Menstruation

 Menstrual / Female Reproductive Cycle – episodic uterine bleeding in response to cyclic

hormonal changes
PURPOSE: bring an ovum to maturity and renew a uterine tissue bed (responsible for a fertilized
ova’s growth)
AVERAGE LENGTH: 28 Days
AVERAGE MENSTRUAL FLOW (MENSES): 4-6 Days (2 for shortest and 7 for longest)
 Menarche – first menstruation (as early as 9 years old)

PHYSIOLOGY OF MENSTRUATION:
4 BODY STRUCTURES
1. HYPOTHALAMUS
 releases Luteinizing Hormone-Releasing Hormone (GnRH / LHRH) that initiate
menstrual cycle
o Transmitted to the Anterior Pituitary Gland that produces FSH and LH
o STOPS:
 estrogen level rises (by ovaries) - same principle with birth control pills
 high levels of pituitary-based hormones: Prolactin, FSH , LH

2. PITUITARY GLAND
 Adenohypophysis (Anterior Lobe): produces
o FSH – most active at early cycle
Function: ovum maturation
o LH - most active at midpoint cycle
Function: ovulation / mature egg release from ovary and growth of uterine lining

3. OVARIES
 Primordial Follicles: activated by FSH to grow and mature
o Follicular Fluid – clear fluid product that contains high degree of estrogen (mainly
estradiol) and some progesterone
o as it grows = propelled to ovarian surface = full maturity (Graafian Follicle)
o DAY 14 (before end of menstrual cycle / mid-point of 28 day cycle): Divided by
Mitotic Division and Meiotic Division (haploid 23):
 Primary Oocyte – bulk of cytoplasm; functional
 Secondary Oocyte – little cytoplasm; non functional
 Upsurge of LH from Pituitary: Prostaglandins are Released = Graafian Follicle ruptures =
Ovulation (FSH decreases and LH increases)
 NOTE! LH influences follicle cells to produce Lutein – bright yellow fluid which is high in
progesterone and some estrogen (vice versa for the contents of follicular fluid) that fills
empty follicle from discharge thus calling it a Corpus Luteum (Yellow Body)

4. UTERUS
FIRST PHASE / PROLIFERATIVE:
 Endometrium: very thin; one cell layer until ovary produce estrogen = proliferates rapidly
around eightfold
 Other Names: Estrogenic / Follicular / Postmenstrual Phase
SECOND PHASE / SECRETORY:
 Formation of Progesterone in Corpus Luteum causes glands of the uterine endometrium
to become corkscrew / twisted and dilated with quantities of glycogen and mucin
 Increase of Endometrium Capillary
 Other Names: Luteal / Premenstrual / Secretory
THIRD PHASE / ISCHEMIC:
 NO FERTILIZATION: Corpus Luteum regress after 8-10 days = progesterone and
estrogen decreases = endometrium degenerates = capillaries ruptures , hemorrhages and
sloughs off
FOURTH PHASE / MENSES:
 End of menstrual cycle (external marker) and the beginning of a new cycle
 Components: Blood (Ruptured Capillaries) + Mucin + Endometrial Tissue Fragments +
Microscopic, Atrophied and Unfertilized Ovum
 Iron Loss: 11 mg

NOTE! Beginning of Menopause – Spotting: progesterone withdrawal is more sluggish rather than
withdrawing smoothly

CERVIX:
- Mucus: changes each month during menstrual cycle
o 1st Half: low ovarian hormone secretion = thick and scant = sperm survival low
o Sperm Penetration: Increase estrogen = thin mucus = sperm survival high
- TESTS:
o Fern Test
 High levels of estrogen before ovulation
 Mucus Appearance: fernlike patterns (Arborization / Ferning) caused
by crystallization of NaCl on mucus fibers
 Dominant Progesterone after ovulation (beginning of Luteal Phase): fern pattern
is no longer discenible
o Spinnbarkeit Test
 Stretchability test
 High Estrogen – thin, watery, long strands
 High Progesterone – thick and viscous
MENSTRUAL DISORDERS:
 Menorrhagia – abnormally heavy menstrual flows
 Metrorrhagia – bleeding between menstrual periods
 Menstrual Migraines
 Premenstrual Dysphoric Syndrome

 Menopause
- cessation of menstrual cycles / marking of inability to bear children
o Perimenopausal – period during which menopausal changes occur
o Postmenopausal – final menses
o AGE RANGE: 40 – 55 years old
o AGE MEAN: 51.3
NOTE! Women Smokers have earlier menopause
- Cause physiologic stress since ovaries are a woman’s chief source of estrogen
o SOLUTION:
 Hormone Replacement Therapy (HR) – decrease symptoms but should not
be taken indefinitely due to adverse effects (prescribed on short-term basis:
1-2 years)
 Low-dose Estrogen / Testosterone – increase sexual libido
 Kegel’s Exercise – strengthen bladder support and reduce urinary
incontinence
- Risk of Osteoporosis
o Decrease in height
o Back pain – vertebral column shortening
o SOLUTION:
 Calcitonin Nasal Spray
 1200 mg Calcium + 400-800 IU Vitamin D Ingestion