Age periods of a woman in gynecology. Physiological processes in the body of a woman in different periods of life

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Physiological periods in a woman's life. Pregnancy planning

Introduction

1.2 Puberty

1.3 Menopause

2. Menstrual cycle

3. Planning for pregnancy

3.1 Methods of contraception

3.2 Planning for conception

Conclusion

Introduction

Throughout the life of a woman there are several periods. They are characterized by certain age-related anatomical and physiological features. These are the periods:

1) childhood;

2) puberty;

3) puberty;

4) climacteric.

The strategy of modern medicine - preventive medicine, the strategy of modern obstetrics is a planned, prepared pregnancy. Now it's a promoted strategy good tone, fashion, and all less people refer to their ancestors who gave birth without any preparation, and increasingly turn to doctors for help in a situation that does not yet exist, for planning a future pregnancy.

It has long been proven that most of the complications that develop during pregnancy can be prevented by proper preparation, namely, replenishment of vitamin deficiency, examination, diagnosis. possible diseases, conditions, predispositions, and their correction.

There are conditions whose harmful effect can be completely eliminated if identified in advance: for example, the lack of immunity to rubella. There are conditions that cannot be completely eliminated, but their diagnosis before pregnancy allows the attending physician to predict possible expected complications, be prepared for them and prescribe their correction in time - literally from the first days of the delay, before going to the doctor, the woman begins taking medications that allow you to save the pregnancy in early terms. So the features female body, his reproductive function very interesting and important to study. The purpose of our work is to study the physiological periods in a woman's life and the features of pregnancy planning.

1. Periods of a woman's life associated with reproductive function

1.1 Puberty of a girl

conception pregnancy menopause menstrual

Puberty takes about 10 years. His age limits are 7 (8) - 17 (18) years. During this time, in addition to the maturation of the reproductive system, physical development female body: body growth in length, formation of physique and distribution of adipose and muscle tissue along female type. Physiological period puberty proceeds in a strictly certain sequence. In the pubertal period (7-9 years), a growth spurt is noted, the first signs of a female figure appear: the hips are rounded, the female pelvis begins to form, the vaginal mucosa thickens. In the 1st phase puberty(10-13 years old) begins to enlarge the mammary glands, pubic hair growth. This period ends with the first menstruation - menarche (at the age of about 13 years), which coincides with the end rapid growth body in length. In the 2nd phase of the pubertal period (14--17 years), the mammary glands and sexual hair growth complete development, the last to end is the hair growth of the armpits, which begins at the age of 13. The menstrual cycle becomes normal (two-phase), the growth of the body in length stops and the female pelvis is finally formed William G. Masters, Virginia E. Johnson, Robert K. Kolodny Fundamentals of Sexology. Per. from English. - M.: Mir, 1998. - S.24-42 ..

In case of menstrual disorders in children and adolescents, it is imperative to contact special pediatric gynecologists and pediatricians. timely qualified treatment will allow in most cases to normalize menstrual cycle and thus ensure a normal future childbearing function. Puberty occurs by the age of 16-18, when the entire body of a woman is finally formed and ready for conception, pregnancy, childbirth and feeding a newborn.

1.2 Puberty

The period of puberty, or the reproductive period, takes about 30 years --since 16--18 to 45 years old. During this period, a woman has a two-phase menstrual cycle. His physiological mechanism very complicated. In a simplified form, it can be represented as follows. In the subcortical zone of the brain, there is a pulsating secretion of special chemical substances(neurosecrets), which circulatory system enter the anterior pituitary gland. Special cells of this gland internal secretion Two types of so-called gonadotropic hormones are produced: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones, entering the blood, act on the ovary, stimulate the growth of the follicle, in which sex hormones (estrogens) begin to be produced and the egg matures. An increase in the production of LH and FSH in the middle of the menstrual cycle (II-15th day) leads to rupture of the follicle and the release of the egg into the abdominal cavity (1st phase of the cycle). In place of the follicle; the corpus luteum appears, in which the production of the hormone begins corpus luteum progesterone (2nd phase of the cycle). Under the influence estrogen hormones in the uterine mucosa, restoration and growth of epithelial cells of the functional layer of the uterine mucosa occur (1st phase of the cycle). After ovulation and the start of production of the corpus luteum hormone (progesterone), glands appear in the uterine mucosa, which are filled with secretions (2nd phase of the cycle, 15-28 days).

If fertilization does not occur, then the corpus luteum wilts, decreases, and then the production of progesterone stops. This leads to the necrosis of the functional layer of the mucous membrane of the uterus, and it begins to be rejected - menstruation begins. At this time, as a result of a change in the concentration of ovarian sex hormones in the blood, the next process of producing neurosecretions in the anterior pituitary gland, the development of a new follicle and the maturation of the next egg in the ovary begin again. All these complex processes regularly occur in the body. healthy woman throughout the entire period of puberty. Menstrual cycle - cyclical changes in the reproductive system of a woman from the 1st day of the previous menstruation to the 1st day of the next menstruation. The normal duration of the menstrual cycle is 21-35 days. Menstruation is the release of blood from the genital tract at the end of each biphasic menstrual cycle. The duration of menstruation is normally 2-7 days.

