Obstetrics and gynecology

LESSON PLAN
FEMALE HORMONAL CYCLES

SUBMITTED TO: BY: ANJALI MADAN

MSc. Nursing 1st year
PROF. RITA SARKAR Batch-( 2013-15).
/11/2013
NAME OF MODERATOR : PROF. RITA SARKAR

NAME OF STUDENT TEACHER : ANJALI MADAN

SUBJECT : OBSTETRICS AND GYNAECOLOGY

DATE AND TIME : NOVEMBER, 2013 @ 12 P.M.

TOPIC OF LESSON : FEMALE HORMONAL CYCLESS

CLASS : BSc.4th year students

NO. OF STUDENTS : 40

DURATION : 60 minutes

VENUE : Lecture hall, PIMS, PANIPAT.

METHOD OF TEACHING : LECTURE AND DISCUSSION

A.V.AIDS : POWER POINT, WHITEBOARD

CENTRAL OBJECTIVES : By the end of the class, students acquire knowledge regarding hormonal changes in the
female body and capable to use this knowledge in their curriculum studies as well as in clinical areas to educate the mothers regarding
ovulation and menstrual cycle.

SPECIFIC OBJECTIVES : The group will be able to:

 Define Graafian follicle & ovulation.

 Enumerate the development of Graafian follicle and ovulation.
 Describe the hormonal control of ovulation
 Define menstrual cycle.
 Describe endometrial changes during the different phases of menstruation.
 Explain the clinical phases of menstruation and menopause.
TIME SPECIFIC CONTENT TEACHER STUDENT ACTIVITY A.V. AIDS EVALUATION
OBJECTIVES ACTIVITY USED

