ITF 1. Sınıf İngilizce Dersi

1. Stages Of Women LifeStages Of Women Life
Dr.Süleyman Engin AkhanDr.Süleyman Engin Akhan
İ.Ü.İstanbul Tıp Fak.İ.Ü.İstanbul Tıp Fak.
Kadın Hastalıkları ve Doğum Anabilim DalıKadın Hastalıkları ve Doğum Anabilim Dalı

2. Stages Of Women Life
1.1. Neonatal period (postpartumNeonatal period (postpartum
first 28 days)first 28 days)
2.2. Childhood period (till at the ageChildhood period (till at the age
of 8)of 8)
3.3. Prepuberty and puberty periodPrepuberty and puberty period
(between the ages of 8 – l2)(between the ages of 8 – l2)
4.4. Adolescence period (betweenAdolescence period (between
the ages 12 - 20)the ages 12 - 20)
5.5. Sexual maturity period(betweenSexual maturity period(between
the ages of 18-50)the ages of 18-50)
6.6. Climacterium and senium (afterClimacterium and senium (after
the age of 50)the age of 50)

3. ♀♀Embryological Development of Reproductive SystemEmbryological Development of Reproductive System
1.1. Development of pituitary glandDevelopment of pituitary gland
2.2. MMigration of primordial germ cellsigration of primordial germ cells
originate in the endoderm of the yolk sacoriginate in the endoderm of the yolk sac
3.3. Development of sex cords, gonads andDevelopment of sex cords, gonads and
mullerian ductsmullerian ducts
4.4. Sex determinationSex determination
5.5. DDevelopment of ovariesevelopment of ovaries andand genitalgenital
ductsducts
6.6. Formation of bFormation of broad ligamentroad ligament
11..TrimesterTrimester 22.. TrimesterTrimester 33.. TrimesterTrimester
22
11
33
44
55
66
72.Gün dişi farklılaşma72.Gün dişi farklılaşma

4. Differantiation of Genital SystemDifferantiation of Genital System
Sertoli CellsSertoli Cells
AMHAMH
Leading to regression
of mullerian ducts
Leydig CellsLeydig Cells
TestosteroneTestosterone
EEnsuring the continuitynsuring the continuity
ofof wwolffian ductsolffian ducts
5-5-αα-reductase-reductase
DHTDHT
DDevelopment and virilizationevelopment and virilization
of theof the external genitaliaexternal genitalia

5. The Uterus and Cervix During
The Intrauterin and Neonatal Period
 There are both wolfian ducts ( mesonephric canal) and mullerian ductsThere are both wolfian ducts ( mesonephric canal) and mullerian ducts
(paramesonephric canal) in the embryo till the 8 th week of gestation and(paramesonephric canal) in the embryo till the 8 th week of gestation and
this period is known as bipotent period. At thethis period is known as bipotent period. At the 12 th gestational week one12 th gestational week one
of these disappearsof these disappears..
 Differentiation is determined by the effect of antimullerian hormoneDifferentiation is determined by the effect of antimullerian hormone (AMH)(AMH)
secreted from Sertoli cells and testosteron secreted from Leydig cells.secreted from Sertoli cells and testosteron secreted from Leydig cells.
 If there is no AMH, the uterus, fallopian tubes and upper 1/3 of vaginaIf there is no AMH, the uterus, fallopian tubes and upper 1/3 of vagina
develop from mullerian canal.develop from mullerian canal.

6.  Fusion of mullerian canal getFusion of mullerian canal get
completed atcompleted at 10 th gestational week10 th gestational week,,
canalization of uterine cavity andcanalization of uterine cavity and
development of cervical canal anddevelopment of cervical canal and
vagina is completedvagina is completed at 22 th weekat 22 th week ofof
gestation.gestation.
 AtAt 20 th gestational week20 th gestational week uterineuterine
cavity is lined with endometriumcavity is lined with endometrium
and original squamocolumnarand original squamocolumnar
junction occurs.junction occurs.

7.  In the neonatal period, breast tissue and uterus are under the effect ofIn the neonatal period, breast tissue and uterus are under the effect of
placental oestrogen-progesteron and gonadotropins. Vaginal mucosaplacental oestrogen-progesteron and gonadotropins. Vaginal mucosa
and endometrium also proliferate under this effect.and endometrium also proliferate under this effect.
 Cervix-corpus ratio is 1/3. Vaginal pH’s asidic. Physiologic eversionCervix-corpus ratio is 1/3. Vaginal pH’s asidic. Physiologic eversion
can be seen at the cervix.can be seen at the cervix.
 Microscopic or macroscopic vaginal bleeding may be seen after birthMicroscopic or macroscopic vaginal bleeding may be seen after birth
because of withdrawal of hormones and it may last 7- 10 days.because of withdrawal of hormones and it may last 7- 10 days.
 The vaginal bleeding seen after 15th postpartum day is alwaysThe vaginal bleeding seen after 15th postpartum day is always
pathologic.pathologic.
 Changes occuring because of placental and maternal originedChanges occuring because of placental and maternal origined
hormones encompass a period of 2 years.hormones encompass a period of 2 years.

