MENSTRUAL DISORDERS

PREPARED AND PRESENTED BY:

MRS. HAJAR HIJAZI_NURS 369_OBSTETRIC AND
GYNECOLOGY_FALL 2023- 2024
 MENSTRUAL DISORDER

1. FETAL DEVELOPMENT

2. MENSTRUAL DISORDER
 1.FETAL DEVELOPMENT

 Conception:

Q1. How many sperm are ejaculated during each ejaculation?

A1. As many as two million sperm can be ejaculated during each ejaculation.

Q2. How many eggs are usually released during a menstrual cycle?
A2. Usually one egg is released.

Q3. What can happen if more than one egg is released?

A3. If both eggs are fertilized, it means a woman may have fraternal twins. Identical twins happen when the fertilized egg
splits into two before cells begin dividing.

Q4. How long does an egg “live” inside a woman’s body?

 1.FETAL DEVELOPMENT

 Conception:
Q5. How long do sperm “live” inside a woman’s body once ejaculated?
A5. 3 to 5 days from the time of ejaculation.

Q6. Will a pregnancy occur every time sexual intercourse occurs?

A6. No. Pregnancy only happens if sperm can fertilize an egg and implant into the wall of the uterus.

Q7. When does a pregnancy occur?

A7. When a sperm fertilizes an egg. This can happen if intercourse takes place within the period of ovulation.

 Women are most likely to become pregnant if intercourse happens around the middle of the menstrual cycle. Each

woman has a different length of menstrual cycle, so it is difficult to predict.

 1. FETAL DEVELOPMENT

 What are the major milestones in fetal development?

 Important fetal development milestones at each stage of prenatal development include:

A. Germinal stage: The division of cells and implantation of the blastocyst.

B. Embryonic stage: The development of the neural tube and organs.

C. Fetal stage: Continued growth of organs and physical development in preparation for birth.
 A. GERMINAL STAGE OF PRENATAL DEVELOPMENT

 The germinal stage begins at conception (Refers to the successful fusion of gametes).

 The fertilized egg is called a zygote.

 Just a few hours after conception, the single-celled zygote begins making a journey down the fallopian tube

to the uterus.

 Cell division begins approximately 24 to 36 hours after conception. Through the process of mitosis, the

zygote first divides into two cells, then into four, then eight cells.

 Once the eight-cell point has been reached, the cells begin to differentiate and take on certain characteristics.
 A. GERMINAL STAGE OF PRENATAL DEVELOPMENT

 As the cells multiply, they will also separate into two distinctive masses: the outer cells will eventually

become the placenta, while the inner cells form the embryo.

 Cell division continues at a rapid rate during the approximately week-long journey from fallopian tube to

uterus wall. The cells develop into what is known as a blastocyst.

 Finally, the blastocyst arrives at the uterus and attaches to the uterine wall (endometrium), a process known

as implantation.
 A. GERMINAL STAGE OF PRENATAL DEVELOPMENT

 At the moment of fertilization, The gender of the baby depends on what sperm fertilizes the egg at the moment of

conception.

 Generally, women have a genetic combination of XX and men have XY. Women provide each egg with an X.

 Each sperm can be either an X or a Y.

 If the fertilized egg and sperm is a combination of an X and

Y, it’s a boy. If there are two Xs, it’s a girl.
 B. EMBRYONIC STAGE OF PRENATAL DEVELOPMENT

 The beginning of the third week after conception marks the start of the embryonic period, At this point, the mass

of cells is now known as an embryo.

 The embryonic stage plays an important role in the development of the brain.

 By the end of the embryonic period, the basic structures of the brain and central nervous system have been

established.

 At this point, the basic structure of the peripheral nervous system is also defined.
 C. FETAL STAGE OF PRENATAL DEVELOPMENT

 Once cell differentiation is mostly complete, the embryo enters the next stage and becomes known as

a fetus.

 The fetal period of prenatal develop marks more important changes in the brain.

