week 1 Flashcards
deep vs superficial female reproductive structures
deep: ovaries, uterus, vagina, pelvic floor
superficial: fascia, muscles, clitoris, vestibular glands, labia, mons pubis
ovaries functions
-store oocytes/ female gametes
-produce steroid hormones
-ovulation
fallopian (uterine) tubes functions
path for sperm to fertilize eggs, site of fertilization
site of fertilization for sperm and egg
fallopian (uterine) tubes
uterus function
fundus and body: site of implantation of zygote, womb that supports and nourishes the fetus
cervix: entrernace to birth canal, doesnt dilate until parturition
which ligaments passively hold the uterus in place
Round ligaments, cardinal ligaments, and uterosacral ligaments
ligaments of the uterus and functions
- Ovarian ligament – attaches the ovary to the uterus medially
- Suspensory ligament of the ovary - extends laterally to the pelvic sidewall, contains ovarian vessels
- Round ligament of the uterus – attaches to the ovarian ligament and extends antero-inferiorly to the mons pubis and labia majora
- Cardinal (transverse cervical) ligament – from the cervix and superior vaginaà lateral walls of the pelvis
- Uterosacral ligaments – pass superiorly and posteriorly from the cervixà sacrum
where does brand ligament connect to
lateral walls and pelvic floor
what ligaments does the broad ligament surround
double layer peritoneum surrounding cardinal, uterosacral, round, ovarian ligaments
parts of broad ligament via what connected to
Mesosalpinx, mesovarium, mesometrium
uterus position
anteverted (lie over bladder)
anteflexed (angle at cervix)
what maintains uterus position
cardinal and uterosacral ligaments
ovary size
almond
ovary location
behind brand ligament, lateral wall of pelvic cavity
ovary vasculature
ovarian artery from abdominal aorta
pampiniform plexus of veins that go into left renal vein or inferior vena cava
lymph drainage of ovary
deep: internal iliac and para-aortic lymph nodes
superficial: inguinal lymph nodes
epithelium of ovary
simple cuboidal
surrounded by tunica albuginea (capsule)
cortex and medulla of ovaries
cortex- where follicles are (periphery)
medulla- CT, blood vessels
parts of fallopian (uterine) tube
infundibulum- peripheral opening lined with fimbriae (fingers to create currents to draw ovulated oocyte in)
ampulla- where fertilization occurs
isthmus- attach to uterus
lymph drainage of fallopian (uterine) tubes
external iliac nodes
vasculature of fallopian (uterine) tubes
ovarian and uterine arteries
uterine plexus for drainage
fallopian (uterine) tube epithelium
folded mucosa with simple columnar ciliated epithelium
(cilia to move fluid to uterus)
also has longitudinal muscle layers
serosa covers mesothelium
type of cell in fallopian tube
peg cells to secrete glycoproteins into lumen
uterus size
inverted pear
parts of uterus
fundus superiorly, the body between the uterine tubes and the isthmus, the isthmus which connects to the internal os of the cervix, and the cervix
lymph drainage of uterus
aortic lymph nodes, internal and external iliac lymph nodes
vasculature of uterus
ovarian and uterin (internal iliac) arteries
uterine plexus –> internal iliac veins
-has lacunae (blood lakes) to drain into veins
2 layers of uterus mucosa
basal and functional layer
which layer of uterus sheds during menses and which doesnt
basal layer- not shed
function layer- shed
basal layer of uterus
Contains the cells that give rise to the functional layer, the beginning of the spiral arteries, and the base of the uterine glands
functional layer of uterus
Lots of surface epithelium (columnar), spongy lamina propria full of ground substance, spiral arteries, and long, tortuous glands that change throughout the cycle
spiral arteries in uterus are sensitive to
progesterone
when progesterone low at end of cycle it causes constriction and ischemia of functional layer of uterus endometrium
myometrium and perimetrium of uterus
myometrium= smooth muscle
perimetrium= serosal layer continuous with uterine ligaments
most inferior part of uterus
cervix
parts of cervix
internal and external os
how does cervix differ from rest of uterus
no spiral arteries or myometrium
limited morphology change throughout menstrual cycle
transformation zone in cervix/ uterus
stratified squamous epithelium at the mouth of the external os –
transition from columnar ( rest of uterus) –> stratified squamous = transformation zone
entrance to vagina and superior part by cervic
enter= Introits
by cercvix= fonices
vasculature of vagina
uterine artery (superior) and internal iliac artery (inferior)
vaginal venous plexus –> internal iliac veins via uterine vein
lymph drainage of vagina
superior: iliac lymph nodes
inferior: superficial inguinal lymph nodes
epitethelium of vagina
stratified squamous lines mucosa, lacks glands
muscular layer
adventitia (outer)
how to get thick vaginal epithelium
estrogen
clitoris has
erectile tissue with muscle that relaxes and engorges with blood via arousal and many nerve endings
parts of clitoris
glans clitoris: midline, nerve endings, only external part of clitoris
body- corpora caverns surrounded by ischiovacernossus muscles (attach to ischium) and bulbosponguisium muscles (fluid secretion)
vestibular glands AKA bartholin glands
deep to labia Minora
release mucus into vestibule to lubricate vagina in sex
menstural cycle length
~ 28 days (25-25)
menstruation to ovulation vaires
ovulation to menses is 14 days (corpus luteum lifespan)
what is the corpus luteum
remnant of ovarian follicle
The corpus luteum is a temporary, hormone-secreting structure in the ovary that forms from the follicle after it has released a mature egg during ovulation.
