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A&P 302 Reproductive System Lecture Notes:

The Reproductive System Function:

Preservation of the species

The Reproductive System Components:

Primary sex organs produce gametes and sex hormones
- Ovaries
- Testes
Accessory reproductive organs
Midline septum important for spermatic cord coming down, it could
cut off the blood supply if they weren't separated

The Reproductive System Male Anatomy:

Spermatic Cord
Duct System
Accessory glands

Male Anatomy Scrotum:

Sac of skin and superficial fascia

Sparse hair
More darkly pigmented
Contains a midline septum
Dartos muscle elevates the scrotum to regulate temperature
o 1 of the 3 mechanisms that regulates temperature regulation

Male Anatomy Testes:

Approximately 4 cm long and 2.5 cm in diameter

To left of pic is posterior other side is anterior

Gross Anatomy
Pathway for Sperm
Blood Supply
Nervous Innervation

Testes Gross Anatomy:

Covered by two tunics
- Tunica vaginalis - outer layer derived from the peritoneum
- Tunica albuginea fibrous layer that divides the testis into 250 300 lobules

Seminiferous tubules sperm factories, 1 4 per lobule

- tubules is where sperm is first formed (a precursor to sperm)

Interstitial cells surround the seminiferous tubules and

produce testosterone

interstitial cells produce testosterone

Testes Pathway for Sperm:

Sperm produced in the seminiferous tubules is conveyed through the tubulus rectus to
the rete testis on the posterior side of the testis
From the rete testis sperm travels through the efferent ductules to enter the epididymis
- Epididymis is outside testis itself
- Epididymis is soft, testis are hard

Know pathway of sperm from when it starts to be formed to

when it is ejected!

The seminiferous tubules tubules rectus to the rete testis effecnt

ductules epididymis

Testes Blood Supply:

Testicular arteries branch from the aorta

Testicular veins arise from a vinelike network call the pampiniform plexus
Plexus absorbs heat from the artery before the blood reaches the testis
Testicular artery = blood supply it branches off the aorta
Females have ovarian artery that also comes off the aorta ovaries
has better blood supply than testis
Plexus just serious of veins that takes blood back up

2nd way to regulate temp the plexus acts as a heat sink (blood
entering from testis is cool, as it travels up the body and comes in
cotact the testicular artery its taking the heat out of that artery)

Testes Nervous Innervation:

Both branches of the autonomic nervous system

Sensory nerves
Nerves travel with blood vessels and lymphatics in the spermatic cord

Male Anatomy The Spermatic Cord:

Cremaster muscle elevates the testis for temperature regulation

3rd way to regulate temp does it by the other muscle does. Draws it
up if its cold, drops if warm

Male Anatomy Penis:

External Anatomy
Internal Anatomy

Penis External Anatomy:

Shaft or body
Glans penis enlargement at the end
Prepuce of foreskin around the glans

Penis Internal Anatomy:

Spongy urethra
Corpus spongiosum surrounds the urethra
Corpora cavernosa paired erectile bodies bounded by the fibrous albuginea and forms
the crura of the penis proximally
Spongy urethra it is also known as the penile urethra (it takes
through corpus spongiosum) corpus = body
Corpora cavernous the erectile bodies, two of those on either side
Notice the central artery in top picture erection is the copora filling
up with blood basically

Male Anatomy Male Duct System:

Ductus Deferens
Ejaculatory Duct

Male Duct System Epididymis:

Comma-shaped about 3.8 cm long
Head joins the efferent ductules and caps the superior aspect of the testis
Body and tail are on the posterior aspect of the testis
Duct of the epididymis is about 20 feet long
Sperm entering the duct are nonmotile and gain mobility in the duct in
about 20 days
o About 20 feet long and about 20 days, will be on test!!?
o Epididymis is 20 feet long and sperm entering the epididymis is
NOT motile, takes 20 days to come active
o During ejaculation sperm travels from Epididymis ductis (vas)

During ejaculation sperm is transferred to the ductus deferens

Q about Epidiymis will be one TEST!

