2 The Ovarian Cycle Fig 27.20

3 Events & Phases of the Ovarian Cycle (a time line) Ovulation Preovulatory Postovulatory Follicular Luteal (variable length) (always 14 days)

5 Hormonal Controls (cont’d)Not in text. But is on my web page. ??? XD

6 Events & Phases of the Uterine Cycle (a time line) Menses Postmenstrual Premenstrual Proliferative Secretory (variable length) (always 14 days)

7 The Uterine (menstrual) CycleFig 27.22

8 The Endometrium Fig 27.15

9 Menses Fig 27.22 If no HCG detected… Corpus Luteum degenerates 7-10 days after ovulation Therefore estrogen and progesterone both  Spiral arteries spasm  ischemia, hypoxia, and necrosis of functional layer Lysosomes in functional layer release enzymes to ‘self digest’ Myometrium contracts (i.e.. “cramps”) to break up functional layer Spiral arteries dilate  fresh blood flushes out functional layer

10 Put it all together… Not in text, but on my website.

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13 Q & A

15 PMS Definition… When… S&S…Food cravings, headache, irritability, depression, back ache, aggression, dramatic mood swings, breast tenderness, nausea, bloating Causes… Men Mostly unknown Estrogen mimics aldosterone… (…explains the bloated feeling) In some women [serotonin] … (…explains the chocolate cravings)

16 PMS Trtmt / Things to try…. Pleeeeease… sugar intake  caffeine “ salt “ B vitamins (meats, shellfish, greens…)  Mg++ (nuts, seeds, rice, wheat…)  Ca++ (milk, cheese, spinach…)  essential FAs (in fish, flax seed oil & evening primrose oil) OTC meds: Midol, Pamprin, Diurex Most contain 3 ingredients: analgesic, diuretic, antihistamine If S&S are more severe… PMDD – Premenstrual Dysphoric Disorder Trtmt: SSRIs during luteal phase often beneficial

18 Preeclampsia / EclampsiaFormerly (& mistakenly) “toxemia of pregnancy” A syndrome characterized by: HTN Proteinuria Possible tissue edema (but many possible causes, so not a good indicator) and possible cerebral edema. Fig 19.17 Fig 25.11 Proteinuria Tissue Edema

19 Preeclampsia / Eclampsia cont’d1 in 10 pregnancies, usually last trimester Cause: vascular spasms results in HTN …. Proteinuria …. edema ? Why…? Ans: loss of plasma proteins at kidney = loss of balance between HP and OP across capillary walls peripheral edema = often ankles, hands, & face Cerebral edema (mom)  seizures (mom) May  BF to placenta & fetus Progression: 1) mild pre… 2) severe pre… 3) eclampsia Criteria for mild = 30 above normal systolic or 15 above normal diastolic

20 Preeclampsia – Eclampsia (cont’d)Trtmt: Childbirth = only cure. Birth may be induced early. If too early for birth… Bed Rest, lying on Left side.  pressure on inferior vena cava and  BF to placenta

21 Preeclampsia – Eclampsia (cont’d)Trtmt cont’d:  dietary intake of Ca++ and Mg++ Ca++ inhibits contractions of smooth muscles (therefore inhibits vasoconstriction) Results in vasodilation and  BP Mg++ calms CNS, thus  odds of seizure Anti-HTN meds and sedatives If urgent: Mag sulfate by IV drip. Effect is anticonvulsant and CNS depressant by  release of ACh in brain

22 Diabetes caused by pregnancy, GDMGDM = Gestational Diabetes Mellitus Begins during pregnancy & resolves at birth Occurs 1 in 20 High levels of estrogen and progesterone (from placenta) cause insulin resistance Placenta also releases excess insulinase Thus hyperglycemia Fetus becomes abnormally large (fat) Trtmt: Diabetic diet Exercise Diabetic meds Insulin injections

23 Also…. Fig 16.5 Diabetes Insipidus of PregnancyRecall ADH is a.k.a. Vasopressin Excess vasopressinase may be released in last trimester so… ADH broken down too quickly so [ADH]  so… urine vol.  dehydration & corresponding S&S … Low BP, HR, thirst, light headed, etc.

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27 Lactation – after pregnancyProlactin… From Ant. Pituitary Stimulates alveolar glands to produce milk… 2-3 days before first “true” milk Colostrum is available immediately - Low in fat & lactose

30 Placenta Previa - OYO Definition… Placenta may tear prematurely May tear during birth May precede infant out of womb

32 Placenta Abruptio - OYODefinition… Premature separation of placenta from uterine wall – usually in last trimester. S&S… Varies with severity of separation. Pain and vaginal bleeding most common. Trtmt: Varies with severity. If minor - Bed rest If severe – induced labor or C-section

33 Remember the 2 circuits and path of BF through heart?

34 3 Vascular “shunts” Ductus venosus Foramen ovale Ductus arteriosusIt’s different while in the womb… 3 Vascular “shunts” Ductus venosus Foramen ovale Ductus arteriosus Fetus Placenta 2 Umbilical arteries 1 Umbilical vein

35 Occlusion of Fetal Vessels & ShuntsFig 28.14

36 Q&A Fig 19.17 Fig 25.11

37 Q&A Fetus Placenta

38 Possible AbnormalitiesPatent ductus arteriosus  Pulmonary BP (HTN) because… Pulmonary edema, SOB, etc. Very audible murmur Atrial Septal Defect, ASD Foramen ovale remains open (‘patent’)  PO2 because… Cyanosis

46 Causes of Birth Defectsweb #1 - alcohol, tobacco, meds, drugs, chemicals, radiation Random chance Genetics

47 FAS = Fetal Alcohol Syndromeweb Results: 1. Mental retardation Now called IDD (Intellectual Development Disorder) 3. Facial deformities

49 Menopause Definition… Climacteric… Perimenopause When… Why…

51 Our “messed up” priorities…5X $$ Alzheimer’s Research

52 30 years from now…

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