Inligting

14.7: Menstruele siklus - Biologie

14.7: Menstruele siklus - Biologie



We are searching data for your request:

Forums and discussions:
Manuals and reference books:
Data from registers:
Wait the end of the search in all databases.
Upon completion, a link will appear to access the found materials.

Taboe -onderwerp

Die banier in Figuur (PageIndex{1}) is in 'n 2014-optog in Uganda gedra as deel van die viering van Menstruele Higiënedag. Menstruele higiënedag is 'n bewusmakingsdag op 28 Mei van elke jaar wat daarop gemik is om wêreldwyd bewus te maak van menstruasie en menstruele higiëne. Om goeie menstruele higiëne te handhaaf is moeilik in ontwikkelende lande soos Uganda as gevolg van taboes op die bespreking van menstruasie en die gebrek aan beskikbaarheid van menstruele higiëne produkte. Swak menstruele higiëne kan op sy beurt lei tot verleentheid, agteruitgang en reproduktiewe gesondheidsprobleme by vroue. 28 Mei is as Menstruele Higiënedag gekies weens die simboliek daarvan. Mei is die vyfde maand van die jaar wat die vyf dae van bloeding gedurende menstruasie elke maand simboliseer. Die 28ste dag is gekies omdat die menstruele siklus gemiddeld ongeveer 28 dae is.

Wat is die menstruele siklus?

Die menstruele siklus verwys na natuurlike veranderinge wat elke maand gedurende die voortplantingsjare in die vroulike voortplantingstelsel plaasvind. Die siklus is nodig vir die produksie van eiers en die voorbereiding van die baarmoeder vir swangerskap. Dit behels veranderinge in beide die eierstokke en die baarmoeder en word beheer deur pituïtêre en ovariale hormone. Dag 1 van die siklus is die eerste dag van die menstruasieperiode, wanneer bloeding vanaf die baarmoeder begin as die opgeboude endometrium wat die baarmoeder beklee, afgestort word. Die endometrium bou weer op gedurende die res van die siklus, net om weer tydens die begin van die volgende siklus afgeskei te word indien swangerskap nie plaasvind nie. In die eierstokke sluit die menstruele siklus die ontwikkeling van 'n follikel, ovulasie van 'n sekondêre oösiet en die degenerasie van die follikel in as swangerskap nie plaasvind nie. Beide baarmoeder- en eierstokveranderinge tydens die menstruele siklus word oor die algemeen in drie fases verdeel, hoewel die fases nie dieselfde is in die twee organe nie.

Menarche en menopouse

Die vroulike voortplantingsjare word afgebaken deur die begin en stop van die menstruele siklus. Die eerste menstruasieperiode vind gewoonlik plaas rondom 12 of 13 jaar oud, 'n gebeurtenis wat bekend staan ​​as menarche. Daar is aansienlike variasie tussen individue in die ouderdom van menarge. Dit kan soms so vroeg as die ouderdom van agt jaar of so laat as 16 jaar voorkom en steeds as normaal beskou word. Die gemiddelde ouderdom is oor die algemeen later in die ontwikkelende wêreld, en vroeër in die ontwikkelde wêreld. Hierdie variasie word vermoedelik grootliks toegeskryf aan voedingsverskille.

Die staking van menstruele siklusse aan die einde van 'n vrou se voortplantingsjare word genoem menopouse. Die gemiddelde ouderdom van menopouse is 52 jaar, maar dit kan normaalweg op enige ouderdom tussen ongeveer 45 en 55 jaar voorkom. Die ouderdom van menopouse wissel as gevolg van 'n verskeidenheid biologiese en omgewingsfaktore. Dit kan vroeër voorkom as gevolg van sekere siektes of mediese behandelings.

Variasie in die menstruele siklus

Die lengte van die menstruele siklus - sowel as die fases daarvan - kan aansienlik verskil, nie net tussen verskillende individue nie, maar ook van maand tot maand vir 'n gegewe persoon. Die gemiddelde tydsduur tussen die eerste dag van een menstruasieperiode en die eerste dag van die volgende menstruasieperiode is 28 dae, maar dit kan wissel van 21 dae tot 45 dae. Siklusse word as gereeld beskou wanneer 'n vrou se langste en kortste siklusse met minder as agt dae verskil. Die menstruasieperiode self is gewoonlik ongeveer vyf dae lank, maar dit kan in lengte wissel van ongeveer twee dae tot sewe dae.

Ovariale siklus

Die gebeure van die menstruele siklus wat in die eierstokke plaasvind, vorm die ovariale siklus. Dit bestaan ​​uit veranderinge wat in die follikels van een van die eierstokke voorkom. Die ovariale siklus word in die volgende drie fases verdeel: die follikulêre fase, ovulasie en luteale fase. Hierdie fases word geïllustreer in Figuur (PageIndex{2}).

Follikulêre fase

Die follikulêre fase Dit is die eerste fase van die ovariale siklus. Dit duur gewoonlik ongeveer 12 tot 14 dae vir 'n 28-dae menstruele siklus. Gedurende hierdie fase word verskeie ovariale follikels gestimuleer om te begin volwasse word, maar gewoonlik word slegs een - die Graafse follikel genoem - heeltemal volwasse sodat dit gereed is om 'n eiersel vry te stel. Die ander volwasse follikels hou op om te groei en disintegreer. Follikulêre ontwikkeling vind plaas as gevolg van 'n styging in die bloedvlak van follikelstimulerende hormoon (FSH), wat deur die pituïtêre klier afgeskei word. Die volwasse follikel stel estrogeen vry, waarvan die vlak regdeur die follikulêre fase styg. Jy kan hierdie en ander veranderinge in hormoonvlakke wat tydens die menstruele siklus voorkom in die grafiek in Figuur (PageIndex{3}) sien.

Ovulasie

Ovulasie is die tweede fase van die ovariale siklus. Dit vind gewoonlik plaas rondom dag 14 van 'n 28-dae menstruele siklus. Tydens hierdie fase bars die Graafse follikel en stel sy eiersel vry. Ovulasie word gestimuleer deur 'n skielike styging in die bloedvlak van luteïniserende hormoon (LH) vanaf die pituïtêre klier. Dit word die LH -oplewing genoem. Jy kan die LH-oplewing in die boonste hormoongrafiek hierbo sien. Die LH-oplewing begin gewoonlik rondom dag 12 van die siklus en duur vir 'n dag of twee. Die oplewing in LH word veroorsaak deur 'n voortdurende toename in estrogeen vanaf die volwasse follikel in die ovarium. Tydens die follikulêre fase onderdruk die stygende estrogeenvlak eintlik LH-afskeiding deur die pituïtêre. Teen die tyd dat die follikulêre fase egter sy einde nader, bereik die vlak van estrogeen 'n drempelvlak waarbo hierdie effek omgekeer word, en estrogeen stimuleer die vrystelling van 'n groot hoeveelheid LH. Die oplewing in LH maak die eiersel volwasse en verswak die wand van die follikel, wat veroorsaak dat die ten volle ontwikkelde follikel sy sekondêre oösiet vrystel.

Luteale fase

Die luteale fase is die derde en laaste fase van die ovariale siklus. Dit duur gewoonlik ongeveer 14 dae in 'n 28-dae menstruele siklus. Aan die begin van die luteale fase veroorsaak FSH en LH dat die Graafse follikel wat die eiersel ovuleer het omskep in 'n struktuur wat 'n corpus luteum genoem word. Die corpus luteum skei progesteroon af, wat op sy beurt FSH- en LH-produksie deur die pituïtêre onderdruk onderdruk en die voortgesette opbou van die endometrium in die baarmoeder stimuleer. Hoe hierdie fase eindig, hang daarvan af of die eiersel bevrug is of nie.

  • As bevrugting nie plaasgevind het nie, veroorsaak die dalende vlakke van FSH en LH tydens die luteale fase die corpus luteum atrofie, sodat die produksie van progesteroon afneem. Sonder 'n hoë vlak van progesteroon om dit in stand te hou, begin die endometrium afbreek. Teen die einde van die luteale fase kan die endometrium nie meer in stand gehou word nie, en die volgende menstruele siklus begin met die afskeiding van die endometrium (mense).
  • As bevrugting plaasgevind het sodat 'n sigoot vorm en dan verdeel om 'n blastosist te word, produseer die buitenste laag van die blastosist 'n hormoon genaamd menslike choriongonadotropien. Hierdie hormoon is baie soortgelyk aan LH en bewaar die corpus luteum. Die corpus luteum kan dan voortgaan om progesteroon af te skei om die nuwe swangerskap te handhaaf.

Uteriene siklus

Die gebeure van die menstruele siklus wat in die baarmoeder plaasvind maak die baarmoeder siklus. Hierdie siklus bestaan ​​uit veranderinge wat hoofsaaklik in die endometrium voorkom, wat die laag weefsel is wat die baarmoeder beklee. Die baarmoedersiklus word in die volgende drie fases verdeel: menstruasie, proliferatiewe fase en sekretoriese fase. Hierdie fases word geïllustreer in Figuur (PageIndex{4}).

