2. Definition
Page 2 – Definition
| Definition |
| The ovaries are paired endocrine and reproductive glands located in the female pelvis. They function as both the site of oocyte production and the main source of female sex hormones, playing a central role in the menstrual cycle, fertility, and hormonal regulation. |
| Category |
Details |
| Structure |
Paired, almond-shaped glands located in the pelvis, near the lateral uterus |
| Function |
Produce ova and secrete hormones (estrogen, progesterone, inhibin) |
| Common Diseases |
Ovarian cysts, PCOS, ovarian cancer |
| Diagnostic Methods |
Pelvic ultrasound, serum hormone tests, CA-125, MRI |
| Common Therapies |
Hormonal therapy, cystectomy, oophorectomy, chemotherapy |
3. Anatomy
Page 3 – Applied Anatomy and Diagnostic Approach
U-SSPCT–C Table
| Feature |
Details |
| Units |
Cortex, medulla, follicles, corpus luteum, germinal epithelium |
| Size |
~3 cm × 2 cm × 1 cm in reproductive-age women |
| Shape |
Almond-shaped |
| Position |
Intraperitoneal, within the pelvis, in the ovarian fossa lateral to uterus |
| Character |
Soft, mobile, hormone-responsive organ with cyclical structural changes |
| Time |
Develop prenatally; mature during puberty; involute post-menopause |
Connections
| Connection Type |
Details |
| Arterial Supply |
Ovarian artery (from abdominal aorta), uterine artery (anastomosis) |
| Venous Drainage |
Ovarian veins → right to IVC, left to left renal vein |
| Lymphatic Drainage |
Para-aortic lymph nodes |
| Nerve Supply |
Autonomic nerves from ovarian plexus (sympathetic and parasympathetic) |
| Ducts |
No direct ducts; releases ova into peritoneal cavity for fimbrial capture |
Supporting Structures
| Structure |
Details |
| Ligaments |
Suspensory ligament (to pelvic wall), ovarian ligament (to uterus) |
| Capsule |
Tunica albuginea |
| Mesentery |
Mesovarium (part of broad ligament) |
Imaging Modalities
| Modality |
Primary Use |
When/Why Used |
| Ultrasound |
First-line for ovarian structure and cystic vs solid evaluation |
Routine gynecologic imaging, acute pelvic pain, infertility |
| MRI |
Detailed soft tissue evaluation |
Complex masses, staging of malignancy |
| CT |
Limited role; used for staging or complications |
Suspected metastasis, pelvic mass assessment |
| PET-CT |
Evaluate metabolic activity in malignancy |
Ovarian cancer follow-up or staging |
Laboratory Tests
| Test |
Purpose |
When/Why Used |
| CA-125 |
Tumor marker |
Suspicion of epithelial ovarian cancer |
| FSH/LH |
Evaluate hormonal function |
Menstrual irregularities, menopause, PCOS |
| Estradiol |
Assess estrogen production |
Infertility, ovarian function assessment |
| AMH |
Ovarian reserve marker |
Fertility evaluation |
Other Diagnostic Tools
| Tool |
Use |
Indication |
| Laparoscopy |
Direct visualization and biopsy |
Endometriosis, cysts, masses |
| Hormonal Panels |
Endocrine function assessment |
PCOS, amenorrhea |
4. Disease and Diagnosis
Page 4 – Clinical Diagnosis
Clinical Signs and Symptoms
| Symptom |
Meaning or Implication |
| Pelvic pain |
Cyst rupture, torsion, endometriosis |
| Menstrual irregularities |
PCOS, ovarian failure, hormonal imbalance |
| Bloating |
Ovarian cancer or large cyst |
| Infertility |
Anovulation, diminished ovarian reserve |
Imaging Modalities
| Modality |
Primary Use |
When/Why Used |
| Ultrasound |
First-line; structural detail and cyst classification |
Menstrual issues, mass detection |
| MRI |
Complex mass evaluation, hemorrhagic cysts |
Advanced imaging in unresolved cases |
| CT |
Mass staging or emergency setting |
Suspected torsion or metastatic disease |
Laboratory Tests
| Test |
Purpose |
When/Why Used |
| CA-125 |
Tumor marker for epithelial cancer |
Suspicious adnexal mass, recurrence |
| Beta-hCG |
Rule out pregnancy |
Before imaging or surgery |
| AMH |
Assess ovarian reserve |
Fertility workup |
| Androgens |
Evaluate hyperandrogenism |
PCOS or virilization |
Other Diagnostic Tools
| Tool |
Use |
Indication |
| Pelvic Exam |
Palpation of adnexal masses |
Routine gynecologic care |
| Laparoscopy |
Visual assessment, biopsy, surgery |
Cysts, endometriosis, infertility |
