It's about menstrual cycle in women during menarch upto menopause

1. Submitted To :- Dr. Mahi Mishra Submitted By :- Anshita Kushwaha
Topic – Menstrual cycle
Menstrual irregularities
ऋतुकालीन परिचर्ाा

2. Menstrual cycle
THE MENSTRUAL CYCLE IS A SERIES OF NATURAL CHANGES IN HORMONE
PRODUCTION AND THE STRUCTURES OF THE UTERUS AND OVARIES OF THE
FEMALE REPRODUCTIVE SYSTEM THAT MAKES PREGNANCY POSSIBLE. THE
OVARIAN CYCLE CONTROLS THE PRODUCTION AND RELEASE OF EGGS AND
THE CYCLIC RELEASE OF ESTROGEN AND PROGESTERONE. THE UTERINE CYCLE
GOVERNS THE PREPARATION AND MAINTENANCE OF THE LINING OF THE
UTERUS (WOMB) TO RECEIVE AN EMBRYO. THESE CYCLES ARE CONCURRENT
AND COORDINATED, NORMALLY LAST BETWEEN 21 AND 35 DAYS, WITH AN
AVERAGE LENGTH OF 28 DAYS.

4. Oogenesis begins in the intrauterine life.
Now , in oogenesis the oogonia develops into 1⁰ oocyte. Now, at the time of puberty this 1⁰ oocyte
undergoes meiosis and gets converted into 2⁰ oocyte.
Early life

5. Hypothalamic pituitary ovarian axis (HPO Axis)
 At puberty, hypothalamic pituitary ovarian axis becomes functional.
Hypothalamus
⬇️
(Pulsatile manner) GnRH release
⬇️
Stimulates anterior pituitary
⬇️
FSH

6. Follicular/ Proliferative phase

8. Luteal / secretory phase
1⁰ Oocyte  2⁰ Oocyte
 Follicle  Corpus luteum
 LH  Maintains corpus luteum in a non pregnant female.
 At day 22 of the menstrual cycle, corpus luteum attains its maximum size and activity
 Note : In a pregnant women hcg maintains the corpus luteum . Hence , LH and HCG are functionally the same.
|----------------------------------------------------|-------------------------------------------------|
Day 14 day 22 day 28
Corpus luteum

9. Hormones released by corpus luteum
Hormones released by corpus luteum
⬇️--------------------------‐---------------------------------------------‐-----------------⬇️
Progesterone (mainly) Estrogen
1. Gives –ve feedback on LH ■ FSH decreases
2. Secretory action: supports uterine
Endometrium.

11. Day 14 ●-----------------------------------------------------------|--------------------------------------------
●Day 28
Day 22
Max size
C.L increasing in size C.L degenerating
On day 14th, after ovulation corpus luteum starts growing under the effect of LH and attains its
maximum size and activity on day 22 . After that it starts degenerating and converts into corpus
albicans.

13. Note:
 Main hormone in first half of the cycle : estrogen.
 Main hormone in second half of the cycle : Progesterone
 Life span of corpus luteum in non pregnant female is 10-12 days.
 Life span of corpus luteum in pregnant female is 10-12 weeks.
Follicular phase luteal phase
●------------------------------------------------|-------------------------------------
-----●
Day 1 day 14 day 28
May vary (depending upon cycle Fixed duration
length).

14. Menstrual irregularities
 Menstrual irregularities are common abnormalities of a woman’s menstrual cycle. Menstrual
irregularities include a variety of conditions in which menstruation is irregular, heavy, painful, or does not
Occur at all.
 Some Common types of Menstrual irregularities include:
⚫️Amenorrhea
⚫️Dysmenorrhea
⚫️Menorrhagia
⚫️polymenorrhea/Epimenorrhea
⚫️Metrorrhagia
⚫️Oligomenorrhea
⚫️Cryptomenorrhea

15. Amenorrhea
 Amenorrhea is the absence of a menstrual period in a female who has reached reproductive
age. Physiological states of amenorrhea are seen, most commonly, during pregnancy and
lactation (breastfeeding). Outside the reproductive years, there is absence of menses before
puberty and after menopause.
 Causes
● physiological causes ● Pathological Causes
- pregnancy -Any disorder of ovary ,anterior
- Lactation pituitary , uterus or CNS in the
- before puberty and after outflow track.
Menopause. - Environmental stress.
- Genetic or chromosomal defects

16. Types of amenorrhea
1.Primary amenorrhea
Primary amenorrhea is the absence of menstruation in a woman by the age of 16. Females who
have not reached menarche at 14 and who have no signs of secondary sexual characteristics are
also considered to have primary amenorrhea.
Examples of amenorrhea include constitutional delay of puberty, Turner syndrome.
2. Secondary amenorrhea
Secondary amenorrhea is defined as the absence of menstruation for three months in a woman
with a history of regular cyclic bleeding or six months in a woman with a history of irregular
menstrual bleeding. Examples of secondary amenorrhea include hypothyroidism,
hyperprolactinemia, polycystic ovarian syndrome.

