MENSTRUATION

MENSTRUAL
CYCLE/MENSTRUATION
• Episodic uterine bleeding in response to cyclic
hormonal changes
• A process that allows conception &
implantation of a new life
• Purpose:
Bring ovum to maturity & renew uterine tissue
bed that will be responsible for its growth
should it be fertilized
 CHARACTERISTICS
OF NORMAL MENSTRUAL
CYCLE
Beginning Age range: 9-17
Average age: 12-13
Interval between Ave: 28 days / 20-45 days
cycles
Duration of menstrual Ave: 2-7 days / 1-9 days
flow
Amount 30-80 ml

Color Dark red ; combination of blood,

mucus, & endometrial cells
Odor Marigolds /fleshy
Iron loss 11 mg
PHYSIOLOGY OF MENSTRUATION
 Body Structures
• When talking of menstruation and pregnancy,
just think HPOU (hook pretty or ugly)
• H – hypothalamus
• P – pituitary gland (anterior)
• O – ovary
• U – uterus
 ORGANS OF MENSTRUATION &
PREGNANCY
HYPOTHALAMUS
>Ultimate initiator of menstrual cycle

Secretes GnRH:
FSHRF: triggered by low serum estrogen level, it
stimulates the APG to release FSH.
LHRF: triggered by low serum progesterone level, it
stimulates the APG to release LH.
 APG

>Under the influence of LHRF &

FSHRF, it produces
gonadotrophic hormones:
1. FSH (triggered by FSHRF and low
serum estrogen)
>Stimulates development of Graafian
follicles in the ovary & their production of
estrogen.
>active early in the cycle.
> Inhibited by high serum estrogen level.
2. LH (triggered by LHRF and low
serum progesterone)
>most active at the midpoint of the
cycle
>stimulates ovulation & development
of corpus luteum and its production
of progesterone and some estrogen.
>Peaks at 16-18 hours before
ovulation.
OVARIES (female gonads)

> Site of ovulation

> Source of estrogen (1st half of the
cycle & progesterone (2nd half of the
cycle)
 ESTROGEN

>FSH stimulates the graafian follicle to

produce estrogen
3 kinds: estradiol, estrone, estriol
Produce from ovaries, adrenal cortex,
and placenta
> Effects:
Hormone of women (it stimulates the
secondary sex characteristics)
Stimulates proliferation of cells in the
endometrium – endometrial thickening
Stimulates mucus to be thin & stretchable
(Spinnbarkeit test)
Stimulates the growth of ductile
structures of the breasts
Menarche and menstruation
–Inhibits production of FSH
–Causes hypertrophy of the
myometrium
–Responsible for the increase vaginal
secretion(leukorrhea)
PROGESTERONE

>LH stimulates the corpus luteum to

produce progesterone
> Hormone of mothers
> Produced by corpus luteum &placenta
> Effects:
• Thermogenic (increase BBT)
• Relaxes uterine muscles
• Cause of PMS
• Tingling sensation and feeling of fullness
in the breast
• Promote growth of the acini cells of the
breasts
• Inhibits production of LH
• Secretes thick/viscous cervical secretions
• Causes weight gain by promoting fluid
retention
• Secretory changes in the endometrium:
stimulates endometrial glands to secrete
mucin and glycogen in preparation for
implantation.
• Increase the endometrium’s supply of
glycogen, oxygen & amino acids for
maintaining pregnancy.
UTERUS
> Organ from which menstrual
discharge is formed
> Changes in the uterine
endometrium are due to
influence of ovarian hormones: E
&P
 HYPOTHALAMUS

PRODUCE GnRH (FSHRF and LHRF)

STIMULATE ANTERIOR PITUITARY GLAND

Gonadotropic hormones
LH (ovulation) and FSH (maturation of ovum)
• FSH – active early in the cycle; responsible for
ovum maturation
• LH – most active at the midpoint of the cycle;
reponsible for ovulation and growth of uterine
lining during the 2nd half of the menstrual cycle.
Phases of menstrual cycle
 HYPOTHALAMIC-PITUITARY CYCLE
• Illustrates the hormonal interplay between the
hypothalamus and the pituitary glands.
• Toward the end of the cycle, level of
progesterone and estrogen in the blood fall which
in turn stimulate the hypothalamus to secrete
GnRH, which in turn stimulates the APG to
secrete FSH.
• Increase in estrogen and decline in prog. Triggers
the hypo to release GnRH to stimulate APG to
release LH and inhibit further FSH secretion
 PHASES of OVARIAN CYCLE:
1. FOLLICULAR PHASE (Day 1-13)
- First half of the cycle
- Formation of the graafian follicle
- 24 hrs before ovulation, serum estrogen level
peaks
2. OVULATION – caused by LH (Day 14)
2. LUTEAL PHASE (postovulatory) (Day 15-28)
- 2nd half of the cycle
- 14 days after ovulation, menstruation will occur
 PHASES OF ENDOMETRIAL CYCLE
1. MENSTRUAL PHASE
2. PROLIFERATIVE PHASE
3. SECRETORY PHASE
4. ISCHEMIC PHASE
OVULATION
 occurs on the 14 th

