2: Physiology and Histology of the Female Reproductive System
- Page ID
- 91816
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)
\( \newcommand{\dsum}{\displaystyle\sum\limits} \)
\( \newcommand{\dint}{\displaystyle\int\limits} \)
\( \newcommand{\dlim}{\displaystyle\lim\limits} \)
\( \newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\)
( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\)
\( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\)
\( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\)
\( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\)
\( \newcommand{\Span}{\mathrm{span}}\)
\( \newcommand{\id}{\mathrm{id}}\)
\( \newcommand{\Span}{\mathrm{span}}\)
\( \newcommand{\kernel}{\mathrm{null}\,}\)
\( \newcommand{\range}{\mathrm{range}\,}\)
\( \newcommand{\RealPart}{\mathrm{Re}}\)
\( \newcommand{\ImaginaryPart}{\mathrm{Im}}\)
\( \newcommand{\Argument}{\mathrm{Arg}}\)
\( \newcommand{\norm}[1]{\| #1 \|}\)
\( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\)
\( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\AA}{\unicode[.8,0]{x212B}}\)
\( \newcommand{\vectorA}[1]{\vec{#1}} % arrow\)
\( \newcommand{\vectorAt}[1]{\vec{\text{#1}}} % arrow\)
\( \newcommand{\vectorB}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\( \newcommand{\vectorC}[1]{\textbf{#1}} \)
\( \newcommand{\vectorD}[1]{\overrightarrow{#1}} \)
\( \newcommand{\vectorDt}[1]{\overrightarrow{\text{#1}}} \)
\( \newcommand{\vectE}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash{\mathbf {#1}}}} \)
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\(\newcommand{\longvect}{\overrightarrow}\)
\( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)
\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)Chapter Author: Samar Hegazy, MD, Ph.D., MEHP
This chapter starts with providing the physiologic principles of the hormonal control of the ovarian and menstrual cycle. The normal histologic structures and functional histology of relevant parts of the female reproductive system are integrated with physiological principles. The rest of the chapter covers abnormalities of the menstrual cycle, dysfunctional uterine bleeding, and common pathological conditions affecting different parts of the female reproductive system and the breast.
The main physiologic function of the female reproductive system is to produce hormones and gametes, support the development of the fetus, and carry out the delivery process. For details about the macro anatomy of different parts of the female reproductive system, please refer to Chapter 1.
The content of this chapter is appropriate for, or easily adapted for the following audiences:
By the end of this chapter, you should be able to
Chapter 2 Bibliography
Baiden-Amissah, Regina Esi Mensimah, Daniela Annibali, Sandra Tuyaerts, and Frederic Amant. “Endometrial Cancer Molecular Characterization: The Key to Identifying High-Risk Patients and Defining Guidelines for Clinical Decision-Making?” Cancers 13, no. 16 (2021): 3988. Work is distributed under the terms of the CC BY 4.0 license. doi.org/10.3390/cancers13163988
Buttram, V. C., V. Gomel, A. Siegler, A. DeCherney, W. Gibbons, and C. March. “The American Fertility Society Classifications of Adnexal Adhesions, Distal Tubal Occlusion, Tubal Occlusion Secondary to Tubal Ligation, Tubal Pregnancies, Müllerian Anomalies and Intrauterine Adhesions.” Fertility and Sterility 49, no. 6 (June 1, 1988): 944–55. doi.org/10.1016/S0015-0282(16)59942-7
Camboni, Alessandra, and Etienne Marbaix. "Ectopic Endometrium: The Pathologist’s Perspective" International Journal of Molecular Sciences 22, no. 20 (2021): 0974. This work is openly licensed via CC BY 4.0 license. doi.org/10.3390/ijms222010974
Chapron, Charles, Silvia Vannuccini, Pietro Santulli, Mauricio S Abrão, Francisco Carmona, Ian S Fraser, Stephan Gordts, et al. “Diagnosing Adenomyosis: An Integrated Clinical and Imaging Approach.” Human Reproduction Update 26, no. 3 (2020): 392–411. doi.org/10.1093/humupd/dmz049
