Gynecology Physiology

functional, 8, 10, low, suppress, less, inhibition, hypothalamus, anterior, FSH, estrogen, androgen, estradiol

Puberty

-Puberty → period of life when reproductive organs grow to adult size and become ___________. Begins at age _ to __ for most girls in United States.

-Before puberty, circulating levels of estrogen and testosterone are ___ but sufficient to _________ secretion of GnRH by hypothalamus 

-As puberty approaches, hypothalamus becomes ____ sensitive to __________ by sex hormones. It releases GnRH in a pulse like manner

-Rising levels of GnRH stimulates ________ pituitary to secrete ___ and LH

-FSH stimulates ovarian follicles which begin to secrete __________, progesterone, inhibin, and a small amount of __________

-Estrogens are feminizing hormones with widespread effects on the body → ________ is the most abundant, followed by estriol and estrone

ovulation, maturation, development, milk, inhibiting, prevents, stimulates

Anterior Pituitary Gland

-Luteinizing Hormone (LH) → causes __________ of mature egg from ovary 

-Follicle Stimulating Hormone (FSH) → stimulates ___________ of eggs 

-Prolactin (PRL) → promotes breast ___________ and _____ production during lactation

• Regulation primarily controlled by prolactin-__________ hormone (PIH)

• PIH _______ release of PRL, until needed, with decreased levels leading to lactation 

• PRL blood levels rise toward end of pregnancy 

• Suckling __________ PRL release and promotes continued milk production

contraction, childbirth, ejection, arousal, bonding

Posterior Pituitary

-Oxytocin → stimulates __________ of uterus during __________, as well as ________ of milk from the breast.

-Also plays a role in sexual ________ and mother-child _______

Thelarche

Onset of breast development, the earliest noticeable sign of puberty 

-Estrogen, progesterone, and prolactin leads to the development of ducts and lobules

-Completion of duct and lobules by glucocorticoids and growth hormone 

-Adipose and fibrous tissue enlarge breast 

Pubarche

Appearance of pubic and axillary hair, sebaceous glands, and axillary glands

-Androgens → stimulate pubarche and libido

Menarche

First menstrual period

-Requires at least 17% body fat in teenager 

-Leptin stimulates gonadotropin secretion

-If body fat and leptin levels drop too low, gonadotropin secretion declines and menstrual cycle might cease

-First few menstrual cycles are anovulatory

-Regular ovulation begins approximately a year after menarche 

ovaries, thickens, acidic, growth hormone, density, fat, HDL

Estradiol: Hormonal Effects

-Estradiol stimulates many changes in puberty

• Stimulates growth of ________ and secondary sex organs

• Vaginal epithelium _________. Has an _______ pH

• Stimulates ______ _______ secretion

• Maintains bone _________, which is why post-menopausal women get osteoporosis

• Stimulates ___ deposition

• Thickens skin

• Increase ___ and decrease LDL

• Prevents vascular injury and platelet adhesiveness

uterus, pregnancy, suppress, negative, uterine, mucus, motility, lactation

Progesterone

-Primarily acts on the _______ getting it ready for ___________

-Estrogens and progesterone _______ FSH and LH secretion through _________ feedback

-Progesterone works with estrogen to establish and regulate the ______ cycle

-Promotes changes in cervical _____

-Effects of placental progesterone during pregnancy → inhibits uterine ________ and helps prepare breasts for ___________

production, haploid, yolk sac, before, oocytes, primodial

Oogenesis: Initial Stages

-Oogenesis → egg ____________

• Gametes are _________ and formed by meiosis 

• One egg released per month

• Production starts before birth

-Female germ cells originate from the ____ ___ and migrate to the gonads to differentiate into oogonia 

• Development is arrested till shortly ______ birth

• Get transformed into primary __________ (meiosis 1 stage) by birth

• At birth all _________ follicles containing primary oocytes are present, and the majority of them degenerate 

resumes, FSH, secondary, polar, metaphase, ovulation, sperm

Oogenesis: Continued

-Oogenesis ________ in adolescence under the influence of ___

• FSH stimulates oocytes to complete meiosis I

• On the day of ovulation, the primary oocytes divide into ________ oocytes and first _____ body.

• Secondary oocytes → large daughter cell that is the product of meiosis I

• First polar body → smaller one which dies to get rid of haploid chromosomes

-Secondary oocytes goes till ______________ II

• Arrests after ___________. If the egg is not fertilized, it dies.

• If fertilized, it completes meiosis II and releases a second polar body

-Chromosomes of the large remaining egg unite with those of the _____ at the time of fertilization

follicles, puberty, squamous, ovulate

Folliculogenesis: Introduction

-Development of the __________ around the egg that undergoes oogenesis

• Primordial follicles (before ______) → primary oocyte surrounded by a single layer of ___________ follicular cells 

• Located close to capsule of ovary, wait 13-50 years before they get reactivated to _______

puberty, cuboidal, growth, larger, granulosa, glycoprotein, connective

Folliculogenesis: Continued

-Primary Follicles (_______) → oocytes surrounded by a single layer of _________ follicular cells

• Controlled by local _______ factors

-Secondary Follicles → oocytes are even _______ and follicular cells now in two or more layers (_________ cells)

• Zona pellucida → layer of ___________ gel secreted by granulosa cells around the oocyte

• Theca folliculi → _________ tissue around the granulosa cells condenses to form a fibrous husk

Estrogen

What do granulosa cells produce?

