WW Final Exam Notes PDF

Reproduction Female reproductive physiology ○ Menstrual cycle Hormone regulation Gonadotropin-releasing hormone (GnGH) ○ Stimulates pituitary to release FSH and LH follicle-stimulating hormone (F...

Reproduction Female reproductive physiology ○ Menstrual cycle Hormone regulation Gonadotropin-releasing hormone (GnGH) ○ Stimulates pituitary to release FSH and LH follicle-stimulating hormone (FSH) ○ Stimulates maturation of ovum ○ Production of estrogen Lutenizing hormone (LH) ○ Stimulates maturation of ovum ○ Stimulates secretion of progesterone ○ Triggers ovulation Estrogen ○ Increases before ovulation ○ Stimulates vascularity and storage of glycogen and other nutrients within endometrium Progesterone ○ Increases after ovulation ○ Stimulates thickening and vascularity of endometrium Increase thickening, vascularity and nutrient stores in endometrium ○ Prepares uterus for fertilized ovum After ovulation, a corpus luteum forms in ovary ○ Temproary structure that secretes progesterone and estrogen ○ Degenerates after a few days unless pregnancy has begun Phases - luteal and follicular Physiological changes and hormone regulation ○ Follicular phase - first half of menstrual cycle Follicle growth and maturation Main hormones: GnRH FSH, LH, and estrogen ○ Luteal Phase - second half of menstrual cycle After ovulation Formation of corpus luteum → increase secretion estrogen and progesterone → thickening of endometrium If ovum not fertilized, corpus luteum will degenerate Decrease in esetrogen and progesterone stimulate menstrual flow ○ Polycystic Ovary Syndrome Hormonal disorder resulting in enlarged ovaries with many small cysts on outer edges Leading cause of female infertility  Primarily related to absence of ovulation Signs and symptoms Diagnosis requires 2 or more of following: ○ Irregular periods Most common symptom Infrequent, irregular, prolonged periods ○ Excess androgen Group of hormones responsible for male traits and reproductive activity Normally in both males and females Elevated levels in females → hirsutism, sever acne Excess weight can exacerbate symptoms ○ Polycystic ovaries Ovaries enlarged and contain numerous cysts ○ Excess insulin Hormone enabling body to use glucose/sugar for energy May increase androgen production Difficulty in ovulation ○ Heredity Certain genes linked to PCOS ○ Low-grade inflammation Srtimulates polycystic ovaries to produce androgens Influential factors/potential causes and risk factors Obesity Insulin resistance High serum insulin levels Relative with PCOS Complications Infertility Gestational diabetes Preeclampsia miscarriage/premature birth Type II diabetes Sleep apnea Depression, anxiety, eating disorders Abnormal uterine bleeding Endometrial cancer Management Decrease insulin resistance/optimize blood sugars Dietary recommendations  ○ Lean proteins, non-starchy vegetables, whole grains/high fiber, regular meals Limit intake of refined grains; consume with protein/fat Weight loss and physical activity → improve prognosis ○ Symptoms can substantially imrpove with weight loss of 5-10% of initial weight Medications to regulate cycle ○ Combination birth control pills Contain estrogen and progestin → decrease androgen production and related estrogen ○ Progestin therapy Taken for 10-14 days every 1-2 months to regulate periods and protect against with endometrial cancer Won’t prevent pregnancy Medications ○ Promote ovulation Clomid, letrzole ○ Decrease insulin resistance Lifestyle factors, metformin ○ Reduce excessive hair growth Birth control pills Elfornithine - cream slows facial hair ○ Endometriosis Physiology Often painful disorder in which tissue similar to tissues that line the uterus - the endometrium - grows outside uterus Most commonly involves only the pelvic organs ○ Ovaries, fallopian tubes, tissues lining pelvis Endometrial tissues very rarely spreads beyond these organs The endometrial-like tissue growing outside of the endometrium acts as endometrial tissue ○ Thickens, breaks down and bleeds with each menstrual cycle But tissue has no way to exit Surrounding tissue can become irritated, eventually developing scar tissue and adhesions ○ Abnormal bands of fibrous tissue Can cause pelvic tissues and organs to stick to each other Endometriosis on ovaries can result in endometriomas ○ Cysts on ovaries caused by endometrial tissues Signs and symptoms  Primary symptom: pelvic pain ○ with menstrual periods Dysmenorrhea ○ Pelvic pain may begin before and extend several days into a menstrual period Pelvic tissues and organs stick to each other from endometrial tissue ○ Exessive bleeding Frequent heavy menstrual bleeding or bleeding between period (intermenstrual bleeding) Pain with intercourse (during/after) Pain with