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1.02
PHYSIOLOGY OF FEMALE REPRODUCTIVE SYSTEM C. OVARY
Dr. JANDOC/AUGUST 17, 2016 Estrogen, Progesterone and acts on UTERINE
PRELIMS:QUIZ 1 ENDOMETRIUM
controls the secretion of the hypothalamus, pituitary
gland, endometrium
Bold red letters- emphasized during lecture; Italic blue letters- normal size of uterus:
Audio; Green- Taken from the book/OT o non pregnant depends on parity:
a. gravida 0=5-6 cm
MENSTRUAL CYCLE b. gravida 1= 6-7cm
Periodic discharge of blood, mucus and cellular debris c. multi gravida= 8-9cm
from the uterine mucosa *Gravida- # of pregnancies
Classic: patients with problems in the uterus like a tumor or
- Interval: 28 Days (+/- 7d)- average myoma that may complain of heavy bleeding, pain
o Menstrual cycle may range from or pressure symptoms they can try medications but
21-35 days if they do not respond, the treatment is
o If a patient has a 21 day cycle, hysterectomy (removal of uterus) but does not
she can have her period 2x a necessarily follow that the ovaries are also removed
month and still it is considered if ovaries are also removed patients undergo surgical
normal menopause which leads to patients complaining of hot
o Before you say that the patient flushes
has an IRREGULAR CYCLE you o drawbacks: (if no estrogen)
have to ask the first day of her a. wrinkles
cycle and the first day of her b. no more lubrication by glands
PREVIOUS cycle in order to if (+)ovarian cyst → removal of entire ovary
establish the INTERVAL bilateral ovarian cyst → if both ovaries removed may
o Clinical application: cause osteoporosis, CVD
If she has a 28 day o solution: cystectomy; preserve any part of the
cycle: 28-14(14 days: ovary that is still normal so that fertilization
average life span of and ovulation would be preserved
corpus luteum)= 14 o 1/16th of an ovarian tissue is still capable of
day of functioning like a normal sized ovary
ovulation/fertility:
day14 there are medications that are given that would have an
Compute: 14 +/- 2 days: effect on the different levels like the hypothalamus,
12-16 days- Range of pituitary gland or even the ovaries
Luteal Phase
Luteal phase: always
constant
- Duration: 2-8 days
- Menstrual blood loss: 60 mL (MBL)- ask
how many pads per day to estimate blood
loss
o 1-3 fully soaked pads/day:
around 50 ml of blood loss
o 13 mg iron lost each period
PURPOSE
1. Provide a fully mature fertilizable ovum for
achievement of pregnancy.
2. Provide an endometrial bed for potential inidation or
implantation of the fertilized ovum.
-If no fertilization would take place then the initial
endometrial bed that was prepared for the ovum or
zygote will be shed of as menstrual blood
HPO AXIS
A. HYPOTHALAMUS
Gonadotropin Releasing Hormone (GnRH)
- acts on the anterior pituitary gland
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HYPOTHALAMUS: GnRH 2. Infancy to puberty
Arcuate nucleus – primary site of GnRH producing - sex hormones secretions are low
neurons - reproductive function is quiescent
GnRH- released from the median eminence and - Sexual characteristics are not being developed
released into the portal system yet.
Internal carotid arteries- blood supply of the 3. Puberty
pituitary gland - hormonal secretion rate increases
- shows cyclical variations during the
Actions: menstrual cycle.
