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Repro > Ovarian And Menstrual Cycles > Flashcards

Ovarian And Menstrual Cycles Flashcards

1
Q

Meiosis begins at 8-9 weeks gestation. Primordial oocytes become primary oocytes. What are primary oocytes held in until ovulation?

A

Prophase I in meiosis I

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2
Q

What cell in oogenesis is held in prophase I until ovulation?

A

Primary oocytes

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3
Q

At puberty/menarche, primary oocyte ends meiosis I to become secondary oocyte. What is the secondary oocyte held in until fertilization?

A

Metaphase II

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4
Q

What cell in oogenesis is held in metaphase II until fertilization?

A

Secondary oocyte

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5
Q

Describe the ovaries

A

Paired, pelvic organs found within broad ligament
Supplied by ovarian vessels (suspensory ligament)
Temporary endocrine gland to prepare uterus for implantation and to maintain the developing embryo

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6
Q

What are the functions of the ovaries?

A

Produce female gametes
Secrete estrogen and progesterone
Regulate postnatal growth of reproductive organs
Control development of secondary sex characteristics

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7
Q

Describe the structure of the ovary

A

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

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8
Q

What are the phases of the ovarian cycle?

A

Follicular (days 1-14)
Ovulation
Luteal (days 15-28)

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9
Q

The follicular, ovulation, and luteal phases make up what cycle?

A

Ovarian cycle

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10
Q

Describe follicular phase

A

Growth of dominant follicle
Primordial to tertiary (Graafian) follicles
Typically lasts 10-14 days
Duration of phase is variable due to length of menstruation

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11
Q

What phase of the ovarian cycle is characterized by the growth of the dominant follicle, which is primordial to tertiary follicles?

A

Follicular phase

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12
Q

Describe ovulation

A

Oocyte ruptures out of Graafian follicle
Occurs mid-cycle at 14
In response to LH surge

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13
Q

What phase in the ovarian cycle is characterized by the oocyte rupturing out of the Graafian follicle in response to the LH surge?

A

Ovulation

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14
Q

Describe the luteal phase

A

Corpus luteum forms and secretes progesterone and estrogen to accommodate potential gestation
Phase is relatively constant lasting 14 days

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15
Q

What phase of the ovarian cycle is characterized by the formation of the corpus luteum, which secretes progesterone and estrogen to accommodate potential gestation?

A

Luteal phase

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16
Q

Describe the primordial follicle

A

Primary oocyte surrounded by squamous epithelium

Before puberty, inactive follicle

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17
Q

What follicle is characterized by primary oocyte surrounded by squamous epithelium?

A

Primordial follicle

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18
Q

What is the early primary or unilayered follicle?

A

Single layer of cuboidal follicular epithelium around primary oocyte
Zona pellucida begins to form

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19
Q

What follicle is characterized by single layer of cuboidal follicular epithelium surrounding primary oocyte with the zona pellucida beginning to form?

A

Early primary or unilayered follicle

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20
Q

What is the late primary or multilayered follicle?

A

Several layers of cuboidal follicular epithelial cells around primary oocyte
Zona pellucida forms glycoprotein coat around oocyte

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21
Q

What follicle is characterized by several layers of cuboidal follicular epithelial cells around primary oocyte with zona pellucida forming a glycoprotein coat around oocyte?

A

Late primary or multilayered follicle

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22
Q

Describe the secondary follicle

A

Follicular cells continue to proliferate -> stratum (zona) granulosum
Ovarian stroma around follicle differentiates into theca interna and theca externa
Call-Exner bodies, which are fluid-filled cavities, appear between follicular cells. Fluid is liquour folliculi
Antrum begins to form

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23
Q

What follicle is characterized with stratum (zona) granulosum, theca interna and externa, Call-Exner bodies filled with liquor folliculi, and antrum?

A

Secondary follicle

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24
Q

Describe theca interna

A

Squamous cells surrounding follicular cells

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25
Q

What part of ovarian stroma has squamous cells surrounding follicular cells?