Progesterone

What does the corpus luteum secrete? 

fibrous, inner, androgens

Folliculogenesis: Theca Folliculi

-Differentiates into two layers

-Theca externa → outer ________ capsule rich in blood vessels

-Theca interna → ______ cellular, hormone-secreting layer producing androgens (androstenedione and testosterone)

granulosa, antrum, mature, earlier, follicular, innermost, barrier

Folliculogenesis: Tertiary Follicles

-___________ cells start secreting follicular fluid into small pools which fuse to form ______

• Antral follicles → tertiary and ________ follicles, which are stimulated by FSH and LH 

• Preantral follicles → _______ stages of the follicles, which are influenced by local factors 

-Cumulus oophorus → a mound of granulosa cells on one side of the antrum that covers the oocyte and secures it to the _________ wall 

-Corona radiata → __________ layer of cells in the cumulus surrounding zona pellucida and oocyte 

• Forms a protective ________ around egg 

before, ovulate, FSH, before, preovulatory

Folliculogenesis: Mature Follicles

-About 20 days ________ ovulation, one follicle becomes dominant (the one destined to _________)

• Remainder degenerate

-It captures and holds ___

-At about 5 days _______ ovulation, it is large enough to be considered a _________ (graafian) follicle

ovary, prior, follicular, luteal

The Ovarian Cycle: Background

-Steps that occur in the ________ in preparation for ovulation, and what occurs _____ to menses if fertilization does not occur

-Consists of three steps → _________ phase, ovulation, and ______ phase

beginning, preovulatory, FSH, granulosa, estradiol, LH, androgens, converted, dominant, degenerate

The Ovarian Cycle: Follicular Phase 

-Follicular phase → ___________ of menstruation until ovulation (Days 1-14) 

-Includes ___________ phase, which is from the end of menstruation until ovulation 

-___ stimulates follicles to grow and stimulate __________ cells to secrete ________

-__ stimulates thecal cells to produce ___________, which is _________ to estrogens by granulosa cells 

-Prior to the start of the cycle, several immature oocytes begin preparation. Only one __________ follicle, which is increasingly sensitive to FSH/LH/estradiol

-All other antral follicles ___________

increases, LH, FSH, estradiol

Follicular Phase: Changes (Days 0-14)

-Follicle slowly starts to grow 

-Body temperature ___________

-__ surges at day 14 with ovulation, with a small peak in ___

-__________ hits a peak during this phase, towards the end 

-Endometrium starts to grow after menses 

temperature, FSH, LH, progesterone

Luteal Phase: Changes (Day 14-28)

-Ovulation occurs, corpus luteum is formed

-Body _____________ peaks with ovulation

-___ and __ are kept at a constant, low level

-______________ peaks with the formation of the corpus luteum. Estradiol is at a lower level

-Functional layer of endometrium continues to regrow

low, ovary, menses, visible, week, antral, dominant, mature

Follicular Phases

-Early

• ___ serum estradiol and progesterone concentrations

• Ovaries and endometrium → ovarian ultrasonography shows ______ is quiescent in the early follicular phase

• The endometrium is indistinct during _______ and then becomes a thin line once menses is complete

• Small follicles of 3 to 8 mm in diameter are _______ on ultrasound

-Mid

• Ovarian and follicular changes → within a _____ from the onset of menses, several 9 to 10 mm ______ follicles are seen on ovarian ultrasonography

-Late

• Ovarian changes → by the late follicular phase, a single ________ follicle has been selected and others undergo atresia. The dominant follicle has _______ size of 20 to 26 mm

released, 14, LH, ovary, 36, fimbrae

Ovulation

-Once matured, the selected mature follicle is __________ by the ovary 

-Typically occurs on day __ of the cycle 

-Ovulation occurs due to a surge in __ stimulated by estradiol

-The oocyte is released from the follicle at the surface of the ____ approximately __ hours after the onset of LH surge

-The ovulated oocyte is picked up by the ________ of the fallopian tubes, taking 2-3 minutes to occur 

swells, enzymes, follicle, secondary

Ovulation: Effects of LH

-Follicle ______ up (resembles blister on ovary)

-Macrophages and leukocytes secrete __________ that weaken _______ wall

-Nipple-like stigma appears on surface

-Follicle bursts and fluid oozes out, carrying the __________ oocyte and cumulus oophorus

estradiol, thickening, mucus, rises, pain, 24

Signs of Ovulation

-Rising serum ________ concentrations cause…

• Gradual ___________ of the uterine endometrium

• Increase in the amount and “stringiness” of the cervical _____

• Resting body temperature ______ 0.4 to 1.0 degrees F

• Mittelschmerz are twinges of ____ at time of ovulation

-Best time for conception is within __ hours after the cervical mucus changes and rise in basal temperature

15, 28, ruptures, corpus luteum, LH, progesterone, pregnancy, declines, shrink, corpus albicans 

The Ovarian Cycle: Luteal Phase (Day __ to __)

-When follicle __________, it collapses and bleeds into the antrum.

