Chapter 28: The female reproductive system.

•Hormonal methods -Most hormonal methods prevent ovulation -"_____" (estrogen and progestin), patch, injection, or vaginal ring •Ovarian follicles do not mature as FSH, LH are inhibited -"____________" = emergency contraceptive pills •High dose of estrogen and progestin or progestin alone •Induce menstruation if implantation has not occurred •Inhibit ovulation, inhibit movement of sperm and egg, inhibit implantation -______: progesterone antagonist •Induces abortion up to 2 months into pregnancy

"The pill" "morning after pills" RU-486

•Breast cancer occurs in ____________ American women -A leading cause of female mortality •Tumors begin with cells from ___________ -May metastasize by mammary and axillary lymphatics •Signs may include lump, _______, changes in skin texture, and drainage from nipple

1 out of 8 or 9 mammary ducts skin puckering

The Ovarian Cycle: •Follicular phase extends from beginning of menstruation until ovulation (Days ______) -Includes __________ phase: from end of menstruation until ovulation -Most variable part of cycle; seldom possible to predict date of ovulation -FSH stimulates follicles to grow and secrete _______ -Dominant follicle becomes increasingly sensitive to FSH, LH, and estradiol •Dominant follicle has rich blood supply and large number of FSH receptors, so it becomes preovulatory follicle •Other ______ degenerate (atresia) •Ovary also contains follicles at earlier stages for maturation in future cycles

1-14 preovulatory estradiol antral follicles

-Primary follicles •About ____ days into cycle, recruited primordial follicles become primary follicles •Contain larger, secondary oocytes and a surrounding layer of _________ -Secondary follicles •Appear about 140 days into cycle •Oocytes are even larger and follicular cells now in two or more layers (_______ cells) •_______—layer of glycoprotein gel secreted by granulosa cells around the oocyte •________—connective tissue around the granulosa cells condenses to form a fibrous husk

140 cuboidal follicular cells granulosa zona pellucida theca folliculi

Secondary follicles (Continued) •Appear about ___ days into cycle •Oocytes are even larger and follicular cells now in two or more layers (____ cells) •_______—layer of glycoprotein gel secreted by granulosa cells around the oocyte •______ —connective tissue around the granulosa cells condenses to form a fibrous husk that differentiates into two layers -Theca ______: outer fibrous capsule rich in blood vessels -Theca _____: inner cellular, hormone-secreting layer producing androgens (androstenedione and testosterone), and granulosa cells convert them to estradiol

140 zona pellucida theca folliculi externa interna

The Sexual Cycle: •Cycle begins with __-week follicular phase -Menstruation occurs during first ____ days of cycle -Uterus replaces lost tissue by mitosis and cohort of follicles grow -Ovulation around day ___: remainder of that follicle becomes corpus luteum •Next 2 weeks: luteal phase -Corpus luteum stimulates endometrial secretion and thickening -If pregnancy does not occur, endometrium breaks down in the last ___ days Menstruation begins and the cycle starts over

2 week 3 to 5 14 2 days

•Breast milk changes composition -Changes over the first ________ -Varies from one time of day to another -At the end of a feeding there is less lactose and protein, but six times the fat •__________ not a good substitute -One-third less lactose but three times as much ______ -Harder to digest and more nitrogenous waste (diaper rash)

2 weeks cow's milk protein

-Mature follicles •About ___ days before ovulation, one follicle becomes dominant (the one destined to ovulate) -Remainder degenerate •It captures and holds ____ •At about ___ days before ovulation it is large enough to be considered a preovulatory (graafian) follicle

20 FSH 5

Pregnancy and Childbirth: •Gestation (pregnancy) -Lasts an average of ___ days from conception to childbirth -Gestational calendar measured from first day of the woman's last menstrual period (LMP) •Birth predicted ____ days (40 weeks) from LMP -____: the duration of pregnancy -____: three 3-month intervals in the term

266 280 term trimesters

•Sexual cycle averages ___ days, varies from ____ days •Hormones of hypothalamus regulate the pituitary gland •Pituitary hormones regulate the ovaries •_____ secrete hormones that regulate the uterus •Basic hierarchy of hormonal control -Hypothalamus---> ____ -----> ovaries ----->____ •Ovaries exert feedback control over hypothalamus and pituitary

28 20 to 45 ovaries pituary uterus

•Labor contractions begin about ___ minutes apart and eventually occur every 1 to 3 minutes -Periodically ____ to increase blood flow and oxygen delivery to placenta and fetus -Contractions strongest in ____ and body of uterus •Weakest in the ____ •Pushes fetus downward

30 relax fundus cervix

-Mother's cardiac output rises ___% to ___% above normal by week 27 •Falls almost to normal during the last ___weeks -Pregnant uterus puts pressure on large pelvic blood vessels: interferes with venous return from legs •Can result in hemorrhoids, _______, andedema of the feet

30% to 40% 8 weeks varicose veins

Breast Cancer: •Tumor discovery usually during breast self-examination (BSE)—monthly for all women •Mammograms (breast X-rays) -Late ____: baseline mammogram -Ages _____: every 2 years -Over age ___: yearly

