Mentrual cycle and disorders

menstrual cycle & its disorder in detail

1. Menstruation cycle and its disorders By – kajal sansoya

2. Introduction Menstrual cycle is defined as a cyclic events take place in a rhythmic fashion during the reproductive period of a women life . The process of shedding and exit of uterine lining along with blood and fluid is called menstruation or menstrual bleeding.

3. Menstrual cycle starts at age of 12 to 15 years, which marks the onset of puberty. Permanent cessation of menstrual cycle in old age is called MENOPAUSE. Menstrual cycle ceases at age of 45-50 years.

4. Duration Duration of menstrual cycle is usually 28 days. But, under physiological conditions, it may vary between 20 – 40 days.

5. Changes during menstrual cycle During each menstrual cycle, series of changes occur in ovary and accessory sex organs. These changes are divided in 4 groups: Ovarian changes Uterine changes Vaginal changes Changes in cervix

6. Ovarian changes Follicular phase Follicular phase extends from the 5 day of cycle until the time of ovulation, which takes place on 14 day. Maturation of ovum with development of ovarian follicles takes place during this phase.

7. Luteal phase Luteal phase extends between 15 and 28 day of menstrual cycle. During this phase, corpus luteum is developed and hence this phase called luteal phase.

8. Ovulation Ovulation occur in between these two phase. Ovulation is process by which the graafian follicle rupture the consequent discharge of ovum into the abdominal cavity. It is influenced by LH . Ovulation occurs on 14 day of menstrual cycle in a normal cycle of 28 days. The ovum enters the fallopian tube.

9. Uterine changes During each menstrual cycle, along with ovarian changes, uterine changes also occur simultaneously. Uterine changes occur in three phase: Menstrual phase Proliferative phase Secretory phase

10. Changes in cervix and vagina Proliferative phase Secretory phase

11. Regulation of menstrual cycle Regulation of menstrual cycle is a complex process that is carried out by a well organized regulatory system. The regulatory system is a highly integrated system, which included hypothalamus, anterior pituitary and ovary with growing follicle . In the whole scenario , the growing follicle has a vital role to play.

12. Hormones involved in regulation The regulatory system functions through the hormones of hypothalamo pituitary ovarian axis. Hypothalamic hormone: GnRH Anterior pituitary hormones: FSH and LH Ovarian hormones : estrogen and progesterone

13. Menstrual cycle disorders

14. Premenstrual syndrome Premenstrual syndrome (PMS) is the symptoms of stress that appears before the onset of menstruation. It also called premenstrual stress syndrome, premenstrual stress or premenstrual tension. It lasts for about 4 to 5 days prior to menstruation. Symptoms appear due to salt and water retention caused by estrogen.

15. Common fearures Mood swings Anxiety Irritability Emotional instability Headache Depression Constipation Abdominal cramping Bloating

16. Abnormal menstruration Amenorrhoea Hypomenorrhea Menorrhea Oligomenorrhea Polymenorrhea Dysmenorrhea Metrorrhagia

17. Amenorrhoea Amenorrhoea is the absence of menstrual period in a women of reproductive age. Physiological states of amenorrhoea are seen commonly during pregnancy and lactation and later also forming basis of a form of contraception known as lactational amenorrhoea method .

18. Classification of Amenorrhoea Primary amenorrhoea may be caused by developmental problems such as.. The congenital absence of the congenital absence of uterus. Failure of ovary to receive or maintain egg cells.

19. Conti … It is defined as absence of secondary sexual characteristics by age of 14 with no menarche or normal secondary sexual characteristics but no menarche by 16 years of age.

20. Secondary amenorrhoea It is often caused by hormonal disturbances from the hypothalamus and the pituitary gland, from premature menopause or intrauterine scar formation.

21. Conti… It is defined as the absence of menses for 3 months in a women with previously normal menstruation or nine month of women with a history of oligomenorrhoea .

22. Menorrhagia It is the most common type of abnormal uterine bleeding characterized by heavy and prolonged menstrual bleeding. In some cases , bleeding may be so severe and daily activities become interrupted. A normal menstrual cycle 21-35 days in duration, with bleeding lasting an average of 5 days and total blood flow between 25 and blood of greater than 80 ml or lasting longer than 7 days constitutes menorrhagia .

23. Hypomenorrhea It is defined as short or scanty periods, is extremely light menstrual blood flow. It a opposite of heavy periods often called menorrhagia .

24. Oligomenorrhea Menstrual periods that occur more than 35 days. Possible causes are : anovulation which may be from endocrine causes ( pregnancy , menopause )or systemic causes ( excessive wt. loss )

25. Metrorrhagia Bleeding occurring any time between the menstrual periods. Possible causes are – endometrial polyps, CA cervix, CA endometrium , exogenous estrogen administration.

26. Menometrorhagia Bleeding that occurs at irregular intervals and varies in amount and duration of bleeding. Caused by any condition that can lead to intermenstrual bleeding.

27. Dysmenorrhea Also known as painful periods, menstrual cramps or pain during menstruation. It is painful menstruation that typically involves cramps caused by uterine contractions. Divided into 2 types :- primary secondary

28. Primary and secondary dysmenorrhea Primary – painful menstruation with no identifiable pelvic pathology . Causes are – increased prostaglandins production by endometrium in an ovulation cycle which causes contraction of the uterus. Secondary – painful menstruation due to pelvic or uterine pathology. Causes – endometriosis, pelvic infection, congenital uterine , uterine fibroids.

29. Refrence : Essentinal of Medical physiology , (6 th edition, page no: 481 – 500), female reproductive system, menstrual cycle and disorders. Davidson’s principle of medicine (22 th edition, page no; 757-815), endocrine diseases.

30. Thank you