The Female Reproductive Cycle.

All-inclusive term for the many physiological and developmental changes which occur in the
female throughout life including:

the life cycle of infertile childhood, puberty, fertile years of youth and adulthood,

menopause, and finally infertile postmenopausal years

the menstrual cycle which is a pair of series of -monthly repetitive physiological and
developmental changes in the ovaries, and in the uterus, as well as some minor

changes in the breasts which accompany the menstrual cycle

The cycle starts in puberty stage usually the ages 10-14
each cycle lasts 28 days consisting sequence of changes occurring in ovaries and
uterus

Here are the steps through cycle:

During reproductive cycle, Gonadotropin-releasing hormone or (GnRH) from the
hypothalamus stimulates the anterior pituitary to release two gonadotropic hormones:
Follicle-stimulating hormone and Lutienizing hormone. The target organ for these two
hormones is the ovary
FSH & LH are released from the anterior pituitary.
FSH causes the follicle to develop..as it develops, the follicle secretes estrogen (and

some progesterone)
Estrogen causes the thickening of the endometrium to begin.
The anterior pituitary releases a surge of stored LH (from more GnRH stimulation)
Ovulation (in response to LH) occurs, and the future-ovum enters the uterine tubes
The remnants of the follicle remain in the ovary, and are now called the corpus luteum.
The corpus luteum secretes lots of progesterone (and some estrogen).
Progesterone causes the thickening of the endometrium to continue (and it makes it

more vascular and glandular)

The high levels of progesterone and estrogen inhibit production of FSH & LH (so no
other follicles develop).

 The corpus luteum degenerates into the corpus albicans, and release of estrogens
decreases. (Note: this only happens if the ovum is NOT fertilized)
Decline in estrogens causes the sloughing off of the endometrium. This Decline in
estrogens releases the inhibition of the anterior pituitary release of gonadotropins, and
FSH and LH can be made again.

Female cycles: Uterine cycle, Ovarian cycle

The ovarian cycle is a series of events in the ovaries that occur during and after the maturation
of an oocyte.

The uterine (menstrual) cycle is a concurrent series of changes in the

endometrium of the uterus to prepare it for the arrival of a fertilized ovum that will develop there
until birth. During the menstrual cycle the endometrium grows to a thick, blood vessel-rich,
glandular tissue layer. The general term female reproductive cycle encompasses the ovarian
and uterine cycles, the hormonal changes that regulate them, and the related cyclical changes
in the breasts and cervix.

Hormonal Regulation of the Female Reproductive Cycle

Gonadotropin-releasing hormone (GnRH) secreted by the hypothalamus controls the
ovarian and uterine cycles. It stimulates the release of follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) from the anterior pituitary.FSH initiates follicular growth, while LH
stimulates further development of the ovarian follicles. The uterine and ovarian cycles are
controlled by GnRH from the hypothalamus, which stimulates the release of FSH and LH by the
anterior pituitary. FSH and LH stimulate development of follicles and secretion of estrogens by
the follicles. LH also stimulates ovulation, formation of the corpus luteum, and the secretion of
progesterone and estrogens by the corpus luteum.

 Estrogens stimulate the growth, development, and maintenance of female reproductive

structures; stimulate the development of secondary sex characteristics; and stimulate
protein synthesis. Progesterone works with estrogens to prepare the endometrium for
implantation and the mammary glands for milk synthesis.
Estrogens- the female sex hormones, including estradiol (the most potent naturally occurring
human estrogen) , estriol (weakest of the three natural human estrogen), and estrone (. it is
Estrogens promote the development and maintenance of female reproductive structures,
secondary sex characteristics, and the breasts. The secondary sex characteristics include
distribution of adipose tissue in the breasts, abdomen, monspubis, and hips; voice pitch; a
broad pelvis; and pattern of hair.
growth on the head and body.
Estrogens increase protein anabolism, including the building of strong bones. In this regard,
estrogens are synergistic with human growth hormone (hGH).
Estrogens lower blood cholesterol level, which is probably the reason that women under age
50 have a much lower risk of coronary artery disease than do men of comparable age.
Moderate levels of estrogens in the blood inhibit both the release of GnRH by the
hypothalamus and secretion of LH and FSH by the anterior pituitary.
Progesterone- hormone secreted by the female reproductive system that functions mainly to
regulate the condition of the inner lining (endometrium) of the uterus. Progesterone is produced
by the ovaries, placenta, and adrenal glands.

