The Menstrual Cycle Color of menstrual Dark red; a combination of blood, mucus, and endometrial

flow cells
What is it?
●​ chromosomal female reproductive cycle. Odor Similar to marigolds
●​ It is episodic uterine bleeding in response to cyclic hormonal changes.
The Physiology of Menstruation
●​ The purpose of a menstrual cycle is to bring an ovum to maturity and renew a
uterine tissue bed that will be necessary for the ovum's growth should it be Four body structures that are involved:
fertilized. ●​ Hypothalamus
●​ Pituitary gland
●​ The length of menstrual cycles differs from person to person, but the average ●​ Ovaries
length is 28 days (from 48 the beginning of one menstrual flow to the ●​ Uterus
beginning of the next).
●​ It is not unusual for cycles to be as short as 23 days or as long as 35 days. For a menstrual cycle to be complete, all four organs must contribute their part;
●​ The length of the average menstrual flow (termed menses) is 4 to 6 days, inactivity of any part results in an incomplete or ineffective cycle
although menses may be as short as 2 days or as long as 9 days.

CHARACTERISTICS OF NORMAL MENSTRUATION CYCLE

Characteristics Description

Beginning Average age at onset, 12.4 years; average range, 9-17

(menarche) years

Interval between Average, 28 days; cycles of 23-35 days not unusual

cycles

Duration of Average flow 4-6 days; ranges of 2-9 days not abnormal
menstrual flow

Amount of menstrual Difficult to estimate; average 30-80 ml per menstrual

flow period; saturating a pad or tampon on less than 1 hour is
heavy bleeding
 ●​ At full maturity, the follicle is visible on the surface of the ovary as a clear
Hypothalamus water blister approximately 0.25 to 0.5 in. across.
●​ The release of GnRH (also called luteinizing hormone-releasing hormone ●​ At this stage of maturation, the small ovum (barely visible to the naked eye,
[LHRH]) from the hypothalamus initiates the menstrual cycle. about the size of a printed period) with its surrounding follicular membrane
●​ GnRH then stimulates the pituitary gland to send the gonadotropic hormone and fluid is termed a graafian follicle.
to the ovaries to produce estrogen.
●​ When the level of estrogen rises, release of GnRH is repressed and no ●​ By day 14 or the midpoint of a typical 28-day cycle, the ovum has divided by
further menstrual cycles will occur (the principle that birth control pills use to mitotic division into two separate bodies: a primary oocyte, which contains the
eliminate menstrual flows). bulk of the cytoplasm, and a secondary oocyte, which contains so little
●​ Excessive levels of pituitary hormones can also inhibit release. cytoplasm that it is not functional.

Pituitary Gland ●​ The structure also has accomplished its meiotic division, reducing its number
— Under the influence of GnRH, the anterior lobe of the pituitary gland (the of chromosomes to the haploid (having only one member of a pair) number of
adenohypophysis) produces two hormones: 23.
●​ FSH a hormone active early in the cycle that is responsible for maturation of
the ovum ●​ After an upsurge of LH from the pituitary at about day 14, prostaglandins are
●​ LH - a hormone that becomes most active at the midpoint of the cycle and is released and the graafian follicle ruptures.
responsible for ovulation, or release of the mature egg cell from the ovary. It ●​ The ovum is set free from the surface of the ovary, a process termed
also stimulates growth of the uterine lining during the second half of the ovulation.
menstrual cycle. ●​ It is swept into the open end of a fallopian tube.

