Menstrual

Cycle
❑ Description
❑ Structures involved
1. Hypothalamus
2. Pituitary gland
3. Ovaries
4. Uterus
❑ Health education
❑ Female Reproductive Cycle
❑ Episodic uterine bleeding in response to cyclic
hormonal changes
❑ Process that allows for conception and
implantation of a new life
❑ Purpose: bring an ovum to maturity and renew a
uterine tissue bed that will be responsible for
its growth should it be fertilized.
 Characteristics of Normal
Menstrual Cycle

❑ Menarche: Average onset: 11-13 y/o;

average range: 9-17 y/o
❑ Interval: Average: 28 days; normal
range: 23-35 days
❑ Duration: Average: 2-7 days; normal
range: 1-9 days
 Characteristics of Normal
Menstrual Cycle

❑ Amount: Difficult to estimate;

average 30-80 mL /menstrual period
❑ Signs and Symptoms: Pain, headache,
tenderness of the breasts, irritability,
nervousness, crying spells
 Characteristics of Normal
Menstrual Cycle

❑Color: Dark red

❑Odor: Similar to that of marigold

Menarche
❑ As early as 8-9 years old and as late as 17 years
old
Dysmenorrhea—painful menstruation
Menorrhagia—abnormally heavy menstrual flow
Metrorrhagia—bleeding between menstrual period
Menopause
❑ Occurs between 40-55 years
Structures Involved in
Menstruation
 1. Hypothalamus

❑GnRH (gonadotrophin-releasing
hormone; a.k.a. leutinizing
hormone-releasing hormone
[LHRH])
1. Hypothalamus
 2. Pituitary Gland

❑Produces growth
hormones FSH and LH
under the influence of
 2. Pituitary Gland

Follicle-Stimulating Hormone
❑ Active early in the cycle
❑ Responsible for maturation of ovum
❑ Stimulates estrogen production
 2. Pituitary Gland

Leutinizing Hormone
❑ Active at the midpoint of the cycle
❑ Responsible for ovulation and growth of uterine
lining during the second half of the menstrual cycle
❑ Stimulates progesterone production
3. Ovary
❑GH causes “trophy”
(growth) in the gonads
 4. Uterus

a. Proliferative phase
(Estrogenic/follicular/postmenstrual phase)
❑ ↑ FSH output
❑ Days 5-14 immediately after the last menstrual
flow
❑ Rapid growth and increase in the thickness of the
endometrium from 1 cell layer to approx. eightfold
b. Secretory phase
(Progestational/luteal/premenstrual phase)
❑ ↑ LH output; ↑ estrogen
❑ Days 15-28 after menstruation
❑ “Corckscrew” endometrium
❑ Increased amount of glycogen and mucin
❑ Rich, spongy velvet appearance of the endometrial
lining (vascular endometrium)
c. Ischemic phase
❑ Regression of corpus luteum
↓
❑ ↓ estrogen and progesterone
↓
❑ Degeneration of the endometrium due to
↓progesterone
↓
❑ Rupture of capillaries, minute hemorrhages, and the
endometrium sloughs off
Menstrual phase
❑ Discharge of the following from the uterus
❖ Blood from ruptured capillaries
❖ Mucin from glands
❖ Endometrial tissue fragments
❖ Unfertilized ovum
❑ Iron loss: 11 mg
❑ Average: 2-7 days
Cervical mucus and
sperm survival
 Cervical Mucus Tests

Fern test
❑ Cervical mucus and ovulation
❑ Arborization or ferning – due to crystallization
of sodium chloride in the mucus
 Cervical Mucus Tests

Spinnbarkeit test
❑ Stretching of a mucus sample between thumb and
pointing finger
 Health Education During
Menstruation

❑Moderate exercises
❑Sexual intercourse in not
contraindicated
❑Promotion of hygiene
 Health Education During
Menstruation

❑ Manage pain
❖Prostaglandin inhibitors
(Ibuprofen, Naproxen, MFA)
❖Heat application
❖Rest
❑ Iron supplement as needed
 Phases of Human Sexual
Response
(Masters and Johnson)

Human sexual
response is a four
stage model of 1. Excitement
physiological 2. Plateau
rsponse to sexual
stimulation which
3. Orgasm
in order of their 4. Resolution
occurrences are
the:
Instructor:

❖ The excitement phase/ initial excitement

phase
❖ It occurs as a result of physical or mental
erotic stimuli such as kissing, petting,
or even viewing erotic images that
leads to sexual arousal.
❖ This stage is the the preparation of the
body for sexual intercourse.
1. Excitement
Among both sexes the excitement phase results in the following:

❑ Parasympathetic nerve stimulation

❑ Arterial dilation and venous constriction at the
genital area → increased blood supply →
vasocongestion
❑ Increased muscular tension
❑ “Sex flush”
❑ Increased RR, PR and BP
❑ Women:
✓ Engorgement of the clitoris
✓ Vaginal lubrication
✓ Erection of the nipple
✓ Enlargement of the breast
✓ Labia majora flattens and spreads apart
✓ Labia minora swells
✓ Cervix and uterus pulls up
✓ “Ballooning” of the upper third of the vagina
❑ Men:
✓ Penile erection
✓ Thickening of the scrotal skin, increased
scrotal sac tension, scrotum pulled up
towards the body
✓ Nipple erection
Instructor

❖ The plateau phase is a period of sexual excitement

prior to orgasm.

