• It’s More than Just Your Period

• When you think about your menstrual cycle, do

you think of just your period? For some of us,
those few days of bleeding are the only thing we
think about, since it’s easy to associate your
cycle with the time of the month when you may
experience some other physical symptoms like
headaches, bloating, and stomach upset.
 Menstruation
• This is the monthly
menstrual bleeding
(also called
menstruation or
menstrual period)
that you have from
your early teen
years until your
menstrual periods
end around age 50
(menopause).
• About once a month,
the uterus grows a
new, thickened lining
(endometrium) that
can hold a fertilized
egg.
• When there is no
fertilized egg to start
a pregnancy, the
uterus then sheds its
lining.
• The menstrual cycle is measured from the first
day of menstrual bleeding, Day 1, up to Day 1
of your next menstrual bleeding.
• A teen's cycles tend to be long (up to 42 days),
growing shorter over several years.
• The average menstrual period is 5 days.
• The amount of blood loss every menstrual
period is 30 to 80 ml.
• The normal color of the menses is dark red that
contains mucus and endometrial cells.
 Organs Involved in Menstruation
Hypothalamus- stimulates Hypothalamus
anterior pituitary gland to
begin production of
gonadotropic hormones.
Pituitary gland- under the
influence of LHRH, the Pituitary Gland
anterior pituitary gland
produces 2 hormones that
act on the ovaries to further
influence menstruation. Ovaries
- FSH : a hormone that is
active early in a cycle & is
responsible for maturation
of the ovum
Uterus
• LH : a hormone that becomes most active at
the midpoint of the cycle & is responsible for
ovulation or release of the mature egg cell
from the ovary, and growth of uterine lining.
• Ovaries –one ovum matures in one or the
other ovary & is discharge from it each
month.
• Uterus – stimulation from the hormones
produced by the ovaries causes specific
monthly effects on the uterus
 What Happens During the Cycle?
• So, what is actually happening inside
your body each month? It’s all about
hormones. The menstrual cycle can
be divided into the following parts: the
ovarian cycle and the uterine cycle.
Estrogens ( Hormone for Woman)
1. Stimulate the growth, development, and
maintenance of female reproductive
structures, secondary sex characteristics
and the breast.
2. They help regulate fluid and electrolyte
balance.
3. The stimulate protein synthesis
4. They lower blood cholesterol levels
5. Spinnbarkeit and ferning
6. Thickening of the endometrium
• Moderate levels of estrogen in the blood
inhibit the release of GnRH, LH and FSH.
• This is the basis for the birth control pill.
Progesterone( Hormone of the Mother)
• Is secreted mainly by the corpus luteum and
works with estrogen to prepare the
endometrium for implantation and mammary
glands for lactation.
• Decrease GI motility
• Increase permeability of kidney to lactose &
dextrose
• Responsible for the mood swings of the
mother
• Mammary gland development
• High levels of progesterone also inhibit
GnRH, LH and FSH.
 FSH
•Release of estrogen from the Ovary
• facilitate the growth of primary
follicle to become graafian follicle
LH
•Stimulates ovary to release
progesterone
•Hormone for Ovulation
 Relaxin
• Produced by the corpus luteum
• Inhibits uterine contractions which
aids implantation.
• During pregnancy, it is produced
by the placenta, and continues to
relax uterine smooth muscle.
• Also relaxes the pubic symphysis
and helps dilate the uterine cervix
for delivery.
 THE MENSTRUAL CYCLE
• On the third day of the menstrual cycle,
serum estrogen level is at lowest which
stimulates the hypothalamus to produce
follicle stimulating hormone releasing factor
(FSHRF).
• FSHRF is responsible for stimulating the
anterior pituitary gland (APG) to produce the
FSH which will act on one immature occyte
inside a primordial follicle, stimulating its
growth.
•
 THE MENSTRUAL CYCLE
• In view of the FSH, estrogen is now going to be
produced in an increasing amount inside the follicle,
which is found in the ovary. Once estrogen is present,
the primordial follicle is now termed Graaffian follicle.
The GF is the structure therefore that contains high
amounts of estrogen.
• Estrogen in the GF will cause the cells in the uterus
to proliferate (grow rapidly), increasing its thickness to
about eight fold. This is called Proliferative/follicular
phase.
• On the 13thday of menstrual cycle, there is now a
very low level of progesterone in the blood. This
stimulates the hypothalamus to produce Luteinizing
Hormone releasing factor (LHRF).
Ovarian Cycle

