MENSTRUATION

• a menstrual cycle (the female reproductive cycle) is episodic uterine bleeding in

response to cyclic hormonal changes.
• the purpose of a menstrual cycle is to bring an ovum to maturity and renew a uterine
tissue bed that will be necessary for the ova’s growth should it be fertilized.

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 MENSTRUATION
• MENARCHE
• first menstruation
• may occur as early as 9 years of age
• it is good to include health teaching information on menstruation
to both school-age children and their parents as early as fourth
grade as part of routine care.

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 MENSTRUATION
• THE LENGTH OF MENSTRUAL CYCLES
• DIFFERS FROM WOMAN TO WOMAN.
• AVERAGE LENGTH IS 28 DAYS (FROM THE BEGINNING OF ONE MENSTRUAL FLOW TO THE
BEGINNING OF THE NEXT).
• IT IS NOT UNUSUAL FOR CYCLES TO BE AS SHORT AS 23 DAYS OR AS LONG AS 35 DAYS.
• THE LENGTH OF THE AVERAGE MENSTRUAL FLOW (TERMED MENSES)
• 4 TO 6 DAYS
• ALTHOUGH WOMEN MAY HAVE FLOWS AS SHORT AS 2 DAYS OR AS LONG AS 9 DAYS (LEDGER,
2012).

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 MENSTRUATION
Characteristic Description
Beginning (menarche) • Average age at onset, 12.4
years; average range, 9–17
years
Interval between cycles • Average, 28 days; cycles of
23–35 days not unusual
Duration of menstrual flow • Average flow, 4–6 days;
ranges of 2–9 days not
abnormal
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 MENSTRUATION
Characteristic Description
Amount • Difficult to estimate;
• Average 30–80 ml per menstrual period;
(1 gram = 1 ml)
• Saturating a pad or tampon in less than 1 hr is heavy
bleeding
Color • Dark red;
• A combination of blood, mucus, and endometrial
cells
Odor • Similar to marigolds
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 THE PHYSIOLOGY OF
MENSTRUATION
• FOUR BODY STRUCTURES ARE INVOLVED:
1. HYPOTHALAMUS
2. ANTERIOR PITUITARY GLAND
3. OVARIES
4. UTERUS.
• FOR A MENSTRUAL CYCLE TO BE COMPLETE, ALL FOUR ORGANS MUST
CONTRIBUTE THEIR PART;
• INACTIVITY OF ANY PART RESULTS IN AN INCOMPLETE OR INEFFECTIVE CYCLE

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 THE PHYSIOLOGY OF
MENSTRUATION
1. THE HYPOTHALAMUS
• release of the GNRH (also called luteinizing hormone–releasing
hormone [LHRH]) from the hypothalamus initiates the menstrual cycle.
• GNRH then stimulates the pituitary gland to send the gonadotropic
hormone to the ovaries to produce estrogen.
• when the level of estrogen rises, release of GNRH is repressed and
no further menstrual cycles will occur.

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 THE PHYSIOLOGY OF
MENSTRUATION
2. THE ANTERIOR LOBE OF THE PITUITARY GLAND (THE
ADENOHYPOPHYSIS)
• under the influence of GNRH, produces two hormones:
1) FSH, a hormone active early in the cycle that is responsible for maturation
of the ovum
2) LH, a hormone that becomes most active at the midpoint of the cycle and
is responsible for ovulation, or release of the mature egg cell from the
ovary.
➢ it also stimulates growth of the uterine lining during the second half of the
menstrual cycle.
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 THE PHYSIOLOGY OF
MENSTRUATION
3. THE OVARIES
• every month during the fertile period of a woman’s life (from
menarche to menopause), one of the ovary’s oocytes is
activated by FSH to begin to grow and mature.
• as the oocyte grows, its cells produce a clear fluid (follicular
fluid) that contains a high degree of estrogen and some
progesterone.
• as the follicle surrounding the oocyte grows, it is propelled
toward the surface of the ovary.
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 THE PHYSIOLOGY OF
MENSTRUATION
3. THE OVARIES
• at full maturity, the follicle is visible on the surface of the ovary as
a clear water blister approximately 0.25 to 0.5 in. across.
• at this stage of maturation, the small ovum (barely visible to the
naked eye, about the size of a printed period) with its
surrounding follicular membrane and fluid is termed a graafian
follicle.

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 THE PHYSIOLOGY OF
MENSTRUATION
3. THE OVARIES
• by day 14 or the midpoint of a typical 28-day cycle, the ovum
has divided by mitotic division into two separate bodies:
1)a primary oocyte, which contains the bulk of the cytoplasm, and
2)a secondary oocyte, which contains so little cytoplasm that it is not
functional.
• the structure also has accomplished its meiotic division,
reducing its number of chromosomes to the haploid (having
only one member of a pair) number of 23.
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 THE PHYSIOLOGY OF
MENSTRUATION
3. THE OVARIES
• after an upsurge of lh from the pituitary at about day 14,
prostaglandins are released and the graafian follicle ruptures.
• the ovum is set free from the surface of the ovary, a process
termed ovulation. it is swept into the open end of a fallopian
tube.
• it is important to teach women that ovulation does not necessarily
occur on the 14th day of their cycle;
• it occurs 14 days before the end of their cycle.
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 THE PHYSIOLOGY OF
MENSTRUATION
3. THE OVARIES
• if their menstrual cycle is only 20 days long, for example, their
day of ovulation would be day 6 (14 days before the end of
the cycle).
• if their cycle is 44 days long, ovulation would occur on day
30, not at the halfway point—day 22.
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 THE PHYSIOLOGY OF
MENSTRUATION
3. THE OVARIES
• after the ovum and the follicular fluid have been discharged from the
ovary, the cells of the follicle remain in the form of a hollow, empty pit.
• the FSH has done its work at this point and now decreases in amount.
• the second pituitary hormone, LH, continues to rise in amount and
directs the follicle cells left behind in the ovary to produce lutein, a
bright-yellow fluid high in progesterone.
• with lutein production, the follicle is renamed a corpus luteum (yellow
body).
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 THE PHYSIOLOGY OF
MENSTRUATION
3. THE OVARIES
• the basal body temperature of a woman drops slightly just before the day of
ovulation because of the extremely low level of progesterone that is present at
that time.
• Your body temperature dips a bit just before your ovary releases an egg. Before
ovulation, a woman's BBT averages between 97°F (36.1°C) and 97.5°F (36.4°C).
• 24 hours After ovulation, it rises to 97.6°F (36.4°C) to 98.6°F (37°C), and stays
up for several days.
• the woman’s temperature remains at this elevated level until approximately day
24 of the menstrual cycle, when the progesterone level again decreases
(Huether & Mccance, 2012).