o Septum is important so spermatic cord doesnt twist around

o Torsion can happen where testis moves. Problem: IF the testicle
turns the spermatic cord also twists and cuts off the blood
supply, ORGAN THREATENING (the testicle will die if not
corrected) can Dx torsion; palpate for epididymis anterior
instead of posterior, but it will be so tender they wont be able to
even tolerate that

Male Duct System Ductus Deferens:

Also known as the vas deferens is about 18 inches long

Runs upward as part of the spermatic cord into the pelvis
Expands at the end to form the ampulla
Vas defers is just one component of the spermatic cord, not all of it
Ampulla like fallopian tube

Male Duct System Ejaculatory Duct:

Ampulla of the epididymis joins the duct of the seminal vesicle to form the
ejaculatory duct MOST MISSED Q ON TEST!

Duct enters the prostate gland and empties into the urethra know!?
o Vasectomy incision in scrotum pull out spermatic cord locate
ductis deferens, you do this by feel. The testicular artery will be
very compressible, while vas deferens will be life half-cooked

Male Duct System Urethra:

Terminal portion of the duct system with three regions
- Prostatic urethra
- Membranous urethra (in the urogenital diaphragm)
- Spongy (penile) urethra

Male Anatomy Accessory Glands:

Seminal Vesicles
Prostate Gland
Bulbourethral Gland
Sperm being released is released as semen provided by top 2

Know how much each of the top two contributes to

the semen for test?!

Another term for semen is ejaculate!! Only difference, semen implies

you could get it without it being ejaculated out

Accessory Glands Seminal Vesicles:

On the posterior bladder wall

About the shape and length of a finger

Produces a secretion that accounts for about 60% of the semen

- Viscous alkaline fluid Know for test!

Accessory Glands Prostate Gland:

Size of a chestnut
Encircles the urethra
Just inferior to the bladder
Enclosed in a thick connective tissue capsule
Made up of 20 30 compound tubular-alveolar glands embedded in smooth muscle and
connective tissue DONT have to know!!
Produces a milky, slightly acidic fluid

Prostate secretions help activate sperm

Accounts for about a third of the semen volume KNOW for TEST!

Joins the prostatic urethra via several ducts

Prostatic smooth muscle contracts during ejaculation
o Smooth muscle is what squeezes the fluid out

KNOW for Exam??

If those sperm are motile too early it will use up all the energy it has, so it activates the sperm at
this time
Prostatitis inflammation of prostate
- elevated, but once treated the BPA drops back down
- To make dx the prostate gets boggy and is tender to palpation instead of firm
- You massage the prostate, get second urinalysis, if WBCs are in the urinalysis then it is
- Usually treats with antibiotics
Prostatic cancer
-BPA is VERY high
-Significant thing is the prostate is hard like a rock
BPH slight enlargement with out cancer
-Slight elevated in BPA
-See on of two things. May or may not enlarge and engorge the urethra, if it does it will make
them get up multiple times to go to backroom at night, weak stream, problems stopping the
-prostate will feel normal, just bigger!
-Meds and TERP can be used to fix it
BPA blood test. It is elevated in ALL 3 conditions

Accessory Glands Bulbourethral Gland:

Also called Cowpers gland

Pea-sized inferior to the prostate
Produces a thick mucus that drains into the spongy urethra
Doesnt make a contribute to semen, it s mucus that is basically a

The Reproductive System Male Sexual Response:


Male Sexual Response Erection:

When not sexually aroused arterioles to the erectile tissue are constricted, limiting the
blood flow

During sexual excitement, smooth muscles of the arterioles relaxes and allow erectile
tissue to fill with blood
Controlled by the parasympathetic system

Initiating event
- Touching genital skin
- Mechanical stimulation of the penis
- Erotic sights, sounds, or smells

Male Sexual Response Ejaculation:

Under sympathetic control

o Ejaculation is sympathetic, erection is parasympathetic
At a certain critical level a spinal reflex is initiated

