what is puberty?
event that triggers the changes in the hormones and brings the sexual organs to maturity
- sexual organs are one of few systems not completely mature following birth
what does the initiation of puberty depend on?
age, health, environment, stress, nutrition, genetics, environmental influence
what is the average for puberty in boys/girls? is it staying the same?
boys around 11-12, girls a bit younger
onset has been decreasing over time mostly due to improvements in nutrition, and that our environment is safer and safer
how does puberty happen?
signal sent to hypothalamus to kick start the feedback loop for the sex hormone
- GNRH being released by the hypothalamus -> goes to pituitary glands stimulating the release of FSH and LH
- hormones go to ovaries for females, and go to testes for males
when can we say puberty has happened?
first ejaculation in males
first menses in women
they are now fertile
what is the difference between sexual maturation and adolescence ?
adolescence = term used in sociology to describe an age regardless of puberty status
sexual maturation = once puberty has happened
these 2 are not always in sync
explain briefly the egg travels in women
egg starts in the ovaries and travels through the fallopian tubes all the way to the uterus
ovulating alternates sides each month -> each ovary ovulates once per 2 months
what are the primary roles of ovaries?
develop the oocytes -> release them when they are ready
responsible for producing and secreting the sex hormones estrogen/progesterone
what are some fun facts about ovaries?
you have a finite number of ovules at birth
- around 2 000 000 oocytes at birth
- around 500 000 when they reach puberty
- this means that we were all technically inside our grandmother's womb at some point
over our average lifespan the # of ovulations is about 400-500
- most will die out due to atresia
- when there's 0 ovules left = menopause
what is a follicle?
fluid filled sacs found in the ovaries, they contain immature and developing eggs
surrounded by granulosis cells -> they act like nannies to the egg
- produce hormones + energy the egg requires to develop
is there only one follicle that develops every menstrual cycle?
No several follicles are developing each menstrual cycle
- only one of them becomes mature enough to be ovulated
what happens to the follicle when the egg is released?
the remaining granuloma cells are left behind and become the corpus luteum
the follicles that were not mature enough for ovulation will be degraded by atresia
what are the female sex hormones?
high progesterone and estrogen, male have opposite
low testosterone, male have opposite -> even this is important if females, and estrogen is important in women
how are the female sex hormones synthesized?
synthesized from precursor cholesterol -> why it is important to have fat/cholesterol in nutrition
how is estrogen and testosterone linked?
estrogen is a subsequent step to testosterone
- there is an enzyme that converts testosterone into estrogen
- this enzyme is more active in women -> why there is more estrogen in women
- this enzyme is less active in men -> why there is more testosterone in men
where is the production sites of female hormones?
mostly in the ovarian cells of the ovaries, also in corpus luteum, placenta and to some extent adipose tissue (also contains the enzyme)
how can we explain why there is less estrogen at menopause?
the amounts of estrogen drop significantly because the corpus luteum and ovaries is dependent on the menstrual cycle, no placenta because cannot become pregnant
so the only source estrogen after menopause is from the adipose tissue
what is the major function of female sex hormones?
the control of the menstrual cycle
- cyclical concentration variations: estrogen and progesterone will rise and drop throughout the month
what is major functions of estrogen?
sex related
- menstrual cycle regulation
- endometrial regeneration
- reproductive organ regeneration + breast enlargement
non-sex related
- bone metabolism -> increased bone deposition
- liver metabolism -> fat regulation
- CNS -> neuroprotective
what is major functions of progesterone?
also called "pregnancy hormone"-> prepares body for potential pregnancy
- secreted mostly by corpus luteum
endometrium thickening for implantation for baby to implant
uterine expansion + inhibition of contractions -> prevents spontaneous delivery
inhibits HPG -> delays menstrual cycle (it would wash out the implanted fetus before it is fully developed)
breast alveoli development + lactation inhibition -> you want to keep milk inside until delivery
helps build immune tolerance to fetus
what leads to breast development? what determines the size and shape?
rise in estrogen during puberty -> it is the first sign of puberty
determined mostly genetics, its based on amount of estrogen and by amount of fatty connective tissue
do breasts change over time?
