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Episodic uterine bleeding in response to cyclic hormonal changes
Brings an ovum to maturity and renews uterine tissue bed Process that allows for conception and implantation
Characteristics of Normal Menstrual Cycles
• Beginning (menarche) – average of onset 12 -13 yrs; average range 9 -17 years
• Interval between cycles – Average 28 days; cycles of 23 – 35 days not unusual • Duration of menstrual flow ( menses )– Average flow 4-6 days ,may have short periods as 2days,long periods as 7 days; ranges 1-9 days not abnormal
Characteristics of Normal Menstrual Cycles
• Amount of menstrual flow –difficult to estimate;
average 30-80 ml • Color of menstrual flow – dark red; combination of blood, mucus and endometrial cells • Odor- similar to that of marigolds
and increased vascularization of the skin. Estrogen . widening and lightening of pelvis 2. such as breast development.female secondary sexual characteristics.triggers uterine changes during the menstrual cycle 4 .HORMONES 1. Progesterone . increased adipose tissue deposition.
Uterus 1.4 Body Structures involved in Physiology of Menstrual Cycle Hypothalamus. 2. Pituitary gland.LH (GnRH is cyclic thus menstrual periods is also cyclic. 5 . Ovaries. → transmitted to anterior pituitary gland→signals the gland to produce gonadotropic hormones 1. FSH. Hypothalamus.release GnRH ( luteinizing hormone-releasing hormone or LHRH) initiates the menstrual cycle.
2. growth of the uterine lining midpoint of the cycle . 2.follicle stimulating hormone.4 Body Structures involved in Physiology of Menstrual Cycle cont. release of mature egg cells. FSH. ant pituitary gland ( adenohypophysis) produces 2 hormones That act on ovaries 1. Pituitary gland – under the influence of GnRH.resp maturation of Ovum -active early of the cycle a. FSH. LH a. LH -Luteinizing Hormone – resp for ovulation.
. Uterus – uterine changes occurs every month as a result of stimulation from the hormones produced by ovaries. propelled towards the surface of the ovary→stage of maturation. small ovum and surrounding follicle membrane and fluid becomes Graafian follicle. 4. Ovaries –one primodial follicle (every month) activated by the FSH to begin to grow and mature→cells produce a clear fluid ( follicular fluid ) contains ↑ degree of estrogen ( estradiol ) and some progesterone→follicle reaches its maximum size. 3.4 Body Structures involved in Physiology of Menstrual Cycle cont.
Ovaries → Day 14 before the end of menstrual cycle.3. ovum divided by mitotic div – 2 separete bodies 1. secondary oocyte ( contains so little of cytoplasm. primary oocyte ( contains the bulk of the cytoplasm. prostaglandinsreleased→Graafian follicle ruptures – ovum is set free ( process of Ovulation ) → swept into the open end of the fallopian tube . 2. →LH from the pituitary.→meitotic div – reducing the number of chromosomes to haploid number of 23.
→LH cont to ↑ I amt – acts on the follicle cells in the ovary→influences cell to produce lutein ( bright yellow fld ) =↑ progesterone. →fluid fills the empty follicle ( Corpus luteum or yellow body ) If conception occurs. the cell of the follicle remain hollow.3. Ovaries →after the ovum and the follicular fluid have been discharged in the ovary. ovum proceeds down a fallopian tube→ implants on the endometrium of the uterus . empty pit →FSH has done its work and ↓ in amt.
Corpus luteum remains troughout the pregnancy ( approx 16 to 20 weeks ) If conception does not occur. . unfertilized ovum atrophies after 4 to 5 days and corpus luteum ( false corpus luteum ) – remains only 8 to 10 days Corpus luteum regresses – replaced by white fibrous tissue ( corpus albicans ) or white body.
Menses 11 .Proliferative phase 2. Ischemic Phase 4.Uterine cycle 4 phases 1.Secretory phase 3.
or lining of the uterus is very thin • Ovary begins to produce estrogen (FSH) endometrium begins to proliferate • Growth is very rapid and increases the thickness of the endometrium (this increase continuous for the first half of menstrual cycle 12 .day 4-5 • Endometrium.Proliferative Phase Immediately after a menstrual flow.
Secretory Phase After the ovulation. • Day 15.day 28 • Capilliaries of Endometrium increase in amount • Uterus is prepared for implantation 13 . the formation of progesterone in the Corpus luteum causes the glands of the uterine endometrium to become – corkscrew or twisted appearance and dilated with quantities of glycogen and mucin.
progesterone and estrogen decreases. . Endometrium begins to degenerate ( approx 24 or 25 day ) Capillaries rupture. with minute hemorrhages and the endometrium sloughs off. the corpus luteum in the ovary begins to regress after 8 to 10 days.Ischemic Phase If fertilization does not occur . as it regresses.
mucin from the gonads.microscopic.fragments of the endometrial tissues. atropied. and unfertilized ovum • Day 1.Menstrual Phase • Menses – menstrual flow Composed of: blood from the rupture capilliaries.day 5 • First day of bleeding is the first day of cycle • Around 60 ml average 15 .
