patient semester 1 hormones and reproduction female

Question 1

name the main anatomical features of the female tract

Answer 1

vagina, cervix , uterine corpus Fallopian tubes, ovaries

Question 2

describe layers of uterus

Answer 2

myometrium (thick contracting layer) and endometrium (thin shedding layer)

Question 3

describe the changes to the lumen space during the menstrual cycle

Answer 3

during menses, the endometrium sheds leaving just the basal endometrium and this causes the lumen space to increase, then as the endometrium regrows this space decreases

Question 4

what are the ovaries

Answer 4

the ovaries are the site of ovulation

Question 5

describe hormone changes during the menustrual cycle

Answer 5

oestrogen dominates the follicular stage whilst progesterone dominates the luteal

steady slow pulse Gnrh causes release of slow rising FSH, causes oestrogen levels being to rise about a week after ovulation
progesterone is fairly steady then rises around day 14
when levels of steroids begin to drop body is getting ready for next menstruation

gonadtrophins:
LH surge occurs before ovulation and FSH

steady slow pulse Gnrh causes release of slow rising FSH (promote follicle cohort), causing the increase in oestrogen. when it begin to rise FSH levels drop. (neg feedback)

close to ovulation you have an increase of LH caused by increasing levels of oestrogen
(positive feedback)

in the late luteal phase oestrogen levels decline and return to negative feedback as well as progesterone negative feedback. as a result GnRH levels drop causing LH and FSh levels to drop post ovulation.

Spike of LH occurs roughly 36 hours before ovulation

Question 6

what drives the regrowth of the endometrium?

Answer 6

oestrogen

Question 7

what is menarche

Answer 7

onset of ovulation

Question 8

where are the oocytes stored?

Answer 8

in the ovaries whilst in utero

Question 9

when does menopause occur on average?

Answer 9

51

Question 10

what is considered to be out of the norms for a menstrual cycle length

Answer 10

less than 22 days or more than 35 days

Question 11

name te stages in menstrual cycle (ovarian)

Answer 11

day 1-5 = menses
days 5-14 = follicular phase (variable in length) - it isn’t possible to accurately time ovulation
14-28 = luteal phase

Question 12

when talking about the uterus and endometrium what are the stages of the menstrual cycle

Answer 12

the prolifitive (growth of endometrium ) and secretory stages (endometrium glands secrete)

Question 13

ovulation

Answer 13

occurs around day 14 of 28
follicle ruptures releasing egg
corpus lutem remains for another week unless rescued in pregnancy

Question 14

describe the differences between gonadatrophins and steroid hormones in therms of structure

Answer 14

gonadatrophins are polypeptide, direct gene products, water soluble , circulate

steroid hormones are produced by enzyme and are insoluble
found in the cell nucleus

Question 15

describe sex steroid synthesis

Answer 15

cholesterol is a starting product for all sex steroids

androgens give rise to by androgen catalysing oestrogen

Question 16

target tissue

Answer 16

a tissue that expresses a receptor

Question 17

where are major steroid receptors found?

Answer 17

intracellular (nuclear)

Question 18

where does transcription occur

Answer 18

nucleus

Question 19

where does translation occur

Answer 19

cytoplasm

Question 20

nuclear receptor superfamily

Answer 20

proteins that have binding sites for both steroids and DNA.

they are receptors for all major classes of steroids, *androgens, oestrogen’s and progestins etc

Question 21

what happens when a steroid ligand binds to the nuclear steroid receptor ?

Answer 21

produces a complex that acts on DNA and alters the expression of genes
proteins produced therefore change

Question 22

steroid receptor can be described as what?

Answer 22

a transcription factor

Question 23

steroid receptor can be described as what?

Answer 23

a transcription factor

Question 24

what receptors do the gonadatrophins bind to?

Answer 24

cell surface receptor FSHR and LHR

Question 25

how is production of the gonadatrophins regulated

Answer 25

by the hypothalamic pituitary axis. HPO axis - GnRH is released in a pulsing action (this frequency changes in women) (fast pulse = LH slow pulse = FSH) this causes the release of the gonadatrophins from the anterior pituitary these travel in the blood to the ovaries: causing production and release of steroid hormones and follicle for ovulation and egg production (control follicle maturation)

Question 26

describe GnRh

Answer 26

GPCR 10 amino acid affected by sex steroid feedback agonists and antagonists are both used in ART to shut down ovary and advance controlled cycle of ovulatory

Question 27

describe how GnRH is manipulated in assisted reproduction

Answer 27

agonists and antagonists are both used in ART to shut down ovary (by blocking GnRH receptor, stopping downstream hormone production and release) and advance controlled cycle of ovulatory

