3.-Reproductive-system-discussion.docx

 **Gametogenesis** -- the development of the egg and sperm cell - **Oogenesis** -- the egg production - Distinctly in a cyclic event - Oocytes go the process of atresia or degeneration - Only 2 million remain at the time of birth, they start deve...

 **Gametogenesis** -- the development of the egg and sperm cell - **Oogenesis** -- the egg production - Distinctly in a cyclic event - Oocytes go the process of atresia or degeneration - Only 2 million remain at the time of birth, they start developing intrauterine but are dormant - Intrauterine -- inside the womb - By puberty only 400 thousand remain. - Beginning in the adolescent period, the follicle stimulating hormone will stimulate the primary oocytes to complete the meiosis. - **Meiosis** -- yield 2 haploid daughter cells of equal size, the one will become the egg and the other one as polar body. - Secondary oocytes will proceed as far as the metaphase only until ovulation. - If it is fertilized during sexual contact, it will complete meiosis producing a second polar body. That larger remaining egg will unite with sperm cell producing the zygote - You are only producing 1 mature egg cell every month. - **Spermatogenesis** -- the production of sperm cell - The production does not start intrauterine - It starts in pre-adolescent period. - Once starts, with the presence of testosterone produced in testicular area will start the production of sperm cell - It takes 74 days for the cell to mature - A normal male will produce 100 million sperm cell per day but that does not mean that it is mature. - The seminal fluid only contains 5% of sperm cells - For sperm to survive: - There is a need for nutrients such as fructose (main nutritive factor in seminal fluid). - There are certain conditions for sperm to survive, it should be: - Constant alkaline environment - **Spermine** is a base that reduces acidity by buffering the vaginal canal. - Sperm is only viable for 72 hours and around a hundred will be able to reach its destination.  The reproductive organs of male and female are homologous - They have similar structure, similar functions, and same germ layer. - The reproductive organs are the last body systems that actually develops. Fertilization will not occur in the first 8 to 10 years of life. - Sex cells: X and Y chromosomes  A. **Intrauterine development** - Establishment the **genotypic sex** - Genotypic sex - chromosomal or genetic sex: Genotypically XX (women) or XY (male) - Development of **phenotypic sex** - The physical expression of genotypic - Testis and penis are phenotypically male while vagina and mammary glands are phenotypically female - **Hermaphroditism** -- if genotypic sex is not concurrent with phenotypic sex - True hermaphroditism - False hermaphroditism The Development of phenotypic sex - Within 5 weeks into the pregnancy - The primitive gonadal tissues formed into 2 undifferentiated ducts - MALE - **mesonephric duct or wolffian duct** - FEMALE -**paramesonephric or mullerian duct** - At 8 weeks into pregnancy or 2 months: - The primitive testes will start to produce the testosterone. The paramesonephric duct will regress. - At 10 weeks: - If you do not produce testosterone, the mesonephric duct will regress and the paramesonephric duct will develop. The oocytes will develop into eggs. - At 12 weeks: - You will see external genitalia development. - At 24 weeks: - The oocytes will already be produced in female. - At 34 to 38 weeks of pregnancy: - The testes will descent into scrotal sac for male from the abdominal area - At 38 to 42 weeks: - The external genitalia is completely developed - You have 300K to 400K immature oocytes in the ovary. B. **Extrauterine Development** - Occurs from birth to full development of secondary characteristics - **Birth** -- prepubertal age (DORMANT STATE) - There is nothing happening in the reproductive organs. - Due to immaturity of hypothalamic function, absence of fat deposit and reproductive hormones. - **Puberty** -- period between childhood and attainment of adult sexual characteristics and function. - Boys mature 2 years later than girls - Varies widely in sequence, the spurt growth changes overlap. **PHYSIOLOGY OF PUBERTY** - The hypothalamic function is not mature, its activity is not active. Once it matured during the pubertal stage, the nervous system will release the neurotransmitter **GnRH (Gonadotropic releasing hormone).