day before the onset

of the next cycle
SIGNS OF OVULATION
• Inc. cervical secretions (raw egg
white)
• Inc. Sex urge
• Inc. energy
• (+) mittleschmerz
• (+) spinnbarkeit test
 –BBT

• Just before ovulation: drops

o
slightly by 0.5 F
> due to low level of P
• Day after ovulation: rises by 10F
> due to high level of P
MENSTRUAL DISORDERS
 DYSMENORRHEA
•Painful menstruation
•Mgt:
–Mild analgesic
–Warm compress
 MENORRHAGIA
•Abnormally heavy
menstrual flow
(hormonal imbalance,
infection,uterine
tumors)
 OLIGOMENORRHEA

•Decreased menstrual
flow/infrequent menses
 POLYMENORRHEA
• Too frequent menses
 METRORRHAGIA
•Bleeding between
menstrual periods (PID,
uterine fibroids, corpus
carcinoma, cancer of the
cervix
 MENOMETRORRHAGIA
-EXCESSIVE OR PROLONGED MENSTRUAL
BLEEDING WHICH MAY LEAD TO OR CAUSE
HYPOVOLEMIA AND ANEMIA

- DYSFUNCTIONAL UTERINE BLEEDING (DUB)

- RELATED TO INFECTION (PID), IUD USE,
UTERINE TUMORS, ENDOCRINE PROBLEMS,
PREGNANCY, SPONTANEOUS ABORTION,
ECTOPIC PREGNANCY
 AMENORRHEA

•Absence of
menstrual flow
 HYPOMENORRHEA
•Abnormally short
menstruation
 HYPERMENORRHEA

•Abnormally long
menstruation
PREMENSTRUAL SYNDROME

Edema of lower extremities

- Abdominal bloating
- Weight gain
- Headache
-Breast tenderness
- Depression
- irritability
- Crying
- Loss of concentration
- Sleep disorders
- Anxiety
- Hostility
- Nausea, vomiting
- Constipation
- Craving for sweets and salty foods
- Acne
- Oliguria, retention
 MENOPAUSE
- REFERS TO THE LAST MENSTRUAL PERIOD
- END OF CLIMACTERIUM – CHANGE OF LIFE
- AGES 45-55; AVE: 51
- A WOMAN ABOVE 45YEARS OLD HAS HAD NO
MENSTRUATION FOR A PERIOD OF AT LEAST ONE
YEAR.
- EARLY MENARCHE IS ASSOCIATED WITH EARLY
MENOPAUSE
- HIGH SOCIOECONOMIC STATUS AND HIGH PARITY
DELAY MENOPAUSE
 POSTMENOPAUSE
• BEGINS 2 YEARS AFTER THE WOMAN’S LMP
AND EXTENDS THROUGHOUT THE YEARS
AFTER WARDS.
 SIGNS AND SYMPTOMS
• Urogenital tract:
- bladder: dysuria, urinary incontinence, urinary
frequency
- Uterus: decline in estrogen results in atrophy
of the uterus
- Vagina: decline in estrogen decreases mucus
production causing dryness and dyspareunia
(painful coitus)
• Circulatory System
- Hot Flushes: sensation of heat that begins in
the face progressing to the chest followed by
reddening of the face, neck, and chest and
profuse perspiration.
- Increase risk for CVD
- Mood instability
- Loss of sexual desire
- Depression and anxiety
• Musculoskeletal symptoms:
- Osteopenia or low bone mass – result of
estrogen withdrawal.
- Estrogen promotes calcium deposition in the
body
- Osteoporosis -main health hazard of
menopause
 Other signs and symptoms:
• Sleep disturbances
• Appearance of facial hair from loss of estrogen
• Weight gain
• Dizziness
• Headaches
• Loss of self-confidence
• Loss of breast mass and firmness
 MANAGEMENT:
• Regular screening for osteoporosis,
cardiovascular (BP, blood cholesterol), and
cancer (mammograms, pap smear, pelvic
examinations
• Health maintenance and lifestyle modification
• Manage signs and symptoms