bowel movements and urinations ○ Especially during menstrual periods Infertility ○ Frequent require in-vitro fertilization (IVF) Fatigue, diarrhea, constipation, bloating, nausea Influential factors/potential causes and risk factors Possible causes (unsure of exact) ○ Retrograde menstruation Menstrual blood containing endometrial cells flow back through fallopian tubes and into pelvic cavity Cells stick to pelvic walls and surface of pelvic organs ○ Transformation of peritoneal cells Hormones or immune factors cause transformation of peritoneal cells into endometrial-like cells ○ Surgical scar implantation After a surgery (C-section, hysterectomy) endometrial cells may attach to a surgical incision ○ Endometrial cell transport Blood vessels or tissue fluid (lymphatic system) may transport endometrial cells to other parts of the body ○ Immune system disorder Issues with immune system may make body unable to recognize and destroy endometrial-like tissue growing outside the uterus Risk factors ○ Never giving birth ○ Onset of menstruation at early age ○ Going through menopause at older age ○ Short menstrual cycles (7 days ○ High levels of estrogen  ○ Reproductive tract abnormalities ○ Low BMI ○ 1 or more relaitves (mother/aunt/sister) with endometriosis Complications Infertility ○ Main complications if endometriosis ○ 35-50% women with endometriosis have difficulty conceiving ○ For pregnancy to occur: Egg must be released from an ovary, travel through fallopian tube, be fertilized by a sperm and attatch to the uterine wall Endometriosis may obstruct fallopian tube, preventing egg and sperm from uniting ○ May also cause damage to sperm and egg Management Pain medication ○ Ease painful menstrual cramps ibuprofen, nonsteroidal anti-inflammatory drugs Hormone therapy ○ Sometimes effective in reducing or eliminationg pain Rise and fall of hormones during menstrual cycle → endometrial implants thicken, breaddown, bleed May slow tissue growth and prevent new implants Conservative surgery ○ Often used when women trying to become pregnant Remove endometrial implants, preserving uterus, ovaries Hysterectomy with removal of ovaries (oophorectomy) ○ Previously considered most effective treatment Less commonly used, replaced by conservative surgery ○ Removing ovaries results in menopause Lack of hormones produced by ovaries relieves symptoms for some, but not others Physiology of fertility and conception ○ Natural capability to produce offspring ○ Males and females become fertile following puberty Women: menarche and onset of ovulation/menstruation Most fertile years between late teens and late 20s Reproductive potential declines with age, ending 5-10 years before menopause  ○ Both egg quality and quantity decline By age 40, 1 year ○ 15% of couples are infertile in the US ○ 44% of couples diagnosed as ‘infertile’ will eventually conceive without use of technology ○ Healthy couples have 20-25% chance of conception within a menstrual cycle ○ Subfertility  Reduced level of fertility characterized by unusually long time for conception Typically takes between 6-12 months to conceive 18% of US couples subfertile ○ Sources of disruption Fertility disruption Weight status Adverse food/nutritional exposure ○ Suboptimal intake: energy, macronutrients, micronutrients ○ Excessive alcohol intake (male affected more heavily) Existing health conditions Severe stress Infection Tubal damage or other structural damage Chromosomal damage Sperm quantity and/or quality Miscarriage Loss of conceptus in 1st 20 weeks of pregnancy Causes: ○ Defect in fetus ○ Maternal infection ○ Structural abnormalities of the uterus ○ Endocrine or immunological disturbances Weight status and fertility ○ Excessive and inadequate levels of body fat are related to declines in fertility in women and men ○ Excessive body fat More likely subfertile ○ Inadequate body fat More likely interfile Critical level of body fat needed for reproductive functions ○ Influence on fertility in males and females Obesity, body fat disruption and fertility Visceral body fat alters reproduction in women and men ○ Women: Increase in circulating insulin Increase in testosterone → disrupts egg development ○ Men: Increase aromatase production → converts testosterone to estradiol Decrease sperm production Fertility treatment and technology ○ Intrauterine insemination  What it is/process/goal Fertility treatment that places sperm inside a womans uterus to facilitate fertilization ○ Provides sperm an ‘advantage’ by giving them a head start Process ○ Woman placed on ovulation stimulating medications cycle days 3-7 ○ Woman monitors for ovulation (LH surge) Procedure occurs 24-36 hours after LH surge ○ Semen sample washed Separates semen from seminal fluid and removes