Menstruasie

Menstruasie (ook genoem die menstruasieperiode of menstruasie) is die eerste fase van die baarmoedersiklus. Dit vind plaas as bevrugting nie tydens die voorafgaande menstruele siklus plaasgevind het nie. Tydens menstruasie ontaard die endometrium van die baarmoeder, wat tydens die voorafgaande siklus opgebou het, en word uit die baarmoeder gestort. Die gemiddelde bloedverlies tydens menstruasie is ongeveer 35 ml. Die bloedvloei gaan dikwels gepaard met baarmoederkrampe, wat by sommige mense erg kan wees.

Proliferatiewe fase

Die proliferatiewe fase is die tweede fase van die baarmoeder siklus. Gedurende hierdie fase veroorsaak estrogeen wat deur selle van die volwasse ovariumfollikel afgeskei word die voering van die baarmoeder om te groei, of te prolifereer. Estrogeen stimuleer ook die serviks van die baarmoeder om groter hoeveelhede dunner slym af te skei wat sperm kan help om deur die serviks en in die baarmoeder te swem, wat bevrugting meer waarskynlik maak.

Sekretoriese fase

Die sekretoriese fase is die derde en laaste fase van die baarmoedersiklus. Gedurende hierdie fase stimuleer progesteroon wat deur die corpus luteum in die ovarium geproduseer word verdere veranderinge in die endometrium sodat dit meer ontvanklik is vir inplanting van 'n blastosist. Byvoorbeeld, progesteroon verhoog bloedvloei na die baarmoeder en bevorder baarmoederafskeidings. Dit verminder ook die kontraktiliteit van gladdespierweefsel in die baarmoederwand.

My liggaam: Menstrueerders, Nie Menstruerende Vroue nie

Binne die veld van kritiese menstruasiestudies moet ons aandag gee aan ons uitbeeldings van menstruasie en menstruasie, en die kennis wat ons produseer in die strewe om menstruasie te de-stigmatiseer. Nie alle vroue menstrueer nie, byvoorbeeld transvroue, postmenopousale vroue, swanger vroue en diegene wat amenorree ervaar, en nie almal wat menstrueer is vroue nie, byvoorbeeld transmans. Ervarings van menstruasie later in die lewe verskil ook tussen menstrueerders. Sommige ly nie aan hul tydperke in direkte verband met hul geslagsidentiteit nie. Ander doen dit, aangesien hulle disidentifiseer met die liggaam as geheel en/of met sekere liggaamsdele soos die geslagsdele of die baarmoeder, of met die liggaamlike funksie van menstruasie. Hierdie lyding hou soms verband met geslagsdisforie. Testosteroonbehandelings is 'n metode wat sommige trans-menstrueerders gebruik om van ongewenste bloeding ontslae te raak. Die voorkoming van die menstruasieperiode is nie noodwendig die hoofrede vir die gebruik van testosteroon nie, maar dit kan een van verskeie gewenste uitkomste wees. Menstruatore is van 'n verskeidenheid geslagsidentiteite (ver verder as diegene wat as trans identifiseer) en dus kan menstruasie nie enkelvoudig gelykgestel word aan cis/vroulikheid nie.

Resensie

1. Wat is die menstruele siklus?

2. Waarom is die menstruele siklus nodig sodat swangerskap kan plaasvind?

3. Watter organe is betrokke by die menstruele siklus? Watter hormone beheer die siklus?

4. Identifiseer die twee groot gebeurtenisse wat die begin en einde van die voortplantingsperiode by wyfies aandui. Wanneer vind hierdie gebeurtenisse gewoonlik plaas?

5. Bespreek die gemiddelde lengte van die menstruele siklus en menstruasie, asook variasies wat as normaal beskou word.

6. Definieer die ovariale siklus.

7. Som die fases van die ovariale siklus op.

8. Vergelyk en kontrasteer gebeure wat in die eierstokke en baarmoeder voorkom, afhangende van of 'n eiersel tydens die menstruele siklus bevrug word of nie.

9. Definieer die baarmoeder siklus.

10. Gee 'n oorsig van die fases van die baarmoedersiklus.

11. As die LH-oplewing nie in 'n menstruele siklus plaasgevind het nie, wat dink jy sal gebeur? Verduidelik jou antwoord.

12. Gee een rede waarom FSH- en LH-vlakke in die luteale fase van die menstruele siklus daal.

13. Wat word die follikel wat die ovuleerde eier gehuisves het in die luteale fase van die menstruele siklus?

14. Waar of Onwaar: Dag 1 van die menstruele siklus is wanneer die sekondêre oösiet uit sy follikel vrygestel word.

15. Waar of onwaar: Die sekretoriese fase van die baarmoedersiklus stem oor die algemeen in lyn met die luteale fase van die ovariale siklus.

Verken meer

Het jy al ooit gehoor van premenstruele sindroom, ook bekend as PMS? Kom meer te wete oor wat dit is en hoekom sommige vroue dit kry hier:


Abstrak

'n Ontleding van die uitslae van gevorderde (A) en gewone (O) vlak eksamens het 'n laer slaagsyfer, laer onderskeidingsyfer en laer gemiddelde punt getoon wanneer die eksamens tydens die premenstruum of tydens menstruasie afgelê is. Dit was die opvallendste by meisies wie se menstruele verlies langer as 6 dae voortduur en dié met menstruele siklusse van meer as 31 dae. By 42% van die een-en-negentig meisies, wie se normale menstruele patroon bekend was, het die stres van die O-vlak ondersoeke 'n verandering in hul menstruele siklus veroorsaak. Dit het daartoe gelei dat meer meisies tydens die eksamenweek menstrueer het as wat van hul normale patroon verwag sou word. Die neiging was dat die siklus eerder verleng as verkort word, maar sommige meisies het tydelike amenorree gedurende die eksamenmaand gehad.


Inhoud

Die menstruele siklus sluit die ovariale en uteriene siklus in. Die ovariumsiklus beskryf veranderinge wat in die follikels van die ovarium voorkom, [1] terwyl die baarmoedersiklus veranderinge in die endometriale voering van die baarmoeder beskryf. Beide siklusse kan in fases verdeel word. Die ovariale siklus bestaan ​​uit afwisselende follikulêre en luteale fases, en die uteriene siklus bestaan ​​uit menstruasie, die proliferatiewe fase en die sekretoriese fase. [2] Die menstruele siklus word beheer deur die hipotalamus en die pituïtêre klier in die brein. Die hipotalamus stel gonadotropien-vrystellende hormoon (GnRH) vry, wat veroorsaak dat die nabygeleë anterior pituïtêre klier follikelstimulerende hormoon (FSH) en luteïniserende hormoon (LH) vrystel. Voor puberteit word GnRH in lae bestendige hoeveelhede en teen 'n konstante tempo vrygestel. Na puberteit word GnRH in groot pulse vrygestel, en die frekwensie en grootte daarvan bepaal hoeveel FSH en LH deur die pituïtêre geproduseer word. [3]

Gemeet vanaf die eerste dag van een menstruasie tot die eerste dag van die volgende, verskil die lengte van 'n menstruele siklus maar het 'n mediaan lengte van 28 dae. [4] Die siklus is dikwels minder gereeld aan die begin en einde van 'n vrou se voortplantingslewe. [4] Met puberteit begin 'n kind se liggaam volwasse word tot 'n volwasse liggaam wat in staat is tot seksuele voortplanting die eerste periode (genoem menarche) vind plaas op ongeveer 12 jaar oud en duur ongeveer 30–45 jaar aan. [5] [6] Menstruele siklusse eindig by menopouse, wat gewoonlik tussen 45 en 55 jaar oud is. [7] [8]

Ovariale siklus Redigeer

Tussen menarge en menopouse wissel die menslike eierstokke gereeld af tussen luteale en follikulêre fases gedurende die maandelikse menstruele siklus. [9] Gestimuleer deur geleidelik toenemende hoeveelhede estrogeen in die follikulêre fase, stop afskeidings van bloedvloei en die baarmoedervoering verdik. Follikels in die ovarium begin ontwikkel onder die invloed van 'n komplekse wisselwerking van hormone, en na 'n paar dae word een, of soms twee, dominant, terwyl nie-dominante follikels krimp en sterf. Omtrent die middel van die siklus, sowat 10–12 uur nadat die luteïniserende hormoon (LH) oplewing, [4] stel die dominante follikel 'n oösiet vry, in 'n gebeurtenis wat ovulasie genoem word. [10]

Ná ovulasie leef die oösiet vir 24 uur of minder sonder bevrugting, [11] terwyl die oorblyfsels van die dominante follikel in die ovarium ’n corpus luteum word – ’n liggaam met die primêre funksie om groot hoeveelhede van die hormoon progesteroon te produseer. [12] [a] Onder die invloed van progesteroon verander die baarmoedervoering om voor te berei vir moontlike inplanting van 'n embrio om 'n swangerskap te vestig. Die dikte van die endometrium neem steeds toe in reaksie op toenemende vlakke van estrogeen, wat deur die antrale follikel ('n volwasse ovariumfollikel) in die bloedsomloop vrygestel word. Piekvlakke van estrogeen word op ongeveer dag dertien van die siklus bereik en val saam met ovulasie. As inplanting nie binne ongeveer twee weke plaasvind nie, ontaard die corpus luteum in die corpus albicans, wat nie hormone produseer nie, wat 'n skerp daling in vlakke van beide progesteroon en estrogeen veroorsaak. Hierdie daling veroorsaak dat die baarmoeder sy voering verloor tydens menstruasie dit is ongeveer hierdie tyd dat die laagste vlakke van estrogeen bereik word. [14]

