Outline Definition of Terms Menstruation Menarche Menopause Phases of Menstrual Cycle FollicularOvulation Luteal

OutlineCycle Abnormalities and Disorder Ovulation OligoovulationAnovulationMenstruationHypomenorrheaPolymenorrheaMetrorrhagia MenorrhagiaOligomenorrhea Amenorrhea

Theres no such thing as permanent in this world except

MenstruationThe terms "menstruation" and "menses" are derived from theLatinmensis(month), which in turn relates to theGreek mene(moon).

menstrual bleeding,menses,catameniaor aperiod.

The flow of menses normally serves as a sign that a woman is not pregnant.

Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal).

The averageblood lossduring menstruation is 35 milliliters with 1080 ml considered normal.Menarche The beginning of the menstrual function

The average age of menarche in humans is 1213 years, but is normal anywhere between ages 8 and 16.

Factors such as heredity, diet and overall health can accelerate or delay menarche.

MenopauseThe cessation of menstrual cycles at the end of a woman's reproductive period .

The average age of menopause in women is 52 years, with anywhere between 45 and 55 being common.

Menopause before age 45 is consideredprematurein industrialized countries.

The age of menopause is largely a result of genetics; however, illnesses, certain surgeries, or medical treatments may cause menopause to occur earlier.

Menstrual cycle thephysiological changes that can occur in fertilewomenfor the purposes of sexual reproductionandfertilization

under the control of theendocrine system, necessary forreproduction

Phases of Menstrual CycleA. Follicular or proliferative phase a hormone causes the lining of the uterus to grow, or proliferate, during this time.rise infollicle stimulating hormone(FSH) during the first days of the cycle, a fewovarian folliclesare stimulated.As they mature, the follicles secrete increasing amounts ofestradiol, anestrogenThe estrogens initiate the formation of a new layer ofendometriumin the uterus, histologically identified as the proliferative endometrium. The estrogen also stimulatescryptsin thecervixto produce fertile cervical mucus, which may be noticed by women practicingfertility awareness.

Ovulation In crease levels of Luteinizing Hormone Matures the egg and weakens the wall of the follicle in the ovary, causing the fully developed follicle to release itssecondary oocyte The secondary oocyte promptly matures into anootidand then becomes a matureovum. The mature ovum has a diameter of about 0.2mm.Which of the two ovariesleft or rightovulates appears essentially random; no known left and right co-ordination exists.[Occasionally, both ovaries will release an egg; if both eggs are fertilized, the result isfraternal twinsOvulationAfter being released from the ovary and into the peritoneal space, the egg is swept into thefallopian tubeby thefimbria, which is a fringe of tissue at the end of each fallopian tube. After about a day, an unfertilized egg will disintegrate or dissolve in the fallopian tube.Fertilization by aspermatozoon, when it occurs, usually takes place in theampulla, the widest section of the fallopian tubes. A fertilized egg immediately begins the process ofembryogenesis or development. The developing embryo takes about three days to reach the uterus and another three days to implant into the endometrium. It has usually reached theblastocyst stage at the time of implantation.In some women, ovulation features a characteristic pain calledmittelschmerz (German term meaningmiddle pain).The sudden change in hormones at the time of ovulation sometimes also causes light mid-cycle blood flow.

Ovulation

Luteal phasesecretory phase

after ovulation, theres a significant production of Progesterone

Progesterone plays a vital role in making theendometriumreceptive toimplantationof theblastocystand supportive of the early pregnancy; it also has the side effect of raising the woman'sbasal body temperature.

After ovulation, thepituitary hormonesFSH and LH cause the remaining parts of the dominant follicle to transform into the corpus luteum, which produces progesterone. The increased progesterone in the adrenals starts to induce the production of estrogen. The hormones produced by the corpus luteum also suppress production of the FSH and LH that the corpus luteum needs to maintain itself. Consequently, the level of FSH and LH fall quickly over time, and the corpus luteum subsequently atrophies.