1)3 min. 1) Introduction: The biological cycles in a Orient the group Listen to the
woman are controlled by the hypothalamus. It about the Female teacher carefully
governs the anterior pituitary gland by Hormonal Cycles. and takes part Power point
hormonal pathways. The anterior pituitary
actively by giving presentation
gland in turns governs the ovaries by
hormones. The hormones produced in the Shows ppt. answers to the
ovaries, control changes in the uterus. All the questions and
changes occur simultaneously & in harmony. A Shows the video. asking doubts.
woman’s mood may change along with cycle &
emotional influences can alter the cycle. Explain ovarian
Define ovarian
2)3 min. 2) THE OVARIAN CYCLE: The ovarian cortex at cycle.
cycle. Explains about the
birth contains about 2lakh primordial follicles.
ovarian cycle and
From puberty onwards certain follicles enlarge
& one matures each month to liberate an process of
ovum. A mature ovum follicle is known as formulation of
GRAAFIAN FOLLICLE. graffian follicle.
3)7 min. Explain the 3) GRAAFIAN FOLLICLE: The ovum is situated at
process of one end of the Graafian follicle and is encircled Shows the video. What is a graffian
maturation of by the narrow perivitelline space. Surrounding
this lays a clump of cells called discus proligerus follicle?
graafian follicle.
which radiate outward to form the corona
radiata. The innermost cells of corona are Shows the ppt.
referred as zona pellucida. The whole follicle is
lined with granulosa cells and contains
follicular fluid. The outer coat of follicle is Asks the question
external limiting membrane and around this to the group.
lies, area of compressed ovarian stroma known Draw the structure
as the theca. of a graffian
4) 6min. Explain ovulation 4) Ovulation: The Graafian follicle grows and Explain the effect Video
process. of hormones on follicle.
matures to a size of 10-12mm under the
influence of FSH and LH. At the same time it the ovarian cycle.
 swells and becomes tense, finally ruptures to
release the ovum in to the fimbriated end of
the fallopian tube, which is cupped beneath What do you
Use white board
the ovary. This is called as ovulation. And it understand by the
to explain
occurs on day 14 of 28 days cycle. A small loss term
of blood occurs at this time in to the peritoneal important terms.
MITTELSCHMERZ?
cavity, termed as MITTELSCHMERZ. The empty
follicle is known as corpus luteum. Which
followed by proliferation, vascularization, Shows ppt.
maturity and regression, it changes in to yellow
color, becomes corpus albicans and
reabsorbed.
5)10min. 5) HORMONAL CONTROL: The hypothalamus
Describe the synthesizes and releases GnRH (gonadotropin Explains the Enlist the
hormonal control releasing hormone). It reaches the pituitary hormonal control hormones
on the female through portal circulation and causes the on female releasing from
reproductive release of FSH and LH. Known as reproductive Answers the pituitary gland.
system. gonadotrophins. The activity of hypothalamus system. question asked in
and pituitary is influenced by positive and between.
negative feedback mechanisms from ovarian
hormones. FSH causes graafian follicle to
develop and enlarge one.FSH rises during the
first half of cycle and when the estrogen level White board
reaches a certain point, its production ceases. Shows power
LH production starts a few days after FSH. point presentation
↑estrogen causes rush in both FSH &LH levels to the group.
resulting in the rupture of a ripened follicle
ovulation. Level of FSH & LH then falls rapidly.
If no pregnancy occurs corpus luteum Negative feedback
degenerates after 14 days. The negative Asks the question is given by which
feedback effect of progesterone ceases and in between to the hormone?
FSH & LH levels rise again to begin a new cycle. students.
PROLACTIN: produced in anterior pituitary
gland. It does not play a part in the control of
 ovarian hormones. If produced in excessive
amounts, it will inhibit ovulation that is the
natural phenomenon during lactation.
6)8 min. 6) OVARIAN HORMONES: ESTROGEN: the
Explain the types Explains the types Enlists the types of
granulosa cells and theca of the ovaries, under
and functions of the influence of FSH produce this hormone. It and functions of ovarian hormones.
ovarian comprises several compounds including nostril, ovarian
hormones. oestradiol & oestrone. Estrogen is responsible hormones.
for secondary sexual characteristics such as the White board.
female shape, growth of breasts and the uterus
and the female distribution of hair. It
influences the production of cervical mucus.
Uses white board
PROGESTRONE: produced by corpus luteum
under the influence of LH. It acts only on to explain the
tissues previously affected by estrogen. During topic.
the second half of the cycle, it causes secretory
changes in the lining of the uterus as the
endometrium develops tortuous glands and an Shows the ppt.
enriched blood supply in readiness for the
possible arrival of a fertilized ovum. It causes
the body temp. of the woman to rise by0.5
degrees after ovulation.
RELAXIN: secreted by corpus luteum and is at
its max. level after 38 weeks of pregnancy. It
relaxes the pelvic girdle, softens the cervix and
suppresses uterine contraction.
7) 5min. 7)MENSTRUAL CYCLE: DEFINITION : Define menstrual
Define menstrual Defines the
It refers to the monthly discharge through the cycle.