In 'n ovulatoriese menstruele siklus is die ovariale en baarmoedersiklus gelyktydig en gekoördineer en duur tussen 21 en 35 dae in 'n volwasse vrou, met 'n bevolkingsgemiddeld van 27-29 dae. [15] Alhoewel die gemiddelde lengte van die menslike menstruele siklus soortgelyk is aan dié van die maansiklus, is daar geen oorsaaklike verband tussen die twee nie. [16]

Follikulêre fase Wysig

Die eierstokke bevat 'n eindige aantal eierstamselle, granulosa-selle en theca-selle, wat saam primordiale follikels vorm. [12] Na ongeveer 20 weke in swangerskap het sowat 7 miljoen onvolwasse eiers reeds in 'n eierstok gevorm. Dit verminder tot ongeveer 2 miljoen teen die tyd dat 'n meisie gebore word, en 300 000 teen die tyd dat sy haar eerste tydperk kry. Gemiddeld word een eiersel volwasse en word elke maand ná menarge tydens ovulasie vrygestel. [17] Vanaf puberteit word hierdie volwasse tot primêre follikels onafhanklik van die menstruele siklus. [18] Die ontwikkeling van die eiersel word oogenese genoem en net een sel oorleef die verdelings om op bevrugting te wag. Die ander selle word as poolliggame weggegooi, wat nie bevrug kan word nie. [19] Die follikulêre fase is die eerste deel van die ovariale siklus en dit eindig met die voltooiing van die antrale follikels. [9] Meiose (seldeling) bly onvolledig in die eierselle totdat die antrale follikel gevorm word. Gedurende hierdie fase word gewoonlik net een eierstokfollikel ten volle volwasse en maak gereed om 'n eiersel vry te stel. [20] Die follikulêre fase verkort aansienlik met ouderdom, en duur ongeveer 14 dae by vroue van 18–24 jaar in vergelyking met 10 dae by vroue van 40–44. [14]

Deur die invloed van 'n styging in follikelstimulerende hormoon (FSH) gedurende die eerste dae van die siklus, word 'n paar ovariale follikels gestimuleer. Hierdie follikels, wat vir die grootste deel van 'n jaar ontwikkel in 'n proses bekend as follikulogenese, ding met mekaar mee om oorheersing. Almal behalwe een van hierdie follikels sal ophou groei, terwyl een dominante follikel – die een wat die meeste FSH-reseptore het – sal voortgaan tot volwassenheid. Die oorblywende follikels sterf in 'n proses wat follikulêre atresie genoem word. [21] Luteïniserende hormoon (LH) stimuleer verdere ontwikkeling van die ovariumfollikel. Die follikel wat volwassenheid bereik word 'n antrale follikel genoem, en dit bevat die ovum (eiersel). [22]

Die theca-selle ontwikkel reseptore wat LH bind, en in reaksie groot hoeveelhede androsteendion afskei. Terselfdertyd ontwikkel die granulosa-selle wat die volwasse follikel omring, reseptore wat FSH bind, en begin in reaksie androstenedion afskei, wat deur die ensiem aromatase na estrogeen omgeskakel word. Die estrogeen inhibeer verdere produksie van FSH en LH deur die pituïtêre klier. Hierdie negatiewe terugvoer reguleer vlakke van FSH en LH. Die dominante follikel gaan voort om estrogeen af ​​te skei, en die stygende estrogeenvlakke maak die hipofise meer reageer op GnRH vanaf die hipotalamus. Namate estrogeen toeneem, word dit 'n positiewe terugvoersein, wat die pituïtêr meer FSH en LH laat afskei. Hierdie oplewing van FSH en LH vind gewoonlik een tot twee dae voor ovulasie plaas en is verantwoordelik vir die stimulering van die breuk van die antrale follikel en vrystelling van die oösiet. [18] [23]

Ovulasie wysig

Rondom dag veertien word die eiersel uit die eierstok vrygestel. [24] Dit word "ovulasie" genoem, dit vind plaas wanneer 'n volwasse eiersel uit die eierstokfollikels in die fallopiese buis vrygestel word, ongeveer 10–12 uur na die piek in LH-oplewing. [4] Tipies bereik net een van die 15–20 gestimuleerde follikels volle volwassenheid, en net een eiersel word vrygestel. [25] Ovulasie vind slegs in ongeveer 10% van siklusse plaas gedurende die eerste twee jaar na menarge, en teen die ouderdom van 40–50 is die aantal ovariale follikels uitgeput. [26] LH begin ovulasie om en by dag 14 en stimuleer die vorming van die corpus luteum. [2] Na verdere stimulasie deur LH, produseer en stel die corpus luteum estrogeen, progesteroon, relaxin (wat die baarmoeder ontspan deur sametrekkings van die miometrium te inhibeer) en inhibien (wat verdere afskeiding LH inhibeer) en stel dit vry. [22]

Die vrystelling van LH maak die eiersel volwasse en verswak die follikelwand in die ovarium, wat veroorsaak dat die volledig ontwikkelde follikel sy oösiet vrystel. [27] As dit deur 'n sperm bevrug word, verouder die oösiet dadelik tot 'n ootis, wat die ander spermselle blokkeer en 'n volwasse eiersel word. As dit nie deur 'n sperm bevrug word nie, ontaard die oösiet. Die volwasse eier het 'n deursnee van ongeveer 0,1 mm (0,0039 duim), [28] en is die grootste menslike sel. [29]

Watter van die twee eierstokke – links of regs – ovuleer lyk ewekansig [30] geen linker- en regterkoördineringsproses is bekend nie. [31] Soms stel beide eierstokke 'n eiersel vry as albei eiers bevrug word, die gevolg is 'n tweeling. [32] Na vrylating uit die eierstok word die eiersel deur die fimbria in die fallopiese buis ingevee – 'n weefselrand aan die einde van elke fallopiese buis. Na ongeveer 'n dag disintegreer 'n onbevrugte eiersel of los dit op in die fallopiese buis, en 'n bevrugte eiersel bereik die baarmoeder binne drie tot vyf dae. [33]

Bevrugting vind gewoonlik plaas in die ampulla, die breedste gedeelte van die fallopiese buise. 'n Bevrugte eiersel begin onmiddellik die proses van embriogenese (ontwikkeling). Die ontwikkelende embrio neem ongeveer drie dae om die baarmoeder te bereik, en nog drie dae om in die endometrium in te plant. Dit het gewoonlik die blastosist-stadium bereik ten tyde van inplanting: dit is wanneer swangerskap begin. [34] Die verlies van die corpus luteum word deur bevrugting van die eiersel voorkom. Die sinsitiotrofoblast (die buitenste laag van die resulterende embrio-bevattende blastosist wat later die buitenste laag van die plasenta word) produseer menslike choriongonadotropien (hCG), wat baie soortgelyk is aan LH en die corpus luteum bewaar. Gedurende die eerste paar maande van swangerskap, gaan die corpus luteum voort om progesteroon en estrogeen op effens hoër vlakke af te skei as dié by ovulasie. Hierna en vir die res van die swangerskap skei die plasenta hoë vlakke van hierdie hormone af – saam met menslike choriongonadotropien (hCG), wat die corpus luteum stimuleer om meer progesteroon en estrogeen af ​​te skei, wat die menstruele siklus blokkeer. [35] Hierdie hormone berei ook die melkkliere voor vir melk [b] produksie. [35]

Luteale fase Wysig

Die luteale fase, wat ongeveer 14 dae duur, [4] is die finale fase van die ovariale siklus en dit stem ooreen met die sekretoriese fase van die baarmoedersiklus. Tydens die luteale fase veroorsaak die pituïtêre hormone FSH en LH dat die oorblywende dele van die dominante follikel omskep in die corpus luteum, wat progesteroon produseer. [37] [c] Die verhoogde progesteroon begin die produksie van estrogeen veroorsaak. Die hormone wat deur die corpus luteum geproduseer word, onderdruk ook die produksie van die FSH en LH wat die corpus luteum nodig het om homself te onderhou. Die vlak van FSH en LH daal vinnig, en die corpus luteum atrofies. [39] Dalende vlakke van progesteroon veroorsaak menstruasie en die begin van die volgende siklus. Vanaf die tyd van ovulasie totdat progesteroononttrekking veroorsaak het dat menstruasie begin het, duur die proses gewoonlik ongeveer twee weke. Vir 'n individuele vrou verskil die follikulêre fase dikwels in lengte van siklus tot siklus, daarenteen sal die lengte van haar luteale fase redelik konsekwent wees van siklus tot siklus op 10 tot 16 dae (gemiddeld 14 dae). [14]

Baarmoeder siklus Redigeer

Die baarmoedersiklus het drie fases: menstruasie, proliferatiewe en sekretoriese. [40]