1.3 Menopause

Currently, instead of the terms "menopause" and "menopause", the following are accepted:

premenopausal period - from 45 years to the onset of menopause;

menopause is the period of absence of menstruation. The last menstruation occurs on average at the age of 50.8 years;

perimenopausal period - postmenopausal period and 2 years after menopause;

The postmenopausal period begins after menopause and lasts until the end of life.

By the age of 45, a woman's reproductive system fades away, and by the age of 55, the hormonal function of the reproductive system.

The premenopausal period of life is characterized by a high social activity of a woman, due to the accumulated life experience, knowledge, etc. At the same time, at this age, the body's defenses decrease, non-infectious morbidity increases, body weight gradually increases against the background of pronounced changes in the reproductive system. Starts to gradually decrease hormonal function ovaries, which is characterized by the onset of menopause. As a result of dysfunction of the ovaries, bleeding occurs from the altered uterine mucosa.

In postmenopause, a progressive decrease in the hormonal function of the ovaries continues. At the same time, involution processes are taking place not only in the organs of the reproductive system, but also in all other organs and systems. The uterus decreases, the mucous membrane of the vagina becomes thinner, folding decreases, and dryness of the vagina appears. happening atrophic changes in the bladder, urethra, muscles pelvic floor. This leads to stress incontinence, prolapse of the walls of the vagina and uterus. Metabolism changes significantly with excessive deposition of subcutaneous fat. Blood clotting increases due to a decrease in the production of estrogen hormones, bone loss of calcium begins, and a decrease in bone substance. All this leads to grave consequences: osteochondrosis, fractures of tubular bones and the most dangerous of them ~ fracture of the femoral neck. With a variety of complications of the menopause, as well as for the purpose of their prevention, it is necessary to contact an obstetrician-gynecologist. modern medicine has highly effective means that can reliably prevent the above complications and ensure a high quality of life for women in pre- and postmenopause.

2. Menstrual cycle

The menstrual cycle is a physiological process of cyclical changes in the functions of the reproductive system of a woman, which are externally manifested by regular uterine bleeding (menstruation, colloquially - monthly) William G. Masters, Virginia E. Johnson, Robert K. Kolodny Fundamentals of sexology. Per. from English. - M.: Mir, 1998. - S.54-59 ..

During the menstrual cycle, a woman's body prepares for conception and pregnancy. If conception does not occur, this process is repeated again.

The first menstruation (menarche) occurs in girls during puberty. Menstruation stops with the onset of menopause, as well as during pregnancy and with certain diseases.

The duration of the menstrual cycle is determined from the first day of menstruation to the first day of the next and is 21-36 days, usually 28 days. menstruation ( uterine bleeding) lasts from 3 to 6 days.

The leading role in the regulation of the menstrual cycle belongs to the central nervous system (cerebral cortex, pituitary gland, hypothalamus and other structures).

In the ovaries during the first phase of the menstrual cycle (in the first 14 days at 28 daily cycle) the follicle grows and matures. The rising vesicle releases estrogens (female sex hormones). Under the influence of estrogens, the uterine mucosa also grows (proliferation). On the 14-16th day, the follicle bursts, and a mature egg, capable of fertilization, comes out of its cavity, that is, ovulation occurs.

Ovulation occurs under the influence of gonadotropic hormones from the pituitary gland and estrogen. Since during the first phase, that is, before ovulation, the follicle matures, it is called follicular. As the growing follicles secrete a large number of estrogen, this phase is also called estrogenic. And since under the influence of estrogen there is a proliferation of the mucous membrane of the uterus, the term proliferative is also used for the first phase.

During each cycle, many thousands of follicles mature, but only one of them reaches ovulation. Thus, in each menstrual cycle, as a rule, one egg is available for fertilization. However, on average, in one in 200 cycles, two follicles mature at the same time, so that two eggs can be fertilized, resulting in the development of fraternal twins.

The egg migrates from the ovary to the abdominal cavity, guided by fimbriae peripheral department fallopian tube into its lumen. Due to the peristaltic movements of the fallopian tube from the abdominal end to the uterine (like intestinal peristalsis), the egg moves in the fallopian tube into the uterine cavity. If there are spermatozoa in the lumen of the fallopian tube, the egg is fertilized.

Meanwhile, the bursting follicle collapses, a small blood clot remains in its emptiness, the place of the rupture closes. From the luteal cells of the granular layer of the follicle, which have yellow, develops a temporary endocrine gland- yellow body. Luteal cells multiply intensively, while the corpus luteum hormone, progesterone, is released. The corpus luteum usually functions for 14 days, that is, the second half of the menstrual cycle.

Influenced advanced level progesterone after ovulation, cryptoid glands develop in the uterine mucosa. In this state, the uterus is most prepared for pregnancy.

Progesterone acts on the body's temperature regulation centers, causing an increase in basal body temperature approximately 0.5oC. With the end of the functioning of the corpus luteum, the basal temperature decreases.

