Anatomy and Physiology of

the Female
Anatomy Reproductive
and physiology of female
reproductive system
System
By Berhanu A., (MSc in Maternity and Reproductive Health)
Learning Objectives

§ Describe the anatomy and physiology of female reproductive organs

§ Explain the hormonal regulation of the menstrual cycle
§ Understand the phases of the menstrual cycle and ovulation
§ Recognize clinical relevance for midwifery practice
§ Apply anatomical knowledge to pregnancy and childbirth
 Definitions of terms.
§ Obstetrics - is a medical specialty focusing on the care of woman during pregnancy , child
birth and postpartum.

§ Gynecology - is a medical specialty focusing on disorders or diseases of reproductive system.

§ Conception & fertilization - The union of egg & sperm in the bench mark of the beginning of
pregnancy.

§ Pregnancy - The condition of having a developing conception with in the maternal body.

– The state from conception to delivery of the fetus.

– The normal duration is 280 days counted from the 1st day of LNMP.

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 Cont..
§ Embryo: Human conceptus from fertilization through eight weeks of

pregnancy.

§ Fetus: From 9week weeks until delivery.

§ Gestational age: Duration of pregnancy expressed in completed weeks and

is calculated from the first day of LNMP/LMP.

§ Developmental age (fetal age)- is age of the offspring calculated from

time of implantation.

§ Gravid- Pregnant 2/20/2026 4

 Cont..
§ Gravidity- Total number of pregnancy including abortion

§ Parity- Total number of deliveries after 28 WKs of gestation.

§ Prenatal : The period before birth

§ Intranatal: Period during with in birth

§ Postnatal period: The period after birth

§ Primigravida: A women pregnant for the 1st time

§ Multigravida: A women pregnant more than one times

§ Primiparas: A women having born one child

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 Cont..
§ Multipara: A women having born more than one child
§ Grundmultipara: A women born more than five child
§ Neonatal period: is the first 28 day of life, and also classified as
ü Early neonatal period ( the first 7 days)
ü Late neonatal period (from day 8 to 28 days)
§ Birth: The complete expulsion or extraction of a fetus from the mother after 28
weeks' gestation.
§ Birth-weight: The weight of a neonate determined immediately after delivery or as
soon thereafter as feasible.

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 Cont..
§ Live birth: Live birth means a baby who shows any sign of life at birth or
after birth.

Ø Breathes spontaneously or

Ø Shows any other sign of life such as

o A heartbeat or

o Definite spontaneous movement of voluntary muscles

§ Stillbirth or fetal death: The absence of signs of life at or after birth.

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 Cont..
§ Early neonatal death: Death of a live-born neonate during the first 7
days after birth.

§ Late neonatal death: Death after 7 days but before 29 days.

§ Stillbirth rate or fetal death rate: The number of babies born without
signs of life for every 1,000 total births(both live births and stillbirths).

§ Neonatal mortality rate: The number of deaths during the first 28

completed days of life per 1,000 live births in a given year or period.

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 Cont..
§ Infant death: All deaths of live-born infants from birth through 12 months
of age.

§ Infant mortality rate: The number of infant deaths per 1000 live births.

§ Low birth-weight: A newborn whose weight < 2500g.

§ Very low birth-weight: A newborn whose weight< 1500 g.

§ Extremely low birth-weight: A newborn whose weight is <1000 g.

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 Cont..
§ Term neonate: A neonate born anytime after 37 completed weeks of
gestation and up until 42 completed weeks of gestation (260 to 294 days).

§ Preterm neonate: A neonate born before 37 completed weeks (the 259th

day).

§ Post-term neonate: A neonate born anytime after completion of the 42

week, beginning with day 295.

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 Cont..
§ Abortus: A fetus or embryo that comes out of the uterus during the first half of
pregnancy.
o This is before 20 weeks of gestation, or before 28 weeks in Ethiopia.
o If the pregnancy age is not known, it refers to a baby born weighing less than 500
grams, or less than 1000 grams in Ethiopia.
§ Direct maternal death. the death of a woman due to problems related to pregnancy,
labor, or the period after delivery.

§ It also includes death caused by wrong treatment, lack of treatment, or

complications from care.

§ An example is a mother who dies from postpartum hemorrhage.