Menstruasie Redigeer

Menstruasie (ook genoem menstruele bloeding, menstruasie of 'n tydperk) is die eerste en duidelikste fase van die baarmoedersiklus en vind eers by puberteit plaas. Genoem menarche, die eerste periode vind plaas op die ouderdom van ongeveer twaalf of dertien jaar. [8] Die gemiddelde ouderdom is oor die algemeen later in die ontwikkelende wêreld en vroeër in die ontwikkelde wêreld. [41] In voorbarige puberteit kan dit so vroeg as ouderdom agt jaar voorkom, [42] en dit kan steeds normaal wees. [43] [44]

Menstruasie word elke maand begin deur dalende vlakke van estrogeen en progesteroon en die vrystelling van prostaglandiene, [20] wat die spiraalslagare saamtrek. Dit veroorsaak dat hulle spasmas, saamtrek en opbreek. [45] Die bloedtoevoer na die endometrium word afgesny en die selle van die boonste laag van die endometrium (die stratum functionalis) word van suurstof ontneem en sterf. Later gaan die hele laag verlore en net die onderste laag, die stratum basalis, bly in plek. [20] 'n Ensiem genaamd plasmien breek die bloedklonte in die menstruele vloeistof op, wat die vloei van bloed vergemaklik en die voering van die baarmoeder afbreek. [46] Die bloedvloei duur vir 2–6 dae voort en ongeveer 30–60 milliliter bloed gaan verlore, [15] en is 'n teken dat swangerskap nie plaasgevind het nie. [47]

Die vloei van bloed dien normaalweg as 'n teken dat 'n vrou nie swanger geraak het nie, maar dit kan nie as sekerheid geneem word nie, aangesien verskeie faktore bloeding tydens swangerskap kan veroorsaak. [48] ​​Menstruasie vind gemiddeld een keer per maand plaas vanaf menarge tot menopouse, wat ooreenstem met 'n vrou se vrugbare jare. Die gemiddelde ouderdom van menopouse by vroue is 52 jaar, en dit kom gewoonlik tussen 45 en 55 jaar voor. [49] Menopouse word voorafgegaan deur 'n stadium van hormonale veranderinge wat perimenopouse genoem word. [7]

Eumenorrhea dui op normale, gereelde menstruasie wat ongeveer die eerste 5 dae van die siklus duur. [24] Vroue wat menorragie (swaar menstruele bloeding) ervaar, is meer vatbaar vir ystertekort as die gemiddelde persoon. [50]

Proliferatiewe fase Redigeer

Die proliferatiewe fase is die tweede fase van die baarmoedersiklus wanneer estrogeen die voering van die baarmoeder laat groei en prolifereer. [39] Die laaste deel van die follikulêre fase oorvleuel met die proliferatiewe fase van die baarmoedersiklus. [30] Soos hulle volwasse word, skei die ovariumfollikels toenemende hoeveelhede estradiol, 'n estrogeen, af. Die estrogeen inisieer die vorming van 'n nuwe laag endometrium in die baarmoeder met die spiraal arterioles. [2]

Soos estrogeenvlakke toeneem, produseer selle in die serviks 'n tipe servikale slym [52] wat 'n hoër pH het en minder viskeus is as gewoonlik, wat dit meer vriendelik vir sperm maak. [53] Dit verhoog die kanse op bevrugting, wat rondom dag 11 tot dag 14 plaasvind. [11] Hierdie servikale slym kan opgespoor word as 'n vaginale afskeiding wat oorvloedig is en soos rou eierwitte lyk. [54] Vir vroue wat vrugbaarheidsbewustheid beoefen, is dit 'n teken dat ovulasie dalk op die punt is om plaas te vind, [54] maar dit beteken nie dat ovulasie beslis sal plaasvind nie. [15]

Sekretoriese fase Wysig

Die sekretoriese fase is die finale fase van die baarmoedersiklus en dit stem ooreen met die luteale fase van die ovariale siklus. Tydens die sekretoriese fase produseer die corpus luteum progesteroon, wat 'n belangrike rol speel om die endometrium ontvanklik te maak vir die inplanting van 'n blastosist ('n bevrugte eiersel wat begin groei het). [55] Glikogeen, lipiede en proteïene word in die baarmoeder afgeskei [56] en die servikale slym verdik. [57] In vroeë swangerskap verhoog progesteroon ook bloedvloei en verminder die kontraktiliteit van die gladdespier in die baarmoeder [22] en verhoog die vrou se basale liggaamstemperatuur. [58]

As swangerskap nie plaasvind nie, begin die ovariale en baarmoedersiklus weer van voor af. [46]

Slegs twee derdes van openlik normale menstruele siklusse is ovulatories, dit wil sê siklusse waarin ovulasie plaasvind. [15] Die ander derde het nie ovulasie nie of het 'n kort luteale fase (minder as tien dae [59] ) waarin progesteroonproduksie onvoldoende is vir normale fisiologie en vrugbaarheid. [60] Siklusse waarin ovulasie nie plaasvind nie (anovulasie) is algemeen by meisies wat pas begin menstrueer het en by vroue rondom menopouse. Gedurende die eerste twee jaar na menarge is ovulasie afwesig in ongeveer die helfte van die siklusse. Vyf jaar na menarge vind ovulasie in ongeveer 75% van siklusse plaas en dit bereik 80% in die volgende jare. [61] Anovulatoriese siklusse is dikwels openlik identies aan normaalweg ovulatoriese siklusse. [62] Enige verandering in die balans van hormone kan lei tot anovulasie. Stres, angs en eetversteurings kan 'n daling in GnRH en 'n ontwrigting van die menstruele siklus veroorsaak. Chroniese anovulasie vind plaas by 6-15% van vroue gedurende hul voortplantingsjare. Rondom menopouse lei hormoonterugvoerdisregulering tot anovulatoriese siklusse. Alhoewel anovulasie nie as 'n siekte beskou word nie, kan dit 'n teken wees van 'n onderliggende toestand soos polisistiese ovariumsindroom. [63] Anovulatoriese siklusse of kort luteale fases is normaal wanneer vroue onder stres verkeer of atlete die intensiteit van oefening verhoog. Hierdie veranderinge is omkeerbaar soos die stressors afneem of, in die geval van die atleet, soos sy by die opleiding aanpas. [59]

Alhoewel 'n normale en natuurlike proses [64] ervaar sommige vroue probleme wat voldoende is om hul lewens te ontwrig as gevolg van hul menstruele siklus. [65] Dit sluit in aknee, sagte borste, moegheid en premenstruele sindroom (PMS). [65] [66] Erger probleme soos premenstruele disforiese versteuring word deur 3 tot 8% van vroue ervaar. [4] [67] Dismenorrhea of ​​"periodepyn" [68] kan krampe in die buik, rug of bo-dye veroorsaak wat tydens die eerste paar dae van menstruasie voorkom. [69] Aftakelende periodepyn is nie normaal nie en kan 'n teken wees van iets ernstigs soos endometriose. [70] Hierdie kwessies kan 'n vrou se gesondheid en lewenskwaliteit aansienlik beïnvloed en tydige ingrypings kan die lewens van hierdie vroue verbeter. [71]

Daar is algemene kultureel gekommunikeerde wanopvattings dat die menstruele siklus vroue se buie beïnvloed, depressie of prikkelbaarheid veroorsaak, of dat menstruasie 'n pynlike, skandelike of onrein ervaring is. Dikwels word 'n vrou se normale buivariasie valslik toegeskryf aan die menstruele siklus. Baie van die navorsing is swak, maar daar blyk 'n baie klein toename in gemoedskommelings tydens die luteale en menstruele fases te wees, en 'n ooreenstemmende afname gedurende die res van die siklus. [72] Veranderende vlakke van estrogeen en progesteroon oor die menstruele siklus het sistemiese effekte op aspekte van fisiologie, insluitend die brein, metabolisme en muskuloskeletale stelsel. Die resultaat kan subtiele fisiologiese en waarneembare veranderinge aan vroue se atletiese prestasie wees, insluitend krag, aërobiese en anaërobiese prestasie. [73] Veranderinge aan die brein is ook regdeur die menstruele siklus waargeneem [74] maar vertaal nie in meetbare veranderinge in intellektuele prestasie nie – insluitend akademiese prestasie, probleemoplossing, geheue en kreatiwiteit. [75] Verbeterings in ruimtelike redenasievermoë tydens die menstruasiefase van die siklus word waarskynlik veroorsaak deur afname in vlakke van estrogeen en progesteroon. [72]

By sommige vroue het ovulasie 'n kenmerkende pyn [d] genoem mittelschmerz ('n Duitse term wat beteken middel pyn). Die oorsaak van die pyn word geassosieer met die gebarste follikel, wat 'n klein hoeveelheid bloedverlies veroorsaak. [20]

Selfs wanneer dit normaal is, kan die veranderinge in hormoonvlakke tydens die menstruele siklus die voorkoms van afwykings soos outo-immuun siektes verhoog, [79] wat veroorsaak kan word deur estrogeenverbetering van die immuunstelsel. [4]