Largely at the level of L1 and L2

1 - reproductive ducts and glands empty their content
2 - bladder sphincter muscle contracts
o 2 why do you want sphincter to contract? So no sperm goes up
into the bladder
3 - bulbospongiosus muscles of the penis undergo a rapid series of contractions

The Reproductive System Semen:

Sperm and accessory gland secretions

Transport medium contains nutrients and chemicals that protect and activate sperm cells

Semen Contents:

Fructose from the seminal vesicles

Prostaglandins that alter cervical mucus and initiates reverse peristalsis in

the uterus
Seminalplasmin an antibiotic chemical and comes from the seminal

If you consider the opening of the cervix, the fallopian tube is not
attached to the ovary it is sitting open.
Dont see lots of ab infections because cervix is plugged with mucus
Reverse peristalsis moves the sperm up into the fallopian tubes
Clotting factor causes fibrinolysis that allow sperm to swim out of the ejaculate

The Reproductive System Sperm:

Head contains DNA

Acrosome - tip of the sperm that carries hydrolytic enzymes to penetrate the egg
Midpiece has contractile elements
Tail - flagellum

The Reproductive System Spermatogenesis:

Mitosis of Spermatogonia
Meiosis of Spermatocytes
Role of Sustentacular Cells

Spermatogenesis Mitosis of Spermatogonia:

Mitosis produces two types of cell

- Type A daughter cell remains a germ cell

- Type B daughter cell becomes a spermatocyte

Spermatogenesis Meiosis of Spermatocytes:

Each primary spermatocyte divides and forms secondary spermatocytes

Secondary spermatocytes divide and become spermatids

Spermatogenesis Spermiogenesis:
Spermatids are nonmotile
During spermiogenesis, spermatids loose cytoplasm and form a tail
Spermatogenesis Role of Sustentacular Cells:

Supporting cells
Have tight junctions that form a blood-testis barrier that prevents antibodies from
attacking sperm (sperm is not recognized as self)
o Prevents sperm from being attacked by antibodies

The Reproductive System Male Hormones:

Control is by the brain- testicular axis

Male Hormone The Brain-Testicular Axis:

Hypothalamus releases gonadotropin-releasing hormone (GnRH)

The anterior pituitary releases follicle stimulating hormone (FSH) and luteinizing
hormone (LH)

FSH stimulates spermatogenesis by prompting sustentacular cells to

release androgen-binding protein (ABP)

ABP causes spermatogenic cells to bind to testosterone and stimulates spermatogenesis

LH binds to interstitial cells stimulating them to secrete testosterone
LH is also known as interstitial cell-stimulating hormone (ICHS)
o LH causes testicles to produce testosterone
o Remember interstitial cells produce testosterone
Testosterone inhibits the release of GnRH
High sperm counts cause sustentacular cells to release inhibin which inhibits both GnRH
and FSH
o Negative feedback loop testosterone inhibiting GnRH
o If you are inhibiting GnRH you are directly inhibiting LH as well,
keep that in mind

KNOW hormones for test?

Many hormones are produced in the hypothalamus

Most are made in pituitary and released from pituitary
Male FSH production of sperm
LH for production of testosterone
Same thing applies for women they make the same FSH & LH

The Reproductive System Female Anatomy:

Duct System
External Genitalia or Vulva
Mammary Gland

Female Anatomy Ovaries:

General Description
Blood Supply

Ovaries General Description:

About twice the size of an almond and shaped like and almond
Contained in the peritoneal cavity NOT RETEROPERITONEAL
The fallopian tube (which is ultimately is in contact with the exterior)
opens up over the ovary, which is why you need mucus plug

Outer cortex for gamete formation

Inner medullary region contains blood vessels
Ovaries have very rick blood supply
You have to take a lot of chemicals into the ovary, they will then
produce hormones, hormones are then released from the ovary
ALL endocrine glands release there product into the blood vessel (like
the ovaries)

Ovaries Blood Supply:

Ovarian arteries branch from the abdominal aorta

Ovarian branch of the uterine artery
In addition to the ovarian artery, you also have the uterine artery that
comes off the (internal) iliac artery NOT the aorta like the testicular
artery and ovarian arteries

