OBSTETRICS & GYNAECOLOGY

NURSING - II

PROJECT
ON

MENSTRUAL CYCLE

Submitted To:
Submitted
By
Mrs. Martha Raut
Mrs. Monika Bagchi
Asst Prof
nd
2 year MSc N

Submitted On: 08/03/2016

MENSTRUAL CYCLE
INTRODUCTION:
The menstrual cycle is the series of changes a woman's body goes
through to prepare for a pregnancy. About once a month, the uterus grows a new
lining (endometrium) to get ready for a fertilized egg . When there is no
fertilized egg to start a pregnancy, the uterus sheds its lining. This is the
monthly menstrual bleeding (also called menstrual period) that women have
from their early teen years until menopause, around age 50. The menstrual cycle
is from Day 1 of bleeding to Day 1 of the next time of bleeding. Although the
average cycle is 28 days, it is normal to have a cycle that is shorter or longer.
Girls usually start having menstrual periods between the ages of 11 and 14.
Women usually start to have fewer periods between ages 39 and 51. Women in
their 40s and teens may have cycles that are longer or change a lot.

WHAT CONTROLS THE MENSTRUAL CYCLE?

Hormones control the menstrual cycle. During each cycle, the hypothalamus of
the brain and pituitary gland send hormone signals back and forth to the ovaries.
These signals get the ovaries and uterus ready for a pregnancy.
The hormones estrogen and progesterone play the biggest roles in how the
uterus changes during each cycle.
Estrogen builds up the lining of the uterus.

 Progesterone increases after an ovary releases an egg (ovulation) at the

middle of the cycle. This helps the estrogen keep the lining thick and
ready for a fertilized egg.
A drop in progesterone (along with estrogen) causes the lining to break
down. This is when the period starts.
A change in hormone levels can affect the cycle or fertility. For
example, teens tend to have low or changing progesterone levels. This is
also true for women close to menopause. That is why teens and women
in their 40s may have heavy menstrual bleeding and cycles that change
in length.
Other things can change the cycle. They include birth control pills, low
body fat, losing a lot of weight, or being overweight. Stress or very hard
exercise also can change the cycle. Pregnancy is the most common cause
of a missed period.
COMMON SYMPTOMS ARE LINKED TO THE MENSTRUAL CYCLE

Some women have no pain or other problems. But other women

have symptoms before and during their periods.

For about a week before a period, many women have some

premenstrual symptoms. Women feel more tense or angry.

Some women may gain water weight and feel bloated.
Breasts may feel tender. Some women may get acne.
Some females may have less energy than usual.

A day or two before the period, females may start having pain
(cramps) in the belly, back, or legs. These symptoms go away

during the first days of a period.

When the ovary releases an egg in the middle of the cycle, there
may be pain in the lower belly. females may also have red spotting
for less than a day. Both are normal.

PHASES OF MENSTRUAL CYCLE

The day count for menstrual cycle begins on the first day of
menstruation when blood starts to come out of the vagina. In this section, the
length of menstrual cycle has been assumed to be 28 days (which is the average
among women). The entire duration of a Menstrual cycle can be divided into
four main phases:
1.

Menstrual phase (From day 1 to 5)

2.

Follicular phase (From day 1 to 13)

3.

Ovulation phase (Day 14)

4.

Luteal phase (From day 15 to 28)

(1) Menstrual phase (day 1-5)

Menstrual phase begins on the first day of menstruation and lasts till the 5th day
of the menstrual cycle. The following events occur during this phase:

The uterus sheds its inner lining of soft tissue and blood vessels which
exits the body from the vagina in the form of menstrual fluid.

Blood loss of 10 ml to 80 ml is considered normal.

Women may experience abdominal cramps. These cramps are caused by

the contraction of the uterine and the abdominal muscles to expel the
menstrual fluid.

(2) Follicular phase (day 1-13)

This phase also begins on the first day of menstruation, but it lasts till the 13th
day of the menstrual cycle. The following events occur during this phase:

The pituitary gland secretes a hormone that stimulates the egg cells in
the ovaries to grow.

One of these egg cells begins to mature in a sac-like-structure called

follicle. It takes 13 days for the egg cell to reach maturity.

