Ovaries

Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall laterally by the suspensory ligament of the ovary and to the uterus medially by the utero-ovarian ligament. These organs function to secrete hormones Hormones Hormones are messenger molecules that are synthesized in one part of the body and move through the bloodstream to exert specific regulatory effects on another part of the body. Hormones play critical roles in coordinating cellular activities throughout the body in response to the constant changes in both the internal and external environments. Hormones: Overview (estrogen and progesterone) and to produce the female germ cells (oocytes), which are expelled and then “captured” by the uterine tubes. The primary blood supply to the ovary is provided by the ovarian artery, a direct branch of the abdominal aorta; the ovarian artery anastomoses with the ascending branch of the uterine artery, providing excellent collateral blood flow.

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Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

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Overview

Definition

The ovaries are the female gonads, located within the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis as paired structures. The ovaries contain haploid gametes known as oocytes.

Functions

  • Produce and release female germ cells (oocytes)
  • Secrete sex hormones Hormones Hormones are messenger molecules that are synthesized in one part of the body and move through the bloodstream to exert specific regulatory effects on another part of the body. Hormones play critical roles in coordinating cellular activities throughout the body in response to the constant changes in both the internal and external environments. Hormones: Overview
    • Estrogen 
    • Progesterone  
    • Testosterone (small amounts)

Embryology

Ovarian development

Weeks 5–10: 

  • Gonads arise around week 5 from the gonadal ridge:
    • Epithelium Epithelium The epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions. Surface Epithelium arises from the coelomic epithelium (mesoderm)
    • Stroma arises from the sub-coelomic mesoderm
    • Invaginations of the epithelium in the cortex region form the primary sex cords (pregranulosa cells) → rete ovarii
  • Primordial germ cells:
    • Differentiate into oocytes in females
    • Originate in the epiblast
    • Migrate to the yolk sac → through the allantois (umbilical cord) → along the dorsal mesentery of the hindgut → gonadal ridges
    • Germ cells invade into the gonadal ridges by approximately 6 weeks
  • Up until 6 weeks of gestation, sex development is identical and nonbinary
  • Development of the ovary from the bipotent gonad requires absence of the SRY gene (normally found on the Y chromosome), preventing differentiation into testes
    • If the SRY gene is present, testes will begin developing around week 6.
    • If the SRY gene is absent, testes will not develop.
    • Around week 10, if testes have not yet developed, ovarian development begins.
Migration of the primordial germ cells around 5 weeks

Migration of the primordial germ cells at around 5 weeks:
These germ cells begin as epiblast cells and start developing within the yolk sac. The cells then migrate down the allantois, along the dorsal mesentery of the hindgut, and then invade the gonadal ridges, which are beginning to form the early gonads.

Image by Lecturio.

Weeks 10–20:

  • Oocyte formation occurs by:
    • Rapid multiplication of the primordial germ cells → oogonia
    • Oogonia differentiate into primary oocytes and arrest at this stage until puberty Puberty Puberty is a complex series of physical, psychosocial, and cognitive transitions usually experienced by adolescents (11-19 years of age). Puberty is marked by a growth in stature and the development of secondary sexual characteristics, achievement of fertility, and changes in most body systems. Puberty
  • Follicle formation occurs by:
    • Pregranulosa cells encircling the germ cells to form primordial follicles
    • Theca cells encircling the primordial follicles 
  • Estrogen production by the follicular cells stimulates the indifferent external genitalia to differentiate into female structures
Embryologic development of the ovaries

Embryologic development of the ovaries

Image by Lecturio.