Distinguish between the corpus luteum of menstruation and the corpus luteum of pregnancy in the case of fertilization of the egg. With the onset of pregnancy, the corpus luteum continues to function throughout pregnancy (yellow body of pregnancy) and the entire period of lactation (yellow body of lactation).

Thus, the second phase of the menstrual cycle, which is associated with the formation of the corpus luteum in the ovaries and glands in the uterus, is called the luteal or secretory.

If fertilization does not take place, the corpus luteum is in the stage of reverse development, the maturation of a new follicle begins, and rejection of the mucous membrane occurs in the uterus and associated bleeding (menstruation).

During the menstrual cycle, cyclic changes occur in the cervix (in the first phase, cell growth is observed and mucus secretion increases, in the second it decreases), in the vagina (in the first phase, epithelial cells grow, in the second they exfoliate), in the mammary glands (in the 1st phase, the development of the tubular system and the expansion of the lobules of the gland, in the 2nd phase, the formation of lobules, an increase in the volume of the gland).

3. Planning for pregnancy

3.1 Methods of contraception

Planning is usually understood not as a simple definition of formal deadlines, but as preparation, implementation of a number of activities and further control over their implementation. Since in our case it is planned not to release any products, but to produce offspring, it is necessary to include the state of the emotional and motivational sphere of the parental couple Bandler R., Grinder J., Satir V. Family Therapy. - Voronezh: NPO "MODEK", 1993. - P. 72-89 ..

Over the past century, the state of society has contributed to the inclusion of women in an active social and professional life. Most women in the West are busy building a career and forming financial independence from a man, which in turn led to a shift in the timing of a woman's first pregnancy by 30 years.

Increasingly common couples where the main source of income is concentrated in the hands of a woman, and care in maternity leave threatened to worsen financial situation. Often a woman delays the conception of a child due to her unwillingness to spoil relations with higher management, who is interested in a full-fledged employee, or, under the threat of losing her job, she is forced to leave the decree much earlier than the deadline set by law.

To protect yourself both externally and internally, to avoid the discomfort associated with restructuring life values, temporal and spatial resources, a woman is forced to plan the conception of a child. But planning should not replace the actual decision to have a baby. To date, maternal values have pretty much lost their positions, more and more voices of adults are heard who declare their unwillingness to have a child.

Pregnancy can be avoided by abstaining from sexual intercourse during the period of the menstrual cycle when a woman can become pregnant. This method of contraception does not require the use of medicines, and therefore no side effects, except for pregnancy, which in this case can occur in 10 - 15% of cases.

Benefits of the natural method of contraception:

no health risk;

no side effects;

men's involvement in family planning;

the possibility of using for pregnancy planning.

Difficulties to be faced:

low contraceptive efficacy (9-25 pregnancies per 100 women during the 1st year of use);

contraceptive effectiveness depends on the couple's motivation and willingness to follow instructions;

the need for abstinence during the fertile phase to avoid conception;

daily records are required;

the presence of a vaginal infection may make it difficult to interpret changes in cervical mucus;

a thermometer is required for some methods;

does not protect against sexually transmitted diseases, incl. HIV infection AIDS.

Who should not use natural family planning methods:

women whose age, number of births or health conditions make pregnancy dangerous;

women with an irregular menstrual cycle (breastfeeding, immediately after an abortion);

women with irregular menstrual cycles;

women whose partner does not wish to abstain from sexual intercourse on certain days of the cycle.

Varieties natural methods family planning:

calendar (rhythmic) method - the least effective;

basal body temperature method;

cervical mucus method;

symptothermal method (a combination of the two methods listed above) is the most effective.

The calendar method of family planning. To avoid becoming pregnant, abstain from sexual intercourse during the fertile period (the period of time during which a woman can become pregnant). If you, on the contrary, want to conceive a child, the fertile period is the period when conception is most likely (in 10 - 20% of cases it can occur at another time).

There are three phases in the menstrual cycle:

absolute sterility;

relative sterility (conception may or may not occur);

fertility (the most favorable phase for conception).

The phase of relative sterility lasts from the last day of menstruation until ovulation. Ovulation occurs approximately two weeks after the start of the cycle (more often on the 11th, 12th, or 13th day of a 28-day cycle). It should be remembered that with a 28-day cycle, ovulation is possible between the 8th and 20th days.

The fertile phase begins at the moment of ovulation and ends 48 hours after it. For practical reasons, it is believed that the fertile phase lasts 6-8 days (+ for inaccuracy of calculations, for the fact that spermatozoa that have fallen into the cervical mucus are capable of fertilization within 5 days).

The phase of absolute sterility begins 48 hours after ovulation and continues until the end of menstruation.

Chemical means of contraception (spermicides). Spermicides are substances that neutralize spermatozoa and prevent sperm from entering the uterus. The main requirement for spermicides is the ability to destroy spermatozoa in a few seconds. Spermicides are available as creams, jellies, foam sprays, melting suppositories, foaming suppositories, and tablets. Some women use for contraception douching after intercourse with solutions that have a spermicidal effect: acetic, boric or lactic acid, lemon juice mixed with water. Given the evidence that spermatozoa are detected in the fallopian tubes 90 seconds after intercourse, douching with a spermicidal preparation cannot be considered a reliable method of contraception. family medicine/ Ed. M. Cohen. - Minsk, 1997. - S.188-194 ..