Ongeveer 40% van vroue met epilepsie vind dat hul aanvalle meer gereeld in sekere fases van hul menstruele siklus voorkom. Hierdie katameniale epilepsie kan wees as gevolg van 'n daling in progesteroon as dit tydens die luteale fase of rondom menstruasie voorkom, of 'n oplewing in estrogeen as dit tydens ovulasie voorkom. Vroue wat gereelde menstruasie het, kan medikasie net voor en tydens menstruasie neem. Opsies sluit in progesteroonaanvullings, die verhoging van die dosis van hul gereelde antikonvulsiewe middel, of die tydelike toevoeging van 'n antikonvulsiewe middel soos klobazam of asetasoolamied. As dit ondoeltreffend is, of wanneer 'n vrou se menstruele siklus onreëlmatig is, dan is behandeling om die menstruele siklus te stop. This may be achieved using medroxyprogesterone, triptorelin or goserelin, or by sustained use of oral contraceptives. [80] [81]

Hormonal contraception Edit

Hormonal contraceptives prevent pregnancy by inhibiting the secretion of the hormones, FSH, LH and GnRH. Hormonal contraception that contains estrogen, such as combined oral contraceptive pills (COCs, often referred to as birth control pills) stop the development of the dominant follicle and the mid-cycle LH surge and thus ovulation. [82] Sequential dosing and discontinuation of the COC can mimic the uterine cycle and produce bleeding that resembles a period. In some cases, this bleeding is lighter. [83]

Progestin-only methods of hormonal contraception do not always prevent ovulation but instead work by stopping the cervical mucus from becoming sperm-friendly. Hormonal contraception is available in a variety of forms such as pills, patches, skin implants and hormonal intrauterine devices (IUDs). [84]

Most female mammals have an estrous cycle, but only ten primate species, four bat species, the elephant shrews and the spiny mouse have a menstrual cycle. [85] The cycles are the same as in humans apart from the length, which ranges from 21 to 37 days. [86] The lack of immediate relationship between these groups suggests that four distinct evolutionary events have caused menstruation to arise. [87] In species that have a menstrual cycle, ovulation is not obvious to potential mates and there is no mating season. [88] [89] There are four theories on the evolutionary significance of menstruation: [87]


This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original authors and the source are credited.

Brandes JL: Migraine in women. Continuum (Minneap Minn) 2012, 18: 835–852.

Peng KP, Wang SJ: Migraine diagnosis: screening items, instruments, and scales. Acta Anaesthesiol Taiwan 2012, 50: 69–73. 10.1016/j.aat.2012.05.002

Ward TN: Migraine diagnosis and pathophysiology. Continuum (Minneap Minn) 2012, 18: 753–763.

Rizzoli PB: Acute and preventive treatment of migraine. Continuum (Minneap Minn) 2012, 18: 764–782.

Allais G, Castagnoli Gabellari I, De Lorenzo C, et al.: Menstrual migraine: clinical and therapeutical aspects. Kundige ds Neurother 2007, 7: 1105–1120. 10.1586/14737175.7.9.1105

Martin VT, Lipton RB: Epidemiology and biology of menstrual migraine. Hoofpyn 2008,48(Suppl 3):S124–130.

Brandes JL, Poole A, Kallela M, et al.: Short-term frovatriptan for the prevention of difficult-to-treat menstrual migraine attacks. Kefalgie 2009, 29: 1133–1148. 10.1111/j.1468-2982.2009.01840.x

Headache Classification Subcommittee of the International Headache Society: The international classification of headache disorders: 2nd edition. Kefalgie 2004,24(Suppl 1):9–160.

Calhoun AH: Current topics and controversies in menstrual migraine. Hoofpyn 2012,52(Suppl 1):8–11.

Bussone G, Allais G, Castagnoli Gabellari I, et al.: Almotriptan for menstrually related migraine. Expert Opin Pharmacother 2011, 12: 1933–1943. 10.1517/14656566.2011.594794

Russell MB: Genetics of menstrual migraine: the epidemiological evidence. Curr Pain Headache Rep 2010, 14: 385–388. 10.1007/s11916-010-0142-6

Colson N, Fernandez F, Griffiths L: Genetics of menstrual migraine: the molecular evidence. Curr Pain Headache Rep 2010, 14: 389–395. 10.1007/s11916-010-0129-3

Von Seggern RL, Mannix LK, Adelman JU: Rofecoxib in the prevention of perimenstrual migraine: an open-label pilot trial. Hoofpyn 2004, 44: 160–165. 10.1111/j.1526-4610.2004.04033.x

MacGregor EA, Frith A, Ellis J, et al.: Prevention of menstrual attacks of migraine: a double-blind placebo-controlled crossover study. Neurologie 2006, 67: 2159–2163. 10.1212/01.wnl.0000249114.52802.55

Almen-Christensson A, Hammar M, Lindh-Astrand L, et al.: Prevention of menstrual migraine with perimenstrual transdermal 17-beta-estradiol: a randomized, placebo-controlled, double-blind crossover study. Fertil Steril 2011,96(498–500):e491.

Allais G, Sanchez del Rio M, Diener HC, et al.: Perimenstrual migraines and their response to preventive therapy with topiramate. Kefalgie 2011, 31: 152–160. 10.1177/0333102410378049

Nelles G, Schmitt L, Humbert T, et al.: Prevention of episodic migraines with topiramate: results from a non-interventional study in a general practice setting. J Headache Pain 2010, 11: 33–44. 10.1007/s10194-009-0163-x

Facchinetti F, Sances G, Borella P, et al.: Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Hoofpyn 1991, 31: 298–301. 10.1111/j.1526-4610.1991.hed3105298.x

Giacovazzo M, Gallo MF, Guidi V, et al.: Nimesulide in the treatment of menstrual migraine. Dwelms 1993,46(Suppl 1):140–141.

Guidotti M, Mauri M, Barrila C, et al.: Frovatriptan vs. transdermal oestrogens or naproxen sodium for the prophylaxis of menstrual migraine. J Headache Pain 2007, 8: 283–288. 10.1007/s10194-007-0417-4

Casolla B, Lionetto L, Candela S, et al.: Treatment of perimenstrual migraine with triptans: an update. Curr Pain Headache Rep 2012, 16: 445–451. 10.1007/s11916-012-0280-0

Tfelt-Hansen PC: Published and not fully published double-blind, randomised, controlled trials with oral naratriptan in the treatment of migraine: a review based on the GSK Trial Register. J Headache Pain 2011, 12: 399–403. 10.1007/s10194-011-0327-3

Sanford M: Frovatriptan: a review of its use in the acute treatment of migraine. CNS dwelms 2012, 26: 791–811. 10.2165/11209380-000000000-00000

Bartolini M, Giamberardino MA, Lisotto C, et al.: Frovatriptan versus almotriptan for acute treatment of menstrual migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study. J Headache Pain 2012, 13: 401–406. 10.1007/s10194-012-0455-4

Allais G, Castagnoli Gabellari I, Mana O, et al.: Treatment strategies for menstrually related migraine. Womens Health (Lond Engl) 2012, 8: 529–541. 10.2217/whe.12.37

Headache Classification Committee of the International Headache Society: Klassifikasie en diagnostiese kriteria vir hoofpynversteurings, kraniale neuralgieë en gesigspyn. Headache classification committee of the international headache society. Kefalgie 1988,8(Suppl 7):1–96.

Tuchman M, Hee A, Emeribe U, et al.: Efficacy and tolerability of zolmitriptan oral tablet in the acute treatment of menstrual migraine. CNS dwelms 2006, 20: 1019–1026. 10.2165/00023210-200620120-00005

Facchinetti F, Allais G, Nappi RE, et al.: Sumatriptan (50 mg tablets vs. 25 mg suppositories) in the acute treatment of menstrually related migraine and oral contraceptive-induced menstrual migraine: a pilot study. Gynecol Endocrinol 2010, 26: 773–779. 10.3109/09513590.2010.487607

Savi L, Omboni S, Lisotto C, et al.: Efficacy of frovatriptan in the acute treatment of menstrually related migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study versus rizatriptan. J Headache Pain 2011, 12: 609–615. 10.1007/s10194-011-0366-9

Brandes JL, Smith T, Diamond M, et al.: Open-label, long-term tolerability of naratriptan for short-term prevention of menstrually related migraine. Hoofpyn 2007, 47: 886–894. 10.1111/j.1526-4610.2007.00809.x

Jadad AR, Moore RA, Carroll D, et al.: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996, 17: 1–12. 10.1016/0197-2456(95)00134-4

Brigo F, Storti M, Nardone R, et al.: Transcranial magnetic stimulation of visual cortex in migraine patients: a systematic review with meta-analysis. J Headache Pain 2012, 13: 339–349. 10.1007/s10194-012-0445-6

Silberstein SD, Elkind AH, Schreiber C, et al.: A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurologie 2004, 63: 261–269. 10.1212/01.WNL.0000134620.30129.D6

Newman L, Mannix LK, Landy S, et al.: Naratriptan as short-term prophylaxis of menstrually associated migraine: a randomized, double-blind, placebo-controlled study. Hoofpyn 2001, 41: 248–256. 10.1046/j.1526-4610.2001.111006248.x

Mannix LK, Savani N, Landy S, et al.: Efficacy and tolerability of naratriptan for short-term prevention of menstrually related migraine: data from two randomized, double-blind, placebo-controlled studies. Hoofpyn 2007, 47: 1037–1049. 10.1111/j.1526-4610.2007.00855.x

