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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 an oocyte?

A

Mature egg

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3
Q

What occurs following mature egg release? endo

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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4
Q

What happens if fertilisation of the mature egg does occur? hcg cl p

A

(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

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5
Q

How is a mature follicle developed?

A

(1) Primordial follicle

(2) Primary follicle

(3) Secondary follicle

(4) Mature follicle

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6
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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7
Q

How is oestrogen synthesised in the follicular phase? 2 cell 2 hormone
3

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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8
Q

What are the phases of the ovarian cycle?FOL

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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9
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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10
Q

What is inhibin?
gc cl
-ve on horm

A

Peptide produced by follicle granulosa cells + corpus luteum

Selective negative feedback on FSH

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11
Q

What is the uterine/ endometrial cycle? psm

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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12
Q

What is considered the dominant follicle?

A

The single follicle selected by day 6 in the follicular phase

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13
Q

What is a Graffian follicle?

A

A pre-ovulatory follicle

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14
Q

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

A

Undergo atresia (degeneration)

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15
Q

Which hormone triggers ovulation?

A

LH from anterior pituitary

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16
Q

When does ovulation occur? hours

A

Within 24 hours of LH surge

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17
Q

How do home ovulation kits work?

A

Detect LH surge in urine

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18
Q

What does the luteinising hormone surge in ovulation cause? 4

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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19
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

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20
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

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21
Q

What treatment is there available for menopause?

A

Symptomatic treatment

(1) Elleste tablets

(2) Estradot patches

(3) Oestrogel

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22
Q

What is the synthetic form of progesterone?

A

Progestogen

23
Q

When is progestogen given alongside oestrogen in HRT? ch

A

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

24
Q

When is tibolone useful in HRT? pmhrt

A

Post-menopausal HRT

Combines oestrogenic/ progestogenic/ and weak androgenic activity

25
Q

What are some common side effects of HRT? 3 risk

A

(1) Breast tenderness

(2) Headaches

(3) Vaginal bleeding

26
Q

What are some risks of HRT use? disorder

A

(1) VTE

(2) Stroke

(3) Coronary heart disease

(4) Endometrial cancer

(5) Breast cancer

(6) Ovarian cancer

27
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

28
Q

What percentage of couple infertility is due to females?

A

45%

29
Q

What percentage of couple infertility is due to males?

A

30%

30
Q

What percentage of couple infertility is undiagnosed?

A

25%

31
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

32
Q

What is menotrophin?

A

LH + FSH in 1:1 ratio

33
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

34
Q

What are some examples of anti-oestrogens?

A

(1) Clomiphene citrate

(2) Letrozole

35
Q

What is clomiphene citrate? od

A

Anti-oestrogen

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

36
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

37
Q

How are ovulatory disorders classified?

A

(1) Hypothalamic pituitary failure

(2) Hypothalamic-pituitary-ovary dysfunction

(3) Ovarian failure

38
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

39
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

40
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

41
Q

What is menorrhagia? period ah

A

Regular + heavy + prolonged periods

Due to increased uterine vasodilatation + reduced haemostasis

42
Q

What is the treatment for menorrhagia?

A

(1) Intrauterine system –IUS

(2) Combined oral contraceptive COC pill, progestogen only pill

(3) NSAIDs

(4) Antifibrinolytic

(5) Hysterectomy

43
Q

What is primary dysmenorrhoea? period ah

A

Painful periods + uterine cramps

44
Q

What is the treatment for primary dysmenorrhoea?

A

NSAIDs/ hormonal contraceptives e.g. progesterone pill

45
Q

what is endometriosis

A

endometrial tissue growing outside uterus under hormonal control, painful, chronic disease

46
Q

what is treatment for endometriosis

A

analgesics, nsaids
cocs or progestogen only pill
surgery - laparoscopy/hysterectomy

47
Q

what can be used as an adjunct to surgery for deep endometriosis

A

3 mths GnRH agonists, stimulate then reduce FSH/LH and reduce oestrogen and androgen production

48
Q

describe ovarian androgen excess and what it could be due to

A

ovaries producing excess androgen, women may develop male characteristics

ovarian tumor,PCOS

49
Q

What is pcos?

A

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

50
Q

what is treatment for PCOS

A

diet modification/weight loss
insulin sensitising drugs e.g. metformin
Clomiphene / FSH for infertility
anti androgens for hair growth spironolactone/finasteride

51
Q

what is uterine fibroids?

A

benign tumors in myometrium
May be asymptomatic or cause heavy or painful periods, abdominal pain, pelvic ‘fullness’, frequent urination, pain during sex (dyspareunia)

52
Q

what is treatment for uterine fibroids

A

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

53
Q

what is libido

A

low sex drive – due to low oestrogen and/or androgen levels

PM3A (36 decks)

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