Female Reproductive Physiology

Question 1

What is included in the female reproductive organs?

Answer 1

Uterus, ovary, fallopian tube, cervix and vagina

Question 2

Describe the surface of the ovaries

Answer 2

Connective tissue capsule covered with layer of simple cuboidal epithelium

Question 3

Describe the cortex of the ovaries

Answer 3

Peripheral part
Connective tissue containing ovarian follicles

Question 4

Describe the medulla of the ovaries

Answer 4

Central part
Connective tissue with blood vessels

Question 5

What is a ovarian follicle?

Answer 5

One oocyte surrounded by single layer of cells

Question 6

What are the functions of the ovaries?

Answer 6

Oocyte production
Steroid hormone production

Question 7

Describe oocyte production

Answer 7

One mature egg per menstrual cycle, 400 ovulated over entire reproductive lifespan
Majority of eggs perish during cycle
Finite number which declines with age

Question 8

Describe steroid production by the ovaries

Answer 8

Oestrogen develops female secondary sexual characters
Progesterone prepares endometrium for pregnancy
50% of testosterone produced by ovaries before menopause

Question 9

Describe oogenesis at birth

Answer 9

Primordial germ cell mitosis in foetal life
The primordial follicles are arrested in stage of first meiotic division at birth so no further development until sexual maturity

Question 10

Describe oogenesis at puberty

Answer 10

First meiotic division is complete and second division starts after puberty which leads to release of one secondary oocyte in menstrual cycle

Question 11

When is second meiotic division completed?

Answer 11

After fertilisation of oocyte with sperm

Question 12

What are primordial follicles?

Answer 12

Primary oocyte arrested in first meiotic division surrounded by one layer of squamous pre granulosa cells

Question 13

What is a primary follicle?

Answer 13

Oocyte surrounded by zona and cuboidal granulosa cells
Activated by puberty

Question 14

What is a secondary follicle?

Answer 14

Increased oocyte diameter and multiple layer of granulosa cells
Resumption of first meiotic division

Question 15

Wat is a tertiary/ Graffian follicle?

Answer 15

Follicular fluid between cells which coalesce to form antrum, completion of first meiotic division to form secondary oocyte and start second meiotic division

Question 16

What are the 2 phases of follicular development stages?

Answer 16

Preantral phase - oogonia to secondary follicle
Antral phase - tertiary to preovulatory follicle

Question 17

Describe a summary of oogenesis

Answer 17

Before birth - oogonium undergoes mitosis to primary oocyte
After puberty meiosis continues to secondary oocyte
Then ovulation and sperm entry causes meiosis to be completed and fertilisation

Question 18

What does the hypothalamus secrete in the hypothalamic-pituitary-ovarian axis?

Answer 18

GnRH

Question 19

What does the pituitary secrete in the hypothalamic-pituitary-ovarian axis?

Answer 19

FSH and LH

Question 20

What does the ovaries secrete in the hypothalamic-pituitary-ovarian axis?

Answer 20

Oestrogen and progesterone

Question 21

Where does oestrogen and progesterone work on?

Answer 21

Uterus

Question 22

When are negative feedbacks in the hypothalamic-pituitary-ovarian axis seen?

Answer 22

Can happen most of the cycle
When hormone levels are too high

Question 23

When are positive feedbacks in the hypothalamic-pituitary-ovarian axis seen?

Answer 23

Day 12-14
Cause the surge responsible for ovulation

Question 24

Describe GnRH and LH secretion and events in the ovary during the ovarian cycle

Answer 24

LH has a surge due to positive feedback loop from oestrogen - results in ovulation
Rise in the hormones leads from egg to developing follicle to ovulation then corpus luteum if not fertilised

Question 25

What is the result of increased oestrogen?

Answer 25

Surge in LH leading to ovulation

Question 26

What is the follicular stage of the ovarian cycle?

Answer 26

FSH causes follicle to mature and produce oestrogen which inhibits the development of other follicles

Question 27

What is the ovulation phase of the ovarian cycle?

Answer 27

LH surges causes ovulation so follicle ruptures and releases secondary oocyte

Question 28

What is the luteal phase of the ovarian cycle?

Answer 28

Ruptured follicle forms a corpus luteum and secretes progesterone

Question 29

What is the menstruation phase of the ovarian cycle?

Answer 29

From day 28 when corpus luteum degenerates and a new ovarian cycle can begin

Question 30

Describe the follicular stage of the menstrual cycle

Answer 30

LH and FSH increase - follicle matures - oestrogen and progesterone increase Spike in the LH and FSH as oestrogen is increased - ovulation

Question 31

What hormone is most important in the follicular stage of the menstrual cycle?

Answer 31

Oestrogen

Question 32

What hormone is most important in the luteal phase of the menstrual cycle?

Answer 32

Progesterone

Question 33

What is the role of progesterone in the menstrual cycle?

Answer 33

Changes in the blood vessels within the lining of the womb and adds thickness

Question 34

What happens when there is no fertilisation of the egg in the menstrual cycle?

Answer 34

Hormone levels drop which starts the bleeding and new menstrual cycle

Question 35

What are the types of amenorrhoea?

Answer 35

Primary - never had a period Secondary - had a period after going through puberty but stopped bleeding for 6 or more months

Question 36

What are causes of amenorrhoea?

Answer 36

Problem with regulating hormones Problem with ovarian function Problem with uterus or outflow tract

Question 37

What are causes of hypothalamic or pituitary cause - hypogonadotropic hypogonadism (low FSH, LH and high prolactin)?

Answer 37

Functional - weight loss/ gain, over exercising and stress Chronic - diabetes, sarcoidosis, TB and renal Intracranial space occupying lesion Infection or trauma Drugs - glucocorticoids, anabolic steroids and opiates Genetic - Kallmann's syndrome

Question 38

What are causes of hypergonadotropic hypogonadism - high or normal FSH or LH?

Answer 38

Genetic - Turner's, fragile X Ageing POI or POF Autoimmune diseases RT or chemo Infection - TB, mumps

Question 39

What are congenital causes for problems in the uterus?

Answer 39

Absent uterus or vagina (MRKH syndrome) Transverse vaginal septum or imperforate hymen-Mullerian duct fail Androgen insensitivity syndrome

Question 40

What are iatrogenic causes for problems in the uterus?

Answer 40

Uterine adhesions or synechiae RT - pelvic or cervical

Question 41

What are the managements for amenorrhoea?

Answer 41

Life style, optimise control of medical illness, stop drugs, prolactinoma - medical treatment, surgery, surgical division hysteroscopic and fertility treatment