Obstetrics and gynecology

NAME

LESSON PLAN

OF

FEMALE HORMONAL CYCLES

MODERATOR

: PROF. RITA SARKAR

NAME OF STUDENT TEACHER

: ANJALI MADAN

SUBJECT

: OBSTETRICS AND GYNAECOLOGY

DATE AND TIME

2013 @ 12 P.M.

TOPIC OF LESSON
HORMONAL CYCLESS

: FEMALE

CLASS

: BSc.4th year students

NO. OF STUDENTS

: 40

DURATION

: 60 minutes

VENUE

: Lecture hall, PIMS, PANIPAT.

METHOD OF TEACHING

: LECTURE AND DISCUSSION

A.V.AIDS

: POWER POINT, WHITEBOARD

NOVEMBER,

BY: ANJALI MADAN

MSc. Nursing 1st year
Batch-( 2013-15).
/11/2013

CENTRAL OBJECTIVES
: By the end of the class, students acquire knowledge regarding
hormonal changes in the female body and capable to use this knowledge in their curriculum studies as well
as in clinical areas to educate the mothers regarding ovulation and menstrual cycle.

SUBMITTED
TO:
SPECIFIC OBJECTIVES

: The group will be able to:

Define RITA
Graafian follicle
& ovulation.
PROF.
SARKAR

Enumerate the development of Graafian follicle and ovulation.

Describe the hormonal control of ovulation
Define menstrual cycle.
Describe endometrial changes during the different phases of menstruation.

Explain the clinical phases of menstruation and menopause.

TIME

SPECIFIC
OBJECTIVES

1)3
min.

2)3
min.

3)7
min.

4)
6min.

5)10mi
n.

Define ovarian
cycle.

Explain the
process of
maturation of
graafian
follicle.

Explain
ovulation
process.

Describe the
hormonal

CONTENT
1) Introduction: The biological
cycles in a woman are controlled by
the hypothalamus. It governs the
anterior pituitary gland by hormonal
pathways. The anterior pituitary gland
in turns governs the ovaries by
hormones. The hormones produced in
the ovaries, control changes in the
uterus. All the changes occur
simultaneously & in harmony. A
womans mood may change along
with cycle & emotional influences can
alter the cycle.
2) THE OVARIAN CYCLE: The
ovarian cortex at birth contains about
2lakh primordial follicles. From
puberty onwards certain follicles
enlarge & one matures each month to
liberate an ovum. A mature ovum
follicle is known as GRAAFIAN
FOLLICLE.
3) GRAAFIAN FOLLICLE: The ovum
is situated at one end of the Graafian
follicle and is encircled by the narrow
perivitelline space. Surrounding this
lays a clump of cells called discus
proligerus which radiate outward to
form the corona radiata. The
innermost cells of corona are referred
as zona pellucida. The whole follicle is
lined with granulosa cells and
contains follicular fluid. The outer coat
of follicle is external limiting
membrane and around this lies, area
of compressed ovarian stroma known
as the theca.
4) Ovulation: The Graafian follicle
grows and matures to a size of 1012mm under the influence of FSH and
LH. At the same time it swells and
becomes tense, finally ruptures to
release the ovum in to the fimbriated
end of the fallopian tube, which is
cupped beneath the ovary. This is
called as ovulation. And it occurs on
day 14 of 28 days cycle. A small loss
of blood occurs at this time in to the
peritoneal cavity, termed as
MITTELSCHMERZ. The empty follicle is

TEACHER
ACTIVITY
Orient the
group about
the Female
Hormonal
Cycles.
Shows ppt.
Shows the
video.

STUDENT
ACTIVITY
Listen to the
teacher
carefully and
takes part
actively by
giving answers
to the
questions and
asking doubts.

A
U

Po
pr

Explains about
the ovarian
cycle and
process of
formulation of
graffian
follicle.
Shows the
video.

Shows the ppt.

Asks the
question to the
group.
Explain the
effect of
hormones on
the ovarian
cycle.

Use white
board to
explain
important

Vi

control on the
female
reproductive
system.

6)8
min.

7)
5min.

