Female Reproductive Health Flashcards
(148 cards)
1
Q
What are the two main functions of ovaries?
A
- Produce, mature and periodically release egg cells (ova), which lie within the ovarian follicles
- Secrete main female sex hormones, oestrogens and progesterones
2
Q
What is the most biologically active oestrogen?
A
Oestradiol. Other oestrogens such as oestrone and oestriol are also produced by the body
3
Q
What is the most biologically active progestogen?
A
Progesterone
4
Q
What is the general role of oestrogens?
A
Promote the growth and proliferation of cells within female reproductive organs and other tissues
5
Q
What is the general role of progesterones?
A
Promote the final preparation of the uterus for implantation of a fertilised ovum, as well as affecting the vagina and cervix
6
Q
What are the target organs of oestrogens and progesterones?
A
Reproductive organs
Bladder
Urethra
Breasts
7
Q
How do oestrogens stimulate target organs?
A
- Circulate through bloodstream until they are delivered to target cells, which they enter passively through the cell membrane
- After entering cell, binds to an oestrogen-receptor proteins within the cytoplasm
- Oestrogen-receptor complex then migrates to the nucleus, where it interacts with certain parts of the cell’s DNA to activate transcription of various different genes within the DNA
- This can then change the structure or function of the cell, depending on which genes are activated
8
Q
What are some of the functions of oestrogens?
A
- Stimulating development of secondary sexual characteristics
- Maintaining lining of womb by suppressing FSH and LH production in pituitary gland
- Controlling puberty and menstrual cycle
- Vaginal lubrication
- Increasing bone formation and reducing bone resorption (breakdown)
9
Q
What are the 3 naturally occurring oestrogens?
A
Oestradiol
Oestrone
Oestriol
10
Q
What are all oestrogens synthesised from?
A
A steroid hormone called androstenedione
11
Q
What is the most potent type of oestrogen?
A
Oestradiol, although oestriol is present in greater quantities
12
Q
Where is most oestradiol produced?
A
In the ovaries, small amounts in adrenal glands
13
Q
Where are most oestrogens produced in menopausal women and those with ovarian failure?
A
Adrenal glands
14
Q
What cells are affected by oestrogens?
A
Only those with oestrogen receptors
15
Q
Where are oestrogens metabolised?
A
Liver
16
Q
What are the products of oestrogen metabolism?
A
Oestradiol is converted to oestriol (least potent form). Oestriol and other metabolites then excreted in urine
17
Q
What is the most abundant form of oestrogen in women with non-function ovaries?
A
Oestrone
18
Q
Production of which oestrogen increases significantly during pregnancy?
A
Oestriol
19
Q
What does progesterone promote?
A
Tissue differentiation (a change in the way a tissue functions)
20
Q
How does progesterone promote tissue differentiation?
A
Binds to a progesterone receptor within target cells which influences DNA expression within the cell, thereby influencing cell function
21
Q
What increases the expression of progesterone receptors?
A
Oestrogen receptors
E.g. in pregnancy increased exposure to oestrogen allows progesterone to stimulate differentiation of glandular breast tissue
22
Q
What does progesterone prevent?
A
Endometrial shedding
23
Q
During development of an embryo, what do germ cells give rise to?
A
Oogonia - several smaller cells that proliferate by mitosis. They degenerate or differentiate to become primary oocytes by the time an individual is born
24
Q
What do not form after birth?
A
New oocytes
25
What stimulates the menstrual cycle?
Gonadotrophin from the pituitary gland stimulates the meiosis of an oocyte during each menstrual cycle, stimulating the release of an ovum
26
What is fertilisation?
The union of egg and sperm to produce a zygote
27
Where does fertilisation usually occur?
Ampulla of the fallopian tube
28
What does seminal fluid raise the pH of the vagina to?
pH 3.5-4.5 to as much as 7.2 within 10 seconds. Allows sperm to survive
29
What acts as a barrier to abnormal sperm?
Cervical mucous
30
What aids the transport of sperm after they have entered the uterus?
Contractions of uterine muscles
31
What is capacitation?
