1 .. .; ;::t:___~--. ~.... ------

W·· . . ~.i/ :~.~

LDL ~-

.. ,' ~I"

~~{~~·

•

These slq)s only bcconw import~nt during the lutc~l ph~sc. \ ________________J

n~~ 1~\ ~} }J -jProgcstcroncj "" :1

1 J_j[7<~-=-l~~'lilll>.':l.1~l-

~l fir .,~~.{~· jd ~ --=~~ l Mtd 17,20-dc:ollhll,~:::.c

. . ~ Q r . ~ l . ,

.. . ~''l:-" ':1 ( l \ II·. .: ~-~~a: {J c:s_:.. actt.\'illCS Zll'C ClDSCnt .

~-~~~~ ~~'\~1 h r I Androstenedione I fJ. / FSH >E-1~{~~ ~~ ~~ 1.' G i '

~-'Ji 1 ·i<~; \1

,· i ~ ·\'\ 17B-HSD/\Aromatase C!:rD s_ .. ·:

·~·- , .. 1 ·® ;;1 \\ / ~~ ' v,;-:1 • ·. , f.~ ';, \ c ______..../ .. -~t·' !6£

I ( . . ·-

l~;" ii . ;.\ ~ i ~1 :... -< " .: i , , ~ •.1 n :· . \\ 'AC · · ll ~~~ j~J'l \\1 T oslosleron~ I I Estrone I ';,/

· · 1 .::\~ : J ~-\.,Aromatase\:J /17B-HSD .r.w ~ ·

~ ~-~-F~ :~; .} '·.·", . \ , . _; ;;, n .... ::~:~_:_< :-· I Estradiol! . t . • '(11 · I

t', -:! ;..@ '\ ~~. ;_ ·; :

l -~ .....

---···--!:f.:c..'. ,_.,

Aromatase activity · ' · ' is absent.

FIGURE 54-10. Two-cell. l\\\)·£L1n~ldLHropin model. During the k)llicular pha;;c. thL· lll;lj\..11' [XL1dUcl or the I'L1ll1l'k i~ l':Oll".lcli,•l. \\ her~.·:t:;; dUi"1rt~ Lhc . luteal phase, the major pwducts of the CL)rpus lutcum arc thL· pr~.1~estins. alth~.1ush c:.tr;ldi~.)l synthesis is still sub~t.mti:ll. In Lhc ldlicuLu· p\usc. LH

<.primes the theca cell LL) I:L1m·cn dwlcstcml w andt\btencdi~.,nc. [.kc:llbl' the tlJL·c.l ~.·d\ Llcks ;l!\11l1;1l:bc. it c:mJll'i ,c:L·n,·1·.ll,. ~.·sLr:ldt,,l l·r,,m 1h1s · androstcncdil)(lc. lnstcau. the andrlbtcncdilmc diiTuscs tl) tl'c ~ranuk1s;t cL·l\. "·lh':OL' .11\lllUl.bl' :lcth·it;- h:b be~.·n ::'lJJnuLllc"d h, I Sl i. ll1c· .l:c•i11.li.~Sc

cnm·crts the andrl1Slcncuil1ne w estradiol. In the luteal phas~.·. the \·as..-ubri:.1llc111 l'!" th~.· U'l"[)LlS lull'LHll tn:lkcs l.l'L ,~_, .ld.lhk L'' ;ilL' .'.'J.UILII,,s,\-lut.._·;:-: cells. Thus. both the theca-lutein and the granuk1sa-lutcin ..-ells can [11\'duc~.· l)r~.'_~L'~IL'rc'Jh'. the m.l)l11" pl·~.xluct 1.1!. thL· '-''I'J'll> lut,·uJn ll>l !'r,,d:JLlll'll ,,! l7a-hrdroxrpn1gestc1\111L' (17n-OH p1\)~cst~.·r~.'11L'), SlllllL' 1.1r th~.· [ll\>)..:cst~.·J\lJlL' dJilu~L·~ 1JliP the Ll1L·c:J-lutcJJ1 L·L·ll. "l1~ci: lu, 111,· I :-11 li;cll,, .... [.t, _,, Jt·:;:

needed rl)f L'llll\'Crting the pn)~L'Stel'l1nC to 17a-hydrP:\)'P1\1~C::.lL'J\llll'. The thL'l..".l-lllll'1Jl L·dl c:m :lbl.) ~cncr:nc the ,11hilcl~tc"llCLlic'!ic' \\I IiLii ,l:li~l:<> '.1\ic·