Pre-ovulatory : follicular phase 2. Post-ovulatory : Luteal phase 17 .Ovarian cycle 3 phases 1. Ovulatory phase 3.
Ovarian Cycle.day 13 • Dominant follicle matures and becomes graafian follicle with primary oocyte • FSH increases initially then decreases because of estrogen increase 18 . preovulatory/follicular • Variable in length: day 6.
Ovarian cycle: Ovulatory phase Day 14 Rupture of the graafian follicle releasing the secondary oocyte Due to the LH surge 19 .
corpus luteum will become corpus albicans then degenerate • Decreased estrogen and progesterone production 20 .day 28 • MOST CONSTANT 14 days after ovulation • Corpus luteum secretes Progesterone • If no fertilization.OVARIAN cycle: Post-ovulatory: luteal phase • Day 15.
CELESTE. RN. MD 21 .MARY LOURDES NACEL G.
Hormonal cycle 1. Proliferative/Pre-ovulatory phase – Increased FSH and Estrogen in small amounts 22 . decreased FSH and decreased LH 2. Menstrual phase – Decreased Estrogen. decreased progesterone.
3. Ovulatory phase – Increased LH (surge). Increased Estrogen 4. Post ovulatory/luteal Phase – Increased Estrogen. increased progesterone until corpus luteum degenerates 23 .
CELESTE. RN.‘ MARY LOURDES NACEL G. MD 24 .
Education 25 .
nulliparous and patients who underwent hysterectomy 26 . Mean age of 51.Menopause • Cessation of menstruation for at least one year occurring at the age of 40-55 due to cessation of ovarian function.3 • Decreased estrogen and progesterone • Genetically determined • May occur earlier in smokers.
Menopause cont. urinari incontinence ● Hormonal Replacement (HR) – decrease menopausal symptoms . vaginal dryness or osteoporosis. • Change of life • Role change – psychological stress • Ovaries – begin to atrophy. reducing estrogen = hot flashes.
related to vaginal atrophy secondary to decreased estrogen 28 . psychocial 6. Loss of libido. Loss of childbearing capacity 2.Concerns 1. Loss of youth 3. spouse and other life events 5. Depression-related to changes in relationship w/ children. Anxiety and irritability –”climacteric syndrome”. Skin changes-related to estrogen deficiency that has a role in collagen storage and restoration 4.
Difficulty in concentration and short term memory loss 11. transient flushing. malignancies and polyps 8. Hot flashes/flushes – recurrent. Osteoporosis 29 . Cardiovascular disease 12. sweating. heavy or prolonged related to to anovulatory cycles * rule out pregnancy. Abnormal bleeding – irregular. chills 9. palpitations. Urinary symptoms – dysuria. urgency and recurrent UTI 10.7. anxiety.
labia minora has a pale . dry appearance.myometrium atrophies. uterus decreases in size 30 . reduction in fat content of labia majora • UTERUS . has atrophic appearance . and dry . with numerous small petecchial hemorrhages.becomes smaller and the size of the upper vagina diminishes .endometrial tissue become sparse.epithelium becomes pale.TARGET ORGAN RESPONSE TO DECREASED ESTROGEN: • VAGINA . thin.
there is relative decrease in circulating androgens. characterized by reduction in bone density and fracture • Hair . lading to osteoporosis. fullness of the breast • Bones .• Breast .with the loss of estrogen.general loss of turgor. form. increase quantity of hair with male pattern distribution 31 .gradual loss of calcium.
coincides with a surge of luteinizing hormones 32 . vasomotor symptoms: .Sequelae of reduced estrogen: A.last for a few seconds or several minutes .Hot flash/ flush.more frequent and severe at night or during time of stress . is the hallmark of the menopausal woman .
• Altered menstrual function: – Oligomenorrhea followed by amenorrhea – Amenorrhea for 6 to 12 months – If vaginal bleeding occurs after 12 months of amenorrhea. endometrial biopsy must be ruled out • Osteoporosis: – Main health hazard associated with menopause 33 .
urethral changes . nervousness. irritability. pruritus of vulvovaginal area.vaginal. dyspareunia and stenosis . headache. depression. palpitation.increased frequency of cystitis . insomia.atrophy of the vaginal mucosa leads to atrophic vaginitis.Menopausal syndrome: Such as fatigue. loss of libido. muscle pain Atrophic changes: . urethral and bladder symptoms 34 .
dyspareunia.Treatment: Estrogen replacement therapy Advantages: Eliminate hot flashes Reversal of atrophic vaginitis. affective symptoms Prevention and treatment of osteoporosis Prevention of cardiovascular disease Retention of youthful skin 35 .
disadvantages: Can cause acute liver disease Acute vascular thrombosis Seizure disorder Hypertension Migraine headache Breast cancer Endometrial cancer 36 .
regular bleeding at intervals < 21 days Amenorrhea – cessation of menses x 6 months Menorrhagia – regular bleeding that is excessive in amount and duration > 5 days Metrorrhagia – irregular bleeding Menometrorrhagia – excessive prolonged bleeding at irregular intervals 37 . irregular bleeding at intervals > 35 days Polymenorrhea – frequent.Menstrual cycle irregularities Oligomenorrhea – infrequent.