Ovaries Capsules:

Tunica albuginea fibrous covering in turn covered by the germinal epithelium

Like the testicle
What's important about this covering is that during ovulation the ova
exits the ovary by going through that capsule

Ovaries Follicles:

Tiny sac like structures in the cortex

Contains oocytes immature eggs
Starting with a structure that is solid and ends with a structure that has
a sac of fluid around it

Surrounding cells are follicle cells if there is only one layer

If more than one layer is present they are granulosa cells
These cells dont just act as covering for the ova, they are the ones
that also produce the hormones

Mature vesicular follicles or Graafian follicles bulges at the surface of the ovary
Ovulation the release of the mature oocyte
Ruptured follicle becomes a corpus luteum
Follicle produces estrogen while the ruptured follicle (corpus luteum)
produces progesterone

Female Anatomy Duct System:

Fallopian Tubes and Oviducts


Duct System Fallopian Tubes and Oviducts:

Receive the ovulated ovum

Site of fertilization
Isthmus constricted region at the insertion of the uterus
Fallopian tube is not attached to the ovary
Fallopian tube is where fertilization takes place
Ampulla enlargement of the distal fallopian tube
Infundibulum funnel-shaped opening with ciliated finger-like projections known as
o Fimbriae are like fingers that pull up the egg
o The ampulla - that is really where fertilization takes place in the
fallopian tube
o Takes about 24 hours for fertilized cell to start dividing
The fallopian tube is not connected to the ovary
Ova move through the tube by beating of cilia and muscular peristalsis
Ova moves through via peristalsis and cilia also help move it along
What puts women at rick for ectopic pregnancy? Scarring in fallopian
tubes like with PID

IUD caused inflammation inhibiting implantation! Doesnt prevent

fertilization. Causing higher incidence of ectopic pregnancy d/t
inflammation all the way up to the fallopian tube. If it is one the right
can be confused with appendicitis but with no fever and no high WBC

Duct System Vagina:

8 10 cm
Lies between the bladder and rectum
The urethra is embedded in its anterior wall
Female organ of copulation

3 coats
- Adventitia fibroelastic outer layer connective tissue on the outside
- Muscularis smooth muscle
- Mucosa has transverse ridges or rugae that stimulate the penis
Mucosa is stratified squamous epithelium
Dendritic cells act as antigen presenting cells (provide route for HIV transmission)

No gland cells mucus comes from cervical glands

Specialized connection in the mucosa. It is an area of high mechanical

wear so it has desmosomes
Dendritic cell is a macrophage (phagocytic) but they allow for HIV
Why is bottom one important? D/t pregnancy, knowing there are
glands in the cervix. How do you know if there water broke? You get
sample of fluid in the vagina, let it dry, then it crystalized (ferning)
amniotic fluid if it ferns. With urine you dont see any ferning
But Mucus coming from the cervix will also fern, so have to be carful
not to pick up cervical mucus.

Vaginal orifice is covered by a hymen with variable durability

Fornix vaginal canal that surrounds the cervix of the uterus
o Fornix allows for pooling of sperm, makes it easier to get

Vaginal secretions
- Acidic in adults helps prevent infections
- Alkaline in adolescents predisposes teenagers to STDs
Female Anatomy Uterus:

General Description

Uterine Wall
Blood Supply

Uterus General Description:

Hollow thick walled muscular organ

Anterior to the rectum
Posterosuperior to the bladder
About the size of a pear
Strongest muscle in the body

Body major portion of the uterus

Fundus rounded superior region uterine cancer is usually in the fundus
Cervix narrow outlet which projects into the vaginal cavity

Normally anteverted inclined forward

Retroverted inclined backwards, seen frequently in older women
Anteflexed - fundus is tilted anteriorly compared to the cervix
Retroflexed fundus is tilted posteriorly compared to the cervix
Version based on whole uterus itself
Should be anteverted and anteflexed

Uterus Supports:

Round ligament goes through the inguinal canal and anchors the uterus to the labia

It is the equivalent to the spermatic cord attaches from the

labia to the uterus

Uterus Uterine Wall:

Perimetrium outermost serous layer

Myometrium - bulky muscular region
Endometrium mucosal lining

Uterus Endometrium:

Stratum functionalis or functional layer undergoes cyclic changes - Stratum

functionalis is what undergoes changes during the menstrual cycle it
sloughs off
Stratum basalis or basal layer forms a new functionalis layer at the end of menstruation

Uterus Blood Supply:

Uterine arteries branch from the internal iliacs

Arcuates branch from the uterine artery to the myometrium
Radial branch comes off the arcuates to the endometrium
Radial branches give off:

- Straight arteries to the stratum basalis

- Spiral (coiled) arteries to the stratum functionalis

Female Anatomy External Genitalia or Vulva:

Perineum diamond-shaped region between the pubic arch,

ischial tuberosities, and the coccyx KNOW FOR TEST

Mons pubis fatty, rounded area overlying the pubis symphysis

Two hair-covered fatty skin folds

- Labia majora (counterpart to the scrotum)
- Labia minora (counterpart to the ventral penis)

Vestibule recess enclosed by the labia minora everything inside

the labia minora: WILL BE ON TEST

Greater vestibular glands or Bartholins glands flank the vaginal opening

- Homologous to the bulbourethral gland

Clitoris largely erectile tissue homologous to the penis

Prepuce of the clitoris skin fold covering the clitoris formed by the junction of the
labia minora folds

Female Anatomy Mammary Glands:

Modified sweat glands are really part of the integumentary system
Areola pigmented skin that surrounds the nipple
- Large sebaceous glands make it bumpy and secrete sebum
Autonomic nervous system controls the smooth muscle of the areola that cause the nipple
to become erect when presented tactile or sexual stimuli or exposure to cold
15 25 lobes that radiate around and open at the nipple
Suspensory ligaments interlobar connective tissue that attaches the breast to the
underlying muscle fascia and overlying dermis
Sebaceous glands secrete sebum purpose is during breastfeeding the
babies saliva can cause cracking. Let nipple air-dry

Lobules - smaller units in the lobes that contain alveoli that produce milk

Lactiferous ducts collect milk produced by the alveoli

Lactiferous sinus dilated region of the lactiferous duct where milk accumulates
o Suckling reflex anytime baby suckles the brain sends prolactin
(stimulates milk production)

The Reproductive System Female Physiology:

Ovarian Cycle
Hormonal Regulation
Menstrual Cycle
Extra Uterine Effects of Hormones

Female Physiology Oogenesis:

Takes years to complete

As oogonia are transformed into primary oocytes, primordial follicles appear

Primary oocytes begin the first meiotic division but are stalled in
prophase I
At puberty select oocytes continue meiosis I producing a large
secondary oocyte and a first polar body
o Meiosis stops twice.
o First part is stalled out in Prophase I. Second is at
meiosis I.
o Only have one ovum eventually and 3 polar bodies
(gives you 4 after two divisions) All of the contents of
the cell is put into one ovum and it will start dividing on
its own.
o Remember prophase I and know it restarts at puberty!
The first polar body undergoes meiosis II and produces two smaller polar bodies END
RESULT IS 3 polar bodies total!

The secondary oocyte undergoes meiosis II but is arrested in

metaphase II
o Prophase one starts again at puberty, arrested at metaphase II
Oocytes are ovulated in metaphase II and only finish meiosis II if penetrated by a
Meiosis II yields one large ovum and a small secondary polar body
Process to finish is fertilization
Big thing to remember is that you are producing very big ovum.
Multiple sperm do get to the ovum, to be fertilized only one has to

Female Physiology Ovarian Cycle:

Follicular Phase
Luteal Phase
Ovarian cycle production of ovum and the production of appropriate
The hormones (estrogen and progesterone) affect the uterus, and is
responsible for the changes in the uterus

Ovarian Cycle Follicular Cycle:

Squamous like cells surrounding the primary oocyte grow becoming cuboidal cells
The oocyte enlarges becoming a primary follicle

o 1 layer of cells follicle cells

o More than 1 layer granulosa cells

Follicular cells proliferate forming a stratified epithelium (granulosa cells)