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Introduction to the Female Reproductive System
§ The female reproductive system is designed for:
ü Production of Gametes: Generating female sex cells (ova/eggs).
ü Hormone Production: Secreting key sex hormones (estrogen,
progesterone).
ü Fertilization Support: Providing the environment for sperm and egg
to meet.
ü Gestation (Pregnancy): Nurturing and protecting the developing fetus.
ü Parturition (Childbirth): Facilitating the birth process.
Major Components of the Female Reproductive System

§ Internal organs: Ovaries, Fallopian tubes,

Uterus, Cervix, Vagina

§ External genitalia: Vulva (mons pubis,

labia, clitoris)

§ Supporting structures: Pelvic floor and

ligaments

§ Hormonal control: Hypothalamus, pituitary,

ovaries
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The Ovaries: Anatomy and Structure
• Location: Paired organs in pelvic cavity, lateral to uterus
• Size: Approximately 3 cm × 2 cm × 1 cm each
• Structure: Cortex (outer) with follicles, medulla (inner) with vessels
• Functions: Gamete production and hormone secretion
• Support: Ovarian ligament to uterus, suspensory ligament to pelvic wall
• Blood supply: Ovarian artery and uterine artery branches
• Clinical relevance: Ovarian torsion, cysts, PCOS, impact on fertility
Ovarian Follicles and Oogenesis
Follicle stages: Primordial → Primary →
Secondary → Graafian → Corpus luteum

Oogenesis begins during fetal development

Approximately 400 oocytes released during

reproductive lifetime

Meiosis I completed before ovulation

Meiosis II completed only after fertilization

Ovarian Hormone Production
§ Estrogen (estradiol):
ü Produced by developing follicles and corpus luteum
ü Stimulates endometrial proliferation
ü Develops secondary sexual characteristics
ü Maintains bone density
§ Progesterone:
ü Produced by corpus luteum after ovulation
ü Prepares endometrium for implantation
ü Maintains pregnancy
§ Inhibin: Regulates FSH secretion
Fallopian Tubes (Uterine Tubes)
§ Four regions: Infundibulum (with
fimbriae), Ampulla (fertilization site),
Isthmus, Intramural
§ Length: 10-12 cm
§ Functions: Transport ovum, site of
fertilization, early embryo nutrition
§ Ciliated epithelium and peristalsis aid
movement
 The Uterus: Anatomy and Wall Layers
§ Size: 7.5 × 5 × 2.5 cm (non-pregnant)
§ Layers:
ü Perimetrium: Outer serous layer
ü Myometrium: Muscular layer,
powerful contractions
ü Endometrium: Inner mucosal lining,
hormone-responsive

§ Divisions: Fundus, body, isthmus, cervix

§ Expands dramatically during pregnancy

Uterine Blood Supply and Supporting Ligaments
§ Blood supply:
ü Main: Uterine arteries (from internal iliac)
ü Additional: Ovarian arteries
ü Rich venous plexus important during pregnancy
§ Supporting ligaments:
ü Broad ligament: Peritoneal fold to pelvic walls
ü Round ligaments: Maintain anteverted position
ü Uterosacral ligaments: Prevent excessive retroversion
ü Cardinal ligaments: Main cervical support
The Cervix: Anatomy and Structure
§ Lower portion of uterus, 2-3 cm length
§ Divisions:
ü Ectocervix: Visible portion,
squamous epithelium
ü Endocervix: Cervical canal,
columnar epithelium
ü Internal/External os: Junctions
§ Transformation zone: Where most
cervical cancers develop
Cervical Function and Clinical Relevance
§ Cervical mucus:
ü Produced by endocervical glands
ü Follicular phase: Thin, alkaline, sperm-friendly (spinnbarkeit)
ü Luteal phase: Thick, acidic, barrier formation
§ Clinical relevance:
ü Cervical cancer screening (smear test, HPV testing)
ü Colposcopy examination
ü Cervical incompetence and cerclage
ü Episiotomy considerations during childbirth
 The Vagina: Anatomy and Physiology
§ Fibromuscular canal: 7-10 cm length
§ Structure: Walls with rugae (folds) for expansion
§ Fornices: Spaces around cervix (anterior, posterior, lateral)
§ Vaginal environment:
ü Stratified squamous epithelium
ü Normal flora: Lactobacillus species
ü Normal pH: 3.8-4.5 (acidic, prevents pathogens)
ü Hormone-responsive
§ Functions: Passageway for menstruation, intercourse, childbirth
 External Genitalia: The Vulva
§ Mons pubis: Fat pad over pubic symphysis
§ Labia majora: Outer folds with fat and sweat glands
§ Labia minora: Inner folds, hairless, erectile tissue
§ Clitoris: Highly sensitive, contains erectile tissue
§ Vestibule: Area with urethral and vaginal openings
§ Vestibular glands: Bartholin glands (lubrication)
§ Perineum: Between vagina and anus
Pelvic Floor Muscles
Levator ani muscles:
§ Pubococcygeus
§ Iliococcygeus
§ Puborectalis