Physiological maturation of the sperm. Biochemical change causes the sperm to become hyperactive and acrosome reaction becomes possible. Sperm cannot fertilise an ovum until they have remained in the reproductive tract for several hours and have been acted on by secretions
32
Sperm cell structure
33
Describe the acrosomal reaction
1. Biochemical acrosome changes allow spermatozoon to bind to corona radiate of ovum
2. Enzymes that can digest a pathway through the zona pellucida are released by the acrosome
3. Spermatozoon penetrate the entire zona pellucida and reach ova's cell membrane, fuses and passes to ova's cytoplasm
4. Viability of formed zygote depends on ability to avoid fusing with any other spermatozoa
5. Second meiotic division
6. Zygote remains in fallopian tube for 5-6 days, increasing levels of progesterone that relax smooth muscle of fallopian tube allowing zygote to enter the uterus
7. Zygote transported down fallopian tube, sheds zona pellucida and attaches to uterus lining
8. Once implanted in uterus lining, zygote is referred to as an embryo
34
What are capable of hormone production from birth?
Pituitary gland and ovaries
35
What is not mature at birth to stimulate hormones?
Hypothalamus, cannot yet stimulate production of gonadotrophic hormones by the pituitary gland. Gradually increases production from around age 8
36
What does the production of gonadotrophic hormones stimulate?
The pituitary gland to produce LH and FSH. This stimulates oestrogen synthesis by ovaries
37
What axis controls the levels of of oestrogen and progesterone?
Hypothalamic-pituitary-gonadal axis (find diagram)
38
What is an anovulatory cycle?
In first few cycles after menarche, ovaries do not release an egg
39
What are the two phases of the ovarian cycle?
Follicular phase
| Luteal phase
40
What are the levels of hormones throughout the ovarian cycle?
41
What happens during the follicular phase?
1. Oestrogen levels low - hypothalamus releases GnRH causing pituitary gland to release FSH, inducing follicular maturation. Only one matures to become a Graafian
2. Graafian matures, approaches surface of ovary. It secretes increasing amounts of oestrogens until peak at day 14 and small amount of progesterone
3. As follicle matures, rising oestrogens stimulate LH surge and smaller FSH release. Surge in LH = ovulation
4. Post-ovulation, LH drops sharply and FSH also decreases
41
Graafian follicle structure
42
What happens during the luteal phase?
1. After ovulation, ruptured follicle fills with blood (corpus haemorrhagicum). Follicular cells proliferate, clotted blood replaced with yellow, lipid-rich cells (corpus luteum)
2. Corpus luteum produces progesterone, suppressing FSH and LH production
3. Progesterone gradually increases until day 27 when rapidly decreases
43
What happens in the luteal phase if fertilisation occurs?
1. Corpus luteum continues to grow until one-half volume of ovary
2. Secretes enough progesterone to support early stages of pregnancy
44
What is the oestrogen activity in the luteal phase?
1. After ovulation levels decline slightly 4-5 days
2. At time progesterone levels peak, oestrogen levels also increase (lower than ovulation peak)
3. Oestrogen levels then drop day 20-23
45
What are the three phases of the uterine cycle?
1. Menstrual phase
2. Proliferative phase
3. Secretory phase
46
What happens during the menstrual phase?
Discharge of endometrial tissue and blood from uterus
47
What happens during the proliferative phase?
Increasing levels of oestrogens stimulate rapid growth of endometrial tissue. Glands and blood vessels grow
48
What three related events must occur for the endometrium to fully prepare itself to receive a fertilised ovum?
1. Ovulation, followed by
2. Formation of corpus luteum, which leads to
3. Increased secretion of progesterone
49
What is the secretory phase characterised by?
Secretions from glandular tissue in the endometrium. Roughly corresponds to luteal phase
50
What happens during the secretory phase if fertilisation does not occur?
1. Corpus luteum begins to degenerate, ceasing hormone secretion
2. Unable to maintain thickened endometrium due to lack of oestrogen and progesterone
3. Menstruation
51
What happens during the secretory phase if fertilisation and implantation do occur?
Thickened endometrium persists. Provides nutrients and allows implantation of zygote.
Corpus luteum maintained to secrete sex hormones in early pregnancy to maintain myometrium and prevent menstruation (later regulated by placenta)
52
What do combined oral contraceptive pills contain?
Oestrogen and progesterone
53
What does the mini-pill contain?
Progesterone only
54
What does the transdermal patch release?
Oestrogen and progesterone
55
What does the vaginal ring release?
Low-does oestrogen and progesterone
56
How do barrier methods prevent pregnancy?
Prevent sperm from reaching uterus
57
What do injectable contraceptives release?
Progesterone only
| Given every 8-13 weeks
58
What does IUD contain?
No hormones
59
What does IUS contain?
Progesterone only
60
What does subdermal implant release?