parts of menstural cycle
follicular phase- develop follicle
ovulation- follicle ruptures + release ovum
luteal phase- follicle fills with blood and becomes corpus luteum, while ovum travels to uterine tubes
menstruation- corpus luteum atrophy + decline in progesterone + uterine lining sloughs off
where is GnRH released from
arcuate and pre optic nuclei in hypothalamus
GnRH makes which hormones where
LH and FSH in anterior pituitary
pulsatile nature of GnRH to make LH vs FSH
rapid pulse= LH
slow pulse= FSH
2 types of cells in ovaries impacted by LH and FSH
theca cells and granulosa cells
does LH or FSH stimulate theca and granulosa cells
theca via LH
granulosa via FSH and LH (under FSH guidance)
theca cells stimulated by LH causes
steroidogenesis- make progesterone and androgens
granulosa cells stimulated by FSH and LH make waht
covert androgens into estrogens
make activins, inhibins, follistatin
activins, inhibins, follistatin function in granulosa cells
activins increase FSH and estrogen
inhibins reduce FSH and estrogen
follistatin reduces activin function
which cell is inside vs outside basement membrane in follicle
theca cells outside and granulosa cell inside
which cell in follicle can access LDL to use cholesterol to make estrogen
theca cell
which cell has aromatase enzyme to turn androgens into estrogen
granulosa cell
what cannot cross basement membrane
LDL
negative feedback in menstrual cycle (majority of cycle)
estrogen and progesterone inhibit GnRH (via kisspeptin, opioids, GABA)
positive feedback in menstrual cycle
in late follicular phase; estradiol promotes GnRH release –> LH surge and ovulation
via prolonged periods of elevated estradiol
what causes the LH surge and in what phase
estradiol in late follicular phase
LH surge
estradiol
increased GnRH receptors and progesterone also promote LH surge
high LH inhibits FSH
when are FSH and LH highest
ovulation
when is progesterone and estradiol highest
estradiol- right before ovulation
progesterone- luteal phase
what causes steroidogenesis in theca cells
LDL –> LH stimulation
theca cells are
vascularized
what does theca cells produce and cannot produce
androstenedione and testosterone [androgens] (and a bit of progesterone)
cannot make estrogens because no aromatase enzyme
granulosa cells and cholesterol/LDL?
inside basement membrane; make cholesterol de novo (inefficient, so mainly steroidogensis in theca cells)
what promotes expression of aromatase enzyme in granulosa cells
FSH
what does granulosa cell produce
turn testosterone and androstenedione from theca cells into estradiol and estrone (estrone converted into active estradiol)
excess androgens (not converted into estradiol) turn into what in granulosa cells
dihydrotestosterone
can lead to apoptosis of granulosa cells and follicular atresia
steps in theca cell to get progesterone and testosterone
LH receptor
cholesterol –> pregnenolone –> progesterone –> andostenedione –> testosterone
what can cross the basement membrane from theca cells to granulosa cells
andostenedione and testosterone [androgens] (get converted into estrone and estradiol in granulosa cell via aromatase enzyme)
what does primordial germ cell undergo and turn into and then stay at until ovulation at puberty
Primordial germ cells undergo mitosis and develop into oogonia within fetus and then develop into primary oocytes and begin their first meiotic division but arrest in prophase (will remain so until ovulation during puberty)
fetus mature into x or atresia (die)
- Primordial follicle (fetus) will either mature into primary follicle or undergo atresia (die off) – this will continue throughout life
how and when can primary follicles develop into secondary follicles
after puberty via high exposure to LH and FSH
in puberty when primary follicles develop into secondary what happens
stromal cells differentiate to theca interna and externa
granulosa cells proliferate and turn androgens from theca cells into estradiol
what do secondary follicles develop into
tertiary/antral follicles
- increase estradiol production, antrum fill with fluid etc.