** - **Follicle stimulating hormone releasing hormone** and **luteinizing hormone** **releasing hormone** are produced via hypothalamus. IN MALE - Activates the **anterior pituitary gland** releasing the **follicle stimulating hormone** and **luteinizing hormone.** - In male: The FSH activate the release of **ABP (androgen binding protein)** that promotes sperm formation. This produce and mature the sperm cell. - A **negative feedback mechanism** will start to decrease its production. - There will be release the **luteinizing hormone** in courtesy of hypothalamus. It decreases the amount of FSH, and it is responsible for the release of testosterone from testes. - The secondary characteristics starts to develop. IF THE HYPOTHALAIC FUNCTION DOES NOT MATURE THE PROCESS WILL NOT START. - There is a blockage in the passage of sperm cell. - There might be a tumor in the brain or problem in the biochemical function that inhibits the function of pituitary gland. - Neurotransmitter are not released. THEREFORE, MALE STERILITY CAN BE TRACED TO NEUROTRANSMITTER FUNCTION. IN FEMALE - Since ovary is the female the primary sex organ, it produces the egg and produces the estrogen and progesterone for development of secondary sex characteristics. - Since it came from the same germ layer and process, identifying process will be the same - If eggs cannot be produced: - Fallopian tube is blocked or scarred due to STI or repeated UTI, PCOS. - Endocrine system or neurofunction has problem. **Tanner staging** -- staging where it is based on the presence of secondary sex characteristics.    **SCROTUM** - Highly rugated -- forms the ridges - It supports and protects the testes - It is responsible for regulating the temperature (1 to 3 centigrade lower or higher than the body is the limit of sperm for survival) - Scrotum is composed of skin and dartos of muscle - **Dartos muscle** produces a certain smell - **RAPHE** -- the consistency of the scrotal surface. Site of incision where the vasectomy is done. - Anatomically, there are 2 structures that are unequal: the scrotum and breast - The left hangs lower than the right **PENIS** - Made up of 3 columns of erectile tissue - **Corpus cavernosum (Pair**) - **Corpus spongiosum** - Both covers the urethra - Full of erectile tissues that allows it to harden **Glans penis** -- located at distal end **Urethral meatus or opening** **Prepuce** -- circular fold that has the capacity to engorge during sexual stimulation **Shaft** -- 4 to 5 inches for Filipinos - Innervated by **pudendal nerve,** very sensitive has the capacity to erect under **parasympathetic nerve stimulation** Functions of external structures: 1. For copulation 2. For excretion of urine **INTERNAL STRUCTURE**  **TESTICLE** -- covered by scrotal sac - Two ovoid glands formed in the pelvic cavity and during intrauterine development it will go down bilaterally unto the scrotum. - **Cryptorchidism** -- the testes doesn't go down. - Unilateral -- reduce 50% - Bilateral -- reduce 100% **Seminiferous tubule** -- very convoluted - This is where the sperm production occurs - Surrounded by blood and vessels - You'll find the: - **Leydig cell** -- produce the testosterone - **Sertoli's cell** -- nourishes and protects the sperm - Site for spermatogenesis and production of testosterone - Forms the **Rete testes** - Thinwalled spaces that forms around 10-15 efferent ducts that empty to epididymis **EPIDIDYMIS** - 5 to 10 meters long - Produces 5% of seminal fluid - Sperm stays in it for 2 to 10 days. - For the very long epididymis it will take 12 to 20 days for sperm to go out. - Reservoir for maturity of sperm cell - 50 to 120 million sperm cells per mL **VAS DEFERENS OR DUCTUS DEFERENS** - 40 centimeters long straight organ. - Joins the spermatic cord - Expands to form the termina ampulla - Unite with seminal vesicle to form the ejaculatory duct - It squeezes rapidly the sperm from the epididymis to next reproductive organ. - It is area for sterilization as it not produces seminal fluid. **SEMINAL VESICLE** - At posterior service of the bladder - Anchored and above the prostate gland - Secrete