Female reproductive system II Enas Omar Notes are in green
Female reproductive system II Enas Omar Notes are in green
Copyright © 2011 by Saunders, an imprint of Elsevier I
C.Luteal phase
nc.
a. Interval between ovulation and menstrual flow (15th - 28th day.(
b. Duration is κ: 14±2 d (t½ = corpus luteum.(
c. Day of ovulation = Length of the menstrual cycle - 14d
d. Predominant Hormone: Progesterone
Corpus luteum
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
• Provides necessary hormones for implantation of blastocyst and maintenance of zygote until placenta can take over
Corpus luteum is composed mainly of
granulosa cells
80 % granulosa cells, 20% thecal cells
If not fertilization, will regress in about 14 d
Avascular scar = corpus albicans
Copyright © 2011 by Saunders, an imprint of Elsevier Inc
.
4 14 28
ovulation
Endometrial 1
Cycle: menstrual proliferative
phase (11 d)
secretory phase (12d)
Ovarian
Cycle: follicular phase luteal phase
(FORMAT FOR NEXT
FEW SLIDES)
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
ovulation LH
surge
Ovarian
Cycle:follicular phase FSH and LH in the
Follicular phase
LH surge lasts 48 h
secretory phase (12d) 28 proliferative phase
(11 d)
FSH
LH
1 4 14
Endometrial
Cycle: menstrual
Inc
GnRH
bursts
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
1 4 14
ovulation
LH
surge
Proliferative
phase Endometrial
Cycle:
estradiol
feedback--G
nRH
Secretory phase (12d) 28
neg
Ovarian
Cycle: follicular phase
Increase in estradiol to stimulate
LH surge. Then estradiol has
negative feedback on GnRH to
reduce LH, FSH.
FSH
LLHH
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
1 4 14
ovulation
Proliferative phase Endometrial
Cycle: menstrual
Ovarian
Cycle: follicular phase
activin
inhibin
Secretor
y phase
(12d)28
_
FSH
Granulosa cells
Activin inhibin
+
Changes in activin and inhibin in
follicular phase.
FSH
activin
inhibin
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Inhibin : a hormone secreted by sertoli cells in the male & the granulosa cells in the female . It inhibits the production of FSH by the ant pituitary . Activin :if there is no formation of ovum .. It’s secreted to enhance FSH secretion.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
4 14
ovulation
Proliferative phase
(11 d(
1
Endometrial
Cycle:menstrual
Ovarian
Cycle: follicular phase
progesterone
activin
inhibin
28
Changes in progesterone
in follicular phase.
progesterone
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
The uterine cycle and normal menstruation:
Because of the monthly cyclic production of estrogens and progesterone, the endometrial lining of the uterus passes into three phases. They are; Proliferative phase, Secretory (or luteal phase), and menstrual phase . These changes are mainly to prepare the uterus for implantation
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
At the beginning of each monthly cycle most of the endometrium has been desquamated by menstruation , after that only a thin layer of stroma remains & proliferate under the influence of estrogen . Then endometrial changes occur to produce a highly secretory endometrium to provide appropriate conditions for implantation of a fertilized ovum
You can see that the thickness in the beginning is completely different from that of the end
1-Proliferative phase
• It is about 9-11 days in duration. • Estrogen secreted in increasing quantities by the
developing follicle causes proliferation of the epithelial cells left after endometrial desquamation.
• Endothelial re-epithelialization occurs within 4-7 days after the beginning of menstruation (when bleeding ceases.)
• The next 7-10 days the endometrial thickness increases greatly to about 3-5 mm (formation of new endometrial glands and blood vessels.)
• The mucus strings secreted by the endometrial glands (especially these of the cervix), align in the cervical canal, forming channels that guide sperm in the proper direction from vagina into the uterus.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
• The length of this phase is remarkably constant at about 14 days.
• Occurs after ovulation (the second half of the cycle.) • Estrogens cause slight additional cellular proliferation, whereas
progesterone causes marked swelling and secretory development with further increase in blood supply to the endometrium. Both blood vessels and glands become highly tortuous.
