Women’s Health
Ricci Chapter 3-4,5,6,8 and ATI Chapters 1-2, 8
Female Development at Puberty
Menarche first menstruation (2 years after thelarche)
Average age: 12 --- differs based off family hx, genetics and nutrition.
Racial differences: Hispanics and African Americans tend to get it earlier
Irregular periods at first.
Thelarche breast development (average 11 years).
Adrenarche sexual maturation – pubic hair, body odor, skin oiliness, and acne (peaks around 10-14 yo)
Tanner stages the Tanner scale is a scale of physical development in children/adolescents.
Uses secondary sex characteristics (breast development, pubic hair) to define physical measurements of development.
Female Menstrual Cycle
Average of a 28 day cycle in which either a period or pregnancy occur
Hormone Released from: Responsibilities
GnRH Hypothalamus induces the release of FSH and LH from the pituitary to assist with ovulation.
LH Pituitary required for final maturation of follicles and stimulates release of one ovum from follicle.
(Estrogen and progesterone secretion continues (estrogen levels a day before
ovulation).
FSH Pituitary responsible for the maturation of the ovarian follicle. Follicles mature then secretes
estrogen.
Progesterone Corpus leuteum just before ovulation. Peaks 5-7 days after ovulation. Induces swelling and secretion of
the endometrium.
“hormone pregnancy” – because of its calming effect (reduces uterine contractions)
Estrogen Corpus leuteum induces proliferation of the endometrial glands in the endometrial cycle. Also causes the
uterus to in size and weight.
Prostaglandins (not technically a hormone, but secreted by all cells). Primary mediators of the body’s
inflammatory processes. Essential for the physiological function of the female reproductive
system. Plays a key role in ovulation by freeing the ovum inside the graafian follicle.
Timeline of the menstrual cycle is as follow:
1. Pituitary gland releases FSH and LH,
which stimulates follicles in ovaries to
mature
Each follicle contains one ovum “egg”
Maturing follicles secrete estrogen.
2. When estrogen peaks this begins
ovulation and the brain is told to FSH
and LH production
3. Ovulation – the most mature ovum bursts
out of its follicle and starts travelling
towards the uterus via the fallopian tube
to potentially become fertilized by a
sperm.
4. In the ovary, the now empty follicle, the corpus luteum, secretes progesterone.
Stimulates uterine lining (endometrium) to plump with blood and nutrients to prepare for implantation of a fertilized
ovum
5. If an ovum gets fertilized, it implants itself into the plump wall of the uterus.
Conception = pregnancy
Fertilization occurs when the sperm and ovum unite <3
Rev. Fall 2019
, Women’s Health
Ricci Chapter 3-4,5,6,8 and ATI Chapters 1-2, 8
Fertilized ovum is called a zygote Zygote matures into a blastocyst
Zygote implants approximately 6-8 days after
ovulation
Blastocyst causes the body to produce human chorionic gonadotropin (hCG)
hCG tells the corpus luteum to continue Maintains the pregnancy until the placenta takes over
secreting progesterone. production, 2-3 months later
6. If the ovum does not get fertilized, the progesterone and estrogen levels drop.
This tells the uterine lining to shed, because it’s not needed to support a pregnancy
Blood, tissue, and the ovum are shed and leave the body via the vagina.
This can take up to 7 days. This is a period or menses.
Assessment
So what are menstrual cramps?
The uterus is a muscle, which contracts to release the unused contents
Vasoconstriction occurs during these contractions of the uterine muscle.
This causes temporary oxygen deprivation, which then causes the pain (or dysmenorrhea) associated with menses.
How its managed:
o NSAIDs can be used to manage pain.
o Eat complex carbs and avoid high sugar items
o Exercise.
Ovarian phases
Follicular phase before the egg release/pre-ovulation
o Starts FSH + LH secretion (follicles are maturing).
Ovulation phase egg is released; follicular rupture and release of ovum
Luteal phase egg has been released
o Corpus luteum secretes progesterone and continues to if pregnancy occurs.
Ricci Chapter 4 and ATI Chapters 1 and 2
Infertility
Definition inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception. Secondary
infertility is the inability to conceive after previous pregnancy.
Cultural and religious considerations
Jehovah witnesses does not believe in birth control.
Marriage before conception, Roman Catholics are not a fan of assisted reproduction
Infertility can be linked primarily with:
Female factors problems with ovulation, tubal damage, hormone imbalance, premature ovarian failure, etc.
Male factors sperms numbers or motility, erectile dysfunction
Unexplained infertility
Risk Factors of female infertility structural issues (fibroids), chromosomal issues (Turner’s syndrome), infection (STIs), chronic
illness, psychosocial risks (eating disorders, drug abuse)
Risk Factors of male infertility obesity, substance abuse, personal habits (hot tub, sauna, wearing restrictive clothing, certain
prolonged sports such as cycling), toxic substance exposure (x-ray, lead, etc.), STIs
Assessment
Complete medical H&P for both women and men
Diagnostic testing include
Rev. Fall 2019
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