Progesterone only
61
What are the aims of hormonal contraceptives?
1. Inhibit ovulation
2. Prevent implantation of fertilised ovum
3. Thicken cervical mucus so that sperm cannot pass to uterus
62
Why do the progesterones in hormonal contraceptives cause side effects?
They are synthetic, therefore chemically different from naturally occurring hormone
63
What is a monophasic COC?
Fixed dose of oestrogen and progesterone
64
What is a multiphasic COC?
'Phased' doses of hormones which vary throughout cycle
65
How do COCs effect ovulation?
1. Suppression of FSH as a result of raised oestrogen prevents development of ovarian follicles
2. Suppression of LH as a result of raised progesterone prevents LH surge and therefore ovulation
66
How do COCs effect implantation?
Inhibits growth and maturation of endometrium
67
How do COCs effect cervical mucus and migration of sperm?
Higher levels of progesterone keep cervical mucus thick and viscous to act as a barrier to sperm cells
68
How does the mini pill have a contraceptive effect?
Thickens cervical mucus or inhibiting ovulation
69
Who is the mini pill not suitable for?
People with heavy periods - causes varied bleeding
70
How does the IUD have a contraceptive effect?
Contains no hormones, works by preventing fertilisation of ovum
71
What are the most common causes of female infertility?
Ovulatory disorders
Damage to fallopian tubes
Uterine or peritoneal disorders
Medication
72
How can infertility be treated medically?
Ovulation can be encouraged in people who do not ovulate or whose ovulation is irregular
73
What medicines can be used to treat infertility and what do they aim to do?
Clomifene, gonadotrophins
| Aim to directly stimulate the axis of sex hormone production to cause ovulation
74
What medicine can be used to treat infertility caused by PCOS?
Metformin (unlicensed use)
75
How can surgery be used to treat infertility?
Remove tissue from blocked or scarred fallopian tubes or inappropriate growth of endometrial tissue
76
How can surgery be used to treat infertility in patients with PCOS?
Laparoscopic ovarian drilling
77
What are the two most common methods of assisted conception?
```
In vitro fertilisation (IVF)
Intrauterine insemination (IUI)
```
78
What is the process of IVF?
1. Woman's ova harvested
2. Fertilised outside of body
3. Zygote implanted back into womb
Clomifene may be used to stimulate ovulation
79
What is the process of IUI?
1. Sperm collected, best quality cells selected
| 2. Sperm inserted into uterus around time of ovulation
80
What is dysmenorrhoea?
Painful periods
81
What is primary dysmenorrhoea?
Cramps occur due to contractions of uterus during menstruation
82
What is secondary dysmenorrhoea?
Menstrual-related pain that accompanies another medical or physical condition, e.g. PID, endometriosis or uterine fibroids
83
How can primary dysmenorrhoea be treated?
Pain relief - NSAIDs or paracetamol
Codeine if above does not reduce pain significantly
COCs
84
How can secondary dysmenorrhoea be treated?
If adequate pain relief not given by primary methods, cause needs to be identified - gynae referral e.g. PID needs antibiotics
85
What is menorrhagia?
Heavy bleeding
86
What conditions have been linked to menorrhagia?
Uterine fibroids
PCOS
IUDs
Anticoagulants
87
How can menorrhagia be treated?
Medication trialled first and surgery offered if this does not work or there is no clear cause such as fibroids
88
What is the aim of treating menorrhagia?
Reduce or stop excessive menstrual bleeding
Improve quality of life
Prevent or correct iron deficiency anaemia caused by heavy bleeding
89
What medications can be used to treat menorrhagia?
IUS
Tranexamic avid - encourages clotting
NSAIDs - reduce production of prostaglandins
COC
Oral norethisterone - artificial progesterone
Injected progesterone
GnRH-a
90
What types of surgery can be used to treat menorrhagia?
Uterine artery embolism - plastic beads block arteries supplying blood to fibroids
Myomectomy - keyhole to remove fibroids
Endometrial ablation - lining of uterus destroyed with microwaves or thermal balloon
Hysterectomy
91
What is amenorrhoea?
Absence of menstruation
92
What is primary amenorrhoea?
A girl does not have menarche by the age of:
16 is she has otherwise developed normal secondary sexual characteristics
14 if she has not developed other secondary sexual characteristics
93
What can cause primary amenorrhoea?
```
Anatomical:
Blockages or narrowing of cervix
Imperforate hymen
Missing uterus or vagina
Vaginal septum
```
Hormonal:
Problems arising in hypothalamus or pituitary
Incorrectly functioning ovaries
94
What can influence hormonal problems that cause amenorrhoea?