Spermicides can be used with condoms, diaphragms, caps, and on their own. Spermicides are injected into upper part vagina 10-15 minutes before sexual intercourse. For one sexual intercourse, a single use of the drug is sufficient. With each subsequent sexual intercourse, it is necessary additional introduction spermicide.

Since spermicides act for a very short period of time and do not affect a woman's ability to conceive, fertilization after their use is possible already during the next sexual intercourse. If pregnancy occurs against the background of the use of spermicides, this can lead to the formation of malformations of various systems and organs in the fetus due to the possible penetration of spermatozoa damaged by spermicides into the egg. It should be noted here that in order to increase the reliability of spermicides, they are recommended to be used in combination with other means. barrier contraception.

Intrauterine contraception (IUD). The mechanism of action of intrauterine contraceptives is as follows: under the influence of the IUD, the endometrium (the inner lining of the uterus) is traumatized, the tone of the muscles of the uterus increases, which leads to the expulsion of the embryo in the early stages of implantation. The IUD increases the contractions of the fallopian tubes and uterus, so the fertilized egg enters the uterus prematurely. The endometrium is not prepared to receive a fertilized egg, resulting in attachment gestational sac to the wall of the uterus is impossible. VMK like foreign body, causes the so-called aseptic inflammatory changes in the endometrium (without the participation of bacteria, due to damage to the inner layer of the uterus with a spiral), which prevent the attachment and further development of the embryo. Such inflammation disappears without a trace after the removal of the IUD. The addition of copper and silver to the IUD enhances the spermatotoxic effect (the effect of destroying spermatozoa).

The IUD is the optimal contraceptive for healthy women who have given birth permanent partner and not suffering from any inflammatory diseases genitals, that is, it is most likely that it is with the help of this method of contraception that the family plans to have a second child.

After removal of the IUD, the ability to conceive is restored, as a rule, very quickly, however, it is recommended to refrain from conception for 2-3 cycles to restore the functioning of the uterus and fallopian tubes and, therefore, reduce the risk of spontaneous miscarriage and ectopic pregnancy.

Before planning the removal of the IUD, it is necessary to contact a gynecologist 2-3 weeks in advance to be tested for the degree of purity of the vagina. In this case, you will have time to conduct anti-inflammatory therapy before removing the IUD. The actual removal of the spiral is carried out on the 2-3rd day of menstruation, when the cervix is ajar and the removal of the IUD is most painless. At the time of the procedure, the cervix is exposed in special gynecological mirrors, the doctor uses the same tools during a routine examination. An IUD that has threads is usually removed by pulling on the threads. If the threads are not visible for one reason or another, then hospitalization is necessary to remove the IUD. Pregnancy occurs after the extraction of the IUD within a year in 90% of women.

If pregnancy occurs against the background of the use of an IUD and the woman’s desire to continue the pregnancy in the presence of threads, the IUD should be removed. If the threads of the IUD are not detected and pregnancy is diagnosed, then the IUD is not removed. It should be noted that there was no increase in the incidence of malformations or any damage to the fetus if the pregnancy is carried out against the background of ICH.

Hormonal contraception. Hormonal contraception is based on the use of synthetic analogues of natural ovarian hormones and is highly effective remedy pregnancy prevention.

Depending on the composition and method of application, hormonal contraceptives are divided into several types.

Combined drugs are the most common oral contraceptives due to their high reliability, reversibility, reasonable cost and good tolerability. Such preparations contain two types of female sex hormones - estrogens and gestagens. Mechanism of action oral contraceptives(OK) is based on the blockade of ovulation, implantation, changes in the movement of spermatozoa and the function of the corpus luteum, which remains in the ovary at the site of the released egg and normally provides normal development fertilized egg.

After stopping OCs, ovulation (the release of an egg from the ovary in the middle of each menstrual cycle) is quickly restored and more than 90% of women are able to become pregnant within two years. A complication that rarely occurs after taking oral contraceptives should be mentioned. This is the so-called "post-pill" amenorrhea - the absence of menstruation and the possibility of conception within 6 months after stopping the use of OK. Such amenorrhea occurs in about 2% of women and is especially characteristic of early and late reproductive periods (that is, it occurs in young girls or women of the premenopausal period) or for women who have an underlying pathology, the manifestation of which provoked the use of OK.

It has been reliably proven that hormonal contraceptives, regardless of the duration of their use, do not affect the fertility (fertility) of a woman and do not cause infertility. After stopping the use of OK in most women, the ability to conceive is restored fairly quickly.

* in most cases, fertility is restored after 2-3 months;

* Availability regular cycle facilitate the calculation of the correct gestational age;

* Hormones included in the composition hormonal contraceptives, change the vitamin-mineral balance in the body, preventing, for example, the absorption of vitamin C, some trace elements and folic acid, and at the same time promoting excessive absorption of vitamin A, which can adversely affect the development of the unborn child.

