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Part 3 – PM3A > (PM3A) Female Reproduction > Flashcards

(PM3A) Female Reproduction Flashcards

1
Q

What are some of the roles of the female reproduction system?

A

(1) Gametogenesis
(2) Secretion of sex hormones
(3) Reception of sperm
(4) Fertilisation
(5) Maintenance of developing foetus + placenta
(6) Parturition – giving birth
(7) Lactation

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2
Q

What is the length of the female reproductive cycle?

A

28 days

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3
Q

Where in the female reproductive cycle is considered as day 1?

A

Day one of menstruation

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4
Q

What is an oocyte?

A

Mature egg

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5
Q

What occurs following mature egg release?

A

(1) Uterus lining (endometrium) is prepared for implantation of ovum if fertilisation occurred
(2) Uterus lining (endometrium) degenerates if fertilisation has not occurred
(3) Maturation of new follicle resumes

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6
Q

What happens if fertilisation of the mature egg does occur?

A

(1) Conceptus in uterus secretes human Chorionic Gonadotropin (hCG)
(2) This rescues corpus luteum (CL)

(3) Progesterone secretion is maintained
– this maintains endometrium (uterus lining)
– blocks FSH + LH + new follicle growth

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7
Q

What is the uterus?

A

Hosts developing foetus

Produces vaginal + uterine secretions

Passes the male sperm to the fallopian tubes

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8
Q

What are the ovaries?

A

Produce female egg cells

Produce + secrete oestrogen + progesterone

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9
Q

How is a mature follicle developed?

A

(1) Primordial follicle
(2) Primary follicle
(3) Secondary follicle
(4) Mature follicle

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10
Q

What are the principle hormones produced by the ovaries?

A

(1) Androgens – e.g. testosterone
(2) Oestrogens
(3) Progesterone
(4) Inhibin

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11
Q

How is oestrogen synthesised in the follicular phase?

A

(1) LH stimulates theca cells to synthesise androgens from cholesterol
(2) Some androgens diffuse to nearby granulose cells of follicle
(3) FSH stimulates conversion of androgens into oestrogens in granulose cells

This is known as the 2 hormone/ 2 cell mechanism

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12
Q

What are the phases of the ovarian cycle?

A

(1) Follicular phase
– Follicle maturation
– Preparation of mature egg (oocyte) release

(2) Ovulation
– mid-cycle
– rupture of follicle
– release of mature egg (oocyte)

(3) Luteal phase
– luteinisation of ruptured follicle
– preparation of reproductive tract for pregnancy if fertilisation occurs

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13
Q

How is the hypothalamic-pituitary-ovary axis regulated?

A

(1) GnRH stimulates release of LH and/ or FSH from pituitary
(2) LH + FSH stimulate release of progesterone, androgen, and oestrogen from ovaries
(3) Progesterone + oestrogen provide negative feedback on pituitary + hypothalamus
(4) Inhibits FSH + LH secretion

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14
Q

What is inhibin?

A

Peptide produced by follicle granulosa cells + corpus luteum

Selective negative feedback on FSH

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15
Q

What is the uterine/ endometrial cycle?

A

(1) Proliferative phase:
– Increased thickness of endometrium (uterus lining)
– Increased growth of endometrial blood vessels + glands
– Secretion of sperm-friendly mucous

(2) Secretory phase:
 – endometrial swelling 
 –secretory development
 – increased blood supply
 – increased lipid + glycogen deposition 
(3) Menstruation:
 – caused by sudden decrease of oestrogen + progesterone at end of luteal phase
 – loss of hormonal stimulation 
 – necrosis in endometrium
 – aided by uterine prostaglandins
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16
Q

What is considered the dominant follicle?

A

The single follicle selected by day 6 in the follicular phase

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17
Q

What is a Graffian follicle?

A

A pre-ovulatory follicle

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18
Q

What happens to follicles not selected as the dominant follicle in the follicular phase?

A

Undergo atresia (degeneration)

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19
Q

Which hormone triggers ovulation?

A

LH from anterior pituitary

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20
Q

When does ovulation occur?

A

Within 24 hours of LH surge

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21
Q

How do home ovulation kits work?

A

Detect LH surge in urine

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22
Q

What does the luteinising hormone surge in ovulation cause?

A

(1) Swelling of follicle + thinning of wall
(2) Mature egg (oocyte) released into peritoneal cavity
(3) Mature egg (oocyte) is drawn into fallopian tube (fimbria)
(4) Remainder of follicle develops into corpus luteum
(5) Lasts for 14 days

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23
Q

What is menopause?

A

Depletion of finite ovarian reserve

Usually by age 50

Decreased production of ovarian hormones

Raised LH + FSH because no negative feedback

24
Q

When does menopause occur?

