WK1 - Menstrual Cycle PDF

Bachelor of Science in Nursing 2YA NCMA217 LEC: MENSTRUATION Discussed by Prof. Francis Vasquez MENSTRUATION Menstruation Ovulation...

Bachelor of Science in Nursing 2YA NCMA217 LEC: MENSTRUATION Discussed by Prof. Francis Vasquez MENSTRUATION Menstruation Ovulation Menstruation - A periodic cyclic discharge of blood coming from the uterus. - A periodic, cyclic, regular, monthly discharge of blood coming Day 1 Day 14 Day 28 from the uterus. Day 1-5 safe & (-5) (+3) - Uterus - organ of menstruation Day 18-28 safe Day 6- 8 Days 9 to 17 - Average blood loss during menstrual period – 30 to 80 cc, an average of 60 cc. Example: 5 days of menstruation - 60 cc = ¼ cup. o Days 1-5 = menstrual period is safe - Iron loss (12- 29 mg) o Deduct 5 days from the day of ovulation 14-5 = 9 - If the woman is heavily having menstrual period, pwede siya o Add 3 days from the day of ovulation 14+3 =17 mamutla/ pallor. o Day 9-17 fertile window, the woman is considered fertile Menstrual period VS Menstrual Cycle o The woman is considered safe to have sex if she doesn’t - Menstrual period are the days where in the woman is want to get pregnant beyond the window so less than 9 menstruating and the average length of the menstrual period is and above 17 three to five days, maximum of seven days. o Specifically, the woman is safe to have sex from day 1 to - Menstrual cycle, starts from the first day of period to the first day 8 but days 1 to 5 have menstrual period. Therefore, day of next period (regla to regla), average of 28 days/cycle day 6- 8 and during menstrual period is safe. - Ranges from 23-35days; maximum of 40 days. o Day 18 – 28 is also safe - Occurs during puberty, 9-17 y/o average of 12 y/o. o Day 9 – 17 fertile days, not safe - First onset of menstrual cycle is menarche Recap: - Menstrual cycle can be regular or irregular. 1st half of the cycle 2nd half of the cycle 28 DAYS CYCLE 1 2 3 4 5 6 7 8 9 10 Menstruation Ovulation Menstruation 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Day 1 Day 14 Day 28 5 days explanation: Day 30 1 2 3 4 5 Day 1 Day 16 Day 1 Day 11 Day 25 9 10 11 12 13 14 28 Days Cycle Legend: Red - menstruation (safe) Ovulation - the day that the one of the 2 ovaries of the woman Green – safe days is releasing a mature egg cell. Orange - fertile window (not safe) The woman is fertile when the one of her 2 ovaries is releasing Violet- ovulation day egg cell. Blue- sex days If the woman is fertile and she had sex there is a possibility 1) If the woman is a 28-day cycle, she will ovulate on day 14, that the egg will be fertilized by the sperm and get pregnant. granted that the menstrual period of the woman is 1-5 days. How are we going to compute for the day of ovulation? 2) From the day of ovulation minus 5 (14-5 =9) & from the day - From the end of the cycle, minus 14. of ovulation plus 3 (14+3 =17) so days 9-17 she is fertile. - 28 – 14 = 14 – she will be ovulating on day 14. 3) Therefore days 1-8 she is safe but if she wants to engage in sex - This is only done by regular beyond menstrual period, she is safe from days 6-8 and from Hormone estrogen is high on the first half of the cycle. day 18-28. Hormone progesterone is high on the second half of the cycle. - Q: Is she ovulating at day 9? A: No, because day 14 is the The length of the cycle affects the day of the cycle? Yes ovulation day The day of ovulation is based on the cycle 1) Day 9 is 5 days before ovulation, means that if you have sex If the length of the cycle is changing every month, then the on day 9 sperm enters the vagina → cervix (w/in 90 sec) → day of your ovulation every month is also changing, then you uterine cavity → fallopian tube (reached w/in 5 min) and; are not regular. 2) Starting from day 9 the sperm is waiting in the ampulla of the fallopian tube for the arrival of the egg for 5 days (kase diba Fertile window ang life span ng sperm is 3-5 days so 5 days siyang mag - These are the days the woman is considered fertile. hihintay sa ampulla) and the egg will arrive on the 5th day at - If you want to get pregnant have sex during the fertile window. exactly day 14 (ovulation day) in the ampulla of the fallopian - If you don’t want to get pregnant have sex outside the window. tube therefore she will get pregnant even if the sex was 5 days ago. J.A.K.E 1 of 4  NCMA217 LEC: WEEK 1 – MENSTRUATION (SIR VASQUEZ) 3) Note the sperm lives for 3-5 days that is why you have to Menstruation Ovulation Menstruation subtract 5 and add 3 is derived from the life span of the ovum/egg cell. It is only 1-2 days or actually average of 24 hrs. Day 1 --------- Day 38 or 1 day, maximum of 48 hrs. or 2 days. Plus 3 kase they added 1 day. 1-5 MP (1-2 safe) 3-27 FW 28-38 safe 4) If you don’t want to get pregnant have sex more than 5 days - Day 5 still menstruating and day 3 ovulation