pear shaped

weight 30–120g, length 7–9cm long (nullipara: 6–8 cm)

Defends against organisms invading the uterine cavity and the abdominal space.

Ensures the passage of sperm.

Contains and nourishes the embryo.

Expels the fetus during childbirth.

vaginal portion

cervix

body

fundus

isthmus

condition of the uterine support structure

degree of fullness in the urinary bladder and rectum

processes of shrinking and displacement in the lesser pelvis

lower third of the uterus: immediately above the symphysis

supravaginal part of the cervix: sacrococcygeal joint

peritoneum

urinary bladder

rectum

vagina

small intestinal loops

sigmoid colon

fallopian tube

ovary

ureter

uterine artery and vein

pelvic floor (levator ani)

suspensory ligament of the ovary–proper ligament of the ovary–round ligament of the uterus

broad ligaments/plica lata

sacrouterine and rectouterine ligaments

vesicouterine ligament

Uterine artery (from the internal iliac artery) anastomosed with the ovarian artery (from the aorta).

Uterine vein and diverse plexus that run into the internal iliac vein.

lumbar lymph nodes

superficial inguinal lymph nodes

external iliac lymph nodes

obturator lymph nodes

sympathetic nervous system from T10 to L2 via the splanchnic nerves to the celiac/superior and inferior mesenteric ganglions and renal plexus

With vessels (ovarian artery) or as independent nerve fibers, the nerves run to the hypogastric and uterovaginal plexus.

Postganglionic supply from the four sacral ganglions and the ganglion impar is under discussion.

Sacral parasympathetic nervous system (S2–S4) to the inferior hypogastric plexus and uterovaginal plexus

Size: 4cm long, 2cm wide, 1cm thick.

Weight: 6–8g.

The ovaries are the female sex glands. In addition, they produce estrogens, progestogens, and steroids.

In the standing female, the ovaries lie on top of the broad ligament (posterior) and between the suspensory ligament of the ovary and the proper ligament of the ovary in an infolding of peritoneum.

The longitudinal axis runs virtually craniocaudal.

The ovary sits higher in nulliparas than in multiparas. It lies in a depression (ovarian fossa) with borders formed by the following structures:

obturator internus (lateral)

external iliac vein (anterior)

umbilical artery, obturator artery, obturator nerve (caudal)

ureter, internal iliac vessels (cranioposterior)

ovarian fossa

peritoneum

psoas fascia (via the insertion of the suspensory ligament of the ovary)

ileum

ovarian vessels

uterine artery

cecum (right ovary)

appendix (right ovary)

piriformis (in multiparas)

obturator nerve

The ovaries project onto the abdominal wall in a line on the anterosuperior iliac spine (ASIS)—upper edge of the symphysis, slightly medial to the edge of the psoas.

Suspensory ligament of the ovary (from ovary to ileum and psoas fascia): this ligament leads the ovarian vessels and nerves to the ovary.

Proper ligament of the ovary (from ovary to angle of the tube): it contains a branch of the uterine artery.

Peritoneal cover with mesovarium: it also covers the two upper ligaments.

uterine artery (from the internal iliac artery)

ovarian artery (aorta)

ovarian vein: on the right drains into the inferior vena cava; on the left drains into the left renal vein and then

inferior vena cava

uterine vein and diverse plexus that run into the internal iliac vein

Lumbar lymph nodes.

sympathetically, the ovaries are supplied by the same segments as the uterus.

vagus nerve

The uterus is highly mobile, its position dependent on the menstrual cycle, the state of fullness in the urinary bladder and rectum, and the position of the small intestinal loops.

Filled Urinary Bladder

The uterus is pressed posteriorly.

Filled Rectum

The uterus is pressed anteriorly.

Filled Rectum and Urinary Bladder

The uterus is pressed superiorly.

Pregnancy

The uterus is pressed inferiorly.

Lateral displacement occurs as the result of scarring.

The fallopian tubes are also very mobile: the fimbriae perform rhythmic movements in three planes at the start of ovulation.

To transport the oocyte, we see both segmental and peristaltic contractions of the entire fallopian tube as well as movements of the fimbriae and cilia in the tube.

The position of the ovary depends on the movements of the uterus.

Uterus

Similar to the urinary bladder: during the expiratory phase, we see a movement posterosuperiorly; during the inspiratory phase the movement is in the opposite direction.

Left ovary: rotation in a clockwise direction and slightly superior.

Right ovary: rotation in a counterclockwise direction and slightly superior.

The reproductive hormones are subject to a hormonal regulatory circuit with the hypothalamus, hypophysis, and ovaries serving as hormonal glands.