Functions:
§ Support for pelvic organs (bladder,
uterus, rectum)
§ Maintain urinary and fecal
continence
§ Allow passage of fetus during
childbirth
§ Contribute to sexual function
 Physiology of the female reproductive organs
§ Hormones and their function
A. Hypothalamus
– Hypothalamus produces a specific releasing and inhibitory hormones or
factors which have effect on the production of pituitary hormones.
I. Gonadotrophic releasing hormones(GnRH)
– Concerned with the synthesis, storage and release of gonadotrophic
hormones (FSH and LH)
[Link] inhibitory factor/ hormones(PIF)
– Inhibits the secretion of prolactin from anterior pituitary
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gland.
 Hormones and their function

III. Thyrotrophin releasing hormone

– Stimulates the release of TSH

IV. Corticotrophin releasing hormone(CRH)

– Stimulate the release of ACTH (adrenocorticosteriod hormones)

V. Growth hormone releasing hormones

– Stimulate the release of growth hormones.

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 Hormones and their function

B. Pituitary hormones
1. Anterior pituitary (Adenohypophsis): I. FSH and LH.
§ FSH- stimulate the growth and maturation of primary oocytes
of which only one develops into a mature follicle.
– In conjunction with LH, it is also involved in ovulation and
steroidogenesis.
§ LH- used for ovulation, corpus luteum formation, progesterone
secretion, estrogen production with FSH.
§ II. Prolactin hormone is responsible for the production of milk
in the breast.
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 Hormones and their function

2. Posterior pituitary(Neurohypophsis) – Oxytocin and ADH.

C. Ovarian hormones
I. Estrogen - is produced by granulosa cells under the influence
of FSH.
§ Function
– Responsible for secondary sexual characteristics.
– Inhibition of FSH secretion from ovary (negative feedback
mechanism).
– Growth of myometrium, endometrium, alveoli and ducts of
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 Cont..
§ Estrogen function cont..

– Myometrial stimulation (increase myometrial contractility).

– Stimulation of protein synthesis in the liver.

– Promotion of calcifications of the bone.

– Angiogenesis (new blood formation).

– Influences the production of cervical mucus and the structure

of the vaginal epithelium.
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 Cont..
[Link]:produced by the corpus luteum under the
influence of LH.
§ Actions
– Growth of ducts and lobules of the breast, induce prolactin
synthesis.
– Relaxation of smooth muscles of the uterus, blood vessels,
GI and urinary tract.
– Secretary changes and Decidualization of the endometrium.
– Vasodilatation & thermogenic (increase BBT).
– Hyperventilation (decrease concentration of co2 .

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 Cont..
[Link]: produced by the theca interna cells.
– They are source for estrogen synthesis.

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Hypothalamic-Pituitary-Ovarian Axis
§ Hypothalamus releases GnRH

§ Anterior pituitary releases FSH and LH

§ Ovaries produce estrogen and progesterone

§ Negative feedback: High estrogen/progesterone

inhibit FSH/LH

§ Positive feedback: High estrogen before ovulation

triggers LH surge

§ Essential for reproductive function coordination

The Menstrual Cycle: Overview
Average 28-day cycle (range 21-35 days)
Three phases:
§ Follicular phase (days 1-14): Follicle development,
rising estrogen
§ Ovulation (day 14): LH surge, egg release
§ Luteal phase (days 14-28): Corpus luteum activity,
high progesterone
Endometrial changes synchronized with hormonal
levels
 Menstrual cycle
§ Is a periodic uterine bleeding in response to cyclic hormonal changes.

