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Outline

Definition of Terms
Menstruation
Menarche
Menopause

Phases of Menstrual Cycle


Follicular
Ovulation
Luteal

Outline
Cycle Abnormalities and Disorder

Ovulation
Oligoovulation
Anovulation
Menstruation
Hypomenorrhea
Polymenorrhea
Metrorrhagia
Menorrhagia
Oligomenorrhea
Amenorrhea

Theres no such thing as


permanent in this world
except

Menstruation

The
terms
"menstruation"
and
"menses"
are
derived
from
theLatinmensis(month), which in turn relates to theGreek mene(moon).
menstrual bleeding,menses,catameniaor aperiod.
The flow of menses normally serves as a sign that a woman is not pregnant.

Eumenorrhea
denotes normal, regular menstruation that
lasts for a few days (usually 3 to 5 days, but
anywhere from 2 to 7 days is considered
normal).

The
averageblood
lossduring
menstruation is 35 milliliters with 1080
ml considered normal.

Menarche
The beginning of the menstrual function
The average age of menarche in humans
is 1213 years, but is normal anywhere
between ages 8 and 16.
Factors such as heredity, diet and overall
health can accelerate or delay menarche.

Menopause
The cessation of menstrual cycles at the end of a
woman's reproductive period .
The average age of menopause in women is 52 years,
with anywhere between 45 and 55 being common.
Menopause before age 45 is consideredprematurein
industrialized countries.
The age of menopause is largely a result of genetics;
however, illnesses, certain surgeries, or medical
treatments may cause menopause to occur earlier.

Menstrual cycle
thephysiological changes that can
occur
in
fertilewomenfor
the
purposes
of
sexual
reproductionandfertilization
under the control of theendocrine
system, necessary forreproduction

Phases of Menstrual Cycle


A. Follicular or proliferative phase
a hormone causes the lining of the uterus to grow, or
proliferate, during this time.
rise infollicle stimulating hormone(FSH) during the first
days of the cycle, a fewovarian folliclesare stimulated.
As they mature, the follicles secrete increasing amounts
ofestradiol, anestrogen
The estrogens initiate the formation of a new layer
ofendometriumin the uterus, histologically identified as
the proliferative endometrium.
The estrogen also stimulatescryptsin thecervixto
produce fertile cervical mucus, which may be noticed by
women practicingfertility awareness.

Ovulation
In crease levels of Luteinizing Hormone
Matures the egg and weakens the wall of the
follicle in the ovary, causing the fully developed
follicle to release itssecondary oocyte
The secondary oocyte promptly matures into
anootidand then becomes a matureovum. The
mature ovum has a diameter of about 0.2mm.
Which of the two ovariesleft or rightovulates
appears essentially random; no known left and
right co-ordination exists.[Occasionally, both
ovaries will release an egg; if both eggs are
fertilized, the result isfraternal twins

Ovulation
After being released from the ovary and into the peritoneal
space, the egg is swept into thefallopian tubeby thefimbria,
which is a fringe of tissue at the end of each fallopian tube.
After about a day, an unfertilized egg will disintegrate or
dissolve in the fallopian tube.
Fertilization by aspermatozoon, when it occurs, usually takes
place in theampulla, the widest section of the fallopian tubes.
A
fertilized
egg
immediately
begins
the
process
ofembryogenesis or development. The developing embryo
takes about three days to reach the uterus and another three
days to implant into the endometrium. It has usually reached
theblastocyst stage at the time of implantation.
In some women, ovulation features a characteristic pain
calledmittelschmerz
(German
term
meaningmiddle
pain).The sudden change in hormones at the time of
ovulation sometimes also causes light mid-cycle blood flow.

Ovulation

Luteal phase
secretory phase
after ovulation, theres a significant production of Progesterone
Progesterone plays a vital role in making theendometrium
receptive toimplantationof theblastocystand supportive of the
early pregnancy; it also has the side effect of raising the woman's
basal body temperature .
After ovulation, thepituitary hormonesFSH and LH cause the
remaining parts of the dominant follicle to transform into the
corpus luteum, which produces progesterone. The increased
progesterone in the adrenals starts to induce the production of
estrogen. The hormones produced by the corpus luteum also
suppress production of the FSH and LH that the corpus luteum
needs to maintain itself. Consequently, the level of FSH and LH fall
quickly over time, and the corpus luteum subsequently atrophies.