Connective tissue condenses around the follicle forming a theca folliculi
Granulosa and thecal cells produce estrogen (some is produced by
adipose tissue as well)
Granulosa cells secrete a thick transparent membrane called the zona pellucida around
the oocyte
When the follicle reaches full size (one inch) it becomes a vesicular follicle and bulges
at the external ovarian surface
Occurs at about 14 days
Normally in a period, you just see one follicle becomes mature

Fluid in mature follicle builds up pressure causing it to be pushing out

of the ovary

Ovarian Cycle Ovulation:

There are always several follicles at different stages of maturation however one is
Dominance is probably due to FSH sensitivity
The ballooning ovary wall ruptures and expels the secondary oocyte

Mittelschmerz intense pain caused by stretching of the ovarian wall

during ovulation
Thick connective tissue over the ovary is tunica albugina it has to be
broken called Mittelschmerz

FSH sensitivity is the hormone that causes the production of gametes (same FSH that
causes the production of sperm)

Ovarian Cycle Luteal Phase:

The ruptured follicle collapses and fills with blood corpus hemorrhagicum is
eventually absorbed

Granulosa cells enlarge and become a corpus luteum

o when it was a follicle the cells were producing estrogen now that
is has ruptured and turned into corpus luteum it will start to
produce progesterone (and some estrogen)

Corpus luteum secretes progesterone and some estrogen

If pregnancy does not occur the corpus luteum degenerates and forms
a scar called the corpus albicans
In the uterus the lining of the uterus is growing in preparation for
acceptance of fertilized ovum under estrogen. Progesterone think
about it as stabilizing the endometrium, why does menses happen?
When progesterone drops off

If an egg implants in the endometrium, you will see a much bigger

change than if it doesnt when the corpus albicans is made is stops
producing hormones
During pregnancy something is being produced d/t fertilized ovum and
the endometrium that prevent the degeneration of the corpus luteum
so it will continue to produce progesterone. PROGESTERONE has to be
present to continue the pregnancy!!
Eventually the contents of the uterus will start to make its own

Female Physiology Hormonal Regulation:

Establishing the Cycle

Hormonal Interactions

Hormonal Regulation Establishing a Cycle:

During childhood ovaries grow and produce estrogen which

inhibits the release of GnRH
At puberty the hypothalamus becomes less sensitive to estrogen;
WILL be on test!!

GnRH produced by hypothalamus

By inhibiting GnRH we are NOT going to have the produce of FSH or LH
You have to have both FSH and LF to have a cycle
What changes? The hypothalamus becomes less sensitive, causing
GnRH to be produced and therefore also FSH and LH

GnRH is released in a rhythmic pulse like manner

The anterior pituitary releases FSH and LH

Gonadotropin levels increase for 4 years without ovulation (but it isnt a

sure bet)

Menarche the first menstrual period

It takes about 3 years for the cycles to become regular and all are ovulatory
ON TEST! First cycles may not produce ova
No ovum is produced during the cycle = Anovulatory cycle
What is significance of mature follicle rupturing causes progesterone production
Change from estrogen to progesterone is what fuels the cycle if there isnt that switch
over there can be some irregularity

Hormonal Regulation Hormonal Interactions:

28 day cycle
There is always some estrogen, at some point there will be virtually no
Waxing and waning of FSH and LH
Positive and negative feedback loops
Day 1 rising levels of GnRH stimulate production of FSH and LH
FSH and LH stimulate follicle growth and maturation and estrogen secretions
o Day 1 of menstrual cycle is when menses begins
o Why levels of GnRH? Because prior to this when we had elevated
estrogen levels we were inhibiting GnRH (and therefore FSH and
LH), once the estrogen levels start to drop off you loose the
inhibiting stuff
FSH affects the follicle
LH affects the thecal cells and granulosa cells to cause them to produce androgens
FSH is important in determining which follicle matures as said
Rising levels of estrogen inhibit production of FSH and LH
Estrogen increases the output of estrogen by intensifying the effect of FSH on the follicle
Inhibin released by the granulosa cells exerts negative feed back on FSH release
Initially a small rise in estrogen inhibits the hypothalamic-pituitary axis

