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  1. 1. Problem no.1
  2. 2. Task question no.1 <ul><ul><ul><ul><ul><li>What is menarche? </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>How does it differ from usual menstrual cycle? </li></ul></ul></ul></ul></ul>
  3. 3. <ul><li>Definition of Menarche : </li></ul><ul><li>Define as the period which is the first cycle occurs. </li></ul><ul><li>Consider as first sign of puberty. </li></ul><ul><li>Definition of Puberty : </li></ul><ul><li>Define as period that endocrine & gametogenic functions of the gonads have first develop to the point where reproduction is possible. </li></ul><ul><li>There are skeletal and neurological maturation resulting from increase secretion of Estrogen. </li></ul>
  4. 4. <ul><li>Other terms associated with Puberty : </li></ul><ul><li>Thelarch : the event that occur in girls which the breast is developed. </li></ul><ul><li>Pubarcha : the development of axillary & pubic hair. </li></ul><ul><li>Menarche: is the last event in the consequent of puberty. </li></ul><ul><li>Men arche </li></ul><ul><li>Men= Menses </li></ul><ul><li>arche =beginning </li></ul>
  5. 5. <ul><li>Adolescence : the period of final maturation & refers to the period between childhood & maturity. </li></ul><ul><li>We have many theories that explain the puberty as: Set point, relation to Leptin……etc. </li></ul><ul><li>Age of menarche : differs from girl to girl may start in age 8 years old to 17 years without being disquiet. </li></ul>
  6. 6. Control of the onset of menarche <ul><li>By increasing the sensitivity of the gonads ( ovaries ) to pulsatile secretion of GnRH from hypothalamic-pituitary axis. </li></ul><ul><li>Then Menarche is occurs. </li></ul>
  7. 7. Differences between menarche & regular menstrual cycle Longer in period. Shorter in period. More in amount. Fewer in amount. Mid cyclic pain is present. No midcyclic pain. Ovultary cycle. Anovultary cycle. Repeated cycle. Not repeated. Regular menstrual cycle Menarche
  8. 8. Question 2 <ul><li>What is menstrual cycle,how does it occur? </li></ul>
  9. 9. <ul><li>Cyclic changes that occur in ovaries, uterus, cervix, vagina & breasts. </li></ul><ul><li>These changes occur under the influence of hormones. </li></ul><ul><ul><li>Cervical changes: </li></ul></ul><ul><ul><ul><li>No desquamation. </li></ul></ul></ul><ul><ul><ul><li>Estrogen --- thin alkaline mucus. </li></ul></ul></ul><ul><ul><ul><li>Progesterone --- thick cellular mucus </li></ul></ul></ul>
  10. 10. <ul><ul><li>Vaginal changes: </li></ul></ul><ul><ul><ul><li>Estrogen --- cornified epithelium. </li></ul></ul></ul><ul><ul><ul><li>Progesterone --- secretion, leukocyte infiltration. </li></ul></ul></ul><ul><ul><li>Breast changes: </li></ul></ul><ul><ul><ul><li>Estrogen --- ducts and stroma proliferation. </li></ul></ul></ul><ul><ul><ul><li>Progesterone --- lobules and alveoli development. </li></ul></ul></ul><ul><ul><li>Breast is swollen, tender and painful </li></ul></ul><ul><ul><li>Changes regress with menstrual cycle. </li></ul></ul><ul><ul><li>Lactation occurs only at the end of pregnancy. </li></ul></ul>
  11. 11. Question 3 <ul><li>What is the mechanisms which control the menstrual cycle? </li></ul>
  12. 12. <ul><li>Under hormonal control: </li></ul>Hypothalamus Pituitary gland Ovaries GnRH FSH LH
  13. 13. <ul><li>FSH: </li></ul><ul><ul><li>Proliferation of follicles </li></ul></ul><ul><ul><li>Convert androgens to estrogen. </li></ul></ul><ul><ul><li>Inhibin production. </li></ul></ul><ul><ul><li>Induce LH receptors production. </li></ul></ul><ul><li>LH: </li></ul><ul><ul><li>Convert cholesterol to androgen. </li></ul></ul>
  14. 14. Question 4 <ul><li>Describe the ovarian cycle? </li></ul>
  15. 15. <ul><li>* At puberty the females begins to undergo reguler monthly cycles </li></ul><ul><li>*GnRH (from hypothalamus) acts on the cells of anterior pit gland which secretles LH & FSH that stimulate and contro cyclic changes in the ovary . </li></ul><ul><li>. These sexual cycles are controlled by the hypothalamus. </li></ul>
  16. 16. <ul><li>*The ovarian cycle is the normal process whereby ova mature and are released during the menstrual cycle . </li></ul><ul><li>* it is hormonally regulated in two phases . The follicle secretes estrogen before ovulation ; the corpus luteum secrete both estrogen and progestrone after ovulation . </li></ul>
  17. 17. <ul><li>* at the beginning of each ovarian cycle </li></ul><ul><li>several primordial follicles begin to enlarge, with cavitation occuring to form an antrum . 15-20 primary stage follicle are stimulated to grow by FSH . Normally one of the follicles become dominant ; and only one oocyte is discharged , and others degenerat and become atretic . this maturing follicle at this stage is called agrafian follicle ; the cells of the theca interna of this structure produce estrogens .. </li></ul>
