Menstrual Cycle
episodic uterine bleeding in response to cyclic
hormonal changes.
Beginning (Menarche): average age at onset,
12.4yrs, average range: 9-12
Interval between cycles: average of 28days,
cycles of 23-35days not unusual
Duration of menstrual flow: average flow, 4-
6days, ranges of 2-9dats not abnormal
Amount of menstrual flow: 30-80mL per
menstrual period
Color of menstrual flow: dark red: blood,
mucus, and endometrial cells
Odor: similar to marigolds
I．Hypothalamus releases
Gonadotrophin Releasing hormone “GnRH”
also called Luteinizing hormone-releasing
hormone
II．under the influence of GNRH, the
anterior pituitary gland produces Follicular
secreting hormone and Luteinizing hormone.
Follicular secreting hormones is active early
in the cycle and responsible for ovum
maturation
Luteinizing Hormone most active at midpoint
of the cycle and responsible for ovulation or
release of the mature egg from the ovary.
Stimulates growth of the uterine during the
2nd half of menstrual cycle.
Menstrual Phase (1st to 4th day)
Proliferative/Follicular/Postmenstrual phase
 5th to 13th day of 28 day cycle
 FSH stimulates the secretion of estrogen,
the endometrium begins to proliferate so
rapidly the thickness of the
endometrium increases into eight folds
from day 5 to 14.
Secretory/luteal /pre menstrual phase
 14 to 25th day of a 28 day cycle
 after the ovulation, the corpus Luteum
produces significant amount of
progesterone. The progesterone causes
the glands of the endometrium to
become corkscrew or twisted in
appearance and dilated with quantities
of glycogen and mucin. “ rich, spongy
velvet appearance”
Ischemic phase
 if fertilization does not occur, the corpus
luteum regress after 8 to 10 days so
progesterone decreases. With the
withdrawal of progesterone, the
endometrium of uterus begins to
degenerate na capillaries rupture, and
endometrium sloughs off.
Menstrual phase
 Day 1-5 of 28 day cycle
 Desquamation of the layer of
endometrium: uterus at its THINNEST
 mixture of blood from ruptured
capillaries, mucin, endometrial Tissue
fragments and atrophied and unfertilized
ovum.
 Contains 30-80 mL of blood loss
 11mg iron loss
Menstrual Problems
 Dysmenorrhea: painful menstruation
“cramps” caused by the release of
prostaglandin
Primary dysmenorrhea: no known cause
Discomfort begins 1-2 days before onset of
menses then subsided by the 2nd day.
Secondary dysmenorrhea: has underlying
disease condition
Causes:
 pelvic inflammatory disease
 Endometriosis
 uterine prolapse
 Uterine myomas and polyps
 Adenomysiss
 Amenorrhea: absence of menses, one
or more missed menstrual periods.
 Anorexia nervous, bulimia,underlying
chronic disease, anxiety, fatigue
 Oligomenorrhea: irregular and in
frequent menstrual flow. Goes more
than 35 days without menstruating.
 Menorrhagia: abnormally heavy and
prolonged menses, greater than 80ml
per menses or soaks more than one pad
per hour
 Metrorrhagia: abnormal uterine
bleeding between menstrual periods
 Polymenorrhea: bleeding at frequent
intervals, menstrual cycles are shorter
than 21days in length
 Premenstrual dysphoric disorder(PDD):
occurs in luteal phase of menstrual cycle
and relieved by the onset of menses.
Symptoms: anxiety,fatigue, abdominal
bloating, headache, irritability or
depression.
Ovulation
 High level of estrogen and low level of
progesterone
 14 days before the menstruation
Signs of ovulation
 Mittelschmerz: lower abdominal pain
during ovulation from the release of
prostaglandin
 Spinnbarkeit: cervical mucus is thin,
watery, abundant, and highly stretchable
due to estrogen
 Increased body temperature due to high
progesterone
 Peak blood level of LH
IUD USER CAN HAVE UNUSUAL AMOUNT OF
MENSTRUAL FLOW.
ORAL CONTRACEPTIVES, MENSTRUAL FLOW
IS LIGHT