Scribd
Upload
16 views50 pages

Physiology of Menstruation

Uploaded by

KAVYA B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
16 views50 pages

Physiology of Menstruation

Uploaded by

KAVYA B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 50

Physiology of menstruation

Prepared by : Dr,
MERVAT.MOHAMMED
Out-lines:
-Definition
- Characteristics of normal menstruation
-The hypothalamic-pituitary-ovarian axis
- Ovarian Cycle
- Uterine Cycle
- Cervical Mucus Changes
-Premenstrual syndrome (PMS)
-Family teaching tips-Relief measures for PMS Diet
- Menstrual hygiene
Definition

Menstruation means cyclic uterine bleeding caused by

shedding of progestational endometrium it occurs between

menarche and menopause.


Characteristics of normal menstruation

 Menarche: 10-16 yrs. average 13 years.

 Duration: 2-7 days (<2days is hypomenorrhea and >7

days is menorrhagia

 Amount: 30:80 ml., uses 3 napkins per day , >80 ml. is

menorrhagia and < 30 ml. is hypomenorrhea.


Characteristics of normal menstruation

 Normally menstrual blood doesn’t coagulate by


fibrinolysin enzyme (plasmin) secreted by the
endometrium.

 Menstrual molimina refers to mild symptoms of 7-


10 days .
The hypothalamic-pituitary-ovarian axis:

There Are two main components of the menstrual cycle,


the changes that happen in the ovaries in response to
pituitary hormones (the ovarian cycle) and the variations
that take place in the uterus, but it is important to
remember that both cycles work together simultaneously
to produce the menstrual cycle.
Ovarian Cycle

1- Follicular Phase:

2- Luteal phase
Ovarian Cycle

Cyclical changes in the ovaries occur in response to

two anterior pituitary hormones: Follicle-stimulating

hormone (FSH) and Luteinizing hormone (LH). The

follicular phase is controlled by FSH, encompasses

days 1 to 14 of a 28-day cycle.


1- Follicular Phase:

At the beginning of each menstrual cycle, the

hypothalamus secretes ----- GnRh in a pulsatile


manner to stimulate ---- ant. Pit. gland to secretes
------ FSH & LH. FSH is responsible for the growth
of several primary follicle only one follicle on one
of the ovaries reaches maturity (graafian follicle)
which secretes oestrogen.
Cont.

 The estrogen peak stimulates secretion of LH. The

LH peak leads to the follicle to burst open, releasing

the mature ovum into the abdominal cavity a process

called (ovulation). and corpous luteum formation.

Ovulation occurs on day 14 of a 28-day cycle.


2-Luteal phase:

After ovulation, LH levels remain elevated and

cause the remnants of the follicle to develop into a

yellow body called the corpus luteum. In addition

to producing oestrogen, the corpus luteum secretes

a hormone called progesterone.


Cont.

when progesterone reaches a high level it inhibits the

secretion of LH leads degeneration of the corpous

luteum (If fertilization does not take place), and so

oestrogen and progesterone drop & separation of the

endometrium (menstruation) & stimulates the

hypothalamus to secrete more GnRH, a new cycle is

started.
Uterine Cycle:
The uterine cycle refers to the changes that are

found in the uterine lining of the uterus. These

changes come about in response to the ovarian

hormones estrogen and progesterone.


phases of Uterine Cycle:

1. Menstrual,

2. proliferative,

3. secretory

4. ischemic.
1-Menstrual Phase
Day 1 of the menstrual cycle is marked by the onset of
menstruation. During the menstrual phase of the uterine
cycle, the uterine lining is shed because of low levels of
progesterone & estrogen. At the same time, a follicle is
beginning to develop and starts producing. The
menstrual phase ends when the menstrual period stops
on approximately day 5.
2-Proliferative Phase

When estrogen levels are high enough, the


endometrium begins to regenerate. Estrogen
stimulates blood vessels to develop. The blood vessels
in turn bring nutrients and oxygen to the uterine
lining, and it begins to grow and become thicker. The
proliferative phase ends with ovulation on day 14.
3-Secretory Phase

 After ovulation, the corpus luteum begins to produce


progesterone. This hormone causes the uterine lining
to become rich in nutrients in preparation for
pregnancy. Estrogen levels also remain high so that
the lining is maintained. If pregnancy doesn’t occur,
the corpus luteum gradually degenerates, and the
woman enters the ischemic phase of the menstrual
cycle.
4-Ischemic Phase

