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Menstruation and Menstrual cycle


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Menstruation WHPL Dr. Angelo Smith m.d


Overview What is menstruation? Significance Which hormones play a role in menstruation? Significance of each hormone What medical conditions will arise due to problems in hormones associated?

What is Menstruation?:

What is Menstruation? The process in a woman of discharging blood and other material from the lining of the uterus at intervals of about one lunar month (28 days) from puberty until the menopause, except during pregnancy.

Menstrual Cycle:

Menstrual Cycle Menstruation is not the same as the menstrual cycle. The Menstrual cycle describes the cyclic changes in a woman’s body going through menstruation , the follicular phase , ovulation , the luteal phase and back to menstruation again to begin the cycle. Menstruation is therefore one of the 4 phases of the menstrual cycle.


Significance Cycle of natural changes that occurs in the uterus and ovary as an essential part of making sexual reproduction possible. Essential for the production of eggs. Preparation of the uterus for pregnancy. Fertile period of a woman’s life between menarche and menopause.

Key terms and definitions:

Key terms and definitions Menarche: Age at onset of menstruation Primary amenorrhea: Absence of menstruation despite signs of puberty Secondary amenorrhea: Absence of menstruation for 3-6 months in a woman who previously menstruated Dysfunctional uterine bleeding: Irregular bleeding due to anovulation or anovulatory cycle Menarche age 12 9 years 16 years

Key terms and definitions:

Key terms and definitions Menorrhagia: Regular menstrual intervals, excessive flow and duration Metrorrhagia: Irregular menstrual intervals, excessive flow and duration Oligomenorrhea: Menstrual interval greater than 35 days Anovulation / anovulatory: Menstrual cycle without ovulation Dysmenorrhea: Menstrual cramping/pain

Normal Features of Menstruation:

Normal Features of Menstruation Duration of menstrual flow Quality of the menstruum, Amount of blood loss, The flow pattern and Associated symptoms.

Duration :

Duration Last from 3 to 7 days. The exact duration varies from woman to woman. It however shows little or no variation for the same woman from cycle to cycle. Most women do not experience cycle to cycle changes more than 1 or 2 days. It is unusual for the same woman to have wide swings such as 3 days duration in one cycle and 7 days in another.

Quality of the menstruum:

Quality of the menstruum Menstrual blood is normally bright or light red in color like the bleeding that occurs after a knife cut or similar injury. It could look brown in some few women and still be normal menstruation. It must not have a foul odor . Small clots may be a normal part of menstrual blood.

Amount of blood loss:

Amount of blood loss The average blood loss during normal menstruation is about 35 ml , with a range of 10 to 80 ml .  Usually understood from the number of pads soaked.

The flow pattern:

The flow pattern Normally, as menses begin to flow, the amount of blood loss seems to increase gradually until it attains a maximum and then starts diminishing as the end of the flow draws near. This pattern is described as crescendo-decrescendo pattern.

Associated symptoms:

Associated symptoms Normal menstruation may be accompanied by other symptoms such as Breasts fullness, Mild lower abdominal pain or Irritability. Fluid retention Cramping Mood swings Weight gain Breast tenderness Diarrhea Constipation These symptoms are never debilitating.

Phases in Menstrual cycle:

Phases in Menstrual cycle


Follicular Begins when estrogen levels are low Anterior pituitary secretes FSH and LH, stimulation follicle to develop Cells around egg enlarge, releasing estrogen This causes this uterine lining to thicken


Ovulation LH and FSH still being released, for another 3-4 days Follicle ruptures, releasing ova into the Fallopian tubes


Luteal Now empty follicle changes to a yellow colour, becomes corpus luteum Continues to secrete estrogen, but now beings to release progesterone Progesterone further develops uterine lining If pregnant, embryo will release hormones to preserve corpus luteum


Menstruation If no embryo, the corpus luteum begins to disintegrate Progesterone levels drop, uterine lining detaches, menstruation can begin Tissue, blood, unfertilized egg all discharged Can take from 3-7 days

Hormones involved in Menstrual Cycle:

Hormones involved in Menstrual Cycle

Days 1-14:

Days 1-14

Days 14 - 28:

Days 14 - 28



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