 It cooperates with estrogens to prepare and maintain the endometrium for implantation of a
fertilized ovum and to prepare the mammary glands for milk secretion. High levels of
progesterone also inhibit secretion of GnRH and LH.

The small quantity of relaxin produced by the corpus luteum during each monthly cycle
relaxes the uterus by inhibiting contractions of the myometrium. Presumably,
implantation of a fertilized ovum

occurs more readily in a quiet uterus.

Duringpregnancy, the placenta produces much more relaxin, and it continuesto relax
uterine smooth muscle. At the end of pregnancy, relaxin also increases the flexibility of
the pubic symphysis and may help dilate the uterine cervix, both of which ease delivery

of the baby.
Inhibin is secreted by granulosa cells of growing follicles and by the corpus luteum after
ovulation. It inhibits secretion of FSH and, to a lesser extent, LH.

Phases of the Female Reproductive cycle

The duration of the female reproductive

cycle typically rangesfrom 24 to 36 days

Four phases: the menstrual phase, the

preovulatory phase, ovulation, and the postovulatory phase
The menstrual phase also called menstruation or menses lasts for roughly the first 5 days
of the cycle. (By convention, the first dayof menstruation is day 1 of a new cycle.)
EVENTS IN THE OVARIES
o

Under the influence of FSH, several primordial follicles develop into primary follicles

and then into secondary follicles.

This developmental process may take several months to occur. Therefore, a follicle
that begins to develop at the beginning of a particular menstrual cycle may not reach
maturity and ovulate until several menstrual cycles later.

EVENTS IN THE UTERUS

o

Menstrual flow from the uterus consists of 50150 mL of blood, tissue fluid, mucus,
and epithelial cells shed from the endometrium. This discharge occurs because the
declining levels of progesterone and estrogens stimulate release of prostaglandins
that cause the uterine spiral arterioles to constrict.

As a result, the cells they supply become oxygen-deprived and start to die.
Eventually, the entire stratum functional is sloughs off. At this time the endometrium
is very thin, about 25 mm, because only the stratum basal is remains. The
menstrual flow passes from the uterine cavity through the cervix and vagina to the
exterior.

The preovulatory phase is the time between the end of menstruation and ovulation. The
preovulatory phase of the cycle is more variable in length than the other phases and accounts
for most of the differences in length of the cycle. It lasts from days 6 to 13 in a 28-day cycle.
EVENTS IN THE OVARIES
o

Some of the secondary follicles in the ovaries begin to secrete estrogens and inhibin. By
about day 6, a single secondary follicle in one of the two ovaries has outgrown all the

others to become the dominant follicle.

Estrogens and inhibin secreted by the dominant follicle decrease the secretion of FSH,
which causes other, less well-developed follicles to stop growing and undergo atresia.

EVENTS IN THE UTERUS

o

Estrogens liberated into the blood by growing ovarian follicles stimulate the repair of the
endometrium; cells of the stratum basal is undergo mitosis and produce a new stratum

functional is.
As the endometrium thickens, the short, straight endometrial glands develop, and the
arterioles coil and lengthen as they penetrate the stratum functional is. The thickness of

the endometrium approximately doubles, to about 410 mm.

also termed proliferative phase because the endometrium is proliferating

The female reproductive cycle

Ovulation
Ovulation the rupture of the mature (graafian) follicle and the release of the secondary oocyte
into the pelvic cavity that usually occurs on day 14 in a 28-day cycle. During ovulation, the
secondary oocyte remains surrounded by its zona pellucid and corona radiata. The high levels
of estrogens during the last part of the preovulatory phase exert a positive feedback effect on
the cells that secrete LH and gonadotropin-releasing hormone (GnRH) and cause ovulation.

The postovulatory phase of the female reproductive cycle is the time between ovulation and
onset of the next menses. In duration, it is the most constant part of the female reproductive
cycle. It lasts for 14 days in a 28-day cycle, from day 15 to day 28

EVENTS IN ONE OVARY

o

After ovulation, the mature follicle collapses, and the basement membrane between the
granulosa cells and theca interna breaks down. Once a blood clot forms from minor

bleeding of the ruptured follicle, the follicle becomes the corpus hemorrhagicum.
Theca interna cells mix with the granulosa cells as they all become transformed into

corpus luteum cells under the influence of LH.