 This period of development begins during the ninth week and lasts until birth.

 This stage is marked by amazing change and growth.

 1.FETAL DEVELOPMENT

 Fetal Development: Stages of Growth

 Fetal development is divided into three stages,

called trimesters.

 Each trimester is a set of about three months. So,

three months pregnancy, it’s about 12 weeks.

 A full-term pregnancy is 40 weeks.

 1.FETAL DEVELOPMENT

 Fetal Development: Stages of Growth

1. First trimester

 The first trimester will span from conception to 12 weeks.

 It is the period of rapid growth and development.

 By the end of the first trimester, all of the baby’s organs will be formed and

functioning.
 1.FETAL DEVELOPMENT

 Fetal Development: Stages of Growth

1. First trimester

 1 day: The sperm and the ovum unite

 7-10 days: The fertilized ovum attaches to the lining of the uterus. The placenta begins to form.

 2 weeks: The baby, called an embryo, is now a layered disc on the uterus wall. A woman will miss her menstrual

period.

 4 weeks: The neural tube forms. This tube will later develop into the central nervous system including the spinal cord

and brain. Part of the brain will develop including: the structures of the forebrain, midbrain, and hindbrain.​

o The head begins to form, quickly followed by the eyes, nose, ears, and mouth. The blood vessel that will become the
 1.FETAL DEVELOPMENT
 Fetal Development: Stages of Growth

1. First trimester

 5th weeks: Buds that will form the arms and legs appear.

 8 weeks: The embryo has all of the basic organs and parts except those of the sex organs. At this point, the embryo

weighs just one gram and is about one inch in length.

 Between the 9th and 12th week: Reflexes begin to emerge. The fetus begins to make reflexive motions with its arms

and legs.
 1.FETAL DEVELOPMENT

 Fetal Development: Stages of Growth

1. First trimester

 12 weeks:

1. Tooth buds are present. Fingernails and toe nails are forming.

2. Immature kidneys secrete urine into the bladder.

3. The sex organs begin to differentiate (External genitalia are forming).

4. The fetus can now move in the amniotic fluid, but these movements cannot be felt.

5. The baby’s heart beat may be heard with an electronic listening device.

6. At this point, the fetus weighs around three ounces.

 1.FETAL DEVELOPMENT
 Fetal Development: Stages of Growth

2. Second Trimester

 During the second trimester (the next three months of pregnancy), the brain

and central nervous system also become more responsive (the brain develops a

lot).

 During the second trimester until about 24 weeks, the fetus cannot live outside of

the body because its lungs, heart and blood systems have not developed
 1.FETAL DEVELOPMENT

 Fetal Development: Stages of Growth

2. Second Trimester
 16 weeks: The face looks more human, the baby has hair, the ears stand out, and the baby can hear the mother’s

voice.

 Between 16 and 20 weeks: The baby’s movements may be felt.

 If this is a woman’s first pregnancy it is possible that the baby’s movements may not be felt until 18 to 20 weeks.
 1.FETAL DEVELOPMENT

 Fetal Development: Stages of Growth

2. Second Trimester
 20 weeks:

 A fine downy hair (lanugo) appears all over the baby’s body. The baby’s

skin is thin, shiny, and covered with a creamy protective coating called
vernix.

 The baby’s legs move well. During the second trimester, meconium (the

baby’s first stool) begins to appear in the intestines.

 1.FETAL DEVELOPMENT
 Fetal Development: Stages of Growth

2. Second Trimester

 24 weeks:

 Early breathing movements begin.

 A substance called surfactant is formed in the lungs. This substance helps the

lungs to expand normally after the baby is born.

 26 weeks:

 The baby’s outline may be felt through the abdomen.

 The eyes may be open now.
 1.FETAL DEVELOPMENT

 Fetal Development: Stages of Growth

3. Third Trimester

 During the third trimester (the last 3 months of pregnancy) the baby could

survive if born before it is full term, but would need special care.