the granlllllSa-lutcin cell rlll' cstradil)l synthesis. AC. alknyly\ c>·cLisc: .\TI'. :ldClll'~1lh' trq)[l\.lSjlh:lk: c.-\\11'. l">·,l~c. .tdL"Illl~\1\C l\hll1t>[lh,,,i,h.k· I'S!:. follkh: stimulating hllrllll)nc: I-lSD. hyd1\1:\)'Stl'1\'id Lkhrdt\l~~.·n:lsL·: UIL_ ll)\\ Lkn~1t>· llJ'c'Jll.l't,·m: Lll. lut~.·inJ.::lll:-". lwJ.ilh'ih'

f'.

f

'

Hypothalamus ..------J

FSH/LH

lnhibinG, y activinc±), .... ..-r------ Ovary ~------~

tollistatine ~

Reproductive tract

Estradiol, progesterone,

androgen

Secondary sex characteristics

Regulation of the reproductive tract in the female. The main reproductive hormones are

shown in boxes. Positive and negative regulations are depicted by

-·· . .. ' . -~

~ FIGURE 38.1

plus and minus signs. .

::fBoth LH and FSH regulate follicular steroidogenesis and androgen and estradiol secretion, and LH regulates the

~

secretion of progesterone frorn the corpus luteun1. _ '}( i~hibi!} suppresses the~ecretfon o-f FSH. A_£!!-y.!p.

(an inhibin-bincling protein) increases the secretion of FSH, and follistatin (an activin-binding protein) reduces the

. ~i~Oi'li!<. . .

secretion of FSH.-'»

,···1

~ u >­u c ro -~

0

Q) E 0 '0 c w

Primary follicles

~l':'i

~~ .:}~t~ v~~

""' GnRF ~ • ~ ~fJULlictldLLLU!:>

~

Anterior pituitary

Secondary ' •~"'-'~ , Ovulation follicle

~tt,Jr~~i .f""c;i.-, ~y;':&

-- / ESTROGENS I

Days

Corpus albicans

C!:5J

2

~. ~r, > ~!~·-~·)

,.;;

Connective tissue

Corpus albicans

Mature corpus luteum

Eai"ly corpus luteum

Primary follicle Zona pellucida Secondary follicles

Tunica albuginea

Germinal epithelium

Follicular fluid

Vesicular ovarian (Graafian) follicle (mature follicle)

Corpus hemorrhagicum (ruptured follicle)

Cortex of stroma Discharged immature ovum

·~~

.!1 A l Ul-(_ 3 oU w e_4 o{ ~ 1 r~~..ffv' o v~ (a) • ~~ 41u.. p.ltt.~ ~ ~(_ {:_~ u o l/ L)...i.e,j.

Figure 28·13a : 11 · ..J _·. J.l { f Tortora/Anagnostakos: Principles of Anatomy and Physiology, 5/e ~) Q. '7l'\.(..V.M7>" aft- f> V!M'I• 'k{ oU"'-! cl~« -lPCf:-J ·

!f'ou9;:;:;,~od~di~;or;;:·g·~~~~';;;N:C 11

"] j) 0~ 'Joo1ooo -110cJ1ooo heA-d, p~u~ iWcJes. nre pri'lllotcli"t follidel("""'~w-Wv>J)~ ! 4) D ~ a)J. N-f.llo J...do'v< duvr ( !7 -5o) '~I l·~~ ~~~d ehild~oo~ some P,fim~rdial ~llic!'s ~ ~b o.J Lf) 0 ~ i},._LJ.L B ~..:Jv.d ... welop "to " /. ~r () ··~ "''"' (,.flf)l ~,-.,...j)l,f),,J_/) o•ll>'-<.if:(lj)::'l'-·,·-'/;(_

'~

c .Q -ctl ~ -c (].) (.) c 0 (.)

(].)

c 0 E ~

0 I

0

Figure 28-19

2

c 0

4 6

LH

.,...

c 0

:;::: ctl ::J > 0

Estrogens I

\'

8

I

10 12 14 16 18 20 22 24 26 28

Days

Tortora/ Anagnostakos: Principles of Anatomy and Physiology, 5/ e Copyright@ 1987 by Harper & Row, Publishers, Inc. All rights reserved.

FEMALE REPRODUCTIVE CYCLE

1- Follicular Phase ~@).Luteal Phase __............ I

Menstrual Phase

l

Proliferative Phase

:2.

_,, .... ... · ......