Question 28

describe how GnRH is manipulated in assisted reproduction

Answer 28

agonists and antagonists are both used in ART to shut down ovary (by blocking GnRH receptor, stopping downstream hormone production and release) and advance controlled cycle of ovulatory agonist e.g. buserelin causes down regulation can then use external hormones to control cycle

Question 29

describe the onset of puberty

Answer 29

leptin is released from fatty tissue rising fat level produces more leptin operates through kisspeptin neurone kickstars GnRH pathway overweight girls tend to start period early

Question 30

describe the ovarian cycle

Answer 30

cohort of follicles recruited every month (about 20) dominant follicles, usually 1 or 2 - moves to ovarian cortex and ovulates follicle enlarge due to oestrogen tertiary follicles are fluid filled and fluid is released at ovulation granulosa cells grow and surround follicle and can be released with oocyte at ovulation follicles that don't ovulate die via atresia process FSH stimulates follicle maturation LH then stimulates ovulation corpus

Question 31

DESCRIBE GRANULOSA CELL

Answer 31

``` somatic cells (full chromosome complement) grow in the follicle during ovarian cycle and surround the follicle and can be released with oocyte at ovulation ```

Question 32

describe the role of the corpus luteum

Answer 32

residual structure left on the surface of the ovary after ovulation endocrine structure that produces progesterone

Question 33

describe the role of the corpus luteum

Answer 33

residual structure left on the surface of the ovary after ovulation endocrine structure that produces progesterone and also oestrogen for a week then it regresses after a week

Question 34

how are gametes produces

Answer 34

Meiosis

Question 35

what type of feedback is exhibited by progesterone?

Answer 35

negative

Question 36

what type of feedback is exhibited by oestrogen ?

Answer 36

negative mainly | positive in late follicular phase to cause increase in LH hormone

Question 37

describe briefly contraceptive options for women

Answer 37

combines oestrogen and progesterone which inhibit GnRh by negative feedback prolonged high levels of oestrogen alone will also have this effect

Question 38

describe the dangers of unopposed/ prolonged oestrogen therapy

Answer 38

endometrial cancer

Question 39

describe effect of steroids on endometrium

Answer 39

estrogen stimulates the growth of endometrium

Question 40

mechanism of steroid hormone

Answer 40

steroids bind receptor in cell complex go to nucleus binds to steroid response element (SRE) on DNA recruit co activatiors and alters rate of transcription more mRNa production more protein produced

Question 41

describe 2 major anti- oestrogen's and their action on oestrogen receptors

Answer 41

a pure antiestrogen e.g fasolodex binds estrogen receptor, doesn't produce correct complex can't bind DNA so inactive and no effect on DNA transcription tamoxifen is a partial antagonist. partial agonist can be used as anti breast cancer drugs

Question 42

what is an oestrogen?

Answer 42

biological activity on oestrogen receptor

Question 43

estrogen causes what to happen to uterine tissue

Answer 43

appearance of progesterone receptors

Question 44

what is menstruation?

Answer 44

shedding og superficial layer (functionalists) of endometrium caused by withdrawal of sex steroid support which leads to : vasoconstriction, tissue hypoxia breakdown of connective tissue, fragmentation local coagulation factors control blood loss locally

Question 45

how is blood loss controlled

Answer 45

local coagulation factors control blood loss locally

Question 46

describe endometriosis

Answer 46

ectopic endometrial tissue arises in over areas of the body e.g. ovaries, common causes pain and infertility mainly caused by reflux menustration - tissue shed at menses passes through Fallopian tubes establishing ectopic sites these lesion continue to cycle under hormonal control but are not lost at menustration

Question 47

describe endometriosis

Answer 47

ectopic endometrial tissue arises in over areas of the body e.g. ovaries, common causes pain and infertility mainly caused by reflux menustration - tissue shed at menses passes through Fallopian tubes establishing ectopic sites these lesion continue to cycle under hormonal control but are not lost at menstruation alternatively occurs from progenitor cells in ectopic tissue not clear why it only happens to some women family history

Question 48

how do you treat or manage endometriosis

Answer 48

surgery an be used to remove lesions treat using NSAIDS or by blocking pharmacologically blocking cycle aromatise inhibitor (inhibits production of oestrogen's from androgens) combined oral steroid contraceptive gonadatrophin releasing hormone modulated (buterlin)

Question 49

how does fertilisation occur

Answer 49

sperm enters and fertilises egg usually in the upper fallopian tube preimplantation development occurs and moves further down fallopian tube blastocyst implants in lining of womb ``` embryos must develop to the blastocysts stage before implantation to endometrium interstitial implantation (embryo buries in the uterus ) the embryo grows within the tissue ```

