The Menstrual Cycle

R E L AT E D T E R M I N O LO G I E S
MENARCHE

Firstmenstruation.
It occurs on the average
of 11-14 years old.
PREMENARCHIAL
VA G I N A L B L E E D I N G
Bleeding that occurs
before menarche.
It is a bleeding from
genital tract from day 0 till
puberty (9-10)
P R E C O C LO U S P U B E RT Y

Development of female
secondary sexual characteristics
and fast growth before reaching
the age of 8 in girls and 9 in boys.
This is more common in girls than
boys.
M E N O PAU S E
cessation of menstruation
Average age is 51 years old.
define as three months of
amenorrhea with elevation of
gonadotropins (FSH and LH)
premature menopause occurs
between the ages of 30 to 40 which is
idiopathic.
P R EMEN STR UA L
SYNDROME (PMS)
the activity of the corpus
luteum and associated high
levels of progesterone before a
period can trigger a range side
effect in susceptible women.
TYPICAL SYMPTOMS:
fluidretention: bloating, edema,
breast tenderness.
autonomic changes: headache,
insomnia, fatigue, heart
pounding.
emotional symptoms: crying,
anxiety, depression, mood
swings
MENSTRUAL CYCLE
HORMONES
1) FOLLICLE STIMULATING HORMONES-
stimulates growth of granulose cells and induces
the enzyme which converts androgens to
estrogens.
2) LEUTENINIZING HORMONES- stimulates
synthesis of prostaglandins to enhance follicle
rupture and ovulation.
3) ESTROGEN- stimulates proliferative changes in
the endometrium. It has a negative feedback to
FSH and a positive feedback to increase GnRH.
4) ANDROGENS- include androstenedione and
testosterone. These are precursors of estrogen
and inhibit FSH induction of LH receptors.
FUNCTIONS OF
ESTROGEN AND
PROGESTERONE
ESTROGEN (Hormone of
t he Wom a n )
A. Primary Function: development
of the secondary sexual
characteristics in female.
B. Inhibits production of Follicle
stimulating hormone (FSH)
C. Responsible for hypotrophy of
myometrium.
Spinnbarkeit- the clear, slippery
texture of an uncooked eggwhite,
typical of cervical mucus during
ovulation.
Ferning – test for the presence of
estrogen in the cervical mucus;
estrogen causes cervical mucus to
dry on a slide in a fernlike pattern; in
pregnancy testing, the fern pattern
does not appear.
E.Responsible for the development of
ductile structure of the breast.
F. Responsible for the increased
osteoblastic activity of long bone
causing an increase in weight.
Osteoblast- cell that begins in the
embryo and during the early growth of
the skeleton, works in forming bone
tissue.
Itbrings together the substances that form
the bone over and over, time grow in
G. Responsible for early closure of
epiphysis of long bones.
H. Responsible for increased sexual
desire in female.
I. Responsible for increased
vaginal lubrication.
J. Responsible for sodium retention
therefore causing weight gain.
PROGESTINE OR
PROGESTERONE
(H ormon
A. Primary e o f tprepares
Function: h e M othe
ther)
endometrium for implantation of
fertilized ovum making it thick and
tortuous (twisted)
B. Secondary Function: inhibits uterine
contractility
C. Inhibits production of luteinizing
E. Responsible for the development
of mammary gland.
F. Responsible for the increased
permeability of kidney to lactose
and dextrose causing (+) 1
sugar in urine.
G. Responsible for increased basal
body temperature.
PA RT S O F T H E B O DY
RESPONSBILE FOR
ME N T R UAT I O N :
Hypothalamus
Anterior Pituitary Gland (APG)-
Master clock of the body
Uterus
Ovaries
W H AT I S
M E N S T R U AT I O N ?
Itis a cyclic uterine bleeding caused
by shedding of progestational
endometrium that occurs between
menarche and menopause.
Also known as: MENSTRAUL
BLEEDING, MENSES or a PERIOD.
CHARACTERISTICS OF
N O R M A L M E N S T R U AT I O N
1. MENARCHE: 10-16 years old (13 is
average)
2. DURATION: 2-7 days (<2 days is
hypomenorrhea and >7 is menorrhagia)
3. AMOUNT: 30-80 ml., uses 3 napkins per
day (>80 ml is menorrhagia and <30
ml. is hypomenorrhea)
THE HYPOTHALAMIC-
P I T U I TA RY- O VA R I A N
A
2X I S components of menstrual
main
cycle:

