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  Menstrual cycle

The menstrual cycle is the monthly recurring cycle of physiological changes that happens in females under the control of the reproductive hormone system and is necessary for reproduction. The onset of menses is termed as menarche which begins at puberty, normally between 8 and 16 years of age and typically runs on a monthly basis until menopause. Menopause is the period occurring between ages of 45 to 55, this is the last period wherein the ovarian function stops. Common usage refers to menstruation and menses as period. This bleeding serves as a sign that a woman has not become pregnant during the reproductive years.

Menstrual cycle Womens health
Menstrual cycle

There are two major phases in each menstrual cycle, the follicular phase and the luteal phase. In the follicular phase, can be called as proliferative phase, the innermost lining of the uterus called endometrium of a sexually mature female starts to build up with gradually increasing amounts of estrogen , and when this hormone reaches a critical level, estradiol is produced. This phase is regulated by the follicle stimulating hormone (FSH) which is secreted by the anterior pituitary gland upon the regulation of the gonadotropin releasing hormone(GnRH) from the hypothalamus. Shortly there afterward, because of the action of the follicle stimulating hormone (FSH), the follicles in the ovaries begin to develop and within a few days one “matures” into an ovum or egg. The ovary now releases this mature egg known as the graafian follicle during the ovulation which is approximately on the 14th day of every menstrual cycle. Occasionally, two eggs are released at the time of ovulation and if fertilization occurs this might result in dizygotic or fraternal/non-identical twins. Identical twins form from a single egg, as a result of the zygote splitting. Twenty-four hours prior to ovulation the level of luteinizing hormone peaks known as the “LH surge”, this weakens the wall of the follicle in the ovary that leads to ovulation. In an average, the LH surge starts around day 12 of the cycle and may last for 48 hours. The finger-like projections (fimbriae) at the end of the fallopian tubes capture the released ovum from either the left or right ovary, which releases egg alternately each month at random. The infundibulum ( the proximal 3rd of the fallopian tubes) provides the exact location of fertilization. A characteristic clear and stringy cervical mucus appears at this stage exhibiting spinnbarkeit which means the female is fertile and ready to accept the sperm from the intercourse. An ovulatory pain known as Mittelschmerz (German term meaning “middle pain”) may occur in some women because of slight mid-cycle bleeding extruded out into the pelvic cavity from the mature ovarian follicle.

After ovulation, the endometrial lining changes and converts the proliferative endometrium into a secretory lining in preparation for possible implantation if fertilization occurs, this is supportive of the early pregnancy. This second phase of the menstrual cycle is known as luteal phase or the secretory phase. Progesterone play a vital role this conversion process. Progesterone is produced by the corpus luteum, a solid body formed in the residual follicle in the ovaries after the egg has been released which continues to grow and divide for a while. In short, the corpus luteum serves as a temporary endocrine structure secreting progesterone under the support of the pituitary hormones. In luteal phase, the body temperature of women raises by one-half to one degree Fahrenheit. If fertilization occurs, the fertilized ovum termed as zygote will travel as an early blastocyst through the fallopian tube to the uterine cavity for implantation at the upper uterine segment which is approximately 6 to 12 days after ovulation. After implantation, (as the placenta develops) a very early sign is the production of the hormone that pregnancy tests can measure which is known as the human chorionic gonadotropin (hCG). This peaks at the first trimester of pregnancy and associated with the early signs and symptoms experienced by a pregnant woman. This signal has an important role in maintaining the corpus luteum because in the absence of pregnancy and without hCG, the corpus luteum regresses and inhibin and progesterone level fall. This progesterone withdrawal set the stage for the next cycle and this is manifested by shedding (progesterone withdrawal bleeding) of the endometrial lining, the menses.

In many women, the most common symptom associated with menses is cramping of the uterus, this can precede the actual onset of menses brought about by the interplay of the female hormones. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen is effective in providing relief of pain. Stronger sensations may include the following: dysmenorrhea (significant menstrual pain), abdominal pain, migraine headaches, depression, emotional sensitivity and changes in sex drive. Breast discomfort caused by premenstrual water retention is very common. These sensations may vary between individuals and from cycle to cycle. The normal menstrual cycle occurs at an average interval of 21 to 35 days, with flow amounts to 20 ml to 80 ml and a duration of three to seven days. Any intervals of 21 days or fewer is known as polymenorrhea while those cycles exceeding 35 days is termed as oligomenorrhea and amenorrhea if intervals exceed 180 days. Sudden heavy flows or amounts in excess of 80 ml is termed as hypermenorrhea or menorrhagia. Prolonged bleeding that no longer shows a clear interval pattern (irregular intervals) refers to metrorrhagia or meno-metrorrhagia. Dysfunctional uterine bleeding refers to hormonal causes of bleeding abnormalities like the typical anovulation but it is a must that pregnancy should always be ruled out first with a pregnancy test as a pregnant patient may present with bleeding.

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Premarin tablets


Premarin contains Conjugated Estrogens, or female hormones. Premarin helps relieve signs of menopause, such as hot flashes and unusual sweating, chills, faintness, or dizziness; to help prevent osteoporosis in women past menopause; in the treatment of som more...



Clomid stimulates the secretion of hormones required for ovulation to take place. Clomid is used to stimulate ovulation (the release of an egg) when a woman's ovaries can generate a follicle but hormonal stimulus is lacking. Clomid may also be used for reasons that are not listed here. more...

Medroxyprogesterone tablets


Medroxyprogesterone contains Progestins or hormones. Progestins are prescribed for several reasons: to properly regulate the menstrual cycle and treat unusual stopping of the menstrual periods; to help a pregnancy occur during egg donor or infertility pr more...

Prempro tablets


Prempro, a combination of Conjugated Estrogens and Medroxyprogesterone, are estrogen and progestin hormones. Progestin lowers the effect of estrogen on the uterus and keeps problems from developing. Estrogens are given to: relieve the signs of menopause, more...

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