OBI 814 - RD2 - Exam 2

• Women's health covers the menstrual cycle, contraceptives, STDs, and menopause

H-P Axis

• The Hypothalamic-Pituitary (H-P) axis controls the female reproductive system
• Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) act on the ovaries
• High estrogen levels inhibit FSH and LH release
• Estrogen and progesterone, along with inhibin and testosterone, stimulate the ovaries
• The ovaries produce estrogen and progesterone, which act on the uterus

Learning Objectives

• Ovarian and uterine changes during the menstrual cycle
• Hormonal profiles (estradiol, progesterone, and LH) during the menstrual cycle
• Definition and sources of female sex steroids (estrogens & progesterone)
• Systemic effects of estrogen and progesterone
• Biological effects of estrogen and progesterone:
  • Hypothalamic-pituitary axis, uterus, and cervical secretion
• Oogenesis and the significance of prophase I and metaphase II arrests
• Menstrual gingivitis
• Effects of contraceptives and STDs on oral health
• Menopause (natural vs. premature) and its effects on oral health

Monthly Menstrual Cycles

• Typical XX females experience monthly menstrual cycles

Ovarian Phases

• There are three ovarian phases
  • Follicular
  • Ovulatory
  • Luteal

Follicular Phase (d1-d14)

• Recruited antral follicles rapidly grow during the early follicular phase
• Selection of one dominant, Graafian follicle occurs during the mid-follicular phase
• Dominant follicle matures fully and causes an estrogen surge, leading to an LH surge on day 14

Ovulatory Phase (d14)

• The oocyte in the dominant follicle matures and is released (ovulation) upon follicular rupture, typically on day 14 (15)
• Morphological and functional changes occur in this follicle toward its differentiation into the corpus luteum (CL)

Luteal Phase (d14-d28)

• The newly formed CL secretes high estrogen and progesterone
• The CL undergoes death toward the end of the cycle, after the 14 days of the typical menstrual cycle
• The luteal phase’s function is the CL's

Ovulatory Phase Details

• The LH surge is responsible for meiotic progression, follicular rupture, and luteinization
• Meiotic progression: prophase I (primary oocyte) becomes metaphase II (secondary oocyte)
• Follicular rupture leads to ovulation where the cumulus-oocyte-complex (COC) with a secondary oocyte arrested at metaphase II, which is released at ovulation, otherwise the oocyte will be trapped inside
• Granulosa and theca cells differentiate into the corpus luteum (CL)

Estrogens

• Estrogens (estradiol E2 >> estrone E1) are present in the plasma of a typical XX female during the menstrual cycle
• Primary source: growing follicles during the follicular phase (1-14 days) and the corpus luteum during the luteal phase (14-28 days)
• Minor source for E1 is fat
• Estrogen activates estrogen receptors (ERs)

Progesterone (P4)

• Progesterone is present in the plasma of a typical XX female
• Ovarian source: the corpus luteum during the luteal phase (d14-28)
• Progesterone activates progesterone receptors (PR)

Systemic Effects of Estrogen and Progesterone

• Estrogen and progesterone together determine the response
• Adipose tissue: Estrogen increases fat metabolism via a lipolytic effect
• Liver: Estrogen improves circulating lipoprotein profiles, increasing HDL and decreasing LDL
• Cardiovascular (CV): Estrogen increases NO production, acting as a vasodilator and hypotensive agent
• Central Nervous System (CNS):
  • Estrogen is neuroprotective
  • Estrogen maintains the stability of the thermoregulatory center
  • Progesterone increases the set-point of the thermoregulator
  • Progesterone is a depressant on the CNS, affecting the amygdala
• Bone:
  • Estrogen causes pubertal long-bone growth to its maximum
  • Estrogen inhibits the osteoclast, preventing osteoporosis

Estrogen and Sperm Entry

• Estrogen facilitates sperm entry
• Oocyte lives up to 24 hours
• Sperm can live around 5 days
• Ovulation coincides with an increased body temperature due to progesterone's effect

Estrogen and Cervical Mucus

• Estrogen stimulates the production of clear, watery, and stretchable cervical mucus
• White, dry, cottage-like, rigid mucus is produced in response to progesterone

Effects of Estrogen and Progesterone on the Uterus

• Follicular phase
  • Estrogen stimulates proliferation of endometrial glands
  • Tubular glands are lined by a simple columnar epithelium in the functional layer of the endometrium
• Luteal phase
  • Progesterone differentiates the endometrium resulting in glands becoming coiled
  • Glycogen rich secretion is produced and blood flow is increased to spiral arteries
• Pre-menstrual phase
  • Progesterone levels decrease
  • Blood flow to the spiral arteries stops causing necrosis of the endometrium which then results in menstruation

