If the fertilization does not take place this whole process recedes. The ovaries return to the rest phase, the ovarian hormones reduce in amount; their reduction withdraws support from the endometrium which is then shed and comes out of the uterus so that the uterus readies itself for the next expected zygote. This extrusion of endometrium along with the blood is menstruation.
Menstruation obviously occurs in response to the cyclical ovarian function. Any disturbance in ovarian function appears as menstrual disturbance.
If pregnancy occurs and is properly implanted in the uterus, hormones production supplemented by placenta will continue, the uterus will take up pregnancy and retain it until delivery. At term, mature baby is born, but if it ends up early the fate is different. Full term pregnancy continues for 9 months with constant production of hormones.
After delivery, the restoring process though extensive is similar to the restoration after menstruation. The uterus sheds decidua (its lining) along with blood (lochia) and reduces to non-pregnant state. In reproductive age she passes through ever changing processes.
Menopause like puberty is a transitory phase, but reverse of it. Ovaries become inactive. Their cyclical function stops. Menstruation ceases. Like pre pubertal phase ovarian hormones produced are in extremely low quantity. There is no negative feedback on pituitary resulting in low estrogens and high levels of circulating gonadotrophins. Changes that took place at puberty recede. Ova become absolutely non responsive and there is no way to activate them for maturation and fertilization. Follicles do not grow. Women become nonproductive. This is nature’s course to limit population.
75 % of changes in women’s reproductive phase are physiological or its variations. If she does not conceive or has uncontrolled fertility, she comes for advise about the physiological phenomenon. Menstrual complaints are mostly the ovarian function variations. Pregnancy is a physiological phenomenon. Pregnant women are in a state of super health compared to the non pregnant.
Women do not understand these physiological transitions at puberty and menopause. They get anxious and worried and seek advice to relieve their concern. There are physiologic changes and adjustments to their normal responsibilities towards fertility and pregnancy. The women require advice so that they remain healthy, understand the changes in their body system and acclimatize to cope with the normal changes or the excessive responses of their body. These excessive responses should be prevented and timely managed without harm. There are also women who suffer from disease and require the treatment.
Advice should be based on the innovative ideas with an ever changing progressive approach to the management of the problems of women. The attitudes and responses should be guided by the concept that majority of women seek advice about their reproductive function and related disturbances and do not suffer from any disease or ill health. Minimally access/invasive approach are adopted for the integrity of the reproductive function.