Initiation of Female Sexual Maturation
Some factors that initiate sexual maturation remain unknown. Secretions of the hypothalamus,
the anterior pituitary, and the gonads all play a part. The hypothalamus is capable of secreting
gonadotropin-releasing hormone (GnRH) to initiate puberty during infancy and early childhood,
but it does not do so in significant amounts until late childhood. Production of tiny quantities of
sex hormones by a young females ovaries inhibits secretions of the hypothalamus, avoiding
premature onset of puberty. Maturation of an unknown area of the brain likely triggers the
hypothalamus to initiate puberty.
HORMONE PRODUCED BY TARGET ORGAN ACTION IN FEMALE
Gonadotropin-releasing Hypothalamus Anterior Pituitary Stimulates release of FSH
hormone (GnRH) and LH, initiating puberty
and sustaining female
reproductive cycles;
release is pulsatile
Follicle-stimulating Anterior Pituitary Ovaries Stimulates growth and
hormone (FSH) maturation before
ovulation
Luteinizing Hormone (LH) Anterior Pituitary Ovaries 1. Stimulates final
maturation of
follicle
2. Surge of LH
about 14 days
before the next
menstruation
causes ovulation
3. Stimulates
transformation
of Graafian
follicle into
corpus luteum,
which continues
secretion of
estrogens and
progesterone for
about 12 days if
ovum is not
fertilized. If
feralization
occurs, the
placenta
gradually
assumes this
function.
Estrogen 1. Ovaries and Internal and external 1. Reproductive
corpus luteum reproductive organs organs:
(females) responsible for
2. Placenta Breasts maturation at
(pregnancy) puberty;
stimulate
endometrium
before ovulation.
2. Breasts: induce
growth of
glandular and
ductal tissue as
the first sign of
puberty; initiate
deposition of fat
at puberty.
3. Bones: stimulate
growth of long
bones but cause
closure of
epiphyses,
limiting mature
height
4. Pregnancy:
stimulates
growth of uterus,
breast tissue,
inhibits active
milk production,
relaxes pelvic
ligaments
Progesterone Ovary, corpus Uterus, female breasts 1. Stimulates
luteum, placenta secretion of
endometrial
glands; causes
endometrial
vessels to
become dilated
and tortuous in
preparation for
possible embryo
implantation
2. Pregnancy:
induces growth
of cells of
Fallopian tubes
and uterine
lining to nourish
embryo;
decreases
contractions of
uterus; prepares
breasts for
lactation but
inhibits prolactin
secretion
Testosterone Adrenal Glands Body conformation after Small quantities of
puberty androgenic hormones
from adrenal glands
cause growth of pubic
and axillary hair at
puberty.
Menstrual CycleOvarian Cycle
Follicular Stage: The follicular phase is the period during which an ovum matures. It begins with the first
day of menstruation and ends about 14 days later in a 28-day cycle. The decrease in estrogen and
progesterone secretion by the ovaries just before menstruation stimulates secretion of FSH and LH by
the anterior pituitary. As the FSH and LH levels rise, Graafian follicles, each containing an oocyte
(immature ovum), start growing faster. Eventually, one follicle matures before the others. The mature
follicle secretes large amounts of estrogen, which depresses FSH secretion. Occasionally, more than one
follicle matures and releases its ovum; this condition can lead to a multiple pregnancy.
Ovulatory Phase: About 2 days before ovulation, LH secretion rises markedly. Secretion of FSH also rises,
but to a lesser extent than secretion of LH. These surges in LH and FSH cause a slight fall in follicular
estrogen production and a rise in progesterone secretion, stimulating final maturation of a single follicle
and release of its mature ovum. Ovulation marks the beginning of the luteal phase of the female
reproductive cycle and occurs about 14 days before the next menstruation. At ovulation, a blister-like
projection called a stigma forms on the wall of the follicle, the follicle ruptures, and the ovum with its
surrounding cells is released from the surface of the ovary. It is picked up by the fimbriated end of the
Fallopian tube for transport to the uterus.
