Disorders of tie menstrual cycle are one of tie mosi common reasons lor women to attend their general practitioner aid, subsequently, a gynaecologist. Although rarely life threatening, menstrual disorders lead to major social and occupational disruption, and can also affect psychological well-being.
Chapter 27 - The reproductive system (part c), the main contents of this chapter include all of the following: Establishing the ovarian cycle, establishing the ovarian cycle, hormonal interactions during a 28-day ovarian cycle, uterine (menstrual) cycle, effects of estrogens,...
For the Seventh Edition of this text, the title has been changed to Kistner's Gynecology
and Women's Health (from Kistner's Gynecology) to recognize the broad scope and
expanded interest in the field of women's health care. Although over the past 35 years,
previous editions of Kistner have appealed largely to students, trainees, and
practitioners in gynecology, this new edition should be useful not only for gynecologists
but for internists, family practitioners, and women's health specialists who are devoting
more of their time and effort to women's medical issues.
The purpose of this book is to consider the woman and her health needs in her
position in her life cycle, her family, and society. Women have historically
been ‘‘the other’’ in medical care. Sigmund Freud and Erik Erikson considered
women’s development to be deviant from the normal, which was men’s.
Although the Greeks Hippocrates and Soranus wrote about women’s medical
needs, women’s health concerns have either been considered abnormal, or,
traditionally, been condensed to their gynecological functions and disorders,
perhaps because these were their only valued functions....
Physiology of the Female Sexual Response
The female sexual response requires the presence of estrogens. A role for androgens is also likely but less well-established. In the CNS, estrogens and androgens work synergistically to enhance sexual arousal and response. A number of studies report enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire.
Sexual motivation is heavily influenced by context, including the environment and partner factors.
Epilepsy has a gender-related pathophysiology and consequences. Therefore, being a
woman with epilepsy is not the same as being a man with epilepsy (Taubøll et al, 2008); in
fact, the frequency and severity of seizures can increase on certain days of the menstrual
cycle (Herzog et al, 1997). Seizures generally exacerbate during the 3 different periods of the
menstrual cycle: in perimenstrual and periovulatory periods in normal cycles, and in
inadequate luteal phase in abnormal cycles (Figure 1).
There is a theoretical concern that women with a short menstrual cycle may ovulate very early
in their cycle, putting them at risk of pregnancy if starting contraception as late as Day 5 or
Day 7 (LNG-IUS). There is no strong evidence to support or refute the risk but some sources of
patient information (e.g. FPA) advise additional contraception for women in this situation if
they have a cycle shorter than 23 days.
Faculty guidance on postnatal sexual and reproductive health includes recommendations on
starting contraceptive methods after childbirth.
Although not specifically referred to as quick starting, previous Faculty guidance has advised
that contraceptive methods can be started at any point in the menstrual cycle if a
practitioner is reasonably certain that the woman is not currently pregnant (Box 1)8 or at risk
of pregnancy. As sperm may be viable in the female reproductive tract for up to 7 days,
health professionals should consider if a woman is at risk of becoming pregnant as a result of
unprotected sexual intercourse (UPSI) within the last 7 days.
Women usually produce one mature egg per menstrual cycle. Because IVF is so expensive,
current clinical practice is to give women hormonal drugs to stimulate multiple eggs in one
cycle, to increase their chances of pregnancy. For this process, women inject three different
hormones over the course of four to six weeks to “shut down” their ovaries, “hyperstimulate”
them, and to control the timing that the mature eggs will be released.
In addition to ovulation, another critical function occurs during the
menstrual cycle. The woman’s body must be prepared in case fertilization
occurs. Everything must be ready to nurture the developing embryo. Dur-
ing the ﬁrst two weeks of the cycle, estrogen causes the lining of the uterus
to thicken. There is also an increase in the amount of blood that ﬂows to
During the second half of the cycle, after ovulation has occurred, the
follicle (now without the egg cell) develops into a yellow-colored body,
the corpus luteum.
The growing tissue then begins
to release more hormones to keep everything in the right condition. How-
ever, if fertilization does not occur, the continued preparations in the
uterus are unnecessary. The body realizes this near the end of the four-
week period of the menstrual cycle. At this time, the level of LH decreases,
the corpus luteum breaks down, and the level of progesterone decreases.
Without this hormone, the uterine lining no longer remains intact.
Instead, the lining breaks down.
Only human females and some other higher primates have a regular
monthly menstrual cycle. Humans, however, are able to mate at any time.
Females of almost all other mammal species will mate only at speciﬁc
times during a year. These times are known as estrus or “heat.” It is only
during estrus that egg cells are released for fertilization. Estrus occurs in
wolves and deer once a year, in dogs usually twice a year, in cows and
horses once a month, and in rats and mice every few days.
Ovulation, mating, and fertilization occur on a speciﬁc timetable.
The ovaries stop releasing eggs (ova), and menstrual periods stop (Menopause). Most women experience menopause around age of 45 to 50. Prior to menopause, menstrual cycles often become irregular.
The vaginal walls become less elastic, thinner, and less rigid. The vagina becomes shorter. Secretions become scant and watery. The external genital tissue decreases and thins (atrophy of the labia). A woman may experience changes in her sex drive (libido) and her sexual response may change, but aging does not prevent a woman from being able to have or enjoy sexual relationships.
Medical practitioners and health care educators must be continually vigilant of the
growing and ever-changing health issues related to girls and women who lead an active
lifestyle and participate in sports and exercise. There have been landmark legislations
that have changed the social perception that girls and women not only can, but should
be physically active. With any changing social milieu, there are evolving health issues
associated with the journey.
The pelvic adnexae include the ovaries and fallopian tubes. In general,
ovaries increase in size throughout childhood, plateau in adulthood, then de-
crease in size in the postmenopausal period (5). Postmenopausal ovary size is
affected by the number of years since menopause and the quantity of prior
pregnancies (6); however, ovaries should not be palpable in a woman who is
two or more years beyond menopause, and such a finding should prompt fur-
ther evaluation with transvaginal ultrasound.
Depression is more common in women than in men and
is known to be mediated by serotonin receptor levels
[43,63]. Specifically, depression is linked to decreased
density of serotonin receptors and decreased efficacy of
serotonin in the brain. The increased risk, timing of onset,
and effectiveness of treatment of depression in women
may be mediated by estrogen's effect on serotonin recep-
In most women, the menstrual cycle continues for at least 40 years
from puberty. Between the ages of 45 and 55, the levels of hormones
change; the menstrual cycle becomes less regular and eventually stops.
This stage, called menopause, marks the point at which a female is no
longer capable of reproducing. Menopause is a normal occurrence in all
women; however, the effects of menopause vary widely from one woman
to another. In men, by contrast, sperm production continues throughout
life, although the number of healthy sperm likely declines with age....
This syndrome, which occurs almost exclusively in women, is characterized by periodic episodes of edema (unrelated to the menstrual cycle), frequently accompanied by abdominal distention. Diurnal alterations in weight occur with orthostatic retention of NaCl and H2O, so that the patient may weigh several pounds more after having been in the upright posture for several hours. Such large diurnal weight changes suggest an increase in capillary permeability that appears to fluctuate in severity and to be aggravated by hot weather.
A woman's hormone balance plays a part in most endometrial cancers. Many of the risk
factors for endometrial cancer affect estrogen levels. Before change of life, the ovaries
are the main source of the 2 main types of female hormones -- estrogen and progesterone.
The balance between these hormones changes during a woman's menstrual cycle each
month. A shift in the balance of these 2 hormones toward more estrogen increases a
woman's risk for getting endometrial cancer.