Ovarian and Menstrual Cycles Flashcards
1
Q
When does meiosis begin?
A
Week 8-9
2
Q
In what phase is primary oocyte arrested in until ovulation?
A
Prophase I of meiosis I
3
Q
At about 20 weeks gestation, there’s about 20 million oocyte, but that number significant decreases to _ by puberty.
A
about 400,000
4
Q
In what phase is secondary oocyte arrested in until fertilization?
A
metaphase II of meiosis II
5
Q
what are the function of ovaries?
A
- produce female gamates
- secrete estrogen and progesterone (maintains the uterus)
- regulate postnatal growth
- control development of secondary sex characteristics
6
Q
Where on the ovary are the oocyte containing the follicles located?
A
Cortex
7
Q
what makes up the medulla of the ovary?
A
stroma and blood supply
8
Q
What are the three phases of the ovarian cycle?
A
- Follicular (days 1-14)
- Ovulation
- Luteal (days 15-28)
9
Q
What happens during the follicular phase?
A
- growth of the dominant follicle
- primordial to tertiary (graffian) follicle
10
Q
How does does the follicular phase typically last?
A
10-14 days
11
Q
What happens during the ovulation phase of the ovarian cycle?
A
- oocyte ruptures out of the graafian follicle
- occurs mid-cycle at Day 14
- in reponse to surge to LH
12
Q
what happens during the luteal phase of the ovarian cycle?
A
-corpus luteum forms, secretes progesterone and estrogen to accomodate potential gestation.
13
Q
How long does the luteal phase usually last?
A
14 days
14
Q
List what changes (names given to the follicle) follicle undergoes in the follicular phase of the ovarian cycle
A
- Primordial follicle
- Early primary or unilayered follicle
- Late primary or multilayered follicle
- Secondary follicle
- Mature Graffian follicle
15
Q
In the primordial follicle, what surrounds the primary oocyte and what time period of life is this most prevalent in?
A
In the primoridal follicle, primary oocyte is surrounded by squamous epithelium. This is before puberty; and this follicle is inactive
16
Q
What happens during the early primary or unilayered follicle phase of the follicular phase?
A
- Single layer of cuboidal follicular epithelium;
- ZP begins to form.
17
Q
What happens during the late primary (multilayered follicle) phase of the follicular phase?
A
- Several layers of cuboidal follicular epithelial cells.
- ZP forms glycoprotein coat around the oocyte
18
Q
What changes take place during the secondary follicle phase of the follicular phase?
A
- Follicular cells continue to proliferate and forms the stratum (zona) granulosum
- Ovarian stroma around the follicle differentiates into: theca interna and theca externa
- Fluid-filled cavities (Call-exner bodies) appear between follicular cells (fluid is liquor folliculi)
- Antrum beings to form
19
Q
What are theca interna cells?
A
Squamous cells surrounding follicular cells
20
Q
What are theca externa?
A
Capsule-like layer continuous with the connective tissue of the ovary
21
Q
During the secondary follicular phase of the follicular phase, the oocyte is in what phase? (primary, secondary, tertiary)
A
Still a primary oocyte.
22
Q
Describe the changes that take place as the follicle becomes a mature graffian follicle.
A
- Antrum occupies much of the space
- Oocyte displaced to one side
- Develop corona radiata
23
Q
what is corona radiata and during what phase are you likely to see its development?
A
Corona radiata is layer of follicular cells surrounding oocyte developed during the mature graffian follicle phase.
24
Q
What is cumulus oophorus and when does it develop?
A
Cumulus oophorus is a pedestal of folliclular cells anchoring oocyte to the wall; develops during mature graafian follicle
25
True or false: a graafian follcle is a tertiary follicle
False It's still a secondary follicle but with some added changes.
26
During ovulation, what two layers accompanies the oocyte as it shot out of the follicle?
zona pellucida and the corona radiata
27
what are the two forms of paracrine signaling that takes place during folliculogenesis?
1. Granulosa cell-primary oocyte bidirectional signaling
| 2. theca cell-granulosa cell synergistic communication
28
Members of which superfamily feature is prominently amongst the growing list of extracellular ligands implicated in the bi-directional communication during foliculogenesis?
TGF-beta
29
Which growth factor and transcriptional factor are needed during the bidirectional signaling during folliculogenesis?
