OBI 814 - RD2 - Exam 2

• RD-2 covers women's health, including the menstrual cycle, contraceptives, STDs, and menopause.

H-P Axis and Female Reproductive Organs

• The hypothalamic-pituitary (H-P) axis regulates the ovaries through follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
• High estrogen levels can inhibit FSH and LH production.
• The ovaries produce estrogen (E) and progesterone (P), which affect the uterus.
• Other factors like inhibin and testosterone (T) also play a role in this axis.
• Estrogen and progesterone influence the hypothalamic-pituitary axis, uterus, and cervical secretion.

Learning Objectives

• Understand ovarian and uterine changes during the menstrual cycle.
• Explain the role of estradiol, progesterone, and LH during the menstrual cycle.
• Define female sex steroids (estrogens and progesterone) and their sources.
• Comprehend the systemic effects of estrogen and progesterone in women.
• Explain oogenesis and the significance of prophase I and metaphase II arrests.
• Define menstrual gingivitis.
• Explain the effects of contraception and STDs on oral health.
• Define menopause (natural vs. premature) and its effects on oral health.

Typical XX Females Experience Monthly Menstrual Cycles

• Typical XX (biological female) individuals experience monthly menstrual cycles

Three Ovarian Phases

• There are three phases, Follicular Phase, Ovulatory Phase and Luteal Phase

Follicular Phase (d1-d14)

• Beginning with the follicular phase (d1-d14), antral follicles grow rapidly and a selection of one dominant Graafian follicle happens.
• The dominant follicle matures completely and causes an estrogen surge, which then leads to an LH surge on day 14.

Ovulatory Phase (d14)

• In the ovulatory phase (d14), the oocyte matures in the dominant follicle and is released (ovulation) after follicular rupture, usually on day 14 or 15.
• Morphological and functional changes occur in this follicle as it differentiates into the corpus luteum (CL).

Luteal Phase (d14-d28)

• During the luteal phase (d14-d28), the newly formed CL secretes high estrogen and progesterone, eventually dying toward the end of the cycle (after 14 days,)

Ovulatory Phase

• The LH surge causes meiotic progression, follicular rupture, anf luteinization.
• Meiotic Progression from prophase I (primary oocyte) to metaphase II (secondary oocyte)
• Follicular Rupture occurs, resulting in ovulation
• Differentiation of granulosa cells and theca cells to form the corpus luteum (CL)

Estrogens during the Menstrual Cycle

• Estrogens, mainly estradiol (E2 >> estrone E1), peak during the menstrual cycle in typical females.
• The primary source of estrogen is growing follicles during the follicular phase (1-14 days); corpus luteum during the luteal phase (14-28 days)
• A minor source of E1 is fat and estrogens activate estrogen receptors (ERs)

Progesterone during the Menstrual Cycle

• Progesterone (P4) is present in the plasma of a typical biological female during the menstrual cycle and the ovarian source is the corpus luteum during the luteal phase (d14-28).
• Progesterone activates progesterone receptors (PR).

Systemic Effects of Estrogen and Progesterone

• Estrogen increases fat metabolism (lipolytic effect).
• Estrogen improves circulating lipoprotein profiles and increases HDL while decreasing LDL.
• Estrogen escalates NO production, acting as a vasodilator and hypotensive agent.
• Estrogens are neuroprotective and maintains the stability of the thermoregulatory center.
• Progesterone intensifies the set-point of the thermoregulator.
• Estrogens cause pubertal long-bone growth.
• Estrogen inhibits osteoclast activity, helping to prevent osteoporosis.
• The ratio of estrogen and progesterone determines the body's response.
• Progesterone acts as a CNS depressant, specifically affecting the amygdala.

Estrogen Facilitates Sperm Entry

• Oocytes survive up to 24 hours, while sperm are able to live for up to 5 days.
• Ovulation usually coincides with an increased body temperature as a secondary effect of progesterone.

Estrogen Stimulates Production of Clear, Watery, and Stretchable Cervical Mucus

• Estradiol promotes clear, watery, and stretchable mucus.
• Progesterone leads to white, dry, cottage-cheese-like, rigid mucus.

Effects of Estrogen and Progesterone on the Uterus

• During the follicular phase, estrogen leads to the proliferation of endometrial glands.
• Tubular glands are lined by a simple columnar epithelium in the functional layer that lines the uterus.
• During the luteal phase, progesterone differentiates the endometrium causing uterine glands to become coiled.
• These glands produce a glycogen-rich secretion, increasing blood flow to spiral arteries.
• During the pre-menstrual phase, progesterone levels decrease, dropping the blood flow to the spiral arteries.
• This leads to necrosis of the endometrium, resulting in menstruation.

Correlation Between Plasma Estrogen and Progesterone Fluctuations and Menstrual Gingivitis

• Changes in the plasma levels of estrogen and progesterone during the menstrual cycle can correlate with menstrual gingivitis; estrogen escalates blood flow to the gums and progesterone decreases the body's immune function.
• This results in changes to the growth of oral bacteria, leading to inflammation, swelling, and bleeding.
• Some biological females develop swollen and bleeding gums (gingivitis) about one to two days before menstruation.
• the symptoms often resolve as menstruation begins.

