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Describe the physiological changes that occur in female reproductive system with age Puberty Pubic hair is often

the second noticeable change in puberty, usually within a few months of thelarche.It is referred to as pubarche. The pubic hairs are usually visible first along the labia. The first few hairs are described as Tanner stage 2.Stage 3 is usually reached within another 612 months, when the hairs are too numerous to count and appear on the pubic mound as well. By stage 4, the pubic hairs densely fill the "pubic triangle." Stage 5 refers to spread of pubic hair to the thighs and sometimes as abdominal hair upward towards the navel. In about 15% of girls, the earliest pubic hair appears before breast development begins. Vagina, uterus, ovaries The mucosal surface of the vagina also changes in response to increasing levels of estrogen, becoming thicker and duller pink in color (in contrast to the brighter red of the prepubertal vaginal mucosa).[44] Whitish secretions (physiologic leukorrhea) are a normal effect of estrogen as well.[41] In the two years following thelarche, the uterus, ovaries, and the follicles in the ovaries increase in size.[45] The ovaries usually contain small follicular cysts visible by ultrasound. Menopause Menopause is a normal part of a woman's aging process. The ovaries stop releasing eggs (ova), and menstrual periods stop. Most women experience menopause around age 50, although it occurs before age 40 in about 8% of women. Prior to menopause, menstrual cycles often become irregular. The ovaries become less responsive to stimulation by follicle-stimulating hormone (FSH) and luteinizing hormone (LH). To try to compensate for the decreased response, the body produces more of these ovary-stimulating hormones for a time. The level of these hormones will eventually decrease. The hormones produced by the ovaries include the different forms of estrogen (including estradiol), progesterone, and androgens (including testosterone). These hormones also decrease around menopause. The ovaries continue to produce small amounts of testosterone and some estrogen. The hormones produced by the pituitary gland are also decreased. Because hormone levels fall, changes occur in the entire reproductive system. The vaginal walls become less elastic, thinner, and less rigid. The vagina becomes shorter. Secretions become scant and watery. The external genital tissue decreases and thins (atrophy of the labia). In both men and women, reproductive system changes are closely related to changes in the urinary system. The pubic muscles lose tone, and the vagina, uterus, or urinary bladder can fall out of position. This is called vaginal prolapse, bladder prolapse, or uterine prolapse, depending on which structure drops. A

prolapse of any of these structures increases the risk of problems such as stress incontinence (urine leakage). Most prolapses can be treated. Irritation of the external genitals can occur (pruritus vulvae). The vaginal walls become thinner and dryer and may become irritated (atrophic vaginitis). Sexual intercourse may become uncomfortable for some women (dyspareunia). There are changes in the levels of normal microorganisms in the vagina, and there is an increased risk of vaginal yeast infections. Pregnancy a. Uterus. (1) Changes in the uterus are phenomenal. By the time the pregnancy has reached term, the uterus will have increased five times its normal size: (a) In length from 6.5 to 32 cm.(b) In depth from 2.5 to 22 cm.(c) In width from 4 to 24 cm. (d) In weight from 50 to 1000 grams.(e) In thickness of the walls from 1 to 0.5 cm. (2) The capacity of the uterus must expand to normally accommodate a seven-pound fetus and the placenta, the umbilical cord, 500 ml to 1000 ml of amniotic fluid, and the fetal membranes. (3) The abdominal contents are displaced to the sides as the uterus grows in size, which allows for ample space for the uterus within the abdominal cavity. (a) Growth of the uterus occurs at a steady, predictable pace. (b) Measurement of the fundal height during pregnancy is an important factor that is noted and recorded (see figure 5-1). (c) Growth that occurs too fast or too slow could be an indication of problems. (d) The size of the uterus usually reaches its peak at 38 weeks gestation. The uterus may drop slightly as the fetal head settles into the pelvis, preparing for delivery. This dropping is referred to as "lightening." This is more noticeable in a primigravida than a multigravida. NOTE: Remember a primigravida is a woman pregnant for the first time. A multigravida is a woman who has been pregnant more than once. b. Cervix. (1) The cervix undergoes a marked softening which is referred to as the Goodell's sign." (2) A mucus plug, which is known as "operculum" is formed in the cervical canal. This is the result of enlarged and active mucus glands of the cervix. It serves to seal the uterus and to protect the fetus and fetal membranes from infection. The mucus plug is expelled at the end of the pregnancy. This may occur

at the onset of labor or precede labor by a few days. When the mucus is blood-tinged, it is referred to as a "bloody show." (3) Additional changes and softening of the cervix occur prior to the beginning of labor. c. Vagina. Increased circulation to the vagina early in pregnancy changes the color from normal light pink to a purple hue which is known as the "Chadwick's sign." d. Ovaries. (1) The follicle-stimulating hormone (FSH) ceases its activity due to the increased levels of estrogen and progesterone secreted by the ovaries and corpus luteum. The FSH prevents ovulation and menstruation. (2) The corpus luteum enlarges during early pregnancy and may even form a cyst on the ovary. The corpus luteum produces progesterone to help maintain the lining of the endometrium in early pregnancy. It functions until about the 10th to 12th week of pregnancy when the placenta is capable of producing adequate amounts of progesterone and estrogen. It slowly decreases in size and function after the 10th to 12th week.