Menarche

1. Problem no.1Problem no.1

2. Task question no.1Task question no.1
What is menarche?What is menarche?
How does it differ from usual How does it differ from usual
menstrual cycle? menstrual cycle?

3. Definition of Definition of MenarcheMenarche::
Define as the period which is the first cycle occurs.Define as the period which is the first cycle occurs.
Consider as first sign of Consider as first sign of puberty.puberty.
Definition of Definition of PubertyPuberty::
Define as period that endocrine & gametogenic Define as period that endocrine & gametogenic
functions of the gonads have first develop to the point functions of the gonads have first develop to the point
where reproduction is possible. where reproduction is possible.
There are skeletal and neurological maturation resulting There are skeletal and neurological maturation resulting
from increase secretion of Estrogen.from increase secretion of Estrogen.

4. Other terms associated with Other terms associated with PubertyPuberty::
ThelarchThelarch: the event that occur in girls which the : the event that occur in girls which the
breast is developed.breast is developed.
PubarchaPubarcha: the development of axillary & pubic hair.: the development of axillary & pubic hair.
Menarche:Menarche: is the last event in the consequent of is the last event in the consequent of
puberty.puberty.
MenMenarchearche
Men= MensesMen= Menses
arche =beginning arche =beginning

5. AdolescenceAdolescence: the period of final maturation : the period of final maturation
& refers to the period between childhood & & refers to the period between childhood &
maturity.maturity.
We have many theories that explain the We have many theories that explain the
puberty as: Set point, relation to puberty as: Set point, relation to
Leptin……etc.Leptin……etc.
Age of menarcheAge of menarche: differs from girl to girl may : differs from girl to girl may
start in age 8 years old to 17 years without start in age 8 years old to 17 years without
being disquiet.being disquiet.

6. Control of the onset of menarcheControl of the onset of menarche
By increasing the sensitivity of the gonads By increasing the sensitivity of the gonads
((ovariesovaries) to pulsatile secretion of GnRH ) to pulsatile secretion of GnRH
from hypothalamic-pituitary axis.from hypothalamic-pituitary axis.
Then Then Menarche Menarche is occurs. is occurs.

7. Differences between menarche & Differences between menarche &
regular menstrual cycleregular menstrual cycle
Longer in period.Shorter in period.
More in amount.Fewer in amount.
Mid cyclic pain is
present.
No midcyclic pain.
Ovultary cycle.Anovultary cycle.
Repeated cycle.Not repeated.
Regular menstrual
cycle
Menarche

8. Question 2Question 2
What is menstrual cycle,how does it What is menstrual cycle,how does it
occur?occur?

9. Cyclic changes that occur in ovaries, Cyclic changes that occur in ovaries,
uterus, cervix, vagina & breasts.uterus, cervix, vagina & breasts.
These changes occur under the influence These changes occur under the influence
of hormones.of hormones.
Cervical changes:Cervical changes:
No desquamation.No desquamation.
Estrogen --- thin alkaline mucus.Estrogen --- thin alkaline mucus.
Progesterone --- thick cellular mucusProgesterone --- thick cellular mucus

10. Vaginal changes:Vaginal changes:
Estrogen --- cornified epithelium.Estrogen --- cornified epithelium.
Progesterone --- secretion, leukocyte infiltration.Progesterone --- secretion, leukocyte infiltration.
Breast changes:Breast changes:
Estrogen --- ducts and stroma proliferation.Estrogen --- ducts and stroma proliferation.
Progesterone --- lobules and alveoli development.Progesterone --- lobules and alveoli development.
Breast is swollen, tender and painfulBreast is swollen, tender and painful
Changes regress with menstrual cycle.Changes regress with menstrual cycle.
Lactation occurs only at the end of pregnancy.Lactation occurs only at the end of pregnancy.

11. Question 3Question 3
What is the mechanisms which control the What is the mechanisms which control the
menstrual cycle?menstrual cycle?

12. Under hormonal control:Under hormonal control:
Hypothalamus
Pituitary gland
Ovaries
GnRH
FSH LH

13. FSH:FSH:
Proliferation of folliclesProliferation of follicles
Convert androgens to Convert androgens to
estrogen.estrogen.
Inhibin production.Inhibin production.
Induce LH receptors Induce LH receptors
production.production.
LH:LH:
Convert cholesterol to Convert cholesterol to
androgen.androgen.

