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The ovarian cycle is a series of events in the
ovaries that occur during and after the maturation
of the oocyte (egg or ovum). During their
reproductive years, nonpregnant females usually
experience a cyclical sequence of changes in their
ovaries and uterus. Each cycle takes about one
month and involves both oogenesis, the process of
formation and development of oocyte, and
preparation of the uterus to receive a fertilizedovum. Hormones secreted by the hypothalamus,
anterior pituitary gland, and ovaries control the
principal events.
The uterine (menstrual) cycle is a concurrent
series of changes in the endometrium of the uterusto prepare it for the arrival of a fertilized ovum
that will develop in the uterus until birth. If
fertilization does not occur, the lining (stratum
functionalis) of the endometrium is shed during
menstruation.
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Menstruation is also called menstrual bleeding, menses, a period or catamenia. The flowof menses normally serves as a sign that a woman has not become pregnant.
A woman's first menstruation is termed menarche, and is one of the later stages ofpuberty in girls. The average age of menarche in humans is 12 years, but is normal
anywhere between ages 8 and 16. Factors such as heredity, diet and overall health canaccelerate or delay menarche
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The cessation of menstrual cycles at the end of a woman's reproductive lifeis termed menopause. The average age of menopause in women is 51 years,Eumenorrheadenotes normal, regular menstruation that lasts for a few days(usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal).[6]
The average blood loss during menstruation is 35 millitres with 1080 ml
considered normal;[7] many women also notice shedding of the endometriumlining that appears as tissue mixed with the blood. An enzyme called plasmin
contained in the endometrium tends to inhibit the blood from clotting.Because of this blood loss, women have higher dietary requirements for iron
than do males to prevent iron deficiency. Many women experience uterinecramps during this time (severe cramps or other symptoms are called
dysmenorrhea).
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Through the influence of a rise infollicle stimulating hormone (FSH), fiveto seven tertiary-stage ovarianfollicles are recruited for entry intothe next menstrual cycle.
These follicles, that have beengrowing for the better part of a yearin a process known as folliculogenesis,compete with each other fordominance. Under the influence ofseveral hormones, all but one of thesefollicles will undergo atresia, while one(or occasionally two) dominant follicleswill continue to maturity. As theymature, the follicles secrete increasingamounts of estradiol , an estrogen.
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The estrogens that follicles secrete,initiate the formation of a new layer ofendometrium in the uterus, histologicallyidentified as the proliferativeendometrium.
During the follicular phase the lining of theuterus thickens, stimulated by graduallyincreasing amounts of estrogen.
Follicles in the ovary begin developingunder the influence of a complex interplayof hormones, and after several days oneor occasionally two follicles become
dominant (non-dominant follicles atrophyand die). The dominant follicle releases anovum or egg in an event called ovulation.
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.
(An egg that is fertilized by aspermatozoon will become a zygote,taking one to two weeks to travel downthe fallopian tubes to the uterus. If theegg is not fertilized within about a dayof ovulation, it will die and be absorbedby the woman's body.[5])
When the egg has matured, it secretesenough estradiol to trigger the acuterelease of luteinizing hormone (LH).
In the average cycle this LH surge startsaround cycle day 12 and may last 48hours. The release of LH matures the
egg and weakens the wall of the folliclein the ovary.
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The egg is swept into the fallopian
tube by the fimbria - a fringe oftissue at the end of each fallopiantube. If fertilization occurs, it will
happen in the fallopian tube. In some women, ovulation features a
characteristic pain calledmittelschmerz
The sudden change in hormones atthe time of ovulation also causes lightmid-cycle bleeding for some women.An unfertilized egg will eventuallydisintegrate or dissolve.
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The corpus luteum is the solid body formedin the ovaries after the egg has beenreleased into the fallopian tube whichcontinues to grow and divide for a while.
After ovulation, the residual follicletransforms into the corpus luteum underthe support of the pituitary hormones.
