Anthropology Exam 2 - Reproductive Health

menarche

the onset of menstruation

age range at which menarche occurs worldwide

12-18 yrs

6 determinants of age at menarche

genes, body fat and nutritional status, physical activity, psychosocial variables, socioeconomic factors, environmental factors 

menstruation

once a month the uterus grows a new lining (the endometrium) in preparation for a fertilized egg. When pregnancy doesn’t occur, the endometrium is shed through the vagina

what happens to the endometrium of mammals which experience a fertile period but not menstruation?

it is reabsorbed

HPA/G axis

the hypothalamic-pituitary adrenal axis or the hypothalamic-pituitary-gonadal axis

3 pituitary hormones

GnRH, LH, FSH

what is GnRH

gonadotrophin releasing hormone

what is LH

lutenizing hormone

FSH

follicle stimulating hormone

endometrium

uterine lining

follicle

fluid filled sac in the ovary containing the oocyte

oocyte

female sex cell (egg)

corpus luteum

the temporary endocrine gland that forms during the luteal phase

what does the corpus luteum do?

produces estrogen and progesterone, if pregnancy occurs it supports hormones throughout pregnancy, if not, it triggers menses

2 ovarian hormones

estrogen and progesterone

what occurs during the follicular phase?

Follicle is developing, FSH peaks

what occurs during the ovulatory phase?

egg is released, LH peaks

what occurs in the luteal phase?

corpus luteum is lessening as phase continues and no pregnancy occurs, progesterone is very high, estrogen is rising again

what occurs during the menses phase?

everything rapidly drops as the endometrium is shed, corpus luteum is very small

Health risks of early menarche

abdominal type obesity, insulin resistance, glucose intolerance, cardiovascular disease, coronary heart disease, increased bone mineral density, increased cancer mortality

health risks of late menarche

osteoporosis, adolescent depression, social anxiety symptoms

population variation in female hormones

higher income societies = higher level of hormones

why do we need to know about the population variation of female hormones

so that pharmaceutical companies can produce drugs that work for specific populations and not make certain populations sick or putting them at risk with a one size fits all solution

medicalization

the process by which non-medical aspects of life are defined, treated, and understood as medical issues, often requiring the intervention or regulation by healthcare professionals (like PMS).

what is PMS?

premenstrual syndrome (not a real thing!!)

what is PMDD?

premenstrual dysphoric disorder

what percent of women have PMDD?

3-8%

what is the connection between PMS and medicalization

society medicalized the concept that women suffer from unladylike, aggressive emotions as a result of their cycles, which led to generations of fraud “solutions” that would reduce these symptoms. However, this wasn’t actually a real thing — just a way to invalidate women’s emotions and moods. PMDD does exist, but much less women have it.

fertility

having a live birth

fecundability

the ability to conceive

3 main proximate determinants of fertility

age, lactational infecundability/amenorrhea, and sexually transmitted diseases

things that affect the possibility of fertility

age at menarche, age at menopause, rates of marriage and sanctioned sexual relationships

possibility

something that might happen

things that affect the probability of fertility

frequency of intercourse, amount of time in ovulatory cycle, duration of ovarian infecundability, probability of pathological sterility (usually caused by stds), frequency of spontaneous abortion/fetal death

probability

something that is likely to happen

at what age does fecundability peak?

around 25

fecundability increases with age (true/false)

false

lactational infecundability/amenorrhea definition

infertility as a result of breastfeeding

definition of amenorrhea

absence of menses

determinants of lactational infecundability/amenorrhea

duration and frequency of breast feeding

duration of lactational infecundability/amenorrhea without pregnancy

3 weeks

duration of lactational infecundability/amenorrhea with pregnancy

about 6 months, if there is 100% on demand breast feeding

sucking stimulates release of prolactin, which stimulates milk production. More milk production = more infant suckling. Then, infant suckling also suppresses the secretion of GnRH from the hypothalamus, which, because of the HPA axis, suppresses the release of pituitary hormones FSH and LH, preventing follicle development and inducing infecundability.

mechanism of lactational infecundability

what sexually transmitted diseases often cause infertility?

gonorrhea and chlamydia

what disease do STIs often cause in females, resulting in the possibility of infertility?