day- they are before ovulation: day 8 paatras. overlapping Another Example: 4 days of menstruation 38 DAYS CYCLE o Fertile window: 19-27 1 2 3 4 5 6 7 8 9 10 o Safe days: 1-18 and 28-38 11 12 13 14 15 16 17 18 19 20 o Ovulation day: 24 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 38 DAYS CYCLE 1 2 3 4 5 6 7 8 9 10 38 Days Cycle for Irregular Legend: 11 12 13 14 15 16 17 18 19 20 Red - menstruation (safe) 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Green – safe days Orange - fertile window (not safe) 38 Days Cycle Legend: NO ovulation day Red - menstruation (safe) 4 Important Structures Green – safe days - That regulate/control the menstrual cycle Orange - fertile window (not safe) - Hypothalamus gland that starts menstrual cycle → Violet- ovulation day hypothalamus stimulates what gland? anterior pituitary gland For irregular there is computation but it is not highly → APG stimulates what organ? ovaries → ovaries affect what recommended because from the very beginning the woman is organ? uterus. irregular. 1. Hypothalamus To know if you are regular or not you have to: Producing:  Monitor your menstrual cycle for at least 6 mos. - GnRH or Gonadotropic Releasing Hormone  For regulars your menstrual cycle should be fixed to Types of GnRH: specific no. of days. o FSHRF or Follicle Stimulating Hormone Releasing Factor - Ex. Your cycle is 30-day cycle so dapat every following o LHRF or Luteinizing Hormone Releasing Factor month 30 days pa din siya. 2. Anterior pituitary gland - Although naiba nung April ng 28 hindi pa din siya Producing: considered as irregular, ask ur self if you are stressed that - FSH or Follicle Stimulating Hormone time because it can alter mens. cycle. - LH or Luteinizing Hormone Type Jan Feb March April May June 3. Ovaries Regular 30 30 30 30 30 30 Producing: Regular 30 30 30 28 30 30 - Estrogen- dominant on the 1st half of cycle Irregular 28 25 28 30 33 26 - Progesterone- dominant on the 2nd half of cycle 4. Uterus  For irregular, you must also monitor your menstrual cycle at least 6 months. Dominant on the Structures Dominant on the - You have to identify the month that has longest cycle and 1st half of cycle 2nd half of cycle the shortest cycle. FSHRF Hypothalamus LHRF - You have to deduct 11 days from the longest cycle then, FSH APG LH - Deduct 18 days from the shortest cycle. Estrogen Ovaries Progesterone - We cannot identify exactly the ovulation day but we will know the fertile window. 4 Dates in the Menstrual Cycle 1. ↓ 3rd day - the level of estrogen in the blood of the woman is Example for irregular: very low. a) (May) Longest cycle – 38 – 11 = 27 days ↑ Considered as the cycle because it is the longest o Days 1-5, she is menstruating at the beginning b) (Aug.) Shortest cycle – 21 – 18 = 3 days menstrual cycle. 2. ↑ 13th day - the level of estrogen in the blood of the woman is very high J.A.K.E 2 of 4  NCMA217 LEC: WEEK 1 – MENSTRUATION (SIR VASQUEZ) 3. ↓ 13th day - the level of progesterone in the blood of the - That high level of the estrogen will send signal to the woman is very low. APG to temporarily stop producing FSH. 4. ↑ 14th day - the level of progesterone in the blood of the - Effect: If the FSH stop producing, then ovary will no woman is very high. longer produce estrogen. (may stock na sya ng estrogen sa graafian follicle) 3rd day  E 13th day  P Second half of the Cycle (P) 1) That’s why on the 13th day of the menstrual cycle the level of Hypothalamus progesterone is very low stimulating the hypothalamus to FSHRF LHRF release LHRF. 2) LFRH stimulates the APG to release LH. Anterior pituitary gland 3) LH stimulates the ovary to release progesterone. Then, FSH LH 4) Progesterone will affect the uterus. Mat. oocyctes Triggers ovulation - When the level of LH is high, LH triggers ovulation. 13th ↑ Ovaries - The high level of progesterone will convert graafian Estrogen Progesterone follicle into corpus luteum. (Corpus luteum -yellowish) Graafian follicle Graafian follicle - Progesterone will stimulate uterus, there will be Uterus increased vascularity on endometrium Corpus luteum - Increase vascularity – building up of temporary capillary. Thickening of myo and endo ↑vascularity on endo - Progesterone builds up temporary capillaries on First half of the Cycle (E) endometrium. 1) Particularly days 1-5, on the 3rd day of menstrual period the - The blood supply will be high when there’s a build-up of level of estrogen in the blood of the woman is already very temporary capillary. low because she is menstruating. - If the blood supply in endometrium will become high, it 2) That low level of the estrogen of woman stimulates the increased supply of O2, H20, Glucose, Amino Acid. hypothalamus to start a new cycle. - Progesterone made the endometrium highly nourished. 