❖ If there is prolong time in the plateau phase without

progression to orgasmic phase, this may result in
frustration if continued for too long.
 2. Plateau

❑ Vasocongestion peaks
❑ Increased RR, PR, BP
❑ Women:
✓ Breasts continue to swell
✓ “Orgasmic platform”
✓ Clitoris retracts into the body
✓ Uterus enlarges
✓ Darkening of the labia majora
❑ Men:
✓ Pre-ejaculatory secretion
✓ Complete erection and swelling of the glans
Instructor

❖ Orgasm is the conclusion of the plateau phase of the

sexual response cycle and this is experienced by
both male and female.
❖ In women ,they also experience vaginal contraction,
and uterine contraction.
❖ An this orgasms are often associated with other
involuntary actions including: vocalization,
muscular spasms in other muscles in the
body(agtigtiger) and Euphoric sensation(is an affective
state and a form of pleasure in which a person experiences intense
feelings of well-being, happiness and excitement)
 3. Orgasm

❑ Rhythmic, vigorous contraction of muscles in the

pelvic area expels or dissipates blood and fluid from
the area of congestion
❑ Women:
✓ One contraction every 0.8 seconds
❑ Men:
✓ Stages:
a. Sensation of ejaculatory inevitability (you
will feel the sensation of ejaculating)
b. Ejaculation (expulsion of semen with sperm
cell for copulation)
 4. Resolution

❑ Internal and external genital organs

return to unaroused state
❑ Sex flush disappears
❑ Usually takes 15-30 minutes
❑ Refractory period
❑ Multiple orgasm
Instruction
❖ This occur after orgasm and allows the
muscles to relax :
✓ BP drops,
✓ Body slows down from its excitement phase

❖ Resolution in males: Masters and Johnson described the

two stages
1. First stage: penis decreases in size from its erect state about 50%
larger than its flaccid state that is in the refractory period.
2. Second stage: Penis decreases in size and can return again to being
flaccid( But it takes time and stimulation for a male to become erected
again).
Instruction
❖ Resolution in females:

➢ According to Johnson and Masters, women have

the ability to have orgasm again very quickly , as
long as they have effective stimulation.
➢ As a result they can have multiple orgasm in a
relative period of time. Why?
➢ Because female do not experience refractory
period thus they can have multiple orgasm.
 THE
PROCESS OF
CONCEPTION
INSTRUCTOR Conception: How it works

❖ To become pregnant the following steps must occur:

1. Sperm transport- sperm must be deposited and
transported to the site of fertilization.
2. Egg transport- ovulation must occur and the egg must be
picked up by the tube.
3. Fertilization and embryo development- union between the
sperm and egg must result.
4. Implantation- the embryo must be implanted and begin to
grow in the uterus.
❖ So what is the definition now of CONCEPTION:
✓ Is the time after ovulation and the sperm cell unite with the
eggs.
✓ Formation of visible zygote by the union of the male sperm
❑Ovulation
❑Fertilization
❑Implantation
1. Ovulation
❖ This is a part of the that is the process of
maturation and rupture of a graafian follicle,
with a discharge of ovum.
❖ This is the release of mature egg from the ovarian
follicle.
❖ Should occur 14 days before the next menstrual
flow is expected.
❖ Occurs approximately once a month during
reproductive years from puberty (age 11- 15) to
menopause (age 45 – 55)
❖ Ovulation is temporarily halted during
pregnancy and may be suppressed by
emotional and physical stress.
❖Usually only 1 follicle develops
fully, the other follicles recedes.
❖This one follicle release an egg
which will be fertilized.
❖The follicles that released the egg
is known as the corpus luteum.
❖ The life span of the egg after
ovulation is 12- 24 hours. This is
the optimum time for
fertilisation to occur.
49 2/24/2022
❖Fertilization must take place within
that hour or else no
fertilization will take place
after that hour.
❖However sperm that is deposited
prior to ovulation can survive in
the female reproductive tract
for 72 hours.
❖So, few days before ovulation is
also considered as fertile days.
50 2/24/2022
 Summary: When do you
ovulate?