 During the period from seven months until birth, the fetus continues to develop,

put on weight, and prepare for life outside the womb. The lungs begin to expand
and contract, preparing the muscles for breathing.

 The closer to full term, the more ready the baby is to cope with the birth process

and life outside the uterus.

 1.FETAL DEVELOPMENT

 Fetal Development: Stages of Growth

3. Third Trimester

 28 weeks: The brain starts to mature faster, with an activity that greatly resembles that of a sleeping newborn. The

baby can hear and respond to sounds.

 32 Weeks: The baby develops a sense of taste and becomes aware of sounds outside the mother’s body. The male

baby’s testicles begin to drop into the scrotum.

 36 weeks: The baby’s skin is smooth, pink, and covered with white cheese-like substance called vernix.

 40 weeks: The testicles of male babies are now in the scrotum, the labia majora of female babies are developed.
 MENSTRUAL DISORDER
 Menstrual Disorders:

1. Premenstrual syndrome (PMS)

2. Dysmenorrhea

3. Amenorrhea (absence of menstrual flow)

4. Excessive bleeding, Irregular bleeding, or bleeding between cycles or unrelated to cycles.

 These disorders need to be discussed with a health care provider and managed individually.
 1. PREMENSTRUAL SYNDROME (PMS)

 PMS is a cluster of physical, emotional, and behavioral symptoms that are usually related to the luteal

phase of the menstrual cycle.

 PMS is very common, affecting many women at some time

in their lives.

 Symptoms begin in the 5 days preceding menses, and relief

occurs within 4 days of onset of menses.

 Dysfunction usually occurs in relationships, parenting, work, or

school.
 1. PREMENSTRUAL SYNDROME (PMS)

Clinical manifestation:

 The physical symptoms of PMS include:  Psychologically, there may be:

 Painful and swollen breasts  Depression

 Headache  Anxiety

 Fatigue  Irritability

 Low back pain  Behavioural changes

 Feeling of abdominal fullness.  Mood swings

 Fear of losing control

 1. PREMENSTRUAL SYNDROME (PMS)

 Premenstrual dysphoric disorder (PMDD):

 Is a severe form of PMS with significant severity of symptoms.

 Is a psychiatric diagnosis that has been developed to distinguish women

whose symptoms are severe enough to interfere significantly with activities of

daily living.

 Or in whom the symptoms are not relieved with the onset of menstruation, as

is usually the case with PMS.

 2. DYSMENORRHEA

1. Primary dysmenorrhea:

 Is painful menstruation, with no identifiable pelvic pathology. Pelvic examination findings are normal.
 It is characterized by crampy pain, it occurs at the time of menarche and continues for 48 to 72 hours.

 Etiology: Caused by increased prostaglandin production by the endometrium in an ovulatory cycle

which cause contraction of the uterus. The highest level is in the first 2 days of menses.
 2. DYSMENORRHEA

2. Secondary dysmenorrhea:
 Is painful menstruation due to pelvic or uterine pathology.

 Pelvic pathology such as endometriosis, tumors, polyps, or pelvic

inflammatory disease (PID) contributes to symptoms.

 Patients frequently have pain that occurs several days before menses. It may

be accompanied by nausea, diarrhea, dizziness.

 Endometriosis: Endometrial tissue in abnormal locations; causes pain with menstruation, scarring, and possible
infertility.
 2. DYSMENORRHEA
 Clinical manifestation:

 Sharp, intermittent spasm, usually in suprapubic area.

 Pain may radiate to the back of the leg or the lower back.

 Systemic symptoms:

1. Nausea

2. Vomiting

3. Diarrhea

4. Fatigue

5. Fever

6. Headache or dizziness
 3. AMENORRHEA
(ABSENCE OF MENSTRUAL FLOW)

1. Primary amenorrhea (delayed menarche):

 Refers to the situation in which a young woman who by age 15 years has not begun developing secondary sex

characteristics or who by age 16 years or older has developed secondary sex characteristics but has not started
menstruation.

