The Female Reproductive System
Amenorrhea
Absence of periods
Suspensory ligament
Anchors the ovary laterally to the pelvic wall . Is where the blood and nerve supply enters and exits the Fallopian tubes.
Gonadotrophins
Anterior lobe; Follicle stimulating hormone (FSH) Luteinising hormone (LH)
Fornices
Anterior, posterior, lateral. Posterior fornix is the deepest
Ovarian Cortex
Deep to tunica Albuginea. Consists of ovarian follicles surrounded by dense connective tissue.
Mature Follicles
Graafian follicles - large fluid filled follicle ready to rupture and expel secondary oocyte - via ovulation.
Ovarian Medulla
Has a rich blood supply, lymphatic and nerve supply
Androgens
Male hormones
Inner layer of uterus
Endometrium Subject to cyclical changes in the make up for pregnancy - the uterine cycle (glandular epithelium)
Transformation zone
Columnar - squamous epithelium. This is where the most tumours occur due to cell change.
Prolapse
Common following pregnancy
Seminoma
Connective tissue cancer (less common)
Ovarian Follicles
Consists of oocytes in various stages of development. Secrete oestrogen as the follicle grows.
Corpus Luteum
Contains remnants of mature follicles after ovulation. Produces progesterone and oestrogen , relaxin and inhibin until it degenerates into a fibrous scar tissue sac - the corpus Albicans.
Ovarian cortex
Contains the developing ova. The primary follicles which develop to Graafian follicles
Broad
Contains the suspensory and mesovarian ligaments.
No fertilisation?
Corpus luteum degenerates LH declines Oestrogen and progesterone levels decline.
Fertilisation
Corpus luteum growth continues
Corpus Luteal Cyst
Corpus luteum may seal and fill with fluid or blood
Organs of the female reproductive system
Ovaries Fallopian tubes (x2) Uterus Cervix Vagina (external genitalia) Breast-accessory organs
Ovaries
Paired organs on each side of the uterus. Found within the the peritoneal cavity. Oval shaped. Size depends on age and hormonal status. Ovaries are not attached to the uterus they are joined by the ovarian ligament.
Infundibulum
The distal part of the Fallopian tube. It is funnel shaped. Terminates in the fimbraie.
Istmus
The tube narrows as it runs medially from the ampulla, narrowest segment at entry to the uterus.
Tunica Albuginea
Whitish capsule of dense irregular connective tissue.
Fibroids
Benign overgrowth of myometrium (muscle layer)
Ovarian Hormones
Oestrogen Progesterone
Endocrine
Secretion of hormones; Oestrogen Progesterone
Size of ovaries
3.5 cm during childbearing years. Double in size during pregnancy. Smaller after pregnancy- atrophic during/after the menopause.
Blood Supply to the Ovaries
Blood and nerve supply enters and exits at the suspensory ligament. Bloody supply is via the ovarian artery. Both left and right arteries originate from the descending aorta. Left vein - renal vein - IVC Right vein - IVC
Ovarian Medulla
Boarder between medulla and cortex is indistinct. Its a more loose connective tissue containing blood vessels, lymphatics and nerves.
Cervix
Dips into the vagina forming 3 fornices Contains the cervical canal Hymen
Ovarian Ampulla
Distal end of Fallopian tube runs around the ovary.
Uterine cycle 6-14
Endometrial layer regenerates stimulated by oestrogen produced produced by ovarian follicles.
Carcinoma
Endothelial Layer
Ovarian cycle 6-14
Follicles stimulate/secrete oestrogen. Increased levels inhibit FSH and LH via negative feedback. On day 12 rising levels of oestrogen via positive feedback and increasing FSH and large amounts of LH. Day 14 LH peak - ovulation.
Ovarian Cycle
Follicular Phase Luteal Phase Ovulation
Uterosacral Ligament
Form posterior of cervix to anterior face of sacrum.
Pubocervical ligament
Form side of cervix to pubic symphysis
Cardinal Ligament
Forms side of cervix to isheal spines
Uterus Structure
Hollow, muscular organ within the pelvis. Posterior to bladder, anterior to rectum. 3 sections- fundus, body, cervix Usually anteverted over bladder Held in place by ligaments
Endometritis
Infection of the uterine cavity
Cervical canal
Internal and external os
Ovarian Cycle 15-28
LH acts on remaining follicle to become corpus luteum. Secretes oestrogen and progesterone which inhibit FSH and LH production.