30s 40 to 49 50

Adjustment to pregnancy: •Respiratory system -Tidal volume and minute ventilation increase about ____% •Respiratory rate remains constant -Two reasons for increased ventilation •Oxygen demand rises in proportion to the woman's increase in ___________ and the increasing needs of the fetus •Progesterone increases the sensitivity of the woman's chemoreceptors to __________ -Ventilation adjusted to keep carbon dioxide levels lower than normal

40% metabolic rate carbon dioxide

Hormones of Pregnancy: •Human chorionic somatomammotropin (HCS) -Placenta begins its secretion about week ___ •Amount secreted increases steadily until term -___ concentration of hormone but function is poorly understood •Effects seem similar to growth hormone, but weaker •Seems to ____ the mother's insulin sensitivity and glucose usage, leaving more for the fetus

5 high reduce

•Woman's pituitary gland grows about ___% larger during pregnancy -Produces markedly elevated levels of thyrotropin, prolactin, and ACTH •______ becomes 50% larger under influence of HCG, pituitary thyrotropin, and human chorionic thyrotropin from placenta -___ metabolic rate of mother and fetus •Parathyroid glands enlarge and increase osteoclast activity

50 thyriod gland increases

-Tertiary follicles •Appear about ___ days before ovulation when granulosa cells begin secreting follicular fluid into small pools •As pools enlarge, they merge, forming a single antrum -_____—tertiary and mature follicles -_______-—earlier stages of the follicles •_______-—a mound of granulosa cells on one side of the antrum that covers the oocyte and secures it to the follicular wall •______—innermost layer of cells in the cumulus surrounding zona pellucida and oocyte -Forms a protective barrier around egg with function similar to blood-testis barrier

60 antral follicles preantral follicles cumulus oophorus corona radiata

Adjustment to pregnancy: •Circulatory system -By full term, placenta requires ______ mL of blood per minute from the mother -Mother's blood volume rises about 30% during pregnancy •Due to fluid retention and _____________ •Mother has about 1 to 2 L of extra blood

625 hemopoiesis

•Puberty begins at age _______ for most girls in United States •Triggered by rising levels of GnRH which stimulates anterior pituitary to secrete FSH and LH •______stimulates ovarian follicles and they begin to secrete estrogen, progesterone, inhibin, and a small amount of androgen •______are feminizing hormones with widespread effects on the body -____ (most abundant), estriol, and estrone

8 to 10 FSH Estrogen Estradiol

•The two sexes indistinguishable for first _______ weeks of development •Female reproductive tract develops from the _____________ -Not because of the positive action of any hormone -Because of the absence of __________ and müllerian-inhibiting factor (MIF)

8 to 10 paramesonephric ducts testrerone

•Uterus weighs about ___ g at the end of pregnancy -Weighs only ___ g when not pregnant -Reaches almost to the xiphoid process

900 50

Hormones of Pregnancy: •_______ stimulates glucocorticoid secretion -This mobilizes amino acids for fetal protein synthesis •_________ secretion rises, promoting fluid retention and increasing mother's blood volume •______ secreted by corpus luteum and placenta -Synergizes progesterone in stimulating multiplication of decidual cells Promotes ______ of blood vessels in the pregnant uterus

ACTH aldosterone relaxin growth

Breast Cancer: •Contibuting causes -BRCA1 and ______: two breast cancer genes •But most breast cancer is nonhereditary -Some breast cancers are stimulated by _____ •Risk factors -Aging, exposure to ionizing radiation, carcinogenic chemicals, excessive alcohol and fat intake, and smoking -Over ___% of cases lack identifiable risk factors

BRCA2 estrogen 70%

Climacteric and Menopause: -__________ levels rise, increasing risk of cardiovascular disease -Bone mass declines, increasing risk of __________ -Blood vessels constrict and dilate in response to shifting hormone balances •Dilations may produce ______: spreading sense of heat from abdomen to thorax, neck, and face •__________—low doses of estrogen and progesterone to relieve some of these symptoms -Risks and benefits still being debated

Cholesterol osteoporosis hot flashes hormone replacement therapy (HRT)

•___________—any procedure or device intended to prevent pregnancy •Behavioral methods -Abstinence -_________ (periodic abstinence) -Withdrawal (coitus interruptus) •Barrier and spermicidal methods -Male and female ______, diaphragm, sponge -_____: foams, creams, jellies

Contraception Rhythm method condom spermicides

•_____: longest stage—lasting 8 to 24 hours •Dilation of cervical canal to 10 cm (size of fetal head) and effacement (thinning) of cervix •Rupture of fetal membranes and loss of amniotic fluid -"Breaking of the waters" -_____—dilation reaches 10 cm in 24 hours or less in primipara (first baby) and in as little as a few minutes in multipara

Dilation Stage late dilation

•______ stimulates many changes in puberty -Stimulates vaginal metaplasia -Stimulates growth of ovaries and secondary sex organs -Stimulates growth hormone secretion •_____ in height and widening of pelvis -Stimulates fat deposition (breast, hips, etc...) -Thickens skin •But girls' skin is still _____, softer, and warmer than boys •Progesterone -Primarily acts on the uterus preparing it for possible pregnancy in the second half of the menstrual cycle

Estradiol increase thinner

•____ and progesterone suppress FSH and LH secretion through negative feedback •Inhibin selectively suppresses ____ secretion •Hormone secretion is distinctly _______ and the hormones are secreted in sequence