~ 1 u ·u_ u···---~·a·;.·', "·~"~·:-,/.l~~-,.:...,-,,,:~:.,~'"'-•C'ii'~/-:.·~-·~·-~-. .

0 7 14

Days

+ • + •

0

Secretory Phase

21

.. .. .. • .. ..

... .. . .. 28

' .:~'·_::.. ' . : ·'-; . ·~~.-,...---- •.• ._ ....... -. ~~~-...--:::.l.i,"~--~-:---¥-~-,-~~"1·-~-:.-.. ~. --~--~---r::···~-=~.,-.-:::--:-·

0 lL

>-0 0 CD

97-

0 2 4 6 8

\ .··

:•. . '.,:..; .. '

-·· ·, t I~ ·!' · .. J .~ '

~·.:

.I

-:;A' • -- - ---:-:--;:---- L ,;..1_ .... , ,• ( "t,. ~~,· ,: • ._ ,!.• ... ~ ~ •• • , ••• t_· -,;~~~;f··,xt·i},t•~·-~:.!:..t";~,...f~~t\#0~ ,, . . : .r};~t:;:ilJ;l' ~[!

,.',' r't~..il;~ ... ,..: ~ ·'i~~;_l,";::;~ ~ ~,r.,~~-.-4~:

. .: .

•":~:~~~li:~:~~~}}{~);;};?}.El *';..~. ,__Q...,.,~ii'~~ .. +~,...!(+ ... ,..~ ·~~~-·, ~>''• '•• • I ,. fr.r:'~

.~J;. ~ ··,.:1·1~~~~ ·~~1£~?1-'~~ ;~:~~~~ .~ .. -: ... .':'"·~ .~-;:: .. ;'E··~.r -~:tt.~

. . . ...... J\,5jt<Jt< ·. . ,., •. -· ·' ''""%~ . . . -: :}~~~-. 7' .. ,;,:c:-"".:-;...' . . .. -:.-l~~"?t·,j:: ~~~ :,,;:. -:~_;, ~-~~~~~~"..:.;.,

_. ~~::.>~' ''"~r';t.;.:1 ri'..:;·,.-...:d~~P' . .. . ,_ i -::t•:t.?i ....... ~ ... t:'""' - :.J .;;t;.- ~i;

• ~ ~%-~ · i ,~~-l~~;~~~:~_~i~.8~s.~~~ .. ~. )·;· :~t;~~~~~~~-1;~~-~,:·;~~i~~~~:

.. ; ) L.~··""-*~:>:·j··-':i..'i. ~! ''·-~"1':.-:i-' ~ -~ ... -'li~!.~.t~~-#f:~~ ... :: JE~~ ' I ' ·.::;..~:"~0.·,..~-;. ,"t ,... ' 1:':i~~o

. - ;;~ ~1~f~ ~ .. .,'" ;.1-;·~ ~ t .. ; . . -",.., ... ~ '·r· ··:.: -~ :;N~1i~~!t~:~;r=·/}~~~!

~[.,!-..,J,.),•l;~.-i,.(•;. .. ..! ( .--;.-..-~.~~ ..... !

. ·~. ;._::.~: (:,

10 .12 14';.~ 16 18 ~ 20 22(24·,·_26~<28 DAY . OF·J·."!cYCLE " .. ,::/-~-.:-.:-{~)';.:;~ '·· ~. c~~:~;;

. . ' -.. \"'t{':~ . . r... ,~·:r%t;

Figure Bl-9. Elevation in body t~!llperatur~. ~~9tJ~y'af~_er ov~_;]~ lation. · · ' ' ·· ' · ' > :~;\'f~~l'ff .· .::g_J

' ' .

I i ~~

8 9 10

Ureast m.lult

I I

. -' - ..:;..-..· _. ·~· ~

Boys

Genital d£wl. tJnuins

Pubic lwir begins

Poak hPi~Jht spurt

Gonitnlin ndult

ru!Jic hnir {H.Jult

12 13

.. J,. ~:-.:· -;-?~~ "" .. ,, .. j.

-

1'1 20

Fl(i. Xl.21. Time of dc\'cluplllcnt of tile different physicalmanilcstations of puberty in boys ;1nd girls.

(Redrawn I rom S;1dow . .I, l. l). ct tJ~. ( llJH()). 1/wnan reproduction. Croom Helm, London.)