PID (pelvic inflammatory disease)

why are gonorrhea and chlamydia known as “silent infections?”

they often go undetected and untreated, resulting in an increased possibility of infertility

length of time without pregnancy in females to be considered infertile

24 mont

infertility is usually the woman’s fault (true/false)

false

what is pelvic inflammatory disease (PID)?

infection of the uterus, fallopian tubes, or ovaries, resulting in symptoms ranging from severe to none

what amount of women are affected by PID?

1 million women worldwide

percent of maternal deaths that are attributable to preventable or treatable complications

75%

quadruped pelvic shape

flat shape, so the only constraint to birth is the width of the birthing canal

characterization of biped/human pelvis

3d bowl shape, trade off between walking efficiency and pelvic width

obstetric dilemma

evolutionary trade-off between the need for a wide birth canal for childbirth and the need for narrow hips for efficient bipedal locomotion in humans

4 factors that solve the obstetric dilemma

1) baby head rotation, 2) relaxin and head molding, 3) standing/squatting, and 4) supported birth

baby head rotation

chimps have smaller heads as well as larger birthing canals, but humans have larger heads and smaller birth canals, so they must rotate 90 degrees during birth

relaxin and head molding

allows mom’s ligaments to stretch and allows baby’s head to change shape to fix through

relaxin

a hormone secreted by the placenta that triggers birth and helps mom through birth

standing/squatting

laying down during birth led to an increase in complications, because it is working against gravity

lithotomy position

laying down with feet in stirrups

supported birth

birth doulas advocate for patient and help to provide a safe birth experience

doula

a person, one typically without formal obstetric training, who is employed to provide guidance and support to a pregnant woman during labor

episiotomy

incision made on the birth giver to give baby more room → ultimately increases risks and makes it harder to recover

pitocin

medical intervention that speeds up birth process

cascade effect

how one medical intervention can lead to a highly medicalized birth process, increasing risk of complications

overreliance on tech that inhibits movement

it can be hard to keep medical measurement devices on, and it raises questions of whether every pregnancy needs the same level of monitoring

menopause

cessation of menses for 1 year

cause of menopause

the natural decline of oocyte due to follicular atresia and ovulation

how many oocytes do you have after 5 months of development?

7 million

how many oocytes do you have at birth?

2 million

how many oocytes do you have at menarche?

400,000

how many oocytes do you have at age 38?

25,000

how many oocytes do you have at menopause?

<1000

population variation of menopause symptoms

african american women suffer from the worst/most often vasomotor symptoms, while japanese women have the least

biocultural interaction of factors of menopause symptoms

hormonal variation, body comp and metabolism, stress, discrimination, and socioeconomic context, cultural meanings and symptom reporting, health behaviors such as smoking, drinking, etc.

examples of medicalization of menopause

“estrogen deficiency” and “ovarian failure”

HRT

hormone replacement therapy

are breast cancer rates rising or falling?

rising

what causes breast cancer?

family history, lifetime exposure to estrogen, health behaviors like smoking, drinking, etc.

what impacts lifetime exposure to estrogen?

late menopause, early menarche, late age @ birth of first child, use of HRT, time spent pregnant or breastfeeding

breast feeding’s protective effect on breast cancer

breast feeding has a protective effect because of lactational amenorrhea

male infertility

the absence of pregnancy in a female partner after 1 year of regular unprotected intercourse

causes of male infertility

problems with the testicles, blockages in ducts that carry sperm, hormone problems, history of high fevers or mumps, genetic disorders, lifestyle factors

rates of sperm counts

50% decline in sperm counts since 1950

why has there been a decline in sperm counts?

environmental estrogens found in pesticides, plastics, detergents, canned foods, personal care products

effect of DES

can lead to male infertility

DES

diethylstilbestrol

erectile dysfunction

inability to maintain or achieve an erection

what percent of men over 20 year have erectile dysfunction?

18%

what percent of men ages 18-25 have erectile dysfunction

7%

what percent of men ages 76-85 years have erectile dysfunction?

85%

causes of erectile dysfunction

stress, depression, anxiety, chronic diseases, medications

viagra

popular drug to help increase erectile function