Menstrual cycle and dis order

topic may help nursing student to understand femal menstrual hermon

1. Menstrual cycle
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2. Objectives:
To list the phases of the menstrual cycle
To describe the hormonal changes during each phase
To describe the hormonal changes behind ovulation
To point the source and control of the hormones involved
in the menstrual cycle
Describe the process of ovulation and its regulation.

3. Objectives
Describe the regulation of the menstrual cycle by the hypothalamic-
pituitary axis.
Discuss the phases of the menstrual cycle.
Discuss the interrelationship of the ovarian and uterine cycles.
Describe the process of ovulation and its regulation.

4. Ovarian Cycle
Average ovarian cycle lasts 28 days
Normally interrupted only by pregnancy
Finally terminated by menopause (45 yrs)

5. Ovary, Tubes and Uterus

6. Variation in the Follicular Phase
―Both menstrual and follicular phase are variable

7. Uterine Wall
Composed of three layers
◦Perimetrium –outermost serous layer; the visceral peritoneum
◦Myometrium –middle layer; interlacing layers of smooth muscle
◦Endometrium –mucosal lining of the uterine cavity

8. Consists of two alternating phases
Follicular phasefollowed by Luteal phase
Dominated by presence of Characterized by the presence
maturing follicles of corpus luteum

9. The LH Surge

10. The Luteal Phase: Progesterone

12. Menstrual cycle
Females of reproductive age experience cycles of
hormonal activity that repeat at about one-month
intervals. (Menstrumeans "monthly"; hence the term
menstrual cycle.) With every cycle, a woman's body
prepares for a potential pregnancy, whether or not that
is the woman's intention.
The term Menstruationrefers to the periodic shedding
of the uterine lining.
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13. Menstrual Cycle
Cyclical changes
occurring the uterus.
3 phases:
1.Menstrual phase
2.Proliferative phase
3.Secretors phase
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The average menstrual cycle takes about 28 days and occurs in
phases( ovarian cycle)
1.the follicular phase,
2.the ovulatory phase (ovulation),
3.and the luteal phase.
There are four major hormones (chemicals that
stimulate or regulate the activity of cells or organs)
involved in the menstrual cycle:
follicle-stimulating hormone,
luteinizing hormone,
estrogen,
progesterone

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18. Follicular phase
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This phase starts on the first day of your period. During the follicular
phase of the menstrual cycle, the following events occur:
Two hormones, follicle stimulating hormone (FSH) and luteinizing
hormone (LH) are released from the brain and travel in the blood to the
ovaries.
The hormones stimulate the growth of about 15-20 eggs in the ovaries
each in its own "shell," called a follicle.
These hormones (FSH and LH) also trigger an increase in the production
of the female hormone estrogen.

19. Follicular phase
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As estrogenlevels rise, like a switch, it turns off the
production of follicle-stimulating hormone. This careful
balance of hormones allows the body to limit the number
of follicles that complete maturation, or growth.
As the follicular phase progresses, one follicle in one
ovary becomes dominantand continues to mature. This
dominant follicle suppresses all of the other follicles in the
group. As a result, they stop growing and die.
The dominant follicle continues to produce estrogen.

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The ovulatory phase, or ovulation, starts about 14 days after
the follicular phase started. The ovulatory phase is the
midpointof the menstrual cycle, with the next menstrual
period starting about 2 weeks later.

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During this phase, the following events occur:
The rise in estrogen from the dominant follicle triggers a surge in the amount
of luteinizing hormone that is produced by the brain.
This causes the dominant follicle to release its egg from the ovary.
As the egg is released (a process called ovulation) it is captured by finger-like
projections on the end of the fallopian tubes (fimbriae). The fimbriae sweep the
egg into the tube.
Also during this phase, there is an increase in the amount and a change in the
consistency of mucus produced by the cervix (lower part of the uterus.) If a
woman were to have intercourse during this time, this receptive mucus
captures the man's sperm, nourishes it, and helps it to move towards the egg
for fertilization