just before ovulation what do the antral follicle(s) develop into
Graafian follicle(s)
-lots of estradiol, growth factors, oxytocin, steroids, peptides
what helps with selection of dominant follicle at ovulation
growth factors
dominant follcile release whats and triggers what
release estradiol to trigger mid cycle LH surge
-primary oocyte matures into secondary oocyte
-ovulation
-selection via FSH stimulation and adequate LH receptors
what does the primary oocyte produce when it completes its 1st meiosis
(1) small 1st polar body, which degenerates and (2) larger secondary oocyte (haploid of duplicated chromosomes; 22 somatic and 1 sex chromosome)
when the secondary oocyte begins it second meiotic division what does it arrest in
metaphase (until fertilization)
what does the LH surge promote the release of that causes the follicle to vasodilate and swell
histamine, prostaglandins and bradykinins
what causes basement membrane to disintegrate
LH surge
what do prostaglandins activate in the ovary
activate lysosomal enzymes that degrade ovarian wall next to the protruding follicle (stigma)
in the LH surge what happens to cause the follicle to rupture and go into the fallopian tubes
Granulosa cells (FSH stimulation) release plasminogen activator→ get activated plasmin and with collagenases (LH stimulation) will digest the connective tissue matrix→rupture follicle ovum is released (prostaglandins promote contractions that help fimbriae to sweep the ovum into uterine tubes)
what helps contractions to help get ovum into uterine tubes from ovaries
prostaglandins
what happens when graafian follicle collapses? what does it turn into?
Fills with blood and transforms into corpus luteum
what does corpus luteum release
progesterone (and some estradiol)
if follicle is not fertilizes what happens to the corpus luteum? turns into?
will regress in 13 days: apoptosis and necrosis→ fibrosis→ corpus albicans
if fertilization occurs what happens to corpus luteum
the corpus luteum will be maintained by hCG that is released by embryonic trophoblasts AND will continue to release progesterone
what helps maintain the corpus luteum under fertilization
hCG
after 10 weeks of gestation what will take over for the corpus luteum to keep making progesterone so that baby ok
placenta
Progesterone maintains the endometrial lining, reduces contractility of the reproductive organs
progesterone function
Progesterone maintains the endometrial lining, reduces contractility of the reproductive organs
phases of menstural cycle
Menstrual Phase (day 1-5): Low estrogen and progesterone.
Follicular Phase (day 1-13): Rising estrogen, low progesterone.
Ovulation (day 14): LH surge, slight drop in estrogen.
Luteal Phase (day 15-28): High progesterone, moderate estrogen; both decline without pregnancy.
when does the LH surge occur
ovulation (day 14)
beginning vs end of follcular phase
beginning: high FSH
end: increase LH (going to have LH surge in ovulation right after)
when does the dominant follicle get selected and based on what?
