Menstrual Cycle

What is a menstrual cycle?

• Series of changes a woman's body goes
through to prepare for a pregnancy.
• About once a month, the uterus grows a new
lining (endometrium) to get ready for a
fertilized egg.
• When there is no fertilized egg to start a
pregnancy, the uterus sheds its lining.
Characteristics of normal menstrual cycle
• Average length is 28 days, but may vary.
• Average duration is 5 days (range of 3-6 days)
• Average blood loss is 50 ml (range of 20-80 ml)
• Starts bw the ages of 11 and 14. Also could be 9-17
• Women get fewer periods between ages 39 and 51.
• The 1st day of bleeding is designated as day 1 of menstrual
cycle
• The menstrual cycle is from Day 1 of bleeding to Day 1 of the
next time of bleeding.
• It prepares uterus for pregnancy. When pregnancy does not
occur, menstruation follows.
 Menstrual Cycle
It is controlled by feedback system of 3 cycles:
• Endometrial
• Hypothalamic-pituitary
• Ovarian
 Hormones
• Ovarian hormones:
• Estrogen
• Progesterone
• Relaxin
• Pituitary hormones:
• FSH
• LH
• Prolactin
 Endometrial cycle
• 4 phases:
• Menstrual phase
• Proliferative phase
• Secretary phase
• Ischemic phase
 1) Menstrual phase
• Shedding of the endometrial layers initiated
by vasoconstriction of the upper layer of the
endometrium.
• Regeneration begins near the end of the cycle
 2) Proliferative phase
• After menstruation is a period of rapid growth
starts from the 5th day to time of ovulation
• Restoration of endometrial surface in day 4 or
before bleeding ceases known as regenerative
phase
• Then, under the control of Estrogen -------
increase thickness & growth occur at
ovulation
 In the ovary
• • FSH lead to maturation of the ovum (one every month)
• The immature ova (oocyte) contains 23 chromosomes,
each oocyte surrounded by a follicle--- becomes Grafian
follicle after maturation & go to surface of ovary.
• When ovulation occur @ day 14, Grafian follicle ruptures
& ovum go to fallopian tubes.
• FSH & LH continue acting on follicle cells of ovaries---
corpus luteum (yellow body) which is high in
progesterone.
 3) Secretary phase
• (after ovulation) extends from the day of ovulation to about 3
days before the next menstrual period.
• After ovulation larger amounts of progesterone produced causing
edema, vascular functional endometrium.
• At the end of this phase, fully matured secretory endometrium
reaches thickness & become heavy & soft.
• It become rich in blood & glandular secretions,,,, suitable
protective & nutritive bed for a fertilized ovum
• If pregnancy occurs-Implantation of fertilized ovum occur at 7-
10 days after ovulation & corpus luteum enlarges & persists until
4-5 months (secretes estrogen & progesterone) then regresse.
 4) Ischemic phase
• If no fertilization---corpus luteum regresse-
rapid decrease estrogen & progesterone
-involution of endometrium, rupture of blood
& vessels----menses bleeding marking day 1 of
the next cycle.
• The blood supply to the functional
endometrium is blocked & necrosis develops.
 Pituitary hormones
• FSH:
• Causes Graafian follicles to develop & enlarge
• Stimulates secretion of estrogen
• Increases during the 1st half of cycle
• LH:
• Produced when ant pituitary stops producing FSH
• Increase LH + decrease FSH--- follicle ruptures & ovulation occurs
• Corpus luteum develops under the influence of LH & produced both
Estrogen & Progesterone
• Prolactin:
• Produced in the ant pituitary. Excessive amounts inhibit ovulation as in
BF
 Ovarian hormones
• Estrogen:
• produced under control of FSH
• Function: responsible for secondary characteristics of the female
• During the cycle, it causes proliferation of uterine endometrium by
inhibiting FSH & encourages fluid retention Progesterone:
• produced by corpus luteum under influence of LH
• Function: It causes body temp to increase by time of
• ovulation, gives fullness of breast before menses Relaxin:
• maximum levels bw 38-42 weeks of pregnancy
• From corpus luteum
• Function: relaxes pelvis, cervix, softens cervix to suppress uterine
contractions & reduces oxytocin
 Problems of menstrual cycle
• Women can have a range of problems with
their periods, including pain, heavy bleeding,
and skipped periods.
 Amenorrhea
• The lack of a menstrual period. This term is used to describe the absence of a
period in:
1. Young women who haven't started menstruating by age 15
2. Women and girls who haven't had a period for 90 days, even if they haven't
been menstruating for long
Causes can include:
Pregnancy
Breastfeeding
Extreme weight loss
Eating disorders
Excessive exercising
Stress
Serious medical conditions in need of treatment
 Dysmenorrhea
• Painful periods, including severe cramps.
• Menstrual cramps in teens are caused by too
much of a chemical called prostaglandin.
• Most teens with dysmenorrhea do not have a
serious disease, even though the cramps can be
severe.
• In older women, the pain is sometimes caused by
a disease or condition such as uterine fibroids or
endometriosis.
 Dysmenorrhea
• Self management:
• Heating pad or taking a warm bath
• Ibuprofen
• If these medicines don’t relieve your pain or
the pain interferes with work or school, you
should see a doctor. Treatment depends on
what’s causing the problem and how severe it
is.
 Menorrhagia
• Excessive menstrual flow lasting more than 7-8
days with blood loss more than 80-100 ml Can be
due to:
• Hormonal disturbances
• Use of IUCDs
• Endometrial infection
• Lesions or malignancies in ovaries, cervix or uterus
• Drug therapy i.e. chemotherapy, steroids or
tranquilizers
 Premenstrual syndrome (PMS)
• Set of both physical & behavioral symptoms that begins approximately 7-10 days before menses
& ends with the onset of menses.
• Symptoms may include:
• Edema
• Abdominal distension
• Weight gain
• Panic & crying
• Irritability
• Headaches
• Insomnia
• Emotional instability
• Pelvic fullness
• Breast tenderness
• Depression
• Fatigue
• Backache