MCN SAS 3

• Average age at onset: 12.4 years Average range: 9 – 17 years
• Average: 28 days Cycles of 23 – 35 days not unusual
• Average flow: 4 – 6 days Ranges of 2 – 9 days not abnormal
• Difficult to estimate; average: 30-80 mL per menstrual period; saturating a pad or tampon in less than 1 hour is heavy bleeding
• Dark red; a combination of blood mucus, and endometrial cells
• Similar to marigolds
• Beginning (menarche) Average age at onset: 12.4 years Average range: 9 – 17 years
• Interval between cycles: Average: 28 days Cycles of 23 – 35 days not unusual
• Duration of menstrual flow: Average flow: 4 – 6 days Ranges of 2 – 9 days not abnormal
• Amount of menstrual flow: Difficult to estimate; average: 30-80 mL per menstrual period; saturating a pad or tampon in less than 1 hour is heavy bleeding
• Color of menstrual flow: Dark red; a combination of blood mucus, and endometrial cells
• Odor: Similar to marigolds
• Menstrual cycle or female reproductive cycle is defined as episodic uterine bleeding in response to cyclic hormonal changes
• HYPOTHALAMUS ❖ The release of GnRH (also called luteinizing hormone-releasing hormone [LHRH]) from the hypothalamus initiates the menstrual cycle.
• PITUITARY GLAND ❖ It is under the influence of GnRH, the anterior lobe of pituitary gland (adenohypophysis) produces two hormones:
• Menstrual cycle


  Episodic uterine bleeding in response to hormonal changes
• Hypothalamus


  • Releases GnRH to initiate the menstrual cycle
  • GnRH stimulates the pituitary gland to send gonadotropic hormone to the ovaries to produce estrogen
  • When estrogen rises, release of GnRH is repressed and no further menstrual cycles will occur
• Pituitary gland


  • Produces FSH and LH, which are gonadotropic hormones that cause growth in the ovaries
  • FSH is responsible for maturation of the ovum
  • LH is responsible for ovulation and stimulates growth of the uterine lining during the second half of the menstrual cycle
• Ovarian cycle


  1. Proliferative phase (Day 1 to 14)

  2. Luteal phase (Day 15 to 28)
• Proliferative phase


  • One oocyte is activated by FSH to begin to grow and mature
  • Graafian follicle develops and ruptures (ovulation) on day 14
• Luteal phase


  • Corpus luteum forms and produces progesterone
  • If no conception, corpus luteum regresses and is replaced by corpus albicans
  • Basal body temperature rises after ovulation due to progesterone
• Uterine cycle


  1. Proliferative phase (Day 4/5 to 14)

  2. Secretory phase (Day 14 to 24)

  3. Ischemic phase (Day 24 to 28)

  4. Menstrual phase (Day 1 to 5)
• Proliferative phase


  • Endometrium proliferates and thickens due to estrogen
• Secretory phase


  • Endometrium becomes spongy and glandular due to progesterone
• Ischemic phase


  • Endometrium degenerates as progesterone and estrogen decrease
• Menstrual phase


  • Endometrium sloughs off, resulting in menstrual flow composed of blood, mucin, endometrial tissue, and unfertilized ovum
• Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) are the 2 hormones produced by the pituitary gland
• Fern test


  Microscopic pattern formed by cervical mucus when estrogen levels are high, indicating impending ovulation
• Spinnbarkeit test


  Stretching test of cervical mucus to assess fertility
• This document and the information thereon is the property of PHINMA Education (Department of Nursing)
• Reference: Pilliteri, Adele and Silbert-Flagg, JoAnne (2018) Maternal and Child Health Nursing, 8th Edition. USA: Lippincott Williams and Wilkins
• Menstrual cycle - Fourth Phase (Menses or Menstrual Phase)

  1. Endometrium of the uterus begins to degenerate

  2. Capillaries rupture, with minute hemorrhages, and the endometrium sloughs off

  3. Happens approximately on day 24 or 25 of the cycle
• Menstrual flow


  Blood from the ruptured capillaries<|>Mucin from the glands – protein<|>Fragments of endometrial tissue<|>Microscopic, atrophied, and unfertilized ovum
• The Fern Test


  • Just before ovulation when estrogen levels are high, the cervical mucus has the ability to form fernlike patterns on a microscope slide when allowed to dry
  • When progesterone is the dormant hormone, as it is just after ovulation, this fern pattern is no longer discernible
• Signs and Symptoms of Menopause:
• Osteoporosis (lack of bone mineral density)


  Aid: practice Kegel exercise to help strengthen
• Women who smoke tend to have earlier menopause
• First Aid: sip a cold drink or use a hand fan
• Aid: use a lubricating jelly such as KY jelly prior to
• Education for Menstruation