Tag Archives: menstruation


The endometrium is under the influence of sex steroids that circulate in females of reproductive age. Sequential exposure to oestrogen and progesterone will result in cellular proliferation and differentiation, in preparation for the implantation of an embryo in the event of pregnancy, followed by regular bleeding in response to progesterone withdrawal if the corpus luteum regresses. During the ovarian follicular phase, the endometrium undergoes proliferation (the ‘proliferative phase’); during the ovarian luteal phase, it has its ‘secretory phase’. Decidualization, an irreversible process  that develop a specialized glandular endometrium, and apoptosis arise when there is no embryo implantation. Menstruation (day 1) is the shedding of the ‘dead’ endometrium and ceases as the endometrium regenerates (which normally happens by day 5–6 of the cycle).

The endometrium is composed of two layers, the uppermost of which is shed during menstruation. A fall in current levels of oestrogen and progesterone for about 2 weeks after ovulation leads to reduce of tissue fluid, vasoconstriction of spiral arterioles and distal ischaemia. This results in tissue breakdown, and loss of the upper layer along with bleeding from fragments of the remaining arterioles is seen as menstrual bleeding. Enhanced fibrinolysis reduces clotting.

The effects of oestrogen and progesterone on the endometrium can be reproduced artificially, for example in patients taking the combined oral contraceptive pill or hormone replacement therapy who experience a withdrawal bleed during their pill free week each month.

Vaginal bleeding will cease after 5–10 days as arterioles vasoconstrict and the endometrium begins to regenerate. Haemostasis in the uterine endometrium is different from haemostasis elsewhere in the body as it does not involve the processes of clot formation and fibrosis.

In rare cases, the tissue breakdown and vasoconstriction does not occur correctly and the endometrium may develop scarring which goes on to inhibit its function. This is known as ‘Asherman’s syndrome’. The endocrine influences in menstruation are clear. However, the paracrine mediators less so. Prostaglandin F2a, endothelin-1 and platelet activating factor (PAF) are vasoconstrictors which are produced within the endometrium and are thought likely to be involved in vessel constriction, both initiating and controlling menstruation. They may be balanced by the effect of vasodilator agents, such as prostaglandin E2, prostacyclin (PGI) and nitric oxide (NO), which are also produced by the endometrium. There is a research shows that progesterone withdrawal increases endometrial prostaglandin (PG) synthesis and reduces PG metabolism. The COX-2 enzyme and chemokines are involved in PG synthesis and this is likely to be the target of non-steroidal anti-inflammatory agents used for the treatment of heavy and painful periods.

Endometrial repair involves both glandular and stromal regeneration and angiogenesis to reconstitute the endometrial vasculature. VEGF and fibroblast growth factor (FGF) are found within the endometrium and both are powerful angiogenic agents. Epidermal growth factor (EGF) appears to be responsible for mediation of oestrogen-induced glandular and stromal regeneration. Other growth factors, such as transforming growth factors (TGFs) and IGFs, and the interleukins may also be important.

Greater understanding of mediators of menstruation is important in the search for medications to control heavy and painful periods. Mefenamic acid is a PG synthetase inhibitor which is widely used as a treatment for heavy menstrual bleeding. It is believed to act by increasing the ratio of the vasoconstrictor PGF2a to the vasodilator PGE2. Mefenamic acid reduces menstrual loss by a mean value of 20–25 per cent in women with very heavy bleeding, and further more effective agents are still being sought.

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Menopause is a process of permanent cessation of menstruation at an end of reproductive life that is cause by loss of ovarian follicular activity. It is when the last and final menstruation occurs. Clinical diagnosis can be confirmed after following stoppage of menstruation (amenorrhea) for 12 consecutive months with no other pathology. This is the time a woman is declared to reach menopause only retrospectively. Premenopause refers to the period prior to menopause, postmenopause to the period after menopause and perimenopause to the period around menopause (40–55 years).

Climacteric is the period of time during which a woman passes from the reproductive to the nonreproductive stage. This phase covers 5–10 years on either side of menopause.

Perimenopause is the part of the climacteric when the menstrual cycle is likely to be irregular.

Postmenopause is the phase of life that comes after the menopause.

Age at which menopause occurs is genetically predetermined. The age of menopause is not related to age of menarche or age at last pregnancy. It is also not related to number of pregnancy, lactation, use of oral pill, socioeconomic condition, race, height or weight. Thinner women have early menopause. However, cigarette smoking and severe malnutrition may cause early menopause. Age of menopause ranges around 45–55 years, average about fifty years.

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Few years prior to menopause, along with depletion of the ovarian follicles, the follicles become resistant to pituitary gonadotropins. As a result, effective folliculogenesis is impaired with diminished estradiol production. There will be a significant reduce with the level of serum estradiol from 50–300 pg/mL before menopause to 10–20 pg/mL after menopause. This decreases the negative feedback effect on hypothalamopituitary axis resulting in increase in FSH. The increase in FSH is also due to diminished inhibin. Inhibin, a peptide, is secreted by the granulosa cells of the ovarian follicle. The increase of LH occurs subsequently.

Disturbed folliculogenesis during this period may result in anovulation, oligo-ovulation, premature corpus luteum or corpus luteal insufficiency. The sustained level of estrogens may even cause endometrial hyperplasia and clinical manifestation of menstrual abnormalities prior to menopause. The mean cycle length is significantly shorter. This is due to shortening of the follicular phase of the cycle.