⚫ OVULATION OCCURS APPROXIMATELY ON

THE

14TH DAY OF YOUR CYCLE (FOR

REGULARS)
⚫ AVERAGE LENGTH OF A CYCLE: _______
DAYS
⚫ SHORT CYCLE: _____ DAYS
⚫ LONG CYCLE: ______ DAYS
28 DAY CYCLE
PEAK

2O DAYS CYCLE: DAY 6

44 DAYS CYCLE: DAY 30
2. Fertilization
 OVA
⚫ Released from the Graafian
Follicle
⚫ Will be surrounded by a ring
of mucopolysaccharide fluid
(Zona pellucida) and a circle
of cells (Corona radiata)
– Zona pellucida and Corona
Radiata protects the ova by
serving as a buffer against
injury
⚫ Moves from the ovary to the
fallopian tube through the
cilia and peristaltic
movement of fallopian tube
 SPERM
⚫ Per ejaculation, 2.5ml semen
containing 50-200M
spermatozoa is released
(ave 400M
sperm/ejaculation)
⚫ Moves through the cervix,
uterus, fallopian tube
because of their flagella and
uterine contractions
⚫ Undergoes CAPACITATION
(changes in the plasma
membrane of the sperm
head to reveal sperm binding
receptor sites) before
penetrating into the corona
radiata
⚫ Sperm clusters around
coronal cells
⚫ Will release
HYALURONIDASE
(proteolytic enzyme) to
dissolve the corona radiata
⚫ Sperm penetrates the cell;
cell membrane of ova
changes composition to
become impenetrable to
other sperm
⚫ Sperm and ova fuse carrying 23 pairs of
chromosomes each
– If sperm carries X sex chromosome paired with the
ovum X chromosome = female zygote
– If sperm carries Y sex chromosome paired with the
ovum X chromosome = male zygote
Zygote
Instructor

❖ While the blastocyst is floating in the uterine

cavity, this is nourished by the uterine glands.
❖ The trophoblast attaches itself to the surface of the
endometrium for nourishment- “NIDATION”
❖ The frequent site of attachment is the upper part of
the posterior uterine wall.
❖ Between 8- 10 days after fertilization.
 3. Implantation

❑ Contact between the growing sperm-ovum

structure and the uterine endometrium, occurring
approx. 8-10 days after fertilization
❑ Migration from the fallopian tube to the body
of the uterus for lasts 3-4 days
❑ Usually happens at the upper portion, anterior
surface of the endometrium
3. IMPLANTATION
⚫ Zygote move from fallopian tube
to uterus
⚫ It will undergo series of mitotic
divisions resulting to a cleavage
formation, 1 in every 22 hour,
with the cleavage division
happening 24 hours after
fertilization
⚫ Once it reaches the uterus,
zygote is now composed of 32 -
50 ball of cell termed as a
MORULA
⚫ Another 3-4 days, morula
becomes a
BLASTOCYST consisting
of:

– An inner cell mass

which will become
the future embryo
– Trophoblast which
will become the
placenta and
membranes
⚫ At approx 8-10 days after
fertilization, blastocyst attaches
to the endometrium
– Sheds off last residues of
corona radiata and zona
pellucida
– Brushes against
endometrium (apposition)
and settles down

⚫ A slight vaginal bleeding is

experienced during
implantation stage because
capillaries are ruptured by the
implanting trophoblast cells
EMBRYONIC & FETAL STRUCTURES
DECIDUA – Endometrium or
mucous membrane lining of
the uterus in pregnancy that
is shed after birth.
EMBRYONIC & FETAL STRUCTURES
3 areas
✓ Decidua basalis – lies directly
under the embryo (portion
where the trophoblast establish
communication with maternal
blood vessel)
▪ The part of the decidua that
unites with the chorion to form the
placenta.
▪ It is shed in lochial discharge
after birth.
EMBRYONIC & FETAL STRUCTURES
3 areas
✓ Decidua capsularis – portion
that stretches or encapsulates
the surface of the trophoblast
✓ This is the part of the decidua
surrounding the chorionic sac.
EMBRYONIC & FETAL STRUCTURES