Tuchman MM, Hee A, Emeribe U, et al.: Oral zolmitriptan in the short-term prevention of menstrual migraine: a randomized, placebo-controlled study. CNS dwelms 2008, 22: 877–886. 10.2165/00023210-200822100-00007

Silberstein SD, Berner T, Tobin J, et al.: Scheduled short-term prevention with frovatriptan for migraine occurring exclusively in association with menstruation. Hoofpyn 2009, 49: 1283–1297. 10.1111/j.1526-4610.2009.01509.x

Lionetto L, Casolla B, Mastropietri F, et al.: Pharmacokinetic evaluation of zolmitriptan for the treatment of migraines. Expert Opin Drug Metab Toxicol 2012, 8: 1043–1050. 10.1517/17425255.2012.701618

Loder E: Prophylaxis of menstrual migraine with triptans: problems and possibilities. Neurologie 2002, 59: 1677–1681. 10.1212/01.WNL.0000034179.17926.2D


Materiaal en metodes

Data obtained from 50 women enrolled in our initial study, which documented two and three follicular waves [ 64], were carefully evaluated to elucidate different patterns of follicle-wave development. Participants were assessed, by history and physical examination, to be healthy women of reproductive age (mean ± SD = 28.0 ± 6.9 yr, range = 19–43 yr). Women who were currently or recently pregnant or lactating, had used hormonal contraception within 3 mo of enrollment, had a history of irregular menstrual cycles, or were taking medication(s) known or suspected to interfere with reproductive function were not eligible to participate. Informed consent was obtained from all women prior to initiating study procedures. The study protocol was approved by the Institutional Review Board of the University of Saskatchewan.

Each volunteer underwent daily transvaginal ultrasonographic evaluation of her ovaries for one interovulatory interval (IOI). An IOI was defined as the interval from one ovulation to the subsequent ovulation. Ultrasound examinations were initiated 12 days after menses (i.e., a few days before the first ovulation) and were continued until 3 days after the second ovulation. Ovulation was defined as the disappearance of a large follicle (>15 mm) that had been identified by ultrasonography on the previous day, and the subsequent visualization of a corpus luteum [ 41, 82]. Follicles ≥2 mm were measured during each examination, and the number of follicles ≥5 mm tabulated. The length and width of each follicle were measured in both the sagittal and transverse planes. Follicle diameter was then calculated by averaging the mean measurement in the sagittal plane by the mean measurement in the transverse plane. The methods used for tracking follicle diameter and follicle number each day during the IOI are as described in Baerwald et al. [ 64].

High-resolution Ultramark 9 and ATL HDI 5000 ultrasound machines with 5–9 MHz multifrequency convex array transducers (Advanced Technologies Laboratories, Bothell, WA) were used to acquire follicular data. Approximately 90% of the examinations were performed by one sonographer (ARB). A second sonographer (RAP) was available when the primary sonographer was not available.

Follicular waves were characterized by an increase and subsequent decrease in the number of follicles ≥5 mm, occurring in association with the growth of at least two follicles to ≥6 mm, as documented in the previous report [ 64]. In the present analysis, major waves were defined as waves in which one follicle grew to ≥10 mm and exceeded the next largest follicle by ≥2 mm (i.e., development of a dominant follicle). Minor waves were defined as those in which the largest follicle developed to <10 mm and did not grow larger than all other follicles of the wave by ≥2 mm (i.e., no evidence of follicular dominance). Wave emergence was defined as the day at which the largest follicle of each wave was first identified, retrospectively, at 4–5 mm. An interwave interval (IWI) was defined as the interval from the emergence of one wave to the emergence of the subsequent wave. Selection was defined as the day on which the prospective dominant follicle became, and remained, larger than all other follicles of a major wave.

Blood samples were drawn every third day during the IOI in a stratified manner among women so that each day of the IOI was represented. The stratification scheme was used to randomly assign one third of the women to have blood drawn on Days 1, 4, 7, etc., one third on Days 2, 5, 8, etc., and the remaining one third on days 3, 6, 9, etc. Blood was collected into a 7-ml clot-activated tube and allowed to sit at room temperature for 15–30 min before centrifugation for 10 min at 3000 rpm (700 × g). The serum was drawn off and stored at −20°C. Sequential competitive fluorescence immunoassays (Immulite Diagnostic Products Corporation, Los Angeles, CA) were performed to measure serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol-17β (E2). Interassay coefficients of variation were as follows: LH (low = 6.3%, medium = 4.0%, high = 4.5%), FSH (low = 8.0%, medium = 2.9%, high = 4.1%), and E2 (low = 9.8%, medium = 5.6%, high = 4.3%). Minimal detectable limits were 0.1 mIU/ml for FSH, 0.1 mIU/mL for LH, and 15 pg/ml for E2.

We initially categorized follicle diameter, follicle number, and endocrine data into two- or three-wave patterns [ 64]. In the present study, data were further partitioned into major and minor wave patterns: minor major (− +), major major (+ +), minor minor major (− − +), minor major major (− + +), and major major major (+ + +). Follicle and endocrine data were centralized to the day of wave emergence and normalized to the mean IOI of the respective wave patterns.

In women with two follicular waves, t-tests were used to compare − + and + + wave cycles with respect to days of wave emergence, IOI, IWI, maximum number of follicles ≥5 mm, follicle diameter, growth rate, and regression rate (SPSS Version 11, 2002). In women with three follicular waves, analyses of variance with the Scheffe post hoc tests were used to compare endpoints between − − +, − + +, and + + + wave cycles (SPSS Version 11, 2002). Student t-tests and repeated measures analyses (SPSS Version 11, 2002 PROC MIXED, SAS/STAT Software, 2002) were used to compare IWI, follicle diameter, growth rate, and regression rate between waves. Repeated measures analyses (PROC MIXED, SAS/STAT Software, 2002) were also used to assess changes in follicle diameter, follicle number, and endocrine status during the IOI.


Menopause and FSH Levels

FSH or follicle stimulating hormone is a crucial hormone for regulating the reproductive processes of the body. In women older than 45 years, high FSH levels may indicate an impending menopause. Know more about the relation between FSH levels and menopause in this article.

FSH or follicle stimulating hormone is a crucial hormone for regulating the reproductive processes of the body. In women older than 45 years, high FSH levels may indicate an impending menopause. Know more about the relation between FSH levels and menopause in this article.

Menopause can be a difficult phase in the life of many women, as they have to deal with some uncomfortable menopausal symptoms, like irregularities in the menstrual cycle, irritability, depression, sleep disorders, and hot flashes, to name a few.

Menopause is actually a process, or a transition period from having regular menstrual cycle to its complete cessation, and during this period, women can experience a lot of irregularities in their menstrual cycle. A major part of the frustration, however, comes from the uncertainty of the fact that whether these are the symptoms of impending menopause, or an indicator of some other health problems.

Wil jy vir ons skryf? Wel, ons soek goeie skrywers wat die woord wil versprei. Kontak ons ​​en ons gesels.

But nowadays, there are certain tests, such as FSH test that can help a woman know, if irregularities in her menstrual cycle is caused by approaching menopause or by some other factors. So, let’s find out what is FSH and its association with menopause.

FSH stands for follicle-stimulating hormone, a hormone secreted by the pituitary gland. This hormone is responsible for regulating growth and development, as well as pubertal maturation in both male and female. It plays a key role in the reproductive processes of the human body.

In women, FSH stimulates the growth of the ovarian follicles and estrogen production, by the ovaries. The hormone also regulates ovulation. A high level of FSH induces ovulation, i.e. the release of an egg by the ovary. When an egg is released by the ovary, the level of FSH decreases in the body, while that of estrogen rises.

The main function of FSH in a menstruating women, is to stimulate the ovarian follicles that contain the eggs. This stimulation causes one of the ovarian follicle to grow and release an egg, after which the level of FSH decreases in the body. In case of menopause, there will not be any drop in the level of FSH, due to the absence of ovulation. Menopause, which marks the end of the menstrual cycle is therefore, characterized by high FSH levels.

Menopause is also characterized by a marked reduction in the level of the hormone, estrogen. As a result, the body signals the pituitary gland to produce more FSH, so that it can promote the ovaries to increase the production of estrogen. But, even a high level of FSH during menopause fails to stimulate the growth of the ovarian follicles, induce ovulation, and increase the level of estrogen.

However, the pituitary gland still tries its best to induce ovulation by continuing to increase the level of FSH. This is the reason why the level of FSH in the body remains high after menopause. In other words, a consistently high level of FSH may indicate that the ovaries are failing and the woman is approaching menopause. The medical definition of menopause is absence of menstrual cycles for 12 consecutive months.

Wil jy vir ons skryf? Wel, ons soek goeie skrywers wat die woord wil versprei. Kontak ons ​​en ons gesels.

The FSH level can be determined with the help of blood, urine, or saliva test. The over-the-counter test kits usually check urine or saliva for the level of FSH. The urine tests are usually 90% accurate, while the saliva tests are not so accurate, as their results can be influenced by several factors, including the use of oral contraceptives and smoking. FSH test is mainly used to find out whether a woman is experiencing irregular menstruation as a premenopausal symptom, or it is caused by certain other factors. A high FSH level can indicate that the body is trying to induce ovulation, but is failing to do so.