A

Theca interna

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26
Q

Describe theca externa

A

Capsule-like layer continuous with connective tissue of ovary

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27
Q

What part of the ovarian stroma has capsule-like layer continuous with connective tissue of ovary?

A

Theca externa

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28
Q

Liquor folliculi is rich in what?

A

Hyaluronic acid

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29
Q

Call-Exner bodies are also seen in ovarian tumors of __ orgin

A

Granulosal

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30
Q

Describe mature (Graafian) follicle

A 
Antrum occupies much of space
Oocyte displaced to one side
Developed corona radiata
Developed cumulus oophorus
Primary oocyte nearing completion of meiosis I
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31
Q

What follicle is characterized by an antrum that occupies much of the space, oocyte displaced to one side and near completion of meiosis I, developed corona radiata, and developed cumulus oophorus?

A

Mature (Graafian) follicle

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32
Q

What is the corona radiata?

A

Layer of follicular cells surrounding oocyte

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33
Q

What is the layer of follicular cells surrounding oocyte?

A

Corona radiata

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34
Q

What is the cumulus oophorus?

A

Pedestal of follicular cells anchoring oocyte to the wall

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35
Q

What is the pedestal of follicular cells anchoring oocyte to the wall?

A

Cumulus oophorus

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36
Q

Describe the progression of follicles

A 
Primordial follicle
Early primary follicle
Late primary follicle
Secondary follicle
Mature Graafian follicle
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37
Q

What molecules are important for control ovarian follicle development?

A

Members of TGF-beta superfamily
GDF-9, BMP-15
AMH, activin, inhibin

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38
Q

Described polycystic ovarian syndrome (PCOS)

A

Enlarged ovaries with multiple cysts
Results from disrupted folliculogenesis caused by a defect in paracrine oocyte-granulosa cell signaling mechanism
Infrequent or prolonged menstrual periods, excess hair growth acne, and obesity
In adolescents, infrequent or absent menstruation may raise suspiciion for the condition

39
Q

What syndrome is characterized by infrequent or prolonged menstrual periods, excess hair growth, acne, obesity, and enlarged ovaries with multiple cysts?

A

Polycystic ovarian syndrome

40
Q

Blood vessels of theca interna invade the antrum to become ___

A

Corpus hemorrhagicum

41
Q

Describe mittelschmerz

A

Mid-cycle pain due to ovulation
Discomfort in lower abdomen due to peritoneal irritation
Follicle ruptures and releases fluid and blood that irritates surrounding tissues
Right or left side depends on which ovary produced oocyte
Can mimic appendicitis
Pain varies by person. Most do not experience discomfort

42
Q

__ stimulates tubal motility, while __ inhibits tubal motility

A

Estrogens

Progesterone

43
Q

Describe tubal motility at ovulation

A

Contractions become vigorous
Mesoalpinx contracts to bring tube in more contact with ovary, while fimbria contracts rhythmically to sweep over ovarian surface

44
Q

Describe tubal motility at 4-6 days after ovulation

A

Progesterone levels rise and inhibit tubal motility

This may lead to relaxation of tubal musculature to allow passage of ovum into uterus by action of tubal cilia

45
Q

Describe the luteal phase

A

After ovulation, residual components of rupture follicle forms corpus luteum (yellow body)

46
Q

What ovarian phase is characterized by residual components of the ruptured follicle that forms corpus luteum?

A

Luteal phase

47
Q

What are the functions of the corpus luteum?

A

Synthesize and secrete steroid hormones that are necessary if pregnancy occurs (stimulus HCG)

48
Q

What synthesizes and secretes steroid hormones that are necessary if pregnancy occurs (stimulus HCG)?

A

Corpus luteum

49
Q

What does the corpus luteum consist of?

A

Follicular (granulosa) cells that make estrogen
Theca cells that makes androstenedione and progesterone
Both follicular and thecal cells accumulate lipids because cholesterol is a precursor for steroid hormones

50
Q

What is corpus albicans?

