Menstruation is the periodic discharge of blood, mucus and

epithelial cells from the uterus.

Menstrual Cycle periodic uterine bleeding in response to cyclic
hormonal changes. A process that allows for conception and
implantation of new life.
It is usually determined by counting as day 1 the 1st day of a
menstrual period until the last day before the next menstrual period.
Purpose:

To bring an ovum to maturity

To renew a uterine tissue bed that will be responsive to fetal

growth

To prepare the uterus for pregnancy

Characteristics of Normal Menstrual Cycles

TERM

DESCRIPTION

Beginning (Menarche)

average age of onset: 12 or 13 years;

average range of age: 9-17 years

Interval between cycles

average 28 days; cycles of 23 to 35

days not usual

Duration of Menstrual flow

average flow: 2-7 days; ranges 1-9

days not normal

Amount of menstrual flow

difficult to estimate; average 30 to 80

ml. per menstrual period; saturating a
pad in less than an hour is considered
heavy bleeding.

Color of menstrual flow

dark red; a combination of blood,

mucus, and endometrial cells

Odor of menstrual flow

marigold

Discomforts of Menstruation
1.

Breast tenderness and feeling of fullness

2.

Tendency towards fatigue

3.

Temperament and mood changes because of hormonal

influence and decreased levels of estrogen and progesterone

4.

Discomfort in pelvic area, lower back and legs

5.

Retained fluids and weight gain

Abnormalities of Menstruation
1.

Amenorrhea absence of menstrual flow

2.

Dysmenorrhea painful menstruation

3.

Oligomenorrhea scanty menstruation

4.

Polymenorrhea too frequent menstruation

5.

Menorrhagia -excessive menstrual bleeding

6.

Metrorrhagia bleeding between periods of less than 2 weeks

7.

Hypomenorrhea abnormally short menstruation

8.

Hypermenorrhea abnormally long menstruation

Four body structure involved in the physiology of the

menstrual cycle:
1.

Hypothalamus

2.

Pituitary gland

3.

Ovaries

4.

Uterus

Reproductive Hormones:
1.

Gonodotropin-Releasing
Hormone (GnRH)
Stimulates release of FSH

and LH initiating puberty and

sustaining menstrual cycle.
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Follicle-stimulating Hormone
(FSH)

secreted by anterior
pituitary gland during the 1st half of menstrual cycle

stimulate growth and maturation of graafian follicle

before ovulation

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thins the endometrium

Luteinizing Hormone (LH)

secreted by the anterior pituitary gland

stimulates final maturation of graafian follicle

surge of LH about 14 days before next menstrual period

causes ovulation

stimulates transformation of graafian follicle into corpus

luteum

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thickens the endometrium

Estrogen

secreted primarily by the ovaries, corpus luteum, adrenal

cortex and placenta in pregnancy

considered the Hormone of Women

stimulates thickening of the endometrium; causes

suppression of FSH secretion

responsible for the development of secondary sex

characteristics

stimulates uterine contractions

increases water content of uterus

high estrogen concentration inhibits secretion of FSH and

Prolactin but stimulates secretion of LH7.

low estrogen concentration after pregnancy stimulates

secretion of Prolactin

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Progesterone

secreted by the ovary, corpus luteum and placenta

during pregnancy

inhibits secretion of LH

has thermogenic effect (increases body temperature)

relaxes smooth muscles thereby decreases contractions

of uterus

causes cervical secretion of thick mucus

maintain thickness of endometrium

allows pregnancy to be maintained = Hormone of

Pregnancy

22

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prepares breasts for lactation

Prolactin

secreted by the anterior pituitary gland

stimulates secretion of milk

Oxytocin

secreted by the posterior pituitary gland

stimulates uterine contractions during birth and compress

uterine blood vessels and control bleeding

stimulates let-down or milk-ejection reflex during

breastfeeding

22

Prostaglandins

fatty acids categorized as hormones

produced by many organs of the body, including the

endometrium

affects menstrual cycle

influences the onset and maintenance of labor

Puberty
Menstruation

Hygiene

Myths

Phases of Menstrual cycle

The day count for menstrual cycle begins on the first day of menstruation when blood starts to come
out of the vagina. In this section, the length of menstrual cycle has been assumed to be 28 days
(which is the average among women). The entire duration of a Menstrual cycle can be divided into
four main phases:
1.
2.

Menstrual phase (From day 1 to 5)

Follicular phase (From day 1 to 13)

3.

Ovulation phase (Day 14)

4.

Luteal phase (From day 15 to 28)

Menstrual phase (day 1-5)

Menstrual phase begins on the first day of menstruation and lasts till the 5th day of the menstrual
cycle. The following events occur during this phase:

The uterus sheds its inner lining of soft tissue and blood vessels which exits the body from
the vagina in the form of menstrual fluid.
Blood loss of 10 ml to 80 ml is considered normal.
You may experience abdominal cramps. These cramps are caused by the contraction of the
uterine and the abdominal muscles to expel the menstrual fluid.

Follicular phase (day 1-13)

This phase also begins on the first day of menstruation, but it lasts till the 13th day of the menstrual
cycle. The following events occur during this phase:

The pituitary gland secretes a hormone that stimulates the egg cells in the ovaries to grow.
One of these egg cells begins to mature in a sac-like-structure called follicle. It takes 13 days
for the egg cell to reach maturity.

While the egg cell matures, its follicle secretes a hormone that stimulates the uterus to
develop a lining of blood vessels and soft tissue called endometrium.

Ovulation phase (day 14)

On the 14th day of the cycle, the pituitary gland secretes a hormone that causes the ovary to release
the matured egg cell. The released egg cell is swept into the fallopian tube by the cilia of the
fimbriae. Fimbriae are finger like projections located at the end of the fallopian tube close to the
ovaries and cilia are slender hair like projections on each Fimbria.

Luteal phase (day 15-28)

This phase begins on the 15th day and lasts till the end of the cycle. The following events occur
during this phase:

The egg cell released during the ovulation phase stays in the fallopian tube for 24 hours.
If a sperm cell does not impregnate the egg cell within that time, the egg cell disintegrates.

The hormone that causes the uterus to retain its endometrium gets used up by the end of the
menstrual cycle. This causes the menstrual phase of the next cycle to begin.