FSH test also helps distinguish between primary ovarian failure and secondary ovarian failure. Primary ovarian failure is caused by the failure of the ovaries themselves, while secondary ovarian failure may be associated with some underlying disorders of the hypothalamus and pituitary gland. Conditions other than menopause, that have been found to cause a high level of FSH are, infertility, and polycystic ovarian syndrome. FSH test is also used to evaluate the condition of early sexual development in children and infertility in men.

Women who are not menstruating, can take the FSH test at any time. But, women in the reproductive stage, should keep in mind that, the level of FSH can fluctuate during the menstrual cycle, and hence, the test should be carried out on a specific day, usually on the third day of the menstrual cycle. Follow-up tests are required to be done, usually after a month.

While evaluating the FSH test results, it should always be kept in mind that the level of this hormone vary depending on your age. For menstruating women, the normal values for FSH blood test, is 4.7 mlU/ml to 21.5 mlU/ml, while for post-menopausal women, it is 25.8 mIU/ml to 134.8 mIU/ml. If the level is higher than 25, then the woman may be in the peri or premenopausal stage, while she is approaching menopause, if the level is around 50.

However, the normal range for FSH can vary from lab to lab, which should be considered while evaluating the results of the test. Further, factors like, taking birth control pills, and hormone replacement therapy, can affect the results of the test.

Before coming to any conclusion regarding the results of FSH test, it should be kept in mind that not all medical communities consider it as a reliable test for determining whether a woman is going through perimenopause or menopause. Women in their 40s and 50s can experience a lot of fluctuations in their menstrual cycle. They may skip a few periods, then have periods for a few months and then again skip them.

The results of FSH tests done when the periods are irregular, can vary greatly. If the test is done while you are having menstrual cycle, it may show normal values, even if you are going through perimenopause and experiencing the menopausal symptoms. Depending on factors like stress, diet, and overall health, a woman can move in and out of perimenopause, and hence, a single value of FSH is not adequate to declare whether you are in menopause. Moreover, conditions other than menopause can also cause the level of FSH to rise in the body, as mentioned already.

So, if the result of FSH test is positive, i.e., if your FSH levels are high, then it is better to talk to your physician, instead of drawing any conclusion. The same goes for those women who have normal FSH level, but are experiencing the troublesome symptoms of menopause. Menopause can be confirmed only by the absence of menstrual cycles for 12 consecutive months. A single hormone test cannot confirm menopause, though the results of lab tests done over a period of time, along with a detailed study of the medical history of the woman and her symptoms, can help assess the condition.

Vrywaring: This article is for informative purposes only, and should not be treated as a substitute for professional medical advice.


Menstrual hygiene products

Several menstrual hygiene products exist for menstrual management. 𖏫] Such products are used especially in order to avoid damage to clothing. They are commonly used in the West, but are less available in some underdeveloped parts of the world. Such products include sanitary napkins and tampons (which are disposable) cloth menstrual pad and menstrual cups (which are reusable). Various improvised products may also be used, especially in the developing world, such as cotton, cloth, toilet paper. In recent years, the problem of inaccessibility to these products has come to light and has become a center of debate in regards to abolishing the excess tax on them or making them completely free. In 2018, Scotland became the first country in the world to “provide free menstrual pads in schools and colleges in an effort to ban period poverty” and the UK followed a similar path in 2019, announcing a campaign to “end period poverty globally by 2030.“ 𖏬]

Seclusion during menstruation

In some cultures, females are isolated during menstruation, as they are seen as unclean, dangerous, or bringing bad luck to those who encounter them. These practices are common in parts of South Asia, especially in Nepal. Chhaupadi is a social practice that occurs in the western part of Nepal for Hindu women, which prohibits a woman from participating in everyday activities during menstruation. Women are considered impure during this time, and are kept out of the house and have to live in a shed. Although chhaupadi was outlawed by the Supreme Court of Nepal in 2005, the tradition is slow to change. 𖏭] 𖏮] Women and girls in cultures which practice such seclusion are often confined to menstruation huts, which are places of isolation used by cultures with strong menstrual taboos. The practice has recently come under fire due to related fatalities. Nepal criminalized the practice in 2017 after deaths were reported after the elongated isolation periods, but “the practice of isolating menstruating women and girls continues.“ 𖏯]

Etymological

The word "menstruation" is etymologically related to "moon". The terms "menstruation" and "menses" are derived from the Latin mensis (month), which in turn relates to the Greek mene (moon) and to the roots of the English words maand en moon. 𖏰]

The Moon

Even though the average length of the human menstrual cycle is similar to that of the lunar cycle, in modern humans there is no relation between the two. 𖏱] The relationship is believed to be a coincidence. 𖏲] 𖏳] Light exposure does not appear to affect the menstrual cycle in humans. ⎗] A meta-analysis of studies from 1996 showed no correlation between the human menstrual cycle and the lunar cycle, 𖏴] nor did data analysed by period-tracking app Clue, submitted by 1.5m women, of 7.5m menstrual cycles, however the lunar cycle and the average menstrual cycle were found to be basically equal in length. 𖏵]

Dogon villagers did not have electric lighting and spent most nights outdoors, talking and sleeping, so they were apparently an ideal population for detecting a lunar influence none was found. 𖏶]

In a number of countries, mainly in Asia, legislation or corporate practice has introduced formal menstrual leave to provide women with either paid or unpaid leave of absence from their employment while they are menstruating. 𖏷] Countries with policies include Japan, Taiwan, Indonesia, and South Korea. 𖏷] The practice is controversial in western cultures due to concerns that it bolsters the perception of women as weak, inefficient workers, 𖏷] as well as concerns that it is unfair to men. 𖏸] 𖏹]


Afsluiting

Here we identified 140 unique differentially expressed miRNAs between AD patients and healthy controls. Using a signature of 12 miRNAs differentially expressed between AD patients and healthy controls we were not only able to distinguish with high diagnostic accuracies between AD patients and healthy controls, but also between AD patients and patients suffering from other neurological disorders including mild cognitive impairment as a potential preliminary stage of AD, and other neurodegenerative diseases like PD and multiple sclerosis as well as mental diseases like SCHIZ, DEP, and BD. However, additional work will be needed to elucidate the applicability of this 12-miRNA signature as a potential diagnostic test for AD and the above-mentioned effects of the drug treatments commonly used in the treatment of the disease. Hopefully, tests of this non-invasive and relatively cheap kind will be applicable to prodromal AD cases and to MCI patients with the aim to recognize early AD to initiate treatment.


Metodes

This study adhered to the research guidelines and ethical protocols of Wageningen University in the Netherlands. Thirty respondents, ten of whom were male were interviewed from September 1996 to September 2000 [19]. The respondents were obtained by snowball sampling, and were found in thirteen different sites, 12 in Trinidad (Paramin, Talparo, Sangre Grande, Mayaro, Carapichaima, Kernahan, Newlands, Todd's Road, Arima, Guayaguayare, Santa Cruz, Port of Spain and Siparia) and one in Tobago (Mason Hall). Snowball sampling was used because there was no other means of identifying respondents. The chief objective of the sampling method was to identify knowledgeable respondents no priority was given to extrapolating the data to the wider population to establish prevalence of use. No statistical analysis is applied to the data since this would have required the use of a random sample thus increasing the risk of not identifying knowledgeable respondents.

Twenty respondents were interviewed once, the other ten (who were healers) were interviewed three or four times. Healers were also asked to reconstruct the circumstances and contexts of the plant uses so that the means of administration of the plants could be identified. No interview schedule of questions was used but a more qualitative, conversational technique. Plants were collected when available to verify that the common names used by each respondent were the same in each ethnic group as those recorded in the literature. The majority of the plants were identified at the Herbarium of the University of the West Indies but voucher samples were not deposited. This ethnomedicinal study was part of a larger research project on ethnoveterinary medicine [11, 18].

Validation of practices

A preliminary validation of ethnomedicinal practices ensures that clinical trials are not wasted on plants that are used solely for cultural or religious reasons. The validation of the remedies was conducted with a non-experimental method [11, 18, 19]. This method consists of:

1. obtaining an accurate botanical identification,

2. determining whether the folk data can be understood in terms of bioscientific concepts and methods,

3. searching the chemical/pharmaceutical/pharmacological literature for the plant's known chemical constituents and to determine the known physiological effects of either the crude plant, related species, or isolated chemical compounds that the plant is known to contain. This information is used to assess whether the plant use is based on empirically verifiable principles or whether symbolic aspects of healing are of greater relevance. If ethnobotanical data, phytochemical and pharmacological information supports the folk use of a plant species it can be grouped into the validation level with the highest degree of confidence.

Four levels of validity were established [19]:

1. If no information supports the use it indicates that the plant may be inactive or no research has been done on the plant.

2. A plant (or closely related species of the same genus), which is used in geographically or temporally distinct areas in the treatment of similar illnesses, attains the lowest level of validity, if no further phytochemical or pharmacological information validates the popular use. Use in other areas increases the likelihood that the plant is active against the illness.

3. If in addition to the ethnobotanical data, phytochemical or pharmacological information also validates the use in Trinidad, the plant may exert a physiological action on the patient and is more likely to be effective than those at the lowest level of validity.