Timing for Conception

• The timing of ovulation determines the time of proception, because the lifespan of secondary oocyte is about one day
• A copious discharge of watery and stretchable cervial mucus coincides with the fertile period.
• Ovulation is associated with a body temperature due to increasing levels of progesterone.
• The fertile period is day 10-16 because sperm lives longer in the biological female than 5-days

Contraceptives Act by Blocking Ovulation and/or Fertilization

• Plan A contraceptives include intrauterine, hormonal, and barrier methods like condoms, which prevent physical contact between male sperm and female reproductive tissues.
• Plan B contraceptives are synthetic progestin, such as levonorgestrel, taken as an emergency contraception (morning after pill).

Menopause and Anovulation

• Menopause happens as a result of follicular depletion, so biological females lose follicles with age, which results in Atresia (Follicular Death)
• Human biological females are bron with an endowment of 500,000 primordial follicles, of which only 500 become secondary oocytes during folliculogenesis which is a selection process.
• Follicular depletion may occur naturally during aging (natural menopause) and may be associated with premature ovarian failure.
• Q- When follicles are depleted what happens to plasma levels of; estogen- progesterone- FSH- LH-

Biological Effects of Estrogen and Progesterone

• Postmenopausal symptoms occur due to diminished biological effects of both estrogen and progesterone
• Those transitioning through this period can have; Itchy, Bitchy, Sweaty, Sleepy, Bloated, Forgetful & Psycho symptoms

Estrogen Effects

• Estrogen decreases fat storage, leading to slowed metabolism and potential weight gain.
• Estrogen diminishes circulating lipoprotein profiles, increasing the risk for heart diseases.
• Estrogen decreases NO production, leading to hypertension.
• Brain - Estrogen is neuroprotective but diminishes maintaining the stability of the thermoregulatory center, leading to dementia risk, hot flashes, night swears, sleep problems and mood swings.
• Estrogen diminishes pubertal long-bone growth and inhibits osteoclast function, preventing osteoporosis.
• Menopausal women can have hot flashes, night sweats, heart palpitations, and changes in blood pressure

Postmenopausal Oral Symptoms

• Oral symptoms result from a lack of biological effects from estradiol & progesterone, symptoms include;gum disease, tissue loss, dry mouth, change of taste, loss of teeth and burning tongue.
• Periodontitis is the bacterial infection breach, local inflammatory insult, and initial cortical bone compromise and there is no estrogen in post menopausal osteoporosis
• Post Menopausal osteoporosis includes estrogen from menopause, and the systematic bone resorption causes bone loss, with risk of fractures

Hormone Therapy Alternatives

• Hormone replacement therapy (HRT) with estrogen (E) with or without progesterone (P) is effective for hot flashes and bone los
• HRT Risks include: Heart Disease, Stroke, Blood Clots, Endocrine Cancers

Sexually Transmitted Infections/Diseases (STIs/STDs)

• Transmission of infections occurs from one biological being, to another through vaginal, anal and oral.
• Infections may be asymptomatic in the beginning.

STI Symptoms - For Biological Males

• Groin Pain, Burning during urinating and Milky Discharge with Anal Itching

STI Symptoms - For Biological Females

• Burning in Urination, Milky Discharge , and pain during intercourse

Most Common STD's

• Gonorhea, Chlamydia, and HPViruses are Most Common STD's

Common STD Stats

• Gonorrhea(70%)- 820k
• Chlamydia(63%)- 2.9 million
• HPV(49%)- 14 million

Many do not know they're infected because STIs often have no symptoms

• The Gonorrhea is- Estimated(200K), Diagnosed(570K)
• Chlamydia is - Estimated( 1M), Diagnosed(1.8M)

Prevention

• STIs are preventable via following these safety protocols such as; Use Condums, Get Tested and Vaccinated, and follow use protection for all forms of sex
• To get tested for sexually transmitted infections is to identify, assess and control your sexual partners

STI Treatment Protocol

• STIs are treatable by various means from; Antiviral medication to antibiotics.
• Without treatment Sexually transmitted infections the pathogens can affect you even with symptoms

Treatment of Sexually Transmitted Infections

• STDs can respond to some antibodies, yet others have developed into the resistant

Side Affects:

• In cases of over-prescribing of antibiotics
• Due to those who have patients not finished their treatments

Symptoms of Sexually Transmitted Diseases in the Oral Cavity

• Chlamydia, Gonorrhea, Syphilis, Herpes, HPV (human papillomavirus), HIV, Trichomoniasis
• Dental Dams could assist with STD prevention using those that require mouth to oral contact.
• Sores in the mouth which will be painless, Red spots similar to strep throat

Explore women's health topics like the menstrual cycle, contraceptives, STDs, and menopause. Learn about the hypothalamic-pituitary axis and its regulation of the ovaries through hormones like FSH and LH. Understand the roles of estrogen and progesterone in the female reproductive system and their systemic effects.