 A complete physical examination, careful health history, and simple laboratory tests help rule out possible causes.

 Treatment is directed toward correcting any abnormalities.

 3. AMENORRHEA
(ABSENCE OF MENSTRUAL FLOW)
 Causes of primary amenorrhea:

1. Extreme wt gain or loss

2. Congenial abnormalities of the reproductive system
3. Stress from a major life event
4. Excessive exercises
5. Eating disorders (anorexia nervosa)
6. Polycystic ovarian syndrome
7. Hypothyroidism
8. Turner syndrome
9. Chronic illness
Turner syndrome
10. Congenial heart disease
11. Ovarian or adrenal tumor
 3. AMENORRHEA
(ABSENCE OF MENSTRUAL FLOW)

2. Secondary amenorrhea:

 (An absence of menses for three cycles or 6 months in women who have previously menstruated

regularly).

 In adolescents, secondary amenorrhea can be caused by minor emotional upset related to being away

from home, attending college, tension due to schoolwork, or interpersonal problems.

 3. AMENORRHEA
(ABSENCE OF MENSTRUAL FLOW)
 Causes of secondary amenorrhea:
8. Hyper prolactinemia
1. Breast feeding
9. Rapid wt gain or loss
2. Emotional stress
10. Chemotherapy or radiotherapy
3. Mal nutrition

4. Pregnancy 11. Kidney failure

5. Depression 12. Colitis

6. Hyperthyroid or hypothyroid
13. Tranquilizers or antidepressant
7. Early menopause
 3. AMENORRHEA
(ABSENCE OF MENSTRUAL FLOW)

 Obesity can result in anovulation and subsequent amenorrhea.

 Eating disorders (anorexia and bulimia), often result in lack of menses because the decrease in body

fat and caloric intake affects hormonal function.

 Infrequent periods (oligomenorrhea) may be related to thyroid disorders, polycystic ovarian syndrome.
 4. ABNORMAL UTERINE BLEEDING

 Dysfunctional uterine bleeding is defined as irregular, painless bleeding of endometrial origin that

may be excessive, prolonged, or without pattern.

 It is usually secondary to anovulation (lack of ovulation) and is common in adolescents and women

approaching menopause.

 Other causes may include fibroids, obesity, and hypothalamic

dysfunction.
 4. ABNORMAL UTERINE BLEEDING

 Types of uterine bleeding disorders:

1. Hypomenorrhea: (Scanty menstruation).

2. Oligomenorrhea: (Infrequent menstruation, periods more than 35 days apart).

3. Menorrhagia: (Excessive menstruation).

 4. ABNORMAL UTERINE BLEEDING

 Etiology:
 Adenomyosis

 Pregnancy

 Hormonal imbalance

 Endometrial polyps or cancer

 Endometriosis

 Polycystic ovary syndrome

 Morbid obesity

 Steroid therapy

 Hypothyroidism

 Clotting disorders
 4. ABNORMAL UTERINE BLEEDING
 Clinical manifestation:

Vaginal bleeding Irregular

Infertility Mood swings Hot flashes
between periods menstrual cycle

Menstrual flow Diabetes: insulin

Vaginal
either scanty or Acne resistance is
tenderness
profuse common
 4. ABNORMAL UTERINE BLEEDING

 Menorrhagia:

 Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow.

 Persistent heavy bleeding can result in anemia.

 It can also be a sign of a bleeding disorder or a result of anticoagulant therapy.

 Treatment may involve endometrial ablation or hysterectomy.

 4. ABNORMAL UTERINE BLEEDING

 Metrorrhagia:

 Metrorrhagia (vaginal bleeding between regular menstrual periods) is probably the most significant

form of menstrual dysfunction because it may signal cancer, benign tumors of the uterus, or other
gynecologic problems.

 Menometrorrhagia:

 Is heavy vaginal bleeding between and during periods. That requires evaluation.