Menstruation PDF

# Menstruation ## Definition A menstrual cycle (female reproductive cycle) can be defined as periodic uterine bleeding in response to cyclic hormonal changes or a series of changes that occur on the ovary, uterus, and cervix in response to hormonal change. The end of a woman's reproductive phase i...

# Menstruation ## Definition A menstrual cycle (female reproductive cycle) can be defined as periodic uterine bleeding in response to cyclic hormonal changes or a series of changes that occur on the ovary, uterus, and cervix in response to hormonal change. The end of a woman's reproductive phase is called the menopause (between the ages of 45 and 55). ## Characteristics Of Normal Menstrual Cycles * **Beginning:** Menarche is the first menstrual period "the most definitive sign of puberty". Average age of onset: 12 or 13 years; average range of age: 9-17 years. * **Between cycles:** average 28 days; cycles of 23 to 35 days not usual. * **Duration:** The usual duration of the menstrual cycle is 3-5 days but flows as short as 1 day and as long as 8 days can occur in normal women. * **Amount of menstrual flow:** Average 30 to 100 cc with no clots; saturating a pad in less than an hour is considered heavy bleeding. * **Dark red:** a combination of blood, mucus, and endometrial cells. * **Odor of menstrual flow:** marigold * **Contents:** blood, mucus, endometrial shreds, desquamated vaginal epithelium and leucocytes. ## Physiology Of The Menstrual Cycle * Four body structures are involved in the physiology of the menstrual cycle: the hypothalamus, the pituitary gland, the ovaries, and the uterus. For a menstrual cycle to be complete all four structures must contribute their part; inactivity of any part results in an incomplete or ineffective cycle. * **Hypothalamus:** initiates the menstrual cycle and releases the gonadotropin releasing hormone (Gn-Rh). * **Pituitary Gland:** produces the gonadotropic hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) * **Ovaries:** produces hormones: estrogen and progesterone * **Uterus:** the one being thickened before menstruation. ## Phases Of The Menstrual Cycle ### Ovarian Cycle * The maturation of ovum consists of three phases: * **The follicular phase:** begins the first day of menstruation and last 12 to 14 days. During this phase, the graafian follicle is maturing under the influence of two pituitary hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The maturing graafian follicle produces estrogen. * **The ovulatory phase:** begins when estrogen levels peak and ends with the release of the oocyte (egg) from the mature graafian follicle. The release of the oocyte is referred to as ovulation. * **The luteal phase:** begins after ovulation and last approximately 14 days. During this phase, the cells of the empty follicle undergo changes and form into the corpus luteum. * The corpus luteum produces high levels of progesterone along with low levels of estrogen. * If pregnancy occurs, the corpus luteum continues to release progesterone and estrogen until the placenta matures and assumes this function. * If pregnancy does not occur, the corpus luteum degenerates. ### Endometrial Cycle * The endometrial cycle responses to the hormonal changes that occur during the ovarian cycle. This cycle consists of three phases: * **The proliferative phase:** starts just after menstruation and ends with ovulation. During this phase, the endometrium is preparing for implantation by becoming thicker (3-4 mm) and more vascular (straight arteries). These changes are in response to the increasing levels of estrogen produced by the graafian follicle. * **The secretory phase:** begins after ovulation and ends with the onset of menstruation. During this phase, the endometrium continues to thicken (6-8 mm) and great vascularity (straight and spiral arteries). The primary hormone during this phase is progesterone which is secreted from the corpus luteum. * If pregnancy occurs, the endometrium continues to develop, and the glands begin to secrete mucin and glycogen (secretory power). * If pregnancy does not occur and the corpus luteum begins to degenerate and the endometrial tissue degenerates. * **The menstrual phase:** cyclic shedding of superficial layers of endometrial due to ischemia, necrosis & shrinkage of endometrial. ## Diagram The diagram shows the different phases of the menstrual cycle, divided into four categories: * **(a) FSH and LH secreted by the anterior pituitary** * **(b) Events in the ovary** * **(c) Ovarian hormones** * **(c) Events in the endometrium of the uterus** Each category shows the changes that occur in each phase, with the focus on how these changes affect the levels of hormones released into the body. The diagram also shows the approximate length of each phase, and the relationship between the different phases. ## Health Teaching About Menstruation | AREA OF CONCERN | TEACHING POINTS | |---|---| | Exercise | It's good to continue moderate exercise during menses because it increases abdominal tone. Sustained excessive exercise. | | Activities of daily life | Nothing is contraindicated (many people believe incorrectly that things like washing hair are harmful). | | Pain relief | Any mild analgesic is helpful. Prostaglandin inhibitors such as ibuprofen are specific to menstrual pain. Applying local heat may also be helpful. | | Rest | More rest may be helpful if dysmenorrheal interferes with sleep at night. | | Nutrition | Many women need iron supplementation to replace iron lost in menses. |