'~tThe adlfe)'\~Lan dYo~\e,1S are Ye.spol1~ible i~ pctrt-for pub arch e. ~~ ,,

Aotre"tl arch e

A

Cell division

Ovulation

Blastocyst

Blastocyst reaches

uterus (days 4-5)

Blastocyst implants

(~ays 5-7)

Trophoblastic ceils invading

B endometrium ~------~------~

Figure 82-2 A, Ovulation, fertilization of the ovum in the fallopian tube, and implantation of the blastocyst in the uterus. B, Action of trophoblast cells in implantation of the blastocyst in the uterine endometrium.

?-f-n1~o'Judu~~:~tv~,,~p61i~thti' germ eel!~) \niw~) dive c \iens: ~penn 'lSC~ l' fit o\'-' •v· d the an' ptlff~ etr1 tltn e ~ ! 1.9c't~ d.e5c.el\dS toward-t~ e. ~t"'lf'(J!i:~Thi~ Ye'luircs coo'1dinaHt.J'n b~t.~e~n smCJ~h rntasc.)~ t~\ltt~cfto", ciliary ltH,Ve'tl'\e~, a" <J flved scc..r etion

1 aqt o~whic.n are vnd~7~or<Mon.ttt Q11G

-a~ Uf! t)'i\ a( c oY'i nA.

~-

OVARY in PREGNANCY h~en pregnancy occurs the ordinar:-y ovarian cyclcz is suspendczd. ·

~After the first 14 days the developing place~ta secretes a LUTEINIZING . . r . ~E 0Hononlc I!Slgonadotrophi!Y. * Under1ls Influence-¥" · -r .

thcz. CORPUS LUTEUM continues to grow until i.t may comcz to occupy 1

' 30% to 50/o of the total volumcz of the OVARY. I . ' I ' I '

.,..\! t ', ~The larqe amount of ',

PROGESTERONE '

~~ re1ches its peak at about

I I I '(

helps to maintain the PREGNANCY in its early stages and is essential for development of the PLACENTA- Lhe special structure through which

6 weeks after conception

the child recei V"es its nourishment from the mother.

It also produces PROGESTERONE which gra.dually takes over. From

thci I

I I I I

I I

l' falls off about 2nd. month

I I

I I

~~ 1 r ~·\'CORPUS LUTEUM -- ceases to

\1' I

be active about 4th month

r- PLACENTAL PROGESTERONE. -- takes over to m~intain the PREGNANCY, .. and to hzlp to preparr~ the mammary

glands for Lactation.

183

-- ------------

'-

SUBSTANCES SECRETED BY THE BLASTOCYST ~'i-~(· ·:: -'""7""' r ·. •

., ... ·.· .. pressive agents . , . __ ~t-activating· factor (PAF) ,:·~~.?,".r)"t..;,l\~:.o.}:-; ~~' .• ·: • . . .·•.

M~ .. !;U,~e.:·:.ct)orionic gonadotropin (hCG)

E~rly pregnancy factor . ; .. Immunosuppressive factor

... ~ .• ' . ·.• . . f

· .erost~glandin E2 . : .. ·.··.t-~+J.~~:·::;\}:~:< ·. . lnterleukins 1 a and '6 :~i5f.~~~;;~3;-~ .

i~hibitory factor

..... ~Qt:-sttmulating factor J.;:l~·:~,~~;'-l~i·:~lf\. . . >

Serine proteascs (facilitate invusion of truphoiJiasl into the endometrium)

Other factors or actions Ovum factor

Early pregnancy factor

Embryo-derived histamine-releasing factor

hCG: autocrine growth factor

Plasminogen activator and its inhibitors

Insulin-like growth factor type II (IGF-11): promotes trophoblast invasiveness

Estradiol

{3 1 lntegrin . . . roteases (facilitate invasion of trophoblast 'into:~):h·e ·endometrium) .~9Ua'g~nases: digest collagen types I, II, Ill, VII, and X ;::·: ·-1~'- ··~:~>c.~.': '

Fibroblast growth factor (FGF)

Transforming growth factor-ex (TGF-cx)

lnhibins .qelatinases: 2 forms, digest collagen type IV and gel-t~latin':.

ysins: digest fibronectin, laminin, and colla- II hCG is one or the !l1(1St imporLmt of the L1Ctors se-(_:Jv, V, and VII cretccl by the trophobbst of the bbstocyst, bOLh pre-1"'...._. . .....------.· · impbnLJtion Jnd postimpbnLaLion. Besides rescuing the

corpus lutcum, hCG Jcts Js an immunosupprcssiYe agent, hJs growth-promoting activity, :.md 3cts ::~s ::~n ::~utocrine growth factor th::~t promotes trophoblast grO\Yth Jnd pla­cental development. Thus, hCG may hJ\'C J role in the adhesion of the trophobbst to the epitheli::t of the endo­metrium. hCG has prote::~se activity, zmd hCG lewls are high in the area where the trophoblast faces the endome­trium. 9

',' ·'

l'-

ng 'hormone.