Ovaries ●​ It is important to teach patients that ovulation does not necessarily occur on
●​ FSH and LH are called gonadotropic hormones because they cause growth the 14th day of their cycle; it occurs 14 days before the end of their cycle.
(trophy) in the gonads (ovaries). ●​ If their menstrual cycle is only 20 days long, for example, their day of
●​ Every month from menarche to menopause, one of the ovary's oocytes is ovulation would be day 6 (14 days before the end of the cycle).
activated by FSH to begin to grow and mature. ●​ If their cycle is 44 days long, ovulation would occur on day 30, not at the
●​ As the oocyte grows, its cells produce a clear fluid (follicular fluid) that halfway point-day 22.
contains a high degree of estrogen and some progesterone.
●​ As the follicle surrounding the oocyte grows, it is propelled toward the surface ●​ After the ovum and the follicular fluid have been discharged from the ovary,
of the ovary. the cells of the follicle remain in the form of a hollow, empty pit.
●​ The FSH has done its work at this point and now decreases in amount.
●​ The second pituitary hormone, LH, continues to rise in amount and directs
the follicle cells left behind in the ovary to produce lutein, a bright-yellow fluid
high in progesterone.
●​ With lutein production, the follicle is renamed a corpus luteum (yellow body).

●​ The basal body temperature drops slightly (by 0.5 to 1° F) just before the day
of ovulation because of the extremely low level of progesterone that is
present at that time.
●​ It rises by 1°F on the day after ovulation because of the concentration of
progesterone, which is thermogenic.
●​ The basal body temperature remains at this elevated level until approximately
day 24 of the menstrual cycle, when the progesterone level again decreases.
●​ Therefore, taking body temperature daily is one method of assessing if
ovulation has occurred.

●​ If conception (fertilization by a spermatozoon) occurs as the ovum proceeds

down a fallopian tube and the fertilized ovum implants on the endometrium of
the uterus, the corpus luteum remains throughout the major portion of the
pregnancy (to about 16 to 20 weeks).

●​ If conception does not occur, the unfertilized ovum atrophies after 4 or 5

days, and the corpus luteum (now called a "false" corpus luteum) remains for
only 8 to 10 days.

●​ As the corpus luteum regresses, it is gradually replaced by white fibrous

tissue, and the resulting structure is termed a corpus albicans (white body).
Uterus
●​ Uterine changes that occur monthly as a result of stimulation from the ●​ After ovulation, the formation of progesterone in the corpus luteum (under the
estrogen and progesterone produced direction of LH) causes the glands of the uterine endometrium to become
corkscrew or twisted in appearance and dilated with quantities of glycogen
(an elementary sugar) and mucin (a protein).

●​ It takes on the appearance of rich, spongy velvet.

●​ This second phase of the menstrual cycle is termed the progestational, luteal,
premenstrual, or secretory phase.

Third Phase of the Menstrual Cycle (Ischemic)

●​ If fertilization does not occur, the corpus luteum in the ovary begins to regress
after 8 to 10 days, and therefore, the production of progesterone decreases.

●​ With the withdrawal of progesterone, the endometrium of the uterus begins to

degenerate (at about day 24 or day 25 of the cycle).

First Phase of the Menstrual Cycle (Proliferative) ●​ The capillaries rupture, with minute hemorrhages, and the endometrium
sloughs off.
●​ Immediately after a menstrual flow (which occurs during the first 4 or 5 days
of a cycle), the endometrium, or lining of the uterus, is very thin, Fourth Phase of the Menstrual Cycle (Menses)
approximately one cell layer in depth. As the ovary begins to produce
estrogen (in the follicular fluid, under the direction of the pituitary FSH), the ●​ Menses, or a menstrual flow, is composed of a mixture of blood from the
endometrium begins to proliferate so rapidly, the thickness of the ruptured capillaries; mucin; fragments of endometrial tissue; and the
endometrium increases as much as eightfold from day 5 to day 14. microscopic, atrophied, and unfertilized ovum.

●​ This first half of a menstrual cycle is interchangeably termed the proliferative, ●​ Menses is the end of an arbitrarily defined menstrual cycle. Because it is the
estrogenic, follicular, or postmenstrual phase. only external marker of the cycle, however, the first day of menstrual flow is
used to mark the beginning day of a new menstrual cycle
Second Phase of the Menstrual Cycle (Secretory)
 ●​ Contrary to common belief, a menstrual flow contains only 30 to 80 mL of
blood; if it seems to be more, it is because of the accompanying mucus and
endometrial shreds.

●​ The iron loss in a typical menstrual flow is approximately 11 mg.