impaired/dysfunctional semen Unexplained infertility ○ Catheter places semen sample directly into the uterus Reason used to help fertility Goal: increase the number of sperm that can reach the fallopian tubes and subsequently increase chances of fertilization Often used in couples with ○ Hostel cervical condition (cervical mucus, scar tissue) ○ Unexplained infertility ○ Ejaculation dysfunction or male factor infertility ○ In-Vitro Fertilization (IVF) What it is/process/goal 5-Step Process ○ 1. Fertility Medications Ovulation-induction meds to stimulate follicular growth Multiple follicles desirable - not all will develop/fertilize after retrieval into mature ova Extensive ultrasound and blood tests to monitor follicular growth/development High-dose hormone meds taken orally and by injection Timing is critical ○ 2. Egg Retrieval Mature eggs (usually >18mm) retrieved from ovaries through surgical procedure; placed in laboratory dish ○ 3. Semen Sample Semen sample obtained and washed ○ 4. Insemination Sperm added to laboratory dish with mature eggs  Eggs monitored around 5 days for sperm fertilization and cell division Once fertilized and cell division begins, considered embryos ○ 5. Transfer Woman needs to be on additional hormonal medication One embryo transferred to woman’s uterus via catheter Many clinics freeze embryo prior to transfer - higher success rates >2 embryos may be transferred in certain circumstances ○ Ex. women >40 years of age; >2 previous failed embryo transfer attempts Remaining ‘unused’ embryos can be frozen for later use Reason used to help fertility Can be used to treat infertility in ○ Women with blocked/damaged fallopian tubes ○ Women with ovulation disorders (premature ovarian failure, uterine fibroids) ○ Individuals with a genetic disorder ○ Male factor infertility (low sperm count or motility) ○ Unexplained infertility Pregnancy ○ Physiology Duration of pregnancy - gestational vs menstrual age ○ Gestational age Assessed from the date of conception Average pregnancy is 38 weeks ○ Menstrual age Assessed from onset of last menstrual period Average pregnancy is 40 weeks Two phases: ○ anabolic phase Occurs during first half of pregnancy 0-20 weeks Blood volume expansion, increased cardiac output Buildup of fat, nutrient, and liver glycogen stores Growth of some maternal organs  Increased appetite, food intake (positive caloric balance) Decreased exercise tolerance Increased levels of anabolic hormones ○ Catabolic phase 20+ weeks Mobilization of fat and nutrient stores Increased production and blood levels of glucose ○ Triglicerides, and fatty acids; decreased liver glycogen stores Accelerated fasting metabolism Increased appetite and food intake decline someone near term Increased levels of catabolic hormones 90% of fetal growth occurs Key placental hormones Human Chorionic Gonadotropin (hCG) ○ Maintains early pregnancy; placental hormone ○ After ovulation, stimulates corpus luteum to secrete progesterone and estrogen Stimulates growth of uterine lining ○ Can first be detected in after conception: In serum: around 11 days In urine: 12-14 days ○ Doubles every 72 hours in early pregnancy ○ Reaches peak in first 8-11 weeks, then levels off for remainder of pregnancy Progesterone ○ Secreted by corpus luteum initially ○ Maintains the implant ○ Stimulates uterine lining growth and nutrient secretion Estrogen ○ Secreted by corpus luteum intially ○ Increased lipid formation and storage, protein synthesis and uterine blood flow The Placenta ○ Organ that develops from embryonic tissue and separates maternal and fetal blood ○ Functions Nutrient and gas exchange Hormone and enzyme production Remove waste from fetus Block many harmful substances ○ Weight gain Weigh gain recommendations Recommendations for weight gain are influenced by the pre-pregnancy weight status of the mother Rate of Pregnancy Weight Gain ○ Around 3-5 pounds in first trimester ○ Gradual and consistent thereafter (1-2 pounds/week) Composition of Weight Gain ○ Fetus only ⅓ of total weight gain Outcomes associated with inadequate and excessive weight gain Excessive weight gain - increased risk for: ○ Maternal pregnancy complications More pronounced pregnancy symptoms (heartburn, achy joints); gestational diabetes; preeclampsia; sleep issues, weight retention postpartum ○ fetus/infant complications Macrosomic infant; childhood obesity ○ Complications during delivery C-section; shoulder dystocia; pre-term delivery Inadequate weight gain - increased risk for ○ Maternal pregnancy complications Depletion of maternal nutrient stores (impaired bone mineral density; thinning hair) ○ fetus/infant complications Small-for-gestational age infant; infant mortality; developmental delays ○ Complications during delivery Pre-term delivery