 12

Discordant Reproductive Development

Answer 12

1. Individual who reaches late teens without menarche but has breast and pubic hair growth
   - Needs evaluation

Question 13

Precocious Puberty

Answer 13

1. Also known as puberty <8 yrs old

- Connected to increase rate of obesity due to adipose tissue releasing estrogen

Question 14

Delayed Puberty

Answer 14

1. Delayed puberty in girls, Ie. No breast enlargement > 13 yrs old
2. Look for Gonadotropin deficiency, tumors, eating disorders, prolactinoma

Question 15

Menopause

Answer 15

1. Ages 48-55 — Gradual process
2. Transition out of childbearing capacity & is similar to puberty in that it is influence by
   - Genes, environment, and culture

Question 16

Phases of the Menstrual Cycle

-Phases

Answer 16

1. Follicular Phase is the first half of the cycle from day 1 to 14.
2. Literal phase is from day 15 to 28

Question 17

Phases of the Menstrual Cycle

-Follicular Phase

Answer 17

1. Development and growth of ovarian egg containing follicles
2. Begins with the onset of menses through ovulation

Question 18

Phases of the Menstrual Cycle

-Luteal Phase

Answer 18

1. Development of a corpus Luteum — forms in place where dominant follicle is released following ovulation
   - Corpus Luteum plays a role in nurturing the released egg
2. Luteal phase begins with ovulation and continues till onset of the next menses

Question 19

Organs involved in Menstrual Cycle

-4 Organs?

Answer 19

1. Hypothalamus
2. Anterior Pituitary
3. Ovary
4. Uterus (Endometrium)

Question 20

Organs involved in Menstrual Cycle

-Endocrine Role

Answer 20

1. Gonadotropic-releasing hormone from the Hypothalamus travels down to the anterior pituitary gland
2. GnRH does not enter systemic blood stream instead traveling through the HHP system
3. GnRH triggers Gonadotrophs in the anterior pituitary which secrete glycoproteins
   - Luteinizing hormone & Follicle-stimulating hormone
4. FSH is transported systemically in the blood stream & in females it promotes follicle growth in the ovary — Promotes growth of a SINGLE DOMINANT follicle
5. LH travels systemically in the blood stream and is the primary hormone involved in OVULATION
   - LH triggers rupture of DOMINANT follicle that was grown by the FSH ***
6. The process of follicular growth and FSH is a POSITIVE FEEDBACK LOOP
7. Surge in LH follows the serum peak of FSH. Ovulation occurs after 12-24 hours of LH peak
   - Once dominant follicle ruptures and releases its egg, hormone signals are sent back from ovary to anterior pituitary & hypothalamus
   - The message is TURN OFF FSH and LH — This is the NEGATIVE FEEDBACK LOOP of the HPO axis

Most hormones are produced in the anterior pituitary. Posterior only produces oxytocin and ADH

Question 21

Ovarian Hormones (Steroid Hormones) 
-Background

Answer 21

1. Steroid hormones are ONLY produced in the gonads (ovaries and Testes) (Small amount in adrenal glands on kidneys)
2. Steroid Hormones Include
   - Androgens (Testosterone)
   - Estrogens
   - Progesterones

Question 22

Ovarian Hormones (Steroid Hormones) 
-Estrogens

Answer 22

1. Estradiol (E2) — MAIN estrogen of the reproductive years**
2. Estriol (E3) — secreted by the placenta
3. Estrone (E1) — Weakest estrogen — primary estrogen of menopause

Question 23

Ovarian Cycle

-Estrogen and Progesterone

Answer 23

1. 16:26 Watch again

• Follicular phase — Estrogen levels supersede progesterone levels
• Luteal phase — Progesterone trumps estrogen

Question 24

Follicle Development

-Process

Answer 24

1. Mittelschmerz — Term to describe pain at ovulation

‘22:35 watch video

Question 25

Follicular Facts

Answer 25

1. Approx 2 million primordial follicles pre-birth 2. NO new ova formed after birth 3. Only 300k follicles remain by puberty 4. 1 egg per cycle = 500 ovulations per lifetime

Question 26

Endometrial Development | -Phases

Answer 26

1. Menstrual Phase - Day 1-4 — Sloughing off of built up lining 2. Proliferate Phase - Day 4-14 — Regeneration of endometrial lining caused by ESTROGEN, turning into long, fluid-filled glandular cells. ”BIG” 3. Secretory Phase - Day 14-26 - S/P Ovulation, Thickened endometrium becomes highly vascularized & retains fluid - This is caused by Estrogen and progesterone — “BIG and JUICY” - Secretion of clear fluid occurs 4. Premenstrual Phase - Day 26-28 — Endometrium becomes necrotic and destabilizes. Caused by regression of corpus luteum

Question 27

Basal Body Temp Cyclic Changes

Answer 27

1. A temp rise of .2 and .6 degrees C. Confirms ovulation has taken place but does NOT predict it.