A

Dense connective tissue scar formed form degeneration of corpus luteum
Remains for variable period
Gradualy absorbed by macrophages within stroma

51
Q

What is dense connective tissue scar from degeneration of corpus luteum that is gradually absorbed by macrophages within stroma?

A

Corpus albicans

52
Q

Describe hormonal control in follicular phase

A

Early on, estrogen and progesterone levels are low -> feedback to increase FSH and LH (via GnRH from hypothalamus) and thus, see rising levels of estrogen
Initially rising estrogen levels inhibit further FSH and LH release (negative feedback)
Later as follicle is developing, rising estrogen levels stimulate FSH an LH release (positive feedback)

53
Q

Describe hormonal control in luteal phase

A

Corpus luteum makes estrogen and progesterone -> feedback to inhibit FSH and LH release
FSH and LH levels fall
Thus, estrogen and progesterone levels fall

54
Q

What are the three layers of the uterus?

A

Endometrium
Myometrium
Perimetrium

55
Q

What is the histology of perimetrium?

A

Simple squamous epithelium

56
Q

What layer of the uterus has simple squamous epithelium?

A

Perimetrium

57
Q

Describe the endometrium

A 
Simple columnar epithelium
Lines endometrial glands
Lamina propria: fibroblasts, ground substance, type II collagen
Functional layer (stratum functionalis)
Basal layer (stratum basalis)
58
Q

What layer of the uterus has simple columnar epithelium and has stratum functionalis and stratum basalis?

A

Endometrium

59
Q

Describe stratum functionalis

A

Part of endometrium
Proliferates and sloughs off during menstruation
Hormone sensitive
Cyclical changes

60
Q

What layer in the endometrium proliferates and sloughs off during menstruation, is hormone sensitive, and has cyclical changes?

A

Stratum functionalis

61
Q

Describe stratum basalis

A

Part of endometrium
Regenerates functional layer
Not hormone sensitive

62
Q

What layer of endometrium regenerates functional layer (stem cells) and is not hormone sensitive?

A

Stratum basalis

63
Q

Describe myometrium

A

3 layers of circularly arranged smooth muscle
Middle layer is thickest and contains arcuate arteries, “stratum vasculare”
Does not change with menstrual cycle
Does not undergo hypertrophy and hyperplasia during pregnancy

64
Q

What layer of the uterus has 3 layers of smooth muscle that has arcuate arteries or “stratum vasculare” and does not change with menstrual cycle or undergo hypertrophy and hyperplasia during pregnancy?

A

Myometrium

65
Q

Describe endometrial blood suppply

A

Uterine arteries give off arcuate arteries in myometrium
Arcuate arteries branch to form 2 sets of arteries (endometrium gets dual blood supply)
Straight arteries to stratum basalis
Spiral (helical) arteries to stratum functionalis
Important in cyclic shedding of stratum functionalis

66
Q

What is leiomyoma (uterine fibroid)?

A

Benign tumors that arise from overgrowth of smooth muscle and connective tissue in uterus
Classified based on location
Genetic predisposition exists

67
Q

What are benign tumors that arise from overgrowth of smooth muscle and connective tissue in uterus?

A

Leiomyoma (uterine fibroid)

68
Q

What is myomectomy?

A

Removal of fibroids with preservation of the uterus

69
Q

What is uterine artery embolization?

A

Radiologic alternative to surgery that involves partial blockage of the uterine arteries with polyvinyl alcohol (PVA) particles and decreases the blood flow to uterus and fibroids

70
Q

What are the phases of the menstrual cycle?

A
  1. Proliferative phase
  2. Secretory phase
    (3. Ischemic)
    3/4. Menstrual phase
71
Q

Describe the proliferative phase

A

Functional layer begins to thicken
Spinal arteries are short and deep in endometrium
Endometrial glands are short, straight, and empty (no glycogen)

72
Q

What menstrual cycle phase is characterized by the functional layer beginning to thicken, short and deep spiral arteries, and short, straight, and empty endometrial glands?

