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Medicine Year 2 > Repro Topic 1 - Female Reproduction > Flashcards

Repro Topic 1 - Female Reproduction Flashcards

1
Q

Describe the structure of the suspensory ligament

A
  • Lateral wall of the pelvus to the ovary
  • Carries ovarian artery and vein
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2
Q

Describe primordial follicles

A
  • At periphery of cortex
  • Most numerous follicle type
  • Single layer of squamous follicular cells
  • Contain the immature primary oocyte
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3
Q

Give examples of disorders of hormone excess

A
  • Polycystic ovarian syndrome
  • Granulosa cell tumour
  • Teratoma
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4
Q

How do steroid hormones function?

A

Lipid soluble - permeable to membranes, bind to intracellular receptors

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5
Q

List the phases of ovarian function during the menstrual cycle

A
  • Follicular phase
  • Luteal phase
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6
Q

Describe primary follicles

A
  • Cuboidal stratified follicular cells - granulosa
  • Contains the primary oocyte
  • Follicular fluid between cells
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7
Q

Describe the arterial supply of the ovary

A

Ovarian artery - arises from aorta at the level of the renal artery

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8
Q

Describe the structure of the broad ligament

A
  • Peritoneal sheet draped over uterus and uterine tubes
  • Ovaries attached to posterior layer by short mesentery - mesovarium
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9
Q

What is the effect of aromatase excess?

A
  • Excessive conversion of androgens to oestrogens
  • Feminisation of male genitalia
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10
Q

Give examples of disorders of hormone resistance

A
  • Testicular femininisation syndrome
  • Reifenstein’s syndrome
  • 5 alpha reductase type 2 deficiency
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11
Q

Describe common structural abnormalities of uterus

A
  • 20% show retroflexion and retoversion (asymptomatic)
  • Bicornate uterus = 2 separate
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12
Q

Describe the action of hormonal contraception

A
  • Oestrogen and progesterone combination or continuous progesterone
  • Selective inhibition of pituitary function - inhibition of ovulation
  • Change in cervical mucous, uterine endometrium and motility/secretion in tubes
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13
Q

List disorders of steroidogenesis

A
  1. Congenital adrenal hyperplasia
  2. Aromatase deficiency
  3. Aromatase excess
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14
Q

What is the significance of the Pouch of Douglas

A

‘Backstreet’ abortions - sharp object up through vagina to the uterus, often accidentally perforates the pouch of Douglas, causing serious infection

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15
Q

Describe the structure of the ovarian ligament

A

Fibrous cord, links ovary to uterus

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16
Q

Give examples of disorders of hormone deficiency

A
  • Hypogonadism
  • Turner’s syndrome
  • Klinefelter’s syndrome
  • Kallman’s syndrome (low GnRH)
  • Hypopituitarism
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17
Q

Describe the effects of the hormonal changes in the menstrual cycle on the cervix

A
  • Late follicular phase - high oestrogen
    • Increased vascularity, watery mucous (allows passage of sperm)
    • External os open
  • Luteal phase - high progesterone
    • Thickens cervical mucous, reduces elasticity
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18
Q

List the types of abnormalities of female endocrine function

A
  1. Hormone excess
  2. Hormone deficiency
  3. Hormone hypersensitivity
  4. Hormone resistance
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19
Q

List the stages in follicle development

A
  1. Primordial follicle
  2. Primary follicle
  3. Secondary follicle
  4. Corpus luteum
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20
Q

Describe the layers of the walls of the uterine tubes

A
  • Mucosa (thick muscosal folds in the ampulla)
    • Epithelium - simple ciliated columnar with secretory cells
    • Lamina propria
  • Circular muscle
  • Longitudinal muscle
  • Serosa
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21
Q

Describe the arterial supply of the uterus

A

Uterine artery, branch of the internal iliac artery

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22
Q

How are female steroid hormones produced?

A
  • Cholesterol is converted to pregnenolone then progesterone
  • Later in the pathway, androstenedione is converted to oesterone by aromatase or testosterone
  • Testosterone is converted to oestradiol by aromatase
  • Oesterone is converted to oestradiol
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23
Q

Describe the components of the female reproductive system

A
  • Paired gonads - ovaries
  • Duct system - paired uterine tubes, single midline uterus, single midline vagina
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24
Q

Describe the uterine lining in the secretory stage

A
  • Bigger more coiled glands
  • More secretions for nutrition of the embryo (pre-implantation)
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25
Q

How do follicles change following ovulation?

A
  • After ovulation, large follicle collapses and becomes the corpus luteum (temporary endocrine organ)
  • Lutein cells from granulosa/theca cells
    • Granulosa form most of the lutein cells, theca form the peripheral lutein cells
  • Much larger than follicle
  • Connective tissue septa and blood vessels form
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26
Q

What is polycystic ovarian syndrome?

