The document discusses the menstrual cycle and menstruation. It defines menstruation as the shedding of the uterine lining every month. It describes the typical phases and characteristics of a normal menstrual cycle, including the ovarian and uterine cycles. The four phases are the menstrual, follicular, ovulatory, and luteal phases. Changes in cervical mucus and potential abnormalities are also reviewed. Comfort measures and health education related to menstruation are provided.

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 .
mainly :-
 Corpus luteum
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