Ovarian descent

  • Ovaries develop in the abdomen and descend into the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis
  • Guided by the gubernaculum (a band of fibrous tissue from the posterior wall)
  • Gubernaculum becomes the ovarian ligament postnatally

Gross Anatomy

Size

  • 2 almond-shaped organs (left and right) 
  • Approximately 4 x 2 x 1 cm during the reproductive years
  • Weight: 5–10 g
  • Size varies somewhat throughout the cycle and stage of reproductive age
  • Smaller after menopause Menopause Menopause is a physiologic process in women characterized by the permanent cessation of menstruation that occurs after the loss of ovarian activity. Menopause can only be diagnosed retrospectively, after 12 months without menstrual bleeding. Menopause

Location

  • Suspended by ligaments in the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis
  • Found in the lateral pelvic cavity, within the ovarian fossa (depressions in the dorsal pelvic wall)
  • Intraperitoneal structures
  • Positioned on the posterior aspect of the broad ligament
  • Somewhat mobile structures:
    • Often found posterior to the uterus in the rectovaginal pouch (i.e., Douglas pouch) 
    • May be found lateral or even (rarely) anterior to the uterus (e.g., retroflexed uterus)
    • May be scarred against the pelvic sidewall

Ligaments

Ovaries are suspended within the peritoneal cavity between the pelvic sidewall and uterus via the several important ligaments.

  • Suspensory ligament of the ovary:
    • Also known as infundibulopelvic (IP) ligament
    • Connects the ovary laterally to the pelvic wall
    • Contains the ovarian vessels:
      • Ovarian artery (direct branch off the aorta)
      • Ovarian vein 
  • Utero-ovarian (UO) ligament: 
    • Also known as the ovarian ligament
    • Connects the ovary medially to the uterus 
    • A thickened portion of the broad ligament within the mesovarium
  • Broad ligament:
    • A thin sheet of peritoneum Peritoneum The peritoneum is a serous membrane lining the abdominopelvic cavity. This lining is formed by connective tissue and originates from the mesoderm. The membrane lines both the abdominal walls (as parietal peritoneum) and all of the visceral organs (as visceral peritoneum). Peritoneum and Retroperitoneum that drapes over the uterus and fallopian tubes like a sheet hanging over a clothesline
    • Divided into 3 parts: mesosalpinx, mesovarium, and mesometrium
    • Mesosalpinx: 
      • Area adjacent to the fallopian tubes
      • Contains the tubal branches of the ovarian and ascending uterine arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries
    • Mesovarium: 
      • Area adjacent to the ovaries
      • Contains the UO vessels
    • Mesometrium: 
      • Area below the UO ligament
      • Superiorly, contains the round ligament (a thickening of the broad ligament off the anterior surface of the uterus, connecting the uterus to the anterior abdominal wall Anterior abdominal wall The anterior abdominal wall is anatomically delineated as a hexagonal area defined superiorly by the xiphoid process, laterally by the midaxillary lines, and inferiorly by the pubic symphysis. Anterior Abdominal Wall before passing through the inguinal canal Inguinal canal The inguinal region, or the groin, is located in the RLQ and LLQ of the anterior abdominal wall, bordered by the thigh inferiorly, the pubis medially, and the iliac crest superolaterally. The inguinal canal is a tubular structure that runs in a straight line from the anterior superior iliac spine to the pubic tubercle. Inguinal Canal and Hernias, terminating in the labia majora)
      • Inferiorly, contains uterine vessels, ureters, and uterosacral ligaments
Gross anatomy of the female reproductive system

Gross anatomy of the female reproductive system

Image by Lecturio.

Microscopic Anatomy

Microscopic structure of the ovaries

  • Ovaries are covered by a simple cuboidal epithelium called the germinal epithelium.
  • Tunica albuginea: 
    • A capsule surrounding the ovary located under the epithelium 
    • Composed of a dense, irregular collagenous connective tissue Connective tissue Connective tissues originate from embryonic mesenchyme and are present throughout the body except inside the brain and spinal cord. The main function of connective tissues is to provide structural support to organs. Connective tissues consist of cells and an extracellular matrix. Connective Tissue.
  • Ovarian cortex: 
    • Outer region
    • Contains the developing follicles, which include:
      • Developing oocytes
      • Granulosa cells (surrounding the developing oocytes) → secrete estrogen
      • Theca cells (outside the granulosa cell cells) → produce testosterone that is converted to estrogen by the granulosa cells
  • Ovarian medulla: 
    • Inner region
    • Composed of:
      • Blood vessels and nerves
      • Connective tissue → provides structure
      • Interstitial cells → become theca cells
      • Myocontractile cells
  • Ovarian hilum: region where the major neurovasculature enters the ovary
Electron micrograph of a secondary follicle

