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INTRODUCTION TO

WOMEN HEALTH

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WOMENS HEALTH

OBSTETRICS: Pregnancy relatedproblems/infertility.

GYNAECOLOGY: Problemspertaining to female reproductivesystem, menopause

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Adolescence

Puberty - Burst of hormones activate

maturation of the gonads: ovaries Females - 8-1 yrs old

!ale " 1# to 1$ years old

%bnormally early & precocious pubertyFunction of Female Repo!ucti"e

S#$tem:

1. Produce se' hormones

(. Produce functioning ova

. )upport * protect developing embryo

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General Physical Changes

%'illary * pubic hair gro+th

hanges in body conformation+idening of hips, development ofbreasts

nset of 0rst menstrual periodmenarche

!ental changes

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Major Organs

varies gonads

terine tubes fallopian tubes

terus

2agina

%ccessory glands

3'ternal genitalia

Breasts

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OARIE! 3ach ovary is about the si4e and shape of an almond.

5n young +omen the ovaries are about 16 - ( inches long, 1

inch +ide * 1/ inch thic7. hey produce ovum, every female is

born +ith a lifetime supply of eggs

hey are among the 0rst organs to be formed as a female baby

develops in the uterus. %t the (#-+ee7 mar7, there +ill be

roughly 9 to million potential egg cells.

he number begins to decrease +ith pregnancy.

% ne+born infant has bet+een 1 million to ( million egg cells.

By puberty the number has plummeted to ##,###. For every

egg that matures and undergoes ovulation, roughly a thousand

+ill fail, so that by menopause, only a fe+ thousand remain.

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;uring the course of an average reproductivelifespan, roughly ## mature eggs are producedfor potential conception.

varies produce hormones : E$to%en '(o%e$teone

hese hormones control the development offemale body characteristics, such as the breasts,body shape, and body hair. hey also regulatethe menstrual cycle and pregnancy)

3strogen controls the gro+th of the lining of theuterus during the 0rst part of the menstrualcycle, cause breast development in pregnancy

and regulates various metabolic processes.

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"allo#ian $%&es '%$erine $%&es(

stretch from the uterus to the ovaries andmeasure about 8 to 1 cm in length. range in +idth from about one inch at the end

ne't to the ovary, to the diameter of a strandof thin spaghetti.

he ends of the fallopian tubes lying ne't tothe ovaries feather into ends called 0mbria.. !illions of tiny hair-li7e cilia line the 0mbria and

interior of the fallopian tubes. he cilia beat in +aves hundreds of times a

second catching the egg at ovulation andmoving it through the tube to the uterinecavity.

Fertili4ation typically occurs in the fallopiantube.

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UTERU!

pear-shaped muscular organ in the upperfemale reproductive tract.

he fundus is the upper portion of theuterus +here pregnancy occurs.

he cervi' is the lo+er portion of theuterus that connects +ith the vagina andserves as a sphincter to 7eep the uterusclosed during pregnancy until delivery.

the uterus e'pands considerably from 1#to (# times its normal si4e duringpregnancy.

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he main body consists of a 0rm outer coat

of muscle

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ENDOMETRIUM Functional *one " ad@acent to the

uterine cavity. his layer is built up afterthe end of menstruation during the 0rstpart of the previous menstrual cycle. 5t isadapted to provide an optimum

environment for the implantation andgro+th of the embryo. his layer iscompletely shed during menstruation.

Ba$al *one " ad@acent tothe myometrium and belo+ the functionallayer, is not shed at any time during themenstrual cycle, attaches functional layer

to myometrial tissue, has terminal ends of

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CERI)

he lo+er portion or nec7 of the uterus.

he cervi' is lined +ith mucus, the Cualityand Cuantity of +hich is governed bymonthly ?uctuations in the levels of the

estrogen and progesterone.