Chen, Liang Hsuan, Wei Che Lo, Hong Yuan Huang, and Hsien Ming Wu. “A Lifelong Impact on Endometriosis: Pathophysiology and Pharmacological Treatment.” International Journal of Molecular Sciences, International Journal of Molecular Sciences 24, no. 8 (2023: 7503. This work is openly licensed via CC BY license. doi.org/10.3390/ijms24087503
Chodankar, Rohan, Hilary O.D. Critchley, and Carlos Simón. “Biomarkers in Abnormal Uterine Bleeding.” Biology of Reproduction 101, no. 6 (2019). This work is openly licensed via CC BY 4.0. license. doi.org/10.1093/biolre/ioy231
Dall, Genevieve V., Anne Hamilton, Gayanie Ratnayake, Clare Scott, and Holly Barker. “Interrogating the Genomic Landscape of Uterine Leiomyosarcoma: A Potential for Patient Benefit.” Cancers 14, no. 6 (2022): 1561. This work is distributed under a CC BY license. doi.org/10.3390/cancers14061561
d’Otreppe, Juliette, Daniel Patino-García, Patryk Piekos, Matthieu de Codt, Diego D. Manavella, Guillaume E. Courtoy, and Renan Orellana. “Exploring the Endocrine Mechanisms in Adenomyosis: From Pathogenesis to Therapies.” Endocrines 5, no. 1 (2024). This work is openly licensed via CC BY license. doi.org/10.3390/endocrines5010004
Giannella, Luca, Camilla Grelloni, Marco Bernardi, Camilla Cicoli, Federica Lavezzo, Gianmarco Sartini, Leonardo Natalini, et al. “Atypical Endometrial Hyperplasia and Concurrent Cancer: A Comprehensive Overview on a Challenging Clinical Condition.” Cancers 16, no. 5 (2024): 914. Distributed under the terms of the CC BY 4.0 doi.org/10.3390/cancers16050914
Haggstrom, Mikael. "Endometrial Intraepithelial Neoplasia". Image from Archives of Pathology & Laboratory Medicine 138, No. 4 (2014): 484–491. Distributed under the terms of the CCO license. doi.10.5858/arpa.2012-0709-RA
Haggstrom, Mikael. "Fibroid locations." Image adpated from Anja Hirschelmann, Rudy Leon De Wilde. "Plastic and reconstructive uterus operations by minimally invasive surgery? A review on myomectomy". GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW No. 1 (2012). This work is distributed under a CC BY 4.0 license. Image available from Wikimedia Commons.
Haggstrom, Mikael. "Histopathology of a leiomyoma in a postmenopausal uterus". Intermediate magnification. Own work. (October 2020). This work is distributed under a CCO license. Image available from Wikimedia Commons.
Herlin, Morten Krogh, Michael Bjørn Petersen, and Mats Brännström. “Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: A Comprehensive Update.” Orphanet Journal of Rare Diseases, 15, No. 214 (2020). doi.org/10.1186/s13023-020-01491-9
Kang, Jia, and Jie Qiao. “Impact of Congenital Uterine Anomalies on Reproductive Outcomes of IVF/ICSI-Embryo Transfer: A Retrospective Study.” European Journal of Medical Research 29, no. 1 (2024). doi.org/10.1186/s40001-023-01544-2
Karve, Simantini. "Anatomy and Physiology of the Female Reproductive System." Human Physiology for Allied Health Professionals, (2022). This work is openly licensed via CC BY NC SA 4.0 Creative Commons License. Available from LibreText, Skyline College.
Kim, Suyeon, Hyunsik Bae, and Hyun Soo Kim. “Dedifferentiated Leiomyosarcoma of the Uterine Corpus with Heterologous Component: Clinicopathological Analysis of Five Consecutive Cases from a Single Institution and Comprehensive Literature Review.” Diagnostics 14, no. 2 (2024): 160. This work is distributed under a CC BY license. doi.org/10.3390/diagnostics14020160
King, Luke, Radhika P Gogoi, Christopher Hummel, Zongming Chen and Ashlee Smith. "Histopathology of epithelioid leiomyosarcoma of the uterus." 40x, H&E staining. (July 12, 2018). This work is distributed under a CC BY 4.0 license. Original Source: "High Grade Uterine Sarcoma with Concurrent Metastatic Adenocarcinoma to the Uterus: A Case Report". Obstetrics and Gynaecology Cases - Reviews 5, No. 4 (2018). This work is distributed under a CC BY 4.0 license. DOI:10.23937/2377-9004/1410127. Image available from Wikimedia Commons.