• Lipid and glycogen deposit greatly in the stromal cells. • The peak of the secretory phase is about 1 week after ovulation.
At this time, the endometrial thickness reaches to 5-6 mm. • During the secretory phase, the endometrium provides appropriate conditions for implantation of a fertilized ovum.
• The fertilized ovum needs 3-4 days to enter the uterine cavity from fallopian tube and another 4-5 days for implantation. During this intervals uterine secretions (uterine milk) provide nutrition for the early dividing ovum.
• Once the ovum implants, trophoblastic cells of the blastocyst begin to digest the endometrium.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Phase 1 : estrogen Phase 2 : progesterone
3. Normal menstruation
• Occurs when fertilization fails to occur during the secretory phase (involution of corpus luteum.)
• The usual duration of the menstrual flow is 3-5 days (1-8 days range). Blood loss reaches up to 80 ml (average 30-40 ml). Bleeding can increase because of medications and diseases that affect the clotting mechanism. Formation of a clot indicates abnormality
• 24 hours before menstruation blood vessels leading to the mucosal layers become vasospastic, presumably because of vasoconstrictor types of prostaglandins.
• The vasospasm + ↓ nutrients + ↓ hormonal stimulation
endometrial necrosis Hemorrhage + Sloughing of outer layers of the
endometrium
• Prostaglandins and desquamated tissues initiate uterine contractions that expel the uterine contents.( necrotic substances ) • The menstrual fluid is normally non-clotting because of released fibrinolysin.
Clots presence may indicate uterine pathology. • Menstrual flow is rich in leukocytes. This outflow of leukocytes may explain
the resistance of uterus to infection during menstruation despite the denuded endothelial surface.( a protective mechanism)
• Two imp things to remember : 1-manstrual fluid has no clots 2- it is rich in leukocytes.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Normal menstruation
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
The standard classification
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
for patterns of abnormal bleeding
(1)Menorrhagia (hypermenorrhea) is heavy or prolonged menstrual flow during regular period. The presence of clots may not be abnormal but may signify excessive bleeding.
(2)Hypomenorrhea (cryptomenorrhea) is unusually light menstrual flow, sometimes only spotting, during regular period. An obstruction such as hymenal or cervical stenosis may be the cause.
(3) Metrorrhagia
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
(intermenstrual bleeding) is bleeding that occurs
at any time between Not prolonged period but frequent
menstrual periods.
(4) Polymenorrhea describes periods that occur too frequently, usually associated with anovulation and rarely with a
phase in the menstrual Is associated with a disease
shortened luteal cycle. Mostly bleeding
(5)Oligomenorrhea describes menstrual periods that occur more than 35 days apart. Bleeding usually is decreased in amount and associated with anovulation, either from endocrine causes (eg, pregnancy, pituitary-hypothalamic causes, menopause) or systemic causes (eg, excessive weight loss.)
Cyclic changes in Cervix, vagina & breasts:
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
1- Cervix 2- Vagina 3- Breasts
Estrogen:make mucus
Thinner,more alkaline If spread on slide dries in fern like manner
Progesterone:make mucus thick,tenaciuous,more cellular,If spread on slide
doesn’t fern
Estrogen:cornification of vaginal epithelium
Progesterone:thick mucus secretion,proliferation of vaginal epithelium and leucocytes infiltration
Estrogen:Proliferation of breasts ducts
Progesterone:growth of breast lobules & alveoli
Copyright ©
2011 by Saunders, an imprint of Elsevier Inc.
This diagram shows the relationship b/w hypothalamus , ant pituitary & the ovary Gnrh secreted by the hypothalamus will stimulate the ant pituitary to release LH & FSH and these hormones will stimulate the ovaries to secrete progesterone & estrogen. Estrogens and progestin exert both positive & negative feedback effects on ant pituitary & hypothalamus depending on the stage of the ovarian cycle . Inhibin which is secreted by granulosa cells has a negative feedback effect on the ant pituitary
H-P-O axis
1.Positive feedback
Sex hormones (E)↑ → GnRH or LH/FSH↑ E peak (≥200pg/ml) → LH/FSH
peak →
During ovulation only.
