Menstrual Cycle
The menstrual cycle is centered around the
preparation of an egg or follicle, its release or ovulation and the implantation of a
fertilized egg into the uterus. The cycle is reset each month if fertilization is not
achieved. The cycle is orchestrated by a compliment of steroid and protein hormones
through which the brain, ovaries and uterus communicate or respond. Immediately following
the period the eggs or follicles begin to develop on both ovaries. Many eggs prepare to
ovulate but only one follicle will become the dominant or ovulatory follicle. This
"preparation" of a follicle is the variable component between women's cycles and
may span a period of twelve to eighteen days. Once ready, the brain triggered by critical
estrogen levels releases a hormone called Leutenizing Hormone (LH) which triggers the
release of an egg. This LH surge is detectable in urine and is the chemical substance that
turns ovulation predictor kits positive. Many women experience a dull ache or ovulatory
pain on either side around the midcycle. This pain is usually self limiting and completely
resolves within twenty four hours. It is during this phase that ovarian cysts are often
detected the majority of which are physiologic and normal. Fertilization and the early
divisions of the fertilized egg or ovum occur in the Fallopian tube. On rare occasions the
ovum implants in the tube. This is more common in women who have had tubal surgery or
sexually transmitted diseases especially Chlamydia or Gonorrhea. It is also a reason to
obtain an early pelvic exam once pregnancy has been diagnosed. By the end of the third
week or one week after fertilization the ovum, now called a Morula, begins to implant into
the uterine lining. Human Chorionic Gonadotropin (beta HCG) is now produced by the
embryonic cells and is detectable in blood. Within a few days it will also be detectable
in urine. This is the pregnancy hormone that causes a home pregnancy test to turn
positive. By the time of the next expected period the early embryo has buried deep into
the uterus and the first signs of pregnancy i.e. the missed period, breast tenderness and
fatigue set in.
Preconceptual Visit
A preconceptual visit to your physician is an
important preparation for pregnancy. Your caretaker will identify with you ways of
maximizing a healthy outcome and start you on prenatal vitamins or a dietary supplement
rich in Folic Acid. For those women on prescription medications especially those treating
skin conditions, diabetes and/or seizure disorders the preconceptual visit is especially
important. Prior difficult pregnancies or adverse outcomes should be identified as well as
a family history of genetic abnormalities. Tobacco, alcohol or drug abuse all increase the
chance for poor outcomes and counseling should be undertaken. Medical conditions that
could impact either maternal or fetal health should be identified and include heart
disease, bleeding disorders, asthma, migraines and infections. Pets, work environments and
exposures to chemicals are additional topics for discussion as is exercise, nutrition and
conceiving. The profound act of creating life merits a little planning and we at the
Arizona Wellness Center for Women hope all our patients will pursue this important visit
when the time is right.
