Reproductive health - Women Flashcards
What is the uterus in TCM and its role in the female reproductive system?
- The uterus plays a vital role in female physiology. A healthy uterus signifies the condition of a woman’s overall health.
- Functions of the uterus: menstruation, implantation, gestation / labour
- Uterus names TCM: Zi bao, bao gong, zi zang, zi chu and zue zang
What are the 6 extraordinary fu?
uterus, marrow, blood vessels, brain, gall bladder, bone
Why is the uterus an extraordinary fu?
- The uterus is referred to as an extraordinary fu which means it’s a combination of both yin and yang.
- The uterus has a storage function of a yin organ (stores blood, placenta and foetus during pregnancy).
- Hallow shape: uterus has the hollow shape of a yang organ (discharge blood, placenta and foetus post pregnancy).
What is the female reproductive system made up of in biomedicine and what does it include?
- Includes the ovaries, uterine tubes, uterus, vagina, vulva and mammary glands.
- The female reproductive includes: the ovarian cycle, uterine cycle, hormonal regulation cycle, cyclical changes in the breasts and cervix.
What are the phases of the menstrual cycle?
- The length of a cycle typically ranges from 24 – 36 days, we assume a duration of 28 days in this discussion.
- Each reproductive cycle is divided into 4 phases as follows: 1. Menstrual phase, 2. Preovulatory phase, 3. Ovulation, 4. Postovulatory.
What hormones are involved in the reproductive cycle?
- Dynamic interaction between Yin and Yang which is closely linked to the hormone’s oestrogen and progesterone.
- Follicle stimulating hormone, oestrogen and luteinising hormone dominate the first half of the cycle (follicular phase) and this is when the Yin peaks.
- Progesterone is at its highest in the second half of the cycle (luteal phase) and this phase is under the influence of Yang.
What is the menstrual phase?
Menstrual phase: lasts for approximately 5 days.
In the ovary:
* Follicular development occurs. Events in the ovary lasts 1-8 days.
In the uterus:
* the endometrium sheds 50-150ml of menstrual flow, including blood, tissue fluid, mucous and epithelial cells.
* Events in the uterine cycle 1-8.
Hormonal changes:
* FSH from the anterior pituitary gland stimulates several primordial follicles to develop primary and secondary follicles.
* Declining levels of progesterone and oestrogen stimulates uterine prostaglandin production that causes the constriction of spiral arterioles.
What is the pre-ovulatory phase?
Pre-ovulatory phase
* The preovulatory phase is the time from the end of menstruation until ovulation days 6-13 of the female reproductive cycle. The is the most variable phase in length amongst women.
In the ovary:
* The follicular phase of the ovarian cycle, a single secondary follicle in one of the two ovaries continues to outgrow the remaining follicles.
* One dominant secondary follicle grows to become a mature follicle.
In the uterus:
* Proliferative phase, endometrium undergoes repair and cell proliferation of the stratum basale layer to give rise to a new stratum functionalis.
* Thickness doubles 4-10mm. Short straight endometrial glands develop and arterioles coil and lengthen.
What hormonal changes occur in the pre-ovulatory phase?
Hormonal changes:
* Maturing dominant follicle continues to secrete oestrogen and inhibin. Due to negative feedback, the reduces the levels of FSH from the anterior pituitary and smaller undergo atresia.
* Rising estrogen stimulates endometrial repair and thickening.
What is ovulation?
Ovulatory phase
* Ovulation takes place on approximately day 14 of the female reproductive cycle
In the ovary:
* Ovulation is marked by the rupture of a mature follicle.
* The ovulated oocyte is surrounded by its corona radiata and zona pellucide.
* Any mature follicles that are not ovulated soon deteriorate.
* Remnants of the ruptured follicle soon becomes the corpus luteum.
In the uterus:
* After ovulation the secondary oocyte is swept into the uterine tube by local currents produced by fimbriae.
* It reaches the uterus 6 to 7 days after ovulation.
* The endometrial lining has thickened due to proliferation of the stratum functionalis.
Hormonal changes:
* Rising levels of oestrogen in the pre-ovulatory stage exert a positive feedback influence on GnRH, FSH and LH right before ovulation.
* A sharp rise in LH causes the rupture of the ovarian mature follicles 9 hours later.
What is the post-ovulatory phase?
Post-ovulatory phase
* Final phase of the female reproductive cycle. It is the most constant part of the cycle and lasts from day 15 to 28.
* Whether or not the ovulated secondary oocyte is fertilised determines when a new cycle resume.
In the ovary:
* During the luteal phase of the ovarian cycle, the remnants of the ruptured follicle form a blood clot (corpus haemorrhagicum).
* Disintegration of the basement membrane causes the granulosa and theca cells to mix and they all become transformed into new corpus luteum cells.
* These cells start to secrete hormones to support endometrial conditions for a potential pregnancy. The blood clot is soon absorbed by them.
In the uterus:
* The secretory phase of the uterine cycle is marked by growth and coiling of the endometrial glands (producing glycogen), increased vascularisation and thickening of the endometrium to ~12-18 mm.
* These preparatory changes peak a week after ovulation.
What hormonal changes occur in the post-ovulatory phase?
Hormonal changes:
* The initial high level of LH stimulates hormone secretion by the corpus luteum cells.
* The corpus luteum subsequently secretes progesterone, oestrogen, inhibin and relaxin
* Levels peak around day 21-22, however soon decline if the corpus luteum is not retained by human chorionic gonadotrophin (hCG).
What is the treatment during the menstrual phase in TCM?
Treating the menstrual phase with TCM
Treatment aim:
* Regulate menses
* Stop bleeding (if heavy)
Treatment principle:
* Invigorate blood circulation
Acupoints:
* Local acupoints
* Acupoints to invigorate blood and qi circulation
What is the treatment during the post menstrual phase in TCM?
Treating the post menstrual phase with TCM
Treatment aim:
* Promote follicular development
Treatment principle:
* Nourish yin and blood
Acupoints:
* Local acupoints
* Acupoints to build blood
* Nourish blood and essence (KID yin)
* Conception vessel points to nourish Yin and Blood
What is the treatment during the mid-cycle phase in TCM?
Treating mid-cycle with TCM (Ovulation)
Treatment aim:
* Promote ovulation
* Harmonise CV and PV
Treatment principle:
* Tonify and strengthen Yang
Acupoints:
* Local acupoints
* Acupoints to warm (moxibustion)
* Tonify qi and blood
