How the menstrual cycle works

How the menstrual cycle works
Hapangama and Bulmer (2016) say that the menstrual cycle has different stages. The follicular or growing process is the first step. During this time, estrogen is the main hormone that is made. In the early steps of the phase, the Follicular Stimulating Hormone (FSH) goes up, which makes the hormone rise. The goal is to make the uterus’s uterine layer grow. It starts on day 0 and goes on for 14 days. As this phase nears its end, the anterior pituitary gland gets news that isn’t good.

Getting an egg is the next step. This happens 14 days before a woman’s period if her cycle is 28 days. Due to the high amounts of estrogen, negative feedback causes FSH and luteinizing hormone (LH) to be released. This is what causes the LH level to rise. This causes the follicles to break, and a developed oocyte is then released. At the end of this time, the cervix changes, and the amount of estrogen drops. (Thiyagarajan et al., 2019)

The luteal or productive phase comes next. Between 14 and 28 days. Progesterone is the most common hormone. It is made by the LH, and its main job is to get the corpus luteum and uterus ready for implantation. As this phase finishes, the amount of LH and FSH drops. (Reavey et al., 2019). If pregnancy happens, the level of progesterone stays the same. If it doesn’t happen, the level of hormones goes down because of negative feedback. This means that the growth of the endometrium can’t be kept up, which breaks down the endometrium and causes the period. It can happen anywhere from day 0 to day 5 of the next monthly cycle. If you lose more than 80ml of blood, that’s not normal. (Hapangama & Bulmer, 2016).

Why the cycle doesn’t work right

Most likely, the irregular cycle is caused by hormone changes during puberty. Hormonal changes in teens can cause their periods to be irregular and heavy in the beginning. Also, it’s not easy to figure out why teenagers have heavy, unpredictable periods, but multiple things have been linked to this problem. There could be a pelvic infection, uterine fibroids, or polyps, so it’s best to do a pelvic check. (Sasaki, 2017).

Additional Questions

Examine for anemia, which could be caused by the heavy bleeding, by asking about lower stomach pain, the number of pads she changes, and how tired she is. (Sasaki, 2017).

How to Understand a Pelvic Exam

I will tell the patient that the process is painful, but that it will help us figure out why she is bleeding a lot and having cycles that don’t happen on time. I will also tell her that the process doesn’t hurt and doesn’t take long. It’s important for figuring out what’s wrong and doesn’t take much time. (Taylor et al., 2017).

Management Plan

A pelvic check will be done to rule out pelvic infections, endometriosis, fibroids, or cancer. The treatment will depend on what the pelvic check shows. The teen can also get help from a counselor, which at her age can be very upsetting. Teenagers can also be told that when their periods start at age 13, they may seem to come at odd times and last longer than usual because their hormones are out of whack. (Sasaki, 2017).

References

Hapangama, D. K., & Bulmer, J. N. (2016). Pathophysiology of heavy menstrual bleeding. Women’s Health, 12(1), 3-13.

Reavey, J. J., Maybin, J. A., & Critchley, H. O. (2019). Physiology of menstruation. Inherited Bleeding Disorders in Women, 29-44.

Sasaki, K. J. (2017). Menstruation Disorders in Adolescents. Medsacpe. Diambil, 25.

Taylor, G. A., McDonagh, D., & Hansen, M. J. (2017). Improving the pelvic exam experience: a human-centered design study. The Design Journal, 20(sup1), S2348-S2362.

Thiyagarajan, D. K., Basit, H., & Jeanmonod, R. (2019). Physiology, Menstrual Cycle. In StatPearls [Internet]. StatPearls Publishing.

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