cycle. vagina of blood and other substances from the menstrual cycle.
uterus in non pregnant adult females. Pays attention
It is rhythmical series of physiological changes toward the topic
that occur in fertile women presented.
the control of the endocrine system Shows the ppt.
Necessary for reproduction
 Average length: 28 days, but typically varies,
with shorter and longer cycles
Menarche: a woman's first menstruation Asks the questions
typically occurs around age 12.
to the group. Explain the term
occurrence depends on overall health and diet
Menopause: end of a woman's reproductive “Menopause”.
phase, commonly occurs between ages 45 and
55
age of menopause is largely the result of Shows the ppt.
genetics
Physiological changes during menstrual cycle
can be observed at three different levels:
Answers the
 neuroendocrine level
 ovaries Uses white board questions asked by
 uterus to explain the the teacher.
Menstrual cycle can be divided into 3 phases: topic.
 menstrual phase
 proliferative / follicular
(estrogen) phase
 secretory / luteal phase
(progesterone) phase
8)5 min. 8) MENSTRUAL PHASE: Menstruation Explains the
Explain the first
menstrual bleeding, menses, period discharge menstrual phase Enlists the phases
phase of
of bloody fluid containing endometrial cells, of menstrual
menstrual cycle of menstrual cycle.
glandular secretions and blood cells, lasts 3 -5 cycle.
Handout
days.
result of the previous menstrual cycle.
due to strong vasoconstriction and proteolytic Asks the questions
activity, functional stratum of endometrial in between to the
tissue dies and is discharged during menstrual group.
bleeding.
Endometrium becomes very thin, but due to Shows the ppt.
low estrogen levels, hypophysis secretes more
FSH. Use white board
 FSH stimulates secretion of estrogen, and to explain the
estrogen serves as proliferation signal to the topic.
endometrial basal layer
9)3 min. Describe the 9) FOLLICULAR PHASE : Due to the rise of
Elaborate the Explain the
follicular phase of follicle stimulating hormone (FSH) during the
menstrual cycle. first days of the cycle, several ovarian follicles follicular phase of hormonal changes
are stimulated menstrual cycle. occur during
 Follicles compete with each other for Follicular phase in
dominance menstrual cycle.
 The follicle that reaches maturity is Shows the ppt.
called a Graafian follicle
 As they mature, the follicles secrete
increasing amounts of estrogen, which
thickens the new functional layer of
endometrium in the uterus
 Estrogen also stimulates crypts in the
cervix to produce fertile cervical mucus Answers the
 At the end of this phase ovulation questions asked to
occurs the group.
10)3min. Explain ovulation. 10)OVULATION: During the follicular phase,
Explains the
estrogen suppresses production of luteinizing
hormone (LH) from the pituitary gland ovulation process.
 When the ovum has nearly matured,
levels of estrogen reach a threshold
What is positive
above which they stimulate production Shows the ppt.
of LH (positive feedback loop) feedback loop?
 The release of LH matures the ovum
and weakens the wall of the follicle in
the ovary, causing the fully developed Asks the questions
follicle to release its secondary oocyte to the group.
 After being released from the ovary,
the ovum is swept into the fallopian
tube
11)3min. Describe the 3rd 11)LUTEAL PHASE: Corpus luteum: solid body Describes the
 phase of formed in an ovary after the ovum has been luteal phase of
menstrual cycle. released into the fallopian tube menstrual cycle,
 Produces significant amounts of What is corpus
progesterone, which plays a vital role luteum?
in making the endometrium receptive
to implantation of the blastocyst
 High levels of E and P suppress Shows the ppt.
production of FSH and LH that the
corpus luteum needs to maintain itself
 Falling levels of progesterone trigger
menstruation and the beginning of the
next cycle
Enlists the cycle
12)3min. List the 12)CYCLE ABNORMALITIES:
abnormalities of  Anovulation abnormalities in video
menstrual cycle.  Anovulatory cycle menstrual cycle. Answers the
Explain the term
 Hypomenorrhea questionnaire given
Amenoeehea.
 Metrorrhagia as a part of
 Oligomenorrhea evaluation. What is
 Amenorrhea
 Polymenorrhea Anovulation?
13)2min. 13) CONCLUSION: Female hormonal cycles are
having their own importance in a woman’s Give conclusion of
body as they are responsible for female the topic
reproductive system to work. Hormonal presented
changes influences the physical as well as the
emotional changes in human body, Summarizes the
furthermore helps in reproduction.
topic presented. questionnaire
14)2min. 14) SUMMARY: We have discussed about the
ovarian cycle and menstrual cycle in detail
including graafian follicle, ovulation, hormonal Give
control, ovarian hormones, and different questionnaire to
phases of menstrual cycle and the cycle the group for
abnormalities in menstrual cycle. evaluation.
REFERENCES:

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2008. Page No.- 88 to 95.

2. Dutta D.C. Texbook of obstetrics. 6th edition. New central book agency pvt. Ltd. 2004.Page
No-32-39.

3. Fraser M. Diane, Cooper A. Margret. Myle’s Textbook for midwifery. 14th edition. Churcill
Livingstone. 2003. Page No-77 to84.

4. Elizabeth Marie. Midwifery for Nurses. Satish Kumar Jain. 2010. Page No.-30 to 35.

5. Sharma J.B. APC Textbook of Obstetrics. Avichal publishing company. 2008. Page no.- 65 to68.