1. stimulates synthesis and storage of FSH and LH - period of active reproduction
2. stimulates the release of FSH and LH 4. Menopause
- reproductive function diminishes and
Pulsatile manner of secretion: ceases
Folicular phase (first half): 1 pulse/hour - Gonads are less responsive
Luteal phase (second half): 1 pulse/2-3 hrs
OVARIAN CYCLE
Gonadotropes respond only to GnRH pulses 2 PHASES:
- Gonadaotropins will only respond if it is released at A. Follicular phase
pulsatile manner. If for example, GnRH was given - not constant
continuously, such as exogenous sources of GnRH, it will - upon release of the ovum it will enter the
now affect the release . luteal phase
Low levels of GnRH - formation and mutation of the Graafian
- increase in number of its own receptors follicle
- it would potentiate pituitary response to
subsequent pulse of GnRH B. Luteal phase
High Levels of GnRH: - always constant, predictable
- Opposite effect - occurs after ovulation,
- DOWN REGULATION in concentration of - corpus luteum (life span: 2 wks -/+ 2d)
GnRH receptors which decreases - ex. 30d cycle: ovulation - 16th day
sensitivity to GnRH 32d cycle: 18th day
- Appreciated in the treatment of gynaecologic problems - For irregular pt’s: we can give medications or hormones to keep
such as endometriosis, dysmenorrhea etc. the cycle in a 28 day period for easier prediction of ovulation
OVARY COHORTS
Master Gland- one that dictates the amount of - 10/15 but only 1 will be selected
hormones to be produced - Which cohort will be selected: follicle with the lowest
Ovarian Cycle- controls the secretion of the FSH threshold
hypothalamus, pituitary gland, endometrium o It will undergo activation of the aromatase
system and begin estradiol production
- increased estrogen from recruited follicles
STAGES IN THE CONTROL OF REPRODUCTIVE FUNCTION gives a negative feedback on FSH
1. Fetal life to infancy
- GnRH, gonadotropin, and gonadal sex
hormones are secreted at high levels
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2 cell 2 Gonadotropin Theory of ovarian Steroidogenesis LH SURGE
(Stimulates 3 major events)
- Should be sustained for 24-48 hours followed by
OVULATION
a. Resumption of meiosis 1 allowing oocyte to
undergo maturation
- from conception until puberty it stays
at meiosis 1
- puberty- resumption of meiosis 1 until
it reaches meiosis 2
b. Luteinization of granulosa and theca cells to
produce progesterone
- with ovulation what would be left is
the corpus luteum that would start to produce
progesterone to get ready for implantation and
development of the conceptus, needed for implantation
c. Follicle rupture with extrusion of mature oocyte -
OVULATION
- there is a specific site in the ovary where rupture
occurs, but in some patients there is a condition called
unruptured so they undergo the stages of recruitment,
- 2 different cells will be able to produce more Estrogen selection and dominance but there is no ovulation
because the area of rupture is very thick such that the
binding of LH to its receptor on ovarian theca ovum is trapped
cells : stimulates conversion of cholesterol to
androstenedione- androstenidione is able to diffuse in LUTEAL PHASE
the granulosa cells - time between ovulation and menses
2. SELECTION
- day 5 to 7
- a single follicle becomes destined to ovulate
(the cohort that has the lowest threshold for FSH)
- FSH decreases due to increased Estrogen
(feedback mechanism)
- the rest of the cohorts that are not selected will still
produce estrogen
3. DOMINANCE
- one cohort was already selected called as Graafian
Follicle
- day 8 to 12: Graafian Follicle
- day 16 to 24: corpus luteum
- Graafian follicle retains its responsiveness to decrease
FSH - If there is fertilization corpus luteum will take over:
- proliferation of granulosa and theca layers corpus luteum of pregnancy extends its life until about 8
- continues to produce estrogen until estradiol peak is weeks (covering the placental development)
reached prior to ovulation - 24 to 36 hours after LH surge
- can be documented by ultrasound
ESTRADIOL PEAK/SURGE
- should be maintained for24 hours, so LH surge to take MECHANISMS OF RUPTURE
place 1. proteolytic digestion of wall: plasmin
- causes pulsatile frequency of GnRH to be more rapid 2. prostaglandin: hydrolases
enhancing the sensitivity of pituitary Gn 3. mucification: hyaluronic acid