alkaline liquid: prostaglandin, fibrinogen, and fructose - Produce the energy source of the sperm cell - Produces 30% of total seminal fluid **PROSTATE GLAND** - Chestnut in size - Located just below the bladder - Secretes 40% of total alkaline fluid that contains zinc, calcium, citric acid, etc. - These minerals help the protection of sperm from immobilizing. **BULBOURETHRAL GLAND OR COWPER'S GLAND** - Produces that last 5% of seminal fluid that contains the mucoproteins - It ensures more safety for the sperm cell, facilitates smooth sperm passage by making the uterine tube alkaline in nature. **URETHRA** - Hollow 6 to 8 inches long - Exit point of both urine and seminal fluid containing the sperm cell. ALL STRUCTURE ARE DESINGED SO THAT THE SPERM CELL WILL BE EJACULATED AT CERTAIN POINT IN TIME FOR CONTINUATION OF HUMAN SPECIES  72 hours to survive **SMEGMA** -- accumulation of dirt at prepuce causing **balanitis** that is why there is a need for circumcision. Should be more than 20 million Factors that relate to male infertility - Temperature - Job description such as exposure to head and radiation - Physiological disorders - Taking in of anti-hypertensive and antidiabetic drugs.  **Cephalocaudal** -- from head going down **Proximodistal** -- center to peripheries **Wet dreams** -- result of spurt production  **EXTERNAL STRUCTURES** **PODENDA OR VULVA** **MONS PUBIS OR MONS VENERIS** - Pad of adipose tissue over the pubic bone which cover or protect the pubic bone or the symphysis pubis from trauma - Area that is covered with pubic hair 2 liplike structure 1. Labia majora 2. Labia Minora **LABIA MAJORA OR LABIA MAJUS** - Made up of adipose tissue, partly with some hair and covered with lots of connective tissue (sensitive) - The outer lip - To protect the external genitalia (protective mechanism) **LABIA MINORA OR LABIA MINUS** - Lip that is hairless and has a lot of connective tissue in the external surface - Covering is mucus membrane in the internal surface. - With a lot of sebaceous glands which is very important for secretions of the female. - At the tip on the upper portion is the clitoris (clitoral head) **CLITORAL HEAD** - Composed of several layers of tissue that has the capacity to be stimulated - Homologous to the penis (can be hardened and develop into a bigger structure) - During stimulation, can expand into as much as 8 times its normal size - Located at the upper portion of labia minora - Skinfolds In between both labias. - Very sensitive due to stimulation of surrounded **ischiocavernosus** muscle - Tip of labia minora and in between labia majora is the fourchette **FOURCHETTE** - Lower portion between the minora and majora and involved during **episiotomy** -- surgical incision done before the delivery of the baby **VESTIBULE** - Whole middle portion enclosed by minora - Boat-like depression in the middle of the labia - There are 6 openings: Contains the **vaginal opening** (lower portion), **urethral meatus** (upper portion), **skene's gland or paraurethral gland** (below the meatus), **Bartholin's gland or paravaginal gland** (near the vagina) - During sexual stimulation, they are responsible in producing certain secretions that helps in lubrications. - Blood supply is provided by **pudendal artery** and portion of **inferior rectus artery** - Nerve supply -- provided by **Genitofemoral nerves from L1** and **pudendal nerve from S3** **BREAST OR MAMMARY GLAND** **Mammary gland** - Supported by **cooper's ligament** (hold up) - Each breast contains 20 lobes, during lactation they are very active and produce milk. They are referred to as milk glands. - Milk empties via **lactiferous duct** during lactation - The **nipple** contains 20 openings - Each lobule is composed of **arsenal cells** that produces milk when lactating - Nipple is surrounded by **areola** - Areola is quite rough because of **Montgomery's tubercle** - a lot of sebaceous glands which cause roughness in areola and serve as protective mechanism in nipple - Main function: nutritive value for the baby and stimulation during sexual contact - Blood supply comes from **thoracic branches (axillary artery)** and **intercostal arteries**. - Lactiferous ducts and lobes are only active when lactating; erectile tissues are active during stimulation that causes nipples to erect - Good references during CPR by locating the midportion of the nipple and in the middle of the chest.  