so there are four phases in the female reproductive cycle menstrual cycle and that's about the first five days of the cycle and this varies a lot according to um the individual woman the pre-ovulatory phase uh that's usually day six to thirteen where we have a follicular phase in the ovary proliferative phase in the uterus the ovulation that's a very short period about two days and that's when the egg is released and then the post ovulatory phase which is about two weeks it has a luteal phase in the ovary and a secretory phase in the uterus where in the uterus it starts developing more glandular tissue in the ovary its maintenance of that corpus luteum so in the ovary about 20 follicles that started development about six days before are now beginning to secrete estrogen the fluid is filling the antrum from the granulosa cells and in the uterus there's declining levels of progesterone causes spiral arteries to constrict the tissue dies and the stratum functionalist has sloughed off along with about 50 to 150 ml of blood on average in the pre-ovulatory phase in the ovary the primary follicle develops into a secondary follicle occasionally more than one happens and if that does occur the dominant follicle is going to continue to increase its estrogen production and it develops into a vesicular ovarian or gravian follicle that's the mature follicle by day 14 it's enlarged and it presses against the surface of the ovary and then secretion of estrogen in heaven slows the secretion of follicle stimulating hormones that no more follicles develop during this time increasing estrogen triggers secretion of luteinizing hormone in the uterus at the same time endometrial repair occurs and the stratum functionalis is repaired and starts to thicken as i said before ovulation is actually a rupture of the follicle releasing the secondary oocyte into the pelvic cavity remember that the fallopian tube or uterine tube and the uterus are not connected we have the fimbriae those finger-like projections coming from the the fallopian tubes that are going to try to coax that oocyte into the tube but it's released into the pelvic cavity so gonadotropin releasing hormone from promotes release of follicle stimulating hormone more luteinizing hormone and the surge of luteinizing hormone brings bad ovulation and here you can see this graphene follicle and then ovulation and what's left this ruptured follicle is the corpus hemorrhagicum some women can tell when they're ovulating certainly there are people that are trying to get pregnant there are different methods to know when the best time to have sex is in order to get pregnant one of them is called the centothermal method and it looks for changes in cervical mucus as well as changes an increase in your basal body temperature some women can also feel the actual rupture they feel sharp pain in their lower abdomen on one side that lasts a few seconds and then it's gone and that's the actual rupture of the follicle after ovulation we have the corpus hemorrhagicum and it's absorbed by the remaining follicle cells and then the remaining cells enlarged they change their character and they've become the corpus luteum under the influence of luteinizing hormone and starts to to secrete estrogen and progesterone the time between ovulation and the next menstrual period is the most constant of the cycle and that's about 14 days in the ovary it's called the luteal phase uh where you're having lots of estrogen progesterone secreted and if fertilization doesn't occur during this time then the corpus albicans is formed and as hormone levels drop because they're not being secreted from the corpus luteum anymore then secretion of the genetic releasing hormone follicle stimulating hormone and luteinizing hormone rise in order to prepare the next follicle for ovulation if fertilization does occur the developing embryo secretes hcg or human chorionic gonadotropin and that keeps the that's the feedback mechanism and that keeps the corpus luteum uh alive until the placenta can start secreting hormones hcg is the hormone that's tested for in early pregnancy tests so as soon as the embryo starts secreting hcg you can test for pregnancy in the uterus at the same time the hormones from the corpus luteum are going to cause the endometrium to thicken and it's going to become more vascular and have more glands and if no fertilization occurs and the menstrual phase begins so excuse me here you can see what's happening in the menstruals in the uterus as well as what's happening in the ovaries at the same time the um eventually as i said the the placenta takes over the hormone-producing function and fertilization incurs the corpus luteum secrecy estrogens and progesterone that allow pregnancy to be maintained and start breast development for lactation um there are a number of menstrual abnormalities amenorrhea a in front of something always means without so this is the absence of menstruation and there are a lot of different things that can cause this hormonal imbalance extreme weight loss or low body fat remember that