Dhen estrogen levels are lo+, the mucustends to be thic7 and sparse, hindering

sperm from reaching the fallopian tubes.But +hen an egg is ready for fertili4ation,estrogen levels are high, the mucus thenbecomes thin and slippery, o>ering a

Efriendly environment to sperm

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The cervical canal expands to roughly 50 times

its normal width in order to accommodate the

passage of the baby during birth

a muscular, ridged sheath connecting the

external genitals to the uterus.

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E+tenal %enitalia

%l*awhich runs from the pubic area downward

to the rectum.

La&ia +ajora or "greater lips" are the part aroundthe vagina containing two glands (artholin!sglandswhich helps lubrication during intercourse.

La&ia +inora or "lesser lips" are the thin hairless

ridges at the entrance of the vagina, which #oinsbehind and in front. $n front they split to enclosethe clitoris

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E,$ernal geni$alia

he clitoi$is a small pea-shaped

structure

he uet,al oi-ce or e'ternal urinaryopening is belo+ the clitoris on the upper

+all of the vagina and is the passage forurine

he intoitu$or opening of the vagina isseparate from the urinary opening

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Ma++ary Glands ' &reas$s(

Present in both se'es - normally only

functional in females )lightly belo+ center of each breast is a

ring of pigmented s7in, the areola - thissurrounds a central protruding nipple

5nternally - they consist of 1G to (G lobesthat radiate around and open at thenipple

3ach lobe is composed of smaller lobules-

these contain alveoli that produce mil7+hen a +omen is lactating.

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GLAND!

Lesser es$i&%lar (%araurethral, &'enes

located on the upper wall of the vagina. They

drain into the urethra and near the urethral

opening

"%nc$ion) mucus production to aid lubricationduring intercourse

Grea$er es$i&%lar (artholins located slightly

below and to the left and right of the opening of

the vagina. They secrete mucus to providelubrication, during sexual arousal.

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PELIC "LOOR MU!CLE!

The right and left le*a$or ani lie almosthori4ontally in the floor of the pelvis.

The levator ani is usually considered in three

parts+

. pubococcygeus,

. %uborectalis

/. iliococcygeus.

. The coccyge%s, situated behind the levator aniand freuently tendinous as much as muscular,

extends from the ischial spine to the lateral

margin of the sacrum and coccyx.

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!uscles of the Pelvic Floor: Pelvic ;iaphragm

Figure 10.12a

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Mu$cle$ Infeio to t,e (el"ic Floo:T,e .o%enital /iap,a%m

6uscles inferior to the pelvic floor &tretches between two sides of the pubic

arch in the anterior half of the perineum

-ontains Dee# $rans*erse #erineal +%scle

E,$rnal %re$hral s#hinc$er +%scle

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!uscles of the Pelvic Floor

Figure 10.12b

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PHI)5JKI F H3!3L)%J IJ3

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/EFINITION

!enstrual cycle can be divided into phases:

menstrual phase proliferative / follicular

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(HASE A0ERAGE START ' EN/ 1 a$$umin% a 234!a# c#cle5

!enstrual phase ;ay 1-G

Follicular phase ;ay 1-1

vulation phase ;ay 1$

Juteal phase ;ay 1G-(8

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M t l , 1! 6

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Men$tual p,a$e 1!a# 6475

!enstrual phase begins on the 0rst day ofmenstruation and lasts till the Gth day of themenstrual cycle. he follo+ing events occurduring this phase:

he uterus sheds its inner lining of soft tissue andblood vessels +hich e'its the body from thevagina in the form of menstrual ?uid.

Blood loss of 1# ml to 8# ml is considered normal.

Iou may e'perience abdominal cramps. hesecramps are caused by the contraction of theuterine and the abdominal muscles to e'pel themenstrual ?uid.