●​ This is enough loss that many adolescents could benefit from intermittent iron
supplementation to prevent iron depletion during their menstruating years

Cervical Changes
●​ The mucus of the uterine cervix also changes in structure and consistency
each month during a menstrual cycle.
●​ At the beginning of each cycle, when estrogen secretion from the ovary is
low, cervical mucus is thick and scant.
●​ Sperm survival in this type of mucus is poor.

●​ At the time of ovulation, when the estrogen level has risen to a high point,
cervical mucus becomes thin, stretchy (spinnbarkeit), and copious.
●​ Sperm penetration and survival in this thin mucus are both excellent.
●​ Because progesterone becomes the major influencing hormone during the
second half of the cycle, cervical mucus again thickens and sperm survival is
again poor.
 ●​ When progesterone is the dominant hormone, as it is just after ovulation, this
fern pattern is no longer discernible.

●​ Cervical mucus, therefore, can be examined at midcycle for ferning to detect

whether a high estrogen surge is present.
●​ Those who do not ovulate usually show a ferning pattern throughout their
menstrual cycle (progesterone levels never become dominant), or they never
demonstrate it because their estrogen levels never rise.

●​ Cervical mucus can be analyzed for changes to help plan coitus so it

coincides with ovulation if a couple wants to increase their chance of
becoming pregnant or plan to avoid coitus at the time of ovulation to prevent
by analyzing how thick or thin the cervical mucus.
●​ During ovulation, the body of the cervix is softer and the os is slightly open
A.​ ferning pattern of cervical mucus occurs with high estrogen levels
compared with the rest of the cycle when it is firm and the os is closed as
B.​ incomplete ferning during secretory phase of cycle.
another indication of ovulation.

Spinnbarkeit Test
Fern Test
●​ At the height of estrogen secretion, yet another property of cervical mucus is
●​ An interesting property of cervical mucus just before ovulation when estrogen
the ability to stretch into long strands, a contrast to its thick, viscous state
levels are high is the ability to form fern-like patterns on a microscope slide
when progesterone is the dominant hormone.
when allowed to dry.
●​ This pattern is known as arborization or ferning.
 ●​ That means performing this test, known as spinnbarkeit, at the midpoint of a THE SEXUAL RESPONSE
menstrual cycle is another way to demonstrate high levels of estrogen are ●​ Two of the earliest researches of sexual response were Masters and
being produced and, by implication, ovulation is about to occur. Johnson.
●​ A person can do this themselves by stretching a mucus sample between ●​ In 1966, they published the results of a major study based on more than
thumb and finger, or it can be tested in an examining room by smearing a 10,000 episodes of sexual activity among more than 600 male and female
cervical mucus specimen on a slide and stretching the mucus between the individuals
slide and cover slip
In this study, they described the human sexual response as a cycle with four discrete
stages:
●​ Excitement
●​ Plateau
●​ Orgasm
●​ Resolution

Excitement
●​ Excitement occurs with physical and psychological stimulation (sight, sound,
emotion, or thought) that causes parasympathetic nerve stimulation. This
leads to arterial dilatation and venous constriction in the genital area.
●​ The resulting increased blood supply leads to vasocongestion and increasing
muscular tension.
●​ In chromosomal females, this vasocongestion causes the clitoris to increase
in size and mucoid fluid to appear on vaginal walls for lubrication.
Spinnbarkeit is the property of cervical mucus to stretch a distance before breaking ●​ The vagina widens in diameter and increases in length.
●​ Breast nipples become erect. In chromosomal males, penile erection occurs
Sexual Health as well as scrotal thickening and elevation of the testes.
●​ Sexuality is a multidimensional phenomenon that includes feelings, attitudes, ●​ In both sexes, there is an increase in heart and respiratory rate and blood
and actions. pressure.
●​ It has both biological and cultural diversity components.
●​ It encompasses and gives direction to a person's physical, emotional, social, Plateau
and intellectual responses throughout life. ●​ The plateau stage is reached just before orgasm.
 ●​ The clitoris is drawn forward and retracts under the clitoral prepuce, the lower ●​ Females do not go through this refractory period, so it is possible for those
part of the vagina becomes extremely congested (formation of the orgasmic who are interested and properly stimulated to have additional orgasms
platform), and there is increased breast nipple elevation. immediately after the first.
●​ Vasocongestion leads to distention of the penis. Heart rate increases to 100
to 175 beats per minute and respiratory rate to about 40 breaths per minute THE INFLUENCE OF THE MENSTRUAL CYCLE ON SEXUAL

