Physiology for medical students in university. Assignment done by students to be used for other university students also. Focus more on the menstruation in female. Why females living in one dorm menstruate at period and synchronization occur for their period. Students can understand the reason why this occur and come to common understand the reason.

1. •
Arba Minch University
College of Medicine & Health Sciences
School of public health

2. .

3. Objectives
• At the end of this lesson we expected to:
1.Recognize the routes of menstrual cycle .
2.Enumerate the characteristics of the normal menstruation
3.Differentiate the ovarian and uterine cycle and phases fall
under them.
4.Determine hormonal effects of uterine and ovarian cycle .
5.Understand prerequisites and cautions using menstrual
hygiene equipments .
6.Mention the Menstrual disorders.

4. Outlines
• Introduction
• Definition
• Characteristics of normal menstruations
• The hypothalamic-pituitary-ovarian axis
• Ovarian Cycle
• Uterine Cycle
• Cervical Mucus Changes
• Premenstrual syndrome (PMS)
• Family teaching tips-Relief measures for PMS Diet
• Menstrual hygiene
• Menstrual disorders

5. Introductions
• Menstruation is a normal physiologic phase that begins
during adolescence wherein the progestational endometrium
is shed leading to blood loss and numerous hormonal
changes.
• The menstrual cycle is the term for changes a woman’s body
goes through to prepare for a potential pregnancy each
month.
• Most women have their first period, or menarche, between
the ages of 11 and 14, and have regular menstrual cycles
until about age 50.

6. Cont...
• The menstrual cycle typically lasts about 28 days; however,
it is normal to have a cycle that is a few days shorter or
longer.
• The brain, ovaries, and uterus work together and
communicate through hormones (chemical signals sent
through the blood from one part of the body to another) to
keep the cycle going.
• The menstrual cycle is a mystery to a lot of people, but it
shouldn’t be! Half of the earth’s population has a menstrual
cycle and without it, the human species wouldn’t even exist!

7. Cont...
• The menstrual cycle is more than just the period. In fact,
periods are just the first part of your cycle.
• Understanding the menstrual cycle is important because it
can impact the body from head to toe.
• You can see changes in your hair skin, bowel
movements, mental health, physical strength, libido, and
so on.
• Hormonal methods of birth control prevent some or all of
the steps in the cycle from happening.

8. Definition
• Menstruation means cyclic
uterine bleeding caused by
shedding of progestational
endometrium
• It occurs between
menarche and
menopause.

9. cont...
• Menstruation is commonly known as a period. When you
menstruate, your uterus lining sheds and flows out of your
vagina. Your period contains blood, mucus and some cells
from the lining of your uterus. The average length of a
period is three to seven days.
• the process in a woman of discharging blood and other
material from the lining of the uterus at intervals of about
one lunar month from puberty until the menopause,
except during pregnancy.

10. Characteristics of normal menstruation
Menarche: 10-16 yrs. average 13 years.
Duration: 2-7 days (<2days is hypomenorrhea and >7
days is menorrhagia
Amount: 30:80 ml., uses 3 napkins per day.
 >80 ml. is menorrhagia
< 30 ml. is hypomenorrhea

11. CONT...
• Normally menstrual blood doesn’t coagulate by
fibrinolysin enzyme (plasmin) secreted by the
endometrium.
• Menstrual molimina(the time between ovulation and the
start of your period) refers to mild symptoms of 7-10 days
.

12. The hypothalamic-pituitary-ovarian axis:
There Are two main components of the
The changes that happen in the ovaries in response to
pituitary hormones (the ovarian cycle) and
 The variations that take place in the uterus.
But it is important to remember that both cycles work
together simultaneously to produce the menstrual cycle.

13. Hormonal regulation of menstruation

14. Ovarian Cycle
1- Follicular Phase 2- Luteal phase
• Ovarian cycle
 Cyclical changes in the ovaries occur in response to
two anterior pituitary hormones:
 Follicle-stimulating hormone (FSH) and
 Luteinizing hormone (LH).
The follicular phase is controlled by FSH, and
encompasses,
 Days 1 to 14 of a 28-day cycle.
 11 to 20 eggs begin developing,
 But only one matures completely.

15. cont...

16. 1- Follicular Phase:
At the beginning of each menstrual cycle,
The hypothalamus secretesGnRh in a pulsatile manner to
stimulate ---- ant. Pit. gland to secretes---- FSH & LH.
FSH is responsible for the growth of several primary
follicle only one follicle on one of the ovaries reaches
maturity (graafian follicle) which secretes oestrogen.