4. If ethnobotanical [20], phytochemical and pharmacological data supports the folk use of the plant, it is grouped in the highest level of validity and is most likely an effective remedy.

A comparable validation process was used to examine the plants used by traditional healers of ancient Persia to induce abortions [21]. The authors evaluated the validity and the efficacy of the plants used by (1) comparing other reported uses of these plants in traditional medicine, (2) investigating the medical and pharmacological literature on the medicinal properties of the plant species used, and (3) investigating the reported cytotoxic effects of compounds prevalent in these plants.


Dysmenorrhoea

Dickerson E, Raghunath AS, Atkin SL. Rational testing: initial investigation of amenorrhoea. BMJ. 2009339:b2184.

Wellman M. Investigating primary and secondary amenorrhoea. Medicine Today. 201516(11):27-32.

Teede H, Misso M, Costello M, Dokras A, Laven J, Moran L. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. Melbourne, Victoria: Monash University 2018. Available from: https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf.

Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea. Vrugbaar Steriel. 200890(suppl 5):S219-25.

Pitts M, Ferris JA, Smith AMA, Shelley JM, Richters J. Prevalence and correlates of three types of pelvic pain in a nationally representative sample of Australian women. MJA. 2008189(3):138-43.

Reddish S. Dysmenorrhoea. Aust Fam Physician. 200635(11):846-9.

National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NG73. NICE 2017. Available from: https://www.nice.org.uk/guidance/ng73.

European Society of Human Reproduction and Embryology. ESHRE guideline for the diagnosis and treatment of endometriosis. ESHRE 2007 [updated 2007 June 30]. Available from: http://guidelines.endometriosis.org/introduction.html.

European society of Human Reproduction and Embryology (ESHRE) Endometriosis Guideline Development Group. Management of women with endometriosis. ESHRE 2013. Available from: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline.aspx.

Petraglia F, Hornung D, Seitz C, Faustmann T, Gerlinger C, Luisi S, et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet. 2012285(1):167-73.

Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F. Role of medical therapy in the management of adenomyosis. Vrugbaarheid en Steriliteit. 2018109(3):398-405.

Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Vrugbaarheid en Steriliteit. 2018109(3):406-17.

National Institute for Health and Care Excellence (NICE). Heavy Menstrual Bleeding: Assessment and Management. NG88. NICE 2018 [updated 2018 Mar]. Available from: https://www.nice.org.uk/guidance/ng88.

Munro M, Critchley HO, Fraser IS, FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Vrugbaar Steriel. 201195(7):2204-8.

Munro M, Critchley HO, Broder MS, Fraser IS, FIGO Working Group of Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011113(1):3-13.

Australian Commission on Safety and Quality in Healthcare (ACSQHC). Heavy Menstrual Bleeding Clinical Care Standard. Sydney: ACSQHC 2017. Available from: https://www.safetyandquality.gov.au/standards/clinical-care-standards/heavy-menstrual-bleeding-clinical-care-standard.

National Institute for Health and Care Excellence (NICE). Heavy Menstrual Bleeding: Assessment and Management. NG88. NICE 2007 [updated: 2016 Aug].

Bateson D, Black K. Heavy menstrual bleeding: Treatment and referral options. Medicine Today. 201819(5):27-32.

Dickerson K, Menon N, Zia A. Abnormal uterine bleeding in young women with blood disorders. Pediatr Clin North Am. 201865(3):543-60.

Department of Health. Understanding the National Cervical Screening Program Management Pathway: A Guide for Healthcare Providers. Australian Government 2017 [updated 2019 Nov 27]. Available from: https://www.health.gov.au/resources/publications/national-cervical-screening-program-understanding-the-national-cervical-screening-program-management-pathway.

Jensen J, Parke S, Mellinger U, Machlitt A, Fraser IS. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstet Gynecol. 2011117(4):777-87.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College statement C-Gyn 23: Uterine artery embolisation for the treatment of uterine fibroids. [Internet]. RANZCOG 2008 [updated 2014]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/Uterine-Artery-Embolisation-(C-Gyn-23)_2.pdf?ext=.pdf.

Abnormal Vaginal Bleeding in Pre- and Peri-Menopausal Women: A Diagnostic Guide for General Practitioners Gynaecologists [internet]. The Royal Australian and New Zealand College of Radiologists, Cancer Australia, National Centre for Gynaecological Cancers: Australian Government 2011. Available from: https://www.canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/abnormal-vaginal-bleeding-pre-peri-and-post-menopausal-women-diagnostic-guide-general-practitioners.

McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J, et al. Sever complications of hysterectomy: the VALUE study. BJOG: an International Journal of Obstetrics and Gynaecology. 2004111:688-94.

Ely J, Kennedy CM, Clark EC, Bowdler NC. Abnormal Uterine Bleeding: A Management Algorithm. J Am Board Fam Med. 200619(6):590-602.

Read C, May T, Stellingwerff M. How to Treat: Irregular Vaginal Bleeding Australian Doctor 200718(May):27 -34.

Selo-Ojeme D, Dayoubi N, Patel A, Metha M. A clinico-pathological study of post coital bleeding. Arch Gynecol and Obstet. 2004270:34-6.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College statement C-Gyn 6: Investigation of intermenstrual and postcoital bleeding. [Internet]. RANZCOG 1995 [reviewed 2015 Mar].

Bateson B, Brand A, Hammond I, Mountford J, Whop L, Cancer Council Australia Cervical Cancer Screening Guidelines Working Party. Signs and symptoms of cervical cancer – identification and investigation of abnormal bleeding. [Internet]. 2019. Available from: https://wiki.cancer.org.au/australia/Clinical_question:Investigation_of_abnormal_vaginal_bleeding.

Goldacre M, Loudon N, Watt B, Grant G, Loudon JD, McPherson K, et al. Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic. Br Med J. 19781(6115):748-50.

National Institute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral. Blood and immune system conditions. NG12. [Internet]. NICE 2015 [updated: 2017 Jul]. Available from: https://www.nice.org.uk/guidance/ng12.

Amerikaanse Psigiatriese Vereniging. Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 5de uitg. Washington DC: APA 2013.

Green L, O’Brien PMS, Panay N, Craig M on behalf of the Royal College of Obstetricians and Gynaecologists. Management of premenstrual syndrome. BJOG. 2017124:e73-e105.

Backstrom T, Heineman K, Nyberg S, Hammarback S. Definition and prevalence of premenstrual syndrome. Gynaecology Forum. 200914:14-7.

Pearlstein T, Bachmann GA, Zacur HA, Yonkers KA. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. 200572(6):414-21.

Van Die M, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med. 201379:562-75.

Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. 2001322(7279):134-7.

Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol. 1998179(2):442-52.

Brown J, O’Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009Apr 15(2):CD001396.

Green L, O’Brien PMS, Panay N, Craig M on behalf of the Royal College of Obstetricians and Gynaecologists. Green-Top Guideline No. 48: Management of Premenstrual Syndrome. BJOG. 2017124:e73-e105.

eTG Complete. Therapeutic Guidelines 2019. Premenstrual Syndrome.

Whelan A, Jurgens TM, Naylor H. Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Can J Clin Pharmacol. 200916(3):e407-e29.

Wyatt K, Dimmock PW, Jones PW, Shaughn O’Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. 199922(318).

Quint E, O’Brien RF, AAP the Committee on Adolescence, AAP the North American Society for Pediatric and Adolescent Gynecology. Menstrual Management for Adolescents With Disabilities. Kindergeneeskunde. 2016137(4):e20160295.

Kirkman Y, Ornstein M, Aggarwal A, McQuillan S. Menstrual Suppression in Special Circumstances. JOGC. 201941(2):e7-e17.

Wilbur J, Torondel B, Hameed S, Mahon T, Kuper H. Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people. PLoS EEN. 201914(2):e210974.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Gyn-10: Fertility and menstrual management in women with an intellectual disability. [Internet]. RANZCOG 1997 (reviewed: 2016 Mar). Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/Fertility-and-menstrual-management-in-women-with-an-intellectual-disability-(C-Gyn-10)-Review-July-2016_1.pdf?ext=.pdf.

Williams C, Creighton S. Menstrual Disorders in Adolescents: Review of current practice. Horm Res Paediatr. 201278:135-43.

Mooed S, Mellor A. Dysmenorrhoea in Adolescents. O&G Magazine. 201719(3).

Velayuthum V, Dahiya R. Disorders of pubertal timing in young people. Medicine Today. 201718(5):24-32.

Abitbol L, Zborovski S, Palmert M. Evaluation of delayed puberty: what diagnostic tests should be performed in the seemingly otherwise well adolescent? Arch Dis Child. 2016101:767-71.

Matthews K, Benny P. Uterine and related structural anomalies. O&G Magazine. 201012(3).

Short A. Congenital anomalies of the female genital tract. O&G Magazine. 201719(3).

Dietrich J, Millar DM, Quint EH. Non-obstructive Müllerian Anomalies. Journal of Pediatric and Adolescent Gynecology. 201427:386-95.


Kyk die video: GCSE Biology - The Menstrual Cycle u0026 Puberty #43 (September 2022).