The hypothalamus produces luteinizing hormone (LH)-releasing hormone (LHRH), which stimulates the adenohypophysis to produce and release gonadotropic hormones.

The follicle-stimulating hormone (FSH) has the following effects in the ovary:

maturation of the follicles

formation of estradiol receptors.

production of estradiol from testosterone (in the testicles, it stimulates spermatogenesis)

The luteinizing hormone (LH) has the following effects in the ovary:

production of estrogen and progesterone

changes in the follicular wall that lead to ovulation (in the testicles, it stimulates testosterone synthesis)

Human chorionic gonadotropin (hCG) in the placenta roughly corresponds to LH.

Most estrogens are formed in the ovary. The starting molecule is cholesterol, which through several intermediary steps is transformed into testosterone. This is then turned into estradiol in yet another conversion. Estrogens are also produced in other tissues from androgens (see below), and they are also formed in the testicles.

The phase of estrogen production coincides with the phase of follicular maturation.

The effect is as follows:

stimulates growth of the female reproductive organs

regeneration and growth of the endometrium

secretion of thin, spinnable, clear, alkaline mucus (facilitates the inflow of sperm)

promotes the movement of the fallopian tubes and their production of secretions

epithelial growth in the vagina; also partially responsible for a normal vaginal environment

formation of subcutaneous fat deposits (female body shape)

promotes formation of secondary sexual characteristics (growth of pubic hair, pigmentation of the nipples and vulva)

lifts the mood

This is formed only in the ovaries and placenta from cholesterol. Progesterone production occurs during the luteal phase.

The effect is as follows:

transforms the endometrium which is proliferating under the influence of estrogen

production of thick cervical mucus that is impermeable to sperm

epithelial cells in the vagina are discharged repeatedly

lowers tonicity in the uterine muscles and reduces uterine contractions–immobilizes the uterus during pregnancy

under the influence of progesterone, we see a general drop in tonicity of the smooth muscles

stimulates the growth of the mammary glands

progesterone causes a rise in body temperature of 0.4–0.6°C

In conclusion, we can say that estrogens prepare the body for conception and progesterone prepares it for pregnancy.

In a negative feedback response, the drop of progesterone in the corpus luteum after menstruation causes an increased release of FSH in the hypophysis.

As a result, several follicles mature.

LH and FSH stimulate the production of estrogens in the follicles. The high estrogen level causes a drop in FSH release, which leads to the destruction of most follicles before they have matured.

The follicle with the greatest maturity reaches ovulation because it does not depend on external FSH due to its internal amount of FSH and estrogens, and it therefore continues to grow.

A peak in LH and the start of progesterone production induce the release of the oocyte from the ruptured follicle.

Under the influence of FSH and LH, the corpus luteum produces estrogens and progesterone. If no fertilization takes place, the corpus luteum begins to disintegrate after 10–12 days.

If fertilization has taken place, however, the corpus luteum continues to have a function. The fertilized egg produces hCG and thereby stimulates continued hormone production in the corpus luteum.

After menstruation, estrogens cause the growth of a new mucous membrane. This takes approximately 10 days.

Progesterone stimulates glandular growth in the new mucosa with the production of large amounts of secretions.

If fertilization does not occur, the progesterone level drops due to the deterioration of the corpus luteum. This missing hormonal stimulus changes the metabolism and circulation in the uterine mucosa, which at last leads to rupture-induced bleeding and fibrinolysis. As a result of the fibrinolysis, menstrual blood does not coagulate. The average loss of blood is 30–80mL.

Due to the effect of estrogen, the surface of the wound is closed again.

Most women experience the great hormonal changes of this period of life between the ages of 45 and 55. There are large organic changes, manifesting in a multitude of symptoms.

In the ovaries, change already occurs in the fourth decade of a woman’s life: scleroses of vessels, decrease in the number of follicles, and lowered response to hormones from the hypophysis. As a result, cycles can occur without ovulation, which explains why it becomes more difficult from the mid-40s on to become pregnant.

The following are the possible effects of estrogen deficiency:

vegetative symptoms such as heat flashes, dizziness, palpitations, sweating, paraesthesia

disturbances in normal menstrual bleeding before the onset of the menopause

atrophic changes in the mucous membranes of the genitalia: loss of elasticity, dry thin skin, greater vulnerability, shrinkage

changes in the skin: thin, dry, wrinkled

arteriosclerosis (female hormones have a preventive effect on vascular diseases)

osteoporosis

Psychological changes such as depression, irritability, sleeping disorders, or nervousness should be not only attributed to the hormone deficiency, but also regarded as the result of the experienced bodily changes and the thought processes involved in coming to terms with these.

incontinence

organ ptoses (bladder, uterus)