Endokrinologi reproduksi siklus menstruasi
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Transcript of Endokrinologi reproduksi siklus menstruasi
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FisiologiEndokrinologi Reproduksi
(Siklus Menstruasi)
Oleh :Hendrik Sutopo
PROGRAM PENDIDIKAN DOKTER SPESIALIS IBAGIAN/SMF OBSTETRI DAN GINEKOLOGI
FK UNUD / RSUP SANGLAH DENPASAR
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PENDAHULUAN
Hypothalamic-Pituitary-Ovarian axis
¯ Hypothalamus Bagian dari SSP¯ Pituitary anterior & posterior.¯ Ovarium Uterus (Endometrium)
Pengaturan hormonal reproduksi Feedback Mechanism
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Hypothalamus Neuroendokrin Product : GnRH, CRH, TSH, ACTH, PIH GnRH :
Pulsatile release (Critical Range ; f & A)Waktu paruh 2-4 mnt
Feedback : Ultrashort, short, long feedback
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Pituitary Dirangsang oleh Hypothalamus GnRH Menghasilkan Gonadotropin : FSH & LH Jumlah tergantung sifat pulsatil GnRH Pituitary anterior mendapat darah dari sistem
portal, dari tempat yang lebih tinggi (hypothalamus)
Target organ : Ovarium
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Pertumbuhan Folikel
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Fase Folikuler Setiap siklus merangsang ±1000 folikel Pematangan sebuah folikel dominant ovulasi Dimulai saat berakhirnya fase luteal (E, P, &
Inhibin ) FSH Pertumbuhan Folikel
Initial recruitment Folikel primordial folikel Preantral
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Fase Folikuler.. The Two-Cell, Two-
Gonadotropin Theory : Theca cells LH
androstenedion Granulosa cells FSH
aromatase Androstenedion
aromatisasi estrogen
E + FSH : FSH-r , granulosa cells
Androstenedion 5 reduktase FSH-r
Androgen
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Fase Folikuler…
estrogen Kadar FSH & LH
Estrogenic Local Microenvironment :
FSH receptors , granulosa cells , estrogen
Proses Seleksi folikel Dominan diketahui
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Fase Folikuler….Sel Ganulosa (+ FSH) juga menghasilkan : Activin aktivitas FSH estrogen Inhibin B :
secara langsung menekan prod. & sekresi FSH GnRH Merusak FSH yang sudah ada
Follistatin mengikat Activin LH-r persiapan luteinisasi , akhir fase folikuler
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Seleksi Folikel (Ovarium)
Dominan FSH-receptors granulosa cells estrogen (Estrogenic microenviroment)
Peka Terhadap FSH
Granulosa cells + LH VEGF Vaskularisasi
Atresia FSH-receptors granulosa cells Androgen (Androgenic microenviroment)
Tidak Peka FSH
Granulosa cells VEGF Vaskularisasi
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LH Surge & Ovulasi
Estrogen >200 pg/ml, > 48h
LH surge (6x), FSH (2-3x),
LH-r , proteolytic enzym, PG, progesteron
Ovulasi, Luteinisasi13
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Akhir fase folikuler E semakin tinggi terjadi LH Surge
LH Surge…
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Ovulasi…LH Surge : proteolytic enzym, prostaglandin, progesteron, OMI (-)
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Luteal Phase granulosa cells :
Luteinization corpus luteum
size rapid
vascularization E & P
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Luteal Phase
Corpus Luteum :E & P : FSH & LH
Inhibin A : FSH Peptide lain
LH mempertahankan corpus luteum :
Angiogenesis VEGF & Angiopoietin
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Corpus Luteum Dipertahankan oleh LH & hCG (bila hamil)
P & Inhibin A = LH fx maks hari ke-8, luteolisis hari ke-9-11, Life span 14 hari (12-16 hari) regresi
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The Luteal-Follicular Transition
Corpus luteum regresi E, P, inhibin A Inhibin A Pituitary : FSH E & P pulsatil GnRH , negative feedback
pituitary (-) : FSH
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Menstruasi
Bila tidak ada kehamilan Regresi corpus Luteum E & P Vasomotor reaction, apoptosis, tissue loss menstruasi
P :PG (PGE2 & PGF2 )Stabilization of lysosomal membrane
ApoptosisPlasminogen Aktivator Inhibitor MMP Modulating leukocyte entry MMP
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Fase Menstruasi / Deskuamasi
Involusi korpus luteumP tiba-tibaPG ReleaseCytokine
Modulating leucocyte entry (MMP)Vasospastik berkepanjangan
Ischemik/Nekrosis jaringan endometrium (proses)
Deskuamasi lapisan endometrium 21
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Menstruasi
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Bila terjadi Fertilisasi/implantasi?
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KESIMPULAN
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Sumber Pustaka
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