MENSTRUATIONDr. L V USHA RANI

MENSTRUATIONDr. L V USHA RANI

• What is Menstruation?

• Why do females undergo Menstruation?

• Puberty changes• Puberty changes

• Menarche and Menopause

• Normal and Abnormal menstruation

• Premenstrual Syndromes• Premenstrual Syndromes

Why do females undergo Menstruation?

Normal and Abnormal menstruation

MENSTRUAL CYCLE

• The reproductive system of women unlike that of men, shows regular • The reproductive system of women unlike that of men, shows regular

cyclic changes that teleologically may be regarded as periodic

preparations for fertilization and pregnancy.

• In humans and other primates, the cycle is a menstrual cycle, and its

most conspicuous feature is the periodic vaginal bleeding that occurs

with the shedding of the uterine mucosa (menstruation).

The reproductive system of women unlike that of men, shows regular The reproductive system of women unlike that of men, shows regular

cyclic changes that teleologically may be regarded as periodic

preparations for fertilization and pregnancy.

In humans and other primates, the cycle is a menstrual cycle, and its

most conspicuous feature is the periodic vaginal bleeding that occurs

with the shedding of the uterine mucosa (menstruation).

ESTROUS CYCLE

• Mammals other than primates do not menstruate, and their sexual • Mammals other than primates do not menstruate, and their sexual

cycle estrous cycle conspicuous period of “heat” (estrus) at the

time of ovulation.

• In spontaneously ovulating species with estrous cycles, such as the

rat, no episodic vaginal bleeding occurs but the underlying endocrine

events are essentially the same as those in the menstrual cycle.

Mammals other than primates do not menstruate, and their sexual Mammals other than primates do not menstruate, and their sexual

conspicuous period of “heat” (estrus) at the

In spontaneously ovulating species with estrous cycles, such as the

rat, no episodic vaginal bleeding occurs but the underlying endocrine

events are essentially the same as those in the menstrual cycle.

• PUBERTY CHANGES

Get taller and heavier

Face changes shape

Oily skin and hair, pimples

Voices get a little deeper

Hair grows under the armpits and around the genitals

Hair on arms and legs grows darker

Breasts and nipples get larger

Body sweats more

Internal and external sex organs grow

Hair grows under the armpits and around the genitals

PUBERTY CHANGES

Key terms and definitions

• Menarche: Age at onset of menstruation• Menarche: Age at onset of menstruation

• Primary amenorrhea: Absence of menstruation despite signs of puberty

• Secondary amenorrhea: Absence of menstruation for 3

woman who previously menstruated

• Dysfunctional uterine bleeding: Irregular bleeding due to anovulation or • Dysfunctional uterine bleeding: Irregular bleeding due to anovulation or

anovulatory cycle

• Oligomenorrhea: Menstrual interval greater than 35 days

Key terms and definitions

Age at onset of menstruationAge at onset of menstruation

: Absence of menstruation despite signs of puberty

: Absence of menstruation for 3-6 months in a

: Irregular bleeding due to anovulation or : Irregular bleeding due to anovulation or

: Menstrual interval greater than 35 days

Key terms and definitions

• Menorrhagia: Regular menstrual intervals, excessive flow and duration• Menorrhagia: Regular menstrual intervals, excessive flow and duration

• Metrorrhagia: Irregular menstrual intervals, excessive flow and duration

• Anovulation/anovulatory: Menstrual cycle without ovulation

• Mittleschmertz: Pain with ovulation

• Molimina: Symptoms preceding menses

• Dysmenorrhea: Menstrual cramping/pain

Key terms and definitions

: Regular menstrual intervals, excessive flow and duration: Regular menstrual intervals, excessive flow and duration

: Irregular menstrual intervals, excessive flow and duration

: Menstrual cycle without ovulation

: Symptoms preceding menses

: Menstrual cramping/pain

MENSTRUAL CYCLE

• This is a series of events, occurring regularly in females every • This is a series of events, occurring regularly in females every

days throughout the childbearing period between menarche and

menopause

• The cycle consists of a series of changes taking place concurrently in

the ovaries and uterine lining, stimulated by changes in blood

concentrations of hormones .