INTERNAL FEMALE REPRODUCTIVE SYSTEM **VAGINAL CANAL** - Around 4 to 6 inches - Highly rugated - Hollow (should not be containing anything at this time); very muscular because it has the capacity to expand and to elongate - Located posterior to the bladder and anterior to the rectum - Vaginal lining - Produces glycogen where **Doderlein's Bacillus** resides - Normal flora of vaginal canal composed mainly of doderlein's bacillus which is a lactus fermenting bacteria -- if lots of glycogen are produced, it breaks down the glycogen forming lactic acid making the vaginal canal highly acidic. - **From birth to prepubertal** **--** 7 to 7.5 pH alkalinic - **Pubertal** -- 4.2 to 4.5 pH acidic (have active bacteria and active glycogen production) - **Post-menopausal** **-- 7.5 pH** (not producing estrogen, not active) - Healthy female -- do not need to use very strong female wash or douche because normal flora (doderlein's bacillus) make sure that the vaginal canal is acidic - Use unless a female has sexually transmitted infection, sexually pregnant, or have multiple partners - Blood supply comes from vaginal artery which emanates from iliac artery - Nerve supply comes from S1 and S3 - Function: - Entry point of sperm cell - External passage of fetus and menstrual product - Protects from trauma of coitus and infection - **Hymen** -- a very thin sheet that is supposed to be present in women, but easily torn with strenuous activities such as contact sport, gymnastics, horseback ridings, and sex. **UTERUS** - The womb - In non-pregnant form, it is 40 to 70 grams and pear shaped and size of the fist, hollow, and highly muscular (will be assuming a lot of function such as growth of fetus) - Around 6 to 8 cm long and divided into 3 areas - **Cervix** -- Lower most portion - **Isthmus** -- middle portion - **Corpus or the body or endometrial cavity** -- upper portion a. **CERVIX OR CERVICAL AREA** - Lowest portion connected to the vagina; supposed to be rosy red or pink - Only around 2.5 cm long from internal OS - ***Internal OS** --* junction of cervix and isthmus to the external OS - ***External OS and Internal OS*** - only open during menstrual period and active labor - start from external OS to internal OS - Can go **effacement** (thinning) and **dilatation** (enlargement) - When a woman is in labor, supposed to perform internal examination, - you will insert the middle and pointing finger into the vaginal canal to reach the cervical area to measure how wide it is already - 1 inch is considered as dilation of the patient - If pregnant, the measurement is 10 when middle finger and pointing finger has fully separated - it is how wide the cervical area will expand, then the baby is about to delivered - Composed of 1/3 of the total uterine size - The consistency is very alkalinic environment - It is where sperm cell can survive - Contains a lot of mucus secreting glands that work as lubricant and bacteriostatic b. **ISTHMUS** - Starts from the internal OS up to corpus (body of the uterus) - Very short around 6 mm - Joins the body to the cervix - If pregnant, considered as **lower uterine segment** which is a site for low segment cesarian section. c. **CORPUS OR ENDOMETRIAL CAVITY** - The body - ***Fundus*** -- uppermost part which can be palpated abdominally to determine uterine growth (can only palpate when the woman is pregnant); at the back of urinary bladder - Basis of palpation when the woman just delivered - Palpate in the first 2 weeks after delivery - ***Cornual** -* Point of insertion of the fallopian tube and this area shortens when in advance pregnancy or labor **UTERINE BODY** -- Compose of 3 layers **WALL OF UTERUS** **PERIMETRIUM** -- outermost layer or serosal layer - Made up of a lot of longitudinal muscles and covered by peritoneal lining **MYOMETRIUM** -- middle layer - Composed of muscle fibers that made up of figure of 8 pattern - Responsible for contractions that produce hemostatic actions. - During menstruation, it is very active because of its very unique configuration of a figure of 8 and has the capacity to stop the bleeding. - During labor, it is the one that will push the baby **ENDOMETRIUM** -- the outermost layer - Made up of mucosal layer - Undergo monthly degeneration or monthly renewal - one being sloughed off during menstruation - Thickens because of hormone, sloughed off, and degenerate as the menstruation - Produces thin watery alkaline solutions help sperm travel upward during intravaginal ejaculation and sperm cell are deposited in the cervical area - Successful fertilization, this characteristic allows nourishment of the developing embryo before implantation - During pregnancy, it is called decidua **What makes the uterus stand up?