2.Negative feedback
Sex hormones (E)↑ → GnRH or LH/FSH↓ Follicular phase: E↑ → FSH↓
Luteal phase: E↑P↑ → LH/FSH↓(formation)
E↓P↓ → LH/FSH↑(regres Co
spyrig
iht
o© 201
n1 by Sa
)unders, an
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
28
FSH
ovulation
4 14
Proliferative phase
(11 d(
1
Endometrial
Cycle: menstrual
Secretory phase (12d)
Ovarian
Cycle:
inhibin
activin
_
FSH
Granulosa cells a
Activin inhibin
+
+
Corpus albicans
Luteal phase
The cells that surround the ovum
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
1 4 14 28
FSH
ovulation
proliferative phase Endometrial
Cycle:
secretory phase
Ovarian
Cycle:
inhibin
_
FSH +
Luteal phase +
Granulosa cells
Activin inhibin
estradiol
Levels of estradiol in luteal phase
Corpus albicans
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
14 28
proliferative phase Endometrial
Cycle:
secretory phase
Ovarian
Cycle: follicular phase
progesterone
Corpus luteum ovulation
Corpus albicans
+
+
_
estradiol
1 4 mens
Produces inhib
GnRH _
Luteal phase
Changes in estradiol
And progesterone
in luteal phase.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Functions of estradiol
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Fat deposition: more subcutaneous fat in women than men
Estrogens: hips and thighs fat deposition
(prior to menopause) then more abdominal
(Men: androgens: abdominal fat deposition (
Skin: increase vascularization of skin, smooth and soft.
Bones: estrogen inhibits osteoclastic activity, so height
increases after puberty,but epiphyses and shafts of
bones unite early and growth stops
So the more the testosterone & estrogen , the less the tall
Functions of estradiol
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
External female sex organs: at puberty, increase in size of fallopian
tubes, uterus and vagina, external genitalia deposition of fat in mons
pubis , labia majora & labia minora
change vaginal epithelia from cuboidal to stratified type endometrium:
proliferation of cells and endometrial glands
(important in nutrition of fertilized ovum(
Breasts: fat deposition, development of stromal cells, ducts
(progesterone, prolactin important in milk production(
Estrogen affect the size of the breast ,deposition of fat , development
of the stromal tissue &growth of the ductile system .
Progesterone & prolactin complete the job in converting the breasts
into milk-producing organs.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
This diagram shows the relationship b/w Estrogen secretion & the age: From birth till puberty very little amount of estrogen is secreted . Then levels of estrogen secretion increase at puberty. You can notice cyclical variation during the monthly sexual cycle . During the first few years of reproductive life , further increase in estrogen secretion is shown . Then a progressive decrease in estrogen secretion toward the end of reproductive life & finally almost no estrogen secretion beyond menopause.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
When estrogen production fall below critical value , the estrogen the estrogen can no longer inhibit the production of gonadotropins FSH & LH instead they are produced in large & continuous quantities.
Functions of estrogen and Progesterone:
Estrogen Progesterone
1- Facilitate growth of follicles 1- Causes secretory phase of menstrual cycle
2- growth of ovaries, fallopian tubes, uterus, vagina and female external genitalia,breasts duct system and deposit of fat in the breast.
2- Stimulate developmentof breast lobules & alveoli
3- Produce female 2ry sex characters,body configuration,fat distribution & increase libido
3- Essentia for maitenance of pregnancy and increase secretion of fallopian tubes essential for nutient of fertilized ovum.
4- Produce proliferative phase of
Menstrual cycle,++uterine blood flow,musculature and make it more sensitive to oxytocin
4- Decrease sensitivity of uterus to oxytocin
5- produce cyclic changes in cervix & vagina 5- Produce cyclic changes in cervix & vagina
6- Control FSH&LH secretion & causes the LH surge at midcycle
6- Inhibit LH secretion during pregnancy (producing amenorrhea)
7- Has metabolic anabolic effects, cause epiphyseal closure of bones(also ++bone density),decrease serum cholesterol level,++angiotensinogen secretion from liver,increase HDL,--LDL(Cardioprotective)
Produce salt & water retention. Increase metabolism and fat deposition , slight increase protein deposition.
