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Fe male reproductive system

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  • 1. Female Reproductive System - Dr. Chintan
  • 2. OVARIAN HORMONES • Estrogens – estradiol. • Progestins - progesterone. • The estrogens mainly promote proliferation and growth of specific cells in the body that are responsible for the development of most secondary sexual characteristics of the female. • The progestins function mainly to prepare the uterus for pregnancy and the breasts for lactation.
  • 3. ESTROGENS • In the normal nonpregnant female, estrogens are secreted in significant quantities only by the ovaries, although minute amounts are also secreted by the adrenal cortices. • During pregnancy, tremendous quantities of estrogens are also secreted by the placenta. • b-estradiol, estrone and estriol • Small amounts of estrone – most formed in the peripheral tissues from androgens and by ovarian thecal cells. • Estriol - weak estrogen - oxidative product - liver. • The estrogenic potency of b-estradiol is 12 times that of estrone and 80 times that of estriol.
  • 4. PROGESTINS • Progesterone & 17- α – hydroxyprogesterone • In the normal nonpregnant female, progesterone is secreted in significant amounts only during the latter half of each ovarian cycle, when it is secreted by the corpus luteum. • large amounts of progesterone are also secreted by the placenta during pregnancy, especially after the fourth month of gestation. • Steroids – cholesterol • Synthesis - progesterone and the testosterone - during the follicular phase of the ovarian cycle - almost all the testosterone and much of the progesterone are converted into estrogens by the granulosa cells. • During the luteal phase - large secretion of progesterone • 1/5th testosterone
  • 5. METABOLISM • Transported in the blood bound mainly with plasma albumin and with specific estrogen and progesterone binding globulins. • Liver conjugates the estrogens to form glucuronides and sulfates and about 1/5th of these conjugated products is excreted in the bile; most of the remainder is excreted in the urine. • liver converts the potent estrogens - estradiol and estrone impotent estriol. • Therefore, diminished liver function increases the activity of estrogens in the body, sometimes causing hyperestrinism. • Progesterone – pregnanediol - urine
  • 6. ESTROGENS FUNCTIONS • Cellular proliferation and growth of the tissues of the sex organs and other tissues related to reproduction. • Puberty - The ovaries, fallopian tubes, uterus, and vagina all increase several times in size. • The external genitalia enlarge, with deposition of fat in the mons pubis and labia majora and enlargement of the labia minora. • estrogens change the vaginal epithelium from a cuboidal into a stratified type, which is considerably more resistant to trauma and infection • Vaginal infection in children
  • 7. FUNCTIONS • Uterus: size + marked proliferation of the endometrial stroma and greatly increased development of the endometrial glands, which will later aid in providing nutrition to the implanted ovum - the muscle becomes more active and excitable - The "estrogen dominated" uterus is also more sensitive to oxytocin. • Fallopian tube: glandular tissues proliferate - number of ciliated epithelial cells increase - activity of the cilia enhanced - cilia always beat toward the uterus, which helps propel the fertilized ovum in that direction. • Breasts: development of the stromal tissues of the breasts growth of an extensive ductile system - deposition of fat in the breasts - pigmentation of the areolas. • lobules and alveoli - progesterone and prolactin
  • 8. FUNCTIONS • Skeleton: Estrogens inhibit osteoclastic activity in the bones and therefore stimulate bone growth - uniting of the epiphyses with the shafts of the long bones – much stronger effect – growth stops earlier – female eunuch taller • Osteoporosis in Old Age – after menopause – no estrogen - increased osteoclastic activity in the bones decreased bone matrix - decreased deposition of bone calcium and phosphate. • Weak bones – vertebra # - prophylactic estrogen • Protein deposition – less potent than testosterone
