Notre Dame of Kidapawan College/Notre Dame of Dadiangas University

Graduate School
Master of Arts in Nursing
Maternal and Child Health

Prepared by John Ryan Borja, RN, LPT, MAED and Thea Micah Q. Toledo, RN

Discussion Guide

HORMONES AND THE MENSTRUAL CYCLE

The menstrual cycle is complex and is controlled by many different glands

and the hormones that these glands produce. A brain structure called the
hypothalamus causes the nearby pituitary gland to produce certain chemicals,
which prompt the ovaries to produce the sex hormones estrogen and
progesterone. The menstrual cycle is a biofeedback system, which means each
structure and gland is affected by the activity of the others.

PHASES OF THE MENSTRUAL CYCLE

The four main phases of the menstrual cycle are:

1. menstruation,
2. the follicular phase,
3. ovulation, and
4. luteal phase.

Menstruation

Menstruation is the elimination of the thickened lining of the uterus

(endometrium) from the body through the vagina. Menstrual fluid contains
blood, cells from the lining of the uterus (endometrial cells) and mucus. The
average length of a period is between three days and one week.
 Sanitary pads or tampons are used to absorb the menstrual flow. Both
pads and tampons need to be changed regularly (at least every four
hours).

Follicular phase

The follicular phase starts on the first day of menstruation and ends
with ovulation. Prompted by the hypothalamus, the pituitary gland releases
follicle-stimulating hormone (FSH). This hormone stimulates the ovary to
produce around five to 20 follicles (tiny nodules or cysts), which bead on
the surface.

Each follicle houses an immature egg. Usually, only one follicle will
mature into an egg, while the others die. This can occur around day 10 of
a 28-day cycle. The growth of the follicles stimulates the lining of the uterus
to thicken in preparation for a possible pregnancy.

Ovulation

Ovulation is the release of a mature egg from the surface of the

ovary. This usually occurs mid-cycle, around two weeks or so before
menstruation starts.

During the follicular phase, the developing follicle causes a rise in the
level of estrogen. The hypothalamus in the brain recognizes these rising
levels and releases a chemical called gonadotrophin-releasing hormone
(GnRH). This hormone prompts the pituitary gland to produce raised levels
of luteinizing hormone (LH) and FSH.

Within two days, ovulation is triggered by the high levels of LH. The
egg is funnelled into the fallopian tube and toward the uterus by waves of
small, hair-like projections. The life span of the typical egg is only around 24
hours. Unless it meets a sperm during this time, it will die.
LUTEAL PHASE

During ovulation, the egg bursts from its follicle, but the ruptured
follicle stays on the surface of the ovary. For the next two weeks or so, the
follicle transforms into a structure known as the corpus luteum. This structure
starts releasing progesterone, along with small amounts of estrogen. This
combination of hormones maintains the thickened lining of the uterus,
waiting for a fertilized egg to stick (implant).

If a fertilized egg implants in the lining of the uterus, it produces the

hormones that are necessary to maintain the corpus luteum. This includes
human chorionic gonadotrophin (HCG), the hormone that is detected in a
urine test for pregnancy. The corpus luteum keeps producing the raised
levels of progesterone that are needed to maintain the thickened lining of
the uterus.

If pregnancy does not occur, the corpus luteum withers and dies,
usually around day 22 in a 28-day cycle. The drop in progesterone levels
causes the lining of the uterus to fall away. This is known as menstruation.
The cycle then repeats.

COMMON MENSTRUAL PROBLEMS

Some of the more common menstrual problems include:

 PREMENSTRUAL SYNDROME (PMS)

o hormonal events before a period can trigger a range of side effects
in women at risk, including fluid retention, headaches, fatigue and
irritability. Treatment options include exercise and dietary changes

 DYSMENORRHOEA
o It is thought that the uterus is prompted by certain hormones to
squeeze harder than necessary to dislodge its lining. Treatment
options include pain-relieving medication and the oral
contraceptive pill
  HEAVY MENSTRUAL BLEEDING
o Also referred to as menorrhagia. If left untreated, this can cause
anaemia. Treatment options include oral contraceptives and a
hormonal intrauterine device (IUD) to regulate the flow

 AMENORRHEA
o This is considered abnormal, except during pre-puberty, pregnancy,
lactation and postmenopause. Possible causes include low or high
body weight and excessive exercise.

MENOPAUSE

Menopause is a natural process that marks the end of the menstrual cycles.
It's diagnosed after months without a menstrual period.

