MENSTRUAL CYCLE

BY: HENLYN E. ATANACIO,RN,MAN

MENSTRUAL CYCLE
 It is termed as “Female
Reproductive Cycle”, monthly
cyclical pattern of ovulation and
menstruation.
 Ovulation
 Menstruation
 Purpose of menstrual cycle
Four (4) Body Structures Important in
the Physiology of Menstruation:

 Hypothalamus
 Anterior Pituitary Gland
 Ovary
 Uterus
 Characteristics of Normal Menstruation Period
CHARACTERISTICS
Beginning (Menarche)
Interval between cycles
Duration/ Length of Menstrual Flow
Amount of Menstrual Flow (Menses)
Color of Menstrual Flow
Odor
DESCRIPTION
Average age onset is 12 or 13 years
old
Average range of age is 9-17 years
Average 28 days; cycles of 23 to 35
days not usual
Average flow 2-7 days; range of 1-9
days
Not abnormal
Difficult to estimate; average is 30 to
80 ml per menstrual period; saturating
pad or tampon in less than an hour is
heavy bleeding/flow
Dark Red; a combination of blood,
mucus, and endometrial cells
Similar to that of marigolds
Hormones Involved in the
Menstrual Cycle
ESTROGEN
 So-called “Hormone of Women” produced by the Graafian follicle. It is
metabolized by the liver and excreted in the urine.
 Inhibits production of FSH
 Stimulates the growth of the ductile structures of the breast
 Increases quantity and pH of fertile cervical mucus, causing it to become
thin and transparent (watery) and highly stretchable (to a distance of 10-
13 cm – SPINNBARKHEIT TEST of ovulation.
 Secondary sex characteristics in female (breast growth and
development, fat deposition that gives a woman’s body a female shape or
body build
 Maintains and thickens the endometrium
 Stimulates the growth of vagina and contraction of the uterus
 Menarche and menstruation
PROGESTERONE
 So-called “Hormones of Mothers”. Produced by the corpus luteum
and the placenta
 Inhibits production of LH
 Prepares the endometrium (increases endometrial turtousity)
 Increases endometrial secretions
 Relaxes uterine muscles
 Decreases muscle tone of gastrointestinal and urinary tract
 Increases musculoskeletal motility
 Facilitates transport of the fertilized ovum through the fallopian
tubes
PROGESTERONE
 Thermogenic effect/ increases basal body temperature
 Maintains pregnancy
 Promotes growth of acini cells of the breast
 Causes fluid retention
 Causes tingling sensation and feeling of fullness in the
breast before menstruation.
 Thought to be the cause of PMS
 Prevents spontaneous abortion of the fetus
 Causes mood swings in mother.
Physiology of Menstruation
 About day 14 an upsurge of LH occurs and the Graafian follicle
ruptures and the ovum is released
 After release of ovum and fluid filled follicle cells remain as an
empty pit; FSH decrease in Amount; LH increase continues to
act on follicle cells in ovary to produce lutein which is high in
progesterone (yellow fluid) thus the name corpus luteum or
yellow body
 Corpus luteum persists for 16 – 20 weeks with pregnancy but
with no fertilization ovum atropies in 4 – 5 days, corpus luteum
remains for 8 -10 days regresses and replaced by white fibrous
tissue, corpus albicans
Physiology of Menstruation
 First: 4-5 days after the menstrual flow; the endometrium is
very thin, but begins to proliferate rapidly; thickness increase
by 8 folds under the influence of increase in estrogen level.
 Secondary: after ovulation the corpus luteum produces
progesterone which causes the endometrium become twisted
in appearance and dilated; capillaries increase in amount
(becomes rich, velvety and spongy in appearance
 Menstrual Phases
 Third: if no fertilization occurs; corpus luteum regresses
after 8 – 10 days causing decrease in progesterone and
estrogen level leading to endometrial degeneration;
capillaries rupture; endometrium sloughs off;
 Final phase: end or final phase of the menstrual cycle; the
first day marks the beginning of a new cycle; discharges
contain blood from ruptured capillaries, mucin from glands,
fragments of endometrial tissue and atrophied ovum.
The following products are discharged
from the uterus as the menstrual flow:
 Blood from the ruptured capillaries
 Mucin from glands
 Fragments of endometrial tissue
 Microscopic, atrophied and unfertilized ovum
Different Menstrual Concerns:
 Amenorrhea
 Oligomenorrhea
 Menorrhagia
 Metrorrhagia
 Polymenorrhea
 Dysmenorrhea
 Menopause
MENOPAUSE
 Mechanism- a transitional phase (period of 1 – 2 years) called
climacteric, heralds the onset of menopause.
 Monthly menstrual period is less frequent, irregular and with
diminished amount.
 Period may be ovulatory or unovulatory - advised to use Family
planning method until menses have been absent for 6
continuous months.
 Menopause is has occurred if there had been no
period for one year.
Classical signs: Vasomotor changes
due to hormonal imbalance
 Hot flushes
 Excessive sweating especially at night
 Emotional changes
 Insomnia
 Headache
 Palpitations
 Nervousness
 Apprehension
 Depression
 Tendency to gain weight more rapidly
 Tendency to lose height because of osteoporosis (dowager hump)
 Muscle pains
 Loss of skin elasticity and subcutaneous fat in labial folds
Teaching about Menstrual Health
AREA OF
CONCERN TEACHING POINTS
Exercise

It’s good to continue moderate exercise during menses because it

increases abdominal tone. Sustained exercise, such as professional
athletes maintain, can cause amenorrhea
Sexual Relations Not contraindicated during menses (the male should wear condom to
prevent exposure to body fluid). Heightened or decreased sexual arousal
may be noticed during menses. Orgasm may increase menstrual flow

Activities of Daily Nothing is contraindicated (many people believe incorrectly that things
Living like washing hair are harmful).
Pain relief Any mild analgesic is helpful. Prostaglandin inhibitor such as ibuprofen
(Motrin) is specific from menstrual pain. Applying local heat may also be
helpful.
Rest More rest may be helpful if dysmenorrheal interferes with sleep at night.

Nutrition Many women need iron supplementation to replace iron loss in menses.
Eating pickles or cold food does not cause dysmenorrhea.