Estrogens FSH cyclic

Hormones of Pregnancy: •Progesterone -Secreted by placenta and corpus luteum -Suppresses secretion of _____and LH, preventing follicular development during pregnancy -Suppresses uterine contractions -Prevents _____________ and menstruation -Promotes ________ of decidual cells of the endometrium on which the blastocyst feeds -Stimulates development of ____ in breast

FSH premature childbirth proliferation acini

•____________—development of the follicles around the egg that undergoes oogenesis -Primordial follicles •Consists of a primary oocyte in early meiosis •Surrounded by a single layer of squamous follicular cells •Follicular cells connected to the oocyte by fine cytoplasmic processes for passage of nutrients and chemical signals •Concentrated in the cortex of the ovary •Wait________ years before they develop further •Adult ovary has __________ primordial follicles •Monthly recruitment of about 24 follicles begins 290-day path to maturity that only one will finish (about 23 die)

Folliculogenesis 13 to 50 90 to 95%

-Vitamin ___ given in late pregnancy and to newborns to promote prothrombin synthesis •Minimizes risk of neonatal hemorrhage, especially in the brain -Vitamin ___ supplements help ensure adequate calcium absorption to meet fetal demand -_______reduces the risk of neurological fetal disorders •Spina bifida, anencephaly •Supplements must be started before pregnancy

K D folic acid

-Transformation from ruptured follicle to corpus luteum is regulated by ____ •LH stimulates corpus luteum to grow and secrete rising levels of _______ and progesterone •10-fold increase in progesterone is most important aspect of luteal phase -_______ has a crucial role in preparing the uterus for possibility of pregnancy -LH and FSH secretion _____ over the rest of the cycle

LH estradiol progesterone declines

The Uterus: -_________ is roughly triangular •Upper two corners are openings to uterine tubes •Lower apex is internal os •Not a hollow cavity, but a potential space in nonpregnant uterus -_________ connects lumen of uterus to vagina •_______—superior opening of canal into body of uterus •_________—inferior opening of canal into vagina -___________: secrete mucus that prevents spread of microorganisms from vagina to uterus

Lumen cervical canal internal os external os cervical glands

•Treatment of breast cancer -______: removal of tumor only -______________: removal of breast tissue only or breast tissue and some axillary lymph nodes -_______________: removal of breast, underlying muscle, fascia, and lymph nodes •Rarely done as it generally does not improve outcome -Surgery is followed by radiation or __________ -Breast reconstruction from skin, fat, and muscle from other parts of the body

Lumpectomy simple mastectomy radial mastectomy chemotherapy

•_______ phase—day 15 to day 28, from just after ovulation to onset of menstruation •If pregnancy _______ occur, events happen as follows: -When follicle ruptures it collapses and bleeds into antrum -_________ is slowly absorbed -Granulosa and theca interna cells multiply and fill antrum -Dense bed of capillaries grows amid them -Ovulated follicle has now become the _________ •Named for yellow lipid that accumulates in theca interna cells, now called lutein cells

Luteal (postovulatory) phase does not clotted blood corpus luteum

•____—first menstrual period -Requires at least 17% body fat in teenager •Improved nutrition has lowered age of onset to age 12 •____ stimulates gonadotropin secretion •If body fat and leptin levels drop too ___, gonadotropin secretion declines and menstrual cycle might cease -Menstruation ceases when body fat drops below 22% in adult woman •First few menstrual cycles are anovulatory (no egg ovulated) •Girls begin ovulating regularly about a year after they begin menstruating

Menarche Leptin low

•____ is continually secreted into mammary acini, but does not easily flow into the ducts •Milk ejection (letdown) is controlled by a ______ reflex -Infant's suckling stimulates sensory receptors in nipple, signaling hypothalamus and posterior pituitary to release oxytocin -_____ stimulates myoepithelial cells around each acinus -Contract to squeeze milk into duct •Milk flow within 30 to 60 seconds after suckling begins

Milk neuroendocrine oxytocin

•___ —rupture of the mature follicle and release of its egg and attendant cells -Typically around day 14 •Estradiol stimulates a surge of ___ and a lesser spike of FSH by anterior pituitary -LH induces several events •_________ completes meiosis I (producing secondary oocyte and first polar body) •Follicular fluid builds rapidly and follicle swells (resembles blister on ovary) •_________ and leukocytes secrete enzymes that weaken follicle wall •Nipple-like stigma appears on surface

Ovulation LH Primary oocyte Macrophages

Puberty: •__________-—onset of breast development, the earliest noticeable sign of puberty -Estrogen, progesterone, and prolactin trigger development of ducts and lobules -Completion of duct and lobules is governed by glucocorticoids and ________________ -Adipose and fibrous tissue enlarge breast •________—appearance of pubic and axillary hair, sebaceous glands, and axillary glands -Androgens from ovaries and adrenal cortex stimulate pubarche and ______