This is a series of events, occurring regularly in females every 26 to 30 This is a series of events, occurring regularly in females every 26 to 30

throughout the childbearing period between menarche and

The cycle consists of a series of changes taking place concurrently in

the ovaries and uterine lining, stimulated by changes in blood

• The average length of the cycle is about

days of the cycle are numbered from the beginning of the menstrual

phase, which usually lasts about 4 days

• This is followed by the proliferative phase (approximately 10 days),

then by the secretory phase (about 14 days).

The average length of the cycle is about 28 days. By convention the

days of the cycle are numbered from the beginning of the menstrual

4 days.

proliferative phase (approximately 10 days),

secretory phase (about 14 days).

Menstrual Cycle Characteristics

Cycle day 1–5

Ovarian phase

Early follicular

Endometrial phase

Menstrualphase

Estrogen/progesterone

Low levels

Menstrual Cycle Characteristics

6–14 15–28

Follicular Luteal

Proliferative Secretory

Estrogen Progesterone

• Duration of the menstrual flow 3–5 days.

• But flows as short as 1 day and as long as

• The amount of blood lost may range normally from slight spotting to • The amount of blood lost may range normally from slight spotting to

average amount lost is 30 mL. Loss > 80 mL

• Obviously, the amount of flow can be affected by various factors, including the

thickness of the endometrium, medication, and diseases that affect the clotting thickness of the endometrium, medication, and diseases that affect the clotting

mechanism

5 days.

and as long as 8 days can occur in normal women.

The amount of blood lost may range normally from slight spotting to 80 mL; the The amount of blood lost may range normally from slight spotting to 80 mL; the

Loss > 80 mL is abnormal.

Obviously, the amount of flow can be affected by various factors, including the

thickness of the endometrium, medication, and diseases that affect the clotting thickness of the endometrium, medication, and diseases that affect the clotting

Anovulatory Cycles

• In some instances, ovulation fails to occur during the menstrual cycle.• In some instances, ovulation fails to occur during the menstrual cycle.

• Such anovulatory cycles are common for the first 12

menarche and again before the onset of the menopause.

• The time it takes for bleeding to occur is variable, but it usually occurs • The time it takes for bleeding to occur is variable, but it usually occurs

in less than 28 days from the last menstrual period.

• The flow is also variable and ranges from scanty to relatively profuse.

In some instances, ovulation fails to occur during the menstrual cycle.In some instances, ovulation fails to occur during the menstrual cycle.

Such anovulatory cycles are common for the first 12–18 months after

menarche and again before the onset of the menopause.

The time it takes for bleeding to occur is variable, but it usually occurs The time it takes for bleeding to occur is variable, but it usually occurs

in less than 28 days from the last menstrual period.

The flow is also variable and ranges from scanty to relatively profuse.

Premenstrual Syndrome

• Some women develop symptoms such as • Some women develop symptoms such as bloating, edema, decreased ability to concentrate, depression, headache, and constipation days of their menstrual cycles.

• Symptoms premenstrual syndrome (PMS) water retentionwater retention

• Treatment options: SSRI – Fluoxetine; benzodiazepine alprazolam; GnRH-releasing agonists.

Premenstrual Syndrome

Some women develop symptoms such as irritability, Some women develop symptoms such as irritability, bloating, edema, decreased ability to concentrate, depression, headache, and constipation during the last 7–10 days of their menstrual cycles.

premenstrual syndrome (PMS) salt and

Fluoxetine; benzodiazepine –releasing agonists.

MENSTRUAL HYGIENEMENSTRUAL HYGIENE

Bacterial Vaginosis

CANDIDIASIS

Trichomoniasis

HPV

Metronidazole (Flagyl)Metronidazole gel 0.75% (Metrogel vaginal)(Metrogel vaginal)Clindamycin cream 2% (Cleocin, Clindesse)

Butoconazole, Clotrimazole (2% vaginal cream)

Metronidazole 2 g once or tinidazole ( indamax) 2 g once

Vaccination as prevention

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Take home Message

•Menstruation is isn’t a disease

• .

•Menstruation is isn’t a disease

• No restrictions nor isolation needed

Take home Message

Menstruation is isn’t a disease – natural biological processMenstruation is isn’t a disease – natural biological process

No restrictions nor isolation needed

Thank You for your AttentionThank You for your Attention