MENSTRUAL CYCLE

About once a month, females who have gone through puberty will experience menstrual
bleeding. This happens because the lining of the uterus has prepared itself for a possible
pregnancy by becoming thicker and richer in blood vessels. If pregnancy does not occur, this
thickened lining is shed, accompanied by bleeding which usually lasts for 3-8 days.
The menstrual cycle, which is counted from the first day of one period to the first day of
the next, isn't the same for every woman. Menstrual flow might occur every 21 to 35 days and
last two to seven days. For the first few years after menstruation begins, long cycles are
common. However, menstrual cycles tend to shorten and become more regular as you age. But,
the typical menstrual cycle is 28 days long.

The menstrual cycle is controlled by a complex orchestra of hormones, produced by two

structures in the brain, the pituitary gland and the hypothalamus along with the ovaries. This is
divided in three phases:
1. Follicular Phase (Days 1-14)
This phase of the menstrual cycle occurs from approximately day 1-14. Day 1 is the first
day of bright red bleeding, and the end of this phase is marked by ovulation. While menstrual
bleeding does happen in the early part of this phase, the ovaries are simultaneously preparing to
ovulate again. The pituitary gland releases FSH – follicle stimulating hormone which causes
several ‘follicles’ to rise on the surface of the ovary. These fluid filled “bumps” each contain an
egg. Eventually, one of these follicle becomes dominant and within it develops a single mature
egg; the other follicles shrink back. If more than one follicle reaches maturity, this can lead to
twins or more. The maturing follicle produces the hormone estrogen, which increases over the
follicular phase and peaks in the day or two prior to ovulation. The endometrium which is the
lining of the uterus becomes thicker and more enriched with blood in the second part of this
phase this is in response to increasing levels of estrogen. High levels of estrogen stimulate the
production of gonadotropin-releasing hormone (GnRH), which in turn stimulates the pituitary
gland to secrete luteinizing hormone (LH). On about day 12, surges in LH and FSH cause the
egg to be released from the follicle. The surge in LH also causes a brief surge in testosterone,
which increases sex drive, right at the most fertile time of the cycle.
2. Ovulatory Phase (Day 14)
The release of the mature egg happens on about day 14 as a result of a surge in LH and
FSH over the previous day. After release, the egg enters the fallopian tube where fertilization
may take place, if sperm are present. If the egg is not fertilized, it disintegrates after about 24
hours. Once the egg is released, the follicle seals over and this is called the corpus luteum.
3. Luteal Phase (Days 14-28)
After the release of the egg, levels of FSH and LH decrease. The corpus luteum produces
progesterone.  If fertilization has occurred, the corpus luteum continues to produce progesterone
which prevents the endometrial lining from being shed. If fertilization has not occurred, the
corpus luteum disintegrates, which causes progesterone levels to drop and signals the
endometrial lining to begin shedding, and menstrual bleeding occurs.
MENSTRUAL DISORDERS
Premenstrual Syndrome (PMS)
PMS is any unpleasant or uncomfortable symptom during your cycle that may
temporarily disturb normal functioning. These symptoms may last from a few hours to many
days, and the types and intensity of symptoms can vary in individuals.
PMS appears to be caused by rising and falling levels of the hormones estrogen and
progesterone, which may influence brain chemicals, including serotonin, a substance that has a
strong effect on mood.

Signs and Symptoms:

 bloating
 swollen, painful breasts
 fatigue
 constipation
 headaches
Treatments
 Exercising 3 to 5 times each week
 Eating a well-balanced diet that includes whole grains, vegetables and fruit, and a
decreasing salt, sugar, caffeine and alcohol intake
 Getting adequate sleep and rest

Amenorrhea

Amenorrhea is characterized by absent menstrual periods for more than three monthly
menstrual cycles. There are two types of amenorrhea:
Primary amenorrhea: Menstruation does not begin at puberty. It's usually caused by some
problem in your endocrine system, which regulates your hormones. Sometimes this results from
low body weight associated with eating disorders, excessive exercise or medications.
 Secondary amenorrhea: Normal and regular menstrual periods which become
increasingly abnormal and irregular or absent. It can be caused by problems that affect estrogen
levels, including stress, weight loss, exercise or illness.

Signs and Symptoms:

 Ovulation abnormality
 Birth defect, anatomical abnormality or other medical condition
 Eating disorder
 Obesity
 Excessive or strenuous exercise
 Thyroid disorder

Dysmenorrhea

Dysmenorrhea is characterized by severe and frequent menstrual cramps and pain

associated with menstruation. The cause of dysmenorrhea is dependent on if the condition is
primary or secondary. With primary dysmenorrheal, women experience abnormal uterine
contractions resulting from a chemical imbalance in the body. Secondary dysmenorrhea is
caused by other medical conditions, most often endometriosis.

Signs and Symptoms:

 Cramping or pain in the lower abdomen
 Low back pain or pain radiating down the legs
 Nausea
 Vomiting
 Diarrhea
 Fatigue
 Weakness
 Fainting
 Headaches

Menorrhagia
Menorrhagia is the most common type of abnormal uterine bleeding and is characterized
by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe that daily
activities are disrupted. There are several possible causes of menorrhagia, including:
 Hormonal imbalance
 Pelvic inflammatory disease (PID)
 Uterine fibroids
 Abnormal pregnancy; i.e., miscarriage, ectopic (tubal pregnancy)
 Infection, tumors or polyps in the pelvic cavity
 Certain birth control devices; i.e., intrauterine devices (IUDs)
 Bleeding or platelet disorders
 High levels of prostaglandins
 Liver, kidney or thyroid disease
Signs and Symptoms:
Typical symptoms of menorrhagia are when a woman has soaked through enough
sanitary napkins or tampons to require changing every hour, and/or a woman’s menstrual period
lasts longer than 7 days in duration. Other common symptoms include spotting or bleeding
between menstrual periods, or spotting or bleeding during pregnancy.

REFERENCES
Mayo Clinic. (2019). Menstrual cycle: What's normal, what's not. Retrieved from:
https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menstrual-
cycle/art-20047186
The Society of Obstetricians and Gynecologists of Canada. (n.d). Menstrual Cycle Basics.
Retrieved from: https://www.yourperiod.ca/normal-periods/menstrual-cycle-
basics/#cycleComprehensive
Pinkerton, J. (2019). Menstrual Disorders and Abnormal Vaginal Bleeding. Retrieved from:
https://www.msdmanuals.com/home/women-s-health-issues/menstrual-disorders-and-
abnormal-vaginal-bleeding/premenstrual-syndrome-pms
Summa Health. (n.d). Menstrual Disorders. Retrieved from:
https://www.summahealth.org/medicalservices/womens/aboutourservices/gynecological-
services/menstrual-disorders
Parker, W. (2009). Menstrual Disorders. Retrieved from:
https://www.healthywomen.org/condition/menstrual-disorders