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Follic la p,a$e 1!a 6

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Follicula p,a$e 1!a# 64685

his phase also begins on the 0rst day ofmenstruation, but it lasts till the 1th day of themenstrual cycle. he follo+ing events occurduring this phase:

he pituitary gland secretes a hormone thatstimulates the egg cells in the ovaries to gro+.

ne of these egg cells begins to mature in a sac-li7e-structure called follicle. 5t ta7es 1 days forthe egg cell to reach maturity.

Dhile the egg cell matures, its follicle secretes ahormone that stimulates the uterus to develop alining of blood vessels and soft tissue calledendometrium

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O"aian C#cle

Figure 27.20

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O"ulation p,a$e 1!a#

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O"ulation p,a$e 1!a#695

n the 1$th day of the cycle, thepituitary gland secretes a hormone thatcauses the ovary to release the

matured egg cell. he released egg cellis s+ept into the fallopian tube by thecilia of the 0mbriae. Fimbriae are 0ngerli7e pro@ections located at the end of

the fallopian tube close to the ovariesand cilia are slender hair li7epro@ections on each Fimbria.

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Luteal p,a$e 1!a# 674235

his phase begins on the 1Gth day and laststill the end of the cycle. he follo+ing eventsoccur during this phase:

he egg cell released during the ovulation

phase stays in the fallopian tube for ($ hours. 5f a sperm cell does not impregnate the egg

cell +ithin that time, the egg celldisintegrates.

he hormone that causes the uterus to retainits endometrium gets used up by the end ofthe menstrual cycle. his causes themenstrual phase of the ne't cycle to begin

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(HYSIOLOGY OF MENSTR.AL CYCLE

he uteine c#cle refers to the cyclicalchanges that occur in the uterus inresponse to ovarian hormones.

;ays 1-G are the follicula 1men$tual

p,a$e5, during +hich plasmaprogesterone +ill drop suddenly and theendometrium +ill start to shed.

5n response to this, the stratumfunctionalis +ill be shed and detachedtissue and blood

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3ays 7)1 are the O*%l%$ion .#roli-era$i*e/

#hase, during which plasma estrogen is rising.

This causes the stratum functionalis to grow thic'erand become more vascular and glandular.

This is in preparation for the possibility of

fertili4ation and pregnancy.

strogen also causes cervical mucus to becomeless viscous.

This will facilitate sperm entry.

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8 ;ays 1$-(8 are the Luteal 1$eceto#p,a$e5

8 %fter ovulation, the egg only lives for ($hours or less +ithout fertili4ation +hile theremains of the dominant follicle in the ovary

become a copu$ luteum)

8this body has a primary function ofproducing large amounts of po%e$teone)

8 nder the in?uence of progesterone, theendometrium

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5f implantation does not occur +ithinappro'imately t+o +ee7s, the corpusluteum +ill involute, causing sharp drops inlevels of both progesterone and estrogen.

hese hormone drops cause the uterus toshed its lining and egg in a process termedmenstruation.

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"EMALE !E)UAL HORMONE!

PROGE!TERONE

%rogesterone causes even more vasculari4ation

of the stratum functionalis and causes the

endometrial glands to twist, coil, and enlarge.

%rogesterone will cause cervical mucus tobecome more viscous.

This helps prevent the embryo from being

attac'ed by any pathogens that may migrate

from the vagina.

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ESTROGEN

%romotes bone lengthening and epiphyseal plate

closure in adolescents $nhibits bone resorption %romotes s'in hydration &timulates female pattern of fat deposit and

growth of axillary and pubic hair $ncreases renal retention of sodium and

conseuently of water

nhances 93: cholesterol (;good cholesterol

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!ale " 1st observable events "enlargement of testes and penis

Female

1st

"helarche " development of breast (nd-Puberche " development of pubic *

a'illary hair

rd-menarche " 1stmenstrual period

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TERMINOLOG0

P%&er$y ) period of life (typically btwn 0y

and 5y during which the reproductive

organs grow to adult si4e and becomefunctional

Menarche ) first menstrual period.

Meno#a%se ) normal cessation of menstrual

cycle

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