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Menstrual Cycle III Kursas 2016 (Close) PDF
Menstrual Cycle III Kursas 2016 (Close) PDF
Laima Maleckiene
Dept.Ob&Gyn
Lithuanian University of Health Sciences
Menstrual cycle
Menstrual cycle is a self-regulating process during which female body
undergoes many physiological and endocrine changes.
The menstrual cycle is regulated via feedback mechanism:
• hypothalamus (GnRH secretion in pulsatile manner)
• anterior pituitary
follicle-stimulating hormone (FSH)
luteinizing hormone (LH)
• ovaries (estrogen, progesterone, androgens)
Menstrual cycle
Menstrual cycle :
ovarian cycle
uterine cycle
Ovarian cycle describes changes that occur in ovarian follicles and is divided
into phases:
follicular phase
ovulation
luteal phase
Follicular phase
Estrogen and progesterone levels are low at early follicular phase.
Baseline FSH and LH levels rise under the influence of GnRH.
FSH triggers 15-20 primordial follicles differentiate into primary follicles.
Primary follicles at the begining of follicular phase develope under the
influence of FSH and one (or occasionally two) become dominant (graafian
follicle).
Dominant follicle will continue mature into preovulatory follicle.
When oocyte is nearly matured, levels of estradiol reach a threshold level
above which this effect is reversed and estrogen stimulates the production of
a large amount of LH (LH surge).
LH surge starts around cycle day 12 and lasts approximately 48 hours.
Ovulation
Approximately 24–36 hours after the LH surge, the dominant follicle
releases the secondary oocyte (ovulation).
The mature oocyte has a diameter of about 0.2 mm.
In some women, ovulation has a characteristic pain called
mittelschmerz (German term meaning middle pain).
The sudden change in level of hormones at the time of ovulation
sometimes causes light mid-cycle bleeding.
Luteal phase
The luteal phase of ovarian cycle corresponds to the secretory phase of
the uterine cycle.
During the luteal phase corpus luteum formates in ovary .
Corpus luteum produces large amount of progesterone.
Under the influence of progesterone, the endometrium prepares for
potential implantation of an embryo.
If implantation does not occurs, corpus luteum degenerates causing
sharp drop in level of progesterone.
Falling level of progesterone triggers a menstruation.
Ovarian cycle
The length of follicular phase often varies from cycle to cycle.
The length of luteal phase is relatively constant (131 day).
Progesterone causes a rise in body temperature of half a degree Celsius
The peak of progesterone is in midluteal phase (21 cycle day).
An elevated progesterone level (21-32 nmol/l) confirms ovulation in
that cycle.
Dipsticks based on LH surge can be used to detect ovulation.
Uterine cycle
The uterine cycle describes mainly changes in the endometrium.
The uterine cycle is divided into:
menstruation
proliferative phase
secretory phase
Uterine cycle
Menstruation (also called menstrual bleeding, menses, or a period) is
the first phase of the uterine cycle.
The flow of menses normally serves as a sign that a woman has not
become pregnant.
The length of menstrual cycle in days is counted starting from the first
day of menstrual bleeding.
The length of regular menstrual cycle varies among women (from 25 to
35 days), with 28 days as the average length.
Normal menstrual bleeding lasts usually 3 - 7 days.
The average blood loss during menstruation is 30-40 ml.
Proliferative phase
The proliferative phase is the second phase of the uterine cycle when
estrogens cause growth (proliferation) of endometrium.
The estrogens also stimulate crypts in the cervix to produce fertile
cervical mucus.
Secretory phase
The secretory phase of the uterine cycle corresponds to the luteal
phase of the ovarian cycle.
During the secretory phase under action of progesterone endometrium
becomes secretory and receptive to possible implantation .
Progesterone reduces the contractility of the smooth muscle in the
uterus (myometrium).
Menstrual cycle
Menarche
The average age of menarche (first menstruation) is 12–13 years
(considered normal between ages 8 and 16).
Factors such as heredity, diet and overall health can accelerate or delay
menarche.
Menarche is followed by 5-7 years period during which the menstrual
cycles become regular (ovulatory).
Menstrual cycle
A woman who experiences variations of less than 10 days between her
longest cycles and shortest cycles is considered to have regular
menstrual cycles.
Irregular menstrual cycle (anovulatory) is most common in women
under 20 and over 40 years of age.
The most regular menstrual cycles in women 25-35 years of age.
The variability increases slightly for women 40 to 44 years of age.
Menopause
The cessation of menstrual cycles at the end of a woman's reproductive
period is termed menopause.
The average age of menopause in women is 52 years (range 45-55
years).
Menopause before age 40 is considered premature.
The age of menopause is largely genetically determinated, but some
factors (surgery, medical treatment) may cause menopause to occur
earlier.
Family planning
Family planning is the planning to have children and the use of
contraception and other techniques to implement such plan.
Family planning allows people to attain their desired number of
children and determine the intervals between pregnancies.
Family planning is achieved through the use of contraceptive methods
and the treatment of infertility.
Family planning
Natural Methods
• Periodic abstinence
• Withdrawal
• Lactational amenorrhea
Barrier Methods
Hormonal contraception
Intrauterine devices
Surgical contraception
Periodic abstinence
Lactational amenorrhea
Breastfeeding causes negative feedback on pulse secretion GnRH.
Breastfeeding women may experience complete suppression of
follicular development, follicular development but no ovulation, or
normal menstrual cycles may resume.
Suppression of ovulation is more likely when suckling occurs more
frequently.
The production of prolactin in response to suckling is important to
maintaining lactational amenorrhea.
Women who are fully breastfeeding return to menstruation at 2-14
months postpartum.
Barrier methods of contraception