** - Lot of uterine ligaments that helps the uterus stand up - In the upper segment - **Broad ligament** keeps the uterus centrally placed and provides stability within the pelvic cavity - **Round ligament** arises from sides of the uterus to make it steady (during labor) and pulls the uterus down ward and forward so that fetal presenting part is moved to the cervix - **Round and broad ligament** - does not only maintain the location and placement of the uterus, it is also responsible for more efficient delivery of the fetus **CENTER PORTION OF THE UTERUS:** **In the middle segment** 1. **Cardinal ligament/ Mackenrodt ligament/ transverse cervical ligament** -- the one that suspends the uterus and arise from the side pelvic wall. Prevents uterine prolapse to avoid uterus to fall downward to the vaginal canal 2. **Uterosacral ligament** -- contains lot of sensory fibers and contributes to dysmenorrhea 3. **Pubocervical ligament** **Lower segment** 1. **Iliococcygeal ligament** 2. **Pubococcygeal** 3. **Puborectalis** 4. **Pubovaginalis ligament** - All support the muscular floor Blood supply of the uterus -- provided by **uterine** and **azygous artery** Nerve supply -- emanating from **T5** **to T10 for efferent nerves** and **T11 to T12 for afferent nerves** **FALLOPIAN TUBE/ UTERINE TUBE/ OVIDUCT (BILATERAL)** - Around 8 to 13.5 centimeters or more than 1 foot - It is emanating on both sides connected to uterus and spread (eagle like) on both sides of the pelvic cavity  **INTERSTITIAL** - very short around 1 centimeter that opens to the uterus **ISTHMUS** - Thin part, narrow, straight and the site for bilateral tubal ligation **AMPULLA OR AMPULLARY REGION** - Outer two-thirds portion of the uterine tube or fallopian tube - Curved and the site for fertilization (where egg cell is deposited) - Curved part of the uterus **INFUNDIBULUM** - Funnel shape and has fingerlike projections - Has **fimbriae ovarica** that is the only one attached to the ovary - Transport ovum by ciliary action from the ovary to the fallopian tube - The fallopian tube provide nourishment to the egg (ovum) or zygote if egg is already fertilized **OVARY** - Bilateral; almond shape; 6 to 10 grams located below the pelvic brim - Female sex gonad: male (testes) counterpart - It does not have any covering **(peritoneal covering)** - allows eruption and easy release of the egg cell, however it can also easily spread cancer cells. - It has 3 layers: - **tunica albuginea** -- outer most part - **Cortex** -- contains ova and follicle - **Medulla** -- surrounded by cortex where nerve endings, blood vessels and lymphatic vessels are located - It matures and releases the egg cell and produces: - **Estrogen** - when achieved already, responsible for the development of secondary sex characteristics; increases bone growth and helps in closure of epiphyseal lining - **Progesterone** -- decreases uterine motility, increases vegetation in the uterus that prepares uterus, prepares breast for lactation, influences cervix to produce very thick mucus (mucus plug) for protection - **Neurohormonal basis** -- signals that is received by the ovary so that female hormone is produced and egg and at the same time, develop the second sex characteristics  - After initial menstrual period, able to produce egg cell already 1-2 years after REPRODUCTIVE SYSTEM - Last to be developed organ or being capable of doing their intended function because they are not use yet at early years of life until puberty life - ***puberty*** -- noting the entire transition stage between childhood and adulthood and signaled by the sexual maturity a person has - development of secondary sex characteristics - production of hormones - females -- transition is manifested by the menstrual cycle (periodic uterine shedding; 14 days after ovulation and usually starts 10-11 years old) - Synergy between the maturity of anterior pituitary gland and hypothalamic center and central nervous system would always be the primary factor to consider where the reproductive system production and maturity is concern - Without the maturity of central nervous system (brain), will not be able to activate properly the reproductive system - **Genotypic sex --** X and Y chromosome from the parents - **Phenotypic sex --** external manifestation of genotypic sex (ex: secondary sex characteristics and internal reproductive system) - This is a process that allows for conception and implantation of a new life. - It allows the shedding and renewal of internal layers of endometrium. - If did not happen, implantation will not be possible - It's purpose is to bring ovum into maturity with interplay of neurohormonal cycle, ovarian cycle and uterine cycle. - Uterine cycle -- renewal of uterine tissue bed that will be responsible for the growth of an egg cell once it is fertilized - It is controlled by the feedback system - The hypothalamic - The ovarian cycle - The uterine or endometrium cycle - 28 days -- average cycle - 5 days -- average duration - Average of 50-80 ml of blood loss - Mild abdominal cramping - Can be affected by many factors: - Fats - Age - Genes - Weight - Should be irregular, unpredictable, painless, and anovulatory - After sustaining a neurohormonal rhythm, will establish the regular production of estrogen of the ovaries so that the regular production or development of ovum will be attained. - Each of these cycles are varying. - Some are 28 days, some are 33 days - The body has to be able to regularly attract rhythm -- will happen if there is a regular function of the parts of the brain that are responsible in initiating action in reproductive organ - On average, the cycle repeats each 28 days, 10-15% of female - Ovulation is at the midpoint before the onset of the next menstruation  LAYERS OF UTERUS - Innermost layer -- endometrium - Middle layer -- myometrium - Outermost layer -- perimetrium Upon reaching prepubertal: The central nervous system will signal the start of the cycle via the neurotransmitters that it is going to produce. The central nervous system starts by activating the hypothalamus to produce FSHRH (first to produce) and LHRH, the anterior pituitary gland will be activated in response to increase of FSHRH. APG will release the FSH. It will tell the ovary to mature a follicle and produce estrogen. The feedback mechanism starts, (in neuroendocrine principle) every time 1 hormone increases, there will be 1 hormone that will decrease its production. Via efferent nerve, it will give signal to hypothalamus, stopping the production of FHSRH, then start producing LHRH, the anterior pituitary gland will stop producing the FSH and start producing the LH. LH will luteinize the theca (ruptured follicle) and reduce the production of estrogen production of the ovary and increase the progesterone production. The dominant hormone that the ovary produce will be progesterone (estrogen decreases). If that happens, as the days go by, the estrogen and progesterone role is done and decrease in amount, a response comes in. The response and effect of feedback mechanism, prostaglandin will be produced by the endometrial cells, will cause vasoconstriction and later on relaxation of the smooth muscle and then vasodilation. The increase of prostaglandins will cause the shedding of uterus and start the menstrual period and cramping, meaning another cycle  **UTERINE CYCLE** This depicts the changes of follicle and whatever it undergoes during its phases. - Follicular phase - Luteal phase When anterior pituitary gland produces FSH, travel through blood, then go to ovary. Follicular phase -- first days (1-14 days) because primarily, the primordial follicles (immature follicles) mature because of the presence of FSH When FSH (influencing hormone) increases, the primordial follicle starts to mature for 14 days. Because of maturation of the follicle, it will [produce estrogen] and the peak of estrogen increase in the 13^th^ day. The primordial follicle will become the **graafian