When estrogen reaches a critical level it exerts a positive

feedback loop

o As estrogen goes up GnRH drops = decreased LH and FSH

o GnRH being produced (and therefore LH and FSH)= negative
feedback loop
High estrogen levels cause a burst of LH
The LH surge causes the dominant follicle to complete the first meiotic division and form
a secondary oocyte around day 14
o The LH burst or surge is a signal for ovulation!! About day 14 of
the cycle (midway)

Blood stops flowing to the protruding part of the follicle wall and within 5 minutes the
follicle wall bulges, thins out, and ruptures

Estrogen levels decline due to damage to the follicle

o Drop in blood flow around follicle and then 5 minutes after that
ovulation will take place
o Why does estrogen drop off? D/t damage to the follicle or you
can say progesterone will start being produced d/t the damage
and estrogen stops being produced
The LH surge causes the formation of the corpus luteum that produces progesterone
Rising progesterone and estrogen levels have an inhibitory effect on the release of LH
and FSH
As LH falls, the corpus luteum degenerates and levels of serum ovarian hormones drop
Declining ovarian hormones ends the blockade of LH and FSH about day 26 28
If implantation doesnt take place then the luteum degenerates
Drop in both estrogen and progesterone is what causes menses

Female Physiology Menstrual Cycle:

Series of cyclic changes made by the endometrium in response to ovarian hormones

Purpose of menstrual cycle is to prepare uterus for implantation
Day 1 of menstrual cycle is when flow begins
There is no direct connection with the blood with the fetus and mother.

Menstrual phase
Proliferative (Preovulatory) Phase
Secretory (Postovulatory) Phase
Secretory phase where you are accepting the fertilized ovum for
First phase of pregnancy the fertilized ovum has to be implanted in the

Menstrual Cycle Menstrual Phase:

Days 1 5 menstruation takes place

Uterus sheds all but the deepest part (functional layer) of the endometrium
3 5 days of bleeding

Menstrual Cycle Proliferative Phase:

Days 6 - 14
Endometrium rebuilds itself under the influence of estrogen
Glands enlarge, spiral arteries increase in number
How much endometrium is produced is based on the amount of
A lot of estrogen = a lot of endometrium
2 extremely important points
1- for the endometrium to stay in place you HAVE to have estrogen.
2-The endometrium can only get so big and then it cannot maintain
If you have too much estrogen you can start slughing off some of the
endometrium important in birth control pills, if you keep LH levels
down they wont spike = no ovulation
Birth control pill with too much estrogen then what you see is middle of
cycle is some spotting (top layer of endometrium being sloughed off)
Endometrium becomes thick and well vascularized
Estrogen induces synthesis of progesterone receptors
Cervical mucus becomes thin and crystalline
Ovulation takes place at the end of the proliferative phase because of a surge in LH

This takes place about day 14

Occurs about the same time as follicular phase
Secretory phase- under influence of estrogen
Proliferative phase progesterone
At ovulation the follicle is called the corpus luteum (produces

Menstrual Phase Secretory Phase:

Days 15 28

Most constant time wise WILL BE ON TEST

o The embryo is buried deep within the endometrium

Endometrium is preparing for implantation of an embryo
Progesterone converts the functional layer into a secretory mucosa
Mucus becomes viscous again forming a mucus plug
o Mucus plug in cervix, around ovulation it becomes more thin and
watery (more susceptive to sperm entering), then the plug gets
thick again
If fertilization does not occur, the corpus luteum degenerates and progesterone levels fall
Dropping progesterone levels cause the spiral arteries to kink and spasm
o Progesterone level is necessary to maintain endometrium in
o In pregnancy the LH hormone is still going to drop, its products of
conceptive that cause the corpus luteum to stabilize and keep
producing progesterone then at some point the ovaries will stop
producing progesterone for the time being
Low oxygen and nutrients cause the functional layer to self digest