| Hormone panels |
Assess ovulatory and endocrine status |
Menstrual and fertility disorders |
5. History and Culture
Page 5 – History, Culture, and Art
Structure: Ovaries
Template: TCV AA
Formatting: Columnated tables only – no paragraph blocks
1. History of Anatomy
| Aspect |
Detail |
| Early Views |
Ancient anatomists (e.g., Galen) believed ovaries were female equivalents of testes |
| Renaissance Era |
Vesalius and Fallopius dissected and described ovaries as distinct reproductive organs |
| Modern Anatomy |
By the 17th–18th century, the ovaries were clearly identified as sites of folliculogenesis |
2. History of Physiology
| Aspect |
Detail |
| Hormonal Discovery |
Estrogen and progesterone identified in early 20th century |
| Menstrual Cycle |
1930s–50s: hormonal regulation of ovulation was mapped |
| Reproductive Role |
Ovulation, fertilization, and corpus luteum formation linked to hormonal cycles |
3. History of Diagnosis
| Aspect |
Detail |
| Early Diagnosis |
Based on pelvic symptoms and bimanual examination |
| Hormonal Assays |
Introduction of FSH, LH, estradiol, AMH tests in mid-20th century |
| Tumor Markers |
CA-125 developed as key marker for ovarian cancer detection and follow-up |
4. History of Imaging
| Aspect |
Detail |
| Ultrasound Introduction |
1970s: Abdominal → 1980s: Transvaginal ultrasound revolutionized ovarian imaging |
| MRI |
Gained value in complex mass characterization and cancer staging |
| CT and PET |
Used primarily for staging and metastatic evaluation, not first-line |
5. History of Laboratory Testing
| Aspect |
Detail |
| Hormonal Testing |
Radioimmunoassay enabled accurate hormone measurement (FSH, LH, estradiol) |
| Fertility Assessment |
AMH introduced as ovarian reserve marker |
| Cancer Screening |
CA-125 became standard for epithelial ovarian tumors |
6. History of Therapies
| Aspect |
Detail |
| Surgical Advances |
From oophorectomy to laparoscopic ovarian cystectomy |
| Hormonal Therapies |
Developed for contraception, ovulation induction, and menopause management |
| Reproductive Technologies |
IVF protocols based on ovarian stimulation and follicular tracking evolved rapidly since the 1980s |
7. Cultural Meaning
| Culture/Tradition |
Symbolic Meaning |
| Ancient Greece |
Ovaries tied to lunar cycles and fertility goddesses (e.g., Artemis, Demeter) |
| Eastern Traditions |
Represented as seeds or origins of female creative power |
| Global Symbolism |
Often equated with the “wellspring of life” in myth, art, and poetry |
8. Artistic Representations
| Medium |
Representation |
| Feminist Art |
Ovaries stylized as flowers, seeds, or branching vines of life |
| Medical Illustration |
Detailed anatomical drawings from 18th century onward highlight ovarian follicles |
| Symbolic Art |
Trees, blossoms, or lunar motifs used to abstractly represent fertility and ovarian rhythm |
9. Notable Figures
| Figure |
Contribution |
| Regnier de Graaf |
Identified and described ovarian follicles (Graafian follicles) |
| Karl Ernst von Baer |
Discovered the mammalian ovum in 1827 |
| Stein and Leventhal |
Characterized PCOS as a clinical entity (1935) |
| Gregory Pincus |
Developed early hormonal therapies influencing ovulatory suppression |
10. Quotes
| Quote |
Author |
| “The ovary is the cradle of human potential.” |
Anonymous |
| “Life begins in the secret chambers of the ovary.” |
Medical aphorism |
| “The mystery of woman lies in the mystery of the ovary.” |
20th-century gynecologist |
7. MCQ's
Page 6 – MCQs
Basic Science MCQ 1
Question:
Which structure directly receives the ovum after ovulation?
A. Uterus
B. Fallopian tube fimbriae
C. Cervix
D. Ovarian ligament
Correct Answer Table
| Correct Answer |
Explanation |
| B. Fallopian tube fimbriae |
Fimbriae sweep the ovum into the fallopian tube after ovulation. |
Incorrect Answer Table
| Choice |
Reason it’s Incorrect |
| A |
Uterus receives fertilized egg, not ovum directly. |
| C |
Cervix is part of the lower uterus, unrelated to ovum entry. |
| D |
Ovarian ligament is supportive, not involved in ovum capture. |
Basic Science MCQ 2
Question:
Which hormone primarily stimulates ovulation?