Orgasm ●​ During the second half Menstrual cycle-the luteal phase-there is increased
●​ Orgasm occurs when stimulation proceeds through the plateau stage to a fluid retention and vasocongestion in the lower pelvis.
point at which a vigorous contraction of muscles in the pelvic area expels or ●​ Because some vasocongestion is already present at the beginning of the
dissipates blood and fluid from the area of congestion. excitement stage of the sexual response, the plateau stage is reached more
●​ The average number of clitoral and vaginal contractions is eight to 15 quickly and orgasm occurs more readily during this time.
contractions at intervals of one every 0.8 seconds. ●​ There may also be an increased libido during this time.
●​ Penile muscle contractions surrounding the seminal vessels and prostate
project semen into the proximal urethra. THE INFLUENCE OF PREGNANCY ON SEXUAL RESPONSE

Orgasm ●​ Pregnancy is another time in life when there is vasocongestion of the lower
●​ These penile contractions are followed immediately by three to seven pelvis because of the blood supply needed by a rapidly growing fetus. This
propulsive ejaculatory contractions, occurring at the same time interval as causes some to experience their first orgasm during pregnancy.
clitoral and vaginal contractions, which force semen from the penis ●​ Following a pregnancy, many individuals continue to experience increased
●​ As the shortest stage in the sexual response cycle, orgasm is usually sexual interest because the new growth of blood vessels during pregnancy
experienced as intense pleasure affecting the whole body, not just the pelvic lasts for some time and continues to facilitate pelvic vasocongestion.
area.
●​ It is also a highly personal experience: Descriptions of orgasms vary greatly ●​ For some, the increased breast engorgement that accompanies pregnancy
from person to person. results in extreme breast sensitivity during coitus.
●​ Foreplay that includes sucking or massaging of the breasts may also cause
Resolution release of oxytocin, but it is not contraindicated unless there is a history of
●​ The resolution is a 30-minute period during which the external and internal premature labor.
genital organs return to an unaroused state.
●​ For the male, a refractory period occurs during which further orgasm is MASTURBATION
impossible. ●​ Masturbation is self-stimulation for erotic pleasure; it can also be a mutually
enjoyable activity for sexual partners. It offers sexual release, which may be
interpreted by the person as overall tension or anxiety relief. Masters and
 Johnson (1966) reported that the female partner may find masturbation to
orgasm the most satisfying sexual expression and use it more commonly
than the male partner.

SEXUAL HARASSMENT AND VIOLENCE

●​ Sexual harassment is unwanted, repeated sexual advances, remarks, or

behavior toward another that is offensive to the recipient or interferes with job
or school performance.
●​ It can involve actions as obvious as a job superior demanding sexual favors
from an employee, or it could be a person sending sexist jokes by email to
another person in the department

Two types exist.

●​ One is quid pro quo (an equal exchange), in which an employer asks for
something in return for sexual favors, such as a hiring or promotion
preference.
●​ The second is a hostile work environment, in which an employer creates an
environment in which an employee feels uncomfortable and exploited (such
as being addressed as "honey" or "babe," asked to wear revealing clothing,
or working where walls are decorated with sexist posters).

●​ Sexual harassment rules apply to same-gender as well as opposite-gender

harassment.
●​ In addition to causing occupational disruption, sexual harassment may be so
distressing that it can lead to short- or long-term psychosocial consequences
for victims and their families, such as emotional distress (e.g., anxiety,
depression, posttraumatic stress disorder, substance abuse), interpersonal
conflict, and impaired intimacy and sexual functioning