Thelarche growth hormone pubareche libido

•The nonlactating breast consists mostly of ______ and collagenous tissue -Breast size determined by amount of adipose tissue •_________ attach breast to dermis of overlying skin and fascia of the pectoralis major

adipose suspensory ligaments

Oogenesis: •Egg development resumes in _________ -____ stimulates monthly cohorts of about 24 oocytes to complete meiosis I -Each oocyte divides into two haploid daughter cells of unequal size and different destinies •Important to produce an egg with as much ________ as possible •If fertilized, it must divide repeatedly and produce numerous daughter cells -__________: large daughter cell that is the product of meiosis I -___________: smaller one that ultimately disintegrates •A means of discarding the extra set of haploid chromosomes

adolescence FSH cytoplasm secondary oocyte first polar body

Respiratory system adjustments (Continued) -Low carbon dioxide level in mother's blood promotes CO_2 diffusion from fetal bloodstream into maternal blood -Some mothers feel "________" from sensitiveity to CO_2 and from pressure on diaphragm from growing uterus -Breathes more easily in the last month due to __________, causing the fetus to drop lower in the pelvic cavity, and thus taking pressure off diaphragm

air hungry pelvic expansion

The Breasts and Mammary Glands: -________: intermediate between sweat glands and mammary glands •Secretions protect the nipple from chapping and cracking during nursing -Smooth muscle fibers in dermis of areola that contract in response to _____, touch, and sexual arousal, wrinkling the skin and erecting the nipple

areolar glands cold

Labor Contractions: •Woman feels need to "_____" -Contraction of abdominal muscles aids in expelling the fetus -Especially when combined with the Valsalva maneuver for _______ intra-abdominal pressure

bear down increasing

Hormones of Pregnancy: •Human chorionic gonadotropin (HCG) -Secreted by ___ and placenta -Detectable in urine ___ days after conception by home pregnancy test kits -Stimulates growth of corpus luteum •__________ secretes increasing amounts of progesterone and estrogen

blastocyst 8 to 9 corpus luteum

•Excitement and plateau -Labia minora become congested with ____ and often protrude beyond labia majora -Labia majora become ___________ •Then flatten and spread away from vaginal orifice -_______: serous fluid that seeps through the walls of the canal -Greater vestibular gland secretions ___ the vestibule and provide lubrication

blood reddened and enlarged vaginal transudate moisten

•Two principal regions of the breast -______: conical to pendulous, with nipple at its apex -______: extension toward armpit •Lymphatics in axillary tail are important as a route for breast cancer metastasis •Nipple surrounded by circular colored zone, called the ____ -Capillaries and nerves close to skin surface: more _______ -Sensory nerve fibers of areola trigger a milk ejection reflex when an infant nurses

body axillary tail areola sensitive

•_______—relatively weak contractions of the uterus over the course of gestation -Strengthen late in pregnancy: false labor -Contractions transform suddenly into more powerful labor contractions •____—the process of giving birth •Marked by the onset of true labor contractions

braxton hicks contractions parturition

•Breast—mound of tissue overlying pectoralis major -Enlarges at puberty and remains so for life -Most of the time it contains very little mammary gland •Mammary gland—develops within the breast during pregnancy -Remains active in the lactating breast -Atrophies when a woman ceases to nurse

breast mammary glands

•Uterine tube (oviduct) or (fallopian tube) •Canal about 10 cm long from ovary to uterus •Muscular tube lined with __________ -Highly folded into longitudinal ridges

ciliated cells

•_____—midlife change in hormone secretion -Accompanied by menopause: cessation of menstruation •Female born with about _____ eggs, climacteric begins when there are about 1,000 follicles left -Follicles less responsive to ____- secrete less estrogen and progesterone -Uterus, vagina, and breast atrophy -Intercourse may become uncomfortable -______ more common Skin becomes thinner

climacteric 2 million gonadotropins vaginal infections

The External Genitalia: Vulva (Continued) -Clitoris: erectile, sensory organ •Primary center for sexual stimulation •Glans, body, and crura -Vestibular bulbs: erectile tissue deep to labia majora •Bracket the vagina -Greater and lesser vestibular and paraurethral glands open into vestibule for lubrication

clitoris vestibular bulbs

•____ forms in late pregnancy -Similar to breast milk in protein and lactose, but contains one-third less fat -Sole nutrition source for first ____ days after birth -Thin watery consistency and a cloudy yellow color -Contains ___ to protect baby from gastroenteritis

colostrum 1 to 3 IgA

•The female reproductive system is more ________ than the male system because it serves more purposes -Produces and delivers _______ -Provides nutrition and safe harbor for fetal development -Gives birth -Nourishes infant •Female system is more ______, and hormones are secreted in a more complex sequence

complex gametes cyclic

Prenatal Development: •____—all products of conception: the embryo or fetus, the placenta, and associated membranes -_____: the developing individual is a hollow ball for the first 2 weeks -____: from day 16 through week 8 -____: from beginning of week 9 to birth •Attached by way of umbilical cord to a disc-shaped placenta -Provides fetal nutrition and waste disposal, secretes hormones that regulate pregnancy, mammary development, and fetal development ____: newborn to 6 weeks

conceptus blastocyst embryo fetus neonate

Uterine Contractility: ____________ may produce chemical stimuli promoting its own birth -Fetal cortisol rises and may increase estrogen secretion by the placenta -Fetal pituitary produces ____, which may stimulate fetal membranes to produce ______ •Uterine stretching thought to play a role in initiating labor -Stretching of smooth muscle increases contractility of smooth muscle

conceptus oxytocin prostaglandin

Hormones of Pregnancy: •Estrogens -Increases to 30 times normal by the end of gestation -___________ is source for first 12 weeks until placenta takes over -Causes tissue growth in fetus and mother •Mother's uterus and external genitalia enlarge •Mammary ducts grow, breasts increase to nearly twice their normal size •_______ pubic symphysis and widens pelvis