It does not follow from the foregoing, however, that if pregnancy occurred immediately after taking OCs, or even if they were taken in the conception cycle, this increases the risk of pregnancy pathology or birth defects. Therefore, such cases are not an indication for termination of pregnancy. In women who used OK, the frequency of spontaneous miscarriages, ectopic pregnancies or fetal disorders does not increase. In those rare cases when a woman accidentally took OK during the period early pregnancy also, their damaging effect on the fetus was not revealed. Moreover, it has been shown that taking OCs in women with reduced fertility increases the likelihood of conception immediately after their withdrawal.

Mini-pills contain 300-500 micrograms of gestagens per tablet, do not significantly limit ovarian function. Mechanism contraceptive action mini-pill lies in the fact that a change in the quantity and quality of the mucus contained in the cervix, an increase in its viscosity, a decrease in the penetrating ability of spermatozoa reduce the likelihood of spermatozoa entering the uterus, changes in the endometrium that exclude implantation, and inhibition of the mobility of the fallopian tubes. Reception starts from the 1st day of the menstrual cycle and is carried out daily in a constant mode.

Reception of mini-pills, as well as combined OK, should be stopped 2-3 months before the planned pregnancy.

Prolonged drugs contain only gestagens (an example of such a drug is depoprover). Injections of drugs are done 1 time in 1-5 months. Subcutaneous implants are capsules that are inserted subcutaneously into the upper arm and secrete a hormone daily, providing contraception for 5 years. An example is norplant, which is 6 cylindrical capsules, which, under local anesthesia, are injected subcutaneously into the forearm of the left hand. There are intrauterine contraceptives containing levonorgestrel in the rod, which is secreted daily for a year (an example of such a drug is Mirena).

Restoration of the ability to conceive after the abolition of long-acting contraceptives may occur only after a few months (up to 1.5 years). Therefore, these contraceptives are recommended only for women who are not planning a pregnancy in the near future.

barrier methods. Such contraceptives are a mechanical barrier to spermatozoa (condoms, caps, diaphragms).

Barrier methods are less effective than most oral contraceptives and intrauterine devices; for some patients, their use is not possible due to an allergy to rubber, latex or polyurethane.

The vaginal diaphragm and cervical cap are used for contraception alone or in combination with spermicides. The diaphragm is a domed rubber cap with a flexible rim that is inserted into the vagina before intercourse so that the back rim is in posterior fornix vagina, the anterior would touch the pubic bone, and the dome would cover the cervix. Operating principle barrier contraceptives is to block the penetration of sperm into the cervical mucus. They are applied and act only locally, without causing changes in the body; therefore, these methods of contraception can be canceled immediately before the planned conception.

Barrier agents do not affect the ability to conceive in any way. Therefore, as the optimal contraceptive for the time that, according to the recommendations of doctors, should elapse between stopping the use of any of the contraceptives described above and conception, it is recommended to use barrier contraception.

Voluntary surgical contraception (sterilization). female sterilization is a surgical blockage of the patency of the fallopian tubes in order to prevent the fusion of the sperm with the egg. This is achieved by ligation, the use of special clamps or rings, or electrocoagulation of the fallopian tubes.

Male sterilization, or vasectomy, involves blocking the vas deferens to prevent sperm from passing through.

After the application of surgical sterilization, pregnancy is possible only with the use of auxiliary reproductive technologies such as in vitro fertilization, etc.

3.2 Planning for conception

Now let's try to figure out how adequate planning takes place in a family that wants to have a child and has made an appropriate decision. First, it's worth understanding that the best time to have a baby will never come, so it's best to just stop at "suitable enough." It is advisable not to be guided by the stereotypes offered in abundance by others, and not to adapt to anyone else (girlfriends, sisters, other relatives). But it is necessary to take into account information about the state of one's own health received from a doctor. The moment of conceiving a child is the decision of two adults who are psychologically ready to have a child and can be responsible for his well-being Varga A.Ya. Systemic family psychotherapy. - St. Petersburg: Speech, 2001. - S.147-152 ..

Thus, the first stage of pregnancy planning includes familiarization with the health status of both parents and the elimination of those diseases that may lead to adverse development of the fetus. Simple and obvious, but in practice the exceptions sometimes prevail over the rule. It is worth giving an account to yourself and your mental state because pregnancy is stressful condition both for the body and for the psyche, capable of exacerbating the problems with which it was previously possible to cope.

The next important component is the determination of the necessary resources. This stage is experienced by parents in very different ways. For some, this is a pleasant pastime, for others, a heavy burden. Generally speaking, it is worth making a holiday out of it, because it is a unique opportunity to experience the joyful moments of having what you may have been deprived of in your infancy and childhood, which comes from identification with the unborn child.

Speaking of resources, first of all, the issue of time and space must be resolved. A mother should always have enough time for her child and the child should have his own place, his own space. This is also a rule that is not difficult to fulfill at the planning stage. Allocating a place for a child and its equipment can become a space for the common dreams of a parental couple, and possibly memories of their own childhood.