A
  • Common
  • Clinical presentation - infertility (no ovulation, lack of menses - high androgens), weight gain, hirsutism, acne
  • LH/FSH secretion out of balance - no negative feedback, continuous oestrogen production
  • 2:1 LH:FSH ratio diagnostic
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27
Q

Explain negative/positive feedback in the menstrual cycle

A
  • Oestrogen and progesterone
    • Negative feedback effect on the pituitary and hypothalamus during most of the cycle
    • Positive feedback effect on the pituitary and hypothalamus on days 12-14
28
Q

How is sex hormone secretion controlled in females?

A

Hypothalamic-pituitary-ovarian axis

29
Q

Describe androgen production

A
  • Ovary - androstenediol, DHEA, small amount of testosterone
  • Adrenal cortex - androstenedione, DHEA, DHEAS
  • Androstenedione and androstenediol converted to testosterone
  • DHEA converted to androstenedione or androstenediol
30
Q

Where is the female reproductive system located?

A

In the pelvic cavity, the vagina extends through the pelvic floor

31
Q

Where are female steroid hormones produced?

A

Produced in gonads, adrenal glands and the placenta

32
Q

How is progesterone produced?

A
  • Synthesised from cholesterol via pregnenolone
  • Produced primarily in the corpus luteum, adrenal gland and placenta during pregnancy
33
Q

How long does the follicular phase of the mentrual cycle last?

A

10-14 days

34
Q

Describe the levels of progesterone and oestrogen in the follicular phase of menstruation

A

Low progesterone

High oestrogen - conversion of androgens to oestrogens via aromatase

35
Q

Describe the hormonal changes which occur during the follicular phase of the menstrual cycle

A
  • High FSH promotes development of follicles
  • LH rises slowly, beginning 1-2 days after FSH increases
  • Oestradiol production by follicles causes increased FSH/LH synthesis but inhibits secretion, especially of FSH, also promotes the proliferation of the uterine lining
  • Granulosa cells produce inhibin, which inhibits FSH
  • Towards the end of the follicular phase, progesterone begins to rise, high oestradiol causes LH secretion by gonadotropes (positive feedback)
  • Stored LH is released - LH surge over 36-48 hours along with a smaller rise in FSH
    • LH surge - enzymes to breakdown follicle wall and release mature oocyte (ovulation)
36
Q

How long does the luteal phase of menstruation last?

A

14 days - usually constant

37
Q
A
38
Q

Describe the uterine lining in the menstrual stage

A
  • If fertilisation/implantation don’t occur - death of corpus luteum, loss of hormone supply
  • Spiral arteries become more coiled, vascular stasis leading to tissue death
  • Active vasoconstriction then relaxation of arteries, flow of blood carries away dying tissue
  • Surface layers (stratum functionalis) shed - stratum basalis remains as it has an independent blood supply from straight arteries, which are a source of regrowth in the next cycle
39
Q

Where are the ovaries located?

A
  • Variable position - especially after childbirth
  • Near laterall wall of pelvic cavity, stabilised by ligaments
40
Q

What is the function of progesterone?

A
  • Endometrial development - smooth muscle control
  • Maintenance of pregnancy (placenta)
  • Mammary gland development
41
Q

Describe the hormonal changes which trigger menstruation

A
  • Inhibin inhibits FSH/LH release
  • Corpus luteum degeneration, reduced progesterone
  • Leukocyte infiltration of endometrium
  • Spiral arteries breakdown
  • Menstruation begins
42
Q

List the peritoneal reflections (pouches) of the female reproductive system

A
  • Rectouterine pouch (of Douglas) - deep pouch between uterus and rectum
  • Utervesical (vesicouterine) pouch - dead end between bladder and uterus, shallow
43
Q

Describe the effects of the hormonal changes in the stages of the menstrual cycle on the vagina

A
  • Early follicular - low oestrogen
    • Epithelium thin + pale
  • Low follicular - high oestrogen
    • Squamous cells mature, epithelial thickening
  • Luteal phase
    • Mature squamous cells shed as cellular debris
44
Q

Describe the uterine lining in the proliferative stage

A
  • Inner endometrium
    • Simple columnar epithelium
    • Long uterine glands
    • Coiled arteries
    • Superficial stratum functionalis and deep stratum basalis
  • Smooth muscle myometrium - thickest in this stage (preparation to deliver child)
  • Outer serosa or perimetrium
45
Q

Describe the venous drainage of the uterus

A

Uterine vein, drains to the internal iliac vein

46
Q

Describe the shape/size of the ovary

A
  • Almond shaped
  • 3cm in young women, get smaller with age
  • Surface scarred and pitted due to ovulation
47
Q

Describe the histological arrangement of the ovary

A
  • Peripheral cortex - follicles
  • Central medulla - blood vessels, nerves, lymphatics
48
Q

What causes congenital adrenal hyperplasia? What are its effects?