Placental-variant growth hormone . ·~ , -· .

Human chorionic somatomammotropins 1 and 2 (hCS1 and hCS2), also known as human placental lactogen (hPL: hPL 1 and hPL2)

Placental proteins PP12 and PP1 4

Thyrotropin-releasing hormone (TRH)

Corticotropin-releasing hormone (CRH)

Growth hormone-releasing hormone (GHRH)

Gonadotropin-releasing hormone (GnRH) Substance p The most important of the placental peptide hormones

Neurotensin is hCG. In the , developing blastocyst, and later in the mature placenta, it is the syncytiotrophoblast cells that

Somatostatin s;nthesize hCG, perhaps under the direction of progester-N . one and estrogens. The placenta also produces t\\·o hu-

ACT eur~pepdtlde Y_ man chorionic somatomammotropins, hCS l and hCS C H)-reate peptide 2, also called human placental L1ctogcn (hPL). hCS 1 and 2

The inhibins are polypeptide hormones that are structurally related to growth hormone and placental-variant gro\nh hormone,

Steroid Hormones as well as to prolactin (see Table 4 7 -l)~ They play a role Progesterone in the con\·ersion of glucose to fatty acids and ketones, Estrone thus coordinating the fuel economy of the fetoplacental

unit. The fetus and placenta use fatty acids and ketones 2.s energy sources and store them as fuels in preparation for the early neonatal period, \\·hen a considerable reser-

Estradiol

--------- \·oir of energy is necessary for the transition from intra­uterine life to life outside the uterus. hCS 1 c.nd 2 also promote de\·elopment of mc.temal mammary glc.nds dur-

Estriol

mg pregnancy.

. ~

>I

"-'J j

·(

~ ~ :1 J

~~;

•• "i ·,:·

-.;

~~~ :1

"•1 ,-~j

cl ·:J

~l r ~~

-~ -~

' }

' ) ~

.- ~

.....-...... ___I

E ----:=J '---"'

C) u ..c

100

50

0

.,,...,.""""', l .hCG·

~ . I /I , t I. \

i . \. I i g li · ... ~ ' ·. I r .

I l \ .f Progesterone ·

! l l l. · PR. ... / .,-. '[' I ,_ ,_ ...... -

.;;,;..,,·.,-. •• n~· ·c-

0 10 15 20

~~

Total estrogen

/ ;

; /

.,. .;

~ '· ' ; ~~-~~n,l~b-'Yt"' .. ~ ..... ~

30 40

Weeks of gestation

-o '20 0 -o

CO:IJ CDr ~--CD :::J ...,co o-­:::J 3 CDr Pl.._.. :::l 0...

10 0

0

~

Ol

CD (/) ~ ...., 0 co

CD :::l .-.· l= co ...._ 0... r .._..

~- .... \

•;

200 ··.

100

. .--. ·•.·

.: .. '

0 ., ', •'·

\'• ''·' ··'

... '~ '·' . 'r

'

_., ;::;

J Maternal Compartment Jl Fetoplacental unit I

Placenta I Fetus Acetate ~

-.,.~:~f7 ., Cholesterol

·";"JG\T" Pregnenolone

sulfate ~IT-~ •-.r~t·

Adr,!3_.f.· al ~ •. '-

"""~·~Jr ·l·

-c(

Dehydroepiandrosteron sulfate

-<;

~

'" Cholesterol ,. ·--:~

........ 0 '. ·-'1..).·''

~ Pregnenolone ~ r~·:

-··,:1~ ': • .. ;· .. '·'.r

( PROGESTERONE \

'" DehycJroepiandrosterone -c( ,. "T"~·:~:~

AndrostenecJione-lestosterone '\!j7J.

~~-~.:_:.~ ··;·

ESTRONE-ESTRADIOL

~

" ,.

~ Pregnenolone sulfate

AcJref)al -· ~. ...

DehycJroepiancJrosterone sulfate

~,, .. i ·i

Liver

16-Hydroxydehy?-~;~epiandrosterone ...(I- 16-HydroxydehydroepiancJrosterone ~ .. \ L.. sulfate

·:::.·>'

16-Hydroxya~-~!.rostenedione --r~:<{/:;--

-c( t l ESTRIOL 1-----+---~

FIGURE 38.7 The fetoplaccntal unit and steroidogenesis. ~late that estriol is the product of react1ons occurnn~ 111

the fetal aclrenal, fetal liver, and placenta. (Moclif1ed from Goodman HM. Basic Medical Endocrinology. ~lew York: F\aven, 1 9S8.)

