Physiology of the Menstrual Cycle

Physiology of the Menstrual Cycle
According to Hapangama & Bulmer (2016), the menstrual cycle occurs in various phases. The first phase is the follicular or proliferative phase. In this phase, the primary hormone secreted is estrogen. The hormone increases due to the upregulation of the Follicular stimulating hormone (FSH) in the initial stages of the phase. The purpose is to grow the endometrial layer of the uterus. It starts on day zero to day 14. As this phase nears the end, negative feedback is sent to the anterior pituitary gland.

Ovulation is the next phase. This occurs 14 days prior to the menses in women having a regular 28-day cycle. Due to the high estrogen levels, negative feedback leads to the secretion of FSH and luteinizing hormone (LH), which causes the LH surge. This leads to the breakage of the follicles, and a mature oocyte is released. Changes occur to the cervix, and levels of estrogen reduced towards the end of this phase (Thiyagarajan et al., 2019)

The next phase is the luteal or secretory phase. Occurs from 14 to 28 day. The common hormone is progesterone, stimulated by the LH, and its primary function is to prepare the corpus luteum and endometrium for possible implantation. As this phase ends, LH and FSH levels are reduced (Reavey et al., 2019). If pregnancy occurs, the level of progesterone is maintained; however, if it does not occur, negative feedback is sent to reduce the level of the hormones. This means that the endometrium growth cannot be sustained, which leads to the degradation of the endometrium, which is the menses. It occurs from day zero to day 5 of the next menstrual cycle and is variable. A loss of more than 80ml of blood considered abnormal (Hapangama & Bulmer, 2016).

Cause of the Irregular Cycle

The most likely cause of the irregular cycle is hormone imbalances in adolescence. Hormonal imbalances can lead to irregular and heavy menses in a various adolescent at the initial stages. Additionally, other causes of irregular heavy menstrual bleeding in adolescents are always not easy to determine, but multiple factors have been linked. Pelvic infections, uterine fibroids, and polyps can be a cause; hence it is advised to conduct a pelvic exam (Sasaki, 2017).

Additional Questions

Questions on lower abdominal pain, the number of pads she is changing, and questions on fatigue assess possible anemia caused by the heavy bleeding exam (Sasaki, 2017).

Explanation on Pelvic Exam

I will tell the patient that the procedure is quite uncomfortable though it will help us determine the cause of the heavy bleeding and irregular cycle. Additionally, I will explain to her that the procedure is short and does not take a lot of time, and it’s essential for diagnosing the underlying problem, and it doesn’t hurt (Taylor et al., 2017).

Management Plan

The plan will be to conduct a pelvic exam to rule out any pelvic infections, endometriosis, fibroids, or cancer. The findings of the pelvic exam will dictate the management. Additionally, the teenager can be counseled, which can be very stressful for her at this age. The teenage can also be educated that at the beginning of the menses at age 13, the periods may seem to be irregular and some prolonged due to the imbalances in the hormones (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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