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Women's Health > Phys and Pathophys - part 1 - Exam 1 > Flashcards

Phys and Pathophys - part 1 - Exam 1 Flashcards

1
Q

What are the 4 main functions of the HPO axis?

A
  1. development of sex characteristics (puberty)
  2. coordinating regular periodic body changes (ovarial and uterine cycle)
  3. cervix, vagina and breast function
  4. maintains pregnancy
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2
Q

Describe the general flow of the HPO axis

A

hypothalamus makes GnRH ->

then travels to anterior pituitary through the blood stream ->

once at the AP, GnRH binds to receptors then LH and FSH are release ->

FSH and LH travel through bloodstream to the ovary, bind to receptors and Estrogen and Progesterone are released (Activin, Follistatin, Inhibin and Relaxin are also released)

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3
Q

What two things do gondotrope cells synthesize and release? What happens next?

A

Gonadotrope cells - synthesize and release

Follicle Stimulating Hormone (FSH)
Luteinizing Hormone (LH)

FSH and LH then travel to the ovary

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4
Q

Where is GnRH made? How is it released? Where does it head next?

A

GnRH in hypothalamus

GnRH is released in PULSES that correlate with their intended action

GnRH then goes to the Anterior pituitary

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5
Q

Once FSH and LH arrive at the ______. What happens next?

A

ovary

binds to theca and granulosa cells

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6
Q

What are theca cells? Granulosa cells?

A

theca cells are the outer shell around the oocyte

ganulosa cells are the inner circle of the oocyte

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7
Q

______ is more responsible for the growth and maturity of the theca and granulosa cells in the oocyte

A

FSH more than LH

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8
Q

What is folliculogenesis?

A

the growth and maturity process that a primordial follicle takes on the way to becoming a mature/Graafian follicle

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9
Q

Besides stimulating the growth and development of a follicle, name 3 additional roles of FSH and LH?

A

FSH and LH also stimulate ovarian production of:

steroid hormones: estrogens, progesterone, androgens

gonadal peptides: activins, inhibins, follistatins

growth factors

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10
Q

What are the 6 roles of estrogens?

A
  1. Assist with libido
  2. Promotes vaginal wall thickness and lubrication
  3. Maintains health of GU mucosa

other:
reduces acne formation
reduces cholesterol and atherosclerosis

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11
Q

What are the 3 secondary sex characteristics that happen has a result of estrogen?

A

breast enlargement and areolar pigmentation

mature female body shape: wider hips and narrow waist

increased scalp hair, less body hair

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12
Q

What are the 3 roles of progesterone? What is the most important one to remember?

A

Major player in maintenance of pregnancy

Decreases uterine contractility: allows it to stretch for a baby

Promotes breast maturation and differentiation

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13
Q

(increase/decrease) progesterone levels trigger ______. (increase/decrease) progesterone levels after pregnancy signal _____

A

decrease progesterone levels trigger menses

decrease progesterone levels after pregnancy signal lactation

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14
Q

_________ stimulate FSH secretion and are
involved in WBC production, embryo development

A

activins

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15
Q

______ inhibit FSH secretion. ____ and _____ are considered counterpoints to each other

A

Inhibins

Activins and Inhibins

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16
Q

______ help regulate gonadotropin secretion and binds to and inhibits activins → less FSH

A

Follistatins

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17
Q

______ inhibits uterine contractions and relaxes pubic symphysis

A

relaxin

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18
Q

sudden high level spikes of estrogen result in what? in terms of LH and FSH

A

increased GnRH and LH and then ovulation happens

decreases FSH

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19
Q

sudden slow gradual increase in estrogen, what happens next? in terms of LH and FSH

A

decrease in LH

decrease in FSH

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20
Q

What are the 2 hormones that use a positive feedback mechanism?

A

Estrogen and Activin (estrogen is an outlier and can also use a negative feedback mechanisms)

everything else uses a negative feedback mechanisms (Progesterone, inhibin, follistatin, lactation and estrogen)

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21
Q

______ inhibits GnRH and LH

A

progesterone

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22
Q

______ and ______ inhibit FSH secretion

A

Inhibin and follistatin

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23
Q

during lactation, ______ causes increased ______ and altered release of ______

A

hyperprolactinemia causes increased dopamine and altered release of GnRH

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24
Q

What are the 5 pathologic reasons that can affect the HPO axis feedback?

A
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25
Q

What is the general age of puberty for female? male? What are the 3 factors that can influence the onset of puberty?

A

females: 8-13

males: 9-14

Weight and nutritional status
Genetic factors
Abnormal hormone levels

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26
Q

What is adrenarche? Is there any evidence to the naked eye? When does it typically start?

A

increase in secretion of adrenal androgens, DHEA

NO! can only tell with labs

starts PRIOR to or at ONSET of puberty

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27
Q

in females, what is the first event of puberty? what effect does estrogen have on breasts? progesterone?

A

thelarche (breast developlement)

estrogen is responsible for enlargement of the breasts (think size)

progesterone: responsible for MATURATION of the lobule and alveoli growth

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28
Q

What is the second event in puberty for females? What is the 3rd event?

A

2nd: pubarche: developement of pubic and axillary hair

3rd: menarche

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29
Q

typically, how long does a pt NOT OVULATE once they start menarche?

A

Typically anovulatory for first 12-18 months

30
Q

How long does the average menstrual cycle last? +/- ____ days

A

roughly every 28 days

+/- 7 days

31
Q

**Draw the chart that has the hormone levels depending on the day of the menstrual cycle. Be sure to include what phase is included for the coorelating day

A
32
Q

a pt has a menstrual cycle that is typically 35 days, what phase is typically longer than average to account for this change

A

follicular phase is the one that can changes in length

ovulation and luteal phase duration are normally fixed

33
Q

How long is the typically follicular phase? What is it called?