corpus luteum relaxes

•At birth, prolactin secretion ____ to nonpregnancy levels •Every time infant nurses, prolactin levels jump to 10 to 20 times this level for an ____ -Stimulates synthesis of milk for the next feeding -Without nursing, milk production stops in _____ •Only 5% to 10% of women become pregnant while breast-feeding -Inhibition of ____ and reduced ovarian cycling -Natural means of spacing births

drops hour 1 week GnRH

Oogenesis: -Transform into primary oocytes: _________ -Most degenerate (atresia) by the time the girl is born -______: any stage from the primary oocyte to the time of fertilization -By puberty, 200,000 oocytes remain •Lifetime supply—probably will ovulate only 480 times

early meiosis I eggs/ovum

______________—growth of endometrial tissue outside of the uterus -Growth is often on peritoneum of pelvic cavity or on surface of ovary -Prevalence: 6% - 10% of women -Causes ____, sometimes infertility -Believed to result from _________—backward flow of menstrual fluid that exits uterine tube

endometriosis pain retrograde menstruation

Uterine Contractility: •Progesterone and ____ balance may be one factor in this pattern of increasing contractility -Progesterone inhibits uterine contractions, but its secretion levels off or declines after ___ months -Estradiol stimulates uterine contractions, and continues to rise

estradiol 6

•High ____ level in pregnancy causes ducts of mammary glands to grow and branch •Growth hormone, insulin, glucocorticoids, and ____ contribute to this development •Progesterone stimulates the budding and development of acini at the end of the ducts •____ organized into grape-like clusters (lobules) within each breast lobe

estrogen prolactin acini

•_____ stage: from entry of head into vagina until baby is expelled -30-60 minutes in primipara; shorter in multipara •_____—when baby's head is visible -Delivery of the head is the most difficult part •After expulsion, attendant drains blood from umbilical vein into baby -_________ is clamped and cut

expulsion crowning umbilical cord

Stages of Labor: •Labor occurs in three stages -Dilation -_________ -Placental stage •______ of each stage tends to be longer in primipara -Woman giving birth for the first time •____ in multipara -Woman who has previously given birth

expulsion duration shorter

•Ducts branch through _____ and converge on the nipple -Mammary gland develops during pregnancy -_______ obes around the nipple -_______ drains each lobe •Dilates to form lactiferous sinus which opens into nipple -Ducts ends in acini (sacs) •Acini are surrounded by myoepithelial cells

fibrous stroma 15 to 20 Lactiferous duct

•Breast-feeding promotes involution -Suppresses estrogen secretion which would make the uterus more ____ -Stimulates ____ secretion which causes myometrium to contract and firm up the uterus sooner

flaccid oxytocin

The Vagina: -______: blind-ended spaces at top of vagina that extend slightly beyond the cervix -Transverse friction ridges (vaginal rugae) at lower end -Mucosal folds form ________across vaginal opening

fornices hymen

•As pregnancy nears _____—posterior pituitary releases more oxytocin (OT), uterus produces more OT receptors -_______ promotes labor in two ways •Directly stimulates muscles of _____ •Stimulates fetal membranes to produce prostaglandins, which are synergists of oxytocin in producing labor contractions

full term oxytocin myometrium

Adjustment to pregnancy: •Integumentary system -Skin ____ to accommodate expansion of abdomen and breasts -Added fat deposition in hips and thighs -Striae or stretch marks can result from tearing the stretched _______ •Reddish at first, but fade after pregnancy -Melanocyte activity increases in some areas •Darkening of the areolae and linea alba (linea nigra) -Temporary blotchy darkening of the skin over the nose and cheeks •"_____" or chloasma •Disappears after pregnancy

grows connective tissue mask of pregnancy

Childbirth: •In the seventh month of gestation, the fetus normally turns into the head-down vertex position -Most babies born _____ first -Head acting as a wedge that widens the mother's cervix, vagina, and vulva during birth •___ is a passive player in its own birth -Expulsion achieved by contractions of mother's uterine and abdominal muscles -Fetus may play a role chemically by stimulating labor contractions -Sending chemical messages that signify when it is developed enough to be born

head fetus

The Evolution of Menopause: •Theory—older mother would not live long enough to rear an infant to a survivable age -Better to become __________ and help rear her grandchildren •Pleistocene (Ice Age) skeletons show early hominids rarely lived past age ___ -_____________ may be an artifact of modern nutrition and medicine allowing us to live longer than our ancestors

infertile 40 menopause

The Uterine Tubes: •Major portions -__________: flared, trumpet-shaped distal (ovarian) end -_______: feathery projections on infundibulum -________: middle and longest part -_________-: narrower end toward uterus •_________: superior portion of broad ligament that enfolds uterine tube

infundibulum fimbriae ampulla isthmus mesosalpinx

•Uterine blood supply is important to menstrual cycle and pregnancy •Uterine artery arises from _________ -Gives off several branches that penetrate myometrium and lead to arcuate arteries •Each travels in a circle around the uterus •Anastomose with arcuate artery on the other side •Spiral arteries penetrate through the myometrium into the endometrium -Wind between endometrial glands toward surface of mucosa -Rhythmically ____________ making mucosa alternately blanch and flush with blood

