Estimating Ovulation

Time
Ovulation –
- usually occurs approximately 14 days
before the first day of the succeeding
menstrual bleeding, corresponding to
the life of the corpus luteum.
SIGNS AND SYMPTOMS
OF OVULATION
A. Abrupt slight rise in basal body
temperature
 3-4 days before – most fertile time
before ovulation
1- 2 days after

B. Presence of mittelschmerz –sensation

of lower abdominal discomfort on
the side of the ovary that ovulated.
C. Identification of fertile cervical
mucus
 Fertile cervical mucus is
characterized as:
 clear and transparent
Slippery and lubricated
Stringy, elastic and stretchable
Having a positive Fern test
The ferning or elasticity, of cervical
mucus increases and the viscosity
decreases as ovulation approaches.
POSITIVE SPINNABARKEIT TEST
Before ovulation, cervical
mucus threads are 1 to 2 cm long.
SPINNABARKEIT – is the ability of
cervical mucus to be stretched up.
 TAKING COMPLETE MENSTRUAL
HISTORY

What to include in menstrual

history taking?
A. Menarche – first menstruation.
 inquire about its duration and
characteristics
B. Duration of menses. The duration
of menstrual flow is variable;
2 to 4 days -the usual duration
C. Intervals between menses
28 days – is the mean interval
between menstrual period…
although 21 to 35 days is
considered the normal range
D. Characteristics of menstrual
flow.
Described as scanty, normal
and heavy.
If there are clots or none.
25 to 60ml – normal amount of
blood lost during menstrual
period.
E. Presence of mittelschmerz or mid-
cycle pain.
F. Date of onset of l tgast menstrual
period. (LMP)
Check if it is normal menstrual period
and not implantation bleeding.
Implantation bleeding is slight blood
loss when the fertilized ovum embeds
onto the uterine wall.
G. Date of past/previous
menstrual period (PMP)
The menstrual period before the
last is the PMP.
It usually has the same
characteristics as the last
menstrual period.
Sample Problem:
Based on the following data on
menstrual periods and periods of
amenorrhea, identify the dates of
(1) the last menstrual period
(LMP), and
(2) The past menstrual period
(PMP)
• May 5-8, moderate in amount
• June 6-9, moderate in amount
• Julu 5-8, moderate in amount
• August, no menses (amenorrhea)
• September, no menses (amenorrhea)
H. Ask about any menstrual
abnormalities or problems:
1. Amenorrhea – absence of
menstruation and be can either primary
or secondary.
Primary A. –related to thyroid gland
abnormality –hyperthyroidism;
endocrine dysfunction or problem of
the hypothalamus, pitiutary gland,
ovaries and uterus.
Secondnary A. – is cessation of
menses for more than 3 months after
regular menstrual cycles have been
established.
Frequent caused:
- pregnancy - making the
identification of last menstrual period
(LMP) vital to assessment.
- stress & hormonal imbalance
- nutritional factor
2. Dyspmerorrhea – is painful menstruation;
characterized by severe cramps which may
cause transient disability.
Primary dysmenorrhea – occurs in the
absence of any underlying anatomic
abnormality.
Secondary D. – occurs when there is an
underlying structural abnormality of the
cervix or uterus (e.g. malposition); a foreign
body (IUD);Pelvic inflammatory disease
(PID); endometriosis or endometritis.
3. Metrorrhagia – abnormal bleeding
between menses/periods.
- related to PID, uterine fibroids,
corpus carcinoma, erosion, and cancer
of the cervix.
4. Menometrorrhagia – is excessive or
prolonged menstrual bleeding.
3. Premenstrual Syndrome (PMS)
- complex physical signs and
behavioral symptoms that occur
during the second half of the
menstrual cycle and that resolve with
the onset of menses.
- signs and symptoms are varied
and multisystem