Electron micrograph (× 1100) of a secondary follicle

Image: “Folliculogenesis” by Phil Schatz. License: CC BY 4.0

Formation of ovum

Oogenesis is the process of ovum production from primordial germ cells. 

  • Mitosis: 
    • Occurs during the embryonic and fetal periods
    • Maximum numbers of oogonia (6 million–7 million) occur around 20 weeks of gestation 
    • Oogonium → differentiates into primary oocytes or undergo atresia (the vast majority)
    • Ploidy: diploid
    • 46 chromosomes
  • Meiosis Meiosis The creation of eukaryotic gametes involves a DNA replication phase followed by 2 cellular division stages: meiosis I and meiosis II. Meiosis I separates homologous chromosomes into separate cells (1n, 2c), while meiosis II separates sister chromatids into gametes (1n, 1c). Meiosis I: 
    • Primary oocytes arrest in prophase I in utero and remain there until puberty Puberty Puberty is a complex series of physical, psychosocial, and cognitive transitions usually experienced by adolescents (11-19 years of age). Puberty is marked by a growth in stature and the development of secondary sexual characteristics, achievement of fertility, and changes in most body systems. Puberty.
    • At puberty Puberty Puberty is a complex series of physical, psychosocial, and cognitive transitions usually experienced by adolescents (11-19 years of age). Puberty is marked by a growth in stature and the development of secondary sexual characteristics, achievement of fertility, and changes in most body systems. Puberty, approximately 400,000 primary oocytes are present.
    • Primary oocyte → divides into a secondary oocyte and 1st polar body
    • Ploidy: diploid → haploid
    • 46 → 23 chromosomes
  • Meiosis Meiosis The creation of eukaryotic gametes involves a DNA replication phase followed by 2 cellular division stages: meiosis I and meiosis II. Meiosis I separates homologous chromosomes into separate cells (1n, 2c), while meiosis II separates sister chromatids into gametes (1n, 1c). Meiosis II: 
    • At puberty Puberty Puberty is a complex series of physical, psychosocial, and cognitive transitions usually experienced by adolescents (11-19 years of age). Puberty is marked by a growth in stature and the development of secondary sexual characteristics, achievement of fertility, and changes in most body systems. Puberty, hormonal stimulation (follicle-stimulating hormone (FSH)) triggers meiosis to resume
    • Arrests in metaphase II until fertilized by a sperm
    • Upon fertilization Fertilization To undergo fertilization, the sperm enters the uterus, travels towards the ampulla of the fallopian tube, and encounters the oocyte. The zona pellucida (the outer layer of the oocyte) deteriorates along with the zygote, which travels towards the uterus and eventually forms a blastocyst, allowing for implantation to occur. Fertilization and First Week, the secondary oocyte divides → mature ovum and 2nd polar body
    • Ploidy: haploid
    • 23 chromosomes
The process of oogenesis

The process of oogenesis

Image: “Oogenesis” by Phil Schatz. License: CC BY 4.0

Follicle development

Folliculogenesis is a complex process in which an ovarian follicle, containing an oocyte, matures through several stages.