Stimulated by LH, the corpus luteum secretes progesterone, estrogen, relaxin, and

o
o

inhibin. The luteal cells also absorb the blood clot.

this phase is also called the luteal phase.
later events in an ovary that has ovulated an oocyte depend on whether the oocyte is
fertilized. If the oocyte is not fertilized, the corpus luteum has a lifespan of only 2 weeks.

Then, its secretory activity declines, and it degenerates into a corpus. As the levels of
progesterone, estrogens, and inhibin decrease, release of GnRH, FSH, and LH rises

due to loss of negative feedback suppression by the ovarian hormones.

Follicular growth resumes and a new ovarian cycle begin. If the secondary oocyte is
fertilized and begins to divide, the corpus luteum persists past its normal 2-week
lifespan.

EVENTS IN THE UTERUS

o

Progesterone and estrogens produced by the corpus luteum promote growth and coiling
of the endometrial glands, vascularization of the superficial endometrium, and thickening
of the endometrium to 1218 mm (0.480.72 in.). Becauseof the secretory activity of the
endometrial glands, which begin to secrete glycogen, this period is called the secretory
phase of theuterine cycle. These preparatory changes peak about 1 week after

ovulation, at the time a fertilized ovum might arrive in the uterus.

If fertilization does not occur, the levels of progesterone and estrogens decline due to
degeneration of the corpus luteum. Withdrawalof progesterone and estrogens causes
menstruation.

REVIEW OF TOPIC:

prepare the endometrium

hypothalamus, which

each month to receive a

stimulates the release of

fertilized egg. The female

FSH and LH by the

reproductive cycle

anterior pituitary. FSH and

1. The function of the

includes both the ovarian

LH stimulate development

ovarian cycle is to develop

and uterine cycles.

of follicles and secretion of

The Female Reproductive

Cycle

a secondary oocyte; the

function of the uterine
(menstrual) cycle is to

2. The uterine and ovarian

cycles are controlled by
GnRH from the

estrogens by the follicles.

LH also stimulates
ovulation, formation of the

corpus luteum, and the

3. Estrogens stimulate the

stimulate the development

secretion of progesterone

growth, development, and

of secondary sex

and estrogens by the

maintenance of female

characteristics; and

corpus luteum.

reproductive structures;

stimulate protein

synthesis. Progesterone

in the ovaries begins to

7. Ovulation is the rupture

works with estrogens to

undergo final maturation.

of the mature (graafian)

prepare the endometrium

One follicle outgrows the

follicle and the release of a

for implantation and the

others and becomes

secondary oocyte into the

mammary glands for milk

dominant while the others

pelvic cavity. It is brought

synthesis.

degenerate. At the same

about by a surge of LH.

time,endometrial repair

Signs and symptoms of

occurs in the uterus.

ovulation include

Estrogens are the

increased basal body

dominant ovarian

temperature; clear,

hormones during the

stretchy cervical mucus;

preovulatory phase.

changes in the uterine

4. Relaxin relaxes the

myometrium at the time of
possible implantation. At
the end of a pregnancy,
relaxin increases the
flexibility of the pubic
symphysis and helps dilate
the uterine cervix to
facilitate delivery.
5. During the menstrual
phase, the stratum
functionalis of the
endometrium is shed,
discharging blood, tissue
fluid, mucus, and epithelial
cells.
6. During the preovulatory
phase, a group of follicles

cervix; and abdominal

pain.
8. During the postovulatory
phase, both progesterone
and estrogens are
secreted in large quantity
by thecorpus luteum of the
ovary, and the uterine
endometrium thickens in
readiness for implantation.
9. If fertilization and
implantation do not occur,
the corpus luteum

degenerates, and the

another reproductive

corpus luteum and later

resulting low levelsof

cycle.

the placenta secrete

progesterone and
estrogens allow discharge
of the endometrium
followed by the initiation of

10. If fertilization and

implantation do occur, the
corpus luteum is
maintained by hCG. The

progesterone and
estrogens to support
pregnancy and breast
development for lactation

BIRTH CONTROL METHODS AND ABORTION

Birth Control
-refers to restricting the number of children by various methods designed to control fertility and
prevent conception.
The only method of preventing pregnancy that is 100% reliable is complete

abstinence,the avoidance of sexual intercourse.

Several other methods are available; each has its advantages and disadvantages.
These includes: surgical sterilization, hormonal methods, intrauterine devices,
spermicides, barrier methods, and periodic abstinence.

