The female genital tract

Question 1

What is the fundamental reproductive unit in females?
What is it composed of?

What is it surrounded by?

Answer 1

• single ovarian follicle
  
  • ​composed of one germ cell (oocyte)
  • surrounded by endocrine cells

Question 2

Avg age of menarche

Answer 2

11-13

Question 3

Female monthly sex cycle controlled by?

Answer 3

gonadotropins

• only single ovum released
• endometrium prepared for implanation

Question 4

Describe the ovarian cycle?

Answer 4

follicular phase - 15 days

Ovulation -occurs day 14

Luteal phase -13 days

Question 5

Phases of endometrial growth and menstration

Answer 5

proliferative phase (11 days) (cells of endometrium are proliferating and becoming thicker)

secretory phase (12 days) (thicking even more)

menstrual phase (5 days) (shed)

Question 6

Describe the Hierarchies of homrones of the female hormonal system?

Answer 6

• Hypothalamus -GnRH
• Anterior pituitary -FSH & LH
• The ovarian hormones- Estrogen (FSH) and Progesterone (LH)

Question 7

A surge in LH is required for?

Answer 7

Ovulation

Question 8

when are estrogen and progesterone at their highest during the cycle?

Answer 8

estrogen: after menses → ovulation
progesterone: after ovulation → menses

Question 9

when are FSH and LH high during the cycle?

Answer 9

• FSH: early follicle maturation, a bit higher than LH on either side of ovulation, spikes but lower than LH at ovulation
• LH: spikes at ovulation

Question 10

what hormone contributes to early follicular maturation?

Answer 10

FSH

Question 11

what hormones contribute to late follicular maturation?

Answer 11

FSH, LH, estrogen

Question 12

How does LH surge cause ovulation?

Answer 12

causes granulosa and theca cells produce more progesterone → transition to luteal phase

Question 13

which anterior pituitary hormone stimulates estrogen and which progesterone?

Answer 13

FSH → estrogen
LH → progesterone

Question 14

Body temperature and ovulation?

Answer 14

-spikes to 98.6 at ovulation, slowly returns to 96.8 over the rest of the luteal phase

Question 15

what happens physiologically during the menstrual cycle?

Answer 15

6 - 12 follicles develop, but only 1 follicle matures → ovulation releases ovum → corpus lutem degrades → corpus albicans

Question 16

what is endometriosis?

Answer 16

• chronic, estrogen-dependent, inflammation w/ varying degree of severity (can be all over or localized)
  
  • Characerized by the presence and growth of endometrial tissue outside the uterine cavity

uterine tissue outside the uterus

Question 17

what are the clinical features of endometriosis?

Answer 17

mod - severe pain, lower back pain, infertility, dysmenorrhea

Question 18

what are the most common sites of endometriosis?

Answer 18

ovaries, cul-de-sac, broad ligaments

⇒cul de sac refers to the rectouterine pouch (the pouch of Douglas)

can be anywhere in the peritoneum

Question 19

pathogenesis of endometriosis is:

Answer 19

multifactoral

-ectopic endometrial tissue, inflammation, imbalanced cell prolif/apoptosis, angiogenesis, genetic factors

Question 20

what are the 2 theories of endometriosis?

Answer 20

Sampson’s theory of retrograde menstruation: endometrial cells flow backwards thru fallopian tubes into peritoneal cavity during menses (can be due to obstruction)

Pre-Menarcheal endometriosis: undifferentiated mullerian cells seed the peritoneal cavity & differentiate into endometrial tissue

Question 21

what are the 3 main players in the pathogenesis of endometriotic pain?

Answer 21

1. endometriotic lesions → directly stimulate sensory nerves → nociceptive pain signal
2. innate immune system release → proinflamm mediators and pro-nociceptive mediators such as nerve growth factor (NGF )→ stimulate sensory nerve endings
3. peripheral nervous system → spinal cord

Question 22

what are uterine leiomyomas?

Answer 22

fibroids: benign myometrial tumors (created from smooth muscle cells of the myometrium)

Question 23

what is the most common pelvic tumor in women?

Answer 23

fibroids (confined & non-malignant) from uterus

Question 24

what are the clinical presentation/clinical significance of fibroids?

Answer 24

alters function/structure → excessive bleeding in uterus

Question 25

How does an Uterine Leiomyoma form?

Answer 25

-transformation of normal myocytes (cells of the smooth muscle) into **abnormal myocytes** **-growth** of abnormal myocytes into clinically apparent, confined **tumors (**affect structure and function- not malignant)

Question 26

which 5 factors contribute to leiomyomas?

Answer 26

1. genetics 2. steroid hormones (estradiol & progesterone) → mitogenic stimuli 3. stem cells 4. angiogenesis 5. ↑ fibrotic factors (ECM, collagen, abnormal fibrotic GFs)

Question 27

what is PCOS?

Answer 27

intraovarian androgen excess & insulin resistance → polycycstic ovaries

Question 28

triad of insulin resistance to keep in mind with PCOS?

Answer 28

triad of insulin resistance to keep in mind with PCOS - DM2 - Obesity - CVD

Question 29

what is the clinical triad of PCOS?

Answer 29

1. an/oligovulation 2. hirsutism - due to hyperandrogenism 3. polycystic ovaries

Question 30

what causes PCOS?

Answer 30

2 Hit: - genetic/acquired predisposition (maternal drugs, nutritional disorders affecting fetus) - insulin resistant hyperinsulinism (obesity, t2dm)

Question 31

Unified Minimal Model of PCOS patho

Answer 31

**-Functional Ovarian Hyperandrogenism (FOH):** accounts for all features of PCOS, most important factor **-Hyperinsulinism and Obesity** **-LH Excess:** secondary to FOH, no negative feedback

Question 32

what does hyperinsulinism do to PCOS?

Answer 32

In the ovary hyperinsulism increas androgen production in theca cells by sensitizing them to LH AND prematurely luteinizes granulosa cells Excess insulin combined w. LH excess, **aggravates ovarian dysfunction**

Question 33

what is PMS?

Answer 33

biopsychological disorder physical/behavioral symptoms in **second half of menstrual cycle (luteal phase)** for at least 2 consecutive cycles

Question 34

what is the clinical triad of PMS?

Answer 34

tender breasts **abdominal bloating** headaches

Question 35

What is the pathogenesis of PMS? What is the common treatment?

Answer 35

* abnormal NT **(serotonin)** response to normal hormonal changes * normal flucuations in hormones through out the cycle, just abnormal response to hormones * SSRI's

Question 36

Development of menopause

Answer 36

getting periods→ menopausal transition (irregular periods) → menopause (no period consectively for one year)

Question 37

which 3 things contribute to menopause?

Answer 37

* **hypothalamic & ovarian aging** * environmental/genetic/lifestyle * systemic diseases

Question 38

what does hypothalamic aging have to do with menopause?

Answer 38

desynchronized GnRH production & an abnormal surge of LH→this leads to no ovulation