• The Follicular Phase: Days 1 through 13

• In response to follicle stimulating hormone
(FSH) released from the pituitary gland in the
brain, ultimately one egg matures.
• Ovulation: Day 14
• At about day 14, in response to a surge of
luteinizing hormone, the egg is released from
the ovary.
• The egg travels through the fallopian tube
toward the uterus.
The Luteal Phase: Days 14 through 28
• The remains of the follicle become the corpus
luteum which releases progesterone
Uterine Cycle
• Proliferative Phase: Days 5 -14
• The uterine lining increases rapidly in thickness,
and the uterine glands proliferate and grow.
• Secretory Phase: Days 14 through 22
• When an egg is not fertilized, the corpus luteum
gradually disappears, estrogen and progesterone
levels drop, and the thickened uterine lining is
shed. This is menses (your period).
• Ischemic phase: Days 23 through 28
• last part of the secretory phase with ischemia due
to blood deficiency, endometrium pales, and spiral
arteries constrict intermittently due to decreased
hormone secretion by the degenerating corpus
luteum
• Hormonal decrease results in stoppage of
glandular secretion, loss of interstitial fluid, and a
shrinking of the endometrium
• The ovarian cycle involves changes in
the ovaries, and can be further divided
into three phases:
 The follicular phase is the time from the first
day of menstruation until ovulation, when a
mature egg is released from the ovary. It’s
called the follicular phase because growth or
maturation of the egg is taking place inside
the follicle, a small sac where the egg
matures.
 Ovulation occurs around day 14 of the
cycle, in response to a surge of luteinizing
hormone (LH) when the egg is released from
the ovary.
 The luteal phase is the time from when the
egg is released (ovulation) until the first day
of menstruation, when you get your period. It
is named after the corpus luteum (Latin for
"yellow body"), and is a structure that grows
in the ovary where a mature egg was
released at ovulation.
• The uterine cycle involves changes
in the uterus. It occurs in tandem
with the ovarian cycle, and is divided
into two phases:
– The proliferative phase is the
time after menstruation and before
the next ovulation, when the lining
of the uterus grows and thickens.
– The secretory phase is the time
after ovulation.
Let’s look at what’s happening during
each of these phases and when they
occur throughout the menstrual cycle.
The timing of these phases can vary
depending on the number of days in
each woman’s menstrual cycle.
 • Time of ovulation
• Women often believe that ovulation
occurs midcycle. It actually occurs
12-16 days before the next period.
So although a woman with a 28 day
cycle may ovulate midcycle (between
day 12 and day 16), a woman with a
36 day cycle will ovulate between
day 20 and day 24.
• An easy way to approximate the time
of ovulation for women with
 regular cycles is to subtract 16 from
the number of days in the cycle and
then add 4. This will calculate the
span of days in which ovulation is
most likely to occur.
• For instance, a woman with a 22 day
cycle is most likely to ovulate
between days 6 and 10 of her cycle
(22-16 = 6 (+4 =10).
 • Ovulation and conception

• Following ovulation, the egg’s life

span can be up to 24 hours, but is
usually between 6 and 12 hours
(3). In contrast, the sperm generally
survive for 3 days, but can live for
up to 5 days if optimal fertile
cervical mucus is present
(4)Therefore, pregnancy is possible 3 to 5
days before ovulation and in the 24 hours
following ovulation.
• By learning the various signs of ovulation
women can calculate their fertile and non-
fertile days for contraceptive purposes or
to optimize the chances of pregnancy.

Signs & Symptoms of Ovulation

• Mittlelschmerz – abdominal tenderness
on left/right iliac regions,brought about by
peritoneal irritation due to blood coming
out from the graafian follicle.
• Spinnbarkeit – vaginal secretion is
clear & transparent
• Change in vaginal mucus
• Goodel’s sign
• Mood changes
• Breast tenderness
• Increased levels of Progesterone
• Change in basal body temperature
 What common symptoms are
linked to the menstrual cycle?
• For about a week before a period,
many women have some premenstrual
symptoms. You may feel more tense
or angry. You may gain water weight
and feel bloated. Your breasts may
feel tender. You may get acne. You
also may have less energy than usual.
A day or two before your period you
may start having pain (cramps) in your
belly, back, or legs. These symptoms
go away during the first days of a
period.
• When your ovary releases an egg in
the middle of your cycle, you may
have pain in your lower belly. You
also might have red spotting for less
than a day. Both are normal
 How can women take care of
bleeding and symptoms?

• You can use pads or tampons to

manage bleeding. Whichever you use,
be sure to change the pad or tampon
at least every 4 to 6 hours during the
day. Pads may be best at night.
• Many women can improve their
symptoms by getting regular exercise
and eating a healthy diet.
 It also may help to limit alcohol and
caffeine. Try to reduce stress.
• A heating pad, hot water bottle, or warm
bath also can help with cramps. You can
take an over-the-counter medicine such
as ibuprofen or naproxen before and
during your period to reduce pain and
bleeding.
 Managing menstrual cramps
Why do I get cramps
when I have my period?
• During your menstrual
cycle, the lining of your
uterus produces a
hormone called
prostaglandin. This
hormone causes the uterus
to contract, or tighten,
which can cause cramping.
Women with severe
cramps may have higher-
than-normal levels of this
hormone, or they may be
more sensitive to it.
 Test Your Knowledge
• Menstrual cramps are often caused by
hormone changes.

