>Definition of terms >menstrual Cycle >4 body structures are involved in physiology of menstrual cycle >Responsible Parenthood Flashcards
Periodic discharge of blood, mucus, and epithelia cell from the uterus
Menstruation
Is the beginning of menstruation to the beginning of the next menstruation
Menstrual cycle
Is the first menstruation in women
Menarche
Is a severe pain during menstruation
Dysmenorrhea
Is the complete bleeding at completely irregular interval
Metrorrhagia
Is the excessive bleeding during menstruation
Menorrhagia
Is the absence of menstruation leading to pregnancy
Amenorrhea
Is the end of menstruation/cessation of menstruation
A
Menopause
A female hormone that is produced by the ovaries. It helps control and guide sexual development, including the physical changes associated with puberty
Estrogen
A hormone that helps to regulate your cycle. But its main function is to help thicken the lining of the uterus to prepare for a fertilized egg.
Progesterone
The mean age for menarche
12.87 years or 1-3 years after breast budding
is actually the end of an arbitrary defined menstrual cycle
Menses
The menstrual phase varies in length for most women
Ave period: 5 days
Ave cycle: 28 days
Normal blood loss: 50cc
Is the hormonal process a woman’s body goes through each month to prepare for a possible pregnancy
Menstrual cycle
a sign that your body is working normally
Regular menstrual periods in the years between puberty and menopause
For menstrual cycle to be complete, all four structures must contribute their part. Therefore, inactivity of any parts results in an incomplete or ineffective cycle
-hypothalamus
-pituitary gland
-ovaries
-uterus
Produces GnRH or Gonadotropin Releasing Hormone to stimulate the anterior Pituitary gland
Hypothalamus
Secretes gonadotropins (FSH and LH): stimulates the ovary (estrogen and progesterone) - if estrogen/progesterone increase in blood vessels, this gives positive feedback to the hypothalamus to decrease all hormones
Anterior Pituitary Gland
After an upsurge of LH, the graafian follicle raptures and the ovum is set free from the ovary
Ovulation
After an upsurge of LH, the graafian follicle raptures and the ovum is set free from the ovary called ovulation and swept into an open end of a fallopian tube, the FSH has done its work and now decreases its amount. It occurs approximately on the 14th day before the onset of the next menstrual cycle.
Ovaries
The ovulation happens at the midpoint of a 28-day cycle
If the cycle is only 20 days long 20-14=6 day of ovulation not the 10th or middle day
What happens if conception does not occur?
the unfertilized ovum atrophies after 4 days and the corpus luteum remain for only 8-10 days and regresses. Stimulation from the hormones produced by the ovaries causes specific monthly effects on the uterus and uterine changes occur during the menstrual cycle
If conception occurs, the fertilized ovum implants on the endometrium of the uterus, the corpus luteum remains throughout
Uterus
Menstrual flow is composed of:
-blood from ruptured capillaries
-mucin from the glands
-fragments of the endometrial tissue
- the microscopic, atrophied, unfertilized ovum
Indications of Ovulation
There is a slight drop in temperature one day prior to ovulation with a one-half to one degree rise in temperature at ovulation that remains elevated for 12-14 days.
Cervical mucus is abundant, watery, clear, and more alkaline. Cervical Os dilates slightly, softens and rises in the vagina
Presence of Spinnbarkeit and ferning under microscope
Egg-white stretchiness of cervical mucus
Spinnbarkeit
is the monthly hormonal cycle a female’s body goes through to prepare for preganancy
Menstrual cycle
is counted from the first day of your period up to the first day of your next period. Your hormone levels usually change throughout the menstrual cycle and can cause menstrual symptoms
menstrual cycle
Four main phases of the menstrual cycle
- menstruation
- follicular phase
- ovulation
- luteal phase
is the elimination of the thickened lining of the uterus (endometrium) from the body through the vagina
Menstruation
contains blood, cells from the lining of the uterus (endometrial cells) and mucus
menstrual fluid
What is the average length of a period?
