Physio Unit 3 Female Repro

Front 1

Fxns of Female Reproductive System

Back 1

-Production of eggs (oogenesis)
-Receive sperm
-Transport sperm and ovum to common place for fertilization
-Maintenance of developing fetus until it can survive in the outside world by forming a placenta
-Parturition
-Lactation

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Embryo vs fetus

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-Initial product of fertilization is an embryo
-After two months of development it becomes a fetus

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Oviducts
(Uterine or Fallopian tubes)

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-Found in close association with ovaries
-Pick up ova after they are released
-Serve as a site for fertilization

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Uterus

Back 4

-Responsible for maintenance of fetus during development
-Responsible for expelling fetus once it is done

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Vagina

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-Muscular, expandable tube that connects the uterus to the outside world
-Lower portion is the cervix

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Cervix

Back 6

-Serves as a passageway for sperms and babies

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External Genitalia (vulva)

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-Vaginal opening: covered by hymen
-Labia
-Clitoris

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Structure of Ovary

Back 8

-Cortex
-Medulla
-Hilum

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Ovarian Cortex

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-Outermost layer
-Largest zone
-Lined with germinal epithelium
-Contains all oocytes enclosed within their follicles

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Ovarian Medulla

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-Middle zone
-Mix of cell types including scattered steroid producing cells

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Ovarian Hilum

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-Inner zone
-Entrance of blood vessels and lymphatics

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Role of Ovaries in Repro

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-Primary reproductive organs
-Produce ova
-Secrete female sex hormones: estrogen and progesterone

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Role of Estrogen in Reproduction

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-Essential for ova maturation and release
-Establishes female secondary sex characteristics
-Essential for transportation of sperm from vag to oviduct for fertilization
-Contributes to breast development in lactation

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Role of Progesterone in Reproduction

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-Important in creating a suitable environment for nourishing a developing fetus
-Contributes to breasts' ability to make milk

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Progression of Cell Types in Oogenesis

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-Primordial germ cells
-Oogonia
-Primary oocytes

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Primordial germ cells

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-Migrate to the fetal ovary
-Undergo mitosis until the 20-24th week of gestation
-Peak of 6-7 million cells

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Oogonia

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-Found from 6-8 weeks to 6 months after birth
-They enter prophase I of miosis and become primary oocytes
-Creates a layer of stromal cells around it (preganulosa)

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Primary Oocyte

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-Development is arrested at Prophase I
-Remain in this state until just before ovulation; meiosis resumes when it is ovulated
-At birth only 2 million remain
-At puberty, only 400k remain

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Oogenesis-steps

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-Primary oocyte completes its first mitotic division and becomes a secondary oocyte and 1st polar body
-It is then ovulated
-Second meiotic division occurs with sperm entry
-Second (haploid) polar body is formed
-This mature haploid ovum meets haploid sperm

Front 20

Spermatogenesis

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-Accomplished with 2 months
-Postpube male can make several hundred million sperm daily
-Each primary spermatocyte yields 4 equally viable spermatozoa

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Oogenesis

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-Can take anywhere from 12-50 years to complete on a cyclic basis
-Born with a limited supply of largely nonrenewable germ cells
-Each primary oocyte yields only one viable ovum and three polar bodies

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Ovarian Cycle Length

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28 days
-Two phases:
1. Follicular
2. Luteal

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Follicular Phase Features

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-First half of cycle
-Granulosa cells become cuboidal and proliferate
-Oocytes within follicles enlarges
-Granulosa cells secrete zona pellucida over oocytes
-Surrounding ovarian cells differentiate into tecal cells
-Granulosa/tecal cells secrete increasing amts of estrogen
-Rapid follicular growth occurs during this phase
-Antrum forms; holds estrogen
-The follicle which grows most rapidly and matures within 14 days becomes Graafian follicle

Front 24

Luteal Phase Features

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-Final 14 days of cycle
-Old follicular cells form corpeus luteum
-Corpeus luteum secretes estrogen/progesterone
-Corpeus luteum becomes fully functional 4 days after ovulation
-If ovum is not fertilized/does not implant, the corpeus luteum becomes corpus albicans due to fibrous tissue formation
-If fertilization does occur, then the corpeus luteum continues to grow and release estrogen/progesterone