1. The changes that happen in the

ovaries in response to the pituitary
hormones (the ovarian cycle)
2. The variations that take place in the
OVARIAN CYCLE
OVARIAN FOLLICLES

1.PREMORDIAL FOLLICLES
– Formed during intrauterine life.
- the immature follicles inside the
ovary that contain premature ova.
- several of these cell develops under
the FSH during menstruation.
2. GRAAFIAN FOLLICLES
- developing primordial follicle is
called graafian follicle.
- described as a blister like structure
barely visible to the naked eye.
- As it develops, the oocyte within it
matures.
- secrete large amounts of estrogen
3. CORPUS LUTEUM
- produce progesterone, although secretes
estrogen
- has life-span of 7-8 days.
- if fertilization occurs, the trophoblast cells of
the zygote secretes HCG which prolongs the life
of corpus luteum and stimulates it in producing
progesterone.
- corpus luteum of pregnancy secretes not only
progesterone but also relaxin, activins, inhibins
and oxytocin
- continue to produce progesterone until 8-12
4. CORPUS AMBILICANS
- complete regression of the CL occurs
before menstruation, later it will be seen
as a white fibrous tissue, called corpus
ambilicans or corpus albicantia.
O VA R I A N C Y C L E

This refers to the Periodic changes that

occur in the ovary every month during
female’s reproductive life.
Cyclical changes in the ovaries in
response to two anterior pituitary
hormones:
FOLLICLE-STIMULATING HORMONE (FSH)
LUTEINIZING HORMONE (LH)
2 I M P O R TA N T P H A S E S I N
T H E O VA R I A N C Y C L E
Follicular phase – corresponds to
the first half of the cycle.
First half of the cycle extends from the
first day of menstruation until ovulation.
Luteal phase – corresponds to the
second half of the cycle.
Second half of the cycle extends from
ovulation to the day before
menstruation covering the secretory
FOLLICULAR PHASE

 This is the time before ovulation .

 Themain event is the formation of the
graafian follicles.
 FSHstimulates the development of
around 30 follicles in each ovary.
 FSHstimulates Graafian follicles to
secrete estrogen.
 LH causes the follicle to reach maturity
LU T E A L P H A S E

The period following the ovulation

of the ovarian menstrual cycle .
This period last usually 14 days
(13-15 is the variation range)
After ovulation, the empty follicle
is transformed into a yellowish
body called corpus luteum that
produces large amounts of
PHASES OF THE
ENDOMETRIAL/
U T E R I N E C YC L E
UTERINE/ENDOMETRIAL
CYCLE
This emphasizes the changes
occurring within the endometrium
under the influence of the different
hormones produce by the ovary.
The endometrium has 3 layers:
basal, compact and spongy
1. MENSTRUAL PHASE
 Begins on the first day of menses and
extends approximately over the first 5
days of a 28 day cycle.
 Menstruation is caused by corpus
luteum regression and the consequent
withdrawal of estrogen and
progesterone.
 Two functional layers of endometrium
are shed causing uterine discharges.

