Menstruation Menstrual cycle Episodic uterine bleeding in response to cyclic hormonal changes.

A process that allows conception and implantation of new life. Menarche may occur as early as 8 or 9 y/o or as late as age 17. Lasts for 23-35 days, average is 28 days cycle. Length of the average menstrual flow is 4-6 days Initiated with menarche and ends with menopause 30cc to 80 cc normal amount of discharged blood 50 CC average amount of discharged blood: average of 3 to 4 sanitary pads per day colordark red menstrual flow containsendometrium, dead ovum, mucus, & blood Associated terms

Dysmenorrhea- painful menstruation Amenorrhea- markedly diminished menstrual flow Menorrhagia- Excessive bleeding Polymenorrhea-frequent menstruation occurring at intervals of less than 3 weeks Physiology of Menstrual cycle 4 body structures involved Hypothalamus Pituitary gland Ovaries Uterus i. on the 3rd day of the menstrual cycle, serum estrogen level is at lowest which stimulates the hypothalamus to produce follicle stimulating hormone releasing factor(FSHRF) ii. FSHRF is responsible for stimulating the anterior pituitary gland (APG) to produce the FSH which will act on one immature oocytes inside the primordial follicle, stimulating its growth. In view of the FSH , estrogen is now going to be produced in an increasing amounts inside the follicle, which is found in the ovary. Once estrogen is present , the primordial follicle is now termed as Graaffian follicle. Estrogen in the Gf will cause the cells in the uterus to proliferate(grow rapidly), increasing its thickness to about eight fold. This is called Proliferative/follicular phase

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On the 13th day of menstrual cycle, there is now a very low level of progesterone in the blood. This stimulates the hypothalamus to produce Luteinizing Hormone releasing factor (LHRF) LHRF is responsible for stimulating the APG to produce LH. The LH in turn, is responsible for stimulating the ovary to produce progesterone. The increased amounts of both estrogen and progesterone push the new matured ovum to the surface of the ovary until the following day (14th) the GF ruptures and releases the mature ovum. Once the ovulation has taken place, the GF which contains increased amount of progesterone will turn to Corpus Luteum which is yellow in appearance. If conception occurs , the fertilized ovum implants on the endometrium of the uterus, corpus luteum remains approx. 16-20 weeks of pregnancy If conception does not occur, the unfertilized ovum atrophies after 4 or 5 days and the corpus luteum remains for 8-10 days, as it regresses it is replaced by white fibrous tissue called corpus albicans.

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Phases of Menstrual Cycle 1. Proliferative Phase (Follicular phase) - immediately after the menstrual flow(4-5 days of cycle) - endometrium thickness increases approximately eightfold - estrogen peaks before ovulation - cervical mucus becomes clear, thin, watery, and alkaline (spinnbarkheit) 2. Secretory Phase (Luteal phase) - estrogen drops and progesterone dominates - uterus may be ready for implantation - formation of progesterone in corpus luteum causes glands of uterine endometrium to become corkscrew or twisted in appearance 3. Ischemic Phase - if fertilization does not occur, the corpus luteum in the ovary regress after 8 to 10 days - both estrogen and progesterone falls - blood vessels rupture and blood escapes 4. Menstrual Phase - estrogen levels are low - discharged from the uterus i. Blood from the ruptures capillaries ii. Mucin from the glands iii. Fragments of endometrial tissue

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The microscopic, atrophied, and unfertilized ovum

Stages of Sexual Responses (EPOR) Initial responses: Vasocongestion congestion of blood vessels Myotonia increase muscle tension 1. Excitement Phase (sign present in both sexes, moderate increase in HR, RR,BP, sex flush, nipple erection) erotic stimuli cause increase sexual tension, lasts minutes to hours. 2. Plateau Phase (accelerated V/S) increasing & sustained tension nearing orgasm. Lasts 30 seconds 3 minutes. 3. Orgasm (involuntary spasm throughout body, peak v/s) involuntary release of sexual tension with physiologic or psychologic release, immeasurable peak of sexual experience. May last 2 10 sec- most affected is pelvic area. - average contractions for the woman is 8 to 15 contractions at intervals of one every 0.8 seconds - in men 3 to 7 propulsive ejaculatory contractions at intervals of one every 0.8 sec 4. Resolution (v/s return to normal, genitals return to pre-excitement phase) Refractory Period the only period present in males, wherein he cannot be restimulated for about 30 minutes TERM Ovum Zygote Embryo Fetus Conceptus TIME PERIOD From ovulation to fertilization From fertilization to implantation From implantation to 5-8 weeks From 5-8 weeks until term Developing embryo or fetus and placental structures throughout the pregnancy

*Pre-embryonic Stage a. Zygote- fertilized ovum. Lifespan of zygote from fertilization to 2 months b. Morula mulberry-like ball with 16 50 cells, 4 days free floating & multiplication c. Blastocyst enlarging cells that forms a cavity that later becomes the embryo. Blastocyst covering of blastocys that later becomes placenta & trophoblast d. Implantation/ Nidation- occurs after fertilization 8 10 days Stages of Human Prenatal Development i. Pre- embryonic stage First 14 days after conception ii. Embryonic stage from 15 days to 8 weeks after conception iii. Fetal Stage from 8 weeks to birth A. Pre-embryonic stage this stage is characterized by rapid growth and differentiation and establishment of embryonic germ layers and membranes.

Implantation of blastocyst occurs approximately 7-9 days after fertilization. Endometrium becomes the deciduas following conception and implantation B. Embryonic stage is the period of differentiation of tissues into organs. 3 primary germ layers of the embryo Entoderm develops into the lining of the GIT, respiratory tract, tonsils, thyroids, bladder and urethra Mesoderm forms into the supporting structures of the body (bones, connective tissue, cartilage, muscles and tendons), circulatory system, reproductive system, kidneys and ureters Ectoderm responsible for formation of the nervous system, skin, hair, and nails and the mucus membrane of mouth and anus. C. Fetal Stage every structure is present that will be found in the full term neonate. The remainder of gestational period is devoted to refinement of structures and organization and perfection of functions.