Kinkel, Karen, Susan M Ascher, and Caroline Reinhold. “Benign Disease of the Uterus.” IDKD Springer Series, 2018. doi.org/10.1007/978-3-319-75019-4_3
Kobayashi, Eiji, Takuhei Yokoyama, Satoshi Nakagawa, Shinya Matsuzaki, Toshihiro Kimura, Yutaka Ueda, Kiyoshi Yoshino, Masami Fujita, Yumiko Hori, Eiichi Morii and Tadashi Kimura. " Histopathology of leiomyosarcoma of the uterus." (July 31, 2013). This work is distributed under a CC BY 4.0 license. Original Source: "Pedunculated Sub-Serous Leiomyosarcoma Mimicking Ovarian Cancer: Case Report and Review of Literature". Gynecology & Obstetrics 3, No. 3 (2012). This work is distributed under a CC BY 4.0 license. DOI:10.4172/2161-0932.1000157. Image available from Wikimedia Commons.
Koltsova, Alla S., Olga A. Efimova, and Anna A. Pendina. “A View on Uterine Leiomyoma Genesis through the Prism of Genetic, Epigenetic and Cellular Heterogeneity.” International Journal of Molecular Sciences 24, no. 6 (2023): 5752 This work is distributed under a CC BY 4.0 license. doi.org/10.3390/ijms24065752
Ladke, Pooja, Ashish N Ambhore, Avinash Dhok, Kajal Mitra, and Vrushali Dalvi. “A Unique Case of Unicornuate Uterus With a Non-Communicating Rudimentary Horn and Hematometra.” Cureus 14, No. 12 (2022): e32640. This work is openly licensed via CC-BY license. doi.org/10.7759/cureus.32640
Lai, Zhen Zhen, Hui Li Yang, Si Yao Ha, Kai Kai Chang, Jie Mei, We Jie Zhou, Xue Min Qiu, et al. “Cyclooxygenase-2 in Endometriosis.” International Journal of Biological Sciences 15, no. 13 (2019). doi.org/10.7150/ijbs.35128
Lamceva, Jelizaveta, Romans Uljanovs, and Ilze Strumfa. “The Main Theories on the Pathogenesis of Endometriosis.” International Journal of Molecular Sciences, 24, No. 5 (2023): 4254. CC BY 4.0 doi.org/10.3390/ijms24054254
Lang, Damaris-Lois. "Anatomy and Physiology of the Female Reproductive System." Chapter 43, Bio 140 Human Biology I, (2022). CC BY NC 4.0 Available from Hostas Library.
Machado-Lopez, Alba, Carlos Simón, and Aymara Mas. “Molecular and Cellular Insights into the Development of Uterine Fibroids.” International Journal of Molecular Sciences 22, no. 16 (2021): 8483. This work is distributed under a CC BY license. doi.org/10.3390/ijms22168483
Munro, Malcolm G., Adam H. Balen, Si Hyun Cho, Hilary O.D. Critchley, Ivonne Díaz, Rui Ferriani, Laurie Henry, Edgar Mocanu, and Zephne M. van der Spuy. “The FIGO Ovulatory Disorders Classification System.” International Journal of Gynecology and Obstetrics 159, no. 1 (2022). doi.org/10.1002/ijgo.14331
Munro, Malcolm G, Adam H Balen, SiHyun Cho, Hilary O D Critchley, Ivonne Díaz, Rui Ferriani, Laurie Henry, Edgar Mocanu, and Zephne M van der Spuy. FIGO Committee on Menstrual Disorders and Related Health Impacts, and FIGO Committee on Reproductive Medicine, Endocrinology, and Infertility. "The FIGO Ovulatory Disorders Classification System," Human Reproduction, 37, No. 10 (October 2022):2446–2464. Distributed under the terms of the Creative Commons CC BY license. doi.org/10.1093/humrep/deac180
Nappi, Luigi, Felice Sorrentino, Sorrentino, Francesca Greco, Laura Vona, Francesco Maria Zullo and Stefano Bettocchi F. "Pathophysiology of Female Reproduction and Clinical Management." This work is openly licensed via CC BY 4.0 DEED Creative Commons license. Bettocchi, C., Busetto, G.M., Carrieri, G., Cormio, L. (eds) Practical Clinical Andrology. Springer, Cham. (2023). doi.org/10.1007/978-3-031-11701-5_16
Neprhon. "Endometriosis -2-cropped". (2012). Own work, licensed under the CC SA 3.0. Available from Wikimedia Commons.
Njoku, Kelechi, Chloe E. Barr, and Emma J. Crosbie. “Current and Emerging Prognostic Biomarkers in Endometrial Cancer.” Frontiers in Oncology, 12 (2022). This work is distributed under the terms of the CC BY 4.0 license. doi.org/10.3389/fonc.2022.890908
Pakurar, Alice S. and John W. Bigbee. Carole W. Christman, Ph.D, Medical Illustrator. Digital Histology, (ND). This work is openly licensed via CC BY SA Creative Commons License. Available from Virginia Commonwealth University.