between three days and one week
starts on the first day of menstruation and ends with ovulation. Prompted by the hypothalamus, the pituitary gland releases follicle stimulating hormone (FSH)
Proliferative/ follicular phase
This hormone stimulates the ovary to produce around five to 20 follicles (tiny nodules or cysts) which bead on the surface
Follicle stimulating hormone (FSH)
This can occur around day 10 of a 28 day cycle
Proliferative/ follicular phase
The growth of the follicles stimulates______ to thicken in preparation for possible pregnancy
lining of the uterus
is the release of a mature egg from the surface of the ovary. This usually occurs mid-cycle, around two weeks or so before menstruation start
Ovulation
During this phase, the developing follicle causes a rise in the level of estrogen. The hypothalamus in the brain recognizes these rising levels and releases a chemical called gonadotrophin-releasing hormone (GnRH)
follicular phase
This hormone prompts the pituitary gland to produce raised levels of luteinising hormone (LH) and FSH
gonadotrophin-releasing hormone (GnRH)
The life span of the typical egg is only around ____ Unless it meets a sperm during this time, it will die.
24 hours.
During ovulation, the egg bursts from its follicle, but the ruptured follicle stays on the surface of the ovary. For the next two weeks or so, the follicle transforms into a structure known as the CORPUS LUTEUM. This structure starts releasing progesterone, along with small amounts of estrogen. This combination of hormones maintains the thickened lining of the uterus, waiting for a fertilized egg to implant
Luteal Phase
A hormone that is detected in a urine test for pregnancy
Human Chorionic Gonadotrophin
keeps producing the raised levels of progesterone that are needed to maintain the thickened lining of the uterus
corpus luteum
explain luteal phase
During ovulation, the egg bursts from its follicle, but the ruptured follicle stays on the surface of the ovary. For the next two weeks or so, the follicle transforms into a structure known as the CORPUS LUTEUM. This structure starts releasing progesterone, along with small amounts of estrogen. This combination of hormones maintains the thickened lining of the uterus, waiting for a fertilized egg to implant
if the pregnancy does not occur, the corpus luteum withers and dies, usually around ____
day 22 in a 28-day cycle
What causes the lining of the uterus to fall away. This is known as menstruation. The cycle then repeats
Drop in progesterone levels
Days 1-5 cycle
Shedding of the endometrium occurs as uterine bleeding, approximately 50 to 60 ml (<2 ounces)
Menstrual phase
Day 5 of ovulation. Endometrium is restored under primary hormone influence of estrogen. In this preovulationary phase, FSH is secreted by the anterior pituitary. Preovulatory surge of LH affects one follicle and ovulation occurs
Proliferative (follicular) phase
(Ovulation) ovulation to approximately 3 days before menstrual cycle. Estrogen levels off and progesterone level increase
Secretory Phase
(Luteal) If fertilization did not occur, the corpus luteum degenerated and estrogen and progesterone levels drop off causing the endometrium to become “blood starved” leading to menstruation
Ischemic Phase
Two common causes of irregular menstrual periods are
-polycystic ovary syndrome (PCOS)
-Hypothyroidism
Is a hormone imbalance that can affect ovulation, and make it more difficult to get pregnant
PCOS
is a man or woman who is able and willing to give the proper response to the demands of a given situation with specific reference to marriage and family life
responsible person
is one who gives the proper responses to the needs of his/her spouse, as well as his own, and of their life together
responsible spouse
Give proper responses to the needs of their children
Responsible parents
Refers more specifically to the voluntary and positive action of a couple to plan and decide the number of children they want to have and when to have them
Family planning
Includes all decision on individual or couple make about having children:
- if and when to have children
- how many children to have
- how children are spaced
Reproductive Life Planning
The concept of family planning includes these elements:
a. responsibility of parents to themselves and to each other
b. responsibility to their present and future children
c. responsibility to their community and country
Purposes of Family planning
- improvement of health
- promotion of human right to determine reproductive performance
- relation of demographic change to economic development
The ultimate goal of family planning is directed towards
birth spacing
birth limitation