Birth Control Methods

Surgical Sterilization
Sterilization is a procedure that renders an individual incapable of further reproduction.
Vasectomy (males) - is a surgical procedure performed on adult males in which the vans
deferentia (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied,
cauterized (burned or seared), or otherwise interrupted. The semen no longer contains
sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce
sperm, but they die and are absorbed by the body
Tubal ligation/ Tubectomy(females)- is a surgical procedure for sterilization in which a
woman's fallopian tubes are clamped and blocked, or severed and sealed, either method of
which prevents eggs from reaching the uterus for fertilization
Non-incisional Sterilization
Essure is a permanent birth control method for women that create a barrier against
pregnancy. It involves placing soft, flexible inserts into the fallopian tubes, which carry
the eggs from the ovaries to the uterus. Over a period of about three months, tissue
forms around the inserts. The build-up of tissue creates a barrier that keeps sperm from
reaching the eggs, thus preventing conception.
Hormonal Methods
It contains a small amount of man-made estrogen and progestin hormones. These
hormones work to inhibit the body's natural cyclical hormones to prevent pregnancy.
Progestins thicken cervical mucus and make it more difficult for sperm to enter the uterus.
Pregnancy is prevented by a combination of factors. The hormonal contraceptive usually
stops the body from ovulating. Moreover, it also change the cervical mucus to make it

difficult for the sperm to go through the cervix and find an egg. It can also prevent pregnancy
by changing the lining of the womb so it's unlikely the fertilized egg will be implanted.
Following are several variations of oral hormonal methods of contraception:
Combined pill- contains both progestin and estrogens and is typically taken once a day for
3 weeks to prevent pregnancy and regulate the menstrual cycle. The pills taken during the
fourth week are inactive (do not contain hormones) and permit mensruation to occur.
Seasonale- contains both progestin and estrogens and istaken once a day in 3-month
cycles of 12 weeks of hormone containingpills followed by 1 week of inactive pills.
Menstruation occurs during the thirteenth week.
Minipill. Contains progestin only and is taken every day of the month.

Following are several variations of non-oral hormonal methods of contraception:

Contraceptive skin patch- contains both progestin and estrogens delivered in a skin patch
placed on the skin (upper outer arm, back, lower abdomen, or buttocks) once a week for 3
weeks. After 1 week, the patch is removed from one location and then a new one is placed
elsewhere. During the fourth week no patch is used.
Vaginal contraceptive ring- a flexible doughnut-shaped ring about 5 cm (2 in.) in diameter
that contains estrogens and progesterone and is inserted by the female herself into the
vagina. It is left in the vagina for 3 weeks to prevent conception, and then removed for one
week to permit menstruation.

 Emergency contraception consists of progestin and estrogens or progestin alone to

prevent pregnancy following unprotected sexual intercourse. The relatively high levels of
progestin and estrogens in EC pills provide inhibition of FSH and LH secretion. One pill is
takenas soon as possible but within 72 hours of unprotected sexualintercourse. The second
pill must be taken 12 hours after the first. The pills work in the same way as regular birth
control pills.
Intrauterine Devices
An intrauterine device (IUD) is a small plastic and copper device that is put into your
uterus (womb). It has one or two threads on the end. These thin threads hang through
the opening at the entrance of your uterus (cervix) into the top of your vagina that
prevents fertilization from taking place by blocking sperm from entering the uterine
tubes.
Spermicides
Various foams, creams, jellies, suppositories, and douches that contain
sperm-killing agents, or spermicides, make the vagina and cervix unfavorable for sperm
survival and are availablewithout prescription. They are placed in the vagina before sexual
intercourse.
Barrier Methods
Barrier methods use a physical barrier and are designed to prevent sperm from
gaining access to the uterine cavity and uterine tubes.
o

A male condom is a nonporous, latex covering placed over the penis that
prevents deposition of sperm in the female reproductive tract.

A vaginal pouch, sometimes called a female condom, is designed to prevent

sperm from entering the uterus. It is made oftwo flexible rings connected by a
polyurethane sheath. One ringlies inside the sheath and is inserted to fit over the
cervix; theother ring remains outside the vagina and covers the female external

genitals.
A diaphragm is a rubber, dome-shaped structure that fits over the cervix and is
used in conjunction with a spermicide.It can be inserted by the female up to 6
hours before intercourse.The diaphragm stops most sperm from passing into the

cervix and the spermicide kills most sperm that do get by.
A cervical cap resembles a diaphragm but issmaller and more rigid. It fits snugly
over the cervix and must be fitted by a health-care professional. Spermicides
should be use with the cervical cap.