The second important step is medical examination. Sometimes women do not want to be examined, citing the fact that nothing bothers them and they feel good. But the trouble is that most pregnancy complications become pregnancy complications, and before it, even if they exist in the form of test deviations, they do not appear subjectively. For example, antibodies to the Rh factor that are formed in Rh-negative women after pregnancy with an Rh-positive fetus. You can find out about them only by passing the analysis, they cannot disturb you in any way.

Some do not comply with prescriptions and enter into pregnancy with an initial deficiency essential substances. The intake of vitamins during pregnancy is of course necessary, but if the first, most important weeks of the development of the fetus occur in a state of deficiency of these substances, their further intake will not help to eliminate the complications that have developed.

To begin with, before conception, it is necessary to conduct an examination:

1. Going to the dentist, therapist

2. Examination by a gynecologist, colposcopy

3. Blood type, Rh factor for both spouses

If a woman has positive rh factor, no problem. If a woman has negative Rh factor- antibodies to the Rh factor (even if the man is also negative). If they are positive, pregnancy is not currently possible and needs to be corrected.

4.TORCH-complex. Antibodies to rubella, toxoplasma, herpes, CMV, chlamydia - quantitative analysis(with caption). The presence of IgG antibodies means immunity to these infections, and is not an obstacle to pregnancy. The presence of IgM means acute stage, planning in this case must be postponed until recovery. If there are no IgG antibodies to rubella, it is necessary to be vaccinated and protected for another 3 months after it.

5. Tests for infections: regular smear, PCR for latent infections - both.

6. Ultrasound of the pelvic organs - at least 2 times per cycle: after menstruation and before menstruation. First time evaluated general state pelvic organs, in the second, the presence of a corpus luteum and endometrial transformation, indicating that ovulation has occurred. Ideally, an intermediate third ultrasound on the eve of the expected ovulation is to detect a dominant follicle ready to ovulate.

7. Graph of basal temperature. From 6 to 7 in the morning, at the same time, without getting out of bed, mercury thermometer 5 minutes in the rectum. All deviations from this regimen and special circumstances (medications, ailments, sleep disturbances, menstruation, sexual life, violations of the chair, etc.) - mark in a special column.

8. Hemostasiogram, coagulogram - features of blood coagulation

9. Determination of lupus anticoagulant, antibodies to chorionic gonadotropin, antibodies to phospholipids - factors of early miscarriage.

10. General clinical blood test (hemoglobin, erythrocytes, leukocytes, platelets, ESR, color index, leukocyte formula). Finger blood.

11. General analysis urine.

Conclusion

The period of childhood in girls lasts from the moment of birth to 7-8 years. It is called "neutral", or "rest period". Nevertheless, during this period, certain changes occur in the reproductive system, which indicate its albeit low, but certain functional activity. During childhood, there is a low content of sex hormones, secondary sexual characteristics are absent.

The period of puberty takes about 10 years, its age limits are considered to be 7 (8) -16 (17) years. The period of puberty is characterized by the activation of the sex glands, the further development of the genital organs, the formation of secondary sexual characteristics (enlargement of the mammary glands, the appearance of pubic hair and armpits), the onset of menstruation (menarche) and the formation menstrual function.

The first ovulation is the culmination of puberty, however, it does not yet indicate puberty. Maturity occurs somewhere around 16-17 years old, when not only the reproductive system, but the whole organism has finally formed and become capable of conception, pregnancy, childbirth and feeding a newborn.

The period of puberty (childbearing, or reproductive) lasts about 30 years - from 16-17 to 45 years. It is characterized highest activity specific functions of the reproductive system aimed at fertility.

The main guarantee of successful pregnancy planning is not to turn this occupation into work, into a duty, into a task that has not been completed so far, into an unrealized area of life, into a family obligation, into attempts to meet some time, age, zodiac interval, into a problem. In any case, the birth of a child is a miracle beyond the control of man, and this is how it should be treated.

List of used literature

1. Bandler R., Grinder J., Satir V. Family therapy. - Voronezh: NPO "MODEK", 1993.

2. Varga A.Ya. Systemic family psychotherapy. - St. Petersburg: Speech, 2001.

3. General practice and family medicine / Ed. M. Cohen. -- Minsk, 1997.

4. William G. Masters, Virginia E. Johnson, Robert K. Kolodny Fundamentals of sexology. Per. from English. -- M.: Mir, 1998.

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Classification of age periods in terms of biology

There is no single classification different time it was made differently. Period separation is associated with certain age when they happen significant changes in the human body.

A person's life is the periods between key "points".

Passport, or chronological age may not coincide with the biological. It is by the latter that one can judge how he will do his job, what loads his body can withstand. biological age can both lag behind the passport, and ahead of it.

Consider the classification of life periods, which is based on the concept of age based on physiological changes in the body:

Age periods

age		period
0-4 weeks		newborn
4 weeks - 1 year		chest
1-3 years		early childhood
3-7 years		preschool
7-10/12 years old		junior school
girls: 10-17/18 years old		teenage
boys: 12-17/18 years old
young men	17-21 years old	youthful
girls	16-20 years old
men	21-35 years old	mature age, 1 period
women	20-35 years old
men	35-60 years old	mature age, 2nd period
women	35-55 years old
55/60-75 years		elderly age
75-90		old age
90 years and over		centenarians

The views of scientists on the age periods of human life

Depending on the era and country, scientists and philosophers have proposed various criteria for grading the main stages of life.