Menstrual Gingivitis

• Estrogen increases blood flow to the gums and progesterone decreases the body's immune function
• Hormones change oral bacteria growth, leading to inflammation, swelling, and bleeding
• Swollen, bleeding gums (gingivitis) develop a day or two before the period, resolving with menstruation

Conception Timing

• Ovulation timing dictates the time of proception because the oocyte lifespan is about 1 day
• Copious watery cervical mucus discharge coincides with the fertile period
• Ovulation is associated with a rise in body temperature due to increased progesterone
• The fertile period stretches from day 10-16, because sperm can live for longer than 5 days

Contraceptives

• Contraceptives act to block ovulation and/or fertilization

Plan A Contraceptives

• Includes Intrauterine, hormonal and physical barrier methods
• Physical barrier methods (e.g., condoms) prevent physical contact between male's semen and female's reproductive tissues

Plan B Contraceptive

• Emergency contraception is available as the "morning after pill"
• It contains synthetic progestin, levonorgestrel

Menopause and Follicular Depletion

• Menopause is caused by follicular depletion
• Females are born with a fixed number of primordial follicles and continuously lose them, beginning in utero
• Atresia (follicular death) can occur at any stage of follicular development
• Females born with ~500,000 primordial follicles, but only about 500 become secondary oocytes through Folliculogenesis
• Naturally occurs due to aging, and is linked to genetics, premature ovarian failure/insufficiency, or induced oocyte death

Follicle Depletion

• When follicles are depleted (no growing follicles or CL in the ovary), plasma levels of these deplete:
  • Estrogen, Progesterone, FSH, LH

Postmenopausal Symptoms

• Postmenopausal symptoms are due to diminished production of estrogen and progesterone

Common Postmenopausal Symptoms

• Adipose tissue: Lower fat storage (lipolytic effect), leading to a slower metabolism and weight gain
• Liver: Impaired lipoprotein profiles, increase heart disease
• CV: Hypotension
• CNS: Increased risks of dementia, hot flashes, night sweats, sleep issues/difficulty waking and mood swings
• Bone: Osteoporosis and hypertension

Vasomotor Symptoms

• Hot flashes, night sweats, heart palpitations, and blood changes

Postmenopausal and Oral Health

• Postmenopausal oral symptoms are due to lack of the biological effects of estradiol and progesterone:
  • Gum disease (e.g., gingivitis or periodontitis)
  • Gum tissue loss or recession
  • Gum injury
  • Gum bleeding
  • Bone loss or osteoporosis (in the teeth and jawbone)
  • Burning tongue, gums, and mouth
  • Dry mouth
  • Changes in taste
  • Menopausal gingivostomatitis

Hormone Therapy

• Hormone Therapy (E or E+P) may not be right for everyone
• Is effective for managing hot flashes or managing the loss of bone mass
• Risks include heart disease, stroke, blood clots, and endocrine cancers

Long-Term Contraceptives

• Long-term use of estrogen-based OCs may lead to hypercoagulation which can cause blood clots/stroke and can cause dry socket after extraction

STIs and STDs

• Sexually transmitted infections and diseases that spread among individuals and cause serious health problems
• Transmission occur typically during vaginal, anal, and oral sex
• Not all infections may cause symptoms

STIs & Transmission

• Groin Pain, burning with urination and milky discharge are symptoms that are common in both genders

STIs and Prevention

• STIs and STDs can be prevented
• Prevention includes limiting sexual partners, condom use, get tested, and get vaccinated

Common STIs

• Common STIs include Gonorrhea, Chlamydia, and HPV
• Gonorrhea, Chlamydia, HPV, Genital Herpes, HIV, and Syphilis are ranked from highest to lowest diagnosis

STIs and Treatments

• Even without symptoms, pathogens are transmissible during the incubation period
• STI and incubation times includes Chlamydia, Gonorrhea, Syphilis, HPV, Herpes, Trichomoniasis, Hepatitis B, Chancroid, Lymphogranuloma venereum, Mycoplasma genitalium, HIV/AIDS, and Mpox

STI Resistance

• STDs can experience increasing resistance to antibiotics
• Increasing resistance to antibiotics includes gonorrhea, chlamydia, and syphilis

Oral Symptoms

• Symptoms of STDs may be present in the oral cavity
• Symptoms include chlamydia, gonorrhea, syphilis, herpes, HPV, HIV, trichomoniasis
• These can be some the blood borne infections but not all
• Sores, lesions like cold sores, strep throat redness and lymph node are all possible