Reproductive System (Menstrual Cycle)

Lesson 5
LESSON: 5
DURATION: 2 hours

Reproductive System (Menstrual Cycle)

SPECIFIC OBJECTIVES:

At the end of the lesson, the students should be able to:

1. Outline the phases of the menstrual cycle, and changes taking place in each phase.
2. Identify the hormones involved in menstruation
3. Identify the role of hormones in regulating the menstrual cycle.

LESSON PROPER:

MECHANISM OF MENSTRUATION
- ushered by menarche and ends with menopause
A. Definition of Terms:
Menstrual Cycle
- Periodic uterine bleeding in response to cyclic hormonal changes
Menarche
- Refers to the first menstrual period
- Age usually is at 12-13
Menopause
- Cessation of menstrual cycle
 Characteristics of Normal Menstruation Period:
 Menarche – average onset 12 -13 years
 Interval between cycles – average 28 days
 Cycles 23 – 35 days
 Duration – average 2 – 7 days; range 1 – 9 days
 Amount – average 30 – 80 ml ; heavy bleeding saturates pad in <1hour
 Color – dark red; with blood; mucus; and endometrial cells

 Menstrual Cycle
- Starts from the first day of the menstrual period to the first day of the next menstrual
period
- Average length is 28 days (but maybe anywhere from 25-35 days)

 Amenorrhea
- Temporary cessation of menstrual flow
 Oligomenorrhea
- Diminished menstrual flow
  Polymenorrhea
- Frequent menstruation occurring at intervals of less than 3 weeks
 Menorrhagia
- excessive bleeding during regular menstruation
 Metrorrhagia
- bleeding at completely irregular intervals

B. Body Structures Involved:

 Hypothalamus – FSHRF & LHRF
 Anterior Pituitary Gland – FSH & LH
 Ovary – Estrogen and Progesterone
 Uterus

C. Effects of Estrogen:
1. Inhibits production of FSH
2. Causes endometrial hypertrophy
3. Stimulates growth of ductile structures in the breast
4. Increases quantity and pH of cervical mucus causing it to be thin and watery and can be
stretched to a distance of 10-13 cms.

D. Effects of Progesterone:
1. Inhibits production of LH
2. Increases in endometrial tortuosity
3. Increases in endometrial secretions
4. Facilitates transport of the fertilized ovum through the fallopian tube.
5. Increases body temperature

FOUR PHASES OF THE MENSTRUAL CYCLE

FIRST PHASE OF THE MENSTRUAL CYCLE

- it is also known as proliferative, estrogenic, follicular, post-menstrual

Four to five days after the end of the menstrual cycle

The thin lining of the endometrium proliferates eightfold upon increase in estrogen levels until
14 days before the next cycle

Physiology:

On the 3rd day of the menstrual cycle, estrogen level is at it’s lowest

Stimulate Hypothalamus to produce FSHRH

FSHRH stimulates the Anterior Pituitary Gland to produce FSH

FSH stimulates growth of the Primordial Follicle containing an immature oocyte

 The follicular cells in the primordial follicle begins to secrete follicular fluid rich in
estrogen as it matures

At full maturity of the primordial follicle it is now termed

the GRAAFIAN FOLLICLE which contains high levels of Estrogen and a primary oocyte
(a result of the meiotic division of the maturing oocyte)

Estrogen causes the uterine endometrium to proliferate

SECOND PHASE OF THE MENSTRUAL CYCLE:

- it is also known as secretory, progestational, luteal, pre-menstrual
 Progesterone formation by the corpus luteum (with the influence of LH) causes the
corkscrew appearance of the endometrium. This layer also, at this phase, is rich in
glycogen and mucin.
 This phase the best time for a fertilized egg to implant.
 The endometrium will continue to thicken until it assumes a spongy, velvety
appearance.

Physiology:
On the 13th day of the menstrual cycle, progesterone is now at its lowest level

Stimulate Hypothalamus to produce LHRF

LHRF stimulates the anterior pituitary gland to produce Luteinizing Hormone

Hence, the LH surge

On the 14th day, the Graafian follicle ruptures and releases the mature ovum, a process
called OVULATION

The LH continues to rise in amount and acts on the Graafian follicle causing the follicle
cells to begin to produce lutein instead follicular fluid, which is rich in progesterone

The Graafian follicle, after release of the ovum is now termed as the CORPUS LUTEUM,
which contains high levels of progesterone

Progesterone causes increase in amount of capillaries in the uterus and increases tortuosity
of the endometrial glands

THIRD PHASE OF THE MENSTRUAL CYCLE:

- it is known as the ischemic phase
 If fertilization does not occur, the corpus luteum will regress. Progesterone and estrogen
levels will decrease, leading to the degeneration of endometrial lining.

Physiology:

Up until the 24th day of the cycle, if the ovum is not fertilized, progesterone starts to
decrease in the Corpus Luteum

Corpus Luteum will eventually become CORPUS ALBICANS

FOURTH PHASE OF THE MENSTRUAL CYCLE:

- it is known as the menses or menstrual phase

Physiology:
After 3-4 days, the thickened lining degenerates and the capillaries rupture

Thus, begins another menstrual period and cycle

MENSTRUATION

Note:

 3rd day of menstrual cycle – estrogen level is at its lowest

 13th day of menstrual cycle – estrogen level is at its highest,
progesterone level is very low
 14 day before the onset of next cycle - OVULATION!
th
Lifespan of egg: 24-36 hours
Signs of ovulation:
1. Thin, abundant, and
stretchy cervical mucus
(Spinnbarkeit)
2. Ferning
3. Mittelschmerz
4. Breast tenderness
5. Increase libido

Most reliable sign: BBT ↓ a day before ovulation followed by an abrupt ↑ after ovulation.

*If fertilization occurs, ovum proceeds down the fallopian tube and implants on the
endometrium

REFERENCES/ADDITIONAL RESOURCES/READINGS:

Pillitteri, Adele (2018). Maternal and Child Health Nursing, Care of the Childbearing and
Childrearing Family, 8th edition.

Seeley, Rod R. (2005). Essentials of Anatomy and Physiology, 5th Edition

Wong, Donna, et.al.(2009). Maternal Child Nursing Care, 3rd edition, Elsevier (Singapore) Pte
Ltd.