follicle** (appears on the 14^th^ day). Once it is already matured, this will now be discharged and released near the fimbria (edge of the fallopian tube; finger-like projections that attract the egg cells so that it will go inside the fallopian tube). It will attract on the 14^th^ day and will release because of the very high FSH and estrogen. Once raptured and released, it is called the **ovulation (divides the follicular and luteal phase)**. - Yellow with brownish color inside structure -- follicle where the mature egg came from The follicle where the mature egg came from were left, this will signal the luteal phase (15^th^ to the 28^th^ day of the cycle) - Make an egg (mature the egg) - Produce estrogen  Luteal phase. This is the time where the ovum has already left the follicle, this is now called the corpus luteum (budding off). The corpus luteum will developed from the ruptured follicle and due to the [presence of luteinizing phase] (influencing hormone). It is called corpus luteum, because the lutein causes yellowish, spherical, and vascularized after 2 to 3 days and will degenerate after ovulation because no one will sustain it. After a week, this will become the corpus albicans (white), corpus means body, and albicans means it is already a tissue scar. This will mean that the prostaglandin production will be increased stimulating the hypothalamic response again making it cyclic. - Creation of corpus luteum (body of yellow substance) - Production of progesterone **UTERINE CYCLE** PRE-OVULATORY STAGE a. Menses b. Proliferative POST-OVULATORY STAGE a. Secretory b. Ischemic - Menstrual or uterine cycle -- tells what happens in the uterus; the bleeding cycle is experienced in response to cycling hormonal changes brought about by the ovary (produce estrogen and progesterone) 4 phases: proliferative phase, secretory phase, ischemic phase, menstrual phase MENSTRUAL PHASE - First 1 to 5^th^ day of cycle. - The hormonal levels are low, very small or scant cervical mucus, but have menses composing blood, mucin, endometrial tissue, and unfertilized egg (every month) - Very distinct odor compared to marigold flower. - The blood loss is around 40 to 80 mL (some are 50 to 80 mL) - The endometrial tissue makes it heavier not the blood. - The regular menstrual blood loss will cause women to loss 0.5 to 1 mg iron per day making them prone to anemia and blood related disorder (secondary to blood loss during menses) - During the menstrual phase, all the hormones are very low except the **prostaglandin** which is very high. PROLEFIRATIVE PHASE - 6^th^ to 14^th^ day of cycle. - This is the time where the endometrial gland began to expand and twisted (layer are renewed). Endometrium will thicken 6 to 8x more, and the peak is before ovulation (14^th^ day). Cervical mucosal secretion become thin and watery and more alkaline as you go along the days favoring the sperm environment in preparation of fertilization and implantation. - As the days goes along until the 14^th^ day, cervical mucus changes in consistency (thin, alkaline/alkalinic, watery) - Endometrium thickens in preparation for ovulation, impending fertilization, and implantation - Ovulation divide it to secretory phase. SECRETORY PHASE - From the 15^th^ to 25^th^ day (some 26^th^ day) - The uterine endometrium become corkscrew, twisted, dilated, many glycogens, and mucin (protein). - Progesterone production is high putting more vegetation in anticipation of implantation making it (uterus) highly vascularize. ISCHEMIC PHASE - Starts 26^th^ to 28^th^ day - The corkscrew or twisted arteries will start to constrict then retract causing deficient blood supply to the endometrium - because the estrogen and progesterone amount will drop. - The degeneration of endometrial lining will start because all the capillaries will rupture, do not have good vegetation, no nutrients - It will signal shedding going back to menstrual cycle. - Ovulation -- divides proliferative (14^th^ day) and secretory phase  - Ovulation occurs 14 days before the onset of the next menses. - Broken line -- ovulation - First day of menstrual flow is the marker for expected date of birth - In cyclic process, the last half of the cycle is always constant. - The egg cell can live 24 to 48 hours and sperm is 48 to 72 