~~~~~~~~~~~~~~==================== ~- ..... -~ ....... - .. - , .. : . ~ow........,~~tzwmtAtZtiHmrt.>t~I!S'I

·~:\>--nb t~ ~~ ~h r;{ e ~tri ~l i'il pla 51\1 a, amn\ (1{\c ~luad1 o,-"'r'•n ~ ara used ~s c\r\ ir\dex of fetltl weV-be.'n1g. low le.vtls o.f estriul Would i11dicc1te poier\ti~l fet\1! distt~ec;s1 a(~h ougJ, r~,r~ ;., hei,ttcl ~ \\tCa i:~ tlE f•'c.i ow.:\t.s ecWHJ/!Io \tc1d to \oVJe.stno{.

I .J,

Mother

Pancreas

Defect in insulin action

t Plasma glucose

Placenta

Fetus

Pancreas

t Plas-na insu!i;)

.1. pl~-~-1 I C.:::·. ':::. .

g!ucc::~

FIGURE 38.8 Effects of maternal diabetes on fetal growth.

~' -~;

:J

<,;;

:·:

-:l

·.·: '

···.:'

\ J

CDACTH 0

Fetal adrenal

CD DHEA-S

CD Cortisol 0

'p'tC I CD CD CD @

~ Lung maturation

Liver glycogen

Intestinal transport and digestion

Close ductus arteriosus

CD Local estrogen r----1\ Progesterone ratio~

~ CD local prostaglandins~

CD Oxytocin

(D Oxrtocin

.. ~ ~

it Catecholamines (M~I?) &/"

{(Fetal?)) )( ~

lC Fig. 51-30 Endocrine regulation of parturition. The fetal pituitary-adrenal axis initiates sig­nals that decrease the ratio of effective progesterone to estrogen in the myometrium. This leads to uterine contractions, which are mediated by prostaglandins. Oxytocin may contribute to labor but is not essential. HO\vever, oxytocin sustains uterine contractions after expulsion of the fetus so as to minimize m:J.tcrnal loss of blood. Cortisol prepares the fetus to adapt to extrauterine life suc­cc<:sftl!lv. ACTH. Adrenocorticotropic hormone: DHEA-S, dehydroepiandrosterone sulfate.

\

., j.

' > : :):~~ j!~ r: r

~; 1I~~r~ I !

.,~l-' ~ .. .}·ffdt;~ ~

~ \' . '

- ' ~ 40 0.. 0 . 0: .... 8 30 ct z g 2o->­a: ~ z 10--0:: :J

g o. - ~~--2-r-O-;;--~t~----·;~-~~----;o--oor----~ AGE

figure 81-7. Total rates of secretion of gonadotropic hor..; n1ones throughout the sexu,,lllves of fernales ,,nd rnales, showing an especlidly abrupt lncre,1Se In gonadotropic horn1ones at the menopause In the fen1ale.

" f .·

' .. !

-/: :.-. .. > ~~~-·.: ~< :;~·:~~-~--~;·.~~~~~~¥'~4+~-~{--!·~.:~· . .. " ,;·: -;:jzc~{~W:}-~ ·;,~~~-

·- ; .. -~ ....

. I

Contraceptive Use and Efficacy Rates in the United States

Accidental Estimated Use Pregnancy

Method (o/o) in Year 1 (o/o}

Pill 32 ')

:) "

FcmJlc stcrilizJtion 19 0.4

Condom 17 12

Ivble sterilization 14 0.15

DiJphrJgm 4-6 2-23

Sperm icicles 5 20 Rhvthm .cl 2U

ltltrJLttcritlc clcvicc ") () -'

h·<lm I )eve I up i ng N cw Con t r<1cc p l i vcs: () bst <tC I es J n d C_) p po nun i­L<:. ·\· d'-.hington, DC: NL~tionJl /\c, d~:i~~~i Press, 1990.

