Ovarian and Menstrual Cycle

Question 1

What are the functions of the ovary?

Answer 1

produce female gametes
secrete estrogen and progesterone
regulate postnatal growth of reproductive organs
control development of 2ry sex characteristics

Question 2

What are the three phases of the ovarian cycle?

Answer 2

follicular
ovulation
luteal

Question 3

What is a cumulus oophorus?

Answer 3

pedestal of follicular cells anchoring oocyte to the wall

Question 4

What are the 2 forms of paracrine signaling that control ovarian follicle development?

Answer 4

Granulosa cell-primary oocyte bidirectional signaling

Theca cell - Granulosa cell synergistic communication

Question 5

What are the paracrine signals that are used during folliculogenesis?

Answer 5

Members of TGF-b superfamily
GDF-9, BMP-15
AMH, Activin, inhibin

Question 6

How does disruption in paracrine signaling explain PCOS?

Answer 6

Defect in the paracrine oocyte-Granulosa cell signaling mechanism causes a disrupt in folliculogenesis
Leads to enlarged ovaries with multiple cysts

Question 7

What the clinical features of PCOS?

Answer 7

Enlarged ovaries with multiple cysts
Infrequent or prolonged menstrual periods
Excess hair growth
Acne
Obesity

Question 8

What stimulates ovulation to take place?

Answer 8

surge of LH

Question 9

What is corpus hemorrhagicum?

Answer 9

Bloody scar; blood vessels of the the a interna invade antrum after ovulation

Question 10

What is mittelschmerz

Answer 10

Mid-cycle pain due to ovulation

peritoneal irritation when fluid and blood from follicle ruptures and irritates surrounding tissues

Question 11

What stimulates the tubal motility?

Answer 11

Estrogens

Question 12

What is the purpose of tubal motility?

Answer 12

mesosalpinx contractions to bring tube closer to ovary

Question 13

What inhibits tubal motility?

Answer 13

progesterone

Question 14

What are the functions of corpus luteum?

Answer 14

synthesize and secreted steroid hormones that are necessary IF pregnancy occurs

Question 15

What does the corpus luteum consist of?

Answer 15

Follicular aka Granulosa lutein cells that makes estrogens

Theca lutein cells that makes androstenedione and progesterone

Question 16

What role does AMH have in folliculogenesis?

Answer 16

Expressed in Granulosa cells from primordial follicle to formation of antrum
Appears to inhibit follicular growth

Question 17

What is corpus albicans

Answer 17

Dense T scar formed from degeneration of corpus luteum
Remains for a variable period
Gradually absorbed by Mo within stroma

Question 18

What are the steroid concentration levels during early follicular phase?

Answer 18

Estrogen and progesterone levels are low

Feedback to increase FSH and LH via GnRH

Question 19

What happens in the ovarian cycle after FSH and LH levels rise in early follicular phase?

Answer 19

Estrogen levels rise and initially inhibit further FSH and LH release
Later as follicle is developing, rise in estrogen lvls stimulate FSH and LH

Question 20

What are the steroid levels in luteal phase?

Answer 20

estrogen and progesterone made by corpus luteum inhibits FSH and LH release
FSH and LH levels fall
Estrogen and progesterone levels fall

Question 21

What are the three layers of the uterus?

Answer 21

endometrium
Myometrium
Perimetrium

Question 22

What are the components of the endometrium?

Answer 22

simple columnar epithelium; lines endometrial glands

Lamina propria-fibroblasts, ground substance, Type III collagen

Question 23

What are the two layers of the endometrium?

Answer 23

Stratum functionalis: hormone sensitive, sloughs off

Stratum basalis: regenerates functional layer; not hormone sensitive

Question 24

What is the blood supply to the endometrium?

Answer 24

uterine aa gives off arcuate aa in myomerium
arcuate aa branches to form 2 sets of aa
They are straight aa to stratum basalis and spiral aa to stratum functionalis

Question 25

What layer of myometrium is the thickest?

Answer 25

middle layer

contains arcuate aa

Question 26

What are the 4 phases of the menstrual cycle?

Answer 26

Proliferative
Secretory
Ischemic
Menstrual

Question 27

Describe the proliferative phse of the menstrual cycle

Answer 27

Functional layer begins to thicken
Spinal aa are short and deep in endometrium
Endometrial glands are short, straight and empty

Question 28

Describe the secretory phase of the menstrual cycle

Answer 28

Functional layer very thick
Spiral aa are long and growing superficially in endometrium
Endometrial glands torturous and filled with glycogen-rich secretory products

Question 29

Describe the menstrual phase of the menstrual cycle

Answer 29

Initiated by regression of corpus luteum
No fertilization
Spiral aa contracting to junction of straight aa
Decreased oxygen to functional layer->necrosis
Endometrial glands undergo necrosis
Neutrophils and lymphocytes infiltrate
*note: above may be considered ischemic phase
Shedding the lining

Question 30

What is leiomyoma?

Answer 30

uterine fibroid

Benign tumors that arise from overgrowth of sm m and CT in uterus

Question 31

What are the surgical treatments for leiomyoma?

Answer 31

myomectomy (remove fibroids) and hysterectomy

Question 32

What is the non surgical treatment for leiomyoma?

Answer 32

uterine artery embolization

• Radiologic alternative
• partial blockage of uterine aa with polyvinyl alcohol particles
• decrease blood flow to the uterus and fibroids

Question 33

What is endometriosis?

Answer 33

presence of endometrial tissue outside the uterus
Responds to ovarian hormones
Lead to cysts, scar tissue and adhesions
Dysmenorrhea

Question 34

What is dysmenorrhea

Answer 34

painful cramps
1-2 days prior and/or during menstrual bleeding
PGE2 and PGF2a released from endometrial cells stimulate uterine contraction causing pain

Question 35

What does HPV cause?

Answer 35

cervical intraepithelial neoplasia

• develop into a carcinoma in situ or progress to invasive carcinoma
• Transformation zone where it goes from simple columnar to stratified squamous

Question 36

Describe the histological structure of the ovary

Answer 36

Germinal epithelium
Tunica albuginea
Cortex: oocyte-containing follicles
Medulla: stroma and blood supply