While the egg cell matures, its follicle secretes a hormone that stimulates
the uterus to develop a lining of blood vessels and soft tissue called
endometrium.

(3) Ovulation phase (day 14)

On the 14th day of the cycle, the pituitary gland secretes a hormone that causes
the ovary to release the matured egg cell. The released egg cell is swept into the
fallopian tube by the cilia of the fimbriae. Fimbriae are finger like projections
located at the end of the fallopian tube close to the ovaries and cilia are slender
hair like projections on each Fimbria.

(4) Luteal phase (day 15-28)

This phase begins on the 15th day and lasts till the end of the cycle. The
following events occur during this phase:

The egg cell released during the ovulation phase stays in the fallopian
tube for 24 hours.

If a sperm cell does not impregnate the egg cell within that time, the egg
cell disintegrates.

The hormone that causes the uterus to retain its endometrium gets used
up by the end of the menstrual cycle. This causes the menstrual phase of the
next cycle to begin.

PROBLEMS FACED BY WOMEN DURING THE

MENSTRUAL CYCLE
Women can have a range of problems with their periods, including pain, heavy
bleeding, and skipped periods.
(1)Amenorrhea:

The lack of a menstrual period. This term is used to describe the

absence of a period in:
Young women who haven't started menstruating by
age 15
Women and girls who haven't had a period for 90
days, even if they haven't been menstruating for long
Causes can include:
Pregnancy
Breastfeeding
Extreme weight loss
Eating disorders
Excessive exercising
Stress
Serious medical conditions in need of treatment

(2) Dysmenorrhoea:
Painful periods, including severe cramps. Menstrual cramps in
teens are caused by too much of a chemical called prostaglandin.
Most teens with dysmenorrhea do not have a serious disease, even
though the cramps can be severe. In older women, the pain is
sometimes caused by a disease or condition such as uterine fibroids
or endometriosis.
For some women, using a heating pad or taking a warm bath helps
ease their cramps. Some over-the-counter pain medicines can also
help with these symptoms. They include:

Ibuprofen

Ketoprofen

Naproxen

(3)Abnormal uterine bleeding:

Vaginal bleeding that's different from normal menstrual periods.
It includes:
Bleeding between periods
Bleeding after sex
Spotting anytime in the menstrual cycle
Bleeding heavier or for more days than normal
Bleeding after menopause

Abnormal bleeding can have many causes. Hormonal Changes can be the cause
which can occur with serious health problems such as uterine fibroids, polyps,
or even cancer.

CARE DURING MENSTRUATION

Females can use pads, tampons, or menstrual cups to manage bleeding.

Whatever is used, be sure to change it at least every 4 to 8 hours.
Pads may be best at night.
Many women can improve their symptoms by getting regular exercise

and eating a healthy diet.

It also may help to limit alcohol and caffeine.
Try to reduce stress.
A heating pad, hot water bottle, or warm bath also can help with cramps.
Can take an over-the-counter medicine such as ibuprofen or naproxen
before and during the period to reduce pain and bleeding.

FREQUENCY TO CHANGE PAD AND/OR TAMPON

Change a pad before it becomes soaked with blood.

Each woman decides for herself what works best.
Change a tampon at least every 4 to 8 hours.
Make sure to use the lowest absorbency tampon needed for the

flow.
For example, use junior or regular tampons on the lightest day of
period.
Using a super absorbency tampon on the lightest days increases the
risk for toxic shock syndrome (TSS).

(TSS is a rare but sometimes deadly disease. TSS is caused by bacteria

that can produce toxins. If the body can't fight the toxins, the immune
(body defense) system reacts and causes the symptoms of TSS)
The Food and Drug Administration (FDA) recommends the following tips
to help avoid tampon problems:
Follow package directions for insertion.

Choose the lowest absorbency for your flow.

Change tampon at least every 4 to 8 hours.

Consider switching between pads and tampons.

Know the warning signs of TSS.

Don't use tampons between periods.