Paxton, Steve, Michelle Peckham, Adele Knibbs, Steve Paxton, Adele Knibbs, and Michelle Peckham. "Female Reproductive system." The Leeds Histology Guide, (2003). University of Leeds.
Pfeifer, Samantha M, Marjan Attaran, Jessica Goldstein, Steven R Lindheim, John C Petrozza, Beth W Rackow, Evan Siegelman, et al. “ASRM m € Ullerian Anomalies Classification 2021.” Fertility and Sterility 116 (2021): 1238–52. doi.org/10.1016/j.fertnstert.2021.09.025
Rabban, Joseph T., C. Blake Gilks, Anais Malpica, Xavier Matias-Guiu, Khush Mittal, George L. Mutter, Esther Oliva, et al. “Issues in the Differential Diagnosis of Uterine Low-Grade Endometrioid Carcinoma, Including Mixed Endometrial Carcinomas: Recommendations from the International Society of Gynecological Pathologists.” International Journal of Gynecological Pathology 38 (January 2019):S25-S39. This work is distributed under a CC BY 4.0 license. doi.org/10.1097/PGP.0000000000000512
Rao, Shalinee, Sandhya Sundaram, and Raghavan Narasimhan. "Biological behavior of preneoplastic conditions of the endometrium: A retrospective 16-year study in south India". Indian Journal of Medical and Paediatric Oncology 30 (4): 131 (2009). doi.10.4103/0971-5851.65335. Distributed under the terms of the CC BY 2.0 license. Available from Wikipedia Commons.
Sardo, Attilio Di Spiezio, Federica Palma, Gloria Calagna, Brunella Zizolfi, Giuseppe Bifulco, Attilio Di Spiezio Sardo, Federica Palma, Gloria Calagna, Brunella Zizolfi, and Giuseppe Bifulco. “Chronic Endometritis.” Arkhiv Patologii 62, no. 3 (June 29, 2016): 48–52. Distributed under the terms of the CC BY 3.0 license. doi.org/10.5772/63023
Sciencia58. "Uterine malformation". (2023) This work is openly licensed via CC0 Creative Commons license. Available from Wikimedia Commons.
Skinner, Michael K. "Regulation ofo primoridal follicle assembly and development." Human Reproduction Update 11, No. 5 (2005): 461-471. doi.org/10.1093/humupd/dmi020
Słopień, Radosław, and Błażej Męczekalski. "Aromatase inhibitors in the treatment of endometriosis". Menopause Review/Przegląd Menopauzalny 15 (1): 43-47. CC BY-NC-SA 4.0 doi:10.5114/pm.2016.58773
Tempest, Nicola, Christopher J. Hill, Alison Maclean, Kathleen Marston, Simon G. Powell, Hannan Al-Lamee, and Dharani K. Hapangama. “Novel Microarchitecture of Human Endometrial Glands: Implications in Endometrial Regeneration and Pathologies.” Human Reproduction Update 28, no. 2 (2022). doi.org/10.1093/humupd/dmab039.
Tomassetti, Carla, Neil P. Johnson, John Petrozza, Mauricio S. Abrao, Jon I. Einarsson, Andrew W. Horne, Ted T.M. Lee, et al. “An International Terminology for Endometriosis, 2021.” Journal of Minimally Invasive Gynecology 28, No. 11 (2021): 1849-1859. CC BY 4.0 doi.org/10.1016/j.jmig.2021.08.032.
Uthman, Ed. "Leiomyoma from a uterine myomectomy." This work is distributed under a CC BY 2.0 license. Image available from Wikimedia Commons.
Williams, Alistair R.W. “Uterine Fibroids - What’s New?” F1000Research, 2017. doi.org/10.12688/f1000research.12172.1.
Zheng, Wenxin. “Molecular Classification of Endometrial Cancer and the 2023 FIGO Staging: Exploring the Challenges and Opportunities for Pathologists.” Cancers 15, no. 16 (2023): 4101. Work is Distributed under the terms of the CC BY 4.0 license. doi.org/10.3390/cancers15164101
Zucchini, Cinzia, Paola de Sanctis, Chiara Facchini, Nadine di Donato, Giulia Montanari, Valentina Bertoldo, Antonio Farina, Alessandra Curti, and Renato Seracchioli. “Performance of Circulating Placental Growth Factor as a Screening Marker for Diagnosis of Ovarian Endometriosis: A Pilot Study.” International Journal of Fertility and Sterility 9, no. 4 (2016). This work is distributed under a CC BY 2.5 license.