menstruation, hormones in menstrual cycle

1. Menstrual cycle- ovulation, uterine cycle, cervical cycle
Hormones in menstruation, diagnosis of pregnancy
Abortion & medical termination of pregnancy

2. Menstrual cycle
Ovulation, uterine cycle, cervical cycle
Hormones in menstruation

3. Menstrual
Cycle
•The word "menstruation" is etymologically related
to "moon“
•“Menstruation" and "menses" are derived from the
• Latin mensis (month), which relates to the
• Greek mene (moon) and to the roots of the
• English words month and moon—
•Reflecting the fact that the moon also takes 27.32
days to revolve around the Earth
•The synodical lunar month, the period between two
new moons (or full moons), is 29.53 days long
Terminology

4. The menstrual cycle is a cycle of physiological
changes that can occur in fertile females
Overt menstruation:
 where there is blood flow from the uterus
through the vagina
 occurs primarily in humans and close
evolutionary relatives such as chimpanzees
Covert menstruation:
 Females of other species of placental
mammal undergo estrous cycles, in which
the endometrium is completely
reabsorbed by the animal at the end of its
reproductive cycle
Overt
Covert
Menstrual
Cycle

5. This is a series of events, occurring regularly in females every 26 to 30
days throughout the childbearing period of about 36 years
The cycle consists of a series of changes that take place concurrently in
the ovaries and uterine walls stimulated by changes in the blood
concentration of the hormones
Hormones secreted in the cycle are regulated by negative feedback
mechanisms

6. Menstrual
Cycle
Eumenorrhea denotes normal, regular
menstruation that lasts for a few days
Usually 3 to 5 days, but anywhere from 2 to 7
days is considered normal
Average blood loss during menstruation is 35
milliliters with 10–80 ml considered normal
Because of this blood loss, women are more
susceptible to iron deficiency than men are
An enzyme called plasmin inhibits clotting in the
menstrual fluid
Duration &
amount

7. Menstrual
Cycle
It is one of the later stages of puberty in girls.
Average age of menarche in humans is 12
years, (Normal 8-16yrs)
Factors such as heredity, diet and overall
health can accelerate or delay menarche.
Menarche

8. Menstrual
Cycle
The cessation of menstrual cycles at the end
of a woman's reproductive period is termed
menopause
Menopause

9. Phases of
menstruation

10. Menstrual
Cycle
Hypothalamus secrets luteinising
hormone releasing hormone (LHRH) which
stimulates the anterior pituitary to
secrete:
 FSH
 LH
Hormonal cycle

12. Menstrual
Cycle
 Follicle Stimulating Hormone (FSH)
 which promotes the maturation of ovarian
follicles and the secretion of estrogen, leading
to ovulation.
 Luteinising Hormone (LH)
 which stimulates the development of corpus
luteum and the secretion of progesterone.
Hormonal cycle

13. Menstrual
Cycle
The hypothalamus responds to changes in the
blood levels of estrogen and progesterone. It is
depressed by high levels and stimulated when they
are low.
Hormonal cycle

15. Phases of
menstruation

16. 1.
Menstrual
phase
How does menstruation occur?
Begin by understanding that an ovum
is released and is not fertilized…

17. Ovum not fertilized
Progesterone causes –ve feedback
LH production falls
Corpus luteum degenerates
Progesterone production falls
Lining of the uterus breaks down
Menstruation
Consists of secretions from
endometrial glands, endometrial
cells, blood from the broken down
capillaries and the unfertilised ovum
P falls below
critical levels
+ve feedback  FSH new ovarian
follicle stimulated for ovulation

18.  The spiral arteries that supply blood to the inner 2/3rd of mucosa
undergo vasoconstriction, with result ischemia & necrosis of
endometrium
 Mucosa gets sloughed off
 Spiral arteries open, producing bleeding over a period of 5 days
 Once it is sloughed off regeneration starts
 Destructive & regenerative processes take place simultaneously
 Women experience pain during this phase due to stimulation of pain
fibers either by chemicals released or by the contraction of myometrium

20. 2.
Proliferative
phase/
follicular
phase
At this stage an ovarian follicle, stimulated by
FSH, is growing towards maturity and is
producing estrogen

21. Menstruation occurs
FSH stimulates new ovarian follicle
Ovarian follicle begins to mature and release Estrogen
Estrogen (E) promotes proliferation of
endometrium to receive fertilized ovum
Cell multiplication + increase in the numbers of
mucus-secreting glands and blood capillaries
Raised E causes +ve feedback LH
surge (both LH and FSh are elevated)
Mature follicle ruptures and releases
ovum = ovulation
Estrogen levels fall

24. 3.
Secretory
phase/
Luteal phase
Immediately after ovulation
Lining cells of the ovarian follicle are stimulated by
LH
 To develop the corpus luteum produces
progesterone
Endometrium become edematous
Secretory glands produce increased amount of
watery mucous
Assists the passage of the sperm through the
uterus to the uterine tubes where the ovum is
usually fertilised

25. Secretory
phase/
Luteal
phase
The ovum may survive in a fertilizable form for a
very short time after ovulation
Sperms deposited in the vagina are capable of
fertilizing the ovum for only about 24 hours
But, sperms can survive for several days.