Postpartum weight retention Concern over pregnancy weight gain and long-term obesity ○ Around 15 pounds lost at delivery ○ Weight loss is difficult in women gaining >44lbs ○ Women with recommended weight gain during pregnancy are around 2 pounds heavier 1 year postpartum ○ Lactating women lose slightly more ○ Energy and macronutrient requirements Energy requirements Be able to calculate a womans daily caloric requirements during pregancy ○ 30 calories/kg + Trimester 1: 300 calories Trimester 2: 340 calories Trimester 3: 450 calories Pre pregnancy weight  Carb requirements Minimum daily intake and rationale for this minimum ○ 175 g/day ○ 45-65% of total caloric intake General changes in metabolism ○ Early pregnancy Increase estrogen and progesterone → insulin resistance Increase insulin secretion → conversion of glucose to glycogen and fat ○ Late pregnancy Human chorionic somatotropin (hCS) inhibits conversion of glucose to glycogen and fat Diverts glucose to fetus Protein requirements 15-35% of total caloric intake 1.1 g/kg ○ Non-pregnant recommended intake 0.8 g/kg 75-100 g/day Fat 20-35% of total caloric intake Importance of omega 3 fatty acids ○ Critical for fetal brain and central nervous system development ○ Micronutrients Vitamins - functions and food sources (not recommended intake) Folate ○ Functions: DNA replication; amino acids synthesis Deficiencies: abnormal tissue formation → neural tube defects ○ Dietary sources: fruits, vegetables, whole grains, fortified grains Choline ○ Functions: fetal brain growth; intellectual development ○ Dietary sources: eggs, liver, peanuts, meat/poultry/fish, dairy, pasta, rice, soybeans, potatoes, quinoa, brussels sprouts Vitamin A ○ Functions: cell differentiation ○ Dietary sources: sweet potatoes, liver, spinach, carrots, cantaloupe, red bell peppers, broccoli, milk (fortified), eggs Vitamin D ○ Function: supports fetal growth; supports immune system  Deficiency associated with: preeclampsia, miscarriage ○ Dietary sources: salmon, tuna, swiss cheese, mushrooms, fortified milk, fortified orange juice, eggs, fortified cereals Minerals - functions and food sources (not recommended intake) Calcium ○ Functions: fetal skeletal mineralization; maternal bone maintenance Deficiency: maternal calcium demineralization ○ Dietary sources: dairy products, sardines/salon with bones, fortified soy milk, fortified cereals, turnip greens, kale Iron ○ Food safety Why pregnant women at increased risk Pregnancy compromises immune systems ability to fight foodborne/other infections Fetus ○ Immune system developing Little capacity to resist/fight foodborne disease fish/mercury recommendations High mercury intakes during pregnancy associated with developmental delays and brain damage Sources to avoid: swordfish, king mackerel, tilefish, some fish in sushi, tuna Dietary guidelines: pregnant women consume 8-12 oz of a variety of a seafood/week from choices lower in mercury Foods to avoid raw/undercooked meat/fish; smoked seafood; raw/unpasteurized milk; raw/unpasteurized milk; soft cheeses made with unpaseurized milk (briw, feta, gorgonzola, roquefort); deli meats Unpasteurized goat’s milk; cat litter box Raw eggs/foods containing raw eggs ○ Potential exposure to salmonella ○ Sources: some caesar dressings, mayo, hollandaise sauces, homemade ice creams/custard Fresh-squeezed juices ○ May not be pasteurized Potential exposure to salmonella and E. coli Pregnancy complications and considerations ○ Gestational Diabetes Mellitus Carb intolerance of variable severity with first recognition during pregnancy Diagnosed 24-28 weeks gestations  Insulin resistance increases in 2nd and 3rd trimesters due to fluctuations in hormone levels Inadequate maternal insulin response to overcome high insulin resistance Risk factors: ○ 25+ years old race/ethnicity ○ Hispanic, black, native americans Pre-pregnancy BMI ○ 26+ kg/m^2 Family history ○ Type 2 diabetes, PCOS Previous pregnancy ○ GDM over 9 lb infant Screening Oral glucose tolerance test ○ Two step aproach ○ Step 1: 50 g dextrose; blood glucose assessed at 1 hour Less than 135 mg/dL at 1 hour, no diagnosis 135 mg/dL or higher at 1 hour, proceed to step 2 ○ Step 2: 100 g dextrose; blood glucose measured hourly for 3 hours - at least 2 elevated measures → GDM diagnosis Fasting blood glucose 95 mg/dL or higher 1 hour blood glucose 180 mg/dL or higher 2 hour blood glucose 155 mg/dL or higher Treatment nutrition ○ Meal and carb timing 3 meals, 2-3 snacks /day Carb counting meal plans Low carb intake with breakfast and morning snack ○ Carb quantity 45-50% of total caloric intake At least 175 g/day ○ Carb quality High fiber; consume with fat and protein Avoid simple sugars Physical activity ○ ACOG guidelines - minimum 30 min/day