Anorexia
Chronic long-term illness e.g. CF or heart disease
Genetic disorders e.g. Turner's syndrome
Other birth defects
Poor nutrition
Rarely, a brain tumour
95
What is secondary amenorrhoea?
Periods that were previously regular stop for at least 6 months in a row
96
What can cause secondary amenorrhoea?
PCOS
Hypothalamic dysfunction - can be cause by anorexia, excessive exercise, weight loss, stress
Hyperprolactinaemia - person has abnormally high levels of hormone called prolactin in blood - caused by pituitary tumour or side effect of medication
Hypo- or hyperthyroidism
Ovarian failure at menopause
97
How can amenorrhoea be treated?
Management of underlying disease
Surgery
PCOS controlled using hormonal treatment
Hypothalamic corrected by cutting down exercise, treating anorexia, reducing stress levels
Hyperprolactinaemia as result of brain tumour treated with surgery, chemo or radiotherapy
Hyperthyroidism - carbimazole
Hypothyroidism - levothyroxine
98
What is PMS?
Physical, emotional and behavioural symptoms that occur in the second half of menstrual cycle
99
What are common symptoms of PMS?
Fluid retention, breast tenderness, feeling irritable, loss of interest in sex
100
Which neurotransmitter fluctuates during the menstrual cycle?
Serotonin
101
What is a more serious form of PMS?
Premenstrual dysphoric disorder (PDD)
| More psychological symptoms
102
If don't respond to lifestyle changes, what medical treatments can be used to treat PMS?
NSAIDs
SSRIs
GnRH analogues
COCs
103
What causes the menopause?
Loss of cell function of the ovaries
| Most critical event is a dramatic reduction in production of oestrogen
104
What are common symptoms of the menopause caused by diminishing oestrogen levels?
Hot flushes, night sweats, vaginal dryness, insomnia
105
What long-term conditions are post-menopausal women at risk of?
Osteoporosis
Myocardial infarction
Stroke
Oestrogen protects against these conditions
106
What can affect menopausal age?
Number of children a woman has had (earlier in women who have never given birth)
Average length of menstrual cycle (shorter cycles associated with earlier menopause)
Rate of atresia (process that reduces number of follicles in ovary)
Smoking (1-2 years in smokers)
Genetic disposition
107
What happens to hormones in pre-menopausal phase?
As oestrogen declines with age, FSH levels increase
Menstrual cycle may become less regular
Pituitary responds to deficiency in ovarian hormone production with erratic secretion of FSH and LH
108
What happens when ovaries reduce their production of oestrogen and progesterone after the menopause?
```
Serum FSH (and to lesser extent LH) reaches peak 2-3 years after menopause, because breakdown in negative feedback loop present in reproductive years
After peak, FSH and LH levels gradually decline
```
109
What happens to testosterone levels post-menopause?
Testosterone secreted in greater amounts due to stimulation of androgen-producing interstitial cells by increased FSH/LH levels
Reduced oestradiol levels lower sex hormone binding globulin (SHBG) levels, resulting in increase in free testosterone
110
How does HRT work?
Provides low does of oestrogen, (sometimes progesterone) to replace these hormones
Oestrogen given continuously, progesterone (if given) can be cyclical to mimic menstrual cycle or continuously given
111
Which oestrogens are preferred for HRT?
Natural are less potent therefore fewer adverse effects than synthetic oestrogens
112
What increase the risk of endometrial cancer?
High or excessively prolonged exposure to oestrogen without a progesterone
113
What is the main drawback of HRT regimens?
Uterine withdrawal bleeding
114
What risks of HRT should women be made aware of?
For longer-term use of HRT, women must be made aware of the increased instance of breast cancer
For short-term use of HRT, benefits outweigh the risks for many women
115
What is endometriosis?
Endometrial tissue is found outside of the uterus i.e. fallopian tubes, ovaries, bladder, bowel, vagina or rectum
116
How does endometriosis develop?
Cells that line the uterus travel out of uterus into pelvic area
These cells survive and respond to oestrogen each month
At the time of a period, these cells will multiply, swell and break down as the cells within the uterus do
117
What are medical treatment options for endometriosis?
Non-hormonal - analgesics e.g. paracetamol
Hormonal - GnRH analogues, which reduce FSH and LH from pituitary and consequently oestrogen. Reduces response of endometrial cells in and outside uterus
COC, POP
118
What are surgical treatment options for endometriosis?