This corpus luteum will produceprogesterone in addition to estrogens forapproximately the next 2 weeks
. Progesterone plays a vital role inconverting the proliferative endometriuminto a secretory lining receptive for
implantation and supportive of the earlypregnancy.
It raises the body temperature by one-half to one degree Fahrenheit
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If fertilization of an egg has occurred, itwill travel as an early blastocyst through thefallopian tube to the uterine cavity andimplant itself 6 to 12 days after ovulation
One very early signal consists of humanchorionic gonadotropin (hCG), a hormone that
pregnancy tests can measure. This signal hasan important role in maintaining the corpusluteum and enabling it to continue to produceprogesterone.
In the absence of a pregnancy and withouthCG, the corpus luteum demises and inhibinand progesterone levels fall. This will set the
stage for the next cycle. Progesteronewithdrawal leads to menstrual shedding(progesterone withdrawal bleeding), andfalling inhibin levels allow FSH levels to riseto raise a new crop of follicles.
http://en.wikipedia.org/wiki/Blastocysthttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Pregnancy_testhttp://en.wikipedia.org/wiki/Inhibinhttp://en.wikipedia.org/wiki/Progestogenhttp://en.wikipedia.org/wiki/Progestogenhttp://en.wikipedia.org/wiki/Inhibinhttp://en.wikipedia.org/wiki/Pregnancy_testhttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Blastocyst7/30/2019 Ovarin Cycle
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Two sex hormones play a role in the controlof the menstrual cycle: estrogen and
progesterone:Estradiol peaks twice, during folliculargrowth and during the luteal phase.
Progesterone remains virtually absent priorto ovulation, but becomes critical in theluteal phase and during pregnancy. Many
tests for ovulation check for the presenceof progesterone.
After ovulation the corpus luteum whichdevelops from the burst follicle and remainsin the ovary secretes both estradiol andprogesterone. Only if pregnancy occurs dohormones appear in order to suspend themenstrual cycle, while production ofestradiol and progesterone continues.Abnormal hormonal regulation leads todisturbance in the menstrual cycle
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These sex hormones come underthe influence of the pituitary
gland, and both FSH and LH playnecessary roles:
FSH stimulates immature follicles inthe ovaries to grow.
LH triggers ovulation.
The gonadotropin-releasing hormoneof the hypothalamus controls thepituitary, yet both the pituitaryand the hypothalamus receivefeedback from the follicle.
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Unlike almost all other species, the external physicalchanges of a human female near ovulation are very subtle.In contrast, other species often signal receptivity throughheat, swellings, and/or changes in color in the genital area.Humans are the only mammal to lack obvious, visiblemanifestations of ovulation, although some argue that theextended estrus period of the bonobo (reproductive-age
females are in heat for 75% of their menstrual cycle)[14]has a similar effect to the lack of a "heat" in humanfemales.[15] While women can be taught to recognize theirown ovulation (fertility awareness), whether men can detectovulation in women is highly debated. At least one recentstudy has argued that men are more likely to initiate sexwith fertile women[16], while another has found male-initiated sex to occur at a constant rate throughout themenstrual cycle.[17]
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Evidence suggests that eggs are formed from germ cellsearly in fetal life. The number is reduced to an estimated400,000 to 450,000 immature ova residing in each ovaryat puberty. The menstrual cycle, as a biologic event, allowsfor ovulation of one egg typically each month. Thus overher reproductive lifetime a woman will ovulate
approximately 400 to 450 times. All the other eggsdissolve by a process called atresia. As a woman's totalegg supply is formed in fetal life,[18] to be ovulateddecades later, it has been suggested that this long lifetimemay make the chromatin of eggs more vulnerable to divisionproblems, breakage, and mutation than the chromatin ofsperm, which are produced continuously during a man'sreproductive life.