Aerobic and strength training improve blood glucose control Emotional support Self-monitoring blood glucose (4-7x per day) Medications  ○ Insulin therapy Breastfeeding and lactation ○ Physiology Functional Units of Mammary Glands Alveoli are functional units of mammary glands ○ Each composed of cluster of secretory cells with duct in the center Myoepithelial cells line the alveoli ○ Contact during letdown → milk ejection Stages of Lactogenesis Lactogenesis I ○ Duration: last trimester - 2-5 days after birth ○ Milk formation begins; lactose and protein content of milk increases Lactogenesis II ○ Duration: around 2-5 days after birth - around 10 days postpartum ○ Increase blood flow to breast; onset of copious milk secretion Lactogenesis III ○ Duration: begins around 10 days after birth ○ Milk composition is stable Hormonal control of milk supply Prolactin and oxytocin are necessary for establishing and maintaining a milk supply Prolactin ○ Stimulates milk production Suckling → stimulates secretion Oxytocin ○ Ejection of milk from the mammary gland (letdown) Suckling → stimulates secretion Regulation - supply and demand ○ Breast milk synthesis is related to: How vigorously an infant nurses How much time the infant is at the breast How many times per day the infant nurses ○ The size of the breast does NOT limit a woman’s ability to nurse ○ Stimulation of adequate milk may require 8-12 expressions/day The Breastfeeding Infant ○ Feeding frequency Newborns: around 10-12 feedings/day  Stomach emptying occurs in around 1.5 hours Human Milk Composition ○ Human milk is the only food needed by most healthy infants for around 6 months Nurture and protects infants from infectious diseases ○ Milk composition changes Over a single feeding Over a day Based on age of infant ○ Breastfeeding Benefits Maternal Benefits ○ Hormonal Benefits Increase oxytocin stimulates uterus to return to pre-pregnancy status ○ Physical Benefits Delay in monthly ovulation resulting in longer intervals between pregnancies ○ Psychological Benefits Increase self-confidence and bonding with infant Infant Benefits ○ Nutritional benefits Balance and composition of nutrients matches infant needs Human milk substitutions use human milk as a standard Meets infants’ protein needs without overloading kidneys Contains soft, easily digestible curd (whey protein) Provides generous amounts of beneficial lipids Minerals more bioavailable ○ Cognitive Benefits Studies show increase in cognitive ability during early childhood ○ Immunological benefits Decrease risk of infant mortality Fewer acute illness ○ Reductions in chronic illness Decrease risk of celiac disease, irritable bowel syndrome (IBS) Decrease risk of allergies and asthmatic disease ○ Childhood weight status  Typically, breastfed infants are leaner at 1 year of age ○ Socioeconomic benefits Decrease need for medical care; cost of formula Barriers Embarrassment Time and social constraints Lack of support from family and friends Lack of confidence Concerns about diet and health Fear of pain Sore Nipples ○ Common when initiating breastfeeding (typically subsides by end of first week) ○ Potential causes: Poor positioning of infant at the breast; improper latch; pumping with too much force; infection ○ Prevention: proper positioning of baby on breast may help Entire areola should be in the babys mouth with tongue extended against lower lip Hyperactive Letdown ○ Streams of milk come from breast ○ More common among first time mothers ○ If too active, may cause infant to choke while nursing ○ Management: Mother may express milk until flow slows, then allow infants to nurse Engorgement ○ Breasts overfilled with milk ○ Common in first week of birth and first time mothers Can decrease milk flow because swollen tissue compresses breast ○ Potential causes: Supply and demand not yet established → milk is abundant Mother-infant separation Sleepy baby Plugged Duct ○ Localised blockage of milk resulting from milk remaining in duct ○ Painful know form in breast ○ Prevention: complete emptying of breasts and changing position of infant while feeding Birth control ○ Pill Types  Combination ○ Contain estrogen and progestin Options with differing doses (alter frequency of periods) Monophasic: all pills contain same dose of estrogen Multiphasic: hormone does varies between pills ○ Mechanism: prevent ovulation (release of egg from ovaries) Slows an egg’s progress through fallopian tube and thickens cervical mucus Prevents egg and sperm from uniting Mini-pill ○ Contains progestin only Fewer options All pills contain same dose ○ Lower does of progestin compared with combination pills ○ Mechanism: slows an egg’s progress through fallopian tubes, thickens cervical mucus, thins endometrium May also suppress