Falling levels of progesterone trigger menstruation and the beginning of the next cycle. From the time of ovulation until progesterone withdrawal has caused menstruation to begin, the process typically takes about two weeks, with 14 days considered normal. For an individual woman, the follicular phase often varies in length from cycle to cycle; by contrast, the length of her luteal phase will be fairly consistent from cycle to cycle.

The loss of the corpus luteum can be prevented by fertilization of the egg; the resultingembryoproduceshuman chorionic gonadotropin(hCG), which is very similar to LH and which can preserve the corpus luteum. Because the hormone is unique to the embryo, mostpregnancy testslook for the presence of hCG.

Cycle abnormalities and disordersInfrequent or irregular ovulation is calledoligoovulation.The absence of ovulation is calledanovulation. Normal menstrual flow can occur without ovulation preceding it: an anovulatory cycle. Cycle abnormalities and disordershypomenorrhea - Very little flow (less than 10 ml)polymenorrhea -Regular cycles with intervals of 21 days or fewermetrorrhagia - frequent but irregular menstruationmenorrhagia -Sudden heavy flows or amounts greater than 80 mlmenometrorrhagia -Heavy menstruation that occurs frequently and irregularlyoligomenorrhea -The term for cycles with intervals exceeding 35 daysAmenorrhea -refers to more than three to sixmonths without menses (while not being pregnant) during a woman's reproductive years.

Important to remember women arefertilefor about 2448 hours around the time of ovulation. Progesterone levels remain high unless the egg goes unfertilized, in which case the egg is re-absorbed and progesterone levels fall. In this event, progesterone levels continue to fall until day 28, when progesterone reaches its lowest level, menstruation occurs, and the cycle repeats. This turning point almost always occurs 14 days after ovulation.

Review Denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal). Eumenorrhea The averageblood lossduring menstruation 35 milliliters with 1080 ml considered normalReviewbeginning of the menstrual functionMenarcheThe cessation of menstrual cycles at the end of a woman's reproductive period .Menopausethephysiological changes that can occur in fertilewomenfor the purposes of sexual reproductionandfertilizationMenstrual Cycle

Review The lining of the uterus grow Follicular Increase levels of Progesterone Luteal increased libido ovulation Experience middle pain Ovulation

Review** Increase estrogen Follicular Decrease FSH Luteal increased LH ovulation It causes light mid cycle blood flow Ovulation

QuestionWhats the Essence of being a woman?

Infertilitymeans not being able to get pregnant after one year of trying or, six months, if a woman is 35 or older. women who can get pregnant but are unable to stay pregnant may also be infertile.

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

What causes infertility in men?

varicocele (VAIR-ih-koh-seel). - This happens when the veins on a man's testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.

Movement of the sperm.- This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example,cystic fibrosisoften causes infertility in men.

What increases a man's risk of infertility?

Heavy alcohol use

DrugsRadiationToxinSmokingMumps

What increases a man's risk of infertility?

heavy alcohol usedrugsenvironmental toxins, including pesticides and leadsmoking cigaretteshealth problems such asmumps, serious conditions like kidney disease, or hormone problemsradiation treatmentandchemotherapy forcancerage

W hat causes infertility in women?

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.Ovulation problems are often caused by polycystic ovarian syndrome(PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman's ovaries stop working normally before she is 40. POI is not the same as earlymenopause.

Less common causes of fertility problems in women include:

blocked Fallopian tubes due topelvic inflammatory disease ,endometriosis, or surgery for anectopic pregnancyphysical problems with the uterusuterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.

What things increase a woman's risk of infertility?

agestresspoor dietathletic trainingbeingoverweightor underweightsmokingexcess alcohol usesexually transmitted infections (STIs)health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency

Aging decreases a woman's chances of having a baby in the following ways:

Her ovaries become less able to release eggs.She has a smaller number of eggs left.Her eggs are not as healthy.She is more likely to have health conditions that can cause fertility problems.She is more likely to have amiscarriage

Some common tests of fertility in women include:

Hysterosalpingography (HIS-tur-oh-sal-ping-GOGH-ru-fee):This is an X-ray of the uterus and Fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the X-ray. Doctors can then watch to see if the dye moves freely through the uterus and Fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the Fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.