BIRTH CONTROL

Methods

Barriers

::,~.:~](\?;:::;,')>~:: ' .

~~~;Lie des.

,., ..

Steriiization

Examples

Cervical Cap Condom

Diaphragm Vaginal Pouch

· ~· 'Contraceptive Sponge ·.creams Douches

, Foams Jellies Suppositories

Rhythm Method Sympto-thermal Method

Vasectomy (male) Tubal Ligation {female)

~ntrauterine Deuice (YnJD) I I

WnthdrawaG (CosttUJs Bnterrrupih .. ns »

I Alborrtio!l1l

I

/ /.

Comments

<_; C:sirog~~ and prog-~sterone -·prevent follicle development ahd oviilation.

_:.:·.··,.: , .. ,;. "

Sperm are prevented from entering the uterine cavity.

Male condoms protect against sexually transmitted diseases.

These methods depend upon sperm-killing chemicals. The contraceptive sponge releases spermicide for up to 24 hours.

The avoidance of sexual intercourse for about 7 days (while a viable ovum is in the uterine tube).

The severing of each ductus deferens in the male and both uterine tubes in the female.

An object placed in the uterine cavity prevents implantation.

The penis is withdrawn from the vagina before ejaculation

occurs.

Surgical or drug-induced removal of the embryo.

-L1

. . ._ ........ , ~-=·:-:-··:._-:::___~·-::. .. ..,..,'7".~·.....,.,;,... . ...;.·,.,.c,_~-.:....:.~~~~"'; .. _<;;+ ..••••. '>r"'~:..,.....,..,·~;.~.--·

' " It~ ·~.'· i ~ ; . , 'I o, 0 ' ' ••••11.~··;Typos of hormonal contracoptlv~ :

Comblnod oral • contracoptivo pill (COCP)

Progostogon·only pill Emergency pill (POP)

Depot (contraceptive lmplan~ : lnjoction) . • ..

Compo::.1I10n

nu0

0°0 ~ ,,••'''~n l'ffiJ,':::.I. u \ .. .,.,.... • a •

' ... _~:-.. ~

:.ynlhclic ocslrogcns and progo:.logon:.

synlhclic progosroucns

hi9h uo!;c of synthclic ocslroncns and prog.:::.rouons

synthetic · ·. • ·, ;. progo.stogc[ls :,

I\ ,o, 0 ,, 1 • I) 1,

. ': ,_ .... i; .. · ',·. : ~

!;ynlholic progcslocF:os tmcdroxy· prouosloro' ,c)

----··--· -·---·--- ··---------f-------------------f--~------ --1--------orol, doily wrthoul a oral, must be Ioken inlramuscu: Jr Administration oral, doily for 21 days

with a 7-doy gop before rho next course of pills (during the 7 day gop a withdrawal bleed occurs)

break between pocks, within 72 h of coilus if injec1ion, IY.;;,ls 8-12 and must be Ioken at po o(hcL weeks ~ · ·

Mode of uc!lon pnncipol action = suppression of ~a

f----·---····-···---- ·-·-·-

the some lime every day

docs nor reliably suppress ovulation

Effectiveness if token/ >99"/o 99% (less effective in applied accord1ng to young women and if

contraccplion was used

inhibils implonlotion

>95%

~ ....

docs not reliably su;Jprcs~ ovulolior:.

>99%

small. soft lubes.~. · inser1ed under the ·skin, losts'up to' · -5 years··: .'.-::7,: -· prevcnls ovulolion ----->99%

'''I·

instructions > 70 kg I ---··- ..... -·-·-·· ....... --------1-----= --------t----------r-----------,-t--------AdvoniCJ£JCS olton decreases useful for women

111C'n:.I1Uoii.Jiecd1ng, who cannel usc tile pain, premenstrual COCP !because POP tension, and acne, contains no and may prolecl oeslrogen)

pos:coilol con1rocep11ve

do nol hove to re1.1ember to lake pills, may protect against .end()m_elrial : ccr.cer · ·

same as for dcpol.

ogoinsl ovarian conce ------·------· ----------1----------t---------t---------t--------

Disodvonloges increased risk of thromboembolic diSCaSC (e.g. deep ve1n thrombosis, pulmonary embolism. ccr\'•bwl thrombosis). dyslipidaemio, hyfJerlension

Comments nol reliable if Ioken > 12 h late. or after vomiling/ diarrhoea

Fig.ll.4 Types o[ hormonol conlraccplivc.

side effecls include: irregular uterine bleeding ('breaklhrou9h blcedinn' or umcnouhoca). brcu~l discomfort, premens1ruoltens1on. skin reactions. increased risk of ectopic pregnancy

nol rcl1oble if taken >3 h laic. or after vomiting/ diarrhoea

some as for COCP, ollhvugh risk is increased owing lo high dose of oc~lro9cn, often cause nausea and vomiting

should not be used as c regular form of conlraceplion