Front 25

Production of Estrogen by Ovarian Follicle

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1. LH stimulates tecal cells in the ovarian follicle
2. Stimulated tecal cells convert cholesterol into androgen
3. Androgen diffuses from tecal cells to nearby granulosa cells
4. FSH stimulates the granulosa cells in the ovarian follicle
5. Stimulated granulosa cells convert androgen to estrogen
6a. Some estrogen is secreted into systemic circulation
6b. Some estrogen remains and contributes to antral formation
7. Local estrogen, along with FSH, stimulates proliferation of the granulosa cells

Front 26

Transport of Ovarian Hormones

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-Hormones are bound to plasma proteins
-Estrogen: Sex Hormone Binding Globulin
-Progesterone: Corticosteroid Binding Globulin
-Binding may be important after menopause and during abnormal ovarian fxn, such as polycystic ovarian dz (increased androgens)

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Effect of Estrogen/Thyroxine on Binding Proteins

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-Increase sex hormone binding protein

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Effect of Progesterone/Androgen on Binding Proteins

Back 28

-Decrease sex hormone binding protein

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Hormonal Interactions

Back 29

-During the follicular phase, an increase in FSH signals the ovarian follicles to secrete more estrogen
-Rise in estrogen feedsback to inhibit FSH secretion which declines as the follicular phase proceeds
-LH levels rise during follicular phase; peaks at midcycle which triggers ovulation
-Estrogen output decreases and the mature follicle is converted to corpus luteum
-The CL secretes estrogen/progesterone during luteal phase
-Progesterone inhibits FSH/LH
-Low LH levels allows corpeus luteum to degenerate
-Progesterone levels also decline which allows FSH levels to rise again renew the cycle

Front 30

Inhibitors of GnRH

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-Prolactin
-Stress
-Exercise
-Endorphins
-Chronic illness

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FSH regulation

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-Inhibin negatively regulates specifically

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General Regulation of Gonadotropes

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-Estrogen

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Hormonal Control of Ovulation

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-High concentrations of estrogen create a positive feedback loop which induces more GnRH release/creation of GnRH receptors
-This is responsible for mid-cycle LH surge

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Hormonal Control of Ovulation: Luteal Phase

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-LH surge has transformed the ruptured follicular granulosa and tecal cells into luteal cells
-These luteal cells make both progesterone and estrogen in high levels
-Progesterone has a negative feedback effect upon hypothalamus and pituitary; this negative feedback suppresses a second LH surge

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Menstrual Cycle

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-Three phases
1. Menstrual Phase: days 0-5
2. Proliferative Phase: days 6-14
3. Secretory/Progestational Phase: days 15-28

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Menstrual Phase

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-Characterized by discharge of blood
-First day is counted as start of new cycle
-Coincides with end of ovarian luteal phase and start of follicular phase
-Release of uterine prostaglandins

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Proliferative Phase

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-Begins at the same time as the end of the last portion of the ovarian follicular phase
-Endometrium beings to repair itself and proliferate under the influence of estrogen from newly growing follicles
-This phase lasts from end of menstruation to ovulation
-Peak estrogen levels trigger LH surge responsible for ovulation

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Secretory/Progestational Phase

Back 38

-Begins when new corpeus luteum is formed
-CL secretes large amounts of estrogen/progesterone
-Progesterone converts endometrium to highly vascularized, glycogen-filled tissue
-If fertilization/implantation do not occur, the CL degenerates and a new follicular phase begins

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Follicular Effects of Estrogen

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-Induces LH receptors on granulosa cells
-Induces E2 receptors on granulosa cells
-Induces FSH receptors on granulosa cells
-Proliferation of granulosa cells, development of antral follicles

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LH Receptors on Granulosa Cells

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-Important for development of CL
-Secretion of progesterone

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Role of E2 Receptors on Granulosa Cells

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-Growth of follicle

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Role of FSH receptors on Granulosa Cells

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-Intensifies effect of FSH on follicle

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Effects of LH Surge

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-LH stimulates cholesterol to pregnenolone conversion
-Meiosis resumed
-Converts antral follicle to Graafian follicle
-Stimulates production of proteolytic enzymes follicle
-Increases prostaglandins which increase bloodflow, follicular wall distensibility, and increases proteolytic enzymes
-Differentiates follicle cells into corpus luteum

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Effects of Estrogen Upon Fallopian Tubes

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-Increases the number of cilia and their rate of beating, drawing the ovum into the tube