Falling levels of progesterone trigger menstruation and


the beginning of the next cycle. From the time of
ovulation until progesterone withdrawal has caused
menstruation to begin, the process typically takes
about two weeks, with 14 days considered normal. For
an individual woman, the follicular phase often varies in
length from cycle to cycle; by contrast, the length of
her luteal phase will be fairly consistent from cycle to
cycle.
The loss of the corpus luteum can be prevented by
fertilization of the egg; the resultingembryoproduces
human chorionic gonadotropin(hCG), which is very
similar to LH and which can preserve the corpus
luteum. Because the hormone is unique to the embryo,
mostpregnancy testslook for the presence of hCG.

Cycle abnormalities and


disorders
Infrequent or irregular ovulation is
calledoligoovulation.
The
absence
of
ovulation
is
calledanovulation.
Normal menstrual flow can occur
without ovulation preceding it: an
anovulatory cycle.

Cycle abnormalities and


disorders
hypomenorrhea - Very little flow (less than 10 ml)
polymenorrhea -Regular cycles with intervals of 21
days or fewer
metrorrhagia - frequent but irregular menstruation
menorrhagia -Sudden heavy flows or amounts greater
than 80 ml
menometrorrhagia -Heavy menstruation that occurs
frequently and irregularly
oligomenorrhea -The term for cycles with intervals
exceeding 35 days
Amenorrhea -refers to more than three to sixmonths
without menses (while not being pregnant) during a
woman's reproductive years.

Important to remember
women arefertilefor about 2448 hours
around the time of ovulation.
Progesterone levels remain high unless the
egg goes unfertilized, in which case the egg
is re-absorbed and progesterone levels fall.
In this event, progesterone levels continue to
fall until day 28, when progesterone reaches
its lowest level, menstruation occurs, and the
cycle repeats. This turning point almost
always occurs 14 days after ovulation.

Review
Denotes normal, regular menstruation
that lasts for a few days (usually 3 to 5
days, but anywhere from 2 to 7 days is
considered normal).
Eumenorrhea
The averageblood lossduring
menstruation
35 milliliters with 1080 ml
considered normal

Review
beginning of the menstrual function
Menarche
The cessation of menstrual cycles at the
end of a woman's reproductive period .
Menopause
thephysiological changes that can occur
in fertilewomenfor the purposes of
sexual reproductionandfertilization
Menstrual Cycle

Review
The lining of the uterus grow
Follicular
Increase levels of Progesterone
Luteal
increased libido
ovulation
Experience middle pain
Ovulation

Review**
Increase estrogen
Follicular
Decrease FSH
Luteal
increased LH
ovulation
It causes light mid cycle blood flow
Ovulation

Question
Whats the Essence
of being a woman?

Infertility
means not being able to get
pregnant after one year of trying or,
six months, if a woman is 35 or older.
women who can get pregnant but are
unable to stay pregnant may also be
infertile.

Is infertility just a woman's problem?


No, infertility is not always a woman's problem.
Both women and men can have problems that
cause infertility.
About one-third of infertility cases are caused
by women's problems.
Another one third of fertility problems are due
to the man.
The other cases are caused by a mixture of
male and female problems or by unknown
problems.

What causes infertility in men?

varicocele (VAIR-ih-koh-seel).
- This happens when the veins on a
man's testicle(s) are too large. This
heats the testicles. The heat can
affect the number or shape of the
sperm.

Movement of the sperm.


- This may be caused by the shape of
the sperm. Sometimes injuries or other
damage to the reproductive system
block the sperm.
Sometimes a man is born with the
problems that affect his sperm. Other
times problems start later in life due to
illness or injury. For example,cystic
fibrosisoften causes infertility in men.

What increases a man's risk of infertility?

Drugs

Heavy alcohol use

Toxin

Smoking

Radiation

Mumps

W hat causes infertility in women?


