Week 8 Topic:
expelling the developed fetus through
Reproductive System
Reproductive System:
Ovaries - the female sexual glands
Testes - male sexual glands-respond to
follicle
- stimulating hormone (FSH) and
luteinizing hormone
(LH) - released from the anterior pituitary
in response to stimulation from
gonadotropin-releasing hormone (GnRH)
released from the hypothalamus.
Female Reproductive System
- consists of two ovaries
- two fallopian tubes
uterus
- accessory structures, including the
vagina, clitoris, labia, and breast tissue.
Hormones - estrogen and progesterone
Ovaries
- almond-shaped organs located
on each side of the pelvic cavity
- store the ova, or eggs (ovum = egg).
Ovum
contained in a storage site called a
follicle
- act as endocrine glands producing the
hormones estrogen and
progesterone
- prepare the body for pregnancy and to
maintain the pregnancy until delivery.
Very near to each ovary is a fallopian
tube.
fallopian tube
- muscular tube with a ciliated lining that
is constantly moving
- propels the ovum released into the
abdomen down the fallopian tube and
into the uterus, or womb, for the
developing embryo and fetus.uterus
- muscular organ, develop a b l o o d
-filledinnerlining,or
Endometrium
- allows for implantation of the fertilized
egg and supports the development of the
placenta, that provides nourishment for
the developing fetus and acts as an
endocrine gland producing the hormones
needed to maintain the active metabolic
state of the pregnancy.The muscular
walls of the uterus are important for
the vagina at delivery.
External genitalia
—clitoris, labia, and v a g i n a
—aresitesoferogenous
stimulation and entry way for sperm to
reach the uterus to allow conception and
the exit path for the developed fetus at
birth.
Breast tissue
- a s e c o n d a r y s e x characteristic, is
controlled by the female sex hormones
and is necessary for producing milk for
the nourishment of the baby
Hormones
Estrogen
- produced by the ovaries include
estradiol, estrone, and estriol.
-enter cells and bind to receptors w i t h i
n t h e cy t o p l a s m t o p r o m o t e
messenger RNA (mRNA) activity, which
results in specific proteins for cell activity
or Structure
Effects of Estrogen
• Growth of genitalia (in preparation for
childbirth)
• Growth of breast tissue (in preparation
for pregnancy and
lactation)
• Characteristic female pubic hair
distribution (a triangle)
• Stimulation of protein building
(important for the developing
fetus)
• Increased total blood cholesterol (for
energy for the mother as well as the
developing fetus) with an increase in
highdensity lipoprotein levels (“good”
cholesterol, which serves to protect the
female blood vessels against
atherosclerosis)
• Retention of sodium and water (to
provide cooling for the heat
generated by the developing fetus and to
increase diffusion of
sodium and water to the fetus through
the placenta)
Inhibition of calcium resorption from the
bones (helps to deposit calcium in the
fetal bone structure; when this property
is lost at menopause, osteoporosis, or
loss of calcium from the bone, is
common)
• Alteration of pelvic bone structure to a
wider and flaring pelvis (to promote
easier delivery)
• Closure of the epiphyses (to conserve
energy for the fetus by halting growth of
the mother)
• Increased thyroid hormone globulin
(metabolism needs to be increased
greatly during pregnancy, and the
increase in thyroid hormone facilitates
this)
• Increased elastic tissue of the skin (to
allow for the tremendous stretch of the
abdominal skin during pregnancy)
• Increased vascularity of the skin (to
allow for radiation loss of heat generated
by the developing fetus)
• Increased uterine motility (estrogen is
high when the ovum first leaves the
ovary, and increased uterine motility
helps to move the ovum toward the
uterus and to
propel the sperm toward the ovum)
• Thin, clear cervical mucus (allows easy
penetration of the sperm into the uterus
as ovulation occurs; used in fertility
programs as an indication that ovulation
will
soon occur)
• Proliferative endometrium (to prepare
the lining of the uterus for implantation