– True
– False
 Menstrual problems
There are a range of problems that
women may experience with their
menstrual cycle. Some of the most
commonly reported menstrual
disorders are amenorrhea (absence of
periods), dysmenorrhea (painful
menstruation), menorrhagia (heavy
bleeding), bleeding between periods
and premenstrual syndrome
Amenorrhea (absence of periods)
• Amenorrhea, (outside of
pregnancy), usually occurs as a
result of a hormonal disturbance.
These disturbances can be
caused by a wide range of factors
including weight gain or loss,
over-exercising, emotional upsets
(both good and bad), anxiety or
stress, travel, dietary changes.
• Dysmenorrhea (painful menstruation)

– While some women experience only mild

discomfort during menstruation, Period pain
can consist of a cramping-type pain, caused by
the contraction of the uterine muscles, or a
heavy dragging pain in the pelvic region. Pain
in the legs and back, headaches, nausea and
diarrhea are also common.
– Popular remedies for mild pain include
analgesics (painkillers), antiprostaglandins (eg.
Nurofen, Ponstan), herbal medicines, warm
baths, heat packs, gentle exercise and rest.
 Menorrhagia (heavy bleeding)

• Because it is hard to accurately measure

the amount of menstrual fluid loss,
defining an amount that constitutes heavy
bleeding can be difficult. The degree to
which menstruation interferes with
everyday functioning can provide a useful
guide. Heavy bleeding can be caused by
a number of factors including hormonal
imbalances, polyps or endometriosis.
• The excessive amounts of blood lost can
lead to a woman becoming anemic.
Treatment may include oral
contraceptives and other hormonal
drugs, the destruction of the
endometrium using a variety of methods,
or the use of the intra-uterine system
(IUS), Mirena.
 Bleeding between periods
( Metrorrhagia)

 Bleeding between periods or spotting can be a

symptom of a number of conditions including
sexually transmitted infections, gynecological
cancer, endometriosis, fibroids or a thyroid
disorder.
 It can also be a side effect of some
contraceptives or medications. If a woman
experiences bleeding between periods she
should consult her doctor.
 Premenstrual syndrome

Premenstrual syndrome refers to a collection of

symptoms that some women experience before
each period . Symptoms include physical
responses like bloating, headaches, tiredness
and food cravings and psychological responses
like irritability, anger, depression and lowered
self-esteem. Women who suffer from
premenstrual syndrome find exercise, dietary
changes, yoga, relaxation techniques and herbal
remedies are helpful in relieving symptoms.
ANTEPARTAL
PERIOD
Ovum – from ovulation to fertilization
Zygote – from fertilization to implantation
Embryo – from implantation to 5-8 weeks
Fetus – from 5-8 weeks until term
Conceptus – Developing embryo or fetus
And placental structure throughout pregnancy
Process of Fertilization
• Fertilization ( Conception,
Fecundation)
- is the union of an ovum and a
spermatozoon. This usually
occurs in the outer third of
fallopian tube.
 Ovum ( zona pellucida & corona radiata)

Capacitation

Hyalurodinase ( proteolytic enzyme)

Ovum & spermatozoa fuse together

(zygote)

Morula(16 – 50 cells)

Blastocyst with trophoblast cells(forming placenta and membrane)

• Implantation or contact
between the growing structure
and the uterine endometrium
occurs approximately 8 to 10
days after fertilization.
• Apposition – the blastocyst
brushes against the rich uterine
endometrium
• Adhesion – it attaches to the
surface of the endometrium
• Invasion – the blastocyst
settles down into its soft folds.
• ***once the zygote
implanted it is an EMBRYO.
SIGNS OF PREGNANCY
PRESUMPTIVE SIGNS:

M – orning Sickness
A – menorrhea
C – hanges in Breast
F – atique
U – rinary Frequency
Q – uickening (18th – 20th weeks)
 Probable signs:
• Changes observed by examiner
C – hadwicks sign
H – egars sign
U – terine enlargement ( 12 weeks)
P – ositive pregnancy test
B – allottement
O – utlining of fetal body
G – oodells sign
S – ouffle, contraction and braxton
hicks( 28 weeks, painless contraction)
 Positive Signs
• Definitive signs of pregnancy
- HEARTBEAT
- 12 weeks by Doppler
- 18 – 20 weeks by auscultation
- Movement felt by the examiner usually
20 weeks
- Skeleton by sonography or X ray