26. Secretory
phase/
Luteal
phase
The period in each cycle during which
fertilisation can occur is relatively short
If the ovum is not fertilised menstruation occurs
and a new cycle begins

28. Menorrhagia :
Excess discharge of first blood during menstrutaion
Dysmenorrhoea :
Excessive pain & other difficulties associated with menstrual cycle
Oligomenorrhoea :
Scanty menstrual bleeding
Amenorrhoea :
No menstrual cycles
Metrorrhagia :
bleeding in the middle of menstrual cycle

29. Diagnosis of pregnancy

30. Symptoms
of
Pregnancy
Amenorrhoea: 4 weeks +
Symptoms:
 Nausea
 Poor appetite
 Breast changes- heaviness, pain etc
 Increased frequency of micturtition

31. Ultrasound
An ultrasound will confirm:
 Intrauterine/ Ectopic
 Bulky endometrium
 G Sac, yolk sac
 Gestational age
 Singleton/ multiple pregnancy
 Fetal heartbeat

32. What is
β hCG
The principle behind
all pregnancy tests

33. Beta hCG
It is a glycoprotein
Heterodimeric in nature
 α subunit: resembles LH, FSH, TSH
 β subunit: unique
 Therefore the beta subunit is used for
confirmation of pregnancy

34. Beta hCG
Urine pregnancy test: Qualitative
 Immunoassay anti hCG reacts with hCG
antigen in the urine to give a colored
reaction
 +ve/ -ve/ weak positive
 Result within 2 minutes
 Stale tests not valid
 Detects >20- 100 mIU/mL
Qualitative

35. Beta hCG
Blood test/ beta hCG test: Quantitative
 Immunoassay to determine levels of hCG in
blood
 >5mIU/mL
 Doubles in 24 hours
Quantitative

36. Beta hCG
 Doubtful cases:
 Beta hCG 0
 Beta hCG 48 hrs
 If levels double, or increase significantly:
+ve
 If levels increase, but not near double:
Miscarriage/ blighted ovum/ ectopic
pregnancy
 Excessively high levels: hyadatidiform
mole/ gestational trophoblastic disease
(GTD)

37. Abortion & medical termination of
pregnancy

38. Definition of
MTP/
abortion
Deliberate termination of pregnancy either by
the medical & surgical method before the
viability of the fetus is called induction of
abortion

39. MTP act
1971
The Indian abortion laws falls under the Medical
Termination of Pregnancy (MTP) Act
Enacted by the Indian Parliament in the year 1971
with the intention of reducing the incidence of
illegal abortion and consequent maternal mortality
and morbidity
The MTP Act came into effect from 1 April 1972 and
was amended in the years 1975 and 2002
Recently, the Supreme Court permitted a rape
survivor to terminate her pregnancy at 24 weeks,
which is beyond the permissible 20 weeks limit
prescribed under the Medical Termination of
Pregnancy Act, 1971

40. Medical
Termination
Of
Pregnancy
Act
MTP is the induction of abortion
Legal
Illegal
In India the abortion was legalized by
 MTP Act, 1971
 Enforced in 1972

41. Legal
Abortion
Termination is performed by the medical
practitioners
 Assisted in at least 25 MTP + MS/ DGO
 Termination is done at the place approved under
the act
 Done for condition & within the gestation week
prescribed by the act
 Abortion has to be reported to the director of
health service of the state

42. Indications
for MTP
Women whose physical and/or mental health were
endangered by the pregnancy
Women facing the birth of a potentially
handicapped or malformed child
Rape
Pregnancies in unmarried girls under the age of
eighteen with the consent of a guardian
Pregnancies that are a result of failure in
sterilization

43. 1st trimester
abortions
MTP kits
 Always confirm whether pregnancy is in
the uterus or in the fallopian tubes by an
ultrasound and under the guidance of an
obstetrician
 Follow up with an ultrasound to confirm
whether the products of conception have
cleared
 History of previous delivery- normal or
LSCS, D & E etc can affect the methodology
of taking drugs to abort
Conservative

44. 1st trimester
abortions
Methotrexate for Ectopic pregnancy
Menstrual regulation
 Aspiration of the endometrial cavity within
14 days of missed period in a woman with
previous normal cycle
D&E with manual vacuum aspiration (MVA) or
electric vacuum aspiration (EVA)
Surgical

45. 2nd
Trimester
Abortions
D & C- dilation and curettage
Hysterotomy: Extracting the products of
conception out of the womb before 28th
week by cutting through the anterior wall of
the uterus
Surgical

46. Complications
of MTP
Injury to the cervix (cervical lacerations)
Uterine perforation during D and E
Hemorrhage and shock due to trauma,
incomplete abortion, atonic
Uterus or rarely coagulation failure
Thrombosis or embolism
Immediate

47. Complications
of MTP
Gynecological complications include
 Menstrual disturbances
Chronic pelvic inflammation
Scar endometriosis (1%)
Remote
Gynecological
complications

48. Complications
of MTP
Obstetrical complications include
Ectopic pregnancy (three fold increase)
Preterm labor
Rupture uterus
Remote
Obstetric
complications

49. Summary

50. Phases of
menstruation

53. Summary
Diagnosis of pregnancy
MTP
Complications of MTP