  • Primordial follicle:
    • Develops in ovaries during the fetal period 
    • Oogonia become surrounded by somatic epithelial cells from the gonadal ridge.
  • Primary follicle:
    • Contains a primary oocyte
    • A glycoprotein layer is created (zona pellucida).
    • Follicular cells proliferate and differentiate to become the granulosa cell layer (single-cell layer).
  • Secondary follicle (also known as preantral follicles): 
    • This stage is responsive to gonadotropins (i.e., FSH).
    • Granulosa cell layer grows.
    • Cells transform from squamous → cuboidal
    • Hormone production increases.
    • Recruitment of theca cells → surround basement membrane
  • Tertiary follicle (also known as antral follicles):
    • Granulosa cells produce:
      • Fluid → create an antrum
      • Estrogen and growth factors → critical for maturation of a healthy oocyte
    • Granulosa cells around the oocyte become the cumulus oophorus
    • Thecal cells differentiate into:
      • Theca interna: contains small vessels and glandular cells; produces testosterone that is converted to estrogen in the granulosa cells
      • Theca externa: stabilizes follicles; derived from connective tissue Connective tissue Connective tissues originate from embryonic mesenchyme and are present throughout the body except inside the brain and spinal cord. The main function of connective tissues is to provide structural support to organs. Connective tissues consist of cells and an extracellular matrix. Connective Tissue
  • Mature follicle (also known as a graafian follicle):
    • Only 1 follicle each cycle will reach this stage.
    • Primary oocyte → secondary oocyte just before ovulation
    • Antrum enlarges (makes up most of the follicle)
    • Innermost layer of the cumulus oophorus → corona radiata
  • Corpus luteum:
    • Formed from the follicle after oocyte release at ovulation
    • Center contains a blood clot formed after ovulation
    • Granulosa and theca cells produce estrogen and progesterone
    • Atrophies if pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-hCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care does not occur
The stages of folliculogenesis

The stages of folliculogenesis:
Note the progression of follicular cell proliferation, thecal cell differentiation, and antrum enlargement.

Image by Lecturio.

Neurovasculature

  • Arterial supply: primarily by the ovarian artery
    • Direct branch off the abdominal aorta (exits at L2) just below the renal arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries
    • Contained within the suspensory ligament of the ovary (IP ligament)
    • Splits into:
      • Ovarian branch
      • Tubal branch
    • Both branches anastomose with the ascending branch of the uterine artery (which also splits into ovarian and tubal branches).
    • The anastomotic region of the ovarian branches is often referred to as the utero-ovarian artery.
  • Venous supply: drained by the ovarian veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins  
    • Venous plexus located within the mesosalpinx and mesovarium → converge into a single ovarian vein on each side
    • The ovarian veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins are contained within the IP ligaments.
    • Right ovarian vein → inferior vena cava (IVC)
    • Left ovarian vein → left renal vein → IVC
  • Lymphatic drainage: drainage via vessels along ovarian veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins to paraaortic nodes
  • Innervation: 
    • Derived from autonomic plexuses:
      • Upper part of ovarian plexus is formed by the renal and aortic plexuses.
      • Lower part is from the superior and inferior hypogastric plexuses.
    • Afferent visceral pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain fibers: run with sympathetic fibers from T11–L1
Blood supply and venous drainage to the ovary

Blood supply and venous drainage to the ovary

Image by Lecturio.

Clinical Relevance

Related anatomical structures

  • Pelvis: consists of the bony pelvic girdle, pelvic cavity, pelvic floor (muscles and connective tissue Connective tissue Connective tissues originate from embryonic mesenchyme and are present throughout the body except inside the brain and spinal cord. The main function of connective tissues is to provide structural support to organs. Connective tissues consist of cells and an extracellular matrix. Connective Tissue), and all the viscera, vessels, and muscles that it contains. The pelvic cavity houses various GI and urogenital structures. 
  • Uterus: pear-shaped, hollow organ composed of smooth muscle that functions to nourish the developing fetus until the end of the pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-hCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care. At the end of pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-hCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care, the uterus is also responsible for expulsion of the newborn Newborn A neonate, or newborn, is defined as a child less than 28 days old. A thorough physical examination should be performed within the first 24 hours of life to identify abnormalities and improve outcomes by offering timely treatment. Physical Examination of the Newborn.
  • Fallopian tubes: thin tubes that act as a conduit between the ovary and the uterus. The fallopian tubes collect the ovulated oocytes; if sperm are present, fertilization Fertilization To undergo fertilization, the sperm enters the uterus, travels towards the ampulla of the fallopian tube, and encounters the oocyte. The zona pellucida (the outer layer of the oocyte) deteriorates along with the zygote, which travels towards the uterus and eventually forms a blastocyst, allowing for implantation to occur. Fertilization and First Week typically occurs in the fallopian tubes and the early embryo is transported to the uterine cavity, where it implants.