ovulation Effectiveness Complete dependent on compliancy ○ If taken consistently/correctly = 99% effective Very rare for full compliance with taking pill ○ Pill is 91% effective Timing: ○ Combination pill protects against pregnancy as long as pill is taken every day Exact timing not essential but beneficial ○ Minipill must be taken same time daily within 3 hour window ○ Intrauterine device (IUD) Types Copper ○ Plastic IUD wrapped in thin layer of copper Copper produces inflammatory reaction in uterus Toxic to sperm ○ Lasts up to 12 years ○ Emergency contraception If placed within 5 days after unprotected sex, over 99.9% effective Hormonal  ○ Use hormone progestin to prevent pregnancy Thickens cervical mucus - prevent sperm reaching an egg Thins uterine lining and partially suppresses ovulation ○ Lasts from 3-7 years, depending on brand Mechanism of action Placed by doctor/nurse Low maintenance ○ 3-12 years ○ Birth control implant Mechanism of action Thin, tiny rod implanted in upper arm by doctor/nurse ○ Releases progestin to prevent pregnancy Thickens cervical mucus on cervix to prevent sperm penetration Prevents ovulation ○ Can last up to 5 years but not permanent Can conceive quickly after removal Effectiveness 99% Low maintenance ○ Birth control vaginal ring Mechanism of action Small, flexible ring inserted inside vagina ○ Releases estrogen and progestin, absorbed through vaginal lining Thickens mucus on cervix, to prevent sperm penetration Prevents ovulation ○ One ring has enough hormones to last for up to 5 weeks ○ Ring schedule depends on how frequently a woman wants to get her period All schedules work just as well to prevent pregnancy Effectiveness 91% effective Self-administered Used on a schedule ○ Replaced monthly ○ Withdrawal Mechanism of action Ca be very effective when done perfectly  ○ Keeping all semen/ejaculation away from vulva/vagina every time ○ Odds of pregnancy if performed perfectly consistently:.04% Difficulties to consistently perform perfectly ○ 22% of people using withdrawal get pregnant Does not prevent STDs Effectiveness 78% effective Dedication and skill required ○ Condoms mechanism of action Small, thin pouches made of latex or plastic Covers penis during sex and collects semen ○ Prevents sperm from entering vagina Fertilizing egg Protect against STDs ○ Prevent contact with bodily fluids ○ Prevents skin to skin contact Herpes and genital warts Effectiveness 85% effective Emergency contraception ○ Copper IUD Period of effectiveness Must be placed within 5 days of unprotected sex ○ Works as well if inserted on post sex hour 1 as hour 120 Most effective type of emergency contraception ○ 99.9% effective if placed within 5 days Mechanism of action Copper produces inflammatory reaction in the uterus ○ Toxic to sperm ○ Morning-after pill (Ella and Plan B) Period of effectiveness Ella ○ Contains ulipristal acetate Progesterone agonist/antagonist Plan B ○ Can be taken up to 72 hours after unprotected sex Sooner taken, the better ○ Loweste effectiveness (75-89%) Regular birth control methods and other emergency contraceptives ○ Available at most pharmacies without prescription  Usually $25 ○ Contains levonorgestrel Synthetic progesterone Used in contraception and hormone therapy Mechanism of action Ella ○ mechanism of action varies depending on time of administration Follicular phase: delays or inhibits ovulation Early luteal phase: alters endometrial lining (decreases thickens and vascularity) Preventing implantation of a fertilized egg ○ If using another form of hormonal brith control, should not be used Plan B ○ Prevents release of an egg from ovaries ○ If ovulation occurs: may prevent sperm fertilization ○ If fertilization occurs: may prevent implantation Issues with weight status Plan B ○ Weight status alters effectiveness Women weighing 165-174: loses potency and effectiveness Women weighint over 175: ineffective Ella ○ More effective than Plan B regardless of weight status Optimal for body weight 155-195 Aging Menopause, perimenopause, post-menopause ○ Definitions Menopause - One year without menstrual bleeding in the absence of any surgery or medical condition that may cause bleeding to artificially stop Due to natural depletion of ovarian oocytes and decreased ovarian estrogen production that occurs with aging ○ Marks permanent end of fertility to a woman Menopause is one single day ○ Often inappropriately referred to as an extended duration of time Perimenopause - Period of time preceding menopause when physiological changes occur in a woman's body that begin the transition to menopause Ovaries begin gradually producing less estrogen ○ Still having menstrual cycles and ability to conceive  Can begin 8-10 years before menopause ○ Usually states in a woman’s 