  • 9. FUNCTIONS • BMR & Fat deposition - ↑ BMR but only 1/3rd - deposition of increased quantities of fat in the subcutaneous tissues – breasts - buttocks and thighs - body fat % greater. • Hair distribution – pubic & axillary – more role of adrenal androgens • Skin – soft & smooth but thick – more vascular - ↑ warmth – greater bleeding - to make sebaceous gland secretions more fluid and inhibit formation of comedones ("blackheads") and acne. • Electrolyte balance – Na & water retention – body fluid retention during pregnancy
  • 10. FUNCTIONS • Estrogens have a significant plasma cholesterol - lowering action and they rapidly produce vasodilation by increasing the local production of NO. • These actions inhibit atherogenesis and contribute to the low incidence of myocardial infarction and other complications of atherosclerotic vascular disease in premenopausal women. • estrogen treatment in postmenopausal women - Large doses of orally active estrogens promote thrombosis - they reach the liver in high concentrations in the portal blood and alter hepatic production of clotting factors - CA Breast, CA Uterus • "tailor-made" estrogens that have the bone and cardiovascular effects of estradiol but lack its growth-stimulating effects on the uterus and breast - tamoxifen and raloxifene • MOA – nuclear receptor
  • 11. PROGESTERONE FUNCTIONS • Uterus – promote secretory changes in the uterine endometrium during the latter half of the monthly female sexual cycle, thus preparing the uterus for implantation of the fertilized ovum. • decreases the frequency and intensity of uterine contractions - to prevent expulsion of the implanted ovum - mifepristone + PGs for abortion • Fallopian Tubes - increased secretion by the mucosal lining - nutrition of the fertilized, dividing ovum before implantation
  • 12. FUNCTIONS • Breasts - development of the lobules and alveoli - alveolar cells to proliferate, enlarge, and become secretory in nature – milk only after prolactin • Thermogenic • Relaxin - corpus luteum, uterus, placenta, and mammary glands - During pregnancy, it relaxes the pubic symphysis and other pelvic joints and softens and dilates the uterine cervix. It also inhibits uterine contractions. • In nonpregnant women, relaxin is found in the corpus luteum and the endometrium during the secretory phase of the menstrual cycle. Its function in nonpregnant women is unknown.
  • 13. FEMALE FERTILITY • Fertile Period - The ovum remains viable and capable of being fertilized after it is expelled - not longer than 24 hours sperm must be available soon after ovulation if fertilization is to take place. • A few sperm can remain fertile in the female reproductive tract for up to 5 days - for fertilization to take place, intercourse must occur sometime between 4 and 5 days before ovulation up to a few hours after ovulation - about 4 to 5 days. • Rhythm (calendar, safe period, natural) Method of Contraception - to avoid intercourse near the time of ovulation - difficulty is predicting the exact time of ovulation - avoidance of intercourse for 4 days before the calculated day of ovulation and 3 days afterward – only if regular • 21, 28, 40 day cycle; shortest – 18 and longest – 11 (10 to 21)
  • 14. CONTRACEPTION • Barrier – mechanical – female condom, diaphragm & cervical caps • Displacements – cervicitis – irritation • Barrier – chemical – spermicidal – ricinoleic acid – nonoxynol 9 – octoxynol 3 • Foam tablets, pastes, creams, jellies, vaginal sponge (TODAY) • Combined – mechanical + chemical • Chemical – OC Pills – Mala N (21) – Mala D (28) • MOA – prevent ovulation, implantation & make cervical secretion thick
  • 15. OC PILL • administration of either estrogen or progesterone, if given in appropriate quantities during the first half of the monthly cycle, can inhibit ovulation. • Prevention of the preovulatory surge of LH secretion by the pituitary gland, which is essential in causing ovulation. • immediately before the surge occurs, there is probably a sudden depression of estrogen secretion by the ovarian follicles, and this might be the necessary signal that causes the subsequent feedback effect on the anterior pituitary that leads to the LH surge. • The administration of sex hormones (estrogens or progesterone) could prevent the initial ovarian hormonal depression that might be the initiating signal for ovulation.