day 5-7
based on SIZE and STEROIDOGENIC ACTIVITY (more resources are directed towards this follicle)
initially in follicular phase have which hromones in which amounts
Initially LOW amounts of: LH, estrogen, progesterone, inhibin, but HIGH amounts of FSH (lack of inhibition)
Inhibit suppresses
FSH secretion
high amounts of FSH at beginning of follicular phase will cause what
stimulate follicle growth into prenatal stage (secondary follicle) between days 3-5
- (1) granulosa cell proliferation (hypertrophy and hyperplasia)
- (2) increase aromatase activity→increase estradiol days 3-7
- (3) increase number of LH receptors on growing follicle
what happens to hormones in late stage of follicular phase
increase estradiol→increase GnRH pulse frequency→increase LH
Also reduce FSH through negative inhibition→atresia of the non-selected follicles due to accumulation of androgens (lack of FSH to facilitate aromatase activity in the granulosa cells)
when does estradiol peak and initiate what
Estradiol rises days 8-10, peaks at day 12 for 24-36 hours and initiates LH surge
LH surge and ovulation
occur within 24-36 hrs (if enough estrodial)
what happens after LH surge and ovulation
estradiol decline, progesterone rise
LH receptor reduction on theca cells causes decreased androgen production
DIAGRAM FOR wk 1, lec 2 helpful
:)
luteal phase (after ovulation)
what does the corpus luteum secrete
progesterone
(and some estradiol), while FSH and LH
production declines
what helps maintain corpus luteum
LH (is declining but) is still higher than in follicular phase and helps to maintain the corpus luteum
daya 24-26 of luteal phase what happens
corpus luteum regresses and the decline in estradiol and progesterone leaves endometrium without support→menses start 2-3 days later
what happens at end of luteal phase when estradiol declines
FSH rises
what is endometrium made of
secretory columnar epitethelium
when is endometrium thickest
luteal/secretory phase (lots of estrogen and progesterone)
during proliferative phase/ mid-late follicular phase what happens to the endometrium (uterus)
- (1) stromal and epithelial layer → hyperplasia and hypertrophy (d/t estradiol)
- (2) endometrial glands elongate and lined with columnar epithelium
- (3) vascularization with spiral arteries (get nutrients to the growing endometrium)
- (4) increased expression of progesterone receptors→increased myometrial excitability and contractility
during the secretory phase/ ovulation and early-mid luteal phase what happens to the endometrium?
- (1) endometrial glands become coiled, store glycogen, secrete carbohydrate rich mucus
- (2) stroma become even more vascularized and edematous
- (3) spiral arteries become tortuous
- Peak thickness is achieved 6-8 days post
ovulation - Progesterone decreases the spontaneous myometrial contractions in preparation for implantation
what helps with ciliated epithelium and motility in uterine tubes
estradiol
cervical mucous quantity, alkalinity, viscosity and elasticity increases during which phase
follicular phase
when does cervical mucous have most elasticity and why?
ovulation
allow sperm to pass through
during luteal phase what happens to cervical mucous and via which hormone
progesterone reduces quantity and elasticity of mucus (1) difficult for sperm to enter (2) difficult for infectious agents to enter
vagina in follicular and luteal phase
- Follicular phase: proliferates and keratinized
- Luteal phase: more WBC, thick mucus, less keratin
when does body temperature increase and due to what
after ovulation bc of increased progesterone
what happens to endometrium during menstuaration
desquamation and sloughing of the functional layer
- low progesterone and estradiol cause vasospasm of spiral arteries –> ischemia of superficial layers
- necrosis and apoptosis of secretory epithelium
- macrophages and WBCs invade stroma and phagocytose ischemic tissue
how much blood leaves body
30-50 mL over 4-5 days
progesterone additional effects
-breast: lobules and alveoli, lactation
-thermogenic
-respiration (i.e. pregnancy it reduces alveolar CO2)
-brain
what is for libido
estrogen
cerebral sympathetic stimulation and peripheral parasympathetic stimulation
cerebral: desire
peripheral: clitoral vasocongestion and vaginal secretions; dependent on nitric oxide
problems with sexual response
-peripheral neuropathy (decrease sensation)
-vascular insufficiency (reduces lubrication –> dyspareunia)
-spinal cord injury (affects sympathetic function + orgasm)
ovarian cysts
usually benign and asymptomatic and spontaneously resolve but if big and rupture can cause pain
2 types of ovarian cyst
follicular and luteal cysts
follicular vs luteal cyst
- Follicular cyst - follicle fails to rupture during ovulation
- Luteal cyst – corpus luteum fails to dissolve/ fibrosis and instead becomes fluid-filled cysts (common with pregnancy)
endometriosis
endometrial tissue in ectopic locations outside uterus (i.e. ovary, lung, lymph nodes, colon)
-can bleed
-respond to cyclical changes
-cant cause menstrual irregularities and infertility
endometrial hyperplasia
increase endometrial gland to stroma ratio
made of typical cells or atypical cells (increase risk of endometrial cancer)
cause of endometrial hyperplasia
excess estrogen stimulation
-anovulatory cycles
-exogenous estrogen administration
-obesity (adipose tissue converting estrogens)
-estrogen-producing ovarian conditions (i.e. PCOS)
fibroids- leiomyomas
benign tumor made of smooth muscle of myometrium
symptoms of fibroids-leoimyomas
menorrhagia (heavy bleeding)
LEC 2 extra charts and slide supplement
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