7- Thermogenic effect(++body temperature by 0.5 C at ovulation)
++respiratory rate ---alveolar CO2
Produce natriuresis
No anabolic functions
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Female sexual act
1-Stimulation of female sexual act : Thinking
lead to sexual desire and this desire change
during the cycle reaching the peak near
ovulation because of high estrogen. Physical
stimulation as in male ( perineal region). Same
nerve signals.
2-Female erection and lubrication (clitoris): as
the penis control by parasympathetic nerves,
same mechanism as in male
3-Female orgasm (female climax):Analog to
emission and ejaculation in male . There is no
ejaculation in females
Female sexual response
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
-- process is similar in males and females:
1)Excitement phase:caused by psychological or physical
stimulation; engorgement and erection of clitoris, vaginal
congestion -- due to NO, secreted by parasympathetic nerves
2)Plateau phase:intensification of these responses, increased
HR, BP, respiratory rate, muscle tension
3)Orgasmic phase:culmination of sexual excitement, intense
physical pleasure
4)Resolution phase:returns genitalia and body systems to
pre-arousal state
Male and female sexual response
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Differences:
Women don’t require refractory time before beginning
excitation again
No ejaculation in the female
Female sexual dysfunction
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
may be as high as 45% in women aged 16-50 yrs
mechanisms:
psychological illness unknown
Menopause
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Defn:obsolescence of ovaries, no estradiol production, ova
only occasional secondary follicle, few primary follicles
Occurs at 51.4 yr of age (average(
Due to reduction in estrogen, low levels of inhibin,
no negative feedback of LH and FSH; therefore, high levels
LH and FSH because there is no estrogen &
progesterone
Can occur naturally, due to surgery or as a result of
chemotherapy
Women’s Health Initiative
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
• Increased risk of CHD, stroke, pulm embolis (3x (,
breast cancer
• “HRT regimen should not be initiated or continued for primary prevention of CHD”
• الدكتور علق عالنقطة الثانية بس ما سمعت منيح اللي عنده فكرة عن pinned postالموضوع يحطها بال
JAMA 2002
ppPP
Physiological changes in the body during menopause 1-Hot flushes 2-Irritability 3-Anxiety 4- Fatigue 5- Psychic dyspnea 6-Decrease strength of the bones 7-Vaginal dryness 8-Gradual atrophy of genital organs Small dose of estrogen reverse these symptoms Some of these symptoms can develop in men when they reach the age of reduced sexual activity
Polycystic ovary syndrome
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Affects 10% of reproductive age women
Characteristics: hyperandrogenemia
oligomenorrhea obesity
hirsutism
Infertility this is the main problem
enlarged cystic ovaries
Rx: metformin, anti-androgens?
Abnormal secretion of the ovaries:
1-Hypogonadism reduce secretion
A- Before puberty cause infantile sexual
organs, no secondary sexual character and
tall female
B- After puberty cause infantile sexual organs
include the uterus, small vagina, breast
atrophy
C-Irregularity of menses and amenorrhea.
2-hypersecretion rare (granulosa cell tumor)
and mainly cause irregular bleeding.
Female fertility: 1-Fertile period of each cycle (4-5 days), before
ovulation
2-Rhythm method for contraceptive (the successful rate75%).one of the commonly
practiced methods of contraceptive is to avoid intercourse near the time of ovulation at least
2 days before & 2 days after the ovulation . This is a physiological contraceptive .
3- Hormonal suppression of fertility (the pills) : use
of estrogen or progesterone in the first half of the
cycle prevent ovulation by prevent preovulatory
surge of LH secretion by pituitary gland (successful rate90%).
4- Female sterility :
A-Failure of ovulation mainly reduce gonadotropin
hormone mainly
B-Endometriosis , salpingitis( inflammation of fallopian tube , this cause fibrosis
,thereby occluding the tubes & preventing sperms from reaching the ovum .)
A student asked : what is the cause of ovulation failure ?
Answer : ovulation is gonadotropin dependent so any thing that affect the availability of
gonadotropins during ovulation period can affect this process .