A

varying length (roughly 14 days)

Preovulatory phase

34
Q

early in the follicular phase, what are FSH and LH doing? _____ begins to enlarge

A

rise in FSH > rise in LH

SEVERAL follicles begin to enlarge

35
Q

early in the follicular phase, ____ causes production of inhibin B. What is the result?

A

FSH causes production of inhibin B

inhibin B decreases release of FSH later in follicular phase

36
Q

What day is considered midfollicular phase? Why is this significant?

A

about day 6

1 follicle grows very rapidly, becoming DOMINANT follicle and all other follicles regress to become atretic follicles

37
Q

When is the FSH level higher than the LH level?

A

at the VERY beginning of the follicular phase, think day 1

38
Q

What happens to the follicle as it starts to mature during the follicular phase?

A

develops LH receptors and releases estrogens

39
Q

What happens as a result of the rising estrogen levels as the follicle matures?

A

Rising estrogen levels → increased GnRH pulses →
LH surge → ovulation

40
Q

**______ hormone is responsible for ovulation

A

huge spike in LH

41
Q

What day in the menstrual cycle does ovulation typically occur?

A

approx day 14

42
Q

What is a Corpus hemorrhagicum?

A

a ruptured follicle that fills with blood

43
Q

What is Mittelschmerz? How would a pt describe it?

A

blood that is leaking from the rupture follicle irritates the peritoneal lining

a “stinging” pain

44
Q

Describe the terminology flow of a follicle through a menstruation cycle

A

Dominate follicle, ovulation, corpus hemorrhagicum, corpus luteum, corpus albicans

45
Q

the corpus luteum reacts to _____ by making _____ and ______

A

corpus luteum reacts to LH by making progesterone and estrogen

46
Q

in the luteal phase, rising levels of estrogen and progesterone result in ????

A

Rising levels of estrogen and progesterone → negative feedback → decline in FSH and LH -> which leads to atrophy of corpus luteum 3-4 days before menses

47
Q

What is corpus albicans?

A

the atrophic corpus luteum

48
Q

What does a declining level of progesterone lead to?

A

shedding of endometrial lining (menses)

49
Q

What are the 3 phases of the uterine cycle? What phase can differ in length?

A

menstrual phase

proliferative phase** can change in duration

secretory phase

50
Q

during menses, _____ layer of the endometrium does NOT slough off. What is the technical term for it? What is the outer 2/3rd of the uterine lining called?

A

deep

stratum basale

stratum functionale

51
Q

What day does the proliferative phase typically begin? **_____ is a growth factor for uterine endometrium

A

usually around day 5-16

**estrogen

52
Q

how does progesterone effect the uterine endometrium? How does it effect your period?

A

tells the endometrium to mature, NOT GROW

progesterone only birth control usually results in lighter periods because endometrium is THINNER

53
Q

When does progesterone typically peak?

A

day 21

54
Q

What is happening in the secretory phase of the uterine cycle as a result of the estrogen and progesterone from corpus luteum?

A

endometrium becomes more vascularized, edematous
Glands become coiled, tortuous and secrete clear fluid

55
Q

during the secretory phase, once the corpus luteum regresses, estrogen and progesterone ______. Then what happens?

A

decline

vascular spasms → endometrial ischemia
Breakdown of extracellular matrix of strata functionalis and necrosis of endometrium and supplying arterial walls which causes hemorrhage which coalesces into menstrual flow

56
Q

Draw all chart that shows both the ovarian and uterine cycle on the same page. Consider looking at this again, if needed

A
57
Q

How does estrogen affect the cervical mucous? progesterone?

A

Estrogen: mucus is thinner and more alkaline which enhances survival and transport of sperm

progesterone: mucus is more thick, tenacious and cellular

58
Q

______ influenced cervical mucus: Dries in a fern-like pattern when spread on a slide

A

estrogen

59
Q

______ influenced cervical mucus: NO fern pattern, goop, no discernible pattern

A

progesterone

60
Q

As estrogen levels rise in puberty, cervical os opens exposing endocervical _____ epithelium. ______ gradually replaces in 20s-30s due to ______ of vagina

A

columnar (when it first gets exposed, gradually shifts to squamous)

Squamous metaplasia (normal healthy adult)

acidic environment

61
Q
A
62
Q

How does progesterone and estrogen affect the fallopian tubes?

A

Progesterone - reduces ciliary beat frequency (CBF)

Estrogen - increases ciliary beat frequency (CBF)

63
Q

How does progesterone and estrogen affect muscle?

A

Progesterone - reduces spasms, relaxes smooth muscle, and antagonizes effects of insulin on glucose metabolism

Estrogen - improves skeletal muscle contractility

Both estrogen and progesterone may regulate protein metabolism

64
Q

Which ovarian hormone is the mediator of fat gain in pregnancy?

A

progesterone

65
Q

in sodium/water balance, ______ is responsible for sodium and water retention. _____ is responsible for sodium and water excretion.

A

estrogen: retention

progesterone: excretion

66
Q

__________ mediates the first half of the menstrual cycle and ____ mediates the second half

A

estrogen: first

progesterone: second

67
Q

If the Y chromosome is not functional,
what gender will a human embryo
develop by “default” (male, female,
or intersex)?

A

female

68
Q
A

longitudinal septum

69
Q

Tetany of the uterine wall
during pregnancy can
result in what pathologic
outcome?

A

fetal hypoxia

70
Q

What hormone causes diminished release of
FSH in the latter portion of the follicular phase?

A

Inhibin B

71
Q

What hormone causes
endometrial glands to
become more convoluted
and secrete fluid?

A

progesterone

72
Q
A

Women's Health (6 decks)

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