it include detail about menstural cycle and its phase. cultural belief and management related with menstrual problem. it also include menopouse and its feature & management

1. MBBS(BANGLADESH)

2. The periodic sheding of blood,damaged tissue
of endometrium and unfertilized ova per vagina
is called menstruation.
MENSTRUAL CYCLE:-
The monthly rhythmic
changes in the rates of secretion of female
hormones and corresponding changes in the
ovaries and sexual organs as well is known as
menstrual cycle.Average-28 1 days(normal)

3. Progesteron release

4. It have 3 phases:-
1)proliferative phase-10 days
(5th to 14th day)
2)Secretory phase-14 days
(15th to 28th day)
3)menstrual phase-4 days
(1st to 4th day)

5. 1)PROLIFERATIVE OR ESTROGENIC
PHASE:-
Under the influence of estrogen
the uterine stroma and epithelial cell
proliferate rapidly so the endometrium
increase in thickness about 3-4 mm.

6. 2)SECRETORY PHASE:-
Under influence of estrogen &
progesterone.
a)Estrogen cause slight additional
proliferation of endometrium.
b)progesteron causes marked swelling
and secretory change like-i)The uterine glands
& blood vessels become large and tortuous.
ii)The cell cytoplasm contain secretory granule
rich in lipid & glycogen. The thickness
becomes 5-6 mm.

7. 3)MENSTRUAL PHASE:-
No influence of estrogen & progesteron
In this phase the estrogen(vasodilator) &
progesteron sharply decrease and some
vasoconstrictor release causes tortuous blood
vessel spasm and necrosis of endometrium
hence the periodic sheding of blood,damaged
tissue of endometrium and unfertilized ova per
vagina is called menstruation.

9. Volume:-30-50 ml
Stratum compactum and spongiosum of
endometrium
Mucous
Unfertilised ovum
Leucocytes
Fibrinolysin
Some chemical substance like glycogen

10.  Liquid,pale,reddish brown in color.
 Fishy smell.
 Never clot due to absence of cloting factor
and presence of fibrinolysin which act as
anticoagulant.
ARTIFICIAL MENOPAUSE:-Permanent
cessation of ovarian function done by artificial
means like surgical removal of ovaries or by
radiation is called artificial menopause.

11. There is wrose belief in society about
menstruation that it is a period in which
female are crushed by god and they
should be kept separately and they are not
allowed to do any household work or pray
for god.Even during that time they can’t
spend time with there husband. During this
period they are even neglated by their
family members.

12. This belief can be improved by following
ways:-
1)proper health education about
menstrution and its process.
2)counceling of the people by
personal discussion,family discussion,
group discussion.

13. 1)Maintain of personal hygiene by-
a)proper and regualar bathing.
b)use of sanitory pad and frequent
changing as it got much soaked.
2)Maintaine of nutrition
3)Proper rest
4)Emotional and psycological support from
the family member(mainly mother) and
society

14. Permanent cessation of menstruation at
the end of reproductive life due to loss of
ovarian follicular activity is called
menopause.
Age of menopause:-45-55 yrs, average 50
yrs.
some of the factor may cause early
menopause like:-cigarette smoking and
severe malnutrition.

15. Abrupt cessation of menstruation(rare).
Gradual decrease in both amount and
duration.it may be spoting or delayed and
ultimately lead to cessation.
Irregular with or without excessive
bleeding.One should exclude genital
malignancy prior to daclare it as the usual
premenopausal pattern.

16. Hot flush with excessive sweating.
Palpitation.
Weakness and fatigue.
Urogenital atrophy may leads to
dyspareunia(painfull sexual intercourse).
Psycological changes like –
depression,anxity,decrease sexual
desire,headache,insomnia,irritability, mood
swing,dementia and inability to
concentrate.

17. Skin and hair:-thining,loss of elasticity and
wrinkling of skin. Loss of axillary and pubic
hair.
Cardiovascular changes:-increase risks of
hypertenson and atherosclerosis.
Bone metabolism:-may lead to
osteoporosis and fracture due to decrease
in osteoblastic activity.

18. Cessation of menstruation for
consecutuive 12 months without any other
pathology.
Appearance of menopausal symptoms
Vaginal cytology-showing maturation
index(feature of low oestrogen)
Low serum FSH & LH

19. Proper counselling
Nutritious diet-diet rich of calcium and
protein.
Supplementary calcium-1 to 1.5 gm
calcium reduce osteoporosis & fracture.
Vitamin D supplementation.
Cessation of smoking and alcohol.
HORMONE REPLACEMENT THERAPY-
oestrogen replacement.