Explain the
types and
functions of
ovarian
hormones.

Define
menstrual
cycle.

known as corpus luteum. Which

followed by proliferation,
vascularization, maturity and
regression, it changes in to yellow
color, becomes corpus albicans and
reabsorbed.
5) HORMONAL CONTROL: The
hypothalamus synthesizes and
releases GnRH (gonadotropin
releasing hormone). It reaches the
pituitary through portal circulation
and causes the release of FSH and LH.
Known as gonadotrophins. The
activity of hypothalamus and pituitary
is influenced by positive and negative
feedback mechanisms from ovarian
hormones. FSH causes graafian
follicle to develop and enlarge
one.FSH rises during the first half of
cycle and when the estrogen level
reaches a certain point, its production
ceases. LH production starts a few
days after FSH. estrogen causes
rush in both FSH &LH levels resulting
in the rupture of a ripened follicle
ovulation. Level of FSH & LH then falls
rapidly. If no pregnancy occurs corpus
luteum degenerates after 14 days.
The negative feedback effect of
progesterone ceases and FSH & LH
levels rise again to begin a new cycle.
PROLACTIN: produced in anterior
pituitary gland. It does not play a part
in the control of ovarian hormones. If
produced in excessive amounts, it will
inhibit ovulation that is the natural
phenomenon during lactation.
6) OVARIAN HORMONES:
ESTROGEN: the granulosa cells and
theca of the ovaries, under the
influence of FSH produce this
hormone. It comprises several
compounds including nostril,
oestradiol & oestrone. Estrogen is
responsible for secondary sexual
characteristics such as the female
shape, growth of breasts and the
uterus and the female distribution of
hair. It influences the production of
cervical mucus.
PROGESTRONE: produced by corpus
luteum under the influence of LH. It
acts only on tissues previously
affected by estrogen. During the

terms.

Shows ppt.

Answers the
question asked
in between.

Explains the
hormonal
control on
female
reproductive
system.

Shows power
point
presentation
to the group.

W
bo

Asks the
question in
between to the
students.

Explains the
types and
functions of
ovarian
hormones.

Uses white
board to
explain the
topic.

Shows the ppt.

Pays attention
toward the
topic
presented.

8)5
min.

9)3
min.

Explain the
first phase of
menstrual
cycle

Describe the
follicular
phase of
menstrual
cycle.

second half of the cycle, it causes

secretory changes in the lining of the
uterus as the endometrium develops
tortuous glands and an enriched blood
supply in readiness for the possible
arrival of a fertilized ovum. It causes
the body temp. of the woman to rise
by0.5 degrees after ovulation.
RELAXIN: secreted by corpus luteum
and is at its max. level after 38 weeks
of pregnancy. It relaxes the pelvic
girdle, softens the cervix and
suppresses uterine contraction.
7)MENSTRUAL CYCLE:
DEFINITION :
It refers to the monthly discharge
through the vagina of blood and other
substances from the uterus in non
pregnant adult females.
It is rhythmical series of physiological
changes that occur in fertile women
the control of the endocrine system
Necessary for reproduction
Average length: 28 days, but typically
varies, with shorter and longer cycles
Menarche: a woman's first
menstruation
typically occurs around age 12.
occurrence depends on overall health
and diet
Menopause: end of a woman's
reproductive phase, commonly occurs
between ages 45 and 55
age of menopause is largely the result
of genetics
Physiological changes during
menstrual cycle can be observed at
three different levels:
neuroendocrine level
ovaries
uterus
Menstrual cycle can be divided into 3
phases:
menstrual phase
proliferative / follicular
(estrogen) phase
secretory / luteal phase
(progesterone) phase
8) MENSTRUAL PHASE:
Menstruation
menstrual bleeding, menses, period
discharge of bloody fluid containing
endometrial cells, glandular

Defines the
menstrual
cycle.

Shows the ppt.

Answers the
questions
asked by the
teacher.

Asks the
questions to
the group.

Shows the ppt.

Uses white
board to
explain the
topic.

Explains the
menstrual
phase of
menstrual
cycle.
Asks the
questions in
between to the
group.
Shows the ppt.