GDF-9 and BMP-15
30
What hormones are required during the bidirectional signaling of folliculogenesis?
AMH, Activin, inhibin
31
What is polycystic ovarian syndrome (PCOS)?
Enlarged ovaries with multiple cysts which results from disrupted folliculogenesis caused by a defect in the paracrine oocyte-granulosa cell signaling mechanism specially related to AMH.
32
what are some clinical features of polycystic ovarian syndrome?
Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity.
-In adolescents, infrequent or absent menstruation may raise suspicion for the condition
33
Ovulation is stimulated by _
LH surge
34
During ovulation, Follicular cells begin to develop receptors for what hormone?
LH
35
What induces the completion of meiosis I?
Ovulation
36
What is corpus hemorrhagican?
Blood vessels of the theca interna invade the antrum to become the corpus hemorrhagicum which is a temporary structure formed immediately after ovulation from the ovarian follicle.
37
What is Mittelschnerz?
It is mid-cycle pain due to ovulation. Patient will complain of discomfort in the lower abdomen due to peritoneal irritation. Can mimic appendicitis.
38
What causes the Mittelschnerz pain?
Follicle ruptures and releases fluid and blood that irritates the surrounding tissues.
39
which hormone is responsible for tubal motility? Inhibition of tubal motility?
Estrogen acting on it's receptors stimulate tubal motility whereas progesterone inhibits tubal motility.
40
With the rise of progesterone levels 4-6 days after ovulation, _ is inhibited. This may lead to relaxation of the tubal musculature to allow passage of the ovum into the uterus by the action of the tubal cilia.
Tubal motility
41
What is the function of the corpus luteum?
-Synthesizes and secretes steroid hormones which are necessary if pregnancy occurs.
42
What is the function of hCG after fertilization?
hCG goes back to the ovary and tells the corpus leuteum to make estrogen and progesteron until the placenta is complete.
43
Corpus leuteum produces both estrogen and progesterone but mainly _
progesterone
44
what is the corpus luteum consist of and what do they make?
Corpus luteum consists of follicular aka granulosa cells which make estrogen; and theca cells which makes androstenedione and progesterone.
45
which cells of the corpus luteum has the ability to accumulate lipids?
Both follicular and theca lutein cells. They use the lipid to make cholesterol which is precursor for steroid hormones.
46
what is the Corpus albicans
Dense CT scar formed from generation of corpus luteum remains for a variable period. It gradually gets absorbed by macrophages within the stroma.
47
what is the level of estrogen and progesterone (high or low) and what changes that during the early follicular phase?
During early follicular phase, estrogen and progesterone levels are low which feedback to increase FSH and LH and thus see rising levels of estrogen.
48
Estrogen levels causes fluctuation of FSH and LH during the follicular phase. Explain this fluctuation.
initially rising estrogen levels inhibit further FSH and LH release (- feedback) and later as follicle develop, the rising estrogen level stimulates FSH and LH release (+ feedback).
49
Complete the following sentence:
In the luteal phase, corpus luteum makes _ 1_and _2_ which feedback to inhibit _3_ and _4_ release, leading to _5_ and _6_ levels to fall and thus _7_ and _8_ also fall.
1. estrogen
2. progesterone
3. FSH
4. LH
5. FSH
6. LH
7. Estrogen
8. Progesterone
50
what are the three layers of the uterus?
1. Endometirum
2. myometrium
3. Perimetrium
51
The endometrium is divided into what two layers?
1. functional layer (stratum functionalis)
| 2. Basal layer (Stratum Basalis)
52
Which layer of the endometrium is sensitive to hormones?
Stratum functionalis. Stratum basalis is not sensitive to hormones
53
What makes up the myometrium?
3 layers of circularly arranged smooth muscle
54
What kind of epithelium makes up the perimetrium?
simple squamous epithelium.
55
The endometrium is lined by what kind of epithelium?
Simple columnar epithelium which lines the endometrial glands
56
Which layer of the endomtrium proliferates and sloughed off during menstruation?
Stratum functionalis
57
what generates the stratum functaionais?
Stratum basalis
58
In which layer of the uterus are the arcuate arteries stratum vaculare located? Be specific.
In the middle layer of the myometrium
59
What changes does the myometrium undergo everything month? During pregnancy?