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High ovarian volume and high antral follicle counts
Ultrasound image of an ovary at the
beginning of a menstrual cycle. Nomedications are being given.The ovary is outlined in blue. Thereare numerous antral follicles visible -marked with red spots16 are seen in this image, this ovaryhad a total of 35 antrals (only 1 plane
is shown above)This is a polycystic ovary, with ahigher than average antral count andvolume (ovary = 37 by 19.5mm)This woman had very irregular periodsand was a "high responder" toinjectable FSH medication
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Normal ovarian volume and "normal" antral follicle counts
Ultrasound image of an ovary at thebeginning of a menstrual cycle. Nomedications are being given.The ovary is outlined in blue. 9 antralfollicles are seen - marked with redspotsThe ovary has normal volume (cursors
measuring ovary = 30 by 17.8mm)This woman had regular periods and anormal response to injectable FSHdrugs
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Low ovarian volume and low antral follicle counts
The left ovary is outlined in blue andis small (low volume)Only 1 antral follicle is seenThis woman had regular periods and anormal day 3 FSH test
The right ovary from the same womanThis ovary is also small with only 2antral folliclesShe only had 3 antrals total - fromboth ovariesAttempts to stimulate her ovaries forIVF were not successfu
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Apparently normal menstrual flow can occur without ovulationpreceding it.In some women, follicular development may start but not becompleted; nevertheless, estrogens will form and will stimulatethe uterine lining.Anovulatory flow resulting from a very thick endometrium causedby prolonged, continued high estrogen levels is called estrogen
breakthrough bleeding.Anovulatory bleeding triggered by a sudden drop in estrogenlevels is called estrogen withdrawal bleeding.[19]Anovulatory flow commonly occurs prior to menopause(premenopause) or in women with polycystic ovary syndrome
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Sudden heavy flows or amounts in excess of 80 ml(hypermenorrheaor menorrhagia) are not normal.Very little flow (less than 10ml) is called hypomenorrhea
Prolonged flow (metrorrhagia, also meno-metrorrhagia) nolonger shows a clear interval pattern. Dysfunctional uterinebleeding refers to hormonally caused flow abnormalities,typically anovulation.All bleeding abnormalities need medical attention; they mayindicate hormone imbalances, uterine fibroids, or otherproblems. As pregnant patients may bleed, a pregnancy testforms part of the evaluation of abnormalAmenorrhea refers to a prolonged absence of menses duringthe reproductive years of a woman. For example, women withvery low body fat, such as athletes, may cease tomenstruate. Amenorrhea also occurs during pregancy.
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The condition precocious puberty hascaused menstruation to occur in girls asyoung as eight months old.[20]
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is any collection of fluid,surrounded by a very thin wall,within an ovary. Any ovarianfollicle that is larger than abouttwo centimeters is termed an
ovarian cyst. An ovarian cyst canbe as small as a pea, or as largeas a grapefruit.
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Ovarian cancer cell
is a malignanttumor, of any histology, on or within an ovary.
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(abbreviated PCOS or PCO), also known clinically as Stein-Leventhal syndrome,is an endocrine disorder that affects approximately one in ten women.[1] Itoccurs amongst all races and nationalities, is the most common hormonaldisorder among women of reproductive age, and is a leading cause ofinfertility.[citation needed] The principal features are weight problems, lack ofregular ovulation and/or menstruation, and excessive amounts or effects ofandrogenic (masculinizing) hormones
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Laparoscopic oophorectomy
In the case of humans, oophorectomies are most often performed due todiseases such as ovarian cysts or cancer; prophylactially to reduce the chancesof developing ovarian cancer or breast cancer; or in conjunction with removalof the uterus.
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In medicine and (clinical) geneticspreimplantation genetic diagnosis (PGD) (or alsoknown as Embryo Screening) refers to proceduresthat are performed on embryos prior toimplantation, sometimes even on oocytes prior tofertilization. PGD is considered an alternative to
prenatal diagnosis. Its main advantage is that itavoids selective pregnancy termination as themethod makes it highly likely that the baby willbe free of the disease under consideration.