with the fertilized egg)
• Anti-insulin effect with increased
glucose levels (to allow increased
diffusion of glucose to the developing
fetus)
• T-cell inhibition (to protect the non–self
cells of the embryo from the immune
surveillance of the mother)
Progesterone
- released into circulation
after ovulation
- many effects that support the early
development of the fetus
- effects on body temperature are
monitored in the “rhythm method” of
birth control to indicate that ovulation
has just occurred
Effects of Progesterone
• Decreased uterine motility (to provide
increased chance that implantation
can occur)
• Development of a secretory
endometrium (to provide glucose and a
rich blood supply for the developing
placenta and embryo)
• Thickened cervical mucus (to protect
the developing embryo and keep out
bacteria and other pathogens; this is lost
at the beginning of labor as
the mucous plug)
• Breast growth (to prepare for lactation)
• Increased body temperature (a direct
hypothalamic response to
progesterone, which stimulates
metabolism and promotes activities for
the developing embryo; this increase in
temperature is monitored in the
“rhythm method” of birth control to
indicate that ovulation has
occurred)
• Increased appetite (this is a direct effect
on the satiety centers of the
hypothalamus and results in increased
nutrients for the developing
embryo)
• Depressed T-cell function (again, this
protects the non–self cells of
the developing embryo from the immune
system)
• Anti-insulin effect (to generate a higher
blood glucose concentration to
allow rapid diffusion of glucose to the
developing embryo)Interaction of the
hypothalamic, pituitary, and ovarian
hormones that underlies the
menstrual cycle. Dotted lines indicate
negative feedback
surge. CNS, central nervous system; FSH,
follicle-stimulating hormone; GnRH,
gonadotropin-releasing hormone; LH,
luteinizing hormone.
Sex Hormones
estrogens and the progestins
- the endogenous female hormone
progesterone and its various derivatives.
Estrogens that are available for use
include estradiol (Estrace, Climara, and
others),
Conjugated estrogens (Premarin),
Esterified estrogen (Menest), and
estropipate (Ortho-
Est, Ogen).
Progestins include drospirenone (Yasmin,
Yaz), etonogestrel
(Implanon), levonorgestrel (Mirena),
medroxyprogesterone
(Provera), norethindrone (Aygestin),
norgestrel (Ovrette),
progesterone (Progestasert and others),
and desogestrel (found
in many contraceptive combinations).
THE FEMALE REPRODUCTIVE SYSTEM
Hypothalamus, Pituitary Gland, and
Ovary
Regulation of the female reproductive
system is achieved by hormones.
Hypothalamus > secretes GnRH Pituitary
> stimulate the secretion of FSH and LH
day 14 of the ovarian cycle - surge of LH
secretion causes one follicle to expel its
oocyte, a process called ovulation
Hormonal changes during the
ovarian and uterine cycles
Ovarian follicles mature > secrete the
female sex hormones
estrogen and progesterone.
Estrogen :
estradiol, estrone, and estriol
-responsible for the maturation of the
female reproductive organs
-appearance of secondary sex
characteristics
- metabolic effects on nonreproductive
tissues, including the brain, kidneys,
blood vessels, and skin.
- estrogen decreases the levels of LDL ;
increases the amount of HDL
- help lower the risk of myocardial
infarction (MI) in premenopausal
women
-causes bones to grow longer and
stronger in younger womencorpus
luteum > secretes a progestins, most
abundant of is progesterone.
- combination of estrogen, progesterone
promotes breast development
- regulates the monthly changes of the
uterine cycle
- uterine endometrium becomes vascular
and thickens in preparation for
receiving a fertilized egg
- final third of the uterine cycle provide
negative feedback to shut off GnRH,
FSH, and LH secretion
- Without stimulation from FSH and LH,
estrogen and progesterone levels
fall sharply, the endometrium is shed, and
menstrual bleeding begins.
- pharmacologic use of the female sex
hormones is to prevent pregnancy
- treat dysfunctional uterine bleeding
-severe symptoms of menopause
-certain neoplasms.