sicc effecl<: ..,re some as for POP, .)Ius: wc,ght Q'1i .. loss of bene de1 ...

n::;: immediately rc·:2rsible

same as for depol, plus: ofien difficult to remove owing lo fibrosis

'(

Description

------ ·-·------------ .. ···-·----------··----

Typos of non-h~rmoncl ~n~cccpH~\·! ~;~I:·~- y::. ~?~:'7':;i~::~~~;!;~~;:•.l~,:~!~?~:'·?: !~_i·?~~~:::··>~~?' • ... , ' \. ··:·; •• . . ··.·.r . . ·· ..•

I Malo condom

rubber sheath, lubricated with spermicidal cream

I Diaphragm or cap with spermicide

flexible rubber device used with spermicide

Intrauterine contraceptive Natural (symptothermol) device (IUCD) method ... _ ....... .

small plastic or copper_ . · device (some contain progestogen) · · · ... · ·

·ovoid ovulation--. unprotected sexual 'intercourse confined to .the ~safe' infertile times of the menstrual cycle

t-- ·- ------ --- --------- --------------f----------+----------l-------~---1 Admini~lral10n

Mode of OCtiOn

put over the erect penis during intercourse

device is inserted into the vagina before intercourse and covers !he cervix; il must stay in for at least 6 h after sex

inserted into the uterus_ and con stay there for 5 years ·

. ,/ .. '.\.·

~ .• the fertile and infertile times· of the menstrual cycle ore identified by

.. measuring monthly 'changes in body

··temperature and ·:··

cervical mucus

prevents sperm from prevents sperm from inhibits sperm migration • _prevents sperm from entering vagina entering uterus and prevents implantation encountering ovum

--------------1---~--~------~----~----------~~------~~--~------~-------Effecllvenes~ 1f Ioken/ 98% 192-94% depending on the 98-99% depending on the 98% [although much op!)t1ed occord1ng to type of device used type of device used lower if the menstrual

~nslrl)C 11ons __________ _[1 ___________________________ L _______________ 1 ___________ -+_c.::..y!..c:..l.::.e.:.is:..:.:ir.::..re_=-='-g.:.u....:lo=-r.::..l ___ _

Advonto~1e~ may protect both partners female is in control of immediately elfective. no side effects from sr.xuuil·( trcmsmittcd controccpt1011 limportont requires littlo follow-up; diseases. and may protect if mole is no! motivated); hormonc-con:aining IUCD female against cerv1cal reusable cause lighter periods cancer

f-.. . ·------·-------· --------- ---------·-----+-----------+------------may cause heovy, prolonged, painful peri:::;d:; and predispose to p12lvic inflammatory ..:iscose

need to u:;c citernoli'lc method during fertile days; requires close

OI~.udvuntuq<~:. require::. lli\']h mot1votion and mCiy 1nlerru~t spontaneity and sensitivity

~'-Fig. 11.5 Types of non-hormonal conlraceplive.

less proteclion a\loinst sexually transmitted disease

. : '. \ attenl1on to symp:oms

i · of cycl12 ' ' · · · ·· · ~

Hormonal Therapy for Ladies and Maintaining Beauty

Hormonal therapy for ladies is necessary through out all stages of life especially after the age of 50 specifically in these cases:

1. To maintain the density of bones and stop osteoporosis. Here, I'd like to assure that taking calcium and vitamin D is no good to help maintain good posture if this is accompanied by the lack of Estrogen or Testosterone.

2. To maintain the beauw..of complexion and prevent wrinkles I'd like to dr~w the attention that anti-wrinkles facial creams are no good for Estrogen is what creates collagen which is permanent unlike Botox which is temporary.

3. For the treatment of extreme facial and body hair. -~._.~~~~~-

4. For the low desire for sex compared to spouse. --~~

5. For the maintaining of the size of breasts pnd preventing atrophy especially in menopause.

6. To ~_rin~i~f~~!!..~~"'i~~~ (unvoluntary)

-- .. y"

I'd like to make sure that hormonal treatment has many kinds and different dozes and is not given by the public. In the west women take the right hormones by the supervision of the doctor.

I'd like to add the Estrogen has proved special importance in the treatment of Zheimer and Amnesia.