Menstruation

• is the monthly discharge of blood from the uterus occurring from puberty to menopause

• An episodic uterine bleeding in response to cyclic hormonal changes

Purpose

1. To bring an ovum to maturity and prepare the uterine tissue bed for implantation

2. The process that allows for conception and implantation of new life

Characteristics of Normal Menstrual Cycle

• Characteristics Normal Menstrual Cycle

• the length of menstrual cycle differs from woman to woman

• average length - 28 days (from the beginning of one menstrual flow to the beginning of the next

• Interval: Average 28 days cycle (23 days - 35 days)

• Length of Average menstrual flow: 4 - 6 days ( 2 - 9 days)

• Amount of flow: 30 - 80 ml

• Color: Dark red

• Odor: Marigold

• Components: Blood, mucin, endometrial tissue, microscopic atrophied and unfertilized ovum

Associated Terms

• Menarche - first menstrual period

• Menopause – the cessation of ovarian function.

• Amenorrhea – absence of menstrual flow

• Menorrhagia – abnormally heavy menstrual flows

• Metorrhagia – bleeding between menstrual periods.

• Dysmenorrhea – painful menstruation

Physiology of Menstruation

1. Hypothalamus

   • Initiate menstrual cycle

   • Releases GnRh (LHRH)

     • Gonadotropin Releasing Hormone (GnRH) - transmitted from the Hypothalamus to the APG and signals the gland to begin producing FSH and LH

2. Anterior Pituitary Glands

   • releases FSH and LH

     • Follicle Stimulating Hormone (FSH)

       1. Maturation of ovum

       2. Transform Primordial follicles to graafian follicles

       3. Stimulate the ovaries to produce Estrogen

     • Luteinizing Hormone (LH)

       1. responsible for Ovulation

       2. Release of mature egg cell from the ovary

       3. Stimulate the ovaries to produce Progesterone

       4. Transform Graafian follicles to corpus luteum.

   • Ovulation

     • Corpus Luteum

       • the structure formed by the follicles after the egg is released from the Graafian follicle.

       • a yellow colored structure that produce progesterone and increasing the cell lining in the uterus.

       • The hormone helps in maintaining pregnancy.

3. Ovaries

   • Contain Primordial follicle

     • Primordial follicle – an ovarian follicle consisting of the ovum enclosed in a single layer of cells.

   • Produces Estrogen and Progesterone

     • Estrogen “ Hormones of Woman”

       1. Primary function: Development of secondary sexual characteristics

       2. Endometrium proliferation (8 folds thickness)

       3. Increase mucus secretion

     • Progesterone “ Hormones of Mother”

       1. Prepare the Endometrium for implantation

       2. Increase basal body temperature (1◦F)

       3. Inhibit production of LH – facilitates transport of fertilized ovum through the fallopian tubes

   • Stage of Maturation

     • small ovum with its surrounding follicle membrane and fluid is termed Graafian Follicle

4. Uterus

   • illustrates uterine changes as a result of stimulation from the hormones produced by the ovaries

Effects of Estrogen in the Body

1. Inhibits production of FSH causes Hypertrophy and Hyperplasia of Myometrium

   • Hypertrophy and Hyperplasia – is the overgrowth of the uterine lining

2. Stimulates the growth of ductile structures of the breast

3. Increases the quantity and pH of cervical mucus causing it to become watery and can be to a distance of 10-13 cm. (Spinnbarkeit)

Menstrual Cycle

Uterine (Endometrial Cycle)

1. Proliferative

   • Estrogenic, Follicular or Postmenstrual Phase

   • Day 5 - 14

     1. Endometrium begins to proliferate

     2. Increases in thickness to eightfold

     3. Increase continues for 1st half of menstrual cycle

2. Secretory

   • Progestational, Luteal, Premenstrual

   • Day 14-28

     1. Uterine endometrium become twisted and dilated

     2. Capillaries of the endometrium increase in amount

3. Ischemic

   • Day 24th - 25th - Begins to degenerate

     1. If fertilization ( - ) corpus luteum in the ovary begins to regress.

     2. Production of progesterone and estrogens decreases.

     3. Withdrawal of progesterone causes endometrium to degenerates.

4. Menses

   1. Capillaries rupture

   2. Endometrium sloughs off

   3. Menstrual flow composed of:

      • Blood from the ruptured capillaries

      • Mucin from the glands

      • Fragments of endometrial tissue

      • Microscopic, atrophied and unfertilized ovum

Ovarian (Follicular Cycle)

1- 4 days – Menses → 4 th -5 th day – Primary follicle FSH → Graafian follicle (Ovum + fluid high in estrogen level with some Progesterone) → 14th day Ovulation

1. Follicular Phase

   • 14th day ovulation

2. Luteal Phase

   • 14-28 days

   • Graafian Follicle

   • Corpus Luteum (Filled with Lutein – high in progesterone level)

   • Fertilization = 16th -10 wks. high progesterone will maintain pregnancy

   • No Fertilization = 8-10 days degenerates and become corpus albicans

     • Estrogen and Progesterone goes down

     • Menstruation

Ovulation

1. Hypothalamus – initiates the Menstrual Cycle

2. Release GnRh (Gonadotropin Releasing Hormone) also called LHRH (Luteinizing Hormone Releasing Hormone)

3. GnRh stimulates the Anterior Pituitary Gland to produce two hormones (FSH and LH)

   • FSH – follicle Stimulating Hormones

   • LH – Luteinizing Hormones

4. Ovary

   • as the ovum (egg cell) grows , its cells produce a clear fluid Follicular fluid that contains a high degree of Estrogen mainly Estradiol and some Progesterone

5. Stage of Maturation – small ovum with its surrounding follicle membrane and fluid, is termed Graafian Follicle

6. Graafian Follicle ruptures

7. OVULATION

   • is the periodic release of an ovum from the ovaries.

   • occurs exactly 2 weeks before the next menstruation.

   • 14 days prior to the first day of the next menstrual cycle

   • First day of the cycle is the first day of menstruation

   • One menstrual cycle is from the first day of the menstrual period till the first day of the next cycle.

Signs and Symptoms of Ovulation

1. Mittlelschmerz – abdominal tenderness on left/right iliac regions, brought about by peritoneal irritation due to blood coming out from the graafian follicle

2. Spinnbarkeit - vaginal secretion is clear and transparent

3. Changes in vaginal mucus

4. Goodel’s sign - Softening of the Cervix

5. Mood changes

6. Breast tenderness

7. Increase levels of Progesterone

8. Change in basal body temperature

Fertility Awareness Methods

1. Calendar Rhythm Method

2. Basal body temperature

   • Drops slightly by 0.5° F to 1° F before the day of ovulation

   • Rises (0.2 ° C) at the time of ovulation

3. Cervical Mucus Method

   • copious, thin, watery and transparent mucus secretion

4. Symptothermal Method

   • combination of BBT methods and cervical mucus, and observes for “ Mittelschmerz

5. Ovulation detection kit (12-24 hrs. before ovulation)