14. Question 4Question 4
Describe the ovarian cycle?Describe the ovarian cycle?

15. * At puberty the females begins to undergo * At puberty the females begins to undergo
reguler monthly cyclesreguler monthly cycles
*GnRH (from hypothalamus) acts on the *GnRH (from hypothalamus) acts on the
cells of anterior pit gland which secretles LH cells of anterior pit gland which secretles LH
& FSH that stimulate and contro cyclic & FSH that stimulate and contro cyclic
changes in the ovary .changes in the ovary .
. . These sexual cycles are controlled by the These sexual cycles are controlled by the
hypothalamus.hypothalamus.

16. *The ovarian cycle is the normal process *The ovarian cycle is the normal process
whereby ova mature and are released whereby ova mature and are released
during the menstrual cycle .during the menstrual cycle .
* it is hormonally regulated in two phases . * it is hormonally regulated in two phases .
The follicle secretes The follicle secretes estrogenestrogen before before
ovulation ; the corpus luteum secrete both ovulation ; the corpus luteum secrete both
estrogen and estrogen and progestroneprogestrone after ovulation . after ovulation .

17. * * at the beginning of each ovarian cycle at the beginning of each ovarian cycle
several primordial follicles begin to several primordial follicles begin to
enlarge, with cavitation occuring to enlarge, with cavitation occuring to
form an antrum . 15-20 primary stage form an antrum . 15-20 primary stage
follicle are stimulated to grow by FSH .follicle are stimulated to grow by FSH .
Normally one of the follicles become Normally one of the follicles become
dominant ; and only one oocyte is dominant ; and only one oocyte is
discharged , and others degenerat and discharged , and others degenerat and
become atretic . this maturing follicle at become atretic . this maturing follicle at
this stage is called agrafian follicle ; the this stage is called agrafian follicle ; the
cells of the theca interna of this cells of the theca interna of this
structure produce estrogensstructure produce estrogens....

18. n.b: FSH is not necessary to promote n.b: FSH is not necessary to promote
devolopmentof primordial follicle to the devolopmentof primordial follicle to the
primary follicle stage , but without it ,primary follicle stage , but without it ,
 these primary follicle die and become atreticthese primary follicle die and become atretic
When afollicle becomes atretic , the oocyte When afollicle becomes atretic , the oocyte
and surrounding folliclular cells degenerate and surrounding folliclular cells degenerate
and replaced by connective tissue , forming and replaced by connective tissue , forming
acorpus atrectium .acorpus atrectium .

19. FSH also stimulates maturation of follicular FSH also stimulates maturation of follicular
( granulosa ) cells surrounding the oocyte .( granulosa ) cells surrounding the oocyte .
In cooperation granulosa and theca cells In cooperation granulosa and theca cells
produce estrogens that :produce estrogens that :
A. proliferate the uterine endometrium .A. proliferate the uterine endometrium .
B. thining of cervical mucus to allow passage of B. thining of cervical mucus to allow passage of
sperm .sperm .
C. stimulate the pit gland to secret LH C. stimulate the pit gland to secret LH
( midcyclic LH surge )( midcyclic LH surge ) that : that :
A. stimulate production of progesterone by A. stimulate production of progesterone by
folliculer stromal cells ( luteinization ) .folliculer stromal cells ( luteinization ) .
B. causes folliculer rupture and ovulation . B. causes folliculer rupture and ovulation .

20. N.b :the number of the antral follicles did not N.b :the number of the antral follicles did not
vary signficantly with stage of ovarian cycle , vary signficantly with stage of ovarian cycle ,
although the follicle size distribution was although the follicle size distribution was
cyclic-stage dependantcyclic-stage dependant . .
* Ovulation occurs at 14 of the cycle ( of a 28 * Ovulation occurs at 14 of the cycle ( of a 28
day cycle ) , with the rupturing of the follicle .day cycle ) , with the rupturing of the follicle .
* the follicle itself fills with blood ( brief pain ) * the follicle itself fills with blood ( brief pain )

