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
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