Spiral arteries constrict one last time and suddenly relax

Blood gushes into weakened capillaries causing rupture and sloughing of the

Female Physiology Extrauterine Effects of Estrogen:

Growth of breasts
Deposit of subcutaneous fat in the hips and breasts
Widening and lightening of the pelvis
Growth of axillary and pubic hair
Metabolic effects:

- Lowers cholesterol but raises HDL

- Facilitates calcium deposits in bone
These are the biggies!! HDL (good cholesterol):

-used to say estrogen was cardioprotective, but not now. But then that means testosterone is
detrimental to the arteries (it raises their cholesterol)
-And calcium deposits in bone:
In menopause usually starts in 50s
Once you have a hysterectomy you cant judge when they will go through menopause
Besides irregularity periods, what are the other big symptom that is had to tolerate? Hot flashes!!
After menopause whats the big concern? Osteoporosis!! If a woman fractures a hip their life
expectancy is about 6 months
Clinical pearl:
Woman with fractured leg will look shorter and is rotated outward, thats how you need an x-ray
for an older persons possible hip fracture
ERT: (estrogen replacement therapy)
Aimed at 1) stopping hot flashes and 2) preventing osteoporosis
First just gave estrogen (without progesterone) and that is called giving estrogen unopposed but
there is a problem, unopposed estrogen is a MAJOR risk factor for uterine cancer
-Then they decided to give progesterone with the estrogen (estrogen first 3 weeks, progesterone
one 1) but that gave them periods again
-Now if you give estrogen and progesterone at the same time you dont have cycles or uterine
-Estrogen takes care of hot flashes, estrogen WILL PREVENT osteoporosis, if they develop
osteoporosis and they are NOT on osteoporosis putting them on estrogen will NOT reverse
the osteoporosis
-But with the ADDITION of progesterone WITH estrogen WILL reverse osteoporosis
If a woman has a hysterectomy you generally dont put them on estrogen replacement, and if you
do theres no compelling reason to also put them on progesterone, just put them on low-dose
Lasts 40 weeks - 10 months
-look for the uterus will stay in pelvis to about week 12 after that you can feel it popping out of
the pelvis
-at week 20 it is at the level of the umbilicus
-then by 40 weeks it almost up to the xiphoid process
-once it hits the umbilicus at 20 weeks it will be about 20 cm - so each week the uterus grows
about 1 cm
-up until about 24-28 weeks you see them once a month, then see then every 2 weeks until 36
weeks, from 36 on you see them every week and you measure the uterus every time!! An
indication of how the baby is growing!! If it is high or low then you do the ultrasound
-If not where you should be, it is usually do to amniotic fluid (too low, not enough fluid, etc.). It
being too high can ALSO be d/t twins
-At 36 weeks you used to say you could go ahead and deliver, now you need to go the full 40
-prior to going into labor, the cervix is thick and closed
-during labor 1) the cervix has to thin out (effacement) and 2) the cervix has to dilate

-It is extremely important to not push until 10 cm!! But if the cervix isnt 100% effaced, the
cervix will swell and the baby will not come out
-Shoulder dyostia when the shoulders get stuck in the pelvis during delivery. Once you get the
head out you have to get the rest of the body out, there isnt time for a C-section
-cervix is completely dilated, when head is visible = crowning which helps thin out perineum
-babies head comes out nose/face down, then you turn so that the shoulders go from anterior to
posterior, you then deliver the top shoulder by taking the head and pulling down until the front
shoulder pops, once the top shoulder comes out the rest is easy
-you clamp the cord, but it is filled with the babies blood and the placenta has a lot of it so you
cant clamp it too quickly the baby will be anemic. If you wait too long, the baby will be very red
d/t high RBC
-The placenta should come of spontaneously so it will just pop out
-after delivery the uterus has to contract very hard and stay contracted usual cause of prolonged
bleeding is all of the placenta did NOT come out (retained placenta) and you have to go get the
rest taken out
-After delivery you have to make sure the uterus and cervix is back to normal usually takes 6
weeks for everything to go back to normal