MENSTRUATION

MENSTRUAL CYCLE
 AKA Female reproductive cycle
 Episodic uterine bleeding in response to
cyclic hormonal changes
 Purpose:
 Bringan ovum into maturity
 Renew uterine tissue bed
 CHARACTIRISTICS OF NORMAL
MENSTRUAL CYCLES
Characteristics Description

Menarche Average age of onset, 12 or 13 years;

average range of 9 – 17 years old

Interveral between cycles Average 28 days; cycles of 23 to 35 days

not unusual

Duration of menstrual flow Averge flow, 2 – 7 days; ranges of 1 – 9

days not unusual

Amount of menstrual flow 30 – 80 mL per menstrual period

Color of menstrual flow Dark red; a combination of blood, mucus,

and endometrial cells
FOUR BODY STRUCTURES INVOLVED IN
THE PHYSIOLOGY OF THE MENSTRUAL
CYCLE

1. Hypothalamus
2. Pituitary gland
3. Ovaries
4. Uterus
 HYPOTHALAMUS

LHRH

PITUITARY GLAND
Estrogen
Progesterone Gonadotrophic
hormone

OVARY

Estrogen Progesterone

UTERUS
HYPOTHALAMUS
 Release of LHRS/GnRH by the hypothalamus
initiates the menstrual cycle
 Repressed by pressence of estrogen
 Cyclical
PITUITARY GLAND
 Produces 2 gonadotrophic hormones:
 FSH
 Active early in the cycle
 Responsible for the maturation of the ovum

 LH
 Active at midpoint of the cycle
 Responsible for ovulation and growth of the uterine

lining dring the second half of the menstrual cycle

OVARY
UTERUS
 Stimulation from the hormones produced by
the ovaraies causes effects on the uterus
MENSES
 Menstrual Flow Consists of:
 Blood from raptured capillaries
 Mucin from glands
 Fragments of endometrial tissue
 Microscopic, atrophied, and unfertilized ovum
 First day of the menstrual flow is used to
mark the beginning day of a new menstrual
cycle
 Blood loss: approximately 30 – 80 ml of
blood
 Iron loss: approximately 11 mg
PROLIFERATIVE PHASE
 Also known as estrogenic, follicular, or
postmenstrual phase.
 Immediately after the menstrual flow (first 4
or 5 days of a cycle)
 The endometrium is very thin

 With the presence of estrogen, the

endometrium begins to proliferate
SECRETORY PHASE
 Protestational, luteal, premenstrual phase.
 Progesterone causes the glands of the
uterine endometrium to become corkscrew
or twisted in appearnce and dilated with
quantities of glycogen and mucin.
 Capillaries of the endometrium increase in
amount
ISCHEMIC PHASE
 If fertilization does not occur
 Withdrawal of progesterone  endometrium
begins to degenerate, capillaries rupture,
with minute hemorrhages, and the
endometrium sloughs off.
CERVIX
 Mucus of the cervix also changes each month
during the menstrual cycle.
 Changes in cervical mucus are helpful in
establishing fertility.
 During the first half of the cycle, when the
hormone is very low, the cervical mucus is thick
and scant
 At the time of ovulation when estrogen level is
high, cervical mucus is thin and copious
 During the second phase of the menstrual
cycle when progesterone level is high,
cervical mucus becomes thick.
FERN TEST
 Visible if there is presence of high estrogen level
 Seen before ovulation
 Cervical mucus forms fernlike patterns when placed
on a glass slide
 Significance:
 Women who do not ovulate conitually show the fern
pattern throughout the menstrual cycle(no
progesterone influence) OR
 Never demonstrate ferning pattern because their
estrogen level never rise
SPINNBARKEIT TEST
 Test for ovulatin
 At the height of estrogen secretion, the cervical
mucus not only becomes thin and water, but it
also can be stretched into long strands
 Indication that ovulation is about to occur.
 Done by stretching a mucus sample between
thumb and finger or by smearing cervical mucus
specimen on a slide and stretching the mucus
between the slide and cover slip
EDUCATION REGARDING MENSTRUATION
 Dispel menstruation myths
 Educate boys about menstruation

 Continue doing moderate exercise

 Sexual relations is not contraindicated during

menses
 Activities of daily life is not contraindicated
during menses
 Using mild analgesics is helpful
 More rest may be helpful if dysmenorrhea
interferes with sleep at night
 Nutrition: iron supplementation may be
needed to replace iron lost in menses
 Eating sour or cold foods does not cause
dysmenorrhea.
MENSTRUAL DISORDERS
 Dysmenorrhea
 Painful menstruation

 Menorrhagia
 Abnormally heavy menstrual flow
 Blood loss greater than 80 mL or more than 7
days
 Metrorrhagia
 Bleeding between menstrual periods
 Premenstrual Dysphoric Syndrome
 Severe form of premenstrual syndrome
MENOPAUSE
 MENOPAUSE
 Cessation of menstrual cycles
 POSTMENOPAUSAL PERIOD
 Time following menopause
 PERIMENOPAUSAL
 Periodduring which menopausal changes are
occuring
MENOPAUSE
 Occurs between 40 and 55 years old
 Familia

 Thea earlier the age of menarch, the earlier

menopause tends to occur.
HEALTH TEACHING DURING
MENOPAUSE
 Help women appreciate that loss of uterine
function may make almost no change in their
life.
 Teach patient about hormone replacement
therapy