  • 16. OCP • too much of either hormone can cause abnormal menstrual bleeding patterns • synthetic progestins in place of progesterone, especially the 19norsteroids, along with small amounts of synthetic estrogens • the natural hormones (oral) are almost entirely destroyed by the liver within a short time after they are absorbed from the gastrointestinal tract into the portal circulation • synthetic estrogens - ethinyl estradiol, mestranol. • Synthetic progestins norethindrone, norethynodrel, ethynodiol, norgestrel. • First 21 days – stopped – menstruation – withdrawal bleeding -
  • 17. CONTRACEPTION • Women are given large doses of estrogens for 4-6 days to prevent conception after coitus during the fertile period (postcoital or "morning-after" contraception) • 2 OCP immediately + 2 OCP after 12 hours • Indications – emergency like rape, contraceptive failure or unprotected sex • I pill, unwanted 72 • MOA - pregnancy is prevented by interference with implantation of the fertilized ovum rather than changes in GnRH secretion + hypermotility of uterus • Minipill – micropill – P only pill – daily for entire cycle – make cervical mucosa thick & ↓ motility of fallopian tubes
  • 18. IUD & IMPLANTS • Intrauterine implantation of pieces of metal or plastic (intrauterine devices, IUDs) - to prevent sperms from fertilizing ova. • Lippes loop – plastic – S shaped – nylon tail - barium sulphate • Copper - T appear to exert a spermatocidal effect – prevent implantation by evoking aseptic inflammation - most common • Adv. – safe, effective, reversible, easily removed, long term • Disadv. – heavy bleeding, come out, ectopic pregnancy • Hormonal IUDs that slowly release progesterone or synthetic progestins have the additional effect of thickening cervical mucus so that entry of sperms into the uterus is impeded – infections • Levonorgestrel skin implant – 5 years – amenorrhea • Injectables, vaginal rings – adv. Not to remember – disadv. Sterility, irregular bleeding
  • 19. TERMINAL • Surgical tubectomy – fallopian tubes are cut & ligated • Laparoscopic tubal occlusion – silicon rubber bands, Falope rings, Hulka clips – quicker, simpler – no hospitalization – reversal • MTP – MTP act 1971 • Conditions, person, place • Indication – medical, eugenic, humanitarian, failure of contraception • • • • 7th to 12th week –D&C –D&E – intravaginal PGs
  • 20. FEMALE STERILITY • Anovulation hormones - hyposecretion of gonadotropic • Abnormal ovaries – thick capsule - cyst • Tests - to analyze the urine for a surge in pregnanediol, the end product of progesterone metabolism, during the latter half of the sexual cycle; the lack of this substance indicates failure of ovulation • Body temp. chart - Secretion of progesterone during the latter half of the cycle raises the body temperature about 0.5°F, with the temperature rise coming abruptly at the time of ovulation.
  • 21. FEMALE STERILITY • Human chorionic gonadotropin, a hormone that is extracted from the human placenta has almost the same effects as LH and is therefore a powerful stimulator of ovulation. • excess use of this hormone can cause ovulation from many follicles simultaneously; this results in multiple births, an effect that has caused as many as eight babies (mostly stillborn) to be born to mothers treated for infertility with this hormone. • Endometriosis – endometrial tissue grows and even menstruates in the pelvic cavity surrounding the uterus, fallopian tubes, and ovaries – fibrosis – ovum cant be released – tube blockage.
  • 22. FEMALE STERILITY • Salpingitis -gonococcal infection - inflammation of the fallopian tubes; this causes fibrosis in the tubes, thereby occluding them. • secretion of abnormal mucus by the uterine cervix • at the time of ovulation, estrogen causes the secretion of mucus with special characteristics that allow rapid mobility of sperm into the uterus and actually guide the sperm up along mucous “threads.” • low-grade infection or inflammation, or abnormal hormonal stimulation of the cervix can lead to a viscous mucous plug that prevents fertilization.
  • 23. THANK YOU…