Physiology

  • Menstrual cycle Menstrual cycle The menstrual cycle is the cyclic pattern of hormonal and tissular activity that prepares a suitable uterine environment for the fertilization and implantation of an ovum. The menstrual cycle involves both an endometrial and ovarian cycle that are dependent on one another for proper functioning. There are 2 phases of the ovarian cycle and 3 phases of the endometrial cycle. Menstrual Cycle: cyclic pattern of hormonal and tissular activity that prepares the uterine environment for the fertilization Fertilization To undergo fertilization, the sperm enters the uterus, travels towards the ampulla of the fallopian tube, and encounters the oocyte. The zona pellucida (the outer layer of the oocyte) deteriorates along with the zygote, which travels towards the uterus and eventually forms a blastocyst, allowing for implantation to occur. Fertilization and First Week and implantation of the embryo. The menstrual cycle includes endometrial and ovarian cycles.
  • Menopause: process of aging with a gradual decrease in ovarian function over several years, until ovulation no longer occurs. The menopause Menopause Menopause is a physiologic process in women characterized by the permanent cessation of menstruation that occurs after the loss of ovarian activity. Menopause can only be diagnosed retrospectively, after 12 months without menstrual bleeding. Menopause transition is characterized by fluctuating hormone levels, after which time, estrogen and progesterone levels permanently decline.

