Week 9: Female Anatomy, Menstrual Cycle, and Pregnancy Symptoms

Uterus

• Pear shaped organ that houses the baby.

  • Placenta is located inside, provides the baby with blood and nutrients.

    • Secretes many hormones, such as estrogen and progesterone, which are essential for regulating and maintaining pregnancy.

• Acts as the lungs, kidney, liver, and gut.

• The placenta is expelled from the uterus during the third stage of labor, a process known as afterbirth.

Urinary Bladder

• The baby uses this as a pillow, causing frequent urination.

• This is normal within the 1st and 3rd trimester.

• Not as common in the 2nd trimester, may be a sign of a UTI.

Follicular Phase- Menstrual Cycle

• Begins on Day 1 through Ovulation (approx. Days 10-14)

  • Purtirity gland releases FSH.

Ovulation Phase- Menstrual Cycle

• Occurs typically on Day 14 of a 28-day cycle.

  • Body releases an egg.

Luteal Phase- Menstrual Cycle

• Days 15 to 28

  • Body releases progesterone, which helps prepare the uterine lining for potential implantation of a fertilized egg.

Ovulation Hormonal Surge

• Day 14, ovum bursts from ovary.

  • Surge of hormones that burst through the ovary.

Menstruation

• Cycle: Monthly expulsion of the inner uterine lining.

• Menarche: Establishment of menstruation.

  • Roughly starts at age 12.

  • The age is decreasing with nutrition, greater body fat, increased stress response/traumatic events.

• Menopause: Cessation of menstrual cycles.

  • 45-55, can become 8 years before.

• Frequency: Varies from 21 to 36 days; average is 28 days.

Breakdown of Menstrual Cycle

• Days 1-7: Menstruation (3-7 days)

• Days 8-11: Thickening of endometrium.

• Days 18-25: Corpus luteum fades if fertilization does not occur.

• Days 26-28: Uterine lining detaches marking menstruation.

Conception

• Conception occurs when a sperm and egg unite, marking the beginning of pregnancy.

  • Implantation starts with the egg in the uterus.

Fertilization

• Occurs in the fallopian tubes.

  • In the amplia of the fallopian tube.

• Sperm is viable for 72 hours; ova for 12-24 hours post ovulation.

• The single ejaculation contains approximately 200–500 million spermatozoa.

  • Swim up in the fallopain tubes.

• Zygote formation occurs following successful union of sperm and egg.

Pre-embryonic Stage

• First two weeks of prenatal development.

Embryonic Stage

• Extends from Day 13 to 8 weeks post-conception; critical for fetal development.

  • Terategens, can cause abnormal fuctions to a developing fetus.

• By the end of 8 weeks, external structure and all organ systems are present.

Gestational Age

• Assessment: Based on last menstrual period (LMP).

• Duration of Pregnancy: 280 days (40 weeks).

• Trimesters:

  • First Trimester: Weeks 1-12

  • Second Trimester: Weeks 13-27

  • Third Trimester: Weeks 28-delivery

• Fractional Weeks Notation: Example - “15 4/7”

Contraception

• Refers to strategies to reduce risk of fertilization or implantation.

• Assessment: Review client’s needs, desires, and preferences related to contraception methods.

• Common Methods:

  • Natural family planning

    • Highly individualized, involving many preferances.

    • Medical contraindications.

    • Desire for children, alongside religious, culutral, and personal beliefs.

  • Barrier methods

  • Hormonal methods

  • Intrauterine devices

  • Surgical procedures

Non-hormonal Contraceptives

• Male condoms

• Vaginal barriers:

  • Diaphragm

  • Internal condom

  • Cervical cap

• Lactation Amenorrhea Method (LAM)

• Abstinence

  • 100% method to prevent pregnancy.

• Permanent methods like vasectomy and tubal ligation.

• IUD- Copper T

Natural Family Planning

• Also known as Fertility Awareness.

• Requires commitment and daily temperature assessment.

• Efficacy:

  • Perfect use: 98%

  • Typical use: 76%

• Uses a string of color-coded beads to keep track of the days of each cycle.

  • Designed for women with a regular cycle.

Basal Body Temperature

• Measure oral temperature each morning.

  • At the same time and before getting out of bed (at a lying state).

• Slight drop before ovulation, followed by a rise of 0.4-0.8 °F post-ovulation.

  • Slightly increases during ovulation.

Cervical Mucus Assessment

• Determines fertility based on cervical mucus characteristics:

  • Dry/Tacky/Thick: Not Fertile

  • Creamy/Sticky: Not Fertile

  • Cloudy/Stretchy: Semi-Fertile

  • Watery/Stretchy/Egg White: Most Fertile

• Spinbarkeit refers to the extent to which cervical mucus can stretch between two fingers, indicating peak fertility during ovulation.

  • Caused by the increase in estrogen.

Lactation Amenorrhea Method

• This method relies on exclusive breastfeeding.

  • Most women are not getting their period from breastfeeding and they may not know when they are ovulating.

• Requirements: Intervals between feeds must not exceed 4 hours during the day and 6 hours at night.

Condoms

• Male and internal condoms; effectiveness varies but typically high when used correctly.