yes, follow cyclical changes shadowing menstrual cycle
rise of estrogen in menstrual cycle leads to a slight increase in vascularity and alveolar hyperplasia -> increase in size and tenderness to sexual stimulation of the breast
when does milk secreting maturation happen?
postpartum -> breast never completes full maturation until person becomes pregnant and delivers baby
female will develop milk production capacity, but milk secretion no -> ability to push the milk outward will not be developed
milk production = continuous -> stored in alveoli
what are the 2 hormones associated with milk maturation/production?
prolactin: promotes lactation + suppress menstrual cycle (body knows she needs to take care of baby, so won't allow her to get pregnant)
- levels only go high enough postpartum to do this
oxytocin: milk ejection -> compression of alveoli filled with milk
why is milk the best nourishment for newborns?
it contains nutrients and immune cells (IgA) from mother
- bestows primary immunity to newborns before their immune system gets a chance to develop
what is the average for the first menses?
12 years
- if higher BMI then earlier
what is the average length of period?
28 days (21-35 = healthy)
- can have longer cycle if only one ovary is producing egg
initial + premenopausal cycles are irregular though
what happens during follicular phase?
at day 0 the menses still happening, and its the start of the follicular "race" day 0-7
- several follicles begin their development and only one will ovulate: winner of race
- race begins when hormone FSH rise
- granuloma cells will synthesize estrogen as "food" for developing follicles -> estrogen levels increase as more follicle grows, more estrogen grows
- once a follicle reaches the "threshold of estrogen produced" it wins - they will remain alive and continue to mature and other follicles will die off through atresia
day 7-14: basically just the maturation of the winner
- all energy invested into one egg
- once it reaches a certain size, body will know because it will produce a certain amount of estrogen
- this will trigger LH surge -> estrogen had been promoting the synthesis of LH this whole time but not releasing it
- LH cues to signal ovulation
what happens during luteal phase?
day 14
- egg is released into fallopian tubes: no longer attached to bloodstream, estrogen produced no longer reaching bloodstream -> drop in estrogen
- progesterone + estrogen will rise due to corpus luteum
- progesterone prepares uterus in case of fertilization: thickens uterine + makes it cozy
- progesterone acts as negative feedback loop onto anterior pituitary which brings down levels of LH and FSH down
- lasts 2 weeks = lifespan of corpus luteum
- corpus luteum dies off = drop in estrogen + progesterone
- period happens because uterine wall washes away
how does oral contraceptives pills work?
give progesterone high amounts all the time
- no LH surge = no ovulation
what is menopause?
amenorrhea for 1 year -> no ovulation anymore
- end of reproductive period
- average 50 years old (40-60)
what happens to estrogen during menopause? why?
it drops - less production sites
- no more ovary cells + corpus luteum + placenta production
- only production is from adipose tissue
what happens to LH and FSH during menopause? why?
they rise up because there is no longer the inhibitory negative feedback loop from ovaries back to anterior pituitary
what is perimenopause? what are the symptoms? why?
irregular cycles 5-10 years prior to menopause
when menopausal symptoms start -> your body is adapting to new homeostasis level
symptoms
- decreased follicle # -> ovaries atrophy
- increased uterine thickness -> heavy menses
- vasomotor flushes (due to changes in constriction/dilation) -> increased HR + Temp + decreased BP -> night sweats, dizziness, palpitations
what is menopause associated with?
decreased bone mass density -> increased osteoporosis (estrogen acts on bones)
increased BP + dyslipidemia -> increased coronary heart disease (estrogen acts on lipid metabolism)
mood swings, migraines, weight gain
vaginal + uterine atrophy -> decreased lubrication + increased vaginitis
increased breast fat deposition -> decreased size and firmness
what has shown to improve menopause symptoms other than medication?
sexual activity
how many sperm enter the vagina? do they all make it to the egg in the end?
300 million
no - millions die in acidic environment/during journey
describe the sperm's journey
1.enter the cervix which is open during ovulation - tons will die in the cervix mucus
2. swim to uterus, musculo-uterine contractions help - tons will die due to immune cells
3. ½ swim in one fallopian tube ½ into the other - eliminates 50%
4. attaches to egg on receptors, enters inside, fertilize
5. egg releases chemicals to prevent other sperm from attaching
6. zygote is formed by combining 23 chromosomes of each
how long is ovule fertile?