§ It is hallmark of reproductive year.

§ Characteristics of normal menses

– Interval 21-35 days(28).

– Amount 10-80 ml(30), Duration 1-8 days, average 5 days

– The blood is arterial (85%) oxygenated the rest 10-15% is deoxygenated.

– Color dark red and non clotted in nature due to a non clotting factor
called fibrinolysin.
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 Physiology of menstruation
§ All potential gametes are produced before birth.

§ The number of oocytes are 6-7 million by 20 weeks of gestation.

§ 1-2 million oocytes remain in the ovary at birth.

§ At puberty only 300,000 oocytes remain.

§ Only 400-500 will ultimately ovulate and they will end up at the time of
menopause.

§ Menarche = onset of menstruation.

– It occurs at an average age of 12, but is normal anywhere between 8 and

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 Menstrual cycle..

§ Components: 2 cycles
1. Ovarian Cycle
– Follicular (preovulatory = estrogenic) phase
– Ovulatory phase
– Luteal (postovulatory = progestational ) phase
2. Uterine Cycle/Endometrial cycle/
– Proliferative phase
– Secretory phase
– Menstrual phase
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 Menstrual cycle
Phase of ovarian cycle
A. Follicular phase (= preovulatory = estrogenic): Hormonal
feedback promote the development of single dominant follicle.
§ Its average length is 10-14 days.
§ Begins with onset of first day of menses (1st to 13th day).
§ Dominant ovarian hormone is estrogen. From graffian follicles
§ Follicular growth, maturation + ONE follicle predominates.

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 Ovarian cycle

§ Variable length: Reasons:

– Rate of maturation of the follicle through the second stage
of development is regulated with FSH.
– LH Surge does not occur until the dominant follicle has
reached the appropriate stage of development.

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Ovarian cycle…..
B. Ovulatory Phase
§ Is short ,critical phase of the menstrual cycle, in which
mature ovarian follicle ruptures and release an ovum.
§ Occur at mid cycle
§ Duration 24-48 hrs (shortest phase of cycle).
§ Estrogen peak(positive feedback)
§ Dominant follicle produce high estrogen( this changes
from negative to positive feedback, hypothalamus and
pituitary)
§ LH surge: it cause rupture of graafian follicle, release of
secondary oocyte.
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 Ovarian cycle…..
§ Indices of ovulation
– Mid-abdominal pain (irritation of the peritoneum).
– ↑Elasticity of cervical mucus (average = 8-12cm).
– ↑Basal body temperature ( 0.5oc).
– ↑Urinary Gonadotropins, E, and pregnanediol.
– Biopsy of the secretory endometrium ( progesterone secretion + CL
formation).
§ Absolute proof of ovulation is pregnancy.

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 Ovarian cycle…
C. Luteal phase

– Interval between ovulation and menstrual flow (15th - 28th

day)
– Duration is 14 days.
– Day of ovulation : Length of the menstrual cycle - 14d
– Predominant Hormone: Progesterone (10x of the basal,
reorganization of the ruptured follicle → corpus luteum).
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 Uterine cycle/Endometrial cycle/
§ Because of the systemic effects of estrogen, the endometrium undergoes
histologic cyclic changes that culminate in menstruation.

§ The superficial 2/3 of the endometrium is called the decidua functionalis

and is composed of stratum spongiosum – superficial zone.

§ The decidua basalis- is the deepest region of endometrium and doesn’t

undergo significant monthly proliferation.

– It is the source of endometrial regeneration after each menses.

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 Uterine cycle/Endometrial cycle/

A. Proliferate phase

§ Begins at the end of menstruation (5th–13th day)

§ Endometrium is thin (1–2 mm) at the start

§ Dominant hormone: estrogen (Uterotrophic)

§ Stroma & epithelium:

ü ↑ Growth of epithelial and stromal cells

ü ↑ Mitosis of stratum basale to regenerate stratum functionale

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 Uterine cycle/Endometrial cycle
B. Secretary phase-

§ It extends from ovulation to the onset of the next menses.