A. FSH
B. LH
C. Progesterone
D. Estrogen
Correct Answer Table
| Correct Answer |
Explanation |
| B. LH |
LH surge triggers ovulation around mid-cycle. |
Incorrect Answer Table
| Choice |
Reason it’s Incorrect |
| A |
FSH promotes follicle growth, not ovulation. |
| C |
Progesterone rises after ovulation. |
| D |
Estrogen contributes to LH surge but doesn’t trigger ovulation directly. |
Clinical MCQ 1
Question:
A 28-year-old woman presents with irregular menses and hirsutism. What is the most likely diagnosis?
A. Endometriosis
B. PCOS
C. Ovarian cancer
D. Tubo-ovarian abscess
Correct Answer Table
| Correct Answer |
Explanation |
| B. PCOS |
Characterized by anovulation, hyperandrogenism, and polycystic ovaries. |
Incorrect Answer Table
| Choice |
Reason it’s Incorrect |
| A |
Endometriosis usually presents with pelvic pain. |
| C |
Cancer is less likely at this age without mass symptoms. |
| D |
Presents with fever and acute pain, not hormonal signs. |
Clinical MCQ 2
Question:
Which of the following is not part of the Rotterdam criteria for PCOS?
A. Hyperandrogenism
B. Polycystic ovaries on ultrasound
C. Insulin resistance
D. Oligo- or anovulation
Correct Answer Table
| Correct Answer |
Explanation |
| C. Insulin resistance |
Not part of diagnostic criteria though commonly associated. |
Incorrect Answer Table
| Choice |
Reason it’s Incorrect |
| A |
Hyperandrogenism is a diagnostic criterion. |
| B |
Polycystic ovarian morphology is part of the criteria. |
| D |
Oligo-/anovulation is essential in diagnosis. |
Radiologic MCQ 1
Question:
What is the first-line imaging modality for ovarian evaluation?
A. MRI
B. CT scan
C. Pelvic ultrasound
D. PET scan
Correct Answer Table
| Correct Answer |
Explanation |
| C. Pelvic ultrasound |
Offers clear visualization of ovarian size and morphology. |
Incorrect Answer Table
| Choice |
Reason it’s Incorrect |
| A |
MRI is second-line for complex cases. |
| B |
CT lacks soft tissue detail for initial ovarian evaluation. |
| D |
PET scan used in staging, not initial diagnosis. |
Radiologic MCQ 2
Question:
A hemorrhagic ovarian cyst appears on ultrasound as:
A. Anechoic with posterior enhancement
B. Thick-walled with septations
C. Complex with internal echoes
D. Calcified with shadowing
Correct Answer Table
| Correct Answer |
Explanation |
| C. Complex with internal echoes |
Hemorrhagic cysts contain clots and fibrin strands. |
Incorrect Answer Table
| Choice |
Reason it’s Incorrect |
| A |
Anechoic suggests simple cyst. |
| B |
Suggestive of neoplastic process. |
| D |
Typical of dermoid cyst, not hemorrhagic. |
Radiologic MCQ 3
Question:
Which imaging feature is most suggestive of ovarian torsion?
A. Simple cyst
B. Free fluid
C. Whirlpool sign
D. Calcifications
Correct Answer Table
| Correct Answer |
Explanation |
| C. Whirlpool sign |
Represents twisted vascular pedicle, classic for torsion. |
Incorrect Answer Table
| Choice |
Reason it’s Incorrect |
| A |
Simple cysts do not suggest torsion. |
| B |
Free fluid is nonspecific. |
| D |
Calcifications may suggest dermoid, not torsion. |
8. Memory Image
Page 7 – Memory Image
| Title |
The Almonds of Life |
| Caption |
Artistic rendering of the ovaries as almond-shaped seeds suspended from delicate floral vines, symbolizing the cycle of life, fertility, and seasonal renewal—mirroring the ovary’s dual role in reproduction and hormone production. |
| Attribution |
AD AI – Modified AI image by Ashley Davidoff MD, TheCommonVein.com (140553.ovaries) |
| Symbol |
Meaning |
| Almonds |
Shape of ovaries; source of life |
| Floral vines |
Monthly cycle and hormonal interplay |
| Twin symmetry |
Paired organs; balance and hormonal rhythm |
| Suspended blossoms |
Fragile yet powerful reproductive potential |
Structure
2. Definition
3. Anatomy
4. Disease and Diagnosis
5. History and Culture
7. MCQ's
8. Memory Image