Luteal Phase: After ovulation and under the influence of LH, the remaining cells of the old follicle persist
for about 12 days as a corpus luteum. The corpus luteum secretes estrogen and large amounts of
progesterone to prepare the endometrium for a fertilized ovum. Levels of FSH and LH decrease during
this phase in response to higher levels of estrogen and progesterone. If the ovum is fertilized, it secretes
human chorionic gonadotropin (hCG), which causes the corpus luteum to persist to maintain an early
pregnancy. If the ovum is not fertilized, FSH and LH fall to low levels, and the corpus luteum regresses.
Decline of estrogen and progesterone levels with the regression of the corpus luteum results in
menstruation as the uterine lining breaks down. The loss of estrogen and progesterone from the corpus
luteum at the end of one cycle stimulates the anterior pituitary to increase secretion of FSH and LH,
initiating a new cycle.
Menstrual Cycle Uterine Cycle
The uterine endometrium responds to ovarian hormone stimulation with cyclic changes.
Four phases mark the changes in the endometrium:
the proliferative phase
the secretory phase
the ischemic phase
the menstrual phase
Proliferative Phase
The proliferative phase takes place as the ovum matures and is released during the first half of the
ovarian cycle. After completion of menstruation, the endometrium is very thin, with only the basal layer
of cells remaining. These cells multiply to form new endometrial epithelium and endometrial glands
under the stimulation of estrogen secreted by the maturing ovarian follicles. Endometrial spiral arteries
and endometrial veins elongate to accompany thickening of the functional endometrial layer and to
nourish the proliferating cells. As ovulation approaches, the endometrial glands secrete thin, stringy
mucus that aids entry of sperm into the uterus.
Secretory Phase
The secretory phase occurs during the second half of the ovarian cycle as the uterus is prepared to
receive a fertilized ovum. The endometrium continues to thicken under the influence of estrogen and
progesterone from the corpus luteum, reaching its maximum thickness of 5 to 6 mm. The blood vessels
and endometrial glands become twisted and dilated. Progesterone from the corpus luteum causes the
thick endometrium to secrete substances that nourish a fertilized ovum. Large quantities of glycogen,
proteins, lipids, and minerals are stored within the endometrium, awaiting arrival of the ovum.
Ischemic Phase
If fertilization does not occur, the corpus luteum regresses, and its production of estrogen and
progesterone falls. Approximately 2 days before the onset of menses, vasospasm of the endometrial
blood vessels causes the endometrium to become ischemic and necrotic.
Menstrual Phase
The necrotic areas of endometrium separate from the basal layers, resulting in menstrual flow. The
average duration of the menstrual phase is about 5 days. During menstruation, women lose about 40 mL
of blood. Because of the recurrent loss of blood, many women are mildly anemic during their
reproductive years, especially if their diets are low in iron.
Place the phases of the endometrial cycle in order, starting with day 1 of the female reproductive
cycle.
1. Menstrual phase
2. Proliferative phase
3. Secretory phase
4. Ischemic phase
Key Points
External female reproductive
structures include the mons
pubis, labia, clitoris,
vestibule, and perineum.
External structures of the
female reproductive system
largely function to
accommodate the male
penis during coitus and to
assist in childbirth.
Internal structures include
the vagina, uterus, Fallopian
tubes, and ovaries.
Internal structures primarily
function for conception and
growth of the fetus. The
uterus also aids in childbirth
by contracting to assist in
delivery.
Puberty is the time during
which the reproductive
organs become fully
functional and secondary
sex characteristics develop.
Hormonesincluding
GnRH, LSH, FH, estrogen,
progesterone, and
testosteroneplay a role in
initiation and maturation of
female sexual reproductive
organs and secondary sex
characteristics.
Female reproductive
changes include breast
changes, skeletal growth,
enlarged reproductive
organs, and menarche.
Secondary sex characteristic
changes in the female include increased fat deposits around the breasts and hips, widened
pelvis, appearance/growth of pubic and axillary hair, and a high-pitched voice.
Variations in the onset of puberty can occur and may be related to factors such as body fat.
The female reproductive cycle is often called the menstrual cycle.
The menstrual cycle includes changes in the anterior pituitary gland, ovaries, and uterine
endometrium to prepare for a fertilized ovum.
The ovarian cycle comprises the hormonal changes that occur during the maturation and release
of the ovum and includes the follicular phase, the ovulatory phase, and the luteal phase.