A
  • 21-hydroxylase or 11-beta hydroxylase deficiency
  • Causes ambiguous genitalia, precocious puberty, anovulation, hirsutism
49
Q

List the layers of the lining of the vagina

A
  • Mucosa - stratified squamous non-keratinised epithelium, lamina propria
  • Muscularis - smooth muscle arranged in longitudinal and transverse bundles
  • Adventitia
50
Q

Describe the hypothalamic-pituitary-ovarian axis

A
  • Hypothalamus
    • Neurosecretory cells release gonadotrophin releasing hormone into pulsatile portal vessels
    • Activates GnRH receptors in the anterior pituitary
  • Pituitary
    • Anterior pituitary releases gonadotrophins (FSH/LH)
  • Ovaries
    • FSH - recruitment and growth of follicles (especially granulosa cells)
    • LH - theca cell support, receptors expressed on maturing follicle, surge triggers ovulation
51
Q

Give examples of disorders of hormone hypersensitivity

A

Hirsutism - excess body hair

52
Q

Describe the location of the uterine tubes

A
  • In free margin of broad ligament, 13cm long
  • Not directly connected to ovary - open into peritoneal cavity
53
Q

Where is the vaginal mucous produced?

A

From glands of the uterine cervix and small amounts from the great vestibular glands of Bartholin

54
Q

Describe secondary follicles

A
  • Antrum - fluid filled cavity
  • Deep in cortex
  • Multilayered follicular cells - granulosa, theca interna, theca externa
    • Interna has many blood vessels, synthesises androgens from cholesterol, which are converted to oestrogens by granulosa cells
    • Circular collagen fibres in externa
55
Q

Describe the structure of the uterine tubes

A
  • Infundibulum - first part, funnel shaped, opens into peritoneal cavity, has finger-like fimbrae
  • Ampulla - middle section, where fertilisation occurs
  • Isthmus - short narrow section, connected to uterine wall
  • Interstitial/uterine part
56
Q

Describe the shape and position of the uterus

A
  • Midline, pear-shaped (fundus at top), bent forwards at 90 degrees to the vagina (anteversion)
  • Body - bent forwards (anteflexion)
  • Cervix (neck)​
    • Openings at each end - internal and external os
    • Cervical canal between
  • Fundus - rounded, projects up above level of uterine tubes
  • Isthmus - narrowing between body and cervix
57
Q

Describe the events of the luteal phase of menstruation

A
  • Formation of corpus luteum from follicle
  • Corpus luteum secretes mostly progesterone - peaks at 6-8 days after ovulation
  • Progesterone causes development of the secretory endometrium
  • LH/FSH decrease due to negative feedback - oestradiol and progesterone secretion decreases
  • If implantation occurs - corpus luteum remains, supported by human chorionic gonadotrophin produced by the developing embryo
58
Q

What is the function of the ovary?

A
  • Endocrine and exocrine function
  • Endocrine - main reproductive hormone source (progesterone and oestrogen)
  • Exocrine - gamete production
59
Q

How is it ensured that the fertilised oocyte will be able to pass the isthmus of the uterine tubes?

A

Zona pellucida keeps it the same size until passed the isthmus

60
Q

How is does the uterine tube assist in conception?

A
  • Peristaltic movements move along the tube to help sperm move along the tube to reach the ampulla, where fertilisation occurs
  • Cilia on epithelial cells move the egg along the tube - undergo hypertrophy in the proliferative phase
61
Q

Describe the circulating oestrogens

A
  • Mix of oestrone and oestradiol
    • Oestrone from ovary or converted from androstenedione
    • Oestradiol from ovary - direct synthesis in developing follicles or conversion of oestrone
62
Q

Describe the venous drainage of the ovary

A

Ovarian vein - left drains to left renal vein, right drains to inferior vena cava

63
Q

Describe the events which occur in the follicular phase of menstruation

A
  • Growth of a dominant follicle
    • Development of primary follicles (from primordial)
    • Development of secondary follicles
  • Uterine changes (proliferative phase) - oestrogens from ovary act on endometrium causing thickening of stroma (connective tissue), elongation of uterine glands and growth of spinal arteries
  • Ovulation (around day 14) - completion of first meiotic division of the oocyte within 36 hours of ovulation
64
Q

List the ligaments of the female reproductive system

A
  • Broad ligament
  • Ovarian ligament
  • Suspensory ligament
65
Q

What is the function of oestrogens?

A

Development of secondary sex characteristics and regulation of the menstrual cycle

66
Q

What is the effect of aromatase deficiency?

A
  • Prevents oestrogen synthesis
  • Ambiguous genitalia
67
Q

List the stages which the uterine lining goes through in the menstrual cycle

A
  1. Proliferative stage
  2. Secretory stage
  3. Menstrual stage

Medicine Year 2 (41 decks)

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