8. Ovaries at the neonatal period
 FSH and LH levels are high during neonatal period. FSH levelFSH and LH levels are high during neonatal period. FSH level
further increases during infancy.further increases during infancy.
 FSH levels are high atFSH levels are high at 6 - l2 moths and at the same period6 - l2 moths and at the same period
follicles respond to this elevated FSH-LH levelsfollicles respond to this elevated FSH-LH levels..
 That is why the MOST FREQUENT abdominal mass in girls isThat is why the MOST FREQUENT abdominal mass in girls is
ovarian cysts till the age of 1.ovarian cysts till the age of 1.

9. Genital Organs and Ovaries During the Childhood Period
 Childhood period is a period of
genital and hormonal silence.
 Gonadotroph cells controlling
hypothalamo-hypophyseal system
are sensitive to the negative feed-
back effect of oestrogen 10- 15
times more compared to adult
period.
 The mucosa of vaginal introitus is
pink and wet. Clitoris is small and
is about 5 cm in length. There are
a few rugae.

10. Genital Organs and Ovaries During the Childhood Period
 Genital organs are susceptible to traumas and infectionsGenital organs are susceptible to traumas and infections because of lowbecause of low
oestrogen levels.oestrogen levels.
 VaginalVaginal pH is notr or slightly alkalinepH is notr or slightly alkaline and it has a mixed bacterial floraand it has a mixed bacterial flora..
 There are multipl follicles during childhood period. Number of follicleThere are multipl follicles during childhood period. Number of follicle
decreases gradually. Ovaries expand their volumes with increasing age anddecreases gradually. Ovaries expand their volumes with increasing age and
descent into minor pelvis.descent into minor pelvis.
 İt is possible to see big follicles at this stage and it does not need any surgicalİt is possible to see big follicles at this stage and it does not need any surgical
intervention or biopsy.intervention or biopsy.

11. Physiology of Puberty
 It is the transition from immature reproductive period to adult reproductiveIt is the transition from immature reproductive period to adult reproductive
period.period.
 The gonadotroph cells controlling hypothalamo-hypophysis system duringThe gonadotroph cells controlling hypothalamo-hypophysis system during
infancy and childhood period are very sensitive to negative feedback ofinfancy and childhood period are very sensitive to negative feedback of
oestrogen(more than 10-15 times compared to adult).FSH-LH is suppressedoestrogen(more than 10-15 times compared to adult).FSH-LH is suppressed
even when oestrogen level is 10 pg/ml.even when oestrogen level is 10 pg/ml.
 3 important events occur with the beginning of puberty:3 important events occur with the beginning of puberty:
 AdrenarcheAdrenarche
 Decrease in suppresion of gonadotroph cells.Decrease in suppresion of gonadotroph cells.
 Peptid-peptid and peptid- steroid interactions increase before puberty.Peptid-peptid and peptid- steroid interactions increase before puberty.

12. Genital Organs and ovaries in Prepuberty and puberty
 Estrogen stimulation of external genital organs starts slowly betweenEstrogen stimulation of external genital organs starts slowly between
ages of 7-10.ages of 7-10.
 Mons pubis, labia major ve minör thicken,Mons pubis, labia major ve minör thicken, vvagina becomes 8 cm inagina becomes 8 cm in
length and , mucosa and hymen thickenlength and , mucosa and hymen thicken..
 CCorpus uteri expandsorpus uteri expands.. UterusUterus grows with especiallygrows with especially myometrialmyometrial
proliferation at age of.proliferation at age of.
 Ovaries are spindle shaped, their length increase. They complete theirOvaries are spindle shaped, their length increase. They complete their
descent to minor pelvis while menarche gets closer. It is possible todescent to minor pelvis while menarche gets closer. It is possible to
see different stages of follicular development but there is nosee different stages of follicular development but there is no
ovulation.ovulation.

13. Stages of Puberty
 FSH-LH increase moderately before 10 years of age. This is followed by increase inFSH-LH increase moderately before 10 years of age. This is followed by increase in
oestrogen level. Oestrogen stimulates GH ( growth hormone) and GH in turn stimulatesoestrogen level. Oestrogen stimulates GH ( growth hormone) and GH in turn stimulates
IGF-1 thus grow- up starts.IGF-1 thus grow- up starts.
 There is a physiologic insulin resistance at puberty. Elevated insulin suppresses IGFBP-1There is a physiologic insulin resistance at puberty. Elevated insulin suppresses IGFBP-1
and IGF-1 increases with effect of oestrogen.and IGF-1 increases with effect of oestrogen.
 Then with order of occurence:Then with order of occurence:
 1. Telarche:1. Telarche: ( 9.96 age) firs sign of puberty.( 9.96 age) firs sign of puberty.
 2. Adrenarche:2. Adrenarche: (10.51 age) Although it is an independent period it occurs 2 years(10.51 age) Although it is an independent period it occurs 2 years
after telarche.after telarche.
 3. Menarche:3. Menarche: (12.88 age) It occurs when grow-up slows. A girl maximum grows 6(12.88 age) It occurs when grow-up slows. A girl maximum grows 6
cm in height after menarche. The cycles following menarche are usually anovulatorycm in height after menarche. The cycles following menarche are usually anovulatory
for 12- 18 months.for 12- 18 months.