Ovarian disorders

  • Ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer: leading cause of cancer-related deaths in gynecologic malignancies. Ovarian tumors can be epithelial, germ cell, sex cord–stromal, or metastatic.
  • Ovarian cysts Ovarian cysts Ovarian cysts are defined as collections of fluid or semiliquid material, often walled off by a membrane, located in the ovary. These cysts are broadly categorized as either functional or neoplastic. Neoplastic ovarian cysts are subcategorized as either benign or malignant. Ovarian Cysts: fluid-filled lesions within the ovary. 
    • Follicular cysts (also known as physiologic cysts): As an oocyte develops in the 1st ½ of the menstrual cycle, the follicle grows into a small cyst, approximately 2–3 cm in size, prior to ovulation. Occasionally, an oocyte may not ovulate and the follicle can become larger (typically < 10 cm) and may persist. On ultrasonography, these oocytes are visible as simple cysts with smooth walls. The cysts typically resolve spontaneously, though large persistent cysts may be treated surgically.
    • Corpus luteal cysts: After ovulation, the follicle transforms into a corpus luteal cyst, secreting both estrogen and progesterone. On ultrasonography, these cysts may have slightly thicker walls and contain some internal debris. Corpus luteal cysts may also become enlarged (< 10 cm) but still usually resolve spontaneously. A corpus luteum is critical to sustaining an early pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-hCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care and should not be confused with an ectopic pregnancy Ectopic pregnancy Ectopic pregnancy refers to the implantation of a fertilized egg (embryo) outside the uterine cavity. The main cause is disruption of the normal anatomy of the fallopian tube. Ectopic Pregnancy.
    • Hemorrhagic cysts: Occasionally, follicular or corpus luteal cysts will bleed, which is known as a hemorrhagic cyst. Hemorrhagic cysts typically present with sudden-onset pelvic pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain in an ovulating female. On ultrasonography, these cysts appear as simple cysts with internal echos (representing blood and clot) and resolve spontaneously over 1–2 menstrual cycles, though if bleeding is significant at presentation, emergency surgery may be warranted to stop the bleeding.
    • Neoplastic cysts: like ovarian cancer, these cysts are classified according to their cell of origin: epithelial cells, germ cells, and sex cord–stromal cells. Each classification has multiple histologic subtypes. These tumors are benign (noninvasive) but have an increased likelihood of torsion, menstrual irregularities, and other bulk-related symptoms.
  • Polycystic ovarian syndrome Polycystic ovarian syndrome Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women, affecting nearly 5%-10% of women in the age group. It is characterized by hyperandrogenism, chronic anovulation leading to oligomenorrhea (or amenorrhea), and metabolic dysfunction. Polycystic Ovarian Syndrome: heterogeneous multisystem endocrinopathy that is characterized by hyperandrogenism, ovarian dysfunction leading to oligomenorrhea, and multiple cysts in the ovaries. Fertility challenges are also common.
  • Primary ovarian insufficiency Primary ovarian insufficiency Primary ovarian insufficiency (POI) is a condition resulting from the depletion or dysfunction of the ovarian follicles, leading to cessation of ovulation and menses before age 40. Primary ovarian insufficiency is primarily idiopathic. Patients present with signs and symptoms of menopause prior to age 40, including oligo- or amenorrhea, vaginal dryness (often leading to dyspareunia), and infertility. Primary Ovarian Insufficiency: condition resulting from the depletion or dysfunction of the ovarian follicles, leading to cessation of ovulation and menses at < 40 years of age. Symptoms include oligomenorrhea or amenorrhea, vaginal dryness (often leading to dyspareunia), and infertility Infertility Infertility is the inability to conceive in the context of regular intercourse. The most common causes of infertility in women are related to ovulatory dysfunction or tubal obstruction, whereas, in men, abnormal sperm is a common cause. Infertility. Key laboratory findings include an elevated FSH level and low estrogen levels. 
  • Ovarian torsion Ovarian torsion Ovarian torsion is a clinical emergency in which the ovaries (with or without the fallopian tubes) twist along their axis, leading to partial or complete obstruction of their blood supply. Ovarian torsion is also called adnexal or tubo-ovarian torsion, especially if a fallopian tube is also involved. Ovarian Torsion: clinical emergency in which the ovaries twist around the suspensory ligament of the ovary and ovarian ligament, cutting off the blood supply to the ovary, resulting in ovarian edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema and severe, sudden onset pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain. Ovarian torsion Ovarian torsion Ovarian torsion is a clinical emergency in which the ovaries (with or without the fallopian tubes) twist along their axis, leading to partial or complete obstruction of their blood supply. Ovarian torsion is also called adnexal or tubo-ovarian torsion, especially if a fallopian tube is also involved. Ovarian Torsion occurs in women of reproductive age, typically in an enlarged ovary (> 5 cm). Management is surgical in order to prevent necrosis of the ovary. 
  • Amenorrhea: absence of menses in a woman of reproductive age. If ovulation does not occur, menses will not occur. Amenorrhea may be a symptom of ovarian disease.

References

  1. Schorge J.O., Schaffer J.I., et al. (2008). Williams Gynecology, pp. 348–354. McGraw Hill.
  2. Saladin, K.S., & Miller, L. (2004). Anatomy and physiology, 3rd ed., pp. 1050–1052, 1061. McGraw Hill.
  3. Moore, K.L., & Dalley, A.F. (2006). Clinically oriented anatomy, 5th ed., pp. 427–429. Lippincott Williams & Wilkins.
  4. OpenStax College. (n.d.). Anatomy and physiology. OpenStax CNX. http://cnx.org/contents/14fb4ad7-39a1-4eee-ab6e-3ef2482e3e22@11.1.

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