Question 50

at what day is endometrium receptive to embryo?

Answer 50

day 7 after ovulation | where progesterone and oestrogen have not yet started to decline (causing menstruation)

Question 51

in contraception what hormones rise

Answer 51

Progesterone | rescues corpus luteum

Question 52

in contraception what hormones rise?

Answer 52

Progesterone and chorionic gonadotrophin (hCG) | rescues corpus luteum (producing oestrogen and progesterone)

Question 53

what is hCG and where is it produced?

Answer 53

human chorionic gonadotrophin (hCG) is a polypeptide hormone that rescues that corpus luteum produced by placenta detected in pregnancy test

Question 54

what accounts for the 'closure' of the receptive period for implantation?

Answer 54

lack of timely appearance of hCG i.e embryo can be implanted but won't survive due to regression of corpus luteum

Question 55

describe hormone changes in pregnancy

Answer 55

hCg rises and peaks ar 8 weeks and declines thereafter | oestrogen and progestin rise dramatically

Question 56

what is the role of progesterone in pregnancy?

Answer 56

regulates transport of egg in Fallopian tubes (cilia moves egg prepares uterus to receive implanting blastocyst sustains uterine lining inhibits myometrial contractility influences the ovary has effect on brain and sexual behaviour

Question 57

describe the luteoplacental endocrine switch

Answer 57

at 7-9 weeks the placenta (that has been growing steadily in first trimester) takes on oestrogen and progesterone production from the corpus luteum corpus luteum is no longer major endocrinal organ miscarriage likely here

Question 58

steroid production in pregnant women

Answer 58

cholesterol imported into the placenta from blood and converted to progesterone then enters fetus and converted to androgen then back to the placenta as estrogen (this means aromatise present in placenta)

Question 59

describe ultrasound imaging importance

Answer 59

pregnancy is viable is heart can be (5 weeks post lmp transvaginally ) (6 weeks post LMP transabdominally)

Question 60

describe ectopic pregnancy?

Answer 60

embryo implants outsides of the uterus i.e. in the Fallopian tubes and grows tubal rupture can be fatal surgery or use of methotrexate (folate antagonist, terminates pregnancy)

Question 61

how is ectopic pregnancy detected?

Answer 61

Abdominal pain hCG scan and no intrauterine body

Question 62

what is the decidua?

Answer 62

Decidua is the endometrium that has been exposed to progesterone for a prolonged time (pregnnacy) which is shed at birth provides glycoprotein when breaksdown

Question 63

what is the limit for pregnancy termination?

Answer 63

Though the law permits terminations up to 24 weeks, the great majority are done before the 13th week.

Question 64

describe how mifepristone causes termination (an abortifacient)

Answer 64

antagonist binds to the progesterone receptor, blocks preparation of endometrium for pregnancy counteracts the suppressive effect of p on myometrial contractility

Question 65

what is the decidua?

Answer 65

Decidua is the endometrium that has been exposed to progesterone for a prolonged time (pregnnacy) which is shed at birth

Question 66

what is hPL? what is its role?

Answer 66

hPL is a polypeptide hormone modulates intermediated metabolism by changing level of insulin like growth factor females are resistant to insulin in pregnancy - inc circulating glucose in turn inc in glucose and amino acids available to foetus

Question 67

planned induction of labour

Answer 67

occurs in pre - eclampsia or severe fatal growth restriction glucocorticoid treatment oftenn used to advance to mature the fatal lungs to prepare for air phase

Question 68

describe hormonal control of labour

Answer 68

unsure how initiates , as progesterone levels stay high till after delivery functional change where progesterone no longer has same effect on the uterus myometrial muscle cells start to 'communicate at junctions -> contraction coordinated from top of uterus lower uterus and cervix need to expand appearance of inflammatory cells

Question 69

how does infection effect late stage pregnancy

Answer 69

can induce labour or cause induction to be needed | oxytocin, thromboxane prostaglandin analogoues

Question 70

viability is affected by

Answer 70

lung phase difference in utero and in

Question 71

drug use in pregnancy

Answer 71

avoid all drugs in 1st trimester essential therapy tapered down to lower effective dose prior to conception most drugs can diffuse across the placenta and enter fatal ciculation some drugs are effluxes out lipophillic unionised drugs or weakly basic drugs don't efflux out

Question 72

why can't valproate be used in pregnancy

Answer 72

valproate causes birth defects fetal valproate syndrome PPP

Question 73

what is pre term labour defined as? what is survival rate at 23 weeks

Answer 73

pregnancy before 37 weeks 42 percent of babies survive at 23 weeks significant affect in future

Question 74

how do we prolong pregnancy?

Answer 74

tocolytics oxytocin antagonist e.g, atosiban, beta adrenoreceptor e.g. ritodrine (crosses placenta membrane) ca 2+ channel blocker nifedipine