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Effects of Estrogen Upon Uterus

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-Myometrium: increases contractions and oxytocin receptors
-Endometrium: thickens, increases permeablity and blood supply; synthesizes receptors for progesterone on uterine cells

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Physiologic Effects of Estrogen Upon Cervix

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-Increases distensibility
-Makes cervix mucous thin, watery, and alkaline
-Dries into fern-like pattern
-Series of channels formed in mucous at cervical opening

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Physiologic Effects of Estrogen Upon Vagina

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-Proliferation of epithelial layer
-Increase in vaginal secretions

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Physiologic Effects of Estrogen Upon Mamms

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-Stimulates growth
-Increases ductal growth
-Increases nipple size/pigmentation

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Physiologic Effects of Estrogen Upon Body

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-Increased deposition of subq fat

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Physiologic Effects of Estrogen Upon Skeletal System/Ca2+ Metabolism

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-Epiphyseal closure
-Facilitates calcium uptake into bone
-Antagonizes PTH on bone which decreases rate of resorption
-Decreases the production of cytokines

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Physiologic Effects of Estrogen Upon Skin

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-Inhibits body hair growth, except pubes

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Physiologic Effects of Estrogen Upon Kidney Electrolytes

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-Increases absorption of Na+, Cl-, and H2O which all contribute to bloating

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Physiologic Effects of Estrogen Upon heart

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-Maintains low blood cholesterol (high HDL, low LDL)
-Acts as arterial dilator
-Decreases atherosclerosis

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Physiologic Effects of Progesterone Upon Uterus

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-Can only act upon tissues that have been stimulated by estrogen
-Increases development/differentiation of endometrial glands; converts uterus into an actively secreting tissue
-Induces decidua formation (this is the maternal part of the placenta)
-Increases water movement into cells for hypertrophy
-Decreases contractility

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Physiologic Effects of Progesterone Upon Cervix

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-Antagonizes estrogen
-Decreases distensibility
-Creates thick, acidic mucous which is a poor environment for sperm

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Physiologic Effects of Progesterone Upon Vagina

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-Opposes estrogen
-Decreases proliferation of epithelial layer

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Physiologic Effects of Progesterone Upon Mamms

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-Increased branching of ductal system

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Physiologic Effects of Progesterone Upon Body

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-Increases body temp by 0.5 which indicates ovulation has occured
-Increases appetite

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Physiologic Effects of Progesterone Upon Kidney Electrolytes

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-Decreases Na+ reabsorption by competing with aldosterone

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Overall Role of Estrogens

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-Responsible for growth and development of vagina, uterus, and oviducts which are all organs essential to ovum transport and zygote implantation

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Role of Progesterone

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-The hormone of pregnancy responsible for the implantation of the zygote and the maintenance of the pregnant state

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Menstrual Cramps

Back 62

-Caused by increased cramps

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PMS

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-Affects 40% of women
-5% have severe impairment
-Does not occur before puberty, during pregnancy, after menopause, or in anovulatory women
-Common s/sx: anxiety, cravings, depression, water-related symptoms

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Menopause

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-Cessation of menstrual cycle
-Usually occurs between 45 and 55
-Preceded by a period of progressive ovarian failure
-This period of transition is called the climateric
-Related to a drop in the critical mass of primordial follicles

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Follicular Atresia Acceleration

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~37.5 years

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Osteoporosis

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-Reduction in the quantity of bone due to lack of estrogen
-Increased osteoclast activity
-Loss of trabecular bone
-Bone loss related to peak bone mass, lifestyle, heredity, and ethnicity

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Cardiovascular DZ

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-Estrogen receptors act to rapidly vasodilate and decrease vascular injury
-Loss of estrogen results in: increased cholesterol (increased LDL and decreased HDL) and an increase in athersclerosis and MI

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Menopausal Syndrome

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-Vasomotor instability
-Hot flashes
-Night sweats
-Mood changes
-Short term memory loss
-Sleep disturbances
-HA
-Loss of libido

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Physical Changes in Menopause

Back 69

-Atrophy of vaginal epithelium
-Changes in vaginal pH
-Decrease in vaginal secretions
-Decrease in circulation to vagina/uterus
-Pelvic relaxation
-Loss of vaginal tone
-CV dz
-Osteoporosis
-Alzheimer's dz