ü The proliferative endometrium, under the influence of progesterone is

changed to secretary type.

ü Glands become tortuous and exhibit secretary activity.

ü The estrogen receptor cells decreases progressively because of the

antagonistic effect of progesterone. As a result there is antagonism of
estrogen induced DNA synthesis and cellular mitosis.
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 Cont.…Secretary phase
§ Duration: 14th - 28th day.
§ Predominant hormone:
– Progesterone (10x, corpus luteum)
– Estrogen
§ Epithelium and stroma
– Secretory changes in the endometrium (↑differentiation).
– (appropriate for implantation, edematous, predecidual cells)
– ↑ Adhesivity of surface epithelium.

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 Cont. Secretary phase
§ Mucous glands
– Elongation and coiling
– Secrete thick viscous fluid
– Glycogen
– Cervical mucus becomes thick.
§ Angiogenesis:
– Spiraling of the blood vessels.
– ↑ Vascularity
§ Receptors:
– ↓
2/20/2026 Number of estrogen + progesterone receptors 47
 [Link] phase
§ Duration: Start from day 1 and usually lasts 3 to 5 days.

– During this phase there is irregular sloughing of the superficial 2/3 of

endometrium (decidua functionalis) accompanied by blood.

– Expulsion of the blood is aided by uterine contraction.

– Stratum functionale: superficial layer, shed during menses, spiral

artery).

– Stratum basale: deeper layer, regenerative, basal artery).

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 Cont.. menstrual phase
§ If the egg is not fertilized, the body does not make hCG.
§ Without hCG, the corpus luteum breaks down, causing estrogen (E) and
progesterone (P) levels to drop.
§ The drop in E and P causes the lining of the uterus (endometrium) to break
down, leading to menstrual bleeding.
§ Increased local prostaglandins (PGF2α) make the spiral arteries contract
strongly, reducing blood flow.
§ This causes the upper layer of the endometrium to die and shed, which leads
to bleeding and menstrual cramps (dysmenorrhea).
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 Menstrual phase cont..
§ Endometrial cells release lysosomal enzymes, which break down the inter-
and intracellular mucopolysaccharides that hold the cells together.
§ This causes sloughing and shedding of the endometrium, leading to
bleeding.
§ Each spiral artery sequentially constricts, dilates, constricts, and finally
shuts off blood flow.
§ ↓ Estrogen (E) and progesterone (P) → ↑ GnRH → ↑ LH and FSH →
menstrual cycle repeats.
§ If conception occurs, the functional life span of the corpus luteum is
extended.
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 Menstrual cycle; ovarian and uterine cycle

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Follicular Phase and Ovulation
§ Follicular phase (days 1-14):
ü FSH stimulates follicle development
ü Multiple follicles begin, dominant follicle emerges
ü Increasing estrogen levels
ü Endometrial proliferation begins
ü Cervical mucus becomes thin and alkaline
§ Ovulation (day 14):
ü Triggered by LH surge
ü Release of mature ovum from Graafian follicle
ü Ovum enters fallopian tube
ü Fertile window: 3-5 days around ovulation
§ Clinical relevance: Fertility awareness, ovulation predictor kits
Luteal Phase and Cycle Regulation
§ Luteal phase (days 14-28):
ü Corpus luteum forms from ruptured follicle
ü High progesterone and estrogen levels
ü Endometrial secretory changes
ü Basal body temperature rises
§ If no fertilization:
ü Corpus luteum regresses after 10-12 days
ü Hormone levels drop
ü Menstruation begins
§ If fertilization:
ü HCG maintains corpus luteum
ü Pregnancy support continues
§ Clinical relevance: Luteal phase defect, fertility assessment
Clinical Applications: Pelvic Examination
§ Anatomical knowledge essential for:
ü Speculum examination: Visualizing cervix and vagina
ü Bimanual palpation: Assessing uterus and ovaries
ü Identifying normal vs abnormal findings
§ Cervical assessment:
ü Position, consistency, cervical os
ü Cervical screening (smear test)
§ Uterine assessment:
ü Size, position, mobility, tenderness
ü Ovarian palpation if enlarged or tender
§ Clinical relevance: Accurate diagnosis, patient comfort
 Thanks!!!

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