INTRODUCTION TO

WOMEN HEALTH

WOMENS HEALTH

OBSTETRICS: Pregnancy related

problems/infertility.

GYNAECOLOGY: Problems
pertaining to female reproductive
system, menopause

Adolescence
Puberty - Burst of hormones activate
maturation of the gonads: ovaries
Females - 8-13 yrs old
Male 10 to 14 years old
Abnormally early = precocious puberty
Function of Female Reproductive
System:
1. Produce sex hormones
2. Produce functioning ova
3. Support & protect developing embryo

General Physical Changes

Axillary & pubic hair growth

Changes in body conformation
[widening of hips, development of
breasts]
Onset of first menstrual period
[menarche]
Mental changes

Major Organs

Ovaries [ gonads]
Uterine tubes [ fallopian tubes]
Uterus
Vagina
Accessory glands
External genitalia
Breasts

OVARIES

Each ovary is about the size and shape of an almond.

In young women the ovaries are about 1 - 2 inches long, 1

inch wide & 1/3 inch thick. They produce ovum, every female is
born with a lifetime supply of eggs

They are among the first organs to be formed as a female baby

develops in the uterus. At the 20-week mark, there will be
roughly 6 to 7 million potential egg cells.

The number begins to decrease with pregnancy.

A newborn infant has between 1 million to 2 million egg cells.
By puberty the number has plummeted to 300,000. For every
egg that matures and undergoes ovulation, roughly a thousand
will fail, so that by menopause, only a few thousand remain.

During the course of an average reproductive

lifespan, roughly 300 mature eggs are produced
for potential conception.

Ovaries produce hormones : Estrogen &

Progesterone

These hormones control the development of

female body characteristics, such as the breasts,
body shape, and body hair. They also regulate
the menstrual cycle and pregnancy.

Estrogen controls the growth of the lining of the

uterus during the first part of the menstrual
cycle, cause breast development in pregnancy
and regulates various metabolic processes.

Fallopian tubes [uterine tubes]

stretch from the uterus to the ovaries and

measure about 8 to 13 cm in length.
range in width from about one inch at the end
next to the ovary, to the diameter of a strand
of thin spaghetti.
The ends of the fallopian tubes lying next to
the ovaries feather into ends called fimbria..
Millions of tiny hair-like cilia line the fimbria and
interior of the fallopian tubes.
The cilia beat in waves hundreds of times a
second catching the egg at ovulation and
moving it through the tube to the uterine
cavity.
Fertilization typically occurs in the fallopian
tube.

UTERUS

pear-shaped muscular organ in the upper

female reproductive tract.
The fundus is the upper portion of the
uterus where pregnancy occurs.
The cervix is the lower portion of the
uterus that connects with the vagina and
serves as a sphincter to keep the uterus
closed during pregnancy until delivery.
the uterus expands considerably from 10
to 20 times its normal size during
pregnancy.

The main body consists of a firm outer coat

of muscle (myometrium) and an inner
lining of vascular, glandular material
(endometrium).

Pregnancy occurs when the fertilized egg

implants successfully into the endometrial
lining. If fertilization does not occur, the
endometrium sloughs off and is expelled
as menstrual flow.

ENDOMETRIUM

Functional zone adjacent to the

uterine cavity. This layer is built up after
the end of menstruation during the first
part of the previousmenstrual cycle. It is
adapted to provide an optimum
environment for the implantation and
growth of theembryo. This layer is
completely shed during menstruation.
Basal zone adjacent to
themyometriumand below the functional
layer, is not shed at any time during the
menstrual cycle, attaches functional layer
to myometrial tissue, has terminal ends of

CERVIX

The lower portion or neck of the uterus.

The cervix is lined with mucus, the quality

and quantity of which is governed by
monthly fluctuations in the levels of the
estrogen and progesterone.

When estrogen levels are low, the mucus

tends to be thick and sparse, hindering
sperm from reaching the fallopian tubes.
But when an egg is ready for fertilization,
estrogen levels are high, the mucus then
becomes thin and slippery, offering a
friendly environment to sperm

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.

External genitalia

Vulvawhich runs from the pubic area downward

to the rectum.

Labia majora or "greater lips" are the part around

the vagina containing two glands (Bartholins
glands)which helps lubrication during intercourse.

Labia minora or "lesser lips" are the thin hairless

ridges at the entrance of the vagina, which joins
behind and in front. In front they split to enclose
the clitoris

External genitalia

The clitoris is a small pea-shaped

structure
The urethral orifice or external urinary
opening is below the clitoris on the upper
wall of the vagina and is the passage for
urine
The introitus or opening of the vagina is
separate from the urinary opening (unlike
males) and located below it.
The hymen is a thin cresentic fold of
tissue which partially covers the opening
of the vagina.

Mammary Glands [ breasts]

Present in both sexes - normally only

functional in females
Slightly below center of each breast is a
ring of pigmented skin, the areola - this
surrounds a central protruding nipple
Internally - they consist of 15 to 25 lobes
that radiate around and open at the
nipple
Each lobe is composed of smaller lobulesthese contain alveoli that produce milk
when a women is lactating.

GLANDS

Lesser Vestibular (Paraurethral, Skene's)

located on the upper wall of the vagina. They
drain into the urethra and near the urethral
opening
Function - mucus production to aid lubrication
during intercourse
Greater Vestibular (Bartholin's) located slightly
below and to the left and right of the opening of
the vagina. They secrete mucus to provide
lubrication, during sexual arousal.

Muscles of the Pelvic Floor (Pelvic Diaphragm)

The pelvic diaphragm is composed of two

paired muscles levator ani and coccygeus
These muscles:
1.
2.
3.
4.

