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