BY - Sakshi Khachi MAA HATESHWARI COLLEGE OF NURSING SUNDERNAGAR MANDI 15 August 2021

2. INTRODUCTION
 Typically a women of child bearing age or
reproductive age (15 -45 years) should
menstruate every 28 days or so unless she is
pregnant or moving into menopause .
 A menstrual cycle consist of natural changes
that occur in a women body every month in
prepration for pregnancy .
 Menstruation starts at puberty and ends at
menopause
 Eumenorrhea is the term for normal
menstruation .

3. DEFINITION
 Menstruation means cyclic uterine bleeding caused
by shedding of progestational endometrium . It
occurs between menarche and menopause .
 Menstruation is also called menstrual bleeding ,
Menses or Periods.
OR
 The cyclic events that takes place in a rhythmic
manner during the reproductive period of a woman
life is called menstrual cycle .

4. 1. Menarche :- First occurance of menstruation .
Starts at 12 to 16 years . Average 14 years .
2. Menopause :- Permanent cessation of menstrual
cycle . Ends at 45- 50 years.
3. Duration :-2 to 7 days . ( < 2 days in hypomenorrhea
and >7 days in menorrhagia.
4. Amount :- 30 to 80 ml. .>80 ml is menorrhagia & <30
ml is hypomenorrhea.
CHARACTERISTICS OF
MENSTRUATION

5. CHARACTERISTICS OF NORMAL
MENSTRUATION
5 . Coagulation :-
 Some authors state that the mixture of mucus with
menstrual blood prevents the clotting of the
menstrual blood .
 Others state that the acidity of vaginal secretion is
responsible for non coagulibility .
 Some states that it does not clot due to
present in endometrial debris .

6. Hypothalmic - Pituitary Ovarian Axis
Hypothalmus Gland
Secrete Gonadotrophin Releasing Harmones
FSH LH

7. Components of Menstrual Cycle
 There are 2 main components of the menstrual cycle :-
1. Ovarian Cycle
2. Uterine Cycle
 Ovarian Cycle :- Changes happen in ovaries in
response to pituitary harmones .
Uterine Cycle :- Changes that takes place in the
uterus .
 But it is important to remember that both cycles work
simultaneously to produce menstrual cycle .
 Changes in the cervical mucus also takes place during
menstrual cycle .

8. OVARIAN CYCLE
 The ovarian cycle refers to periodic changes that
occur in the ovary every month during the female
reproductive life .
 Cyclical changes in the ovaries occur in response to 2
anterior pituitary harmones .
1. Follicle stimulating harmone (FSH)
2. Luteinizing harmone ( )

9. UTERINE CYCLE
 The uterine cycle refers to changes that are found in
the lining of the uterus
 The changes come about in response to the ovarian
harmones :-
1. Estrogen
2.

11. PHASES OF MENSTRUAL CYCLE
 There are 4 phases of menstrual cycle .
1. Menstrual phase
2. Follicular OR preovulatory OR proliferative phase
3. Ovulation OR Ovulatory phase
4. Luteal OR Post ovulatory OR secretary Phase

13. Menstrual Phase
 It is called Bleeding phase .
 Average duration of this phase is 3-5 days .
 Day 1 of the menstrual cycle is marked by onset of
menstruation.
 During the menstrual phase the uterine lining is shed
because of .
 The menstrual flow consist of the secretions from the
endometrial gland , endometrial cells , blood from the
degenerating capillaries and unfertilized ovum.
 The menstrual phase ends when menstrual period stops
on day 5.

14. Follicular &Pre ovulatory and Proliferative
phase
 This phase of the cycle extends from the day 5th of
the menstrual phase till the time of ovulation .
 This phase generally lasts for 8-9 days .
 During this phase some 10 - 15 primordial follicles
start maturing .
 But only one follicle of one of the ovaries reaches
maturity .
 The mature follicle is called which
secretes estrogen .
 Estrogen has a negative feedback on the FSH .
 This is to stop the other follicles from maturing .

15. Follicular &Pre ovulatory and Proliferative
phase
 Estrogen has another function also.
 Estrogen causes the level to rise further .

16. OVULATORY PHASE
 Estrogen peak stimulates the secretion of LH.
 LH peak leads to :-
 The follicle to burst open releasing the mature ovum .
This is called as ovulation .
 Ovulation occurs on 14 th day of each 28 day cycle .

17. LUTEAL or POSTOVULATORY or SECRETARY PHASE
 This phase starts from day 15 and last till the end
of cycle that is from day 15 to 28.
 After ovulation LH levels remains elevated and
cause the remnants of the follicle to develop into a
yellow body called corpus luteum .
 Corpus luteum mainly :-
1. Estrogen
2. Progesterone
These 2 harmones function to maintain the lining
of the uterus that is endometrium and prepare it
for pregnancy

18. LUTEAL PHASE
 When there is no fertilization for about 7-8 days
then degeneration of corpus luteum starts .
 Due to corpus luteum degeneration level of
estrogen and progesterone also falls down .
 Corpus luteum then changes to corpus albicans
and then it is reabsorbed .
 Cells or lining of endometrium develops a
condition of ischemia . So they starts to fall
down or there shedding starts .
 And women is once again at the day 1 of
menstrual cycle .

20. CERVICAL MUCUS CHANGES
 Changes in cervical mucus takes place
over the course of the menstrual cycle.
 During the menstrual phase the mucosa
of cervix does not undergo shedding off
like endometrium.
 As proliferative phase begins the cervix
begins to produce a thin watery alkaline
secretions .
 At the time of ovulation the cervical
mucus is thinnest and its elasticity is
maximum. .

21. Cervical mucus changes
 It can be stretched like a long thin elastic
thread upto 8 to 12 cm . This is called
Spinnbarkeit Effect . This nature of
cervical mucus favours the tansport of
sperms in the female genital tract and
makes the condition favourable for
fertilization .
 After ovulation cervical secretions
decrease in quantity and becomes thick .
These changes make a plug and prevent
entry of sperm through cervical canal .

23. CYCLE ABNORMALITIES
 Menorrhagia
 Hypomenorrhea
 Amenorrhea
 Dysmenorrhea
 Pre mentrual syndrome

24. Comfort measures during menstruation
 Sanitary pads and tampoons
 Vaginal spray and douching
 SANITARY PADS AND TAMPOONS :-
 Wash hands before and after giving self perineal
care .
 Washing or wiping the perinum should be always
from front to back.
 Use tampoons only for heavy menstrual flow.

25. Comfort measures during menstruation
 Vaginal spray & douching :-
 Spray should be used externally only ;
not with pads .
 Should not be applied with broken ,
irritated or itched skin.
 Douching washes away natural mucus ,
thus liable to infecton.

26. HEALTH EDUCATION
 Advise that heating pads may be very
effective for cramps.
 Advise all womens to keep self and her
genitals clean.
 Use cotton pads for better absorption of the
blood and to maintain hygiene .
 ased on the need and
amount of bleeding.
 Do not dispose the soiled pads into the toilet
and drains; it may get blocked .
 Clean your bathroom , wash your clothing
and dry under the sun .

27. BIBLIOGRAPHY
1. Jacob Annamma. Midwifery and Gynaecological
nursing. 5th edition. New Delhi: Jaypee
publishers; 2019. p.46-49
2. Magon Shally .Midwifery and Obstetrics. 3rd ed.
New Delhi: Lotus publishers; 2013.p.900
3. https://www.slideshare.net>mobile
4. https://www.better health.vic.gov.in
5. https://www.stay.free .in