Close the inferior outlet of the pelvis

Support the pelvic floor
Elevate the pelvic floor to help release feces
Resist increased intra-abdominal pressure

Pelvic Diaphragm is pierced by the rectum

and urethra and vagina in females
Region inferior to the pelvic diaphragm is the
perineum

PELVIC FLOOR MUSCLES

1.
2.
3.
.

The right and left levator ani lie almost

horizontally in the floor of the pelvis.
The levator ani is usually considered in three
parts:
pubococcygeus,
Puborectalis
iliococcygeus.
The coccygeus, situated behind the levator ani
and frequently tendinous as much as muscular,
extends from the ischial spine to the lateral
margin of the sacrum and coccyx.

Muscles of the Pelvic Floor: Pelvic Diaphragm

Figure 10.12a

Muscles Inferior to the Pelvic Floor:

The Urogenital Diaphragm

Muscles inferior to the pelvic floor

Stretches between two sides of the pubic
arch in the anterior half of the perineum
Contains
Deep transverse perineal muscle
Extrnal urethral sphincter muscle

Muscles of the Pelvic Floor

Figure 10.12b

PHYSIOLOGY OF THE
MENSTRUAL CYCLE

DEFINITION

Menstrual cycle can be divided into 3

phases:
menstrual phase
proliferative / follicular (estrogen) phase
secretory / luteal phase (progesterone)
phase

PHASE

AVERAGE START & END ( assuming a 28day cycle)

Menstrual phase

Day 1-5

Follicular phase

Day 1-13

Ovulation phase

Day 14

Luteal phase

Day 15-28

Menstrual phase (day 15)

Menstrual phase begins on the first day of

menstruation and lasts till the 5th day of the
menstrual cycle. The following events occur
during this phase:
The uterus sheds its inner lining of soft tissue and
blood vessels which exits the body from the
vagina in the form of menstrual fluid.
Blood loss of 10 ml to 80 ml is considered normal.
You may experience abdominal cramps. These
cramps are caused by the contraction of the
uterine and the abdominal muscles to expel the
menstrual fluid.

Follicular phase (day 113)

This phase also begins on the first day of

menstruation, but it lasts till the 13th day of the
menstrual cycle. The following events occur
during this phase:
The pituitary gland secretes a hormone that
stimulates the egg cells in the ovaries to grow.
One of these egg cells begins to mature in a saclike-structure called follicle. It takes 13 days for
the egg cell to reach maturity.
While the egg cell matures, its follicle secretes a
hormone that stimulates the uterus to develop a
lining of blood vessels and soft tissue called
endometrium

Ovarian Cycle

Figure 27.20

Ovulation phase (day

14)

On the 14th day of the cycle, the

pituitary gland secretes a hormone that
causes the ovary to release the
matured egg cell. The released egg cell
is swept into the fallopian tube by the
cilia of the fimbriae. Fimbriae are finger
like projections located at the end of
the fallopian tube close to the ovaries
and cilia are slender hair like
projections on each Fimbria.

Luteal phase (day 15-28)

This phase begins on the 15th day and lasts

till the end of the cycle. The following events
occur during this phase:
The egg cell released during the ovulation
phase stays in the fallopian tube for 24 hours.
If a sperm cell does not impregnate the egg
cell within that time, the egg cell
disintegrates.
The hormone that causes the uterus to retain
its endometrium gets used up by the end of
the menstrual cycle. This causes the
menstrual phase of the next cycle to begin

PHYSIOLOGY OF MENSTRUAL CYCLE

The uterine cycle refers to the cyclical

changes that occur in the uterus in
response to ovarian hormones.
Days 1-5 are the follicular (menstrual
phase), during which plasma
progesterone will drop suddenly and the
endometrium will start to shed.
In response to this, the stratum
functionalis will be shed and detached
tissue and blood (menses) will slough
out the vagina

Days 6-14 are the Ovulution (proliferative)

phase, during which plasma estrogen is rising.
This causes the stratum functionalis to grow thicker
and become more vascular and glandular.
This is in preparation for the possibility of
fertilization and pregnancy.
Estrogen also causes cervical mucus to become
less viscous.
This will facilitate sperm entry.

 Days 14-28 are the Luteal (secretory

phase)
After ovulation, the egg only lives for 24
hours or less without fertilization while the
remains of the dominant follicle in the ovary
become acorpus luteum.
Tthis body has a primary function of
producing large amounts ofprogesterone.
Under the influence of progesterone, the
endometrium (uterine lining) changes to
prepare for potential implantationof an

If implantation does not occur within

approximately two weeks, the corpus
luteum will involute, causing sharp drops in
levels of both progesterone and estrogen.

These hormone drops cause the uterus to

shed its lining and egg in a process termed
menstruation.

FEMALE SEXUAL HORMONES

PROGESTERONE

Progesterone causes even more vascularization

of the stratum functionalis and causes the
endometrial glands to twist, coil, and enlarge.
Progesterone will cause cervical mucus to
become more viscous.
This helps prevent the embryo from being
attacked by any pathogens that may migrate
from the vagina.

ESTROGEN

Promotes bone lengthening and epiphyseal plate

closure in adolescents
Inhibits bone resorption
Promotes skin hydration
Stimulates female pattern of fat deposit and
growth of axillary and pubic hair
Increases renal retention of sodium and
consequently of water
Enhances HDL cholesterol (good cholesterol)
and reduces LDL cholesterol (bad cholesterol)

Male 1st observable events

enlargement of testes and penis
Female
1st Thelarche development of breast
2nd-Puberche development of pubic &
axillary hair
3rd-menarche 1st menstrual period

TERMINOLOGY

Puberty - period of life (typically btwn 10y

and 15y) during which the reproductive
organs grow to adult size and become
functional
Menarche - first menstrual period.
Menopause - normal cessation of menstrual
cycle