The menstrual cycle is a series of carefully coordinated events that prepares the woman's body for pregnancy. All contraceptive methods prevent pregnancy by either influencing parts of the menstrual cycle or by keeping the man's sperm from reaching the woman's ovum (egg).
It is important for family planning (FP)/reproductive health (RH) clinical service providers to understand the processes of the menstrual cycle in order to explain to clients how contraceptive methods work and to effectively respond to clients' problems and questions concerning contraceptive methods.
This Training Information Packet (TIP) describes the changes that occur in the average 28-day menstrual cycle and how the major contraceptive methods relate to the menstrual cycle. It also presents 21 client case studies in which FP/RH clinical service providers must apply their knowledge about the menstrual cycle in order to appropriately respond to client concerns and requests. This TIP is offered as a reference for FP trainers as they develop training activities and materials on these and other applications of reproductive anatomy and physiology.
This TIP is intended to promote client-centered quality care for FP services, in the context of integrated RH services. This TIP does not provide guidance on counseling and interpersonal communication skills, which are essential to responding to client concerns and requests.
CONTENTS
Acknowledgments
Abbreviations
Introduction
PART I: The Menstrual Cycle
- A. Definition of the Menstrual Cycle
B. Primary Organs Involved in the Menstrual Cycle
C. Effects of Hormones on the Menstrual Cycle
- 1. Hormone of the Hypothalamus
2. Hormones of the Anterior Pituitary Gland
3. Hormones of the Ovaries
4. The Process of Feedback
D. The Three Phases of the Menstrual Cycle
- 1. The Menstrual Bleeding Phase
2. The Estrogen Phase
3. The Progesterone Phase 12
E. Effects of Pregnancy on the Menstrual Cycle
F. Effects of Abortion (spontaneous/induced) on the Menstrual Cycle
Study Questions
Answers to Study Questions
PART II:
How Contraceptive Methods Interrelate with the Menstrual Cycle
- A. Fertility Awareness Methods
- 1. Cervical Mucus Method (CMM)
2. Calendar Method
3. Basal Body Temperature Method (BBT)
4. Symptothermal Method (STM)
B. Lactational Amenorrhea Method (LAM)
C. Progestin-Only Contraceptives
- 1. Progestin-Only Injectable Contraceptives
2. Progestin-Only Pills (POPs)
3. NORPLANT® Implants
D. Combined Contraceptives
- 1. Combined Oral Contraceptives (COCs)
2. Once-a-month Combined Injectables
E. Intrauterine Contraceptive Device (IUD)
F. Voluntary Surgical Contraception (VSC)
- 1. Tubal Ligation
2. Vasectomy
G. Barrier Contraceptive Methods and Spermicide1. Condom
- 1. Condom
2. Spermicides
3. Diaphragm
H. Emergency Contraceptive Pills (ECPs)
Study Questions
Answers to Study Questions
PART III:
Applying Knowledge of the Menstrual Cycle to Management of Family Planning Client Concerns and Requests
A. METHOD INITIATION
- 1. Client requests combined oral contraceptives (COCs) mid-cycle
2. Client requests NORPLANT® Implants on day 7 of her cycle
3. Client requests tubal ligation on day 7 of her cycle
4. Amenorrheic breastfeeding client requests injectables at 10 months postpartum
5. Amenorrheic breastfeeding client requests intrauterine contraceptive device (IUD) insertion at 5 months postpartum
B. METHOD SWITCHING
- 1. Breastfeeding client chooses lactational amenorrhea method (LAM).
2. Intrauterine contraceptive device (IUD) user at mid-cycle requests a switch to combined oral contraceptives (COCs)
3. Amenorrheic Depo-Provera® user requests an intrauterine contraceptive device (IUD)
4. Breastfeeding client who takes progestin-only pills (POPs) asks about switching to combined oral contraceptives (COCs) when she stops breastfeeding
C. BLEEDING/SPOTTING
- 1. Intrauterine contraceptive device (IUD) user complains of heavy menses
2. NORPLANT® Implants user complains of frequent spotting
3. New Depo-Provera® user complains of prolonged/heavy bleeding
4. Combined oral contraceptive (COC) user complains of bleeding/spotting
5. Once-a-month combined injectable contraceptive (CIC) user complains of prolonged bleeding
6. Emergency contraceptive (EC) user is concerned about early menstrual bleeding
D. AMENORRHEA
- 1. Combined oral contraceptive (COC) user with absent menses is concerned about pregnancy
2. NORPLANT® Implants user with absent menses is concerned for her fertility
3. Depo-Provera® user with absent menses is concerned about her fertility
E. FORGOTTEN PILLS OR MISSED RE-INJECTION VISIT
- 1. Combined oral contraceptive (COC) user forgets 2 pills
2. Progestin-only pill (POP) user forgets 2 pills
3. Client returns 4 weeks late for Depo-Provera® re-injection
Study Questions
Answers to Study Questions
Part III Citations
References
Download
The Menstrual Cycle And Its Relation To Contraceptive Methods
