Menstruation

MENSTRUATION

MENSTRUAL CYCLE AKA Female reproductive cycle  Episodic uterine bleeding in response to cyclic hormonal changes  Purpose: 

 Bring

an ovum into maturity  Renew uterine tissue bed

CHARACTIRISTICS OF NORMAL MENSTRUAL CYCLES Characteristics

Description

Menarche

Average age of onset, 12 or 13 years; average range of 9 – 17 years old

Interveral between cycles

Average 28 days; cycles of 23 to 35 days not unusual

Duration of menstrual flow

Averge flow, 2 – 7 days; ranges of 1 – 9 days not unusual

Amount of menstrual flow

30 – 80 mL per menstrual period

Color of menstrual flow

Dark red; a combination of blood, mucus, and endometrial cells

FOUR BODY STRUCTURES INVOLVED IN THE PHYSIOLOGY OF THE MENSTRUAL CYCLE 1. 2. 3. 4.

Hypothalamus Pituitary gland Ovaries Uterus

HYPOTHALAMUS

LHRH

PITUITARY GLAND Estrogen Progesterone

Gonadotrophic hormone OVARY

Estrogen

Progesterone

UTERUS

HYPOTHALAMUS 

Release of LHRS/GnRH by the hypothalamus initiates the menstrual cycle  Repressed  Cyclical

by pressence of estrogen

PITUITARY GLAND 

Produces 2 gonadotrophic hormones:  FSH

Active early in the cycle  Responsible for the maturation of the ovum 

 LH

Active at midpoint of the cycle  Responsible for ovulation and growth of the uterine lining dring the second half of the menstrual cycle 

OVARY

UTERUS 

Stimulation from the hormones produced by the ovaraies causes effects on the uterus

MENSES 

Menstrual Flow Consists of:  Blood

from raptured capillaries  Mucin from glands  Fragments of endometrial tissue  Microscopic, atrophied, and unfertilized ovum 

First day of the menstrual flow is used to mark the beginning day of a new menstrual cycle

Blood loss: approximately 30 – 80 ml of blood  Iron loss: approximately 11 mg 

PROLIFERATIVE PHASE Also known as estrogenic, follicular, or postmenstrual phase.  Immediately after the menstrual flow (first 4 or 5 days of a cycle)  The endometrium is very thin  With the presence of estrogen, the endometrium begins to proliferate 

SECRETORY PHASE Protestational, luteal, premenstrual phase.  Progesterone causes the glands of the uterine endometrium to become corkscrew or twisted in appearnce and dilated with quantities of glycogen and mucin.  Capillaries of the endometrium increase in amount 

ISCHEMIC PHASE If fertilization does not occur  Withdrawal of progesterone  endometrium begins to degenerate, capillaries rupture, with minute hemorrhages, and the endometrium sloughs off. 

CERVIX 







Mucus of the cervix also changes each month during the menstrual cycle. Changes in cervical mucus are helpful in establishing fertility. During the first half of the cycle, when the hormone is very low, the cervical mucus is thick and scant At the time of ovulation when estrogen level is high, cervical mucus is thin and copious



During the second phase of the menstrual cycle when progesterone level is high, cervical mucus becomes thick.

FERN TEST   



Visible if there is presence of high estrogen level Seen before ovulation Cervical mucus forms fernlike patterns when placed on a glass slide Significance:  Women who do not ovulate conitually show the fern pattern throughout the menstrual cycle(no progesterone influence) OR  Never demonstrate ferning pattern because their estrogen level never rise

SPINNBARKEIT TEST  

 

Test for ovulatin At the height of estrogen secretion, the cervical mucus not only becomes thin and water, but it also can be stretched into long strands Indication that ovulation is about to occur. Done by stretching a mucus sample between thumb and finger or by smearing cervical mucus specimen on a slide and stretching the mucus between the slide and cover slip

EDUCATION REGARDING MENSTRUATION Dispel menstruation myths  Educate boys about menstruation  Continue doing moderate exercise  Sexual relations is not contraindicated during menses  Activities of daily life is not contraindicated during menses 

Using mild analgesics is helpful  More rest may be helpful if dysmenorrhea interferes with sleep at night  Nutrition: iron supplementation may be needed to replace iron lost in menses  Eating sour or cold foods does not cause dysmenorrhea. 

MENSTRUAL DISORDERS 

Dysmenorrhea  Painful



menstruation

Menorrhagia  Abnormally

heavy menstrual flow  Blood loss greater than 80 mL or more than 7 days



Metrorrhagia  Bleeding



between menstrual periods

Premenstrual Dysphoric Syndrome  Severe

form of premenstrual syndrome

MENOPAUSE



MENOPAUSE  Cessation



POSTMENOPAUSAL PERIOD  Time



of menstrual cycles

following menopause

PERIMENOPAUSAL  Period

during which menopausal changes are occuring

MENOPAUSE Occurs between 40 and 55 years old  Familia  Thea earlier the age of menarch, the earlier menopause tends to occur. 

HEALTH TEACHING DURING MENOPAUSE Help women appreciate that loss of uterine function may make almost no change in their life.  Teach patient about hormone replacement therapy 