17. cont...
• The estrogen peak stimulates secretion of LH.
• The LH peak leads to the follicle to burst open, releasing
the mature ovum into the abdominal cavity a process
called (ovulation). and corpous luteum formation.
• Ovulation occurs on day 14 of a 28-day cycle.

18. 2-Luteal phase:
• After ovulation, LH levels remain elevated and cause the
remnants of the follicle to develop into a yellow body
called the corpus luteum.
• In addition to producing oestrogen, the corpus luteum
secretes a hormone called progesterone.

19. cont...
When progesterone reaches a high level,
It inhibits the secretion of LH.
 leads degeneration of the corpous luteum (If fertilization
does not take place).
and progesterone drop &
separation of the endometrium (menstruation) &
stimulation of the hypothalamus to secrete more GnRH, a
new cycle is started.

20. • The uterine cycle refers to the changes that are found in
the uterine lining of the uterus.
• These changes come about in response to the ovarian
hormones estrogen and progesterone.
• phases of Uterine Cycle:
1. Menstrual,
2. proliferative,
3. secretory
4. ischemic

21. Bleeding phase (3-5 days)
•Desquamation of the functional layer
•Loss of 50 ml (30-80 ml) of blood
•Caused by sudden withdrawal of sex
hormones
Proliferative phase
•Growth & development of
endometrial glands
•Proliferation of endometrial stromal cells
•Growth of spiral arteries
•Prepared by estrogen
Secretary phase
•Glands become secretory
•Arteries become more spiral
•Thickness = 6 mm
•Caused by prog & estr

22. 1-Menstrual Phase
• Day 1 of the menstrual cycle is
marked by the onset of
menstruation. During the menstrual
phase of the uterine cycle, the
uterine lining is shed because of
low levels of progesterone &
estrogen.
 At the same time, a follicle is
beginning to develop and starts
producing.
 The menstrual phase ends when
the menstrual period on
approximately day 5.

23. Why females living together has
synchronized their period?
• According to the study, women's
pheromones can affect the menstrual cycles
of other women with whom they live or work
- so that eventually they menstruate
together.
• How? By Phermone interaction that entered
through smelling function through out the
body.

24. 2-Proliferative Phase
When estrogen levels are high enough,
the endometrium begins to regenerate.
Estrogen stimulates blood vessels to develop.
 The blood vessels in turn bring nutrients and oxygen to
the uterine lining, and it begins to grow and become
thicker.
The proliferative phase ends with ovulation on day 14.

25. 3-Secretory Phase
• After ovulation, the corpus luteum begins to produce
progesterone. This hormone causes the uterine lining
to become rich in in preparation for
pregnancy.
• Estrogen levels also remain high so that
the lining is maintained.
• If pregnancy doesn’t occur, the corpus luteum gradually degenerates, and the
woman enters the ischemic phase of the menstrual cycle.

26. 4-Ischemic Phase
• On days 27 and 28, estrogen and progesterone levels fall
because the corpus luteum is no longer producing them.
• Without these hormones to maintain the blood vessel
network, the uterine lining becomes ischemic.
• When the lining starts slough, the woman has come full
cycle and is once again at day 1 of the menstrual cycle.

27. How to calculate
menstrualperiod?
To calculate, take
average of three
months period days
and average
division of the three
P=M1+M2+M3/3

28. Cervical Mucus Changes
• Changes in cervical mucus
takes place over the course
of the menstrual cycle.
• Some women use these
characteristics to help
determine when ovulation is
likely to happen.
• During the menstrual phase
the cervix doesn’t produce
mucus.
fig: cervical mucus at finger

29. cont...
As the proliferative
phase begins,
The cervix begins to
produce a tacky,
crumbly type of
mucus that is yellow
or white.
As the time of ovulation
becomes near,
 The mucus becomes
progressively clear, thin
and lubricative, with the
properties of raw egg
white. At the peak of
fertility (i.e.,during
ovulation), the mucus has
a distensible, stretchable
called spinbarkheit.

30. cont...

The mucus becomes
scanty, thick, and opaque.

31. Premenstrual syndrome (PMS)
• PMS presents with a wide variety of symptoms.
• May be physical, behavioral or both.
• Many women get after ovulation and
• Researchers think that PMS happens in the days after ovulation
because,
levels begin falling dramatically if you
are not pregnant.

