(PM3A) Female Reproduction Flashcards
What are some of the roles of the female reproduction system?
(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
What is an oocyte?
Mature egg
What occurs following mature egg release? endo
(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
What happens if fertilisation of the mature egg does occur? hcg cl p
(1) embryo 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
How is a mature follicle developed?
(1) Primordial follicle
(2) Primary follicle
(3) Secondary follicle
(4) Mature follicle
What are the principle hormones produced by the ovaries?
(1) Androgens – e.g. testosterone
(2) Oestrogens
(3) Progesterone
(4) Inhibin
How is oestrogen synthesised in the follicular phase? 2 cell 2 hormone
3
(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
What are the phases of the ovarian cycle?FOL
(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
How is the hypothalamic-pituitary-ovary axis regulated?
(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
What is inhibin?
gc cl
-ve on horm
Peptide produced by follicle granulosa cells + corpus luteum
Selective negative feedback on FSH
What is the uterine/ endometrial cycle? psm
(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
What is considered the dominant follicle?
The single follicle selected by day 6 in the follicular phase
What is a Graffian follicle?
A pre-ovulatory follicle
What happens to follicles not selected as the dominant follicle in the follicular phase?
Undergo atresia (degeneration)
Which hormone triggers ovulation?
LH from anterior pituitary
When does ovulation occur? hours
Within 24 hours of LH surge
How do home ovulation kits work?
Detect LH surge in urine
What does the luteinising hormone surge in ovulation cause? 4
(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
What is menopause?
Depletion of finite ovarian reserve
Usually by age 50
Decreased production of ovarian hormones
Raised LH + FSH because no negative feedback
What are the most common symptoms of menopause in order, starting with the most common?
(1) Flatulence
(2) Hot flushes
(3) Sleep disturbance
(4) Mood swings
(5) Night sweats
What treatment is there available for menopause?
Symptomatic treatment
(1) Elleste tablets
(2) Estradot patches
(3) Oestrogel
What is the synthetic form of progesterone?
Progestogen
When is progestogen given alongside oestrogen in HRT? ch
Reduction of risk of cystic hyperplasia of the uterus lining (endometrium)
When is tibolone useful in HRT? pmhrt
Post-menopausal HRT
Combines oestrogenic/ progestogenic/ and weak androgenic activity
What are some common side effects of HRT? 3 risk
(1) Breast tenderness
(2) Headaches
(3) Vaginal bleeding
What are some risks of HRT use? disorder
(1) VTE
(2) Stroke
(3) Coronary heart disease
(4) Endometrial cancer
(5) Breast cancer
(6) Ovarian cancer
What is the definition of human infertility?
Failure to conceive after having unprotected sex for more than 12 months
Less than 12 months if <35yrs old
What percentage of couple infertility is due to females?
45%
What percentage of couple infertility is due to males?
30%
What percentage of couple infertility is undiagnosed?
25%
What is the initial advice for women regarding infertility?
(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
What is menotrophin?
LH + FSH in 1:1 ratio
What are LH and FSH used for as a treatment?
(1) Treatment of infertility of women with proven hypopituitarism
(2) To induce multiple follicle development (superovulation) for assisted contraception
– e.g. IVF
What are some examples of anti-oestrogens?
(1) Clomiphene citrate
(2) Letrozole
What is clomiphene citrate? od
Anti-oestrogen
Used in treatment of female infertility
– for ovulatory dysfunction only (e.g. PCOS)
What is letrozole?
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
How are ovulatory disorders classified?
(1) Hypothalamic pituitary failure
(2) Hypothalamic-pituitary-ovary dysfunction
(3) Ovarian failure
What is first line treatment for hypothalamic pituitary failure (class 1)?
Increase BMI to >19 if it is lower
Pulsatile administration of gonadotrophin-releasing hormone with LH to induce ovulation
What is the first line treatment for hypothalamic-pituitary-ovary dysfunction (class 2)?
Decrease BMI to <30 if it is higher
Use clomifene citrate/ metformin or both
2nd line:
– gonadotrophins
– laparoscopic ovarian drilling
What are some anti-fertility drugs?
(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
What is menorrhagia? period ah
Regular + heavy + prolonged periods
Due to increased uterine vasodilatation + reduced haemostasis
What is the treatment for menorrhagia?
(1) Intrauterine system –IUS
(2) Combined oral contraceptive COC pill, progestogen only pill
(3) NSAIDs
(4) Antifibrinolytic
(5) Hysterectomy
What is primary dysmenorrhoea? period ah
Painful periods + uterine cramps
What is the treatment for primary dysmenorrhoea?
NSAIDs/ hormonal contraceptives e.g. progesterone pill
what is endometriosis
endometrial tissue growing outside uterus under hormonal control, painful, chronic disease
what is treatment for endometriosis
analgesics, nsaids
cocs or progestogen only pill
surgery - laparoscopy/hysterectomy
what can be used as an adjunct to surgery for deep endometriosis
3 mths GnRH agonists, stimulate then reduce FSH/LH and reduce oestrogen and androgen production
describe ovarian androgen excess and what it could be due to
ovaries producing excess androgen, women may develop male characteristics
ovarian tumor,PCOS
What is pcos?
polycystic ovarian syndrome
abnormal follicle development, LH/FSH ratio altered
androgen excess = many small antral follicles
SYMPTOMS: hirsutism, acne, anovulation, irregular cycles
strong link w insulin resistance and obesity
what is treatment for PCOS
diet modification/weight loss
insulin sensitising drugs e.g. metformin
Clomiphene / FSH for infertility
anti androgens for hair growth spironolactone/finasteride
what is uterine fibroids?
benign tumors in myometrium
May be asymptomatic or cause heavy or painful periods, abdominal pain, pelvic ‘fullness’, frequent urination, pain during sex (dyspareunia)
what is treatment for uterine fibroids
mild:
nsaids, COC, progestogen only pill
DEBILITATING:
GnRH agonists e.g. goserelin (stop ovaries producing oestrogen and can shrink fibroids)
endometrial ablation to remove uterus lining
surgery to remove fibroids or hysterectomy
what is libido
low sex drive – due to low oestrogen and/or androgen levels
