MENSTRUAL CYCLE

• Normal Menstrual Physiology Abbreviations:

  • Estradiol (E)
  • Progesterone (P)
  • Gonadotropin-releasing hormone (GnRH)
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Transvaginal Ultrasound (TVUS)
• Puberty:

  • Transition period from biologic immaturity to biologic maturity
  • Occurs between ages 12 to 16, generally 2 years earlier in girls
• Adolescence:

  • Period from puberty to maturity lasting from 6 to 10 years
  • At puberty, young females develop the adult female form:
  • Thelarche: breast enlargement and round shape
  • Pubarche: hair growth in armpit and genital area
• Menstruation:

  • Periodic, physiologic discharge of blood, mucus, and cellular debris from uterine mucosa
  • Occurs at regular intervals from puberty to menopause
  • Menarche: onset of first menstruation
  • Menopause: cessation of menstrual function, on average at 47 years of age
• Menstrual Cycle Phases:

  • Follicular phase (proliferative phase or preovulatory phase)
  • Ovulation
  • Luteal phase (secretory phase or postovulatory phase)
  • Menstruation
• Ovarian Processes:

  • Follicular phase: high FSH levels stimulate follicles, one egg matures, follicle secretes estrogen
  • Ovulation: follicle ruptures, releases mature egg
  • Luteal phase: corpus luteum produces progesterone
  • Menstruation: shedding of inner lining of uterus
• Hormone Groups:

  • Group 1: Control ovary changes (development of ovum)
  • Gonadotropin-releasing hormone (GnRH)
  • Follicle-stimulating Hormone (FSH)
  • Luteinising Hormone (LH)
  • Group 2: Control uterus changes (thickening of endometrium)
  • Estrogen
  • Progesterone
• Uterine Processes:

  • Follicular phase: endometrium proliferates
  • Luteal phase: corpus luteum secretes progesterone, stimulates endometrial glands
  • Corpus luteum produces estrogen and progesterone for about 10 to 12 days
• Length and Timing of Menstrual Cycle:

  • Normal cycle: 20 to 36 to 40 days, average about 28 days
  • Menstruation starts on day 1, ends around day 4-5
  • Follicular phase: about day 5 to day 13
  • Ovulation: day 14
  • Luteal phase: day 15 to end of cycle, day 28
• Menstrual Problems:

  • Amenorrhea, infrequent or irregular menstruation, prolonged menstruation, dysmenorrhea
  • Menopause: cessation of menstruation, associated with symptoms like flushes and flashes
• Causes of Irregular Menstrual Cycle:

  • Stress, tension, medications, caffeine, smoking, alcohol, weight changes, over-exercise, hormonal imbalance, etc.
• Dysmenorrhea:

  • Menstrual cramps, affecting over 50% of women
  • Two types: primary (no underlying gynecologic problem) and secondary (underlying condition contributing to pain)
• Normal Menstrual Physiology Abbreviations:

  • Estradiol (E)
  • Progesterone (P)
  • Gonadotropin-releasing hormone (GnRH)
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Transvaginal Ultrasound (TVUS)
• Puberty:

  • Transition period from biologic immaturity to biologic maturity
  • Occurs between ages 12 to 16, generally 2 years earlier in girls
• Adolescence:

  • Period from puberty to maturity lasting from 6 to 10 years
  • At puberty, young females develop the adult female form:
  • Thelarche: breast enlargement and round shape
  • Pubarche: hair growth in armpit and genital area
• Menstruation:

  • Periodic, physiologic discharge of blood, mucus, and cellular debris from uterine mucosa
  • Occurs at regular intervals from puberty to menopause
  • Menarche: onset of first menstruation
  • Menopause: cessation of menstrual function, average at 47 years of age
• Menstrual Cycle Phases:

  • Follicular phase (proliferative/preovulatory)
  • Ovulation
  • Luteal phase (secretory/postovulatory)
  • Menstruation
• Ovarian Processes:

  • Follicular phase: high FSH levels stimulate follicles, one egg matures
  • Ovulation: follicle ruptures, releases mature egg
  • Luteal phase: corpus luteum produces progesterone
  • Menstruation: shedding of uterine lining
• Hormone Groups:

  • Group 1 (ovary changes): GnRH, FSH, LH
  • Group 2 (uterus changes): Estrogen, Progesterone
• Uterine Changes:

  • Follicular phase: endometrium proliferates
  • Luteal phase: corpus luteum secretes progesterone for nourishment
  • Hormone output declines if no pregnancy
• Cycle Length and Timing:

  • Normal cycle: 20 to 40 days, average 28 days
  • Menstruation: day 1-4/5
  • Follicular phase: day 5-13
  • Ovulation: day 14
  • Luteal phase: day 15-end of cycle, day 28
• Menstrual Problems:

  • Amenorrhea, infrequent/irregular menstruation, prolonged menstruation, dysmenorrhea
  • Menopause symptoms: flushes, flashes due to estrogen drop
• Types of Menstrual Disorders:

  • Oligoovulation, anovulation, hypomenorrhea, polymenorrhea, menometrorrhagia, menorrhagia, oligomenorrhea, dysmenorrhea
• Causes of Irregular Menstrual Cycle:

  • Stress, medications, caffeine, smoking, alcohol, weight changes, hormonal imbalance, etc.
• Menstrual Cramps:

  • Not the same as PMS
  • Primary dysmenorrhea: no underlying gynecologic problem
  • Secondary dysmenorrhea: underlying abnormal condition contributes to pain