internal iliac artery constrict and dilate

•Orgasm -Late in plateau phase, many women experience ____________, followed by 1 to 2 sec of "suspension" or "stillness" preceding orgasm -_______: intense sensation spreading from clitoris through the pelvis •Sometimes with pelvic throbbing and a spreading sense of warmth •Pelvic platform gives three to five strong contractions about 0.8 sec apart ________ plunges spasmodically into vagina

involuntary pelvic thrusts orgasm cervix

Labor Contractions: •At first, pain of labor is mainly due to ____ of the myometrium -Muscles hurt when they are deprived of blood, and contractions restrict circulation •As fetus enters vagina, pain becomes stronger -Stretching of the cervix, vagina, and perineum, sometimes with ____ -___________ may be necessary: an incision in the vulva to widen the vaginal orifice to prevent random tearing -____ is an evolutionary product of two factors •Unusually large brain and head of the human infant •Narrowing of the pelvic outlet which helped humans adapt to bipedal locomotion

ischemia tearing episiotomy pain

•____—the synthesis and ejection of milk from the mammary glands -Lasts as little as 1 week in women who do not breast-feed their infants -Can continue for many years as long as the breast is stimulated by a nursing infant or a mechanical device (breast pump) -Women traditionally nurse their infants until a median age of about_____ years

lactation 2.8

•Colostrum and milk have a laxative effect that clears intestine of ______ (green, bile-filled fecal material in newborn) •Supplies antibodies and colonizes intestine with beneficial bacteria •Nursing woman can produce ____ of milk per day

meconium 1.5 L

•_____—cessation of menstrual cycles -Usually occurs between ages of _________ -Age of menopause has increased in last century -Menopouse considered complete when there has been no menstruation for a year

menopause 45 to 55

•_______ phase (menses)—discharge of menstrual fluid from the vagina •First day of discharge is day 1 of the new cycle •Average woman expels about ___ mL of blood and 35 mL of serous fluid over a 5-day period •Contains _______ so it does not clot

menstrual 40 fibrinolysin

•____ cycle—consists of a buildup of endometrium during most of the sexual cycle, followed by its breakdown and vaginal discharge -Divided into four phases: proliferative phase, secretory phase, premenstrual phase, and menstrual phase -First day of noticeable ______ is defined as day 1 of the sexual cycle •Menstrual phase average: ___ days

menstrual cycle vaginal discharge 5

Oogenesis: -Secondary oocyte proceeds as far as __________ •Arrests until after ovulation •If ________, it dies and never finishes meiosis •If ________, it completes meiosis II and casts off a second polar body -Chromosomes of the large remaining egg unite with those of the sperm

metaphase II not fertilized fertilized

•Vaginal epithelium -Undergoes _______: transformation from one tissue type to another •Childhood:__________ •Puberty: estrogens transform it to ___________ -Bacteria ferment glycogen producing acidic pH in vagina to inhibit growth of pathogens -Has antigen-presenting dendritic cells: route by which ____ from infected semen invades the female body

metaplasia simple cubiodal stratified squamous HIV

•Prolactin (from anterior pituitary) promotes ____ -Inhibited by dopamine when not pregnant -Synthesis of hormone begins ____ weeks into pregnancy, by full term it is 10 to 20 times normal level •Little effect on mammary glands until after birth since steroids from placenta oppose it -Milk synthesis also requires growth hormone, ____, insulin, and parathyroid hormone to mobilize necessary amino acids, fatty acids, glucose, and calcium

milk synthesis 5 cortisol

•External genitalia are collectively called the vulva or pudendum -Mons pubis: mound of fat over pubic symphysis bearing most of the pubic hair -Labia majora: pair of thick folds of skin and adipose tissue inferior to the mons •Pudendal cleft—fissure between labia majora -Labia minora: thin, hairless folds medial to labia majora •Space between forms vestibule which contains urethral and vaginal openings •Anterior margins of labia minora join to form hood-like prepuce over clitoris

mons pubis labia majora pudendal cleft labia minora

Adjustment to Pregnancy: •Digestive system -__________: nausea; especially arising from bed in first few months of gestation •Unknown cause -Constipation and heartburn due to: •______ intestinal motility •Pressure on stomach causing reflux of gastric contents into esophagus •Metabolism -__________________: rises about 15% in second half of gestation •Appetite may be strongly stimulated Healthy average weight gain: ____

morning sickness reduced basal metabolic rate (BMR) 24 pounds

-High levels of estradiol and progesterone, along with inhibin from the corpus luteum, have a ______ effect on the pituitary -Corpus luteum begins process of involution (_______) •Beginning about day ___ (8 days after ovulation) •By day 26 involution is complete and what was corpus luteum becomes ______—small scar •With diminishing ovarian steroid secretion, FSH levels rise, ripening a new cohort of follicles -Ovulation occurs in _____ per cycle with the two ovaries usually alternating from month to month -Ovulated oocyte began ripening 290 days earlier and began development before birth

negative feedback shrinkage 22 corpus albicans one ovary

-Cervical stretching induces a _____ reflex through spinal cord, hypothalamus, and posterior pituitary •Posterior pituitary releases ____ •Carried by the blood and stimulates uterine muscles -Directly and through the action of ________ -Cervical stretching → oxytocin secretion → _________ → cervical stretching