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The luteal phase begins right after ovulation and involves the following
processes:
Once it releases its egg, the empty follicle develops into a new structure called
the corpus luteum.
The corpus luteumsecretes the hormone progesterone. Progesterone
prepares the uterus for a fertilized egg to implant.
If intercourse has taken place and a man's sperm has fertilized the egg (a
process called conception), the fertilized egg (embryo) will travel through the
fallopian tube to implant in the uterus. The woman is now considered
pregnant.
If the egg is not fertilized, it passes through the uterus. Not needed to
support a pregnancy, the lining of the uterus breaks down and sheds, and
the next menstrual period begins.

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28. 1 -Hypothalamic releasing hormone “ Gonadotropin-releasing
hormone (GnRH)
2 -The anterior pituitary sex hormones, i.e. Follicle-stimulating
hormone (FSH) and luteinizing hormone (LH).Both hormones are
controlled by GnRH from the hypothalamus
3 -The ovarian hormones, oestrogen and progesterone, which are
secreted by the ovaries in response to hormones from anterior
pituitary ( LH & FSH)
The hormonal system in the female has three
levels of Hierarchies of hormones :

29. The common
menstrual
problems
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30. Normal menstrual cycle involves hypothalamus-
pituitary-ovary and uterus and is 28 days
Vaginal bleeding is abnormal (Abnormal Uterine
Bleeding--AUB) when:
◦Volume is excessive or
◦Occurs at times other than expected, including during pregnancy or
menopause
Known as dysfunctional uterine bleeding (DUB)
when organic causes are excluded(10-2-% of case)

31. Dysmenorrhea
Dysmenorrhea is the most common gynecologic problems in women
It means pain during or shortly before menstruation.
Many adolescents have dysmenorrhea in the first 3 years after
menarche.
Dysmenorrhea is differentiated as:
1.Primary dysmenorrhea
2.Secondary dysmenorrhea
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32. Primary Dysmenorrhea
It is a condition associated with ovulatory cycles.
It has a biochemical basis & arise from the release of
prostaglandins with menses.
It usually appears 6-12 months after menarche when
ovulation is established.
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33. Signs & Symptoms
Lower abdominal cramps
Backache
Weakness
Sweats
Gastrointestinal symptoms(anorexia, nausea, vomiting & diarrhea).
CNS symptoms ( dizziness, headache, & poor concentration)
NOTE ( Pain Begins At The Onset Of Menstruation And Lasts 8-48 Hrs)
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34. Secondary Dysmenorrhea
It is acquired menstrual pain that develops later in life than primary
dysmenorrhea, typically after age 25.
It is associated with pelvic pathology such as adenomyosis, endometriosis,
pelvic inflammatory disease, endometrial polyps, uterine fibroid, or use of IUD.
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35. Signs & Symptoms
Dull pain starts few days before menses, but it can be continue through the first
days of menses.
Lower abdominal aching radiating to the back or thighs
Feelings of bloating or pelvic fullness.
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36. Premenstrual Syndrome (PMS)
PMS is a complex, poorly understood condition that includes one or more of a large
number
( more than 100) of physical & psychological symptoms.
It begins in the luteal phase of the menstrual cycle, and followed by a symptoms-
free period.
It occurs to a such degree that lifestyle or work is affected.
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37. Signs & Symptoms of PMS
Physical symptoms
1.abdominal pain, headache, fatigue, & backache.
2.Fluid retention ( abdominal bloating, pelvic fullness, edema
of the lower extremities ,breast tenderness,& weight gain)
Behavioral or emotional changes
1.Depression, crying spells, irritability, panic attacks, &
impaired ability to concentrate)
2.Premenstrual cravings (sweats, salt, & increased appetite)
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38. Evaluation of Abnormal Uterine
Bleeding
Duration >7 days or
Flow >80ml/cycle or
Occurs more frequently than 21 days or
Occurs more than 35 days apart or
Intermenstrual or postcoital bleeding

