1. Anatomy of the female reproductive system
   1. external part
      1. clitiros
      2. labia
         1. majora
         2. minora
      3. vaginal opening
   2. internal part
      1. ovaries
      2. uterine tubes
         1. infundibulum
            1. fimbrae
         2. ampulla
         3. isthmus
         4. uterine
      3. uterus
         1. fundus
         2. body
         3. internal OS
         4. cervical canal
         5. external OS
      4. vagina
         1. 2 vaginal fornix
         2. posterior to
            1. urethra
   3. blood supply
      1. abdominal aorta
         1. ovarian arteries
            1. ovarian branch
            2. tubal branch
      2. interna illiac
         1. ascending branch of uterian a
   4. blood drainage
      1. pampiniform plexus
      2. uterine venous plexus
      3. R & L ovarian veins
         1. IVC
2. Histology of the female reproductive system
   1. ovaries
      1. encapsulated by the tunica albuginea
      2. covered by the germinal epithelium
         1. simple cuboidal epithelium
      3. PRIMORDIAL FOLLICLES
         1. principle follicles present before birth
            1. consists of
            2. primary oocyte
            3. enveloped by
            4. single layer of flattened follicular cells.
      4. PRIMARY FOLLICLES
         1. zona pellucida
      5. SECONDARY FOLLICLES
         1. enlargement of the zona granulosa
         2. follicular antrum
      6. MATURE (GRAAFIAN) FOLLICLE
         1. corona radiata
   2. uterine tubes
      1. musculomembranous tube
      2. simple columnar epithelial layer
         1. peg cells
         2. ciliated cells
   3. uterus
      1. outer wall of the uterus
         1. perimetrium (Serosa)
      2. middle layer
         1. myometrium
      3. inner most layer
         1. endometrium
   4. vagina
      1. non-keratenized stratified squamous epithelium
3. aly
4. sara
5. safa
6. menstrual disorders
   1. dysmenorrhea
      1. severe, frequent cramping
   2. menorrhagia
      1. heavy period
   3. amenorrhea
      1. primary
         1. girl doesn't menstruate at the age of 16
      2. secondary
         1. period that was regular stop for 3months
   4. oligomenorrhea
      1. infrequent menstruation
   5. hypomenorrhea
      1. light menstruation
   6. pre-menstrual syndrome
      1. physical, emotional symptoms that occur 7days before menstruation
7. female physical examination
   1. supplies
      1. gloves
      2. drapes
      3. source of light
      4. chaperone
   2. preparation
      1. empty bladder
      2. comfortable temperature
      3. privacy
      4. hand hygiene
      5. explain the procedure and answer questions
      6. patient in lithotomy position
   3. assessment
      1. inspection
         1. smooth, clean, intact skin
         2. redness, excoriation, rashes or lesion
         3. genital warts
         4. bruises or scaring
         5. discharge
      2. palpation
         1. bartholins glands
8. lab investigation for female infertility
   1. progesterone
      1. less than 3ng/ml
         1. no ovulation
   2. high FSH & low estradiol
      1. primary ovarian failure
   3. AMH levels
      1. decrease nearing menopuse
   4. TSH
      1. hyper/hypothyrodism
   5. prolactin
      1. prolactinoma
   6. testosterone
      1. hyperandrogenic disorders
9. .
10. Physiology of Female Reproductive Tract
    1. Menstrual cycle
       1. Under hormonal control
       2. Pre-ovulatory phase
          1. Characterized with high estrogen levels
          2. Follicular phase in ovaries
             1. Follicle development and release of oocyte
          3. Proliferative phase in uterus
             1. Endometrium thickening
             2. Emergence of spiral arteries
             3. Thin watery cervical mucus
             4. More hospitable for sperms
       3. Ovulation
          1. In day 14 of the cycle
          2. Due to Estorgen induced LH surge
             1. Rupture of graafian follicle
             2. Expulsion of the ovum
             3. Entrance of ovum to fallopian tube
       4. Post-ovulatory phase
          1. Characterized with high progesterone levels
          2. Luteal phase in ovaries
             1. Formation of corpus luteum
             2. Production of progesterone/ estrogen and inhibin
             3. Degenerates to corpus albicans if there was no fertilization
          3. Secretory phase in uterus
             1. Spiral arteries grow longer
             2. Uterine glands secrete more mucus
             3. Thick cervical mucus
             4. Less hospitable for sperms
             5. Functional layer of endometrium sloughs off if there was no fertilization
             6. Menstruation
    2. Fertilization
       1. In ampulla
       2. 3 Phases
          1. Penetration of corona radiata
             1. After capacitation of sperms
          2. Penetration of zona pellucida
             1. Acrosome reaction
          3. Fusion of oocyte and sperm cell membrane
             1. Cortical and zona reaction
11. Noora
    1. PCOS
       1. Caused by elevation of LH
          1. Overstimulate theca cell
             1. Produce androstenedione
             2. Increase LH To FSH ratio
       2. Insulin resistance
          1. Hyperinsulinemia via inc androgenic enzymes and dec in SHBG
    2. Clinical features
       1. Hirsutism
       2. Acne
       3. Male pattern alopecia
       4. Menstrual abnormalities
       5. Weight gain 60%
       6. Acanthus is nigricans
    3. Risk factor
       1. Genetic-Obesity - sedentary lifestyle - intrauterine androgen exposure
    4. Morphology
       1. Both ovaries will be enlarged with multiple subcortical cysts