helping those who do not have children to have children
to allow the mothers time to rest and regain their health before the next pregnancy
Birth spacing
when the desired number of children is reached
birth limitation
Advantages of family planning to the mother
- enables the mother to regain her health after the delivery
- gives mother enough time and opportunity to love and provide attention to her husband and children
- Provides mother who has chronic illness enough time for treatment and recovery without further exposure to the physiologic burden of pregnancy
- Prevents high risk pregnancy
- Gives mother more time to herself, family and community
Advantages of family planning to the children
the practice of family planning will make them healthier, happier, feel wanted and satisfied, secure
Advantages of family planning to the fathers
- Lightens his burden and responsibility in supporting his family
- enables him to give his children a good home, good education and better future
- Enables him to give his family a happy and contented life
- gives him time for his personal advancement
- Provides a father who has chronic illness enough time for treatment and recovery from illness
Advantages of family planning to the family
- Gives the family members more opportunity to enjoy each other’s company with love and affection
- Enables the family to save some amount for improvement of standard of living, and for emergencies
Advantages of family planning to the community
- improves the economic and social status of the community
- better job opportunities
- health status will improve
- Extra resources in the community (less congestion, less poluution, potable water supply)
- Members will have more time to socialize with each other; to participate in socio-civic activities
Is any device used to prevent fertilization of an egg leading to pregnancy
Contraception
Contraception considerations
- Personal values
- Ability to use method correctly
- How method will affect sexual enjoyment
- Financial factors
- Status of couple’s relationship
- Prior experiences
- Future plans
- Contraindications
Kinds of contraceptives
- Natural methods
- Hormonal methods
- Barrier methods
- Permanent methods
Examples of natural methods (contraception)
Rhythm method or calendar method
-basal body temperature
-billings method or cervical mucus method
-coitus interruptus or withdrawal
-lactation amenorrhea method
examples of hormonal methods (contraceptives)
-oral contraceptives
-injected or implanted steroidal contraceptive
Examples of barrier methods
chemical barriers and mechanical barriers
examples of chemical barriers
spermicides
-gels
-vaginal suppositories
-sponges
Examples of mechanical barriers
Condoms
-cervical cap
-diaphragm
-intrauterine device (IUD)
Examples of permanent methods
- tubal ligation
- vasectomy
Entails keeping a day by-day record of your cycle for 6 consecutive months, noting the onset of bleeding as day 1 and the last day before your next menstrual bleeding as the final day of your cycle
CALENDAR METHOD
This will show you your longest and shortest cycles from which you can calculate your FERTILE DAYS
6 MONTH RECORD
Life span of an egg from the woman lives for only around ___
24 hours
Sperm from the man can survive up to ___, possibly longer
3 days
First unsafe day explain
Subtract 18 from the number of days in last unsafe day; subtract 11 from the number of days in your longest cycle
ex. shortest 24-18 = day 8
longest 31-11 day 20
UNSAFE PERIOD IS DAY 8-20
Is a periodic abstinence from intercourse during fertile period; based on the regularity of ovulation; variable effectiveness. The oldest method
Coitus Interruptus
The couple proceed with this until moment of ejaculation, then the man withdraws and spermatozoa are emitted outside the vagina
Coitus Interruptus
Offers little protection because ejaculation may occure before withdrawal is complete and despite the care used, spermatozoa may be deposited in the vagina
Coitus Interruptus
Involves taking the temperature every morning before the woman gets out of bed and recording it.
The temperature drops slightly 24 hours before ovulation, then rises to about half a degree higher than normal and remains thus for to three days: UNSAFE period
BASAL BODY TEMPERATURE
Not a very efficient method unless combines with calendar and mucus methods.
BASAL BODY TEMPERATURE
Involves becoming aware of the normal changes in the cervical secretions that occur throughout your cycle by inserting the forefinger into the vagina first thing in the morning. A few days after menstrual bleeding, there is a little secretion, vagina is dry and gradually, secretion increases and becomes thicker, cloudy white and sticky.