Does not change with menstrual cycle, thus no changes monthly except during pregnancy. During pregnancy the myometrium hypertrophies and undergo hyperplasia.
60
what artery gives off the arcuate aa seen in the myometrium?
Uterine artery.
61
Which layer of the uterus gets dual blood supply?
Endometrium
62
What the two sets of blood supply to the endometrium and where do they branch off of?
The arcuate aa branches to form two separate arteries:
1. Straight aa to the stratum basalis
2. Spiral (helical) aa to stratum functionalis
63
Which artery is involved in the month shedding?
Spiral arteries
64
From which layer of the uterus do leiomyoma (uterine fibroid) arise from?
Leiomyoma is a overgrowth of the smooth muscle and connective tissue from the myomtrium
65
What is a surgical treatment for uterine fibroid?
Myomectomy. It's also done for hysterectomy.
66
True for Flase: In myomectomy the uterus is removed.
False
67
Explain how uterine artery embolization is performed and what it is useful for.
Uterine artery embolization is a radiologic alternative to the surgery that involves partial blockage of the uterine arteries with polyvinyl alcohol (PVA) particles and decreases the blood flow to the uterus and fibroids.
68
What artery is used to enter the body for uterine artery embolization?
Femoral a.
69
What does menarche begins?
12-15 years
70
What are the phases of the menstrual cycle?
1. Proliferative phase
2. Secretory Phase
(3. Ischemia)
3/4. Menstrual Phase.
71
What changes occur during the proliferate phase?
- Functional layer begins to thicken
- Spinal arteries are short and deep in the endometrium
- endometrial glands are short, straight and empty (no glycogen)
72
What changes occur during the secretory phase?
- Functional layer becomes very thick
- Spiral arteries are long and growing superficially in the endometrium
- endometrial glands are tortuous and are filled with glycogen-rich secretory products
73
The menstrual phase is initiated by the regression of _
Corpus luteum because no fertilization occurred and thus no estrogen and progesterone to maintain the endometrium
74
Explain what happens to the spiral arteries leading to endometrium being sloughed off?
Spiral arteries begin contracting to junction of the straight arteries and this leads to decreased O2 to functional layer and the functional layer undergo necrosis.
75
During menstrual phase, what happens to the endometrial glands?
They undergo necrosis and detach from functional layer
76
What is endometriosis?
_presence of endometrial tissue outside of the uterus, usually the uterine tubes, ovary and peritoneal lining of abd and pelvis
-responds to ovarian hormones.
77
What is the clinical significance of endometriosis?
Trapped endometrial tissue on the outside can lead to cysts, and scar tissue and adhesion.
-leads to dysmenorrhea (painful period)
78
What is dysmenorrhea?
Painful cramps
- usually begins 1-2 days prior and/or during menstrual bleeding
- Broad range of symptoms-- mild to severe
- lower abdominal discomfort to nausea and vomiting
79
What is the pathophysiology of dysmenorrhea?
Prostaglandins (PGE2, PGF2 alpha) released from endometrial cells --> stimulate uterine contraction --> pain
80
What is mayer-rokitansky-kuster-hauser syndrome?
aka Mullerian agenesis. Absence of derivatives of the paramesonephric (mullerian) ducts
81
What is persistent mullerian duct syndrome
(PMDS) 46, XY, males. Caused by defect in AMH gene or its receptor (AMHR2)
82
What two cancers can arise from the cervix?
Cervical intrapeihtelial neoplasia which can develop into a carcinoma in situ.
2. HPV infection can progress to invaiave carcinoma of the cervix.
83
what is the transformation zone of the cervix and what cells make up the junction?
It is the squamocolumnar junction of the cervix. The endocervix is made up of single layer of columnar mucuous cells and the ectocervix is covered with nonkeratinized stratified squamous epithelium. During puberty and pregnancy, the endocervix extends outwards over the ectocervix and the due to the acidic environement of the vagina, the endocervix cells undergo metaplasia to squamous epithelium.
84
The transformation zone is the most common site of _ preceded by changes called cervical intraepithelial neoplasia (CIN) dysplasia within epithelial layer.
squamous cell carcinoma
85
what vaccine is used today as a cervical cancer vaccine that help protect against 4 types of human papillomavirus (HPV)
Gardasil
86
what type types of HPV causes the 70% of cervical cancer cases.
Type 16 and 18