A

Usually by age 50

Mean age of 51 in UK

25
Q

What happens to LH and FSH levels during menopause?

A

Increase

No negative feedback

Due to decreased ovarian hormone production

26
Q

What are the most common symptoms of menopause in order, starting with the most common?

A

(1) Flatulence
(2) Hot flushes
(3) Sleep disturbance
(4) Mood swings
(5) Night sweats

27
Q

What treatment is there available for menopause?

A

Symptomatic treatment

(1) Elleste tablets
(2) Estradot patches
(3) Oestrogel

28
Q

What are some less common symptoms of menopause?

A

(1) Vaginal dryness
(2) Itching
(3) Atrophy

29
Q

What is oestrogen hormone replacement therapy?

A

Given cyclically or continuously for many gynaecological symptoms

30
Q

What is the synthetic form of progesterone?

A

Progestogen

31
Q

When is progestogen given alongside oestrogen in HRT?

A

Reduction of risk of cystic hyperplasia of the uterus lining (endometrium)

32
Q

What is the most suitable type of oestrogen for HRT?

A

Natural is more suitable than synthetic

33
Q

When is tibolone useful in HRT?

A

Post-menopausal HRT

Combines oestrogenic/ progestogenic/ and weak androgenic activity

34
Q

What are some common side effects of HRT?

A

(1) Breast tenderness
(2) Headaches
(3) Vaginal bleeding

35
Q

What are some risks of HRT use?

A

(1) VTE
(2) Stroke
(3) Coronary heart disease
(4) Endometrial cancer
(5) Breast cancer
(6) Ovarian cancer

36
Q

How often should HRT treatment be reviewed?

A

Monthly

37
Q

What is the definition of human infertility?

A

Failure to conceive after having unprotected sex for more than 12 months

Less than 12 months if <35yrs old

38
Q

What percentage of couple infertility is due to females?

A

45%

39
Q

What percentage of couple infertility is due to males?

A

30%

40
Q

What percentage of couple infertility is undiagnosed?

A

25%

41
Q

What is the initial advice for women regarding infertility?

A

(1) Drink no more than 1-2 units of alcohol once/ twice per week
(2) Reduce smoking and passive smoking
(3) Losing weight if BMI >30
(4) Gain weight if BMI <19

42
Q

Why are fertility drugs given to women?

A

Increase chances of achieving pregnancy

43
Q

What is menotrophin?

A

LH + FSH in 1:1 ratio

44
Q

What are LH and FSH used for as a treatment?

A

(1) Treatment of infertility of women with proven hypopituitarism

(2) To induce multiple follicle development (superovulation) for assisted contraception
– e.g. IVF

45
Q

What are some examples of anti-oestrogens?

A

(1) Clomiphene citrate

(2) Letrozole

46
Q

What is clomiphene citrate?

A

Anti-oestrogen

Used in treatment of female infertility
– for ovulatory dysfunction only (e.g. PCOS)

47
Q

What is letrozole?

A

Anti-oestrogen

Licensed for breast cancer

Induces FSH + LH release

Binds to oestrogen receptors in hypothalamus

Stimulates increased production of pituitary gonadotrophins
– stimulates maturation of ovarian follicle

48
Q

How are ovulatory disorders classified?

A

(1) Hypothalamic pituitary failure
(2) Hypothalamic-pituitary-ovary dysfunction
(3) Ovarian failure

49
Q

What is first line treatment for hypothalamic pituitary failure (class 1)?

A

Increase BMI to >19 if it is lower

Pulsatile administration of gonadotrophin-releasing hormone with LH to induce ovulation

50
Q

What is the first line treatment for hypothalamic-pituitary-ovary dysfunction (class 2)?

A

Decrease BMI to <30 if it is higher

Use clomifene citrate/ metformin or both

2nd line:
– gonadotrophins
– laparoscopic ovarian drilling

51
Q

What are some anti-fertility drugs?

A

(1) GnRH antagonists
– inhibit LH + FSH for anterior pituitary
– inhibit follicle development
– inhibit ovarian steroid output

(2) Oral contraceptive pills
– inhibit follicle development + ovulation
– exert negative feedback on hypothalamus + anterior pituitary

52
Q

What is menorrhagia?

A

Regular + heavy + prolonged periods

Due to increased uterine vasodilatation + reduced haemostasis

53
Q

What is the treatment for menorrhagia?

A

(1) Intrauterine system –IUS
(2) Combined oral contraceptive
(3) NSAIDs
(4) Antifibrinolytic
(5) Hysterectomy

54
Q

What is primary dysmenorrhoea?

A

Painful periods + uterine cramps

55
Q

What is the treatment for primary dysmenorrhoea?

A

NSAIDs/ hormonal contraceptives

Part 3 – PM3A (28 decks)

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