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PGD thus is an adjunct to assisted reproductivetechnology, and requires in vitro fertilization (IVF) toobtain oocytes or embryos for evaluation. The termpreimplantation genetic screening (PGS) is used to denoteprocedures that do not look for a specific disease but usePGD techniques to identify embryos at risk. PGD is apoorly chosen phrase because, in medicine, to "diagnose"means to identify an illness or determine its cause. Anoocyte or early-stage embryo has no symptoms of disease.They are not ill. Rather, they may have a genetic conditionthat could lead to disease. To "screen" means to test foranatomical, physiological, or genetic conditions in theabsence of symptoms of disease. So, both PGD and PGSshould, be referred to as types of embryo screening.
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(IVF) is a technique in which egg cells are fertilised bysperm outside the woman's womb
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The most fertile period (the time with the highestlikelihood of pregnancy resulting from sexual
intercourse) covers the time from some 5 daysbefore ovulation until 12 days after ovulation. Inan average 28 day cycle with a 14-day lutealphase, this corresponds to the second and thebeginning of the third week of the cycle. Fertilityawareness methods of birth control attempt to
determine the precise time of ovulation in order tofind the relatively fertile and the relatively infertiledays in the cycle.
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If a woman wants to conceive, the most fertiletime occurs between 19 and 10 days prior to theexpected menses. Many women use ovulationdetection kits that detect the presence of the LHsurge in the urine to indicate the most fertiletime. Other ovulation detection systems rely on
observation of one or more of the three primaryfertility signs (basal body temperature, cervicalfluid, and cervical position).
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Among women living closely together, the onsets ofmenstruation may tend to synchronise somewhat. ThisMcClintock effect was first described in 1971, andpossibly explained by the action of pheromones in1998.[11] However, subsequent research has called thisconclusion into question.[12]
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Estrogens and progesterone-like hormones make upthe main active ingredients of hormonal birthcontrol methods such as the pill. Typically theycause regular monthly flow that roughly mimics amenstrual cycle in appearance, but suppressesovulation.
With most pills, a woman takes hormone pills for21 days, followed by 7 days of non-functionalplacebo pills or no pills at all, then the cycle startsagain.
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During the 7 placebo days, a withdrawal bleedingoccurs; this differsfrom ordinary menstruation, and skipping the placebos and continuingwith the next batch of hormone pills maysuppress it. (There are twomain versions of the pill: monophasicand triphasic. With triphasic pills,skipping placebos and continuing with the next month's dose can make awoman more likely to experience spotting or breakthrough bleeding.) In2003, the U.S. Food and Drug Administration (FDA) approved low-dosemonophasic birth control pills that induce withdrawal bleeding every 3
months. Yet another version of the pill is the Loestrin Fe, which hasonly a four-day placebo "week" (the placebos are actually ironsupplements intended to replenish iron lost by uterine shedding); theother three placebos are replaced with active hormone pills. Thissystem is intended to help shorten periods. Mircette contains severaldays of estrogen-only pills in addition to the usual combinationestrogen/progestin pills, in the case of women who may have problemswith low estrogen during the placebo days with other pills.
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Other types of hormonal birth control which affectmenstruation include the vaginal Nuvaring and thetransdermal patch (like the standard pill pack, activehormones are given for three weeks, followed by a one-week break for bleeding) and the injection (which caneliminate all flow as long as the injections are takenevery twelve weeks, although spotting is a common sideeffect).
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All such methods are designed to regulate monthly bleeding.Because of this, they are often chosen by females who wish toregulate the frequency and length of their period, often forbasic convenience and especially when such factors are irregularand problematic on their own. Hormonal contraception has alsobeen shown to improve menstrual factors such as cramping,heavy flow, and other bothersome physical and emotional issuesrelated to periods.
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Hormonal methods which are controlled by the user day-to-day, including pills, the ring, and the patch, need not alwaysbe used according to the standard cycle/calendar. Their usecan be rescheduled and altered in various ways to postpone orskip periods when desired for reasons of convenience (e.g.,traveling or scheduled gynecological exams), personal enjoyment
(such as expected sexual encounters or events like a weddingor dance), or health (including very painful periods orsensitivity to hormone fluctuations). Similarly, abrupt cessationof use can induce a breakthrough period mid-cycle.
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