as ovulation approaches, this secretion or mucus becomes copious, clear, thin, less viscous, more liquid, slipper, or string as soo as this change begins and for 3 full days later: UNSAFE PERIOD
Cervical Mucus Billings Method
Cervical Mucus Billings Method checkings
- begin checking the mucus
- checking the sensation of wetness or dryness
Cervical mucus is thin, watery and can be stretched into long strands means there is high level of estrogen and ovulation is about to occur
Spinnbarkeit test
At the height of estrogen stimulation just before ovulation. Is due to crystallization of sodium chloride on mucus fibers
Ferning or arborization of cervical mucus
Mucus if abundant, slippery, watery, thin, and stretchable. It has a ferning pattern when viewed under the miscroscope. AS SOON AS YOU NOTICE CHANGES IN YOUR MUCUS, CONSIDER yourself fertile. Avoid sexual intercourse
During fertile period
Mucus is thick, scant, yellowish, or absent. Sexual intercourse is allowed
During infertile period
Combines BBT and cervical mucus methods. The woman takes her temperature daily, watching for the rise in the temperature that marks ovulation. She also analyzes her cervical mucus daily
Abstain from the intercourse until3 days after the rise in temperature or the fourth day after the peak of mucus change
Sympto-thermal method
As long as woman is breastfeeding an infant, there is some natural suppression of ovulation. Not dependable- woman may be fertile even if she has not had a period since childbirth
The effectivity of this method is greatly dependent on the frequency and duration of sucking
98% effective when all the following conditions are present if she is fully breastfeeding, amenorrheic and within 6 months’ postpartum period
Lactation amenorrhea Method
The greater the frequency and duration of sucking the more pronounced the pronounced the suppression of ovulation due
due to constant secretion of prolactin
Composed of varying amounts of estrogen combined with small amount of progesterone. 99% effective. Estrogen suppresses FSH and LH, thereby suppressing ovulation. Progesterone decreases the permeability of cervical mucus
Oral Contraceptives
effects on the cervical mucus oral contraceptives
The pill makes the cervical mucus thick, scanty, & cellular so that sperms have difficulty in penetrating it & reaching the uterus. Prevention of implantation due to the effect of progestin on the endometrium
Effects on the sperm oral contraceptives
Capacitation, the activation of enzymes that permit the sperm to penetrate the ovum, maybe inhibited. This makes the sperm unable to penetrate and fertilize the ovum
Fixed doses of estrogen and progesterone: 21-28 day cycle
Monophasic cycle
may come with 21 tables, seven day pill free interval/seven iron/ vitamin tables
98% - 100% effective
Monophasic
There is constant amount of estrogen with increased progesterone
Biphasic
Varying levels of estrogen and progesterone
Triphasic
Benefits of oral contraceptives are:
decrease incidences of:
-dysmenorrhea
-premenstrual dysphoric syndrome
-iron deficiency anemia
-acute pid with tubal scarring
-endometrial and ovarian cancer and ovarian cysts
-fibrocystic breast disease
side effects of contraceptives
nausea, weight gain, headache, breast tenderness, breakthrough bleeding, monilial vaginal infections, mild hypertension, depression
Absolute contraindications to OCs
Breastfeeding, family history of CVA or CAD, history of thromboembolic disease, history of liver disease, undiagnosed vaginal bleed
Possible Contraindication to OC’s
age 40+
-breast of reproductive tract malignancy
-diabetes mellitus
-elevated cholesterol or triglycerides
-high blood pressure
-migraine or other vascual type headavhes
-obesity
-pregnancy
-seizure disorders
- sickle cell or other hemoglobinopathies
-smoking
-use of drug with interaction effect
Other contraceptives
continuos or extended regimen pills
mini pills
estrogen-progesterone patch
vaginal rings
highly effective, weekly hormonal birth control patch that’s worn on the skin. Combination of estrogen and progestin. Is absorbed on the skin and then transferred into the bloodstream. Can be worn on the upper outer arm, buttocks, upper torso, or abdomen. Worn for 1 week, replaced on the same day of the week for 3 consecutive weeks. No patch 4th week
Estrogen-progesterone patch
The morning- after pills. high level of estrogen. Must be initiated within 72 hours of unprotected intercourse
Emergency postcoital contraceptives
How to take emergency postcoital contraceptives or morning pills
Take 1 pill everyday, always start your pill on the day one of your menstruation. Those taking a 21 day pill have a 7day pill free period then start taking the ist pill on the next pack. For the 28 day pill start the next day after all 28 pills have been taken. There is no pill free.
nonbiodegradable silastic implants with synthetic progesterone embedded under the skin on the inside of the upper arm. Slowly relase the hormone over the next 5 years.