neuroendocrine oxytocin prostaglandin uterine contraction

•___________—egg production -Produces _____ gametes by means of meiosis -Distinctly cyclic event that normally releases one egg each month -Accompanied by cyclic changes in hormone secretion -Cyclic changes in histological structure of the ovaries and uterus •Uterine changes result in monthly menstrual flow

oogenesis haploid

Excitement and Plateau: -Lower one-third of vagina constricts: ________ •Narrower canal and vaginal rugae enhance stimulation and help induce orgasm in both partners -Upper end of vagina dilates (becomes cavernous) -____: uterus stands nearly vertical, where normally it tilts forward over the bladder -Breasts ___ and nipples become erect -Erectile clitoris is primary focus of sexual stimulation

orgasmic platform tenting effect swell

•____ cycle—three principal steps -Follicular phase, _____, and luteal phase •This cycle reflects what happens in the ____ and their relationship to the hypothalamus and pituitary

ovarian cycle ovulation ovaries

•________—female gonads that produce egg cells (ova) and sex hormones -Almond-shaped and nestled in the ovarian fossa of posterior pelvic wall -Tunica albuginea capsule, like on testes -Outer cortex where __________ develop -Inner medulla occupied by major arteries and veins -Each egg develops in its own fluid-filled follicle -___________-: bursting of the follicle and releasing of the egg

ovaries germ cells ovulation

Pap Smears and Cervical Cancer: •Best protection against cervical cancer is early detection by _______ -Cells removed from _______ and vagina and microscopically examined •Three grades of cervical intraepithelial neoplasia -Class I is ___________ -Class II calls for a ________ -Class III results may call for radiation therapy or hysterectomy

pap smear cervix mild dysplasia biopsy

Orgasm: -Uterus exhibits _________ -Anal and urethral sphincters constrict -Paraurethral glands (homologous to prostate) sometimes expel copious fluid similar to prostatic fluid (female ejaculation) -Tachycardia, _________ -Sometimes women experience ___________ flush on the lower abdomen, chest, neck, and face

peristaltic contraction hyperventilation reddish, rash-like

•Nutrition -__________ stores nutrients in early gestation and releases them in the last trimester -Demand especially high for protein, iron, calcium, and phosphates -Pregnant woman needs extra __ during late pregnancy or will become anemic

placenta iron

•_____ stage: uterine contractions cause placental separation •Membranes (afterbirth) inspected to be sure everything has been expelled

placenta stage

•______ feedback theory of labor -Labor induced by stretching of cervix -Triggers a __________ of the uterine body -Pushes the fetus downward -Stretches the ____ even more -Self-amplifying cycle of stretch and contraction

positive reflex contraction cervix

Menstrual Cycle: •______ phase: period of endometrial degeneration -Last ___ days of the cycle -Corpus luteum atrophies and progesterone levels ___ -Triggers spasmodic contractions of spiral arteries -Causes ______ (interrupted blood flow) -Brings about tissue necrosis and menstrual cramps -Pools of blood accumulate in the functional layer -Necrotic endometrium mixes with blood and serous fluid:________

premenstrual 2 falls endometrial ischemia menstrual fluid

Hormones of Pregnancy: •Hormones with strongest influence on pregnancy: -Estrogens -_____ -Human chorionic gonadotropin -__________ •All primarily secreted by the placenta -Corpus luteum is important source for first several weeks •If _______ removed before 7 weeks, pregnancy terminates -From week 7 to week 17, the corpus luteum ____ and placenta takes over its endocrine function

progesterone human chorionic somatomammotropin corpus luteum degenerates

Menstrual Cycle: •______ phase—rebuilding of functional layer of endometrium that was lost in last menstruation -At day ___ of menstruation, the endometrium is about 0.5 mm thick and consists only of basal layer -As new cohort of follicles develops, they secrete more estrogen -____ stimulates mitosis in basal layer and regrowth of blood vessels to regenerate the functional layer -By day ____, endometrium is 2 to 3 mm thick -Estrogen also stimulates endometrial cells to produce ______ receptors

proliferative 5 estrogen 14 progesterone

The Puerperium: •First 6 weeks postpartum (after birth): _____ -Period in which mother's anatomy and physiology stabilize and reproductive organs return nearly to pregravid state (condition prior to pregnancy) •____—shrinkage of the uterus -Loses ___% of its weight in the first week -Involution is achieved by autolysis (self-digestion) of uterine cells by their own lysosomal enzymes -For about 10 days produces a vaginal discharge, called ____ -Bloody at first and then turns ____

puerperium involution 50 lochia serous

Resolution: •During resolution, the uterus drops forward to its resting position •Orgasmic platform quickly _____ -Rest of vagina returns more slowly to normal dimensions •Flush disappears quickly •Areolae and nipples undergo rapid detumescence -Breasts may take ____ minutes to return to normal size •Postorgasmic perspiration •Women do not have refractory period -May quickly experience additional ___________

relaxes 5 to 10 orgasms

•____ cycle—sequence of events from fertilization to giving birth and returning to fertility •____ cycle—events that recur every month when pregnancy does not intervene -Consists of two interrelated cycles controlled by shifting patterns of hormone secretion •____ cycle—events in ovaries •_________ cycle—parallel changes in uterus

