USMLE Step 1 Web Prep Female Reproductive System: Part 1

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Chapter 11: Female Reproductive System

THE E!STR"#L C$CLE We will divide the menstrual cycle into the following phases or events: Follicular phase, also called the proliferative or preovulatory phase This phase is dominated by the peripheral effects of estro%e& 'vulatio& !haracteri"ed by the LH sur%e which actually induces ovulation Luteal phase #ominated by the elevated plasma levels of pro%estero&e which along with the estrogen secreted prepares the uterus for implantation e&ses Withdrawl of the hormonal support of the endometrium
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Follicular )hase &appro'imately day 1 to day 1%( )can vary

Thecal cell in ovaries &li*e +eydig( 1 +, stimulate

$ produce androgen - not released to the circulation, diffuse to the granulosa cell 3 lac* aromatase activity *ra&ulosa cell &li*e .ertoli( 1 has aromatase activity &converts androgen to the estrogen( $ has /., receptors 3 secretes inhibins &not well understood role( most estrogen produced by granulose cell estrogen slo+ly rising during early follicle phase- negative feedbac* ) for ,oth /., and +, estrogen increases more dramatically at the later part follicle phaseas estrogen rises- you e'pect oversuppression /., and +,, but it continues to rise because estrogen has local effect &on granulose and thecal cells(- positive local feedbac* loop- so it continues to rise &enhances its own production(
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)eripheral effects of estro%e& duri&% the follicular phase:

!irculating estrogens stimulate the female se' accessories and secondary se' characteristics 1ising levels of estrogens cause the endometrial cells of the uteri&e mucosal layers to increase their rate of mitotic division & proliferate( They cause the cervical mucus to be thin and +atery, ma*ing the cervi' easily transversable by sperm
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'vulatio& &appro'imately day 1%(

once estrogen rises 34567 certain plasma level- it no longer creates negative feedbac* to anterior pituitary - it switches to a positive feedbac* cause +, and /., surge only LH sur%e is re8uired for ovulation /., surge- not re8uired for ovulation

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Luteal )hase &appro'imately day 1% to day $9( ) al+ays 1% days

even before +, surge- thecal and granulose cells start to change- in anticipation to the luteal phase 1 granulose cells- begin to produce +, receptors metabolic pathway favor production estrogen &primary end-product( $ pathways move away from estrogen and produce progesterone we will have +, surge- final conversion of thecal and granulose to the luteal cellsecrete progesterone and continue to secrete estrogen #uring luteal )+, stimulate luteal cell- pro%estero&e- main negative feedbac* to LH, the higher progesterone ) the greater suppression of +, :ea* )in the middle of luteal phase and then decline
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The i&creased plasma level of pro%estero&e has several actions:

!auses the uterine endometrium to become secretory, providing a source of nutrients for the blastocyst !auses the cervical mucus to become thic1, sealing off the uterus from further entry of sperm or bacteria ,as thermogenic properties causing the basal body temperature to i&crease by 0 5-1 0< /
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e&ses

+, stimulate luteal cells ) progesterone increases- negative feedbac*oversuppresing +, - then progesterone decreases- less negative feedbac*- +, increases- progesterone should increases, but it decreases +uteal cell- stop responding to +,, progesterone decreases, and decreases in progesterone cause menses &withdraw support from endometrium( =>s: at the midpoint ) second pea* luteal phase - second pea* estrogen ) should be second +, surge Why not have second +, surge- hi%h level of pro%estero&e prevent +, surge because it i&hi,its LH ?aintain high level progesterone- always prevent +, surge- women should never ovulate and never menstruate &because progesterone withdrawal cause menses( =>s: if women ta*es birth control pills high in progesterone, she need to induce menses: stop ta*ing the pills: plasma progesterone decreases, withdrawal of progesterone support- cause menses 7strogen and progesterone- lipid-soluble- bound to protein-so not e'creted in urine: go metaboli"ed- converted to water-soluble compounds and e'creted in urine @ou can follow urine metabolites of estrogen and progesterone to draw conclusion about menstrual cycle: =>s: low progesterone metabolites and low but slowly rising estrogen: early follicle phase

+ow progesterone and rapidly rising estrogen: later part of follicle phase Aust before ovulation +, surge occurs after estrogen has pea* =>s: estrogen are still rising: ovulation has not occurred &no +, surge( 7levated progesterone: luteal phase or pregnancy #ates of menstrual cycle is varied 2ariatio& is usually in follicle phase .o luteal phase is always 1% days ?enstrual cycle in days, what days is ovulation- luteal phase is always 1% days 7strogen- generic terms: 3 type of natural estrogens: 1. 10--estradiol- maAor estrogen by ovary &potent( $ estron- not important 3 estrol- maAor estrogen secreted by place&ta &least potent of the three(