For example:

Chinese scientists divided human life into 7 phases. “Desirable”, for example, was called the age from 60 to 70 years. This is the period of development of spirituality and human wisdom.
The ancient Greek scientist Pythagoras identified the stages of human life with the seasons. Each lasted 20 years.
The ideas of Hippocrates became fundamental for the further definition of periods of life. He singled out 10, each 7 years long, starting from birth.

Periods of life according to Pythagoras

The ancient philosopher Pythagoras, considering the stages of human existence, identified them with the seasons. He singled out four of them:

Spring is the beginning and development of life, from birth to 20 years.
Summer - youth, from 20 to 40 years.
Autumn - heyday, from 40 to 60 years.
Winter - fading, from 60 to 80 years.

The periods of human life according to Pythagoras had a duration of exactly 20 years. Pythagoras believed that everything on Earth was measured by numbers, which he treated not only as mathematical symbols, but also endowed them with some kind of magical meaning. Numbers also allowed him to determine the characteristics of the cosmic order.

Pythagoras also applied the concept of “four” to age periods, because he compared them with eternal, unchanging natural phenomena, for example, the elements.

Periods (according to Pythagoras) and their advantages are based on the doctrine of the idea of eternal return. Life is eternal, like the successive seasons, and man is a part of nature, lives and develops according to its laws.

The concept of "seasons" according to Pythagoras

Identifying the age intervals of human life with the seasons, Pythagoras focused on the fact that:

Spring is the time of the beginning, the birth of life. The child develops, absorbing new knowledge with pleasure. He is interested in everything around him, but everything is still happening in the form of a game. The child is flourishing.
Summer is the growing season. A person blossoms, he is attracted by everything new, still unknown. Continuing to flourish, a person does not lose his childish fun.
Autumn - a person has become an adult, balanced, former gaiety has given way to confidence and slowness.
Winter is a period of reflection and summing up. Man has gone most of the way and is now considering the results of his life.

The main periods of the earthly path of people

Considering the existence of an individual, we can distinguish the main periods of human life:

youth;
mature age;
old age.

At each stage, a person acquires something new, reconsiders his values, changes his social status in society.

The basis of existence is the periods of human life. The features of each of them are associated with growing up, changes in the environment, the state of mind.

Features of the main stages of the existence of a personality

The periods of a person's life have their own characteristics: each stage complements the previous one, brings with it something new, something that has not yet been in life.

Youth is inherent in maximalism: there is a dawn of mental, creative abilities, the main physiological processes of growing up are completed, appearance, well-being. At this age, a system is established, time begins to be valued, self-control increases, and others are reassessed. A person determines the direction of his life.

Having reached the threshold of maturity, a person has already reached certain heights. In the professional field, he occupies a stable position. This period coincides with the strengthening and maximum development social status, decisions are made deliberately, a person does not avoid responsibility, appreciates today, can forgive himself and others for mistakes, realistically evaluates himself and others. This is the age of achievements, conquering peaks and getting the maximum opportunities for your development.

Old age is more about loss than gain. A person ends his labor activity, his social environment changes, inevitable physiological changes appear. However, a person can still engage in self-development, in most cases it happens more on a spiritual level, on the development inner peace.

Critical points

The most important periods of human life are associated with changes in the body. They can also be called critical: the hormonal background changes, which causes changes in mood, irritability, nervousness appear.

Psychologist E. Erickson identifies 8 crisis periods in a person's life:

Teenage years.
Entry of man into adult life- thirty years.
The transition to the fourth decade.
Fortieth anniversary.
Middle of life - 45 years.
fiftieth anniversary.
Fifty-fifth anniversary.
Fifty-sixth anniversary.

Confidently overcome "critical points"

Overcoming each of the presented periods, a person moves to a new stage of development, while overcoming the difficulties that have arisen on his way, and strives to conquer new heights of his life.

The child breaks away from his parents and tries to find his own direction in life.

In the third decade, a person reconsiders his principles, changes his views on the environment.

Approaching the fourth ten, people are trying to gain a foothold in life, to climb career ladder begin to think more rationally.

In the middle of life, a person begins to wonder if he lives correctly. There is a desire to do something that will leave a memory of him. There is disappointment and fear for their lives.

At the age of 50, a slowdown in physiological processes affects health, age-related changes. However, the person has already correctly placed life priorities, his nervous system works stably.

At 55, wisdom appears, a person enjoys life.

At 56, a person thinks more about the spiritual side of his life, develops his inner world.

Doctors say that if you are prepared and aware of the critical periods of life, then they will be overcome calmly and painlessly.