SYMPTOMS

In the months or years leading up to menopause (perimenopause), some

might experience these signs and symptoms:

 Irregular periods  Sleep problems

 Vaginal dryness  Mood changes
 Hot flashes  Slowed metabolism
 Chills  Thinning hair and dry skin
 Night sweats  Loss of breast fullness

MANAGEMENT OF MENOPAUSE

Menopause requires no medical treatment. Instead, treatments focus on

relieving your signs and symptoms and preventing or managing chronic
conditions that may occur with aging. Treatments may include:
 Hormone therapy. Estrogen therapy is the most effective treatment option
for relieving menopausal hot flashes. Estrogen also helps prevent bone loss.
Long-term use of hormone therapy may have some cardiovascular and
breast cancer risks, but starting hormones around the time of menopause has
shown benefits for some women.

 Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered

directly to the vagina using a vaginal cream, tablet or ring. This treatment
releases just a small amount of estrogen, which is absorbed by the vaginal
tissues. It can help relieve vaginal dryness, discomfort with intercourse and
some urinary symptoms.

 Low-dose antidepressants. Certain antidepressants related to the class of

drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease
menopausal hot flashes. A low-dose antidepressant for management of hot
flashes may be useful for women who can't take estrogen for health reasons
or for women who need an antidepressant for a mood disorder.

 Gabapentin (Gralise, Horizant, Neurontin). Gabapentin is approved to treat

seizures, but it has also been shown to help reduce hot flashes. This drug is
useful in women who can't use estrogen therapy and in those who also have
nighttime hot flashes.

 Clonidine (Catapres, Kapvay). Clonidine, a pill or patch typically used to

treat high blood pressure, might provide some relief from hot flashes.

 Medications to prevent or treat osteoporosis. Depending on individual needs,

doctors may recommend medication to prevent or treat osteoporosis.
Several medications are available that help reduce bone loss and risk of
fractures. Your doctor might prescribe vitamin D supplements to help
strengthen bones.
 THE THREE DELAYS MODEL

The Three Delays Model identifies three groups of factors which may stop
women and girls accessing the maternal health care they need:

1: DELAY IN DECISION TO SEEK CARE DUE TO;

 The low status of women

 Poor understanding of complications and risk factors in pregnancy and when to

seek medical help

 Previous poor experience of health care

 Acceptance of maternal death

 Financial implications

SOLUTIONS:

 Provide communities (men and women) with information on

pregnancy, childbirth and newborn healthcare so they know
when to seek medical help.

 Facilitate income generation schemes for women to enable them

to become financially independent and empowered to make
decisions about their own sexual and reproductive health and to
become future leaders.

2: DELAY IN REACHING CARE DUE TO;

 Distance to health centres and hospitals

 Availability of and cost of transportation

 Poor roads and infrastructure

 Geography e.g. mountainous terrain, rivers

 SOLUTIONS:

 Improving access to healthcare with the provision of health

centres in rural and remote areas as well as outreach healthcare
workers visiting villages to provide care.
 Construction of waiting houses next to health centers for
expectant mothers to stay in before their due date so when they
go into labor assistance is on site. Provision of motorbike
ambulances for mountainous terrain to improve access to health
centers.

3: DELAY IN RECEIVING ADEQUATE HEALTH CARE DUE TO;

 Poor facilities and lack of medical supplies

 Inadequately trained and poorly motivated medical staff

 Inadequate referral systems

SOLUTIONS:

 Training local midwives who will remain in rural areas when qualified,
training nurses, doctors and healthcare professionals to provide safe births
now and for future generations. Ensuring health centres are suitably
equipped to provide safe deliveries and improving referral systems
between health centres and hospitals.
 THE MILLENNIUM DEVELOPMENT GOALS

The Millennium Development Goals (MDGs) are eight goals with

measurable targets and clear deadlines for improving the lives of the world's
poorest people. To meet these goals and eradicate poverty, leaders of 189
countries signed the historic millennium declaration at the United Nations
Millennium Summit in 2000. At that time, eight goals that range from providing
universal primary education to avoiding child and maternal mortality were set
with a target achievement date of 2015.

MDG 4: REDUCE CHILD MORTALITY

Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five
mortality rate

4.1 Under-five mortality rate

4.2 Infant mortality rate

4.3 Proportion of 1 year-old children immunized against measles

MDG 5: IMPROVE MATERNAL HEALTH

Target 5.A: Reduce by three quarters, between 1990 and 2015, the
maternal mortality ratio.

5.1 Maternal mortality ratio

5.2 Proportion of births attended by skilled health personnel

Target 5.B: Achieve, by 2015, universal access to reproductive health

5.3 Contraceptive prevalence rate.

5.4 Adolescent birth rate

5.5 Antenatal care coverage (at least four visits)

5.6 Unmet need for family planning

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