Menstruation

axilla. Breast self-examinations are not as effective in detecting

early breast lesions as once believed and so are no longer rou-tinely recommended (Kosters
& Gotzsche, 2007). Women

should have a yearly breast examination done by a health care

professional, however, as this can detect breast disease. When

palpating for breast health this way, always include the axillary

region in the examination, or some breast tissue can be missed.

Milk glands of the breasts are divided by connective tissue

partitions into approximately 20 lobes. All of the glands in

each lobe produce milk by acinar cells and deliver it to the

nipple via a lactiferous duct. The nipple has approximately

20 small openings through which milk is secreted. An am-pulla portion of the duct, located
just posterior to the nipple,

serves as a reservoir for milk before breastfeeding.

A nipple is composed of smooth muscle that is capable of

erection on manual or sucking stimulation. On stimulation,

it transmits sensations to the posterior pituitary gland to re-lease oxytocin. Oxytocin acts to
constrict milk gland cells and

push milk forward into the ducts that lead to the nipple. The

skin surrounding the nipples is darkly pigmented out to ap-proximately 4 cm and is termed
the areola. The area appears

rough on the surface because it contains many sebaceous

glands, called Montgomery’s tubercles.

The blood supply to the breasts is profuse because it is

supplied by thoracic branches of the axillary, internal mam-mary, and intercostal arteries.
This effective blood supply is

important in bringing nutrients to the milk glands and

makes possible a plentiful supply of milk for breastfeeding.

However, it also aids in the metastasis of breast cancer if this

is not discovered early with breast examination or mammog-raphy (McCance & Huether,
2007).

MENSTRUATION
A menstrual cycle (a female reproductive cycle) is episodic

uterine bleeding in response to cyclic hormonal changes. The

purpose of a menstrual cycle is to bring an ovum to maturity

and renew a uterine tissue bed that will be responsible for the

ova’s growth should it be fertilized. It is the process that allows

for conception and implantation of a new life. Because menar-che may occur as early as 9
years of age, it is good to include

health teaching information on menstruation to both school

age children and their parents as early as fourth grade as part

of routine care. It is a poor introduction to sexuality and wom-anhood for a girl to begin
menstruation unwarned and unpre-pared for the important internal function it represents.

The length of menstrual cycles differs from woman to

woman, but the average length is 28 days (from the beginning

TABLE 5.1 ✽Characteristics of Normal Menstrual Cycles

Characteristic Description

Beginning (menarche) Average age at onset, 12.4 years; average range, 9–17 years

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

Duration of menstrual flow Average flow, 2–7 days; ranges of 1–9 days not abnormal

Amount of menstrual flow Difficult to estimate; average 30–80 mL per menstrual period;
saturating pad or tampon

in less than an hour is heavy bleeding

Color of menstrual flow Dark red; a combination of blood, mucus, and endometrial cells

Odor Similar to that of marigolds

Hypothalamus

LHRH

Pituitary

Ovary

Uterus

Estrogen

Progesterone

Progesterone

Estrogen
Gonadotropichormones