hours. - During ovulation period, the libido of girl is at its peak. - Female -- can achieve higher number of orgasm due mainly to the increase of retention of fluid and capability of the lower pelvic area to vasoconstrict in response to the influence of hormones **MENSTRUAL CYCLE**  **Ovulation** -- release of mature egg from the ovarian follicle and depicted by a lot of ways. 4 ways to take note of ovulation: **1. FERN TEST**  - Cervical or vaginal mucus under the microscope, it will show a broken glass pattern. - Fern like pattern is caused by high amounts of estrogen. - If positive, this is the best time for sexual contact, because you are at the peak of last phase of follicular phase, about to undergo ovulation and you can get pregnant any time. **2. SPINNBARKEIT TEST**  - Check the cervical mucus on the 14^th^ or 13^th^ day, when it is collected, it is stretchy around 6 mm - Effects of estrogen in cervical mucus - Estrogen levels are high. - If positive, ovulation is possible **3. MITTLESCHMERZ** - Pain on the right or left lower quadrant. - Some women are very sensitive, they felt the rupture of graafian follicle and release of ovum resulting in acute pain that is called mittelschmerz. **4. MITTLESTAIN** - In some women upon the rupture of the egg, there is very minimal bleeding seen externally during ovulation. **5.** Increase of temperature of 0.3 to 0.6 degrees Centigrade within 24-48 hours during ovulation/ **BASAL BODY TEMPERATURE INCREASE.** Ex: 37.2 temp 37.3 (depict ovulation; pursue in a day or 2 days) Based on uterine cycle Menses - June 1 to 5 Proliferative -- June 6 to 14 (14^th^ day is the peak; 13^th^ day has the highest estrogen influence) Ovulation -- 14^th^ of Night; positive in 5 indication and be pregnant during 15 to 17. Secretory -- June 15 to 25^th^ Ischemic phase -- June 26 to 28^th^ Menstruation starts at 29^th^ - The last half of the cycle is always constant because only starts after ovulation **HEALTH EDUCATION DURING MENSTRUATION (**high amount of prostaglandins can cause massive abdominal and muscle contraction) - **Moderate exercises** -- start in breathing - **Sexual intercourse in not contraindicated** - **Promotion of hygiene** - High amount of prostaglandin can cause massive abdominal and muscle contraction.  **Post-menopausal period** - Occurs around 40 to 45 years old - Signals the start of menopausal period - Physiological changes like hot flashes, irritability and menstrual pattern changes **Menopausal period** - Around 45 to 55 years old - The earlier the menarche, the earlier the menopausal period. - Permanent cessation of menses will occur - End the ability to conceive and the time where there is sudden estrogen decrease. Resulting in mood swings, osteoporosis, amenorrhea.  **Menstrual history:** - **M -- menarche** (first menstrual period) - **I -- interval** (from first menstruation up until now what are days apart) - **D -- duration** (how long is menstruation) - **A -- amount** (how many pads, and is it fully soaked? 1 mg = 1 mL) - **S -- signs and symptoms** accompanying the menses of the patient (**Dysmenorrhea** -- pain during menstrual period)  If these things occur on a female, document it, let them look for check ups - It would indicate hormonal imbalances or pregnancy - Iron lost during menstruation -You can only get access to family planning methods at the age of 17. **Oginoknause formula** -- used by women who have regular cycle **Obstetric history** -- check for gynecologic diseases, does the female perform breast self-exam every month? Get number of sexual contacts. **OGINOKNAUSE FORMULA**  **LMP** -- (last menstrual period) when you are supposed to start countering (June 6) - Count back 14 days (ovulation is 14 days before the onset of menses) - May 22-23 is the ovulation of the client The woman has a regular cycle for the last 6 months. - **Shortest cycle** 25 -- 18 (constant) = 7 - **Longest cycle** 29 -- 11 (constant) = 18 - **Fertile days**: Therefore, from the 7^th^ to the 18^th^ day of each month, you are fertile, you cannot have sexual contact, because there is a high probability that you'll ovulate and get pregnant.   Some women will experience any of the symptoms. If and when sexual contact occurs this is will happen. - Pre-Embryonic stage - Embryonic stage