14. What is Adolescence?What is Adolescence?
Adolescence is the time period of physical,Adolescence is the time period of physical,
cognitive and social development betweencognitive and social development between
childhood and adulthood.childhood and adulthood.

15. The stages of adolescenceThe stages of adolescence
 Early periodEarly period:: 12-14 years12-14 years
 Period of pubertal growth and menstruation.Period of pubertal growth and menstruation.
 TheyThey start separating from the familystart separating from the family andand interpretinterpret the familythe family
according toaccording to their own valuestheir own values
 Middle period:Middle period: 15-17 years15-17 years
 They start creating their moral values and begin to make choices.They start creating their moral values and begin to make choices.
 TheyThey interpretinterpret the rights and wrongsthe rights and wrongs in their ownin their own again.again.
 TTheyhey begin to takebegin to take risks in their relationshiprisks in their relationship..
 They care about their appearance and health more than beforeThey care about their appearance and health more than before..
 They argue with their parents.They argue with their parents.
 Late period:Late period: 18-21 years18-21 years
 Formal thought is developed. TheyFormal thought is developed. They begin to consider possiblebegin to consider possible
outcomes and consequences of actions.outcomes and consequences of actions.
 They accept the parent's value andThey accept the parent's value and can even become a parent.can even become a parent.

16. Mensturation
 Maturation of hypothalamic-hypofiser axes continu after 5 years of theMaturation of hypothalamic-hypofiser axes continu after 5 years of the
menarche.menarche.
 Near menarche there is no estradiol positive (+) feed-back effect.Near menarche there is no estradiol positive (+) feed-back effect.
Because of this we can’t observe ovulation. In the same time after 2Because of this we can’t observe ovulation. In the same time after 2
years of the fist mensturation there is no LH surgeyears of the fist mensturation there is no LH surge
 After fist years of menarche the levels of FSH, LH, E2 and progeteroneAfter fist years of menarche the levels of FSH, LH, E2 and progeterone
are loware low
 At the end of 2.year E2 and 5.year FSH/LH level rise to the normalAt the end of 2.year E2 and 5.year FSH/LH level rise to the normal
reproductive women level.reproductive women level.
 After menarche first 2 years 80% of all mestruel cycles are anovulatuarAfter menarche first 2 years 80% of all mestruel cycles are anovulatuar

17. Perimenopausal Period –I-
 Perimenopause is a transitional period between reproductive ages and
menopause.
 Clinically this period is defined as irregular menstrual bleeding.
In Perimenopause:
FSH increases (↑)
Inhibin decreases (↓)
LH normal (→)
Östrojen slightly increases (↑)
 37 – 38 aged woman has approximately 25.000 follicules.
 Rapid follicule expense starts in this period. This situation presents itself
as decrease in inhibin levels and increase in FSH levels.

18. Perimenopausal Period –II-
At this period the main problem is endometrial
hyperplasia which occurs due to irregular bleeding and
relatively increased estrogen levels.

19. Hormonal Equilibrium In Postmenopausal period-I-
In menopausal period FSH level increases 10-20 times,
LH level increases 3 times.
At postmenopausal period total estrogen production is
approximately 45 µgr in 24 hours.
Almost all of the estrogen level depends on peripheral
conversion of androstenodione and estrone level is
higher than estrodiol.
The ratio of Androgen/Estrogen changes in the favor
of androgens.

20. Vasomotor
Symptoms
Flushing
Sweating
Palpitations
Psychological
Symptoms
Mood Changes
Irritability
Depression
Sleeplessness
Urogenital System
Urinary symptoms
Vaginal discharge,
dryness, dispareunia
Vulvar itching or
burning
The Effects of Postmenopausal Syndrome

21. What Happens in Menopause ?
1.Body architecture changes:
 Central fat increases.
 Waist circumference increases.
2. Muscle mass decreases and generally fat tissue increases.This
condition is more evident in androgen deficiency syndrome :
 Muscle tonus and vital energy decreases
 Fatique sensation increases .
3. Skin wrinkles increases and they are more realized by the woman
 2% of connective tissue and collagen decreases yearly.
 38% of sweat and sebaseous gland secretion decreases.
4. Atrophy is developed in genitourinary system.
 Atrophy in vaginal mucosa
 Vaginal lubrication decreases, disparonia

22. Long Term Effects of
Postmenopausal Syndrome
 OsteoporosisOsteoporosis
 Cardiovascular diseasesCardiovascular diseases
 Alzheimer DiseaseAlzheimer Disease
 Loss of LibidoLoss of Libido