12-24h
how long is sperm fertile?
3-5d
when is fertility window?
5d - fertilization could happen if you had sex on day 9, and ovulated on day 14
where does fertilization happen most of the time?
upper fallopian tubes
explain day 0 to day 9 for fertilization
day 0: fertilization
day 1: zygote
day 2: 2 cell stage
day 3: 4 cell stage, secretion of hCG
day 4: 8 cell stage
day 5: blastocyst
day 8-9: implantation, attach to bloodstream of mom
what does hCG do during fertilization?
it maintains corpus luteum alive, otherwise it would die off and period would happen, fetus would get washed away
- keeps it around so it can keep secreting progesterone
where is the best sites for implantation?
top of uterus
what happens once fetus implants into uterine wall?
starts to form blood vessels to try to connect to blood supply of mother
- receive nutrient and immune protection
THIS TAKES ABOUT 2 WEEKS
what is the placenta? what else does it do?
organ that develops to link the baby vasculature to the mothers
it also produces progesterone to prevent menses from happening - takes over role of corpus luteum
what is an ectopic pregnancy? why is this a problem?
when the implantation occurs NOT in the uterus
- cervical, interstitial, tubal, ovarian
those areas were not designed to accommodate a growing fetus
- leads to complications, difficult to bring to term
what can be the first signs of pregnancy?
missed menses
fatigue
frequent urination
breast enlargement + tenderness
nausea + vomiting
why do we classify pregnancy as a medical condition?
it creates changes in the physiology of what we consider normal
- will require medical supervision, adaptations
what are the systemic physiological changes of pregnancy?
increase in estrogen + progesterone
increase in metabolic requirement - provide for baby too
physical space of fetus - could compress other organs
organs affected - heart, lungs, GI, kidneys all have to work harder to help develop fetus
linea nigra - increase in melanocyte stimulating hormone
striae gravidarum - scarring due to sudden weight change
what are the changes in the 1st trimester for the mother?
mostly endocrine changes
- morning sickness
- tired
- increased urination
- breast pain
- constipation
what are the changes in the 2nd trimester for the mother?
mix of endocrine + physical change
- increased appetite + food cravings
- leg cramps
- changes in skin
what are the changes in the 3rd trimester for the mother?
mostly due to physical change
- tired
- increased urination
- heartburn
- hemorrhoids
- edema in ankles
- backache
- insomnia
explain fetal vulnerability in development
fetus will be particularly vulnerable at certain stages - vulnerable to teratogenic agents
vulnerability window is usually between week 2-3 - that's where most of the organs are developing
still possible to have teratogenic damage later on, but won't be as bad
what is a teratogen?
a chemical that could disturb normal and healthy development of baby
- excessive hormone, drugs, alcohol, meds...
why does vulnerability only start at week 2-3?
because it is the amount of time it takes the baby to attach to the moms bloodstream
- teratogen would not reach baby
why is folic acid important early on in pregnancy? can you catch up on deficiency?
because the CNS is developing from week 3-8
NO, you cannot just start consuming a lot of folic acid, because the CNS is past its developing stage, damage is already done
when is baby HR felt?
week 3
what happens during the 1st trimester for fetal development?
all major organs are developing
- changes are really fast
what happens during the 2nd trimester for fetal development?
fetus starts to take human appearance
14 weeks - development of sexual organs (prostate or ovaries)
18 weeks - development of immune system + ability to hear
20 weeks - 1st movements felt by mom
24 weeks - bone marrow + spleen make RBC, can rely on own blood supply
what happens during the 3rd trimester for fetal development?
weight doubles in final 6-8 weeks
32 weeks - endocrine system starts, lung surfactant
36 weeks - baby gains the most weight
39 weeks - can see in 3D, ready for delivery
what are the last 3 organs to develop?