✓ Decidua vera – the remaining

portion of the uterine lining
✓ Non placental decidua lining the
uterus.
CHORIONIC VILLI
➢ Miniature villi similar to
probing fingers that
appear on the 11th or
12th day
➢ They begin the
formation of the
placenta
➢ Consists of a central
core of connective
tissue and fetal
capillaries
⚫ Consists of 2 layers of trophoblast cells:
– Syncytiotrophoblast (syncitial layer) – produces
HCG, somatomammotropin (human placental
lactogen), estrogen and progesterone
– Cytotrophoblast (middle or Langhan’s layer) –
functions in early pregnancy to protect the growing
embryo and fetus from infection (eg syphilis)
PLACENTA
➢ 15-20CM IN
DIAMETER, 2-3 CM
DEEP, 400-600g at
full term
➢ Has 25-30
cotyledons (placental
compartments that
lie on the maternal
side)
➢ Has 2 sides
✓ Maternal – dirty
rough
✓ Fetal – shiny smooth
FUNCTIONS:
➢ Serves to conduct oxygen and nutrients for the
fetus
➢ Secretes endocrine hormones (syncytial cells)

❖ Human Chorionic Gonadotropin – Sustains

luteum until 6-8 weeks
1stplacental hormone
ensures corpus luteum to continuously
produce progesterone and estrogen
suppresses maternal immunologic reaction so that
placental tissue is not detected and rejected as a
foreign substance
  iffetus is male, stimulates the testes to begin producing
testoterone
 at 8 week, begins progesterone production, as a result,
Corpus Luteum disintegrates and hCG production
decreases

❖ ESTROGEN (estriol) – “hormone of women”

contributes to mammary gland development
of mother in preparation for lactation
stimulates uterine growth to accommodate
growing fetus
❖ PROGESTERONE - “Hormone for Mothers”
necessary to maintain endometrial lining of the
uterus during pregnancy
reduces contractility of uterus during
pregnancy preventing preterm labor

❖ HUMAN PLACENTAL LACTOGEN (human chorionic

somatomammotropin)
 with both growth promoting and lactogenic
(milk producing) properties
promotes mammary gland (breast) growth in preparation
for lactation
regulates maternal glucose, protein and fat levels so that
adequate amounts of these are always available to
the fetus.
AMNIOTIC FLUID
➢ 800-1200ml (500- 1500)
➢ Slightly alkaline pH 7.2
➢ Fetal urine adds to its volume
➢ Comes out first before the baby.

Composition:
✓ Epithelial cells
✓ Leukocytes
✓ Urates
✓ Organic and inorganic salts
✓ Waqter
✓ Enzymes
✓ Hormones

✓ Lanugo
Functions:
➢ Shields fetus against pressure or blow to the
mother’s abdomen
➢ Protects fetus from temperature change- Provides
stable temperature
➢ Aids in muscular development because it allows
fetus’ freedom to move
➢ Protects the umbilical cord from pressure protecting
fetal oxygen supply- prevents cord compression
➢ Helps in delivery process
Hydramnios – excessive amniotic fluid
 more than 2000ml or pockets of fluid larger
than 8cm on UTZ

Oligohydramnios – reduction in the

amount of amniotic fluid
less than 300ml or no pockets of fluid larger
than 1 cm on UTZ
AMNIOTIC MEMBRANES
1. Chorionic membrane – the outermost fetal membrane;
purpose is to form a sac that contains the amniotic fluid

2. Amniotic membrane/Embryonic membrane –Begin to form

at the time of implantation
 These membrane protects and supports the embryo
as it grows and develop inside the uterus.
 2nd membrane lining the chorionic membrane; forms
beneath the chorion
a. AMNION- thin protective membrane that contains
amniotic fluid.
produces amniotic fluid (AMNION)
produces phospholipids that initiates the
formation of prostaglandins which can cause
uterine contractions and may be the trigger that
initiates labor.
b. CHORION-Thick membrane develops from the
trophoblast called chorionic villi.
 Outermost and continuous with the surface of
the umbilical cord.
 Supports the sac that contains the amniotic
fluid.
UMBILICAL CORD
➢ Formed from the amnion and chorion
➢ 53cm (21 in) length; 2 cm thick
➢ Wharton’s jelly – a gelatinous
mucopolysaccharide that forms the bulk of the
umbilical cord giving it its body; prevents
pressure on the veins and arteries
➢ Outer surface is covered with amniotic membrane
➢ Composed of 1 vein (carrying blood from
placental villi to the fetus) and 2 arteries (blood
from fetus back to palcental villi)
➢ Blood flow is 350ml/min at term
➢ Walls are with smooth muscles,
no nerve supply
➢ Function:
✓ Transports oxygen and nutrients to
the fetus from placenta and return
waste products from fetus to
placenta
Research the following (not
the meaning but the process)

1. Cleavage
2. Morula
3. Blastocyst
4. Embryo
Fetal
Circulation
 Activity

❑ Read the notes on fetal circulation and

accomplish the following:
✓ Trace the path of fetal circulation from the placenta
through the fetal body and back to the placenta.
Present it in a diagrammatic scheme.
✓ Trace the path of blood circulation among a person
with
▪ Patent ductus arteriusus
▪ Patent foramen ovale