40s, but can start in the 30s Lasts up until menopause ○ Drop in estrogen production significantly drops during the last 1-2 years of perimenopause Post-menopause - Period after which a woman has not had menstrual bleeding for one year Remainder of a woman’s life after reaching menopause Menopausal symptoms may ease for many women ○ But some continue to experience menopausal symptoms for a decade or longer after menopause Menopause physiology ○ Hormonal changes Woman born w/ life supply of oocytes With age, diminish in both quantity and quality Menstrual cycle: FSH and LH secreted during follicular phase by pituitary gland Granulosa cells of a maturing oocyte grow and increase estrogen production ○ Main source of estrogen in human body Menopause: significant decline in granulosa cells of the ovary Significant decline in estrogen Normal menstrual cycle hormonal fluctuations distrupted Absence of ovulation and menstruation Menopause histopathology - general understanding of changes in: ○ Ovaries Notable changes to two structures of ovaries Cortex Outer region of ovary; house ovarian follicles Becomes significantly thinner ○ Distinction between cortex and medulla less evident Fewer follicles Medulla Highly vascularized supportive tissue in center of ovary Develops fibrosis ○ Remodeling of connective tissue → permanent scar tissue Deterioration of vasculature vessel walls ○ Vagina Contains several epithelial layers Mucosa (most superficial) ○ Atrophies due to decreased estrogen Becomes drier/thinner Vaginal mucosa loses elasticity and increases in fragility  Muscularis Adventitia (deepest) ○ Bone Healthy bone constantly remodeling Osteoblasts: bone formation Osteoclasts: bone resorption Estrogen deficiency increases osteoclastic activity Imbalance of osteoclastic and osteoblastic activity ○ More bone reabsorbed and overall bone loss ○ Arteries Arteries consist of three layers Tunica intima (surrounds lumen) Tunica media Tunica extrema Estrogen believed to have positive effect on tunica intima Help keep blood vessel flexible Estrogen deficiency → vasoconstriction of vessel walls and increased low-density lipoprotein cholesterol Increased risk for cardiovascular disease Diagnosis ○ Occurs between age of 45-55 Considered natural menopause; natural part of aging Average 51 years old ○ Generally clinically based on woman's age and symptoms Clinical symptoms direct result of decreased estrogen Typically made retrospectively after a woman has missed menses for 12 consecutive months ○ Laboratory testing can be done Often less accurate because clinical symptoms precede changes in serum laboratory values Elevated serum FSH (>40 mIU/ML) can be indicative of menopause insensitive; can be altered by drugs like estrogens, androgens, hormonal contraceptives Symptoms ○ Vasomotor symptoms - 75% Hot flashes Night sweats Palpitations Migraines Other headaches Cluster, tension ○ Urogenital symptoms - 60% Vaginal atrophy dryness, pruritus, dyspareunia  Urethral atrophy stress incontinence, frequency, urgency, dystonia Sexual dysfunction Decline in libido ○ Psychogenic symptoms - 45% anger/irritability anxiety/tension Depression Sleep disturbances Loss of concentration Loss of self-esteem/confidence ○ anthropometric/physical symptoms weight/height On average, women gain 5lbs during perimenopause Decrease in height due to osteoporosis and spine fractures Blood pressure Elevated BP may result from arterial vasoconstriction Breasts Palpation usually shows decreased breast size Vagina Dryness and urogenital atrophy Early and premature menopause ○ Early menopause: occurs before age of 45 Regardless of cause Experienced by 5% of women ○ Premature menopause: occurs before age of 40 Regardless of cause Experienced by 1% ○ Causes Can naturally occur with unknown causes or result from certain surgeries, medications, or health conditions Bilateral oophorectomy Hormone levels (estrogen, progesterone) drop quickly Menstruation ceases → unable to conceive Menopausal symptoms often occur shortly after surgery Hysterectomy Menstruation ceases → unable to conceive Unlikely to have menopausal symptoms immediately after ○ Natural menopause may occur 1-2 years earlier than expected Chemotherapy or pelvic radiation treatments for cancer can damage ovaries ○ Menstruation may stop temporarily or permanently Menopause does not always result from these treatments  ○ The younger a woman is at the time, the less likely Smoking Smoking women often reach menopause 1-2 years More severe menopausal symptoms Family history ○ Diagnosis Menopause occurs >45 years of age - diagnosis can be made clinically with no testing For younger women, necessary to rule out other diagnoses that can cause secondary amenorrhea Primary amenorrhea: absence of