32. Physical syndrome
Edema weight gain
fainting Nausea
Abdominal bloating Abdominal cramping
Constipation Hot flashes
Breast swelling & pain Headache , migraine
Acne Rhinitis
heart palptation Joint swelling and pain

33. Behavioral symptoms:
Aggressive behavior Emotional liability
Confusion Depression
Increased appetite Food cravings (salt, sweet..)
Fatigue & lethargy Poor concentration
Sex drive changes Suicidal thoughts
Withdrawal from others Anxiety, insomnia
get anger easily craving cabohydrates

34. Family teaching tips-Relief measures for PMS
Diet
Reduce or eliminate caffeine intake (coffee, tea, colas and
chocolate)
Avoid simple sugars as in candy, cakes, cookies
Reduce salt intake (pickles, fast foods, chips
Drinks 2 quarts of non-caffeinated fluid, preferably water,
each day
 Eat six small meals (to stabilize blood glucose)

35. Menstrual hygiene
• 1. Sanitary pads and tampons:
• Wash hands before & after giving self-perineal care.
• Washing or wiping the perineium should be always done
from front to back.
• Reduce use of tampons by substituting sanitary pads
especially at night.
• Tampoon a plug of soft material inserted into the vagina to
absorb menstrual blood.

36. Fig. pad

37. Fig. Tampoon

38. cont...
• Use tampon only for heavy menstrual flow.
• Avoid it at the end of the period when vaginal walls are dried.
• If toxic shocks syndrome occurs, eliminate all
use tampons, until infection relieved.
• If high fever, vomiting, diarrhea, vaginitis occur while using
tampons, consult the physician.
• Apply perineal pad snugly enough so it won’t
slide back and froth with her movements. - Don’t touch the side of the perineal
pad that will come in contact with the perineum.

39. 2-Vaginal spray and douching:
• Spray should be used externally only not with pads.
• Should not be applied with broken irritated or itched skin.
• Douching is unnecessary since the vagina cleans itself

40. Measures to alleviate general discomfort
and cramping:
• Nutritional self-care: neutralize the
excessive amounts of estrogen produced by the ovaries,
thus reduces nervousness that sometimes occur
premenstrual.
• It is present in lean meats, whole grains, and dark green
leafy vegetables.

41. cont...
• Vit. B6 can relieve the heavy bloated puffy feeling that is
often experienced before the period.
• Vit.E is a mild prostaglandin inhibitor similar to aspirin but
without the side effects.
• It improves circulation; reduce muscular spasm and pain.
• Iron is needed to prevent depletion of the female iron
stores.

42. cont...
• - Calcium may also provide relief from the menstrual
symptoms. It presents in yogurt and cheese.
• Exercises:
• Daily exercise can prevent cramps, relieves
constipation.
• Deep breathing brings more oxygen in the
blood, which relaxes the uterus.
• It also alleviates irritability and tension.

43. Sleep and rest
• Maintain regular sleep
schedule.
• Drink a glass of milk before
bedtime.
• Schedule exercise for early
morning or
early afternoon.
• Give yourself a quiet time to
relax just
before going to bed

44. Time to see a health care provider:-
• Should consult the health care provider for the following: -
• If not started menstruating by the age of 16.
• If the period has suddenly stopped.
• If she have bleeding for more days than usual.
• If she is bleeding excessively.
• If you bleed between periods (more than justa few drops).
• If there is severe pain during the period. -If she is bleeding
excessively.

45. Menstrual disorders

46. REFERENCE
1.https://www.physio-
pedia.com/Menstrual_Cycle_and_Physical_Activity#cite_ref
-:0_1-1
2.202;18(4):1667.
Shultz SJ, Sander TC, Kirk SE, Perrin DH. Sex differences
in knee joint laxity change across the female menstrual
cycle. The Journal of sports medicine and physical fitness.
2005 Dec;45(4):594.
3.https//www.ncbi.nlm.nih.gov/pmc/articles/PMC7916245

47. .
• 4.Treloar AE. Menstrual cyclicity and the pre-menopause.
Maturitas. Dec 1981;3(3-4):249-264.
• 5.Taffe J, Dennerstein L. Retrospective self-report
compared with menstrual diary data prospectively kept
during the menopausal transition. Climacteric. Sep
2000;3(3):183-191.
• 6.Waller K, Swan SH, Windham GC, Fenster L, Elkin EP,
Lasley BL. Use of urine biomarkers to evaluate menstrual
function in healthy premenopausal women. Am J
Epidemiol. Jun 1 1998;147(11):1071-1080.

49. Group-3 memebers
• Name ......................................................ID.no.
• 1 Yossaf Fikru .........................................NSR/2776/14
• 2 Maireg Markos......................................NSR/2447/14
• 3 Ashenafi kochare..................................NSR/075/14
• 4 Temesgen Tesema................................NSR/1295/14
• 5 Burka Gamado......................................NSR/1541/14
• 6 Rediat Hiruy...........................................NSR/1897/14
• 7 TsegayTeka ...........................................NSR/2957/14
• 8 Reath Gatkuo ...................................... NSR/1896/14