• Clotted blood is slowly absorbed

• Granulosa and theca interna cells multiply and get filled with yellow lipid, called ______ ______

• Regulated by __

-LH stimulates corpus luteum to secrete _____________ in large amounts and some estrogen 

• Progesterone prepares the uterus for ___________

• LH and FSH secretion ________ over the rest of the cycle 

-No pregnancy:

• Corpus luteum begins to ______, beginning about day 22 

• By day 26, involution is complete, and the _______ ________ forms 

endometrial, ovarian, proliferative

Menstrual Cycle: Background

-Process of steps that occur in __________ layer of the uterus at the same time as _______ cycle

-The cycle is separated into 3 phases → menstrual, _____________, and secretory phase

regrowth, shed, estrogen, regeneration, triple

Menstrual Cycle: Proliferative Phase

-________ of functional layer of endometrium that was ____ in last menstruation

• At day 5 of menstruation, the endometrium is 0.5 mm thick

• As new follicles develop in the ovary, _________ levels rise

• Estrogen stimulates ____________ of the functional layer

• By day 14, endometrium is 2 to 3 mm thick

-USG endometrial changes → under the influence of estradiol, uterine endometrium becomes thicker, with an increase in number of glands and the development of a “______ stripe” pattern on ultrasound

thickens, progesterone, 14, glycogen

Menstrual Cycle: Secretory Phase

-Endometrium __________ more under the effect of ___________ from corpus luteum 

-Fixed phase (__ days) of menstrual cycle 

-Preparation of the body for pregnancy → day 15 to 26 

-Thickening due to secretion and fluid collection, where endometrial glands secrete ___________

-Glands grow wider, longer, and more coiled

-Endometrium 5 to 6 mm thick

degenerates, progesterone, spasm, ischemic, cramps, functional, serous

Menstrual Cycle: Premenstrual Phase

-Endometrium __________, last 2 days of the cycle

• ___________ levels fall due to CL degeneration

• _____ of spiral arteries

• Endometrium becomes __________

• Tissue necrosis and menstrual ______

• Pools of blood accumulate in the ___________ layer

• Menstrual fluid → necrotic endometrium mixed with blood and ______ fluid

discharge, falls, LH, fibrinolysin

Menstrual Cycle: Menstrual Phase

-_________ of menstrual fluid from the vagina

-______ in estradiol and progesterone levels due to disintegrating corpus luteum leads to endometrial ischemia causing it to slough, and the onset of menses approximately 14 days after __ surge

-First day of discharge is day 1 of the new cycle

-Average loss is 40mL of blood and 35mL of serous fluid over a 5-day period

-Contains ___________ so it does not clot

-USG → endometrium is relatively indistinct during menses and then becomes a thin line once menses is complete

hormonal, estrogen, keratinized, epithelium 

Vaginal Response

-Vaginal endothelium responds to cyclic ___________ changes of the menstrual cycle 

-Under the influence of ________, cells of the vagina epithelium grow maximally during the follicular/proliferative phases

-Cornification → after ovulation, layers of ____________ cells overgrow the basal epithelium

-Decornification → close to the end of the luteal phase, the leukocytes invade vaginal __________, removing the outer layers 

thin, estrogen, elastic, sperm, reduced

Cervical Mucus Response

-Proliferative phase → the cervical mucus is ____ and watery

-Ovulation → highest ________ levels occur just before ovulation. Copious amounts of _______ cervical mucus is produced. Tiny channels develop in the mucus, which allows _____ access to the interior of the uterus

-After ovulation → amount of cervical mucus is _________, becomes thicker and stickier, and blocks sperm migration

estrogen, progesterone, luteal, menses, hormonal

Breast

-_________ stimulates the growth of ducts, while ___________ stimulates stromal growth

-Cyclical breast pain is bilateral and diffuse pain that begins during the late _______ phase and disappears with the onset of ________

-Caused by cyclical ________ changes that stimulate the proliferation of normal glandular breast tissue and result in pain

year, atrophy, depression, thinning, HDL

Menopause

-Has occurred when menses have ceased for an entire ______

-No equivalent to menopause in males 

-Declining estrogen levels cause:

• _______ of reproductive organs and breasts

• Irritability and ____________ in some 

• Hot flashes as skin blood vessels undergo intense vasodilation

• Gradual __________ of skin and bone loss 

• Increased total blood cholesterol levels and falling ___