39. Terminology
Menorrhagia: excessive flow
Menometrorrhagia: excessive volume
Oligomenorrhea: scanty flow
Dysmenorrhea: painful menstrual cycles

40. Causes of Menstrual Disorders
Structural
Pregnancy associated
Hormonal and endocrine
Hematologic and coagulation disorders
Other

41. Causes--structural
Endometrial polyps
Endometrial hyperplasia
Endometritis
Fibroids
Intrauterine devices
Uterine arterio-venous malformation (AVM)
Uterine sarcoma

42. Pregnancy related
Implantational bleeding
Ectopic pregnancy
Spontaneous abortion [incomplete, missed, septic, threatened]
Therapeutic abortion
Gestational trophoblastic disease

43. Hormonal and Endocrine
causes
Anovulatory (including polycystic ovary syndrome)
Ovarian cyst
Estrogen-producing ovarian tumor
Perimenopause
Hormonal contraceptives
Hormone Replacement Therapy
Hypothyroidism

44. Hematologic
Von Willebrand’s disease (most common inherited bleeding disorder
with frequency 1/800-1000)
Hemophilia
Thrombocytopenia
Hematologic malignancies (leukemia)
Liver disease

45. Other
DUB (dysfunctional uterine bleeding): non-organic
causes, either ovulatory or anovulatory
Fallopian tube cancer
Traumaa
Foreign body
Cervical bleeding--mets, cervicitis, cervical cancer
Vaginitis--atrophic, cancer of vagina
Endometrial cancer (10% of post-menopausal bleeding)

46. Evaluation of Abnormal
Uterine Bleeding (AUB)
Acute
History suggestive of:
Pregnancy and related
complications
Recent and Heavy bleeding
Pelvic pain
Medications contributing to above
Chronic
History:
Long standing abnormal menstrual history
Symptoms of anemia, hypothyroidism,
perimenopause
Personal or family history of excessive
bleeding

47. AUB Examination
Assess vitals/hemodynamic stability
Look for features of anemia (pallor, tachycardia, syncope)
Look for features of hypothyroidism
Look for metabolic syndrome (obesity, hirsutism, acne)
Pelvic exam for structural abnormalities: fibroids, pregnancy, active
bleeding—uterine vs. cervical bleeding

48. AUB Lab Studies
Serum HCG to rule out pregnancy
CBC and iron studies to assess severity of anemia
TSH for thyroid disorders
Coagulation studies (PT, PTT, platelet count, VWF) (primarily for
adolescents)
Transvaginal ultrasound to look for fibroids and other
masses/lesions
Endometrial biopsy to rule out endometrial cancer in
perimenopausal and chronic anovulatory cycles (primarily for
women >35 years with AUB and postmenopausal women)
Sonohysterography is useful in diagnosis of anatomical lesions
which might even be missed with transvaginal ultrasound

49. Treatment of Chronic
Menorrhagia
Combined hormonal contraceptives (cyclical or continuous)
DMPA (depot medroxyprogesterone)
Medicated IUD (Intrauterine devices)(mirena)

50. Histological findings in women with postmenopausal bleeding: Jordanian
figures
I. Bani-Irshaid1and A. Al-Sumadi1
Introduction
Postmenopausal bleeding represents one of the most common reasons for
referral to gynaecological services.
Methodology
A retrospective review was made of the hospital records of 482 women
presenting with postmenopausal bleeding to a referral hospital in Amman,
Jordan. Histopathological reports and patients’ records were reviewed and
different causes of bleeding were identified and related to patients’ age.
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51. The result :
Adenocarcinoma was responsible for 9% of cases, and hyperplasia for 11%. Atrophy of
the endometrium was the most common finding (52%of women), followed by
hyperplasia (with and without atypia) (11%) and carcinoma (9%).
The risk of cancer increased with increasing age while the incidence of bleeding
decreased with age. Other pathology was reported as the main finding in 11 cases
(2%) with postmenopausal bleeding. These preliminary data are the first reports from
Jordan of histopathologicalfindings in this group of patients, and a larger study is
required to establish national figures.
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