Periodic Abstinence
Rhythm method- It involves abstaining from sexual activity on the days that ovulation
is likely to occur in each reproductive cycle. During this time (3 days before ovulation,
the day of ovulation, and 3 days after ovulation) the couple abstains from intercourse.
The effectiveness of the rhythm method for birth control is poor in many women due to
the irregularity of the female reproductive cycle.
Sympto-thermal method - in which couples are instructed to know and understand
certain signs of fertility. The signs of ovulation include increased basal body
temperature; the production of abundant clear, stretchy cervical mucus; and pain
associated with ovulation. If a couple abstains from sexual intercourse when the signs of
ovulation are present and for 3 days afterward, the chance of pregnancy is decreased. A
big problem with this method is that fertilization is very likely if intercourse occurs 1 or 2
days before ovulation.
Abortion

Abortion refers to the premature expulsion of the products of conception from the
uterus, usually before the twentieth week of pregnancy. An abortion may be
spontaneous (naturally occurring; also called a miscarriage) or induced (intentionally
performed).
Types of induced abortions:
Mifepristone (miniprex) - It is a hormone approved only for pregnancies 9 weeks or
less when taken with misoprostol (aprostaglandin). Mifepristone is an antiprogestin; it
blocks theaction of progesterone by binding to and blocking progesterone receptors.
Vacuum aspiration (suction) and can be performed up to the sixteenth week of
pregnancy. A small, flexible tube attached to a vacuum source is inserted into the uterus
through the vagina.

Dilation and evacuation

The embryo or fetus,placenta, and lining of the uterus are then removed by suction. For
pregnancies between 13 and 16 weeks
Late-stage abortion may be employed using surgical methods similar to dilation and
evacuation or through nonsurgical methods using a saline solution or medications to
induce abortion. Labor may be induced by using vaginal suppositories, intravenous
infusion, or injections into the amniotic fluid through the uterus.

Review of topic:

Birth Control Methods and Abortion

1. Methods include complete abstinence, surgical sterilization (vasectomy, tubal
ligation), non-incisional sterilization, hormonal methods (combined pill, minipill,
contraceptive skin patch, vaginal contraceptivering, emergency contraception, hormonal
injections), intrauterine devices, spermicides, barrier methods (male condom, vaginal
pouch, diaphragm, cervical cap), and periodic abstinence (rhythm and sympto-thermal
methods).
2. Contraceptive pills of the combination type contain progestin and estrogens in
concentrations that decrease the secretion of FSH and LH and thereby inhibit
development of ovarian follicles and ovulation, inhibit transport of ova and sperm in the
uterine tubes, and block implantation in the uterus.
3. An abortion is the premature expulsion from the uterus of the products of conception;
it may be spontaneous nor induced.

DEVELOPMENT OFTHE REPRODUCTIVE SYSTEMS

In sexual reproduction, genes from two individuals are combined in random and novel ways.
This generates diversity within the species.
Normally each cell in the adult has 23 pairs of chromosomes or 46 total chromosomes.

22 pairs are called autosomal chromosomes

1 pair is called the sex chromosomes

XX sex chromosome is female

XY sex chromosome is male.

Formation of Testis and Ovaries

After conception the embryonic gonads of males and females are similar (for about the
first 40 days). Therefore the embryo can form either testes or ovaries. The presence or
absence of the Y chromosome determines what happens. SRY (sex determining region
of the Y chromosome) on the Y chromosome male. SRY gene encodes the testidetermining factor.

Accessory Sex organs:

For the first 40 days the reproductive system of the embryo is undifferentiated and has
accessory organs characteristic of either sex.

Male: Wolffian ducts epididymis, ductus (vas deferens), seminal vesicles, ejaculatory duct.

Sertoli cells: Mullerian inhibitory factor (MIF): regression of the Mullerian ducts

Leydig cells: Testosterone: epididymis, ductus (vas) deferens, seminal vesicles,

ejaculatory duct.

Female: Mullerian ducts uterus, fallopian tubes

The developing Sertoli cells secrete a hormone called Mllerian-inhibiting

substance (MIS), which causes apoptosis of cells withinthe paramesonephric (Mllerian) ducts.
A. External Genitalia
External genitalia of males and females are identical for the first 60 days.

Male: penis, urethra, prostate, and scrotum

Female: clitoris, labia majora

The external genitals of both male and female embryos (penis and scrotum in males and
clitoris, labia,and vaginal orifice in females) also remain undifferentiateduntil about the eighth
week. Before differentiation,all embryos have the following external structures:

Urethral (urogenital) folds

These paired structures develop from mesoderm in the cloacal region.

