MENSTURAL CYCLE and disorders of menstruation

1. PHYSIOLOGY OF MENSTRUAL CYCLE And DISORDERS OF MENSTRUATION Deepmala paul Govt college of nursing Gwalior

2. DEFINITION The cyclic events that take place in a rhythmic fashion during the reproductive period of a woman’s life is called menstrual cycle.

3. OVARIAN CYCLE: Ovarian cycle refers to rhythmic changes occurring in ovaries during each female sexual cycle of about 28 days. During each cycle a single mature ovum is released from the ovary. The ovarian cycle can be divided into three phases: • Pre-ovulatory phase • Ovulation • Post-ovulatory phase

4. 1.Pre-ovulatory phase: • Preovulatory phase of the ovarian cycle extends from the 5th day of the cycle till the time of ovulation(14th day of the cycle).Thus this phase generally lasts for 8-9 days. • Changes in the ovary during this phase are mostly under the influence of follicle stimulating hormone(FSH) from the anterior Pituitary. • During this phase of each cycle,some 10-15 primordial follicles start maturing,but only one follicle matures fully and rest undergo atrophy at different stages of development.

5. 2.Ovulation: Ovulation is the process in which there is rupture of graffian follicle with consequent discharge of ovum into abdominal cavity. • This occurs after the maturity of follicle.It is influenced by LH.The ovulation occurs usually on 14th day of menstrual cycle in a normal cycle of 28 days. • The ovum must be fertilized soon,within 24-48 hours after ovulation because,only during this time it is viable for fertilization.

6. After fertilization, the ovum is called zygote.From the fallopian tube, the zygote reaches the uterus on 3rd day after ovulation. • And the implantation of the zygote in the uterine wall occurs on 6th or 7th day. • If fertilization does not occur,the ovum degenrates.

7. 3.Post-ovulatory phase: Postovulatory phase also called Luteal phase Of ovarian cycle is of remarkably constant period of about 14 days.This phase is characterized by following events: • Formation of corpus haemorrhagicum: Following ovulation,the outer wall of the graffian follicle collapses and promptly fills with blood forming so called corpus haemorrhagicum. • Formation of corpus luteum:Soon the granulosa cells and theca cells of the Follicle lining begin to proliferate,and the clotted blood is rapidly replaced with yellowish lipid-rich luteal cells.

8. Formation of corpus albicans:If there is no fertilization and pregnancy does not occur,the corpus luteum begins to involute after 24th day of cycle and eventually due to falling levels of FSH and LH. • Corpus luteum of pregnancy:However, if the ovum released is fertilized and pregnancy occurs,then the corpus luteum formed during postovulatory phase persists and servs as the major source of oestrogen and progestrone till the 3rd month of pregnancy when the placenta takes over its endocrine function.

9. ENDOMETRIAL CYCLE:Endometrialcycle refers to the cyclic changes occuring in the endometrium during active reproductive period in females The endometrial cycle of 28 days can be divided into three phases: • Menstrual phase(1st to 5th day) • Proliferative phase(6th to 14th day) • Secretory phase(15th to 28th day)

10. Menstrual phase: The average duration of this phase is 3-5 days.About 24 hours before the end of menstrual cycle,there is a sharp decline in the plasma levels of oestrogen and progestrone,which is responsible for menstrual bleeding. • Average amount of blood loss during each menstrual cycle is 30 ml. •  Endometrial Debries contains necrosed sloughed off tissue,blood,Serous fluid and large amount of prostaglandins and fibrolysins.

11. Proliferative phase: Extent of proliferative phase of endometrial cycle is from day 6th to 14thday.It follows the phase of menstruation,after which only a thin basal layer of original endometrium is left. Hormone responsible for changes in the endometrium during this phase is oestrogen. • Thickness of endometrium,which is less than 1mm at the end of menstrual phase, increases to 3-4mm at the end of the proliferative phase.

12. Secretory phase: Extent of secretory phase is from day 15th to 28th day. • Hormone responsible for changes in the endometrium during this phase are both oestrogen and progesterone. • Thickness of endometrium increases to 5-6mm at the end of secretory phase. Thus the thickened endometrium with large amount of nutrients is ready to provide appropriate conditions for implantation of Ovum during this phase

13. VAGINAL CHANGES DURING MENSTRUAL CYCLE: • Proliferativephase:The epithelial cells of vagina are cornified.Estrogen released from ovary is responsible for the cornification of vaginal epithelial cells. • Secretory phase: Vaginal epithelium prolife- rates due to the actions of progesterone.

14. CHANGES IN THE CERVIX DURING MENSTRUAL CYCLE • Proliferativephase:Under the influence of estrogen,duringproliferativephase,the mucous membrane of cervix becomes thinner and more alkaline. • Secretoryphase:Because of the actions of progesterone during secretoryphase,the mucus membrane of cervix becomes more thick and adhesive.

15. HORMONAL REGULATION OF MENSTRUAL CYCLE: • Role of Hypothalamus:Hypothalamus regulates the secretions of gonadotropins (both FSH and LH) through gonadotropin releasing hormone(GnRH). • Role of Anterior Pituitary:The anterior pituitary plays its role in female sexual cycle regulation by releasing gonadotropins(FSH and LH).

16. Regulation of gonadotropins: 1.Gonadal Hormones 2.Human chorionicgonadotropin(HCG) 3.Prolactin 4.Activin • ROLE OF OVARIES:Ovaries Play an important role in regulation of Ovarian cycle and endometrial cycle by secreting gonadal hormone(oestrogen and progesterone).

17. Oestrogen: Oestrogen through its positive feedback effect is responsible forOvulation due to LH surge. • Progestrone:After ovulation there occurs formation of corpus luteum and the progesterone concentration starts rising. Progestrone prepares the oestrogen primed endometrium for implantation.

18. MENSTRUAL DISORDERS: menstrual disorder are those problems that affects a woman’s normal menstrual cycle. they includes painful cramps during menstruation, abnormally heavy bleeding, or not having any bleeding. menstruation occurs during the year between puberty and menopause.

20. AMENORRHEA:- Absence of menstrual cycle/periods

21. DYSMENORRHEA:- • Severe menstrual cramps.

22. MENORRHAGIA:- Prolonged or heavy periods or bleeding with menstrual cycle.

23. METORRHAGIA:- • Abnormal bleeding, may occur every few weeks and flow may be heavier than usual.

24. OLIGOMENORRHEA:- • Infrequent menstrual periods.

25. PREMENSTRUAL SYNDROME:- Group of symptoms that occurs in women, between ovulation and a period.

30. . Herbal Supplements green tea, chaste berry, and maca root. These herbs are known for supporting hormone balance. Green tea, for instance, is packed with antioxidants and is believed to improve overall reproductive system functioning in both men and women. While chaste berry helps to boost progesterone levels in women which may help reduce PMS and other menstrual symptoms like cramping. Lastly, maca root acts as an adaptogen and helps the body cope with stress.

32. Yoga & Mindfulness Yoga works on numerous levels to promote reproductive health—it helps in cooling down excess heat present in the body associated with hormonal imbalances but it also works to relieve stress and keep cortisol levels low which can then create conditions conducive for conception mindful activities such as meditation have been shown to lower cortisol levels while reducing mental tension and increasing relaxation to foster better prospects of conception at a higher rate than those not employing mindfulness techniques.