a first period in a young woman by the age of 16 Secondary amenorrhea: cessation of menstruation for >3 months in a woman who previously had normal menstrual cycles Pregnancy Most common cause of amenorrhea Breastfeeding Endocrine gland disorders Thyroid dysfunction, adrenal gland disorders Anatomic defects Scarring of uterine cavity, obstruction of uterine outflow tract Eating disorder/disordered eating Treatment and management ○ Focused on minimizing disruptive symptoms and preventing long-term complications ○ Determining if and what medications to use is complicated ○ Hormonal treatments Prescription medicine used to relieve some menopausal symptoms when severe enough to disrupt daily life HT replaces some of the hormones no longer made by ovaries Relieve menopausal symptoms Safe for women up to 59, but usually only within 10 years of menopause ○ Lifestyle factors Exercise Prevent weight gain ○ Tendency to lose muscle mass and gain abdominal fat around menopause Reduce risk of cancer ○ Maintaining healthy weight protects again several cancers (breast, colon, endometrial) Reduce risk of osteoporosis and fractures ○ Weight-bearing exercise slow bone loss after menopause Decrease risk of chronic disease  ○ Menopause weight gain increase risk of heart disease, obesity, type II diabetes, metabolic syndrome Enhance mood ○ Natural release of endorphins released Aerobic activity - 150 min/week ○ establish/maintain healthy weight ○ Decrease risk for coronary artery disease Strength training - 2x/week ○ Reduce body fat/maintain muscle mass Improve metabolism/weight status ○ Strengthen muscles/prevent bone loss Decrease risk of osteoporosis and fractures Stretching, stability, balance ○ Improve flexibility and decrease risk of falls/fractures Diet Fiber-rich diet ○ Whole grains, fruits, vegetables, legumes, nuts, seeds ○ Benefits: maintain bowel health Lower bad cholesterol Improve heart health Reduce blood pressure/inflammation Recommended intake for women: 50 or younger: 25 g/day 50+: 21 g/day Consume healthful dietary pattern ○ 3 meals/day Fiber-rich, lean protein, low-fat dairy, fruits, vegetables ○ Do not go longer than 5 hours without eating Slows metabolism → less energy efficient ○ Consume nutrient dense NOT energy dense foods Staying physically active, including strength training ○ Adequate protein intake to promote muscle-protein synthesis Lean protein foods Consume each meal Protein intake at breakfast suboptimal Vitamin D ○ Optimal vitamin D level to maintain muscle and bone health ○ Other critical vitamins/minerals Magnesium, phosphorus, potassium Smoking cessation  Phytoestrogens ○ Estrogens that occur naturally in some plants Beans, soy products, peas, lentils, whole grains, seeds ○ May help alleviate menopause symptoms Sleep quality ○ Disturbance common symptom of menopause ○ Sleep loss interrupts appetite regulation Elevated levels of hunger hormone Decreased level of satiety hormone ○ Strategies: Refrain from drinking caffeine 4-6 hours before bed Refrain from alcohol 3 hours before bed Avoid eating heavy meal close to bedtime Establish regular sleep routine Engage in regular physical activity, not within 3 hours of bedtime Gastrointestinal issues ○ bloating , bowel discomfort, abdominal pain, altered bowel patterns ○ Gut microbiota changes with age Decline in number and diversity of protective microbes ○ Strategies to improve GI discomfort: Drink 48-64 oz water daily; adequate daily fiber intake Choose less gassy sources over insuline or whole wheat fibers ○ Chia and pumpkin seeds, strawberries Other Alcohol intake ○ May exacerbate menopause symptoms Even with moderate intake ○ regular/excessive intake decrease bone density Risk for osteoporosis and fractures Smoking ○ Increases severity and frequency of symptoms ○ Prohibits use of many hormonal therapies ○ Increases heightened risk for coronary artery disease Sexual activity ○ Regular activity may decrease vaginal dryness caused by vaginal atrophy ○ May improve:  Depressive symptoms Self-confidence Quality of life Mind-body relaxation and stress reduction ○ May improve depressive symptoms and lessen mood swings Physical Activity Energy ○ Active females exercising 6-10 hours/week 2,500 kcals/day or more to maintain body weight ○ Competitive female athletes exercising 10-20+ hours/week 3,000 kcals/day ○ Importance of adequate energy intake for female athletes and potential consequences of suboptimal intake Energy 30 years Layoffs, limited or complete absence of child care Women of color and working low-wage jobs most impacted ○ Women much more likely than men to live in poverty and uncertainty about future, decreased access to community and healthcare services Feelings of negativity, low self-esteem, lack of control over life