Kindly Refer To Chapter 5

Kindly refer to Chapter 5: The Nursing Role in Reproductive and Sexual Health-The Menstrual Cycle p.92.
I. Characteristics of A Normal Menstrual Cycles:
Characteristic Description
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

II.Physiology of Menstruation:
DEFINITION: Menstrual cycle or female PURPOSE: To bring an ovum to maturity & renew
reproductive cycle is defined as episodic uterine uterine tissue bed that is responsible for the
bleeding in response to the cyclic hormonal growth of the fertilized ovum Release is triggered
changes by FSH, ovaries in females excrete a high level of
estrogen.
A. 4 STRUCTURES INVOLVED IN MENSTRUAL CYCLE
1. HYPOTHALAMUS
 The release of GnRH (also called luteinizing hormone-releasing hormone
[LHRH]) from the hypothalamus initiates the menstrual cycle.
 GnRH then stimulates the pituitary gland to send gonadotropic hormone to the ovaries to
produce estrogen
 When the level of estrogen rises, release of GnRH is repressed and no further
menstrual cycles will occur (the principle that birth control pills use to eliminate
menstrual flows). Excessive levels of pituitary hormones can also inhibit release.
2. PITUITARY GLAND
 It is under the influence of GnRH, the anterior lobe of pituitary gland (adenohypophysis)
produces two hormones:
 Follicle-stimulating hormone (FSH) = is a hormone active early in the cycle that is
responsible for maturation of the ovum.
 Luteinizing hormone (LH) = is a hormone that becomes most active at the midpoint of the
cycle and
is responsible for ovulation, or release of mature egg cell from the ovary. It also
stimulates growth of the uterine lining during the second half of the menstrual cycle.
 FSH and LH are called gonadotropic hormones because they cause growth (trophy) in
the gonads (ovaries).
3. OVARIES (OVARIAN CYCLE) B. LUTEAL PHASE – from Day 15

A. PROLIFERATIVE PHASE –from Day 1 to Day 14 of to Day 28 of a 28- day
a 28-day menstrual cycle
menstrual cycle
 Every month, one of the ovary’s oocytes is
activated by FSH to begin to grow and  After the ovum and the follicular fluid
mature have been discharged from the ovary,
 As the oocyte grows, its cell produce a clear the cells of the follicle remain in the
fluid (follicular fluid) that contains a high form of a hollow, empty pit. The FSH
degree of estrogen and progesterone. As the has done its work at this point and
follicle surrounding the oocyte grows, it is now decrease in amount
propelled toward the surface of the ovary as
a clear blister (Graafian follicle).  The second pituitary hormone, LH,
 After an upsurge of LH, prostaglandins are continues to rise in amount and directs
released and the graafian follicle ruptures the follicle cells left behind in the ovary
(ovulation) to produce lutein, a bright-yellow fluid
 This happens on the 14th day before the onset high in progesterone. With lutein
of the next cycle (not the midpoint). production, the follicle is renamed a
corpus luteum (yellow body).
 If conception (fertilization by a
spermatozoon) occurs as the ovum
proceeds down a fallopian tube and the
fertilized ovum implants on the
endometrium of the uterus, the corpus
luteum remains throughout the major
portion of the pregnancy (to about 16
to 20 weeks).
 If conception does not occur, the

unfertilized ovum atrophies after 4 to 5
days, and the corpus luteum remains for
only 8 to 10 days. As the corpus luteum
regresses, it is gradually replaced by
white fibrous tissue called corpus
albicans (white body).
 The basal body temperature of a woman
drops slightly (by 0.5O to 1OF) just before
the day of ovulation because of the
extremely low level of progesterone that
is present at that time. It rises by 1OF on
the day after ovulation
because of the concentration of progesterone,
which is thermogenic.
 The woman’s temperature remains at

this level until approximately day 24 of
the menstrual cycle, when the
progesterone level again decreases.
4. UTERUS (UTERINE CYCLE) = the uterus also changes monthly as a result of stimulation from the
estrogen and
progesterone produced by the ovaries
A. First Phase of the Menstrual Cycle (PROLIFERATIVE B. Second Phase of the Menstrual Cycle (Secretory
PHASE) = from day 4 or 5 to day 14 Phase) = Day 14 to 24 of menstrual cycle
 Immediately after menstrual flow  After ovulation, the formation of