The uterine cycle comprises the changes that occur in the endometrial lining during the
menstrual cycle and includes the proliferative phase, the secretory phase, the ischemic phase,
and the menstrual phase.
Effects of Substance Abuse during Pregnancy
Tobacco: Nicotine causes vasoconstriction and reduces placental blood circulation. Carbon monoxide
inactivates fetal and maternal hemoglobin. Together these substances reduce the amount of oxygen
delivered to the fetus (Pitts, 2010). The degree of fetal growth restriction varies with the number of
cigarettes smoked daily. Women who stop smoking during pregnancy reduce the amount of growth
restriction suffered by the fetus (Walker & Walker, 2011). Infants born too soon or too small are at
increased risk for adverse birth outcomes, and smoking may be a greater risk factor than illicit drugs.
Alcohol: Alcohol passes easily across the placenta. The amount and timing of alcohol intake influence
the specific effects on the fetus. Abstaining from alcohol all together is advised during pregnancy. During
the first trimester, it is believed to affect cell membranes and alter the organization of tissue, causing
structural defects. Throughout pregnancy, alcohol interferes with the metabolism of nutrients and thus
retards cell growth and division. Common facial anomalies associated with fetal alcohol syndrome (FAS)
include microcephaly, short palpebral fissures (the openings between the eyelids), epicanthal folds, flat
midface with a low nasal bridge, indistinct philtrum (groove between the nose and upper lip), and a thin
upper lip.
Marijuana: Marijuana is the most commonly used illicit drug in the United States (Pitts, 2010). The
active constituent of marijuana is tetrahydrocannabinol (THC), which crosses the placenta and
accumulates in the fetus. Because it is often used with other drugs, such as cocaine and alcohol, its
precise effects are difficult to determine. It increases blood carbon monoxide content of the mothers
blood and may reduce oxygen available to the fetus. There may be neurobehavioral problems in the
infant such as tremors and sleep disturbances.
Substance Maternal Effects Fetal or Neonatal Effects
Tobacco Increases risk for abruption of placenta Prematurity
Increases risk for PROM and preterm labor Neurodevelopmental
problems
Increases risk for spontaneous abortion
Increased incidence of SIDs
Alcohol Increases risk for abruption of placenta Fetal demise
Increases risk for spontaneous abortion Fetal alcohol spectrum
disorders
Marijuana Exact effects undetermined, but is often Exact effects undetermined
used with other drugs
Cocaine Hyperarousal state Tachycardia
Euphoria Stillbirth
Lethargy Prematurity
Generalized vasoconstriction Irritability
Hypertension Sleep, followed by agitation
Tachycardia
Increases risk for spontaneous abortion
Increases risk for abruption of placenta
Increases risk for PROM and preterm labor
Amphetamines and Vasoconstriction Increased risk for fetal
Methamphetamines growth restriction
Hypertension
Prematurity
Substance Maternal Effects Fetal or Neonatal Effects
Tachycardia Increased risk for cleft
palate
Increases risk for spontaneous abortion
Agitation
Increases risk for abruption of placenta
Poor feeding
Increases risk for preterm labor
Key Points
The age of the expectant mother impacts the health of the pregnancy and newborn.
Adolescent mothers are more likely to have sexually transmitted infections, anemia,
preeclampsia, and preterm birth. After birth, they are more likely to have infection and
depression.
Patients over the age of 35 are considered mature gravidas. These mothers face an increased
risk of fetal chromosome abnormalities, uterine myomas, spontaneous abortion, gestational
diabetes, cesarean birth, preterm delivery, stillbirth, preeclampsia, multifetal gestation, placenta
previa, abruptio placentae, and low-birth-weight infants.
It is imperative for the nurse to understand the risks associated with adolescent pregnancy and
delayed childbearing.
Patient education and nursing care should include these age considerations.
Substance abuse has detrimental effects on the pregnant patient and her baby.
The most common substances that are used in pregnancy are tobacco, alcohol, and marijuana.
Other drugs including cocaine and opioids can cause obstetrical complications including
abruption placentae and newborn complications including drug withdrawal.
Nurses can provide education and support to improve patient outcomes.