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 THE PHYSIOLOGY OF
3. THE OVARIES
MENSTRUATION
• if conception (fertilization by a spermatozoon) occurs as the ovum
proceeds down a fallopian tube and the fertilized ovum implants on the
endometrium of the uterus, the corpus luteum remains throughout the
major portion of the pregnancy (to about 16 to 20 weeks).
• if conception does not occur, the unfertilized ovum atrophies after 4 or 5
days, and the corpus luteum (now called a “false” corpus luteum)
remains for only 8 to 10 days.
• as the corpus luteum regresses, it is gradually replaced by white fibrous
tissue, and the resulting structure is termed a corpus albicans (white
body).

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 THE PHYSIOLOGY OF
MENSTRUATION
4. THE UTERUS
• uterine changes that occur monthly is a result of
stimulation from the estrogen and progesterone
produced by the ovaries.

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THE PHYSIOLOGY OF
MENSTRUATION

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 THE PHYSIOLOGY OF
MENSTRUATION
1. THE FIRST PHASE OF THE MENSTRUAL CYCLE (PROLIFERATIVE)
• immediately after a menstrual flow (which occurs during the first 4 or 5
days of a cycle)
• the endometrium, or lining of the uterus, is very thin, approximately one cell
layer in depth.
• as the ovary begins to produce estrogen (in the follicular fluid, under the
direction of the pituitary FSH), the endometrium begins to proliferate so
rapidly the thickness of the endometrium increases as much as eightfold
from day 5 to day 14.
• also called the proliferative, estrogenic, follicular, or postmenstrual
phase.
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 THE PHYSIOLOGY OF
MENSTRUATION
2. THE SECOND PHASE OF THE MENSTRUAL CYCLE (SECRETORY)
• after ovulation, the formation of progesterone in the corpus luteum
(under the direction of LH) causes the glands of the uterine
endometrium to become corkscrew or twisted in appearance and dilated
with quantities of glycogen (an elementary sugar) and mucin (a protein).
• it takes on the appearance of rich, spongy velvet.
• is termed the progestational, luteal, premenstrual, or secretory
phase.

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 THE PHYSIOLOGY OF
MENSTRUATION
3. THE THIRD PHASE OF THE MENSTRUAL CYCLE (ISCHEMIC)
• if fertilization does not occur, the corpus luteum in the ovary begins to
regress after 8 to 10 days, and therefore, the production of progesterone
decreases.
• with the withdrawal of progesterone, the endometrium of the uterus begins
to degenerate (at about day 24 or day 25 of the cycle).
• the capillaries rupture, with minute hemorrhages, and the endometrium
sloughs off.

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 THE PHYSIOLOGY OF
MENSTRUATION
4. THE FOURTH PHASE OF THE MENSTRUAL CYCLE (MENSES)
• menses, or a menstrual flow, is composed of
1) a mixture of blood from the ruptured capillaries;
2) mucin;
3) fragments of endometrial tissue; and
4) the microscopic, atrophied, and unfertilized ovum.
• because it is the only external marker of the cycle, the first day of
menstrual flow is used to mark the beginning day of a new menstrual
cycle.

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 THE PHYSIOLOGY OF
MENSTRUATION
4. THE FOURTH PHASE OF THE MENSTRUAL CYCLE (MENSES)
• a menstrual flow contains only 30 to 80 ml of blood;
• if it seems to be more, it is because of the accompanying mucus and
endometrial shreds.
• the iron loss in a typical menstrual flow is approximately 11 mg.
➢this is enough loss that many adolescent women could benefit from a
daily iron supplement to prevent iron depletion during their
menstruating years (bitzer, sultan, creatsas, et al., 2014).

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MENSTRUAL CYCLE
Hypothalamus

GNRH OR LHRH

Anterior Pituitary Gland

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 FSH & LH
prostaglandins are
Promotes Growth Of Follicle released

in estrogen (estradiol) Graafian Follicle ruptures

and some progesterone

Ovulation
endometrial tissue build-up
(proliferative phase)
Follicle Becomes FSH
Corpus Luteum
(Luteal Phase)

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 LH continues to

corpus luteum produce lutein

lutein is high in progesterone (& some

estrogen)

stimulates glands of temp. by 0.3 – 0.6°C

endometrium to secrete (0.5 – 1.0°F) on the
mucin & glycogen day after ovulation

capillaries in endometrium
in amount

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 endometrium becomes softer
unfertilized ovum atrophies after fertilization
4 – 5 days

corpus luteum remains

corpus luteum becomes corpus
albicans 16 – 20 wks.

estrogen & progesterone hcg stimulates corpus luteum to

secrete estrogen & progesterone
ischemic phase

progesterone reduce frequency of

menstruation uterine contractions

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