CAUSES OF MENSTRUAL CYCLE IRREGULARITIES

Menstrual cycle irregularities can have many different causes, including:
(1)Pregnancy or breast-feeding:A delayed or missed period can be an early sign of pregnancy. Breastfeeding typically delays the return of menstruation after pregnancy.
(2)Eating disorders, extreme weight loss or excessive exercising:

Eating disorders such as anorexia nervosa extreme weight loss

and increased physical activity can disrupt menstruation.
(3)Polycystic ovary syndrome (PCOS):
This common hormonal disorder can cause small cysts to develop on
the ovaries and irregular periods.
(4)Premature ovarian failure:
Premature ovarian failure refers to the loss of normal ovarian function
before age 40. Women who have premature ovarian failure also known
as primary ovarian insufficiency might have irregular or infrequent
periods for years.
(5)Pelvic inflammatory disease (PID):This infection of the reproductive organs can cause irregular menstrual
bleeding.

(6)Uterine fibroids:Uterine fibroids are noncancerous growths of the uterus. They can cause
heavy menstrual periods and bleeding between periods.

A FEW ADDITIONAL FACTS

The female sex hormones that control menstrual cycle naturally rise and fall
throughout the month, as shown in the chart below. It's a dynamic process that
repeats itself every 28 days, on average.

 The hormones estrogen and progesterone control the whole process

The term progestogen describes the synthetic forms of progesterone

used in birth control pills
Menstrual cycles vary in length: some last longer than 28 days, while

others are shorter

The menstrual cycle can be thought of as having 4 different phases:

Menstruation, the stage during which a woman gets her period

The preovulatory (follicular) phase, when her body is preparing for

ovulation

Ovulation, a woman's most fertile period, when her body releases an egg

The postovulatory (luteal) phase, essentially the lead-up to menstruation,

when the whole cycle begins again

The average woman will have approximately 500 periods in her lifetime

Some women bleed for only 3 or 4 days4; others bleed for a week

The average amount of blood lost in a single period is usually in

the range of 30-40 ml with an upper limit of 80 milliliters.

If there is excessive blood loss that interferes with the physical,

emotional, social or material quality of life, consult a doctor regarding heavy

periods.

SEX HORMONE LEVELS VARY DURING THE

MENSTRUAL CYCLE

Although the duration of each phase of the menstrual cycle can vary, the basic
sequence of events does not.

Day 1: Period
The first day of period is considered Day 1 of cycle. At this time, estrogen and
progesterone, the 2 main types of reproductive hormones, are at low levels.
Day 5: One egg is selected
Inside the ovary, each egg is present within a blister called a follicle. As an
individual egg develops, the follicle releases increasing amounts of estrogen.
Days 6-14: Preparing for ovulation
Toward the end of this stage, estrogen levels rise slowly, then more rapidly.
Around Day 14: Ovulation
The follicle surrounding the egg breaks open and the ovary releases the egg into
the fallopian tube so it can be fertilized by sperm. The follicle remains in the
ovary.
Days 15-28: After ovulation
After ovulation has occurred, levels of progesterone start to increase. If the egg
that was released is not fertilized, estrogen and progesterone levels drop after
approximately 2 weeks and the lining of the uterus gets ready to be shed. The
next period begins and the cycle starts again.

CONCLUSION:
The menstrual cycle is the regular natural change that occurs in the
uterus and ovaries that make pregnancy possible. The cycle is required for the
production of oocytes, and for the preparation of the uterus for pregnancy. Up to
80% of women report having some symptoms during the one to two weeks prior
to menstruation. Common symptoms include acne, tender breasts, bloating,
feeling tired, irritability, and mood changes. These symptoms interfere with
normal life and therefore qualify as premenstrual syndrome in 20 to 30% of
women. In 3 to 8%, they are severe. The first period usually begins between
twelve and fifteen years of age, a point in time known as menarche. They may
occasionally start as early as eight, and this onset may still be normal. The
average age of the first period is generally later in the developing world and
earlier in developed world. The typical length of time between the first day of
one period and the first day of the next is 21 to 45 days in young women and 21
to 31 days in adults (an average of 28 days). Menstruation stops occurring after
menopause which usually occurs between 45 and 55 years of age. Bleeding

usually lasts around 2 to 7 days. The menstrual cycle is governed by hormonal

changes

RESEARCH ARTICLES
Indian Journal of Community Medicine. 2016 Jan-Mar;41(1):39-44.
(1)Menstrual Hygiene Practices in Context of Schooling: A Community
Study Among Rural Adolescent Girls in Varanasi, Uttar Pradesh, India.
INTRODUCTION:
Up until now, poor menstrual hygiene in developing countries has been an
insufficiently acknowledged problem. The lack of attention to this issue is
striking as we cannot achieve several Millennium Development Goals (MDGs),
that is, 2, 3 4,5, and 5B. This study aimed to assess the level of awareness about
menarche and hygienic practices during menstruation in context of schooling.