Suppress ovulation, stimulating thick cervical mucus and changing the endometrium so implantation is difficult
Subcutaneous implants
Administer every 12 weeks and contain medroxy progesterone (depo provera) 100% affective
intramuscular injections
advantages of intramuscular injections
- highly effective 99.6%
- safe, convenient, easy to use
- can be used by breast feeding mothers
- does not interfere w/ intercourse. easily administer by physcical
- Does not contain estrogen, so that the heart & blood - clotting effects do not occur
- rapidly effective
disadvantages of intramuscular injections
1 menstrual irregularities maybe experienced.
weight gain in some women due to increase in appetite
A t-shaped plastic device with copper. with progesterone
Must be fitted by physician, nurse,practitioner or midwife. 5-7 year effecicay.
Intrauterine devices
Intrauterine devices mechanism of action
- Inactivating the sperm due to the action of the copper
- interfering w the transport of sperm in the genital tract due to the production of prostaglandin & enzymes
- Seeding the ovum/s transport through the fallopian tubes
Effectiveness and precaution of Intrauterine devices
98-99%
The IUD should not be given to women w/ pregnancym, active recent recurrent pelvic infections.
Advantages of IUD
- LOW PREGNANCY RATE
2.easy to remove - inexpensive; can be used for 8 years
4 requires yearly check up to make sure it is in place - no mess
Disadvantages of IUD
- may feel pain during the first few day
2.IUD may be expelled - not protected from stds
side effects:
spotting or uterine cramping, increased risk for PID
heavier menstrual flow, dysmenorrhea and rctopic pregnancy
Other Barrier methods
Spermicidal products
1. diaphragms
2. cervical caps
3. condoms
To kill sperm before the sperm enters the cervix
Spermicidal agent
made up of gel, creams, films, foams, suppositories. It is 82% effective
Spermicidal agent / Nanoxynol-9
Advantages of Spermicidal agent
safe to use, protection agains STDs
Disadvantages of Spermicidal agent
need to used for every act of coitus, messy and sometimes irritating, temporary skin irritations to the vulva/penis caused by sensitivity
Precautions Spermicidal agent
Hypersensitivity to the spermicidal foam, jelly, cream/ tablets
Mechanically blocks sperm from entering the cervix.soft latex dome supported by a metal rim.can be inserted 2 hours before intercourse; removed at least 6 hours after coitus or within 24 hours. size must fit the individual, washable, may be used for 2-3 years.
Diaphragm
similar to diaphragm but smaller thimbleshaped rubber cap held onto the cervix by suction.
a. Cervical cap
Is widely used method both in developing & developed countries. Mechanical barriers covering the penis had been used for protection against pregnancy.
a. Male condom
Mechanism of action Condom
is a rubber sheath worn over an erect penis during sexual intercourse. It acts as barrier that blocks the man’s sperm from entering the vagina in order to prevent pregnancy
Effectiveness and advantages of condom
Effectiveness 85-87% Advantages: No serious side effects.no prescription. Encourage male participation in contraception
disadvantages of condom
- Decrease sensation 2. New condom should be used for each act of
coitus 3. Sexual activity is interrupted
condom precaution
- Couples who are allergic to rubber 2. Men who cannot maintain erection while
using condom
Instruction condom
- Put the condom on the erect penis
- Condom can tear be careful with them
- Leave 1/2 Inch of empty space at the tip of the condom
4 Wait until the vaginas well lubricated because condom can tear if the vagina is dry
5 extra lubrication is needed use water, ky jelly, gel cream - After ejaculation, while the penis is still erect hold on to the rim of the condom withdraw the penis immediately
- Check condom for tears throw it away
28% of all women in US. Fallopian tubes are cut, tied/cauterized to block passage of ova and sperm.
Tubal ligation
is the procedure to perform tubal sterilization
Laparoscopy
Advantages of tubal ligation
- very effective and safe
- no long term side effect
- does not interrupt sexual activity
- permanent method
disadvantages of tubal ligation
- discomfort during and shortly after the procedure
- discomfort of serious bleeding, injury to the internal organs/ infection soon after the procedure
- irreversible
Almost 11% of all men in US. Incision are made in the side of scrotum; vas deferens is cut and tied. Then plugged or cauterized. It blocks the passage of sperm. The sperm is viable for 6 months post op. It is reversible 95%
Vasectomy
Advantages of vasectomy
- very affective (99.5-99.9%)
- no long term side effect
- does not interfere w sexual activity
Disadvantage of vasectomy
Client feel some discomfort during and shortly after the procedure
complications of vasectomy
there is scrotal swelling, discoloration, discomfort & pain, hematomas, wound infection