CNS, eyes + lungs
- explains why preterm babies often have cognitive, vision + respiratory issues
what is PCOS? what is its prevalence?
polycystic ovarian syndrome
at least 2 of these characteristics:
- polycystic ovaries (don't necessarily need these to be diagnosed)
- anovulation
- hyperandrogegism (high testosterone)
leading cause of infertility
4-12% - genetic basis
what does PCOS also involve ? how does this translate?
endocrine system
co-morbidities:
- metabolic syndrome
- weight gain
- appetite regulation
- insulin sensitivy
what is the hyperandrogegism characterized by in PCOS?
increased follicular growth but undergo atresia
-> decreasing # of oocytes for the future -> anovulation
what is the anovulation characterized by in PCOS?
abnormal FSH/LH release -> menstrual dysfunction
- lack of LH surge
what is the vicious cycle between hyperandrogegism and anovulation?
lack of ovulation = keeps LSH/FH out of whack = contributes to hyperandrogegism = further promotes anovulation
how is insulin linked to PCOS?
there is a form of insulin resistance + hyperinsulinemia that occurs
- the higher the insulin levels, the more disorganized FSH/LH, the more elevated testosterone will be
self-promoting cycle
what are PCOS individuals more at risk for? why?
uterine + endometrial cancer due to overactivity of cells
what is a pelvic organ prolapse? what are the types?
form of herniation of pelvic musculature, organ will bulge out or move out of their appropriate location
3 types: uterus, bladder, rectal
uterus prolapse: what are the 3 grades of prolapse? what are the symptoms? risk factors?
grade 1: halfway pre-hymen
grade 2: hymen level
grade 3: halfway post hymen
symptoms: depends on grade
- painful intercourse -> decreased fertility
- incontinence
- constipation
risk factors
- aging/menopause
- increase abdominal pressure
- pelvic floor trauma
bladder prolapse: what is is called? what are the symptoms? risk factors?
cystocele
risk: childbirth
main symptoms: vaginal pressure + bladder infections
rectal prolapse: what is is called? what are the symptoms? risk factors?
rectocele
risk: childbirth + menopause
main symptoms: vaginal pressure + constipation
how many females suffer with sexual dysfunction at any point in their lives?
45%
what are the contributing factors apart of the vicious cycle of sexual dysfunction?
main culprit : performance pressure, which leads to:
- fear of failure
- inhibitory anxiety
- sexual dysfunction
as much psychological as physical
what are main symptoms of sexual dysfunctions?
decreased libido
inability to orgasm
painful intercourse
these 3 interplay, promote each others
what are some causes of sexual dysfunctions?
chronic illness
abuse/trauma
vaginal spasms
STBI
drug adverse effects
vaginal infection
stress
genital surgery
what percentage of couples are infertile? what percentage is female issues? male?
15% total
40% female issues - this includes carrying baby to term
20% male issues
40% combined issues
what are contributing factors to female fertility issues?
complexity of system
ovulation disturbance
uterine disorder
age
what are contributing factors to male fertility issues?
hormonal disorder
sperm dysfunction
what are tests for female fertility issues?
ovulation pattern
endometrium accomodation
reproductive tract lesion
what are tests for male fertility issues?
sperm count
sperm motility
hormone levels
pre-term labour: what is timing? signs? risk factors?
before 37 weeks
cervical thinning + dilation
vaginal bleeding
abdominal cramping
decreased fetal activity
placental ischemia
bacterial infection of uterus
cervical changes
multiple gestation
what does multiple gestation mean for pregnancy + labour?
shorter gestation
- space limited, push on cervix + uterine wall
increased nutritional demands
synergistic increase in risk of complications (more than doubled)
what is difference between dizygotic + monozygotic twins?
dizygotic
- siblings born at same time
- 2 ovum, 2 sperms
- genetically distinct
-separate placentas
monozygotic
- 1 ovule, 1 sperm
- genetically identical (differences due to epigenetics)
- shared placentas
- high incidence of umbilical cord suffocation
uterine rupture: what is timing? signs? risk factors?
during labour - EMERGENCY
severe hemorrhage
placental abruption
prior C section - scar tissue is weaker
hypoxic-ishemic encephalopathy risk for newborn
shoulder dystocia: what is timing? signs? risk factors?
during delivery - shoulder gets stuck on pubic bone
maternal postpartum hemorrhage
newborn: brachial plexus damage, cerebral palsy
short stature
older mom (35 years)
gestation >42 - cuz baby is so big
maternal diabetes - excessive weight gain
postpartum hemorrhage: what is timing? signs? risk factors?