21. # After ovulation the theca and granulosa cells # After ovulation the theca and granulosa cells
proliferate and luteal cells forms the yellow body proliferate and luteal cells forms the yellow body
or corpus luteum . These cells secretes or corpus luteum . These cells secretes
progesterone and estrogensprogesterone and estrogens . .
* If prgnency does not occur progesterone from * If prgnency does not occur progesterone from
corpus luteum will inhibit the production of LH . corpus luteum will inhibit the production of LH .
The lower level of LH will cause the corpus The lower level of LH will cause the corpus
luteum to degenerate( about four days prior to luteum to degenerate( about four days prior to
menses ) and the level of estrogen and menses ) and the level of estrogen and
progesterone will dropoff .progesterone will dropoff .

22. Question 4Question 4
Describe the endometrial cycle?Describe the endometrial cycle?

23. Endometrial changesEndometrial changes
Proliferative (postmenstrual,preovulatory):Proliferative (postmenstrual,preovulatory):
All but deep layers are sloughed.All but deep layers are sloughed.
Estrogen __ growth of stratum functionale and Estrogen __ growth of stratum functionale and
spiral arteries and glands (10 folds).spiral arteries and glands (10 folds).
Secretory phase:Secretory phase:
Mainly by progesterone.Mainly by progesterone.
Provide nutrients to fertilized ovum.Provide nutrients to fertilized ovum.
Short active glandsShort active glands
Mucus, glycogen, amino acids & enzymes.Mucus, glycogen, amino acids & enzymes.

24. Differentiation of the endometrium into:Differentiation of the endometrium into:
Stratum compactum.Stratum compactum.
Stratum spongiosum.Stratum spongiosum.
Stratum basalis.Stratum basalis.
Under control of estrogen and Under control of estrogen and
progesterone.progesterone.

25. Menstrual phase:Menstrual phase:
Regression of corpus luteum.Regression of corpus luteum.
Thinning of endometrium + necrosis foci.Thinning of endometrium + necrosis foci.
PGFPGF
22αα
Menses blood:Menses blood:
Usually doesn’t clots unless flow is excessive.Usually doesn’t clots unless flow is excessive.
Usual duration is 3-5 days (1-8)Usual duration is 3-5 days (1-8)
Usual amount is 30-35 mL (spots-80).Usual amount is 30-35 mL (spots-80).

27. Question 5Question 5
What is ovulation?What is ovulation?

28. DefinitionDefinition
Expulsion of oocyte from mature follicle at Expulsion of oocyte from mature follicle at
midcycle usually once in the cycle during the midcycle usually once in the cycle during the
reproductive life--- 1 to 2 years after reproductive life--- 1 to 2 years after
menarche to few years before menopause.menarche to few years before menopause.

29. Mechanisms:Mechanisms:
Physical: increase in the hydrostatic pressure result in Physical: increase in the hydrostatic pressure result in
distension of the follicle and ultimately its rupture.distension of the follicle and ultimately its rupture.
Hormonal: LH surge occurs which stimulate antral Hormonal: LH surge occurs which stimulate antral
filling and proteolytic activity through chemical filling and proteolytic activity through chemical
mediators (MCP-1,IL-8,PGs, metalloproteinases).mediators (MCP-1,IL-8,PGs, metalloproteinases).
9-36 hours after the surge9-36 hours after the surge
Cannot occur in pregnancy but may occur after Cannot occur in pregnancy but may occur after
peurperium.peurperium.
Control is hormonal: FSH, LH.Control is hormonal: FSH, LH.
Multiple ovulations may occur.Multiple ovulations may occur.

31. Question 6Question 6
What are the diagnostic methods for What are the diagnostic methods for
ovulation?ovulation?

32. Rise in basal body temperature.Rise in basal body temperature.
Thermometer with wide gradations (oral or Thermometer with wide gradations (oral or
rectal).rectal).
Increase in blood hormone levels.Increase in blood hormone levels.
Midcyclic pain due to irritation.Midcyclic pain due to irritation.

33. Question 8Question 8
What are conditions associated with What are conditions associated with
menstruation?menstruation?

34. Fever--- progesteroneFever--- progesterone
Pain--- irritation.Pain--- irritation.
Headache.Headache.
FatigabilityFatigability
Vomiting.Vomiting.