Most cases of female infertility are caused by problems
with ovulation. Without ovulation, there are no eggs to
be fertilized. Some signs that a woman is not ovulating
normally include irregular or absent menstrual periods.
Ovulation problems are often caused by polycystic
ovarian syndrome(PCOS).
PCOS is a hormone imbalance problem which can
interfere with normal ovulation. PCOS is the most
common cause of female infertility.
Primary ovarian insufficiency (POI) is another cause of
ovulation problems. POI occurs when a woman's
ovaries stop working normally before she is 40. POI is
not the same as earlymenopause.

Less common causes of fertility problems in women include:

blocked Fallopian tubes due topelvic


inflammatory disease ,endometriosis,
or surgery for anectopic pregnancy
physical problems with the uterus
uterine fibroids, which are noncancerous clumps of tissue and
muscle on the walls of the uterus.

What things increase a woman's risk of infertility?

age
stress
poor diet
athletic training
beingoverweightor underweight
smoking
excess alcohol use
sexually transmitted infections (STIs)
health problems that cause hormonal changes,
such as polycystic ovarian syndrome and
primary ovarian insufficiency

Aging decreases a woman's chances of having a baby in the following ways:

Her ovaries become less able to


release eggs.
She has a smaller number of eggs
left.
Her eggs are not as healthy.
She is more likely to have health
conditions that can cause fertility
problems.
She is more likely to have
amiscarriage

Some common tests of fertility in women include:

Hysterosalpingography (HIS-tur-oh-sal-ping-GOGHru-fee):
This is an X-ray of the uterus and Fallopian tubes.
Doctors inject a special dye into the uterus through
the vagina. This dye shows up in the X-ray. Doctors
can then watch to see if the dye moves freely
through the uterus and Fallopian tubes. This can
help them find physical blocks that may be causing
infertility. Blocks in the system can keep the egg
from moving from the Fallopian tube to the uterus.
A block could also keep the sperm from reaching
the egg.

Laparoscopy (lap-uh-ROS-kuhpee):
A minor surgery to see inside the
abdomen. The doctor does this with a
small tool with a light called a laparoscope
(LAP-uh-roh-skohp). She or he makes a
small cut in the lower abdomen and inserts
the laparoscope. With the laparoscope, the
doctor can check the ovaries, Fallopian
tubes, and uterus for disease and physical
problems. Doctors can usually find scarring
and endometriosis bylaparoscopy.

Doctors oftentreat infertility in menin the following ways:

Sexual problems:Doctors can help men deal


withimpotenceor premature ejaculation. Behavioral
therapy and/or medicines can be used in these cases.
Too few sperm:Sometimes surgery can correct the
cause of the problem. In other cases, doctors surgically
remove sperm directly from the male reproductive tract.
Antibiotics can also be used to clear up infections
affecting sperm count.
Sperm movement:Sometimes semen has no sperm
because of a block in the man's system. In some cases,
surgery can correct the problem.
In women, some physical problems can also be
corrected with surgery.

What medicines are used to treat infertility in women?

Clomiphene citrate (Clomid):This medicine causes


ovulation byClomifene
acting on the pituitary gland. It is often used
in women who have polycystic ovarian syndrome (PCOS)
Citrate
or other problems with ovulation. This medicine is taken
by mouth.
Human
menopausal
gonadotropin
or
hMG
(Repronex, Pergonal):This medicine is often used for
women who don't ovulate due to problems with their
pituitary gland. hMG acts directly on the ovaries to
stimulate ovulation. It is an injected medicine.
Follicle-stimulating hormone or FSH (Gonal-F,
Follistim):FSH works much like hMG. It causes the
ovaries to begin the process of ovulation. These
medicines are usually injected.

Gonadotropin-releasing
hormone
(Gn-RH)
analog:These medicines are often used for women who
don't ovulate regularly each month. Women who ovulate
before the egg is ready can also use these medicines. GnRH analogs act on the pituitary gland to change when the
body ovulates. These medicines are usually injected or
given with a nasal spray.
Metformin (Glucophage):Doctors use this medicine for
women who haveinsulin resistanceand/or PCOS. This drug
helps lower the high levels of male hormones in women
with these conditions. This helps the body to ovulate.
Sometimes clomiphene citrate or FSH is combined with
metformin. This medicine is usually taken by mouth.
Bromocriptine (Parlodel):This medicine is used for
women with ovulation problems due to high levels of
prolactin. Prolactin is a hormone that causes milk
production.