  18. 18. <ul><li>n.b: FSH is not necessary to promote devolopmentof primordial follicle to the primary follicle stage , but without it , </li></ul><ul><li>these primary follicle die and become atretic </li></ul><ul><li>When afollicle becomes atretic , the oocyte and surrounding folliclular cells degenerate and replaced by connective tissue , forming acorpus atrectium . </li></ul>
  19. 19. <ul><li>FSH also stimulates maturation of follicular ( granulosa ) cells surrounding the oocyte . </li></ul><ul><li>In cooperation granulosa and theca cells produce estrogens that : </li></ul><ul><li>A. proliferate the uterine endometrium . </li></ul><ul><li>B. thining of cervical mucus to allow passage of sperm . </li></ul><ul><li>C. stimulate the pit gland to secret LH ( midcyclic LH surge ) that : </li></ul><ul><li>A. stimulate production of progesterone by folliculer stromal cells ( luteinization ) . </li></ul><ul><li>B. causes folliculer rupture and ovulation . </li></ul>
  20. 20. <ul><li>N.b :the number of the antral follicles did not vary signficantly with stage of ovarian cycle , although the follicle size distribution was cyclic-stage dependant . </li></ul><ul><li>* Ovulation occurs at 14 of the cycle ( of a 28 day cycle ) , with the rupturing of the follicle . </li></ul><ul><li>* the follicle itself fills with blood ( brief pain ) </li></ul>
  21. 21. <ul><li># After ovulation the theca and granulosa cells proliferate and luteal cells forms the yellow body or corpus luteum . These cells secretes progesterone and estrogens . </li></ul><ul><li>* If prgnency does not occur progesterone from corpus luteum will inhibit the production of LH . The lower level of LH will cause the corpus luteum to degenerate( about four days prior to menses ) and the level of estrogen and progesterone will dropoff . </li></ul>
  22. 22. Question 4 <ul><li>Describe the endometrial cycle? </li></ul>
  23. 23. Endometrial changes <ul><li>Proliferative (postmenstrual,preovulatory): </li></ul><ul><ul><li>All but deep layers are sloughed. </li></ul></ul><ul><ul><li>Estrogen __ growth of stratum functionale and spiral arteries and glands (10 folds). </li></ul></ul><ul><li>Secretory phase: </li></ul><ul><ul><li>Mainly by progesterone. </li></ul></ul><ul><ul><li>Provide nutrients to fertilized ovum. </li></ul></ul><ul><ul><li>Short active glands </li></ul></ul><ul><ul><li>Mucus, glycogen, amino acids & enzymes. </li></ul></ul>
  24. 24. <ul><li>Differentiation of the endometrium into: </li></ul><ul><ul><li>Stratum compactum. </li></ul></ul><ul><ul><li>Stratum spongiosum. </li></ul></ul><ul><ul><li>Stratum basalis. </li></ul></ul><ul><li>Under control of estrogen and progesterone. </li></ul>
  25. 25. <ul><li>Menstrual phase: </li></ul><ul><ul><li>Regression of corpus luteum. </li></ul></ul><ul><ul><li>Thinning of endometrium + necrosis foci. </li></ul></ul><ul><ul><li>PGF 2 α </li></ul></ul><ul><li>Menses blood: </li></ul><ul><ul><li>Usually doesn’t clots unless flow is excessive. </li></ul></ul><ul><ul><li>Usual duration is 3-5 days (1-8) </li></ul></ul><ul><ul><li>Usual amount is 30-35 mL (spots-80). </li></ul></ul>
  26. 27. Question 5 <ul><li>What is ovulation? </li></ul>
  27. 28. <ul><li>Definition </li></ul><ul><ul><li>Expulsion of oocyte from mature follicle at midcycle usually once in the cycle during the reproductive life--- 1 to 2 years after menarche to few years before menopause. </li></ul></ul>
  28. 29. <ul><li>Mechanisms: </li></ul><ul><ul><li>Physical: increase in the hydrostatic pressure result in distension of the follicle and ultimately its rupture. </li></ul></ul><ul><ul><li>Hormonal: LH surge occurs which stimulate antral filling and proteolytic activity through chemical mediators (MCP-1,IL-8,PGs, metalloproteinases). </li></ul></ul><ul><li>9-36 hours after the surge </li></ul><ul><li>Cannot occur in pregnancy but may occur after peurperium. </li></ul><ul><li>Control is hormonal: FSH, LH. </li></ul><ul><li>Multiple ovulations may occur. </li></ul>
  29. 31. Question 6 <ul><li>What are the diagnostic methods for ovulation? </li></ul>
  30. 32. <ul><li>Rise in basal body temperature. </li></ul><ul><ul><li>Thermometer with wide gradations (oral or rectal). </li></ul></ul><ul><li>Increase in blood hormone levels. </li></ul><ul><li>Midcyclic pain due to irritation. </li></ul>
  31. 33. Question 8 <ul><li>What are conditions associated with menstruation? </li></ul>
  32. 34. <ul><li>Fever--- progesterone </li></ul><ul><li>Pain--- irritation. </li></ul><ul><li>Headache. </li></ul><ul><li>Fatigability </li></ul><ul><li>Vomiting. </li></ul>