A

Proliferative phase

73
Q

Describe secretory phase

A

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

74
Q

What menstrual cycle phase is characterized by very thick functional layer, long and superficial spiral arteries, and tortuous endometrial glands filled with glycogen-rich secretory products?

A

Secretory phase

75
Q

What are the cells in oogenesis?

A

Primordial oocyte
Primary oocyte
Secondary oocyte

76
Q

Describe the menstrual phase of the menstrual cycle

A

Initiated by regression of corpus luteum because no fertilization occured -> decrease in estrogen and progesterone
Spiral arteries begin contracting to junction of straight arteries -> decreased O2 to functional layer -> necrosis
Endometrial glands undergo necrosis and detach from functional layer
Neutrophils and lymphocytes infiltrate
Shedding of endometrial lining

77
Q

What phase of the menstrual cycle is characterized by regression of corpus luteum, contraction of spiral arteries, necrosis and detachment of endometrial glands, infiltration of neutrophils and lymphocyte, and shedding of endometrial lining?

A

Menstrual phase

78
Q

What is endometriosis?

A

Presence of endometrial tissue outside of uterus, usually uterine tubes, ovary, peritoneal lining of abdomen and pelvis
Responds to ovarian hormones
Trapped endometrial tissue can lead to cysts, scar tissue, and adhesions
Dysmenorrhea (painful periods)
Commonly first diagnosed in infertility workup

79
Q

What is characterized by the presence of endometrial tissue outside of the uterus in the uterine tubes, ovary, peritoneal lining of abdomen and pelvis? The tissue responds to ovarian hormone and can lead to cysts, scar tissue, adhesions, and dysmenorrhea.

A

Endometriosis

80
Q

What is dysmenorrhea?

A

Painful cramps that usually begin 1-2 days prior and/or during menstrual bleeding
Mild to severe symptoms: lower abdominal discomfort to nausea and vomitting
Pathophysiology: prostaglandins (PGE2, PGF2alpha) released from endometrial cells -> stimulate uterine contraction -> pain

81
Q

What is Mulerian agenesis or Mayer-Rokitansky-Kuster-Hauser syndrome?

A

Absence of derivatives of paramesonephric ducts

82
Q

What causes persistent Mullerian duct syndrome (46 XY)?

A

Defect in AMH gene or its receptor (AMHR2)

83
Q

Describe the ovaries of Turner’s syndrome (45X)

A

Atrophic

84
Q

Cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV)) can develop into __

A

Carcinoma in situ (CIN)

Or progress to invasive carcinoma

85
Q

Describe the transformation zone of the cervix

A

Most common site of squamous cell carcinoma
Preceded by changes called cervical intraepithelial neoplasia (CIN) dysplasia within epithelial layer
If proliferating epithelial cells cross basal lamina into underlying CT - invasive CA
Detected by pap smear
Majority of cervical CA are related to HPV

86
Q

What does FSH do in the ovarian cycle?

A

Stimulates follicular phase to allow for follicle maturation and estrogen production

87
Q

What stimulates the follicular phase to allow for follicle maturation and estrogen production?

A

FSH

88
Q

What does LH do in ovarian cycle?

A

Gradually increases and stimulates ovulation at midcycle

89
Q

What stimulates ovulation at mid-cycle?

A

LH

90
Q

What hormone increases post-ovulation due to corpus luteum?

A

Progesterone

91
Q

What menstrual cycle phases correspond with the follicular phase of the ovarian cycle?

A

Menstrual phase

Proliferative phase

92
Q

Menstrual and proliferative phases of the menstrual cycle are associated with what ovarian cycle phase?

A

Follicular

93
Q

What menstrual cycle phase is associated with luteal phase of the ovarian cycle?

A

Secretory phase

94
Q

The secretory phase of the menstrual cycle is associated with what phase in the ovarian cycle?

A

Luteal phase

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