17. Dysmenorrhea
Dysmenorrhea means cases of painful menstruation of sufficient magnitude so as to incapacitate day to day
activities.
Dysmenorrhea is characterized by severe and frequent menstrual cramps , pain is cramping, throbbing or dull
type ache radiated to leg.
Types of Dysmenorrhea
1. Primary /Spasmodic Dysmenorrhea 2. Secondary Dysmenorrhea (congestive)
• No identifiable pelvic pathology • presence of pelvic pathology
• mostly in adolescent age • Elderly/porous women
• confined to ovulatory cycle • Pain starts 7-10 days before the onset of
• starts before the onset or just menstruation and relieves with the onset of bleeding
Before the mensus. • No systemic discomfort
•Pain is related dysrhythmic uterine • Intermenstrual period not completely free of pain.
contractions usually gets cured following
pregnancy and vaginal delivery.

18. Menorrhagia
 Menorrhagia is defined as cyclic bleeding at normal intervals ; the bleeding is either
excessive in amount ( > 80 ml ) or duration ( > 7 days) or both.
( In a normal cycle, cycle interval is of 28 days {21-35 days} ; menstrual flow is for
4-5 days and menstrual blood loss is 35 mL { 20-80 mL }.
● Causes of menorrhagia includes liver dysfunction, severe hypertension ,
Hypothyroidism, hyperthyroidism, platelet deficiency ( thrombocytopenia)
Or due to disturbed hypothalamo- pituitary- ovarian- endometrial axis.

19. Polymenorrhea/ Epimenorrhea
 Polymenorrhea is defined as cyclic bleeding where the cycle is
is reduced to a limit of less than 21 days and remains constant at
that frequency.
● If the frequent cycle is associated with excessive and/ or prolonged
bleeding, it is called epimenorrhagia.
● Causes: It is seen predominantly during adolescence,
preceding menopause and following delivery and abortion.
Hyperstimulation of the ovary by the pituitary hormones
may be the responsible factor.

20. Metrorrhagia
 Metrorrhagia is irregular, acyclic abnormal bleeding between regular menstrual periods from
the uterus.
 Amount of bleeding is variable.
 Common causes of metrorrhagia include carcinoma cervix, breakthrough bleeding in pill use ,
submucous fibroid or DUB.
Oligomenorrhea
■ Infrequent menstrual bleeding at intervals longer than 35 days and which remains constant at that
frequency is called oligomenorrhea.
■ Causes: 1.obesity
2. stress
3. endocrine disorders like PCOS (most common) ,
hyperthyroidism, hyperprolactinemia.

21. Cryptomenorrhea
 Cryptomenorrhea is a medical condition in which menstrual bleeding occurs but remains hidden
due to a congenital septum or part of hymen retains the menstrual flow( imperforate hymen),
resulting in symptoms of menstruation without external bleeding.
 A patient with cryptomenorrhea will appear to have amenorrhea but will experience cyclic
menstrual pain.
 Acquired causes include stenosis of cervix after amputation or obstetric injuries of cervix and
vagina.
 Clinical features of cryptomenorrhea Include:
- Retention of urine
- Attacks of lower abdominal pain for a few days every month.
- constipation and painful defecation.

22. ऋतुकालीन परिचर्ाा
(Mode of living during menstruation.)

23. • रजोदर्शन क
े समय से लेकर तीन रात्रि (त्रदन एवं रात्रि) ब्राह्मचाररणी
रहकर भूत्रम में र्यन करे।
• हाथ में अजजशर (त्रिना टू टा हुआ) पाि में अन रखकर भोजन करे।
त्रकसी भी प्रकार का प्रक्षालन न करे।
• तदुपरांत चतुथश त्रदवस उिटन लगाकर, त्रर्र से स्नान कर, श्वेत वस्त्र
धारण करे, पुरुष भी श्वेतवस्त्र धारण करे।
• इस प्रकार श्वेतवस्त्र एवं पुष्पमाला धाररत, प्रसन्न मन एक दू सरे को
चाहने वाले उन पत्रत-पत्रियों को वैद्य सहवास की आज्ञा दे ।

24. Thankyou