Negative feedback control of the
female reproductive hormones
Facts in Female Reproduction
■ There is a wide range of ages at which
women reach menopause: 8 of 100
women will stop menstruating before age
40, and 5 of 100 women will continue to
age 60 and beyond.
■ About 90% of dysfunctional uterine
bleeding occurs due to lack of ovulation.
■ It is estimated that approximately 10%
to 15% of all sexually active women use
no birth control, contributing to the
almost 50% unintended pregnancy rate.
■ Over 10% of sexually experienced
women aged 15 to 44 have used
emergency contraception (Plan B).
■ Oral contraceptives confer benefits
besides contraception, including the
following:
Reduced risk for colorectal, ovarian, and
endometrial cancer
Decreased risk for benign breast disease,
ovarian cysts, primary dysmenorrheal
and iron-deficiency anemia
Improvement in acne and bone mineral
density
ORAL CONTRACEPTIVES
- drugs used in low doses to prevent
pregnancy.
- “the pill”
- prevent fertilization by inhibiting
ovulation.
Estrogens and Progestins as Oral
Contraceptives:
- common estrogen used for
contraception is ethinyl estradiol
- most common progestin is
norethindrone
- hormonal contraception is nearly 100%
effective
- administration of an OC begins on day 5
of the menstrual cycle and continues for
21 days. During the other 7 days of the
month, the woman takes a placebo.
placebos contain iron, which replaces iron
lost due to menstrual bleeding
- reason for treatment failure
(pregnancy), is forgetting to take the
medication
Daily
ORAL CONTRACEPTIVES
Estrogen–Progestin OCs:
monophasic
- delivers a constant dose of estrogen
and progestin throughout the 21-day
treatment cycle.
biphasic agents
- amount of estrogen in each pill remains
constant, but the amount of progestin is
increased toward the
end of the treatment cycle to better
nourish the uterine lining.
triphasic formulations
- amounts of both estrogen and progestin
vary in three distinct phases during the
treatment cycle.
four-phase OC
– first, Natazia contains estradiol valerate,
a synthetic estrogen, and dienogest, a
progestin this is the first drug containing
this specific combination.
Natazia
- estradiol valerate, a synthetic estrogen
- first OC to be approved to treat heavy
menstrual bleeding
Dienogest
- a progestin this is the first drug
containing this specific combination
progestin-only Ocs - called minipills
-prevent pregnancy primarily by
producing thick, viscous mucus at the
entrance to the uterus that discourages
penetration by sperm.
-inhibit implantation of a fertilized egg.
-less effective than estrogen progestin
combinations, having a failure rate of 1%
to 4%.
- a higher incidence of menstrual
irregularities such as amenorrhea,
prolonged menstrual bleeding, or
breakthrough spotting.
- reserved for patients who are at high
risk for estrogen-related side effects
- not associated with a higher risk of
thromboembolic events
- have no effect on breast cancer.
-pregnancy category X.
SELECTED ORAL CONTRACEPTIVES
Long-Term Hormonal Formulations:
- extended-duration formulations are
equally effective in preventing
pregnancy and have the same basic
safety profile as OCs.
-advantage for women who are likely to
forget their daily pill
- prefer a greater ease of use
● Depot injections
- deep IM injection of
medroxyprogesterone that provides 3
months of contraceptive protection. Also
providing 3 months of contraception is
Depo-SubQ-Provera, the same drug
administered by the subcutaneous route.
● Implants
- a single rod containing the progestin
etonogestrel that is inserted under the
skin of the upper arm that provides 3
years of
contraceptive protection.
Long-Term Hormonal Formulations:
● Transdermal patches
- Ortho-Evra is a transdermal patch
containing ethinyl estradiol and
norelgestromin; changed every 7 days for
the first 3 weeks, followed by a patch-free
week 4.
● Vaginal route
- NuvaRing is a 2-inch-diameter ring
containing estrogen and progestin that
is inserted into the vagina to provide 3
weeks of contraceptive protection. The
ring is removed during week 4, and a new
ring is inserted during the first week of
the next
menstrual cycle.