Ovarian cycle 1-5
LH and FSH stimulate ovarian follicles to mature.
Pathology of Fallopian Tubes
Mainly occur due to STI's. Tubal disease is often due to Chalmydia.
Uterine Cycle 1-5
Menses- shedding of endometrial layer.
Middle layer of uterus
Myometrium - smooth muscle
Ovulation
Occurs mid cycle usually day 14.
Graafinian
One egg is ready for ovulation
Structure and function of Fallopian tubes
Oocyte is released from ovary into peritoneal cavity. Fimbraie sweep it into tube. Cilia on inner wall 'waft' to create a current-beating movements in the direction of the uterus. Smooth muscle of tubes generate peristaltic movements which move the ovum along towards the uterus.
Ovarian functions
Oogenesis Endocrine Cannot complete one junction without the other
Ovary Structure
Outer fibrous coat Cortex Medulla
Germinal Epithelium
Outer layer of simple cuboidal or squamous epithelium.
Ovarian Ligaments
Ovarian Suspensory Mesovarian Broad
Luteal Phase
Period of corpus luteum of activity (14-28)
Follicular Phase
Period of follicle growth 1-14 days
Outer covering of uterus
Peritoneum drapes over uterus
Regulatory Hormones
Pituitary Hormones (anterior lobe)- gonadotrophins Ovarian hormones
Uterine cycle
Preparation of uterus to receive fertilised ovum
Ovarian lymphatic drainage
Primarily to the aortic nodes. Inferiorly the illiac nodes are also involved.
Corpus Luteum
Produces hormones Degenerates into corpus albuginea.
Oogenesis
Production and release of mature ova. Exocrine function
Pathology of Uterus and Cervix
Prolapse Fibroids Endometritis Carcinoma Seminoma
Fallopian Tubes
Provides passageway to the uterine cavity for released ovum . Approx 10cm long. No physical contact with uterus, attached via ligaments. Radiate laterally from uterus, running through the peritoneum.
Ovarian Cycle
Rising levels of FSH. Stimulates oestrogen production by follicle cells which surround the oocyte. Days 1-14 (regular cycle) of the ovarian cycle; follicular phase. Formation of corpus luteum - progesterone secretion increases (positive feedback) Transportation of ovum along Fallopian tube into uterus. 14-28 is the luteal phase.
Uterine cycles 15-28
Rising levels of progesterone form corpus luteum increase endometrial lining and blood supply.
Uterine cycle
Rising oestrogen levels stimulates endometrium growth. Days 4-14 of reproductive system- proliferative phase. Rising levels of progesterone (14-28) stimulates the development of blood vessels and secretory activity of the endometrium. - Secretory phase. Also stimulates myometrial inactivity. No fertilisation - fall in progesterone and oestrogen levels as corpus luteum atrophies. Menses- shredding of endometrium (1-4/5)
Vagina structure
Runs in a superior, posterior direction. From cervical canal to external surface. 8-10cm in length. Lies posterior to uterus, anterior to rectum. Thin walled, distensible tube. Contains the birth canal.
Ovarian Nerve Supply
Runs with the vasculature via the suspensory ligament. Enters the ovary at the hilum. Supply is through the ovarian, hypogastric and aortic plexuses.
Seminoma
Squamous tissue cancer
Mesovarian ligament
Suspends the ovary inbetween the ovarian and suspensory ligaments.
The Menstrual Cycle
Synchronised ovarian and uterine cycles of activity. Average 28 day cycle. Cycles regulated by pituitary and ovarian hormones. Normal ovary contains over 2 million primary oocytes at birth. Around 10 million mature per cycle. Only one becomes the dominant follicle. Other follicles become atretic and fibrous.
Periods
Throughout the fertile period of a woman's life hormonal changes control cyclical changes to reproduce organs. Every month, an egg is released from the ovaries and the endometrium thickens in readiness to accept it - if it is fertilised. If contraception does not take place, then this uterine lining is discarded and a menstrual bleed occurs.
Functions of uterus
To receive, retain, protect and nourish the fertilised ovum and developing egg - fetus. To expel the mature follicle at the end of pregnancy.
Epithelial Tissue
Usual ovarian cancer
Ovarian ligament
anchors the ovary to the uterus medially