3) Estrogen stimulate hypothalamus to release FSHRF 4) FSHRF stimulates the APG to release FSH. 5) FSH stimulates the ovary to release estrogen. Then, 6) Estrogen will affect the uterus. - Once APG release, FSH – will develop egg cells. It will cause the maturation of oocytes (1st effect). (Oocyte – immature egg cells) - (2nd effect of FSH) FSH stimulates ovaries to release estrogen so once estrogens is release, it converts the follicle of the ovary into graafian follicle. - Follicle is the compartment in the ovary where you can find the egg cells and becomes graafian follicle. Estrogen Pathway of woman getting pregnant is the hormone that is very high in the graafian follicle. Menstruation Ovulation Menstruation - The effect of the estrogen on the uterus is thickening of myometrium and endometrium. Corpus luteum (2 weeks life span) Day 1 Day 14 - Myometrium is also thickening – the uterus will slightly enlarge during menstrual cycle because of the hormone She is fertile and she had estrogen. sexual intercourse 2 months CL is aging - If the woman gets pregnant the level of estrogen is high that is why estrogen enlarges the uterus. Positive fertilization - Hindi sabay pinoproduce ng ovary ang estrogen and (beginning of pregnancy) Placenta progesterone. Isa isa lang. - Estrogen partner niya si FSH. Progesterone is LH 9th month – aging How ovaries produce progesterone? - Estro is low on 3rd day and high on 13th day so on the 13th Increase uterine day the level of estro is high and pro is low. Since the 13th Labor Low progesterone contraction day the level of estrogen is already very high, there will be a feedback effect. - Kaya minus 14 kase 14 days ang life span ng CL J.A.K.E 3 of 4  NCMA217 LEC: WEEK 1 – MENSTRUATION (SIR VASQUEZ) - Corpus luteum came from graafian follicle, GF produce To simplify estrogen. CL combines estrogen with progesterone. But progesterone is higher during pregnancy. F H L - 2 hormones produced by CL is estrogen and progesterone. A - Estrogen is high (encourage contraction) but progesterone is E O P higher (prevent contraction) and we need these 2 hormones in G U C pregnancy. - Legend: green- structure, yellow- hormones - The reason why the woman will not menstruate when she gets - FEG- HAOU- LPC pregnant because lifespan of CL after fertilization, extends - If hormones contain “RF” releasing factor it came from from 2 weeks to 2 months. Since nag extend menstruation hypothalamus walang “RF” from APG missed. - If the questions are about structures look at the middle - On the 2nd month, corpus luteum is aging/degenerating. - If the question is about the hormones look at the outside. - On the 2nd month of pregnancy, the placenta will develop. And the placenta produces estrogen and progesterone, but the QUESTIONS: progesterone is higher than estrogen. 1. What gland that starts menstrual cycle? Hypothalamus - The lifespan of placenta (inunan) is 9 months. 2. Hypothalamus stimulates? APG - When the placenta reaches the 9th month of pregnancy, 3. APG stimulates? Ovary placenta is considered aging. (Progesterone – preventing 4. Ovary affects? Uterus contraction) then, 5. Hormone high in the graafian follicle? Estrogen - The ability of the placenta to produce progesterone, will begin 6. Hormone high in the CL? Progesterone to decrease. Therefore, it will increase uterine contraction. 7. What gland stimulate ovary to produce estrogen and Then the woman enters the labor. progesterone? APG 8. What hormone will stimulate the ovary to produce Pathway of woman menstruation estrogen? FSH Menstruation Ovulation Menstruation 9. What hormone will stimulate the ovary to produce progesterone coming from what gland? APG, under the Corpus luteum (2 weeks) Day 1 Day 14 Day 28 regulation of hypothalamus gland 10. What hormone will stimulate APG to produce LH? LHRF No sexual intercourse coming from hypothalamus No fertilization decreased E and P 11. What day the level of estrogen is highest? 13th 12. What day the level of progesterone is lowest? 13th 13. What day the level of progesterone is highest? 14th increase uterine contraction 14. What day the level of estrogen is lowest in the blood of the woman? 3rd day because she is menstruating temporary capillaries 15. What hormones trigger ovulation? LH Menstrual discharge rupture - She did not engage in sexual intercourse, or she engaged in sexual intercourse but protected. That’s why there’s no fertilization. - If there is no fertilization, there is no pregnancy to support. So, CL will not extend life span from 2 weeks to 2mos. So, within 2 weeks the corpus luteum is degenerating. - If the corpus luteum is degenerating, the level of estrogen and progesterone will begin to decrease. - If the estrogen and progesterone decrease, the uterine contraction will increase. - The temporary capillaries will begin to rupture – giving you menstrual discharge. J.A.K.E 4 of 4