after delivery
- primary 24h, secondary after 24h
vaginal delivery = 1/2L of blood loss
C-section = 1L of blood loss
decreased uterine tone (constricts blood vessels) -> most common
placental tissue left behind
genital trauma
low thrombin -> clotting disorder
PPD: what is timing? signs? risk factors?
around delivery - can affect dad too
persistent sadness
difficulty concentrating
thoughts of harm
anger + severe anxiety
changes in appetite
insomnia
history of mental illness
what is pre-eclampsia?
new onset hypertension
- systolic BP >140mmHg / diastolic BP >90 mmHg
- severe: systolic BP >160mmHg / diastolic BP >110 mmHg
-- can lead to hemorrhagic stroke or placental abruption
proteinuria
- marker of kidney damage
what is eclampsia?
preeclampsia + seizures
what are risk factors of preeclampsia?
o First pregnancy
o Multiple gestations
o Mothers > 35 years
o Hypertension
o Diabetes
o Obesity
o Family history
what is the cause of preeclampsia?
exact cause unclear
- Development of an abnormal placenta
o In preeclampsia, spiral arteries become fibrous, narrow and less blood gets to fetus = poorly perfused placenta
§ Intrauterine growth restriction
§ Fetal death
§ Releases pro-inflammatory proteins -> go into mothers’ circulation -> endothelial cell dysfunction
· leads to vasoconstriction + kidneys retain more salt = hypertension
what are other complications of preeclampsia?
less blood to kidneys -> glomerular damage -> oliguria + proteinuria
less blood to retina -> blurred vision, flashing, scotoma
less blood to liver -> injury + swelling -> right upper quadrant pain
thrombi formation -> HELLP syndrome
increased vasculature permeability -> generalized + pulmonary + cerebral edema
what is treatment of preeclampsia?
depends
delivery of fetus
medications
usually goes away after delivery
explain how newborn hemolytic happens
dad has Rh+ and mom has Rh-
- they have a first Rh+ child: moms body freaks out, but doesn't create antibodies before baby is delivered
- they have second Rh+ child: moms body has antibodies, destroys babies RBC
what is Rh+ and Rh-?
rhesus factor
- precedes of protein in blood
- + means yes, - means no
what can newborn hemolytic disease lead to? how do we treat?
brain damage, deafness, blindness, swollen liver + abdomen
we vaccinate while mother is pregnant
what are Hox genes?
important instructions for fetal development
- in like small "boxes" and are all in a sequence and are activated at the right moment for their role in embryo development
- you have Hox sequence for heart, lungs, CNS...
how do teratogens come into plan with Hox genes?
they can interrupt the Hox genes, and mess up the development specific to that Hox gene
- produce birth defects
what is fetal alcohol syndrome? why is alcohol so damaging?
significant drinking = >2 drinks day
- does not guarantee FAS though
1. crosses placenta
2. affects CNS development
3. no fetal detoxifying enzyme - no defence
what are the main consequences of FAS?
structural: brain + hippocampus lesions, craniofacial malformations
neurological: epilepsy, motor disorders
functional: learning disabilities, decreased IQ
what is spina bifida? risk factors? how do you screen? symptoms?
neural tube defect
- incomplete closure of spinal cord, leading to bump and protrusion of CNS outside spinal cord
- risk of perforation, permanent damage, inflammation
folate deficiency (rare, a lot in flour)
anti epileptics
diabetes + obesity
family history
amniocentesis: take sample of placental fluid
- looking for alpha fetoprotein
motor impairments, BM alterations, decreased functions + academic skills
what is trisomy 21? what are the complications? risk factors? can you screen?
extra 21 chromosome
⅓ trisomy that is viable
decreased growth + craniofacial malformations
increased risk heart defect + respiratory tract infections
cognitive deficits (IQ=8-9)
alzheimers symptoms = 40 years
mothers age is HUGE risk factor
yes with genetic testing
what are preterm birth complications?
Lack of Surfactant → Respiratory Distress Syndrome
Heart Defects → Ductus Arteriosus (shunt going from L atria to R is not closed, deoxygenated blood goes into systemic)
Infections: Pneumonia, UTI
CNS Disorders: Cerebral Palsy, Retinopathy
Metabolic Disorders: Immature Liver Enzymes, Hypoglycemia