- 24hrs after,it will lead to LH SURGE then ovulation 4. muscle activity- expel the ovum
- Patients who have the same level of estrogen all
througout the follicular phase—there will be no LH Clinical application:
surge—no OVULATION: they are having menstruation - During menstruation, Selection period is already
but they are not fertile happening. While the patient is shedding, there is already
a follicle destined to ovulate (basis of contraception)
- oral contraceptives (prevents ovulation) are given at a
first 5 days of the cycle, not at any time. If the patient
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takes it at 7th day, the follicles might already recruited Summary:
and at 5-7 days, follicle might had been selected= chance From the hypothalamus, it will produce GnRH—GnRH will act on
of positive pregancy the Anterior pituitary gland-- Anterior pituitary gland will
CLINICAL ASPECTS OF OVULATION produce FSH and LH—Gonadotropins will act on the ovaries to
1. Mittleschmertz stimulate estrogen and progesterone production (FSH will act on
- In the extrusion of a mature ovum, the antral fluid that is the granulosa cells to produce estrogen, LH will act on the Theca
present is also being released, thus the body reacts via cells to produce progesterone . But the with 2 cell theory, Theca
spasm—14th day: pain in the hypogastric area cells will be able to produce estrogen by virtue of aromatization of
- Clinical Application: For couples who are trying to androstenidione)-- increase estrogen level-- estradiol peak—at
conceive, mid-cycle pain can be one indicator that the 24 hours, it should be maintained-- LH surge—after 24-36 hours—
woman has ovulated Ovulation
o Other method: Follicle monitoring via
Ultrasound CORPUS LUTEUM
- mid cycle pain; sharp pain Developmental stages:
- pain associated with ovulation a. proliferation
- usually 14th day of cycle b. vascularization: capillaries + fibroblasts
2. Spinnbarkheit phenomenon - in ovulation, it’s not only the antral fluid that is
extruded out but there’s also the hemorrhagic corpus
luteum—signifies certain amount of bleeding
o Some patients may not need medical treatment
but in patients who are presenting signs of
acute abdomen, they might need to be
operated to removethehemorrhage, however,
medical treatment can be sufficient
c. maturation: active secretion of progesterone
d. regression: if there is no fertilization
MECHANISMS OF REPRODUCTION
MITOSIS
- process of cell division giving rise to 2 daughter cells
that are genetically identical to the parent cell
- each daughter cell receives the complete
- complement of 46 chromosomes
Meiosis II is completed only if the oocyte is fertilized Inadequate corpus luteum- spontaneous abortion may
otherwise, the cell degenerates approximately 24hrs occur; give external sources of hormones
after ovulation LH kit- sample: urine, to test when ovulation occurred
SPERMIOGENESIS
from spermatids into spermatozoa
a. formation of the acrosome
b. condensation of the nucleus
c. formation of neck, middle piece, and tail
d. shedding of most of the cytoplasm
- this processes are needed in order for the sperm to swim
spermatogonium to mature spermatozoon - 64 days
BLASTOCYST
cells undergo differentiation and morphogenesis
cells of the trophoblast mediate the implantation of the
blastocyst into the uterine wall
Implantation begins when blastocyst comes in contact
with the ENDOMETRIUM
IMPLANTATION
takes place during the second week of development
trophoblast cells surrounding the blastocyst secrete
digestive enzymes that break down the endometrial
cells
Syncytiotrophoblast
- the trophoblast that grows into the endometrium
- produces hcg
- That’s why if you have a positive pregnancy test, it means
that you have already a detectable levels of hcG in your
urine. But that’s not always the case. There are cases in
which at 2 months, the patient is pregnant but with no
ovum or embryo. We call this as BLIGHTED OVUM or
ANEMBRYONIC PREGNANCY (it was discovered
because of early ultrasound: as early as 4 weeks)
- Earliest positivepregnancy test: 10 days after the
completed menstrual cycle (e.g 28th day +10 days)
Cytotrophoblast
- inner layer of the trophoblast
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ANSWERS:
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