Remember
Many fertility drugs increase a
woman's chance of having twins,
triplets, or other multiples. Women
who are pregnant with multiple
fetuses have more problems during
pregnancy. Multiple fetuses have a
high risk of being born too early
(prematurely). Premature babies are
at a higher risk of health and
developmental problems.

Review
Infertility means not being able to get
pregnant after one year of trying or, six
months, if a woman is 35 or older.
True
What causes infertility in men?/women?
What increases a mans risk of
infertility?/ women?
How does aging affect a womans
chance of having a baby

Review**
What are the common tests of
fertility in women?
What medicines are used to treat
infertility in women?
What is the side effect of fertility
drugs?

Description:
OVA-MIT belongs to the triphenethylene
clans of compound derived from
diethylstilbetrol which displays a variety of
estrogenic and anti-estrogenic activities.
OVA-MIT is used primarily in ovarian
stimulation in female infertility due to
anovulation (e.g. due to polycysticovarian
syndrome).

Pharmacological Effects:
OVA-MIT competitively blocks estradiol binding to
its receptor but the specific pharmacological
activity it produces depends upon the specific
tissues and the cellular end point measured.
Initial animal studies with clomiphene citrate
showed slight estrogenic activity, but the most
striking effect was the inhibition of the pituitarys
gonadotropic function. In both male and female
animals, Clomiphene citrate acted as
contraceptive.

In contrast, the most prominent


effect in women was enlargement of
ovaries and induced ovulation in
many patients with amenorrhea and
dysfunctional bleeding with
anovulatory cycles.

MECHANISM OF ACTION:
OVA-MIT Clomiphene citrate binds with
estrogen receptor and prevents the binding
of estrogens.
OVA-MIT stimulates ovulation in women
with an intact hypothalmic-pituitary-ovarian
axis and adequate endogenous estrogens
who have failed to ovulate.
OVA-MIT also has been used in men to
stimulate gonadotroropin release and
enhance spermatogenesis.

Clomiphene Citrate
OVA-MIT
Composition:
50 mg Clomiphene Citrate

Action:
- a non-steroidal agent that stimulates pituitary
gonadotropic hormones, which stimulate the maturation
and endocrine activity of the ovarian follicle

Indications:
- for the treatment of ovulatory failure in women desiring
pregnancy
- oligospermia (low sperm count)

ABSORPTION &
EXCRETION:
OVA-MIT clomiphene citrate is well
absorbed following oral
administration and eliminated
primarily in the feces and to lesser
extent, in the urine.
The half-life is 5-7 days.

DOSAGE &
ADMINISTRATION:
The usual dose of OVA-MIT is 50mg daily for 5
days, starting on or about 5th day of
menstrual cycle or at any time if there is
amenorrhea.
If ovulation does not occur, a course of
100mg daily for 5 days may be given.
In oligospermic patients, recommended
dosage is 25mg once daily for 60-90 days.

CONTRAINDICATIONS:
Patients with liver disease or a history of liver
dysfunction, endometrial carcinoma, or ovarian cyst
(other than polycystic ovary), undiagnossed abnormal
uterine bleeding.
Manufactured by:
Remedica Ltd., Cyprus

Availability and Price:


Each tablet contains 50 mg
clomiphene citrate
A VERY AFFORDABLE PRICE
of

Php 99.85/tab

Php 998.50/Box of 10s


Available in ALL Mercury Drug and
Watsons outlets

Target Doctors
OB-Gynecologist

Urologist
FM
IM

Comparative Price
Analysis
BRAND NAME

PRICE

PRICE DIFFERENCE

Clomid

244.75

144.90

Clostil

190.00

90.15

Clomiphene Generic

178.50

78.65

Ovamit

99.85

CLOMIPHENE CITRATE

OVA-MIT
50mg tablet
NOW,

PRODUCTIVE

MITings may BEGIN!

THANK YOU...

PF Rigucira