Destruction of patches of endometrial tissue via diathermy (heat)
Laser therapy
Physical excision of visible area of endometriosis
However often recurs
Serious cases can consider hysterectomy
119
What is PCOS?
Increase number of follicles develop in ovaries, affecting balance of oestrogen and progesterone with ovaries making more testosterone than usual
120
What are the symptoms of PCOS?
Ovulation patterns and period cycles affected, therefore anovulatory and irregular periods
Hirsutism (thick dark hair)
Acne
Male-pattern baldness
Amenorrhoea
Raised levels of testosterone or LH in bloodstream
121
What factors are believed to be involved in PCOS?
Insulin - acts on ovaries to produce testosterone. Raised testosterone interferes with follicle development
LH - increases testosterone produced by ovaries
Hereditary factors and being overweight (leading to insulin resistance)
122
How can PCOS be treated?
Losing weight for overweight patients to reduce insulin levels
Metformin increases insulin sensitivity and therefore lowers testosterone levels
Eflornithine - cream to stop excess hair growth
123
What are symptoms that can suggest ovarian cancer?
Persistent abdominal distension (bloating)
Feeling full and/or loss of appetite
Pelvic or abdominal pain
Increased urinary urgency and/or frequency
124
What tests are carried out to diagnose ovarian cancer?
Blood test for CA125 (specific biomarker)
Ultrasound of lower abdomen and pelvis
If these indicate ovarian cancer CT scan performed to evaluate extent of disease
125
What are the surgical treatment options for ovarian cancer?
Early stage disease - remove affected ovary and fallopian tube
Later stage disease - total abdominal hysterectomy and bilateral salpingo-oophrectomy
126
What are the chemotherapeutic treatment options for ovarian cancer?
Carboplatin, can be used alone or in combination with paclitaxel depending on stage of disease
127
What is the most common symptom of endometrial cancer?
Abnormal vaginal bleeding
128
How can endometrial cancer be treated surgically?
Early stage - hysterectomy
| Later stage - total abdominal hysterectomy and bilateral salpingo-oophorectomy
129
How can endometrial cancer be treated with radiotherapy?
Course of radiotherapy recommended if there is a risk the cancer could return to the pelvis
May be used to slow spread of cancer when surgical cure not possible
130
What is the most common cause of cervical cancer?
HPV
| Two strains responsible for 70% cases, HPV 16 and HPV 18
131
What are the common symptoms of cervical cancer?
Often has no symptoms in early stages
Where symptoms are present - unusual vaginal bleeding, which can occur after sex, between periods or after menopause
Later symptoms - blood-stained vaginal discharge, pelvic pain, dyspareunia (pain during sex)
132
What is treatment for cervical cancer if diagnosed early?
Surgery
Radical trachelectomy - upper vagina including cervix removal
Radical hysterectomy - cervix, uterus, ovaries and fallopians removed, advanced stage 1 and 2
Pelvic exenteration - above plus bladder and rectum, only recommended if cancer has returned
133
When is radiotherapy used to treat cervical cancer?
Used on its own for stage 1. Combined with chemo for later stages
134
How can radiotherapy be delivered?
External - machine used to deliver pulses of radiation to pelvis
Internal - radioactive implant placed inside vagina
135
Which cytotoxic agent is usually used to treat cervical cancer?
Cisplatin
136
What are the common symptoms of gonorrhoea?
Pain on urination, white-coloured discharge
137
What can gonorrhoea cause?
PID
138
What are common symptoms of chlamydia?
Pain on urination, dyspareunia or watery discharge
139
Which bacterial colonises a normal vagina?
lactobacilli
| Convert glucose to lactic acid maintaining pH
140
What is PID?
A bacterial infection that can affect any of the structures of the female reproductive tract
141
What are the most frequent causes of PID?
Chlamydia and gonorrhoea
142
What is endometritis?
Inflammation and infection of the endometrium
143
What is salpingitis?
Inflammation and infection of fallopian tubes
Eggs become unable to move through normally, increasing risk of ectopic pregnancy
Women can become infertile as a result
144
What is parametritis?
Infection and inflammation of tissue around the uterus
145
What is oophoritis?
Inflammation and infection of the ovaries
146
What is an abscess?
Pocket of infected fluid - usually around ovary or fallopian tube
147
What is pelvic peritonitis?
Inflammation and infection of the peritoneum (lining inside of abdomen)