Luteal phase length remaining constant. Ultimately, no more follicles are available and even some exist, they are resistant to gonadotropins Estradiol production drops down to the optimal level of 20 pg/mL → no endometrial growth → absence of menstruation.

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Following menopause, the predominant estrogen is estrone and to a lesser extent estradiol. Serum level of estrone (30–70 pg/mL) is higher than that of estradiol (10–20 pg/mL). The major source of estrone is peripheral conversion (aromatization) of androgens from adrenals (mainly) and ovaries. The aromatization occurs at the level of muscle and adipose tissue. The trace amount of estradiol is derived from peripheral conversion of estrone and androgens. Compared to estradiol, estrone is biologically less (about one-tenth) potent.

When the sources fail to provide the precursors of estrogen for around 5–10 years after menopause, there will be a significant reduce in estrogen and trophic hormones. Then it can be confirmed that the woman is in a state of true menopause.

Few Reasons Why You Should Have Sex During Menstruation

Many people, both men and women, find sex during menstruation disgusting. But the truth is that there is no real reason for that, in fact sex during menstruation can sometimes be even better.

Many women during menstruation are more aroused and they say that sex during menstruation is better for them. The direct reason for this is the increased bleeding of the uterus. In addition, menstruation leads to certain hormonal changes in the body which causes increased desire for sexual intercourses in some women. Some experts suggest that the fact that many people think that sex during menstruation should not be practiced and that it is not appropriate to do it, can cause counter effect – people will be even more tempted to try it. Besides that, the vagina is constantly moisturized during menstruation making the penetration of the penis very easy. This makes men enjoy sex even more. Those men who don’t like foreplay, will find this situation very useful because they can skip the whole process.

During menstruation women usually feel cramps and tension in the stomach but with the help of an orgasm they can ease all types of pain. On the other hand, don’t rush to have sex if the cramps and the tension in the stomach are very strong because you won’t be able to enjoy sex at all. Doctors advise women that are suffering from menstrual pain or women that want to prevent menstrual pain to increase their physical activity and sex is of course more than good physical activity because it will relax the vaginal muscles. Furthermore, orgasm triggers release of endorphins, hormones that will temporarily remove pain and discomfort. Because of the more intensive squeezing of the uterus during sex, a greater amount of blood is released through the vagina. This means that in some cases sex during menstruation can shorten the number of days of menstruation.

Some women have menstrual periods that last up to seven days. This can be a very long period for couples that are used to have frequent sex and the real question is why they should wait. That’s why they should use the menstrual period to improve their techniques or try some new things that they’ve missed before. These new things can be practiced especially during the period of the day when the menstruation is stronger. Try some other types of sex and forget about vaginal sex. Try some new oral pleasures, maybe stimulation with the hands. Focus on hugging and kissing, and practice sex when the menstrual bleeding is not so intensive.

Another good reason for having sex during menstruation is the lower possibility of conception. Of course, this doesn’t mean that there is no chance of conception at all. The biggest risk of conception is during ovulation and that’s the period right between two menstruations. Most women don’t have ovulation during menstruation and that’s why the chance of conception during this period is minimal or in some cases impossible.

How to Use Birth Control Pills

If you are not familiar with oral hormonal contraceptives, the best thing to do before using them is to consult with your doctor.

There are many types and brands of oral contraceptives but what is common for all of them is that they usually include 21 pills in one package and they also have the number of days and weeks starting from 1 to 21 marked next to the pills. The birth control pills should be taken on the first day of menstruation in case the menstruation before where regular and proper. In this way the women will be protected from unwanted pregnancy starting from day one. In cases of heavy menstrual bleeding, the best thing is to start using these pills starting from the fifth day of menstruation. The fact is that birth control pills can increase the level of bleeding and intensify the menstruation and that is why it is better to be cautious in these cases. If the pills are taken from day 5 for the first time, full contraceptive protection will be present starting from the second cycle of taking of these oral contraceptives.

If the birth control pills are marked with days of the week, then try to balance the intake from the day you’ve got your period. Let’s explain this with an example. If the first day of your menstruation started on Thursday, start the process by taking the pill that is labeled as Thursday (usually it is shorten to Thu). In case the pills are marked with numbers take the pill marked with number one. Keep taking pills daily and remember to respect the instructions until you reach number 21. When you are out of pills, it is necessary to take a break that lasts for one week. In this period you will notice bleeding that usually appears a couple of days after you have stopped taking the pills. After these break, start using the pills once again starting from the same day as previously. In our example this means Thursday. Disregard the bleeding and remember that if you want this to work you have to start again after one week exactly. It is highly recommended to take the pills in the same period of the day, so you can take them after 24 hours exactly. If you stick to the instructions, the protection from unwanted pregnancy applies even for the period when you are making a break.

However there are two factors that can make these sex pills less effective no matter how regular you take these pills.

Diarrhea and strong vomiting in the first hours after taking a pill can certainly lower the effectiveness.

Mixing these pills with antibiotics can also make them less effective. So try to avoid antibiotics whenever it is possible.

If you have forgotten to take a pill and there are less than 12 hours from the time when you had to take it, the pill should be taken as soon as possible. The next pill should be taken as scheduled before.

If you have missed to take a pill for more than 12 hours, the effects of the pills will be reduced, but you should however take the pill as soon as possible and continue with the schedule.