2 . P R O L I F E R AT I V E
P H Acalled
 Also S E FOLLICULAR,
POSTMENSTRUAL, and ESTROGENIC
PHASE
 Fromday 6 to day 13 of a 28 day cycle
which last for 8-10 days depending on
the duration of the cycle.
 Theendometrial surface is completely
restored to its normal thickness in
approximately 4-5 days after the first
day of menstruation or before it stops.
 Estrogen promotes the growth of new
cells and capillaries in the
endometrium
 Levelling
off of endometrial growth
occur during ovulation.
 Estrogen prepares the genital tract for
sperm migration by stimulating
cervical glands to produce more
cervical mucus that is thin, watery,
stretchable and transparent.
rd
3 . S E C R E T O RY P H A S E
 Extendsfrom 14th day to the 25th day
of the menstrual cycle.
 Ovulation
occurs 14 (+ or – 2 days)
before menstruation.
 After
ovulation, empty follicle is
transformed into corpus luteum that
produce primarily the progesterone.
 Progesterone causes the endometrium
to dilate and assume a spiral or
corkscrew shape.
 Endometrium becomes very soft, spongy
and edematous, very rich in nutrients
from blood and glandular secretions,
proving an ideal protective and nutritive
bed for the ovum to implant but
fertilization must first take place.
 Corpusluteum has an average lifespan of
7-8 days.
SIGNS OF OVULATION CAN BE:
 MITTELSCHMERZ- refers to lower abdominal pain felt at
the side of the ovary that releases the ovum
 SPINNBARKHELL- does not indicate the exact time of
ovulation but signals that a woman is nearing ovulation
or ovulating.
- characterized by cervical mucus that is thin,
watery and transparent, abundant and highly
stretchable.
 INCREASED BASAL TEMPERATURE because of the
thermogenic effect of progesterone.
 PEAK BLOOD LEVEL OF LUTEINIZING HORMONE
occurs 24-48 hours before ovulation.
4. ISCHEMIC PHASE
 Corpusluteum shrivels at approximately 3 days
before menstruation if not fertilization takes place.
 Degenerationof corpus luteum results in
progesterone withdrawal.
 Prostaglandinscauses contractions. This Muscular
contractions maybe too strong to cause
discomfort in women, AKA menstrual cramps or
dysmenorrhea.
 Endometrium rebuilds the basal layer to upward.
A N OV U L AT I O N

The failure of the ovary to

release ova over a period of time
generally exceeding 3 months.
Ovulation does not take place.
May cause infertility.
HYPOMENORRHEA

Regular menstruation
occurring at normal
intervals but with heavy
blood loss.
METRORRHAGIA

Bleeding that occurs

frequent irregular
intervals.
OLIGOMENORRHEA

Abnormal prolongation of
the intermenstrual period
every 5 weeks or more
Infrequent or light
menstrual cycles.
AMENORRHEA
 Absence of menstruation.
 This
is considered abnormal apart from pre-
puberty, pregnancy, lactation and
menopause.
 Primary
amenorrhea means that the
menstrual bleeding has never occurred.
 Secondaryamenorrhea means that previously
menstrual bleeding had occurred.
 Possible
causes include low body weight and
excessive exercise. Most often it is a result of
of hormonal imbalances involving the ovaries,
P O LY M E N O R R H E A

Regular menstruation which

is normal in amount but it
occurs in short interval
three weeks or less.
Too frequent menstruation.
MENOMETRORRHAGIA

Prolonged bleeding that occurs at

irregular intervals
Meno= prolonged
Metro= short
Rrhagia= excessive flow/
discharge
DY S M E N O R R H E A
Painful menstruation.
 it is thought that the uterus
is prompted by certain
hormones to squeeze far
harder than necessary to
dislodge its lining
Treatment options includes
MENORRHAGIA
Excessive or heavy bleeding
Excessive period can cause anemia.
Treatment options includes oral
contraceptives to regulate the flow.
It may be cause by endocrine
disturbances, a retroverted uterus,
fibroids of the uterus, adenomyosis,
endometritis(inflammation)and
other conditions.
CLINICAL FINDING:
A M Eflushes
hot N O R R– H E A
unpredictable profuse
sweating and sensation of heat.
decreased vaginal lubrication,
vaginal pH and increased
susceptibility to vaginal infection.
mood alterations, emotional
lability, sleep disorder, depression.
osteoporosis – decreased bone
density.
SIGNS AND SYMPTOMS OF
MENSTRUATION
 Headache
 Acne
 Bloating
 Pains in the lower abdomen
 Tiredness
 Mood changes
 Food cravings
 Breast soreness
 diarrhea
CAUSES OF IRREGULAR
PERIODS
T R E AT M E N T S T H AT C A N R E D U C E O R
R E L I V E S Y M P T O M S O F M E N S T R UA L
DISORDERS
 HORMONE SUPPLEMENTS
 ORAL CONTRACEPTIVES
 TRANQUILIZERS
 VITAMINS OR MINERAL SUPPLEMENTS
 DIETARY MODIFICATIONS
 ANTIDEPRESSANTS
 REGULAR EXERCISE
 SURGERY
SOURCES