On days 27 and 28, estrogen and progesterone levels


fall because the corpus luteum is no longer producing
them. Without these hormones to maintain the blood
vessel network, the uterine lining becomes ischemic.
When the lining starts slough, the woman has come
full cycle and is once again at day 1 of the menstrual
cycle.
Cervical Mucus Changes:

Changes in cervical mucus takes place over the


course of the menstrual cycle. Some women use
these characteristics to help determine when
ovulation is likely to happen. During the menstrual
phase the cervix doesn’t produce mucus.
Cervical Mucus Changes:
As the proliferative phase begins, the cervix begins to
produce a tacky, crumbly type of mucus that is yellow or
white. As the time of ovulation becomes near, the mucus
becomes progressively clear, thin and lubricative, with the
properties of raw egg white. At the peak of fertility (i.e.,
during ovulation), the mucus has a distensible, stretchable
called spinbarkheit. After ovulation the mucus becomes
scanty, thick, and opaque.
 Premenstrual syndrome (PMS)
 PMS presents with a wide variety of
symptoms which may be physical, behavioral
or both
o Edema o weight gain

o Abdominal bloating o Abdominal cramping

o Constipation o Hot flashes

o Breast swelling & pain o Headache , migraine

o Acne o Rhinitis

o Heart palpitation o Joint swelling and pain

o Sore throat o Urinary difficulties

o Asthma o Back pain

o Fainting o Nausea
Behavioral symptoms:
o Aggressive behavior o Emotional liability

o Confusion o Depression

o Increased appetite o Food cravings (salt, sweet..)

o Fatigue & lethargy o Poor concentration

o Sex drive changes o Suicidal thoughts

o Withdrawal from others o Anxiety, insomnia


Family teaching tips-Relief
measures for PMS Diet
 Reduce or eliminate caffeine intake (coffee, tea,
colas and chocolate)
 Avoid simple sugars as in candy, cakes, cookies
 Reduce salt intake (pickles, fast foods, chips
 Drinks 2 quarts of non-caffeinated fluid, preferably
water, each day
 Eat six small meals (to stabilize blood glucose)
Menstrual hygiene
1- Sanitary pads and tampons:
- Wash hands before & after giving self-perineal care.

- Washing or wiping the perineium should be always


done from front to back.

- Reduce use of tampons by substituting sanitary pads


especially at night.
- Use tampon only for heavy menstrual flow.

- Avoid it at the end of the period when


vaginal walls are dried.
- If toxic shocks syndrome occurs, eliminate all
use tampons, until infection relieved.
- If high fever, vomiting, diarrhea, vaginitis occur
while using tampons, consult the physician.
- Apply perineal pad snugly enough so it won’t
slide back and froth with her movements.
- Don’t touch the side of the perineal pad that will
come in contact with the perineum.
2-Vaginal spray and douching:

- Spray should be used externally only not


with pads.
- Should not be applied with broken irritated
or itched skin.
- Douching is unnecessary since the vagina
cleans itself.
3-Measures to alleviate general discomfort
and cramping:

- Nutritional self-care: Vit. B complex


neutralize the excessive amounts of
estrogen produced by the ovaries, thus
reduces nervousness that sometimes occur
premenstrual. It is present in lean meats,
whole grains, and dark green leafy
vegetables.
- Vit. B6 can relieve the heavy bloated puffy
feeling that is often experienced before the
period.

- Vit. E is a mild prostaglandin inhibitor similar


to aspirin but without the side effects. It improves
circulation; reduce muscular spasm and pain.
- Iron is needed to prevent depletion of the
female iron stores.
- Calcium may also provide relief from the
menstrual symptoms. It presents in yogurt
and cheese.
4-Exercises:
- Daily exercise can prevent cramps, relieves
constipation.
- Deep breathing brings more oxygen in the
blood, which relaxes the uterus.
- It also alleviates irritability and tension.
Sleep and rest

 Maintain regular sleep schedule


 Drink a glass of milk before bedtime
 Schedule exercise for early morning or
early afternoon
 Give yourself a quiet time to relax just
before going to bed
6-Time to see a health care provider:-

Should consult the health care provider for the


following:
-If not started menstruating by the age of 16.
-If the period has suddenly stopped.
-If she have bleeding for more days than usual.
6-Time to see a health care provider:-

-If she is bleeding excessively.


-If you bleed between periods (more than just
a few drops).
- If there is severe pain during the period.
-If she is bleeding excessively.

You might also like