Urethral groove.
An indentation between the urethral folds, which is the opening into the urogenital sinus.

Genital tubercle.
A rounded elevation just anterior to the urethral folds.

Labioscrotal swelling
Paired, elevated structures lateral to the urethral folds.

In male embryos, some testosterone is converted to a second androgen called

dihydrotestosterone (DHT). DHT stimulates development of the urethra, prostate, and
external genitals (scrotum and penis). Part of the genital tubercle elongates and
develops into a penis. Fusion of the urethral folds forms the spongy (penile) urethra and
leaves an opening to the exterior only at the distal endof the penis, the external urethral
orifice. The labioscrotal swellings develop into the scrotum

Review of topic:
1. The gonads develop from gonadal ridges that arise from growth of intermediate mesoderm. In
the presence of the SRY gene, the gonads begin to differentiate into testes during the seventh
week. The gonads differentiate into ovaries when the SRY gene is absent.
2. In males, testosterone stimulates development of each mesonephric duct into an epididymis,
ductus (vas) deferens, ejaculatory duct, and seminal vesicle, and Mllerian-inhibiting substance
(MIS) causes the paramesonephric duct cells to die. In females, testosterone and MIS are
absent; the paramesonephricducts develop into the uterine tubes, uterus, and vagina and the
mesonephric ducts degenerate.
3. The external genitals develop from the genital tubercle and are stimulated to develop into
typical male structures by the hormone dihydrotestosterone (DHT). The external genitals
develop into female structures when DHT is not produced, the normal situation in female
embryos.

AGING AND THE REPRODUCTIVE SYSTEMS

Puberty- is the period when secondary sexual characteristics begin to develop and the
potential for sexual reproduction is reached.
Effects of aging on the reproductive systems:
In females:

The reproductive cycle normally occurs once each month from menarche the first
menses, to menopause, the permanent cessation of menses. Thus, the female
reproductive system has a time-limited span of fertility between menarche and

menopause.
With age, fertility declines. Between the ages of 40 and 50 the pool of remaining ovarian
follicles becomes exhausted. As a result, the ovaries become less responsive to
hormonal stimulation. The production of estrogens declines, despite copious secretion
of FSH and LH by the anterior pituitary. Many women experience hot flashes and heavy

sweating, which coincide with bursts of GnRH release.

Other symptoms of menopause are headache, hair loss, muscular pains, vaginal
dryness, insomnia, depression, weight gain, and mood swings. Some atrophy of the
ovaries, uterine tubes, uterus, vagina, external genitalia, and breasts occurs in
postmenopausal women. Due to loss of estrogens, most women experience a decline in
bone mineral density after menopause. Sexual desire (libido) does not show a parallel
decline; it may be maintained by adrenal sex steroids. The risk of having uterine cancer
peaks at about 65 years of age, but cervical cancer is more common in younger women.

In Males:

At about age 55 a decline in testosterone synthesis leads to reduced muscle

strength, fewer viable sperm, and decreased sexual desire.

Although sperm production decreases 5070% between ages 60 and 80, abundant

sperm may still be present even in old age.

Enlargement of the prostate to two to four times its normal size occurs in most males
over age 60. This condition, called benign prostatic hyperplasia (BPH) decreases
the size of the prostatic urethra and is characterized by frequent urination, nocturia
(bed-wetting), hesitancy in urination, decreased force of urinary stream, postvoiding
dribbling, and a sensation of incomplete emptying.

Review of topics:
1. Puberty is the period when secondary sex characteristics begin to develop and the potential
for sexual reproduction is reached.
2. The onset of puberty is marked by pulses or bursts of LH and FSH secretion, each triggered
by a pulse of GnRH. The hormone leptin, released by adipose tissue, may signal the
hypothalamus that long-term energy stores (triglycerides in adipose tissue) are adequate for
reproductive functions to begin.
3. In females, the reproductive cycle normally occurs once each month from menarche, the first
menses, to menopause, the permanent cessation of menses.
4. Between the ages of 40 and 50, the pool of remaining ovarian follicles becomes exhausted
and levels of progesterone and estrogens decline. Most women experience a decline in bone
mineral density after menopause, together with some atrophy of the ovaries, uterine tubes,
uterus, vagina, external genitalia,and breasts. Uterine and breast cancer increase in incidence
with age.