reproductive cycle sexual cycle ovarian cycle menstrual cycle

-Ovulation takes only 2 to 3 minutes •Stigma seeps follicular fluid for 1 to 2 minutes •Follicle bursts and remaining fluid oozes out carrying the ____ and cumulus oophorus •Normally swept up by ____ current and taken into uterine tube

secondary oocyte ciliary

Menstrual Cycle: •____ phase—endometrium thickens more in response to progesterone from corpus luteum -Day __ to day ___ -____ due to secretion and fluid accumulation rather than mitosis -Endometrial glands secrete _____ -Glands grow wider, longer, and more coiled -Endometrium 5 to 6 mm thick -Soft, wet, nutritious bed available for embryonic development

secretory 15 26 thickening glycogen

-Endometrium—inner mucosa •____________ epithelium, compound tubular glands, and a stroma populated with leukocytes, macrophages, and other cells -_______________ —superficial half, shed each menstrual period -__________—deep layer, stays behind and regenerates a new functional layer with each menstrual cycle •During pregnancy, endometrium is the site of attachment of the embryo and forms the maternal part of the placenta from which the fetus is nourished

simple columnar epithelium functional layer basal layer

•Ovarian and uterine arteries anastomose along margin of ovary -Give off multiple small arteries that enter the ovary •Ovarian veins, lymphatics, and nerves also travel through the __________

suspensory ligaments

•Without _________: -Causes mesonephric ducts to degenerate -Genital tubercle becomes the glans clitoris -Urogenital folds become the labia minora -Labioscrotal folds develop into the labia majora • Without MIF: -________________ develop into the uterine tubes, uterus, and vagina

testosterone paramesonephric ducts

Signs of Ovulation: •Couples attempting to conceive a child (or avoid pregnancy) may wish to know when ovulation occurs -Cervical mucus becomes ____________ -Resting body temperature rises 0.4° to 0.6°F •Best measured first thing in the ___ before arising from bed •Record for several days to see the difference -______—twinges of pain at time of ovulation •Best time for conception -Within 24 hours after the cervical mucus changes and the basal temperature ___

thinner and more stretchy morning mittelschmerz rises

•Intrauterine device (IUD) -Springy device that is left in place for extended period of time -Irritates ___________ and interferes with implantation •Surgical sterilization -Clamping or cutting the _________ (uterine tubes or ductus deferens)

uterine lining genital ducts

•____ prepares to catch oocyte -It swells with edema •Its fimbriae envelop and caress the ovary in synchrony with the woman's heartbeat •Cilia create gentle current in nearly _______

uterine tube peritoneal fluid

The Genitalia •Internal genitalia -Ovaries, ___________, uterus, and vagina •External genitalia -_________, labia minora, and labia majora •Occupy the perineum •Primary sex organs -__________ •Secondary sex organs -Other internal and external genitalia

uterine tubes clitoris ovaries

•______: perimetrium, myometrium and endometrium -_________—external serosa layer -________—middle muscular layer •Constitutes most of the uterine wall •Composed mainly of smooth muscle -Sweep downward from fundus; spiral around body -Less muscular and more fibrous near cervix -Produces labor contractions, expels fetus

uterine wall perimetrium myometrium

Ligaments: •________ is supported by muscular floor of pelvic outlet and folds of peritoneum that form ligaments -Broad ligament has two parts •Mesosalpinx •Mesometrium on each side of the uterus -_______________: support cervix and superior part of vagina extending to pelvic wall -____________: attach posterior side of uterus to the sacrum -_______: arise from anterior surface of uterus, pass through inguinal canals, and terminate in labia majora •Similar to gubernaculum terminating in male scrotum

uterus cardinal ligaments (lateral cervical) uterosacral ligaments round ligaments

•______—thick muscular chamber that opens into roof of the vagina -Usually tilts forward over urinary bladder -Harbors fetus, provides a source of nutrition, and expels the fetus at the end of its development -Pear-shaped organ •_____—broad superior curvature •______—middle portion _______—cylindrical inferior end

uterus fundus body (corpus) cervix

•Ligaments of ovary -Attached to _____ by ovarian ligament -Attached to pelvic wall by suspensory ligament •Contains ____________, vein, and nerves -Anchored to broad ligament by the _________ •Ovary receives blood from two arteries -Ovarian branch of the uterine artery -Ovarian artery •Equivalent to ___________ in male

uterus ovarian artery mesovarium testicular artery

•_____________—8 to 10 cm distensible muscular tube -Allows for discharge of menstrual fluid, receipt of penis and semen, and birth of baby -Outer adventitia, __________, and inner mucosa -Tilted posteriorly between rectum and urethra -Vagina has no glands •Transudation lubricates vagina—"_______" -Serous fluid through its walls and by mucus from the cervical gland above it

vagina (birth canal) middle muscularis "vaginal sweating"

•Urinary system -Aldosterone and steroids of pregnancy promote ____ and _____ retention by kidneys -Glomerular filtration rate increases ___% and urine output is slightly elevated •Enables woman to dispose of both her own and the fetus's metabolic wastes -Pregnant uterus compresses the bladder and reduces its capacity •Frequent urination and uncontrollable leakage of urine (______________)

water and salt 50 incotinence

Oogenesis: •Embryonic development of ovary -Female germ cells arise from ____ -Colonize gonadal ridges the first ____ weeks of development -Differentiate into oogonia and multiply until the _______ •6 to 7 million in number

yolk sac 5 to 6 fifth month