MATERIALS AND METHODS:

Community-based cross-sectional study using a mix method approach
(qualitative and quantitative). It was conducted among 650 adolescent girls in
the field practice area of Rural Health and Training Centre, Chiraigaon block of
district Varanasi between January and June2011. Pretested, semistructured
interview schedule was used. Data were analyzed statistically by using
Statistical Package for Social Sciences (SPSS) software.
RESULTS:
Out of the total 650 respondents, 590 (90.78%) had attained menarche at the
time of interview and only one-third of the respondents (29.4%) were aware of
menstruation before menarche and sisters (55%) played the key role in
providing information to them. Only 31% respondents were using sanitary pads
during menstruation. Self-reported reproductive tract infection (RTI) was
observed more in respondents not maintaining hygienic practices (6.6%) as
compared to those maintaining hygiene (2.6%).
CONCLUSION AND RECOMMENDATIONS:
From the Focus Group Discussions (FGDs) as well as quantitative survey it was
observed that the awareness about menarche before its onset was still poor in
rural areas. Significant association (P < 0.05) was observed between respondent
education and their awareness about menarche before its onset. Therefore, it is
recommended that teachers can play an influential role in informing them about
changes during adolescence, especially about menarche and other issues related

to menstruation. As per the present study, sisters and mothers were the major
source of information. Therefore, there is a need for the provision of
comprehensive family life education for the parents also.
By Kansal S & Singh S

(2) The effect of hypnosis on dysmenorrhoea at Sir Sayaji General

Hospital , Gujarat, India.
The International Journal of Clinical & Experimental Hypnosis.
2014;62(2):164-78.
Abstract:
This randomized control trial studied the effect of hypnosis on
dysmenorrhea. Fifty eligible nursing students were randomly divided into 2
groups according to baseline pain scores. One group was given hypnosis and the
other given medications for pain relief for 3 menstrual cycles, followed by 3
cycles without any treatment. They were evaluated for functional restriction of
activity on a 3-point scale. There was significant improvement in quality of life
after the third cycle in both groups compared to baseline. The effect of hypnosis
and medications on quality of life was similar in both groups at the third and
sixth cycles.
By Patel S & Bakshi H.

REFERENCES

1. Hallberg L, Hogdahl AM, Nilsson L, Rybo G. Menstrual blood lossa

population study. Variation at different ages and attempts to define
normality. Acta Obstet Gynecol Scand. 1966;45:320-351.
2. Fraser IS, Weisberg E, Minehan E, Johansson ED. A detailed analysis of
menstrual blood loss in women using Norplant and Nestorone
progesterone-only contraceptive implants or vaginal rings. Contraception.
2000;61:241-251.
3. Hale GE, Manconi F, Luscombe G, Fraser IS. Quantitative measurements
of menstrual blood loss in ovulatory and anovulatory cycles in middle- and
late-reproductive age and the menopausal transition. Obstet Gynecol.
2010;115(2 pt 1):249-256.
4. National Institute for Health and Clinical Excellence. 2007. Heavy
Menstrual Bleeding. Clinical Guideline. London, UK: National Institute for
Health and Clinical Excellence
5. D C Dutta Text Book Of Obstetrics 8th Edition 2015 India: New
Central Book Agency Page No: 717
6. Annamma Jacob A Comprehensive Text Book Of Midwifery and
Gynaecological Nursing Third Edition 2012 Jaypee Brothers Medical
Publications, Page Number-188
7. Myles (2003) Text Book For Midwives (14th Edition), Philadelphia
;Churchill Livingstone Publishers, Page No:-342

WEBSITE:
1.

Menstrual cycle, http://en.wikipedia.org

2.

Menstruation and the menstrual cycle fact sheet,

http://womenshealth.gov

3.

What is a menstrual cycle?, https://myhealth.alberta.ca