Answers the

10)3mi
n.
Explain
ovulation.

11)3mi
n.
Describe the
3rd phase of
menstrual
cycle.

12)3mi
n.
List the
abnormalities
of menstrual
cycle.

13)2mi
n.

14)2mi
n.

secretions and blood cells, lasts 3 -5

days.
result of the previous menstrual cycle.
due to strong vasoconstriction and
proteolytic activity, functional stratum
of endometrial tissue dies and is
discharged during menstrual
bleeding.
Endometrium becomes very thin, but
due to low estrogen levels,
hypophysis secretes more FSH.
FSH stimulates secretion of estrogen,
and estrogen serves as proliferation
signal to the endometrial basal layer
9) FOLLICULAR PHASE : Due to the
rise of follicle stimulating hormone
(FSH) during the first days of the
cycle, several ovarian follicles are
stimulated
Follicles compete with each
other for dominance
The follicle that reaches
maturity is called a Graafian
follicle
As they mature, the follicles
secrete increasing amounts of
estrogen, which thickens the
new functional layer of
endometrium in the uterus
Estrogen also stimulates crypts
in the cervix to produce fertile
cervical mucus
At the end of this phase
ovulation occurs
10)OVULATION: During the follicular
phase, estrogen suppresses
production of luteinizing hormone (LH)
from the pituitary gland
When the ovum has nearly
matured, levels of estrogen
reach a threshold above which
they stimulate production of LH
(positive feedback loop)
The release of LH matures the
ovum and weakens the wall of
the follicle in the ovary, causing
the fully developed follicle to
release its secondary oocyte
After being released from the
ovary, the ovum is swept into
the fallopian tube
11)LUTEAL PHASE: Corpus luteum:
solid body formed in an ovary after

Use white
board to
explain the
topic.

questions
asked to the
group.

Elaborate the
follicular phase
of menstrual
cycle.

Shows the ppt.

Explains the
ovulation
process.

vi

Shows the ppt.

Asks the
questions to
the group.

Describes the
luteal phase of
menstrual
cycle,

Shows the ppt.

Answers the
questionnaire
given as a part
of evaluation.

qu
e

the ovum has been released into the

fallopian tube
Produces significant amounts of
progesterone, which plays a
vital role in making the
endometrium receptive to
implantation of the blastocyst
High levels of E and P suppress
production of FSH and LH that
the corpus luteum needs to
maintain itself
Falling levels of progesterone
trigger menstruation and the
beginning of the next cycle
12)CYCLE ABNORMALITIES:
Anovulation
Anovulatory cycle
Hypomenorrhea
Metrorrhagia
Oligomenorrhea
Amenorrhea
Polymenorrhea
13) CONCLUSION: Female hormonal
cycles are having their own
importance in a womans body as
they are responsible for female
reproductive system to work.
Hormonal changes influences the
physical as well as the emotional
changes in human body, furthermore
helps in reproduction.
14) SUMMARY: We have discussed
about the ovarian cycle and
menstrual cycle in detail including
graafian follicle, ovulation, hormonal
control, ovarian hormones, and
different phases of menstrual cycle
and the cycle abnormalities in
menstrual cycle.

Enlists the
cycle
abnormalities
in menstrual
cycle.

Give
conclusion of
the topic
presented
Summarizes
the topic
presented.
Give
questionnaire
to the group
for evaluation.

REFERENCES:
1. Jacob Annamma . A comprehensive textbook of midwifery.
Second edition. Jaypee brothers. 2008. Page No.- 88 to 95.
2. Dutta D.C. Texbook of obstetrics. 6th edition. New central
book agency pvt. Ltd. 2004.Page No-32-39.

3.Fraser M. Diane, Cooper A. Margret. Myles Textbook for

midwifery. 14th edition. Churcill Livingstone. 2003. Page No77 to84.
4.Elizabeth Marie. Midwifery for Nurses. Satish Kumar Jain.
2010. Page No.-30 to 35.
5.Sharma J.B. APC Textbook of Obstetrics. Avichal publishing
company. 2008. Page no.- 65 to68.