• Water-soluble lubricants should be used with condoms.

• Condom Application:

  • Ensure the rolled ring is outside.

  • Squeeze the tip to avoid air traps.

• Pros: Accessible, inexpensive, protect against STId and HIV, prevents pregnancy, and is a non-hormonal method.

  • Side note (on HIV): well over 100 types, about 40 affect the genitals. Can lead to development of cancers and HPV, get tests and practice safe sex.

• Cons: Partner compliance and doesn’t fully provide prevention.

Spermicide

• Example: Nonoxynol 9

  • Typically used with other barrier methods.

  • Efficacy: Perfect use ~80%, typical use ~70%.

  • Risks include irritation and increased STI risk if overused.

• Makes the vaginal flora become more acidic.

Diaphargm

• A dome-shaped soft latex cup used in conjunction with spermicide.

  • Needs to be fitted.

  • As similar to the cervical cap that blocks sperm from entering the cervical canal.

    • Insert the canal at least 30 minutes before sex; can be left in for 48 hours.

• Place 2 hours before intercourse and leave in position for at least 6 hours post-intercourse.

• Efficacy rates: perfect use 98%, typical use 80% (for cervial cap)

Combination Hormonal Contraceptives

• Estrogen contraceptive contraindications:

  • Hx of thrombophlebitis, CVA/CV disease, Estrogen-dependent cancer/breast cancer, HTN, Impaired liver function, Heavy smoker, Major surgery requiring prolonged immobilization.

  • Risk factors: DVT (Leg pain, warmth on one leg), Pulmonary embolism (SOB, chest pain), Stroke/CVA.

• Transdermal Patch:

  • Sustained release of estrogen and progesterone.

  • Prevent ovulation, thickens cervical mucus, and alters endometrial lining.

  • Placed on the lower abdomen, upper outer arm, upper torso, or buttock.

Progesterone-Only Contraceptive

• Depo-Provera

  • An IM injection of progestin.

  • Prevents ovulation for 12 weeks, Failure rate of 3%.

  • Side Effects: Irregular menstrual bleeding, weight gain (4 lbs per year), depression, headaches, nervousness, decreased libido, and breast discomfort.

  • Prolonged use (Black Box warning): decreased bone density in teens, therefore you must stress adequate calcium and vitamin D.

  • No effects on breast milk and fertility.

• Implantable Progestins:

  • Flexible rods are inserted under the skin of the upper arm.

  • Effective for a minimum of 3 years, Does not protect against STIs.

  • Side Effects: Irregular menstrual bleeding.

  • Contraindications: Unexplained VB.

Intrauterine Device (IUD)

• Most common.

• Copper IUD is the only non-hormonal one.

• Creates foreign body inflammatory reactions that prevent implantation.

• Side effects: Irregular periods, perforation of the uterus at insertion, ectopic pregnancy, and risk of infection.

• If pregnancy does occur, spontaneous abortion or preterm birth.

Female/Male Sterilization

• Process: Commonly performed via abdominal surgery post-birth.

• Efficacy: 99.6% with no adherence required, but does not protect against STIs.

• Procedure: Outpatient vasectomy; effectiveness achieved after 3 months.

• Efficacy: 99.8%.

Emergency Contraceptives

• Types:

  • ParaGard IUD, Ella, Plan B One-Step

  • Most effective 72 hours after unprotected sex.

  • Combination of estrogen/progestin or progestin-only forms.

• Timing:

  • Must be initiated within specific periods post-intercourse (Varies by type).

  • ParaGard & Ella can be used within 5 days.

Early Signs of Pregnancy

• Morning sickness

• Increased appetite or thirst

• Food cravings/aversions

• Sore breasts

• Missed period and many more.

Infertility

• A lack of conception after 12 months of unprotected intercourse (rule varies with age)

  • Primary: in a woman who never conceived.

  • Secondary: conceived in the past, but unable to do so again.

Symptoms of Infertility

• Hormonal changes affecting mood and behavior

• Increased fatigue and sleep disturbances

• Potential emotional responses related to reproductive health

Risk Factors for Infertility in Men

• Abnormality of the sperm (oligospermia (low sperm count)/motility)

• Abnormal ejaculations (retrograde: is deposited into the bladder)

• Structural or hormonal disorders

• Mumps after adolescence

• Cancers/tumors

• Poor nutrition/obesity

• ATIs

• Substance use

• SSRIs and MAOIs are used

• Age (35 and older)

Risk Factors of Infertility for Women

• Abnormalities of the Fallopian Tube

• Abnormalities of the cervix

• Disorders of ovulation

• Age (35 and older)

Infertility Diagnosis and Treatment

• Diagnostic Tests: ovulation prediction, ultrasonography, and post-coital test (cervical mucus/sperm function).

• Infertility Therapy

  • Timing of intercourse

  • Medications

  • Ovulation induction

  • Surgical procedures

  • Therapeutic insemination

    • Partner or donor semen

    • IUI (intrauterine insemination): sperm placed directly into the uterus.

  • Egg donation

    • Fewer donors than for sperm donation.

    • An in-depth screening process where the client takes medications to speed the growth of their egg.

  • Surrogate Parents

  • Assisted Reproductive Technology