Laparoscopy (lap-uh-ROS-kuh-pee):A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, Fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis bylaparoscopy.

Doctors oftentreat infertility in menin the following ways:

Sexual problems:Doctors can help men deal withimpotenceor premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.Too few sperm:Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.Sperm movement:Sometimes semen has no sperm because of a block in the man's system. In some cases, surgery can correct the problem.In women, some physical problems can also be corrected with surgery.

What medicines are used to treat infertility in women?

Clomiphene citrate (Clomid):This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.Human menopausal gonadotropin or hMG (Repronex, Pergonal):This medicine is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.Follicle-stimulating hormone or FSH (Gonal-F, Follistim):FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.

Clomifene CitrateGonadotropin-releasing hormone (Gn-RH) analog:These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.Metformin (Glucophage):Doctors use this medicine for women who haveinsulin resistanceand/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.Bromocriptine (Parlodel):This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.

RememberMany fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

Review Infertility means not being able to get pregnant after one year of trying or, six months, if a woman is 35 or older. True What causes infertility in men?/women? What increases a mans risk of infertility?/ women? How does aging affect a womans chance of having a baby

Review** What are the common tests of fertility in women? What medicines are used to treat infertility in women? What is the side effect of fertility drugs?

Description:OVA-MIT belongs to the triphenethylene clans of compound derived from diethylstilbetrol which displays a variety of estrogenic and anti-estrogenic activities.

OVA-MIT is used primarily in ovarian stimulation in female infertility due to anovulation (e.g. due to polycysticovarian syndrome).

Pharmacological Effects:OVA-MIT competitively blocks estradiol binding to its receptor but the specific pharmacological activity it produces depends upon the specific tissues and the cellular end point measured.

Initial animal studies with clomiphene citrate showed slight estrogenic activity, but the most striking effect was the inhibition of the pituitarys gonadotropic function. In both male and female animals, Clomiphene citrate acted as contraceptive. In contrast, the most prominent effect in women was enlargement of ovaries and induced ovulation in many patients with amenorrhea and dysfunctional bleeding with anovulatory cycles.

MECHANISM OF ACTION:OVA-MIT Clomiphene citrate binds with estrogen receptor and prevents the binding of estrogens.OVA-MIT stimulates ovulation in women with an intact hypothalmic-pituitary-ovarian axis and adequate endogenous estrogens who have failed to ovulate.OVA-MIT also has been used in men to stimulate gonadotroropin release and enhance spermatogenesis.

Composition:50 mg Clomiphene Citrate

Action:- a non-steroidal agent that stimulates pituitary gonadotropic hormones, which stimulate the maturation and endocrine activity of the ovarian follicle

Indications:- for the treatment of ovulatory failure in women desiring pregnancy- oligospermia (low sperm count)

Clomiphene CitrateOVA-MIT

ABSORPTION & EXCRETION:OVA-MIT clomiphene citrate is well absorbed following oral administration and eliminated primarily in the feces and to lesser extent, in the urine.The half-life is 5-7 days.

DOSAGE & ADMINISTRATION:The usual dose of OVA-MIT is 50mg daily for 5 days, starting on or about 5th day of menstrual cycle or at any time if there is amenorrhea.

If ovulation does not occur, a course of 100mg daily for 5 days may be given.

In oligospermic patients, recommended dosage is 25mg once daily for 60-90 days.CONTRAINDICATIONS:

Patients with liver disease or a history of liver dysfunction, endometrial carcinoma, or ovarian cyst (other than polycystic ovary), undiagnossed abnormal uterine bleeding.

Manufactured by: Remedica Ltd., CyprusAvailability and Price:Each tablet contains 50 mg clomiphene citrateA VERY AFFORDABLE PRICE of Php 99.85/tabPhp 998.50/Box of 10sAvailable in ALL Mercury Drug and Watsons outlets

Target Doctors OB-Gynecologist Urologist FM IMComparative Price AnalysisBRAND NAMEPRICEPRICE DIFFERENCEClomid244.75144.90Clostil190.0090.15Clomiphene Generic178.5078.65Ovamit99.85

CLOMIPHENE CITRATEOVA-MIT50mg tablet

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