● Intrauterine route
- Mirena is a polyethylene cylinder that is
placed in the uterus and releases
levonorgestrel; size of a quarter and
shaped like the letter T, Mirena acts
locally to
prevent conception for 5 years.
● Extended-regimen Ocs
 - Seasonale consists of tablets containing
levonorgestrel and ethinyl estradiol that
are taken for 84 consecutive days,
followed by 7 inert tablets (without
hormones); allows for continuous
contraceptive protection while extending
the time between menses; only four
menstrual periods are experienced per
year.
-Seasonique is similar, but instead of
inert tablets for 7 days, the patient takes
low-dose estrogen tablets.; has a lower
incidence of bloating and breakthrough
bleeding.
Assessing for Adverse Effects of Oral
Contraceptives:
“ACHES” is a mnemonic developed to
assist health care providers,
nurses, and women on OCs to remember
the possible adverse effects
of OCs in order to ensure they are
promptly reported and assessed
(FHI360, 1996, 2012):
A - abdominal pain;
C – chest pain;
H – headache;
E – eye problems, blurred or loss of
vision;
S – swelling.
If any of these occur or are severe while a
woman is on OCs, she should report them
promptly to her health care provider.
ASSESSMENT:
Baseline assessment prior to
administration:
■ Obtain a complete health history
including cardiovascular, peripheral
vascular, thyroid, hepatic, or renal
disease; migraine headaches; diabetes;
pregnancy; or breast-feeding. Note
personal or family history of
thromboembolic disorders (e.g., MI,
stroke, PVD) and of reproductive cancers
(e.g.,breast, uterine, or ovarian cancer).
■ Obtain a drug history including
allergies, current prescription and OTC
drugs,
herbal preparations, alcohol use, and
smoking. Be alert to possible drug
interactions.
■ Evaluate appropriate laboratory
findings (e.g., complete blood count
[CBC], platelets, electrolytes, glucose,
lipid, and thyroid function levels, Pap
test).
■ Obtain baseline height, weight, and
vital signs.
NURSING PROCESS: PATIENTS RECEIVING
ORAL CONTRACEPTIVES
Assessment throughout administration:
■ Assess for desired therapeutic effects
depending on the reason
the drug is given (e.g., pregnancy
prevention).
■ Continue periodic monitoring of CBC,
platelets, and glucose.
■ Monitor vital signs and weight at each
health care visit.
■ Assess for adverse effects: nausea,
vomiting, headache, weight gain, breast
tenderness, skin rash, acne, fluid
retention, changes in mood, and
breakthrough bleeding. Immediately
report tachycardia, palpitations, and HTN,
especially associated with angina; severe
headache; cramping in calves; positive
Homans’ sign; chest pain; or dyspnea.
POTENTIAL NURSING DIAGNOSES:
■ Decisional Conflict
■ Disturbed Body Image
■ Deficient Knowledge (drug therapy)
■ Risk for Excess Fluid Volume, related to
adverse drug effects
■ Risk for Ineffective Peripheral Tissue
Perfusion, related to adverse drug effects
■ Risk for Ineffective Cerebral Tissue
Perfusion, related to adverse drug effects
■ Risk for Ineffective Cardiac Tissue
Perfusion, related to adverse drug effects
PLANNING: PATIENT GOALS AND
EXPECTED OUTCOMES
The patient will:
■ Experience therapeutic effects (e.g.,
effective birth control).
■ Be free from, or experience minimal,
adverse effects.
■ Verbalize an understanding of the
drug’s use, adverse effects, and required
precautions.
■ Demonstrate proper self-administration
of the medication (e.g., dose, timing,
when to notify provider).
PLANNING: PATIENT GOALS AND
EXPECTED OUTCOMES
The patient will:
■ Experience therapeutic effects (e.g.,
effective birth
control).
■ Be free from, or experience minimal,
adverse effects.
■ Verbalize an understanding of the
drug’s use, adverse
effects, and required precautions.
■ Demonstrate proper self-administration
of the
medication (e.g., dose, timing, when to
notify provider).