PUBERTY AND MENSTRUATION
Puberty is the growth phase characterized by physical development of the sex organs and the beginning of sexual activity, This growth phase is heralded by the onset of the first menstrual period known as the menarche. there is more to understand about puberty and girls on their period and in light of this article it is addressed.
The menstrual cycle and its endocrine basis
Every woman is with two ovaries. Each ovary contains a large number of primordial follicles at birth. These primordial follicles are capable of producing ova. Every month one primordial follicles ripens under the influence of hormones of the anterior pituitary gland. The follicle later ruptures and liberates an ovum. The two ovaries produce an ovum alternately so that one ovary produces one ovum every two months.
The first menstrual period in a girl's life is called the menarche. After the menarche, a girl should menstruate every month if her periods are regular. Sometimes the first periods after the menarche are irregular and anovulatory.
The mechanism of menstruation
Under the influence of the follicle stimulating hormone (F.S.H) of the anterior pituitary gland, one primordial (Graafian) follicle ripens. the ripened follicle produces the female sex hormone (oestrogen) in large quantities. The effect of oestrogen is to bring about proliferation of the endometrium. This phase of menstruation is known as the follicular phase in the ovary and proliferative phase in the endometrium. The Graafian follicle later ruptures and an ovum is released, The ovum is wafted into the fallopian tube by the fimbria ovarica.
The process whereby the Graafian follicle ruptures and the ovum is liberated is known as ovulation. In some women, ovulation is accompanied by abdominal pain and vaginal bleeding (ovulation pain and bleeding). Ovulation usually takes place 14±2 days before the onset of the next menstrual period.
The remaining portion of the follicle is converted into the corpus luteum under the influence of luteotrophic hormone of the anterior pituitary gland . The corpus luteum thus formed produces oestrogen and progesterone, but the later is produces in larger quantities than the former. Progesterone converts the proliferative endometrium into a secretory one. (puberty and girls on their period)
The endiometrial glands grow more tortuous and show evidence of secretion. Later the endometrial glands are filled with secretion and endometrium, usually now referred to as progestational endometrium, is prepared for the reception of the ovum if fertilized. This phase is known as the luteal phase in the ovary and the secretory phase in the endometrium. There is high level of progesterone and the endometrium which had previously had been developed by oestrogen is well supported by preogesterone form the corpus luteum. If fertilization of the ovum does not take place, the corpus luteum degenerates, bringing about a fall in the level of oestrogen and progesterone. The endometrium, now lacking hormonal support breaks down and is shed in the form of menstrual period. This explains why the menstrual flow is often referred to as the "tears of a disappointed uterus"
All the endometrial layers with the exception of the basal layer are shed during menstruation. Regeneration of the endometrium in the next cycle takes place from the basal layer. The menstrual periods usually last four to five days on average, but there are wide variations depending on the individual girl and on the presence or absence of disease. The menstrual cycle usually lasts 28days on average, but again, there are wide variations.
The type of menstruation described is the ovular type of menstruation because it is preceeded by ovulation. Sometimes, ovulation does not take place and menstruation is then anovular. an important characteristics of the menstrual blood is that it does not clot. When it clots, there is usually some underlying abnormality.puberty and girls on their period
Ovulation Pain and Ovulation Bleeding
The discomfort of ovulation pain appears between the 10th and 14th days of the cycle. It is felt in the hypogastrium or in one or other iliac fossa and is occasionally referred to the rectum. It usually lasts 12 to 24 hours and may be accompanied by bleeding (ovulation bleeding).
Ovulation pain is thought to be due to:
- Contractions of the tubes or uterus
- Increased tension in the Graafian follicle or the ovary
- Irritation of the peritoneum by the discharge of fluid and blood from the follicle
- Muscle cramps in the caecum or pelvic colon
Ovulation pain and bleeding require reassurance. No active treatment is necessary .
Other menstrual disturbances include menstrual migraine and premenstrual tension . In menstrual migraine the headaches are localized to one area of the head. They are severe and incapacitating and may be accompanied by nausea and vomiting. They occur only during the periods and are , of course, cured temporarily by pregnancy although they may be become troublesome during lactation.
Pre-menstrual tension has a psychological or functional basis. it may be caused by undue anxiety , unhappy married life, psychomeurosis, etc. The symptoms include a feeling of bloatedness, headache, enlargement, congestion and pain in the breasts and oedema of the feet and ankles about seven to ten days before the onset of the periods. Usually, the symptoms are relieved by the onset of the menstrual flow.puberty and girls on their period
In the treatment of pre-menstrual tension correction of the environmental causal factor is important. Elimination of retained fluids with diuretics may help. Occasionally hormones may help.