estrogens and progesterone are steroid hormones they're made from cholesterol so if you're very low body fat you're not going to have enough cholesterol to be used to make these steroid hormones also rigorous athletic training women athletes developed this thing called female athlete triad and it consists of three things amenorrhea disordered eating and also development of premature osteoporosis dysmenorrhea is severe pain associated with menstruation this happens oftentimes if there are uterine tumors a lot of women have ovarian cysts and develop severe pain endometriosis can also do it as well as uh a lot of times when women get an iud put in they'll have a lot of pain and also a lot of abnormal bleeding other things that can cause abnormal uterine bleeding would be fibroids as well as hormonal imbalances an abnormal uterine bleeding is defined as excessive amount or duration or inter menstrual in other words bleeding in between periods many women who are first put on the birth control pill may not even be sexually active but they have found that by putting a woman on the pill it regulates the menstrual period so it will decrease this excessive bleeding and allow there to be a short defined period of time during which menstruation occurs fibroids are benign tumors from the muscle in the smooth muscle and it forms they form in the wall of a woman's uterus and they can form at different places they can form submucosal layer the subserus level in the muscle itself they can come off the top of the fundus they can be in the cavity and here you can see a woman with pronounced a uterus from a woman who had pronounced fibroids these cause pain heavy or regular menstrual bleeding painful intercourse increased frequency of urination and can really depending on how large the fibroids get it can cause the abdomen to bloat as women age many women develop fibroids and for the most part they're not a problem polycystic ovary syndrome occurs when numerous cysts develop in the ovaries and these cysts come from the follicles so every month about 20 follicles start to grow usually only one matures and the um follicles that are left over um in in women who have polycystic ovary syndrome the follicles grow but they don't mature and they stay in the ovaries cysts cysts are fluid-filled sacs um so they don't produce an egg they don't have progesterone coming from the corpus luteum uterine lining doesn't thicken um and so they're essentially infertile the uh other health problems that are associated with this diabetes or pre-diabetes by age 40 four to seven times higher risk of heart attack high cholesterol levels and a greater risk of high blood pressure and again here you can see in both of these pictures development stops and you end up with cysts these immature follicles become cysts and so you end up with multiple cysts in here now one thing the cysts do is produce male hormones and the male hormones cause um the androgens so the genetic predisposition to excess ovarian androgen secretion cause things like hirsutism which is an increased level of hair and also problems with insulin resistance and hyperinsulinemia and here you can see the hirsutism on a woman with polycystic ovary disease as well as an increase in acne acne levels can often be correlated with testosterone teratomas are tumors with tissue or organ components resembling normal derivatives more than one germ layer so these terra toma means monster tumor and these are i've seen them already and they're actually quite frightening to look at because they have hair coming out of them teeth fingernails sometimes bones the more defined ones can even have eyes torsos hands feet limbs there are lots of conflicting hypotheses about how these develop where they come from usually they're they have a capsule around them so they don't they're not malignant they don't metastasize and they're benign but the immature malignant teratomas are more often found in men the ones that come from germ cells are commonly found in ovaries of women testes of men and if you think about the germ cells they have the ability once fertilization occurs the fertilized egg can become anything you know some of the cells in there can become anything some are going to become liver some are going to become hard some are going to become skin and so this has to do with why there are so many different tissues seen in teratomas so this is a picture of a teratoma and here you can see the hair in it i believe this is a finger and a tooth here's one that almost looks like a skull with lots of teeth and a jawbone again they quite often have teeth um as well as hair hair and teeth are are big components of teratomas and they can get quite large and there's another one the goals for lecture eight are to describe the effects of following hormones in uterine and or ovarian cycles luteinizing hormone follicle stimulating hormone estrogen progesterone inhibiting relaxin list and describe the four phases of the female reproductive cycle define amenorrhea dysmenorrhea fibroids polycystic ovary syndrome and teratoma