2. INTRODUCTION
When a female reaches puberty she usually has a
menstrual period every month.
The start of periods is known as menarche.
Menarche doesn't happen until all the parts of a girl's
reproductive system have matured and are working
together.
This event occurs until the woman reaches
MENOPAUSE
Menopause is the permanent cessation of menses.
3. Menstruation is the periodic discharge of blood and
sloughed endometrium (collectively called menses or
menstrual flow) through the vagina.
Menstruation occurs throughout a woman's
reproductive life in the absence of pregnancy.
The average Menstrual Cycle length is 28 days
(usual range, about 25 to 36 days).
Average duration of menses is 5 (± 2) days.
Blood loss per cycle averages 30 ml (normal range,
13 to 80 ml) and is usually greatest on the 2nd day.
MENSTRUAL CYCLE
4.
5. INTRODUCTION
This ‘period’ is apart of a cyclical process which
prepares the woman's body for the development of a
fertilized egg.
The process is controlled by several hormones.
What is a hormone?
A chemical substance produced by an endocrine
gland to coordinate one or more specific processes
in the body.
6. The process is controlled by several hormones.
GONADOTROPIN-RELEASING HORMONE (GnRH)
FOLLICLE STIMULATING HORMONE (FSH)
LEUTENIZING HORMONE (LH)
LUTEOTROPPIC HORMONE
OESTROGEN
PROGESTERONE
7. Each month, the ovary releases an egg cell. It
travels down the fallopian tube towards the uterus.
8. - The egg matures when FSH from the
pituitary gland reaches the ovary.
- The mature egg is surrounded by a
fluid and a jacket of cells known as
the Graafian follicle.
10. OVULATION
The mature Graafian follicle moves toward the
surface of the ovary and ruptures releasing the
egg(ovum) from the follicle and the ovary.
This process, ovulation occurs about the 14th day
after the beginning of the menstrual period.
When the ovum is released it enters the oviduct and
passes along the oviduct to the uterus
11. After ovulation, the pituitary gland secretes lutenizing
hormone (LH).
LH changes the remains of the follicle into the
corpus luteum/yellow body.
Corpus luteum produces the hormone progesterone.
Progesterone further thickens the uterus lining and
increases blood supply
12. If fertilization does occur the corpus luteum enlarges
and continues to produce progesterone. The lining of
the uterus thickens and blood supply increases.
Progesterone also causes the breast to enlarge.
These are pregnancy changes, progesterone is also
known as the ‘pregnancy hormone’.
Both oestrogen and progesterone slow down FSH
production when their concentrations become high.
Thus no more eggs develop.
13. If fertilization does not occur the corpus luteum
degenerates to ordinary ovary tissue and the
progesterone level falls.
The lining of the uterus breaks down and the egg
dies.
Lining along with blood passes out the vagina as the
menstrual period.
Cycle continues with increased FSH production and
egg development.
Cycle lasts approximately 28days
14. Normal Menstrual Cycle
What is the mean duration of the MC?
Mean 28 days (only 15% of ♀)
Range 21-35
What is the average duration of menses?
3-7 days
What is the normal estimated blood loss?
Approximately 30 ml
When does ovulation occur?
Usually day 14
36 hrs after the onset of mid-cycle LH surge
15.
16. Hypothalamus
Pitutary gland
Follicle stimuating
hormone & LH
Maturation of
follicles
Estrogen hormone
Lining of the
uterus to thicken
Leutenizing
hormone
Results in
ovulation
stimulates
secrets
causes
Follicle releases
causes
Pitutary releases
Mature follicle burst
PATHOPHYSIOLOGY
17. Menstrual Cycle
The Menstrual Cycle can be divided into 3 Phases.
- Follicular (Preovulatory) Phase
- Ovulatory Phase
- Luteal (Postovulatory) Phase
18. Follicular Phase
Day 1-13
Hypothalamus releases GnRF which stimulates release of LH and
FSH from Anterior Pituatary
Pituitary gland produces FSH
(Follicular Stimulating Hormone)
During this Phase ovary also
secretes increasing level of
Estrogen, to initiate
Endometrium
FSH act on ovary for prompt
development of several follicles (Each
Follicle Contains Egg)
During this phase one follicle
mature
19. Ovulatory Phase
Lasts for 14 to 36 hours
Phase begins when the level of LH surges.
LH stimulates dominant follicle to bulge
from the surface of ovary and finally
rupture, releasing the Egg.
Egg travel to Fallopian Tube. This is the
time when the women is most likely to
become Pregnant. The Egg can be
fertilized for only up to about 12 hours after
its release.
20. Luteal Phase, Day 15-28
After releasing Egg this empty Follicle develops the structure
called Corpus Luteum (CL)
CL secrets increasing amount of Progesterone. CL prepares Uterus
in case fertilization occurs.
Progesterone causes the Endometrium to thicken
If Egg is not Fertilized
If Egg is Fertilized
The embryo produces Human Chorionic Gonadotropin
(hCG) which will be detected by CL and this Human
Chorionic Gonadotropin maintains CL and its
Progesterone secretion.
The egg moves to the uterus and attaches itself to the
endometrium about six or seven days after ovulation,
where it begins to develop into a fetus.
CL destroys after 14 days
an new Menstrual Cycle
begins
21.
22. MENSTRUAL DISORDERSMmenstrual
disorderENSTRUAL DISORDERS
Amenorrhea
Amenorrhea is the absence of a menstrual period in
a woman of reproductive age.
Primary Amenorrhea
Primary Amenorrhea is the absence of menstruation
in a woman by the age of 16.
Secondary Amenorrhea
Secondary Amenorrhea is where an established
menstruation has ceased—for 3 months in a woman
with a history of regular cyclic bleeding, or 9 months
in a woman with a history of irregular periods.
MENSTRUAL DISORDERS
23. Dysmenorrhea
Dysmenorrhea is a gynecological medical condition
characterized by severe uterine pain during
menstruation.
Menorrhagia/Hypermenorrhea
Menorrhagia is an unusually heavy and prolonged
menstrual period at regular intervals.
A blood loss of greater than 80 ml or lasting longer than 7
days constitutes menorrhagia
Hypomenorrhea
Hypomenorrhea is extremely light menstrual blood flow
(scanty periods).
MENSTRUAL DISORDERS
24. Metrorrhagia
Metrorrhagia is uterine bleeding at frequent, irregular
intervals, particularly between the expected menstrual
periods.
Menometrorrhagia
Menometrorrhagia is a condition in which prolonged or
excessive uterine bleeding occurs irregularly and more
frequently than normal.
Polymenorrhea
Polymenorrhea is the medical term for cycles with
intervals of 21 days or fewer.
Oligomenorrhea
Oligomenorrhea is infrequent (or very light) menstruation.
More strictly, it is menstrual periods occurring at intervals
MENSTRUAL DISORDERS