(MENSTRUAL PHASE from Days 1-4), the progesterone in the corpus luteum
endometrium, or the lining of the uterus, is causes the glands of the uterine
very thin, approximately one cell layer in endometrium to become corkscrew or
depth. twisted in appearance.
 As the ovary begins to produce estrogen (in  The capillaries of the endometrium
the follicular fluid), the endometrium begins increase in amount until the lining takes
to proliferate. on the appearance of rich, spongy
 This growth is very rapid and increases the velvet.
thickness of the endometrium approximately  Also known as pregestational,
eightfold. luteal, premenstrual, or secretory
 This happens from day 5 – 14 phase
 Also known as estrogenic, follicular,
or postmenstrual phase
C. Third Phase of Menstrual Cycle (Ischemic Phase) D. Fourth Phase of Menstrual Cycle (Menses or
= Day 24 to 28 of menstrual cycle Menstrual Phase) = first day of the menstrual
flow to 5 days
 If fertilization does not occur, the corpus
luteum in the ovary begins to regress after Menstrual flow is composed of:
8 – 10 days.
 Blood from the ruptured capillaries
 Production of progesterone and estrogen
decreases.  Mucin from the glands – protein
 The endometrium of the uterus begins to  Fragments of endometrial tissue
degenerate.  Microscopic, atrophied, and unfertilized
 Capillaries rupture, with minute ovum
hemorrhages, and the endometrium
sloughs off.
5 of 9
 Happens approximately on day 24 or 25 of the
cycle.
B. The Fern Test
6 of 9
 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. This
pattern is known as arborization or ferning.
 When progesterone is the dormant hormone, as it is just after ovulation, this fern
pattern is no longer discernible.
C. Spinnbarkeit Test
 At the height of estrogen secretion, the cervical mucus has the ability to stretch into long
strands.
 Stretching the mucus at the midpoint of a menstrual cycle is another way to
demonstrate that high levels of estrogen are being produced, and that ovulation is
D. Education for Menstruation Signs and Symptoms of Menopause:
Myths during menses: Periods of amenorrhea
 Should not plant vegetables or the “hot flashes”

vegetables will die..
Vaginal dryness leading to dyspareunia
 Should not eat sour foods because this will
cause cramping Aid: use a lubricating jelly such as KY jelly prior to
sexual intercourse.
Menstrual disorders:
Osteoporosis (lack of bone mineral density)
 Dysmenorrhea = painful menstruation
 Menorrhagia = abnormally heavy menstrual Urinary incontinence
flows
 Metrorrhagia = bleeding between Aid: practice Kegel exercise to help strengthen
menstrual periods bladder supports
 Amenorrhea = absence of menstrual flow
Hot flashes can be accompanied by heart
 Menopause = is the cessation of menstrual palpitations and
7 of 9
cycles can occur up to 20 – 30 episodes a day
Perimenopausal = is a term used to denote the First Aid: sip a cold drink or use a hand fan
period during which menopausal changes occur.
Postmenopausal = describes the time of life

following the final menses
Age range: 40 – 55
Mean average: 51.3
Women who smoke tend to have earlier menopause
8 of 9

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Kindly refer to Chapter 5: The Nursing Role in Reproductive and Sexual Health-The Menstrual Cycle p.92.

I. Characteristics of A Normal Menstrual Cycles:

Beginning (menarche) Average age at onset: 12.4

Duration of menstrual flow Average flow: 4 – 6 days

Amount of menstrual flow Difficult to estimate; average: 30-80 mL per menstrual

Odor Similar to marigolds

3. OVARIES (OVARIAN CYCLE) B. LUTEAL PHASE – from Day 15

 If conception does not occur, the

 The woman’s temperature remains at

 Immediately after menstrual flow  After ovulation, the formation of

B. The Fern Test

D. Education for Menstruation Signs and Symptoms of Menopause:

Myths during menses: Periods of amenorrhea

 Should not plant vegetables or the “hot flashes”

Postmenopausal = describes the time of life

Mean average: 51.3

Women who smoke tend to have earlier menopause

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