Conclusion

A person decides for himself by what criteria he divides his life periods, and what he puts into the concept of "age". It could be:

Purely external attractiveness, which a person seeks to prolong by all available means. And he considers himself young, as long as appearance allows it.
The division of life into "youth" and "the end of youth." The first period lasts as long as there is an opportunity to live without obligations, problems, responsibility, the second - when problems, life difficulties appear.
Physiological changes in the body. A person clearly follows the changes and identifies his age with them.
The concept of age is associated with the state of the soul and consciousness. A person measures his age by the state of his soul and inner freedom.

As long as a person's life is filled with meaning, the desire to learn something new, and all this is organically combined with the wisdom and spiritual wealth of the inner world, a person will be forever young, despite the weakening physical abilities of your body.

The functional state of the reproductive system of a woman is largely determined by the periods of life, among which it is customary to distinguish the following:

Antenatal (intrauterine) period;
- neonatal period (up to 10 days after birth);
- the period of childhood (up to 8 years);
- puberty, or puberty (from 8 to 16 years);
- the period of puberty, or reproductive (from 17 to 40 years);
- premenopausal period (from 41 years to the onset of menopause);
- postmenopausal period (from the moment of persistent cessation of menstruation).

Antenatal period.Ovaries. In progress embryonic development the sex glands are laid first (starting from 3-4 weeks of intrauterine life). By 6-7 weeks of embryo development, the indifferent stage of gonad formation ends. From the 10th week, female-type gonads are formed. At week 20, primordial follicles form in the fetal ovaries, which represent an oocyte surrounded by compacted epithelial cells. At week 25, the ovarian membrane appears. At 31-32 weeks, granular cells of the inner membrane of the follicle differentiate. From 37-38 weeks, the number of cavity and maturing follicles increases. By the time of birth, the ovaries are morphologically formed.

Internal reproductive organs. Fallopian tubes, uterus and upper third The vaginas originate from the paramesonephric ducts. From 5-6 weeks of embryo development, the development of the fallopian tubes begins. At 13-14 weeks, the uterus is formed by the fusion of the distal sections of the parameso-nephric ducts: initially, the uterus is bicornuate, later it acquires a saddle-shaped configuration, which often persists at the time of birth. At 16-20 weeks, the cervix differentiates. From the 17th week, the labia develop. By 24-25 weeks, the hymen is clearly defined.

The hypothalamic-pituitary system. From 8-9 weeks of the antenatal period, the secretory activity of the adenohypophysis is activated: FSH and LH are determined in the pituitary gland, fetal blood and in small quantities in amniotic fluid; in the same period GnRH is identified. At 10-13 weeks - neurotransmitters are detected. From the 19th week - the release of prolactin by adenocytes begins.

Neonatal period. At the end prenatal development fetus high level maternal estrogen inhibits the secretion of gonadotropins of the fetal pituitary gland; a sharp decrease in the content of maternal estrogen in the body of a newborn stimulates the release of FSH and LH by the girl's adenohypophysis, which provides a short-term increase in the function of her ovaries. By the 10th day of a newborn's life, the manifestations of estrogenic effects are eliminated.

Childhood period. Characterized by low functional activity reproductive system: the secretion of estradiol is negligible, the maturation of follicles to antral occurs rarely and haphazardly, the release of GnRH is inconsistent; receptor connections between subsystems are not developed, the secretion of neurotransmitters is poor.

The period of puberty. During this period (from 8 to 16 years), not only the maturation of the reproductive system takes place, but also the physical development of the female body is completed: body growth in length, ossification of the growth zones of tubular bones, the physique and the distribution of adipose and muscle tissues according to the female type are formed.

Currently, in accordance with the degree of maturity of the hypothalamic structures, three periods of maturation of the hypothalamic-pituitary-ovarian system are distinguished.

First period- prepubertal (8-9 years) - characterized by increased secretion of gonadotropins in the form of separate acyclic emissions; estrogen synthesis is low. There is a “jump” in body growth in length, the first signs of feminization of the physique appear: the hips are rounded due to an increase in the amount and redistribution of adipose tissue, the formation of the female pelvis begins, the number of layers of the epithelium in the vagina increases with the appearance of cells of an intermediate type.

Second period- the first phase of the pubertal period (10-13 years) - is characterized by the formation of a daily cycle and an increase in the secretion of GnRH, FSH and LH, under the influence of which the synthesis of ovarian hormones increases. An increase in the mammary glands, pubic hair growth begins, the vaginal flora changes - lactobacilli appear. This period ends with the appearance of the first menstruation - menarche, which coincides in time with the end of the rapid growth of the body in length.

Third period- the second phase of the pubertal period (14-16 years) - is characterized by the establishment of a stable rhythm of GnRH release, high (ovulatory) release of FSH and LH against the background of their basal monotonous secretion. The development of the mammary glands and sexual hair growth is completed, the growth of the body in length, the female pelvis is finally formed; the menstrual cycle becomes ovulatory.

First ovulation represents the culmination of puberty, but does not mean puberty, which occurs by 16-17 years. Puberty is understood as the completion of the formation of not only the reproductive system, but also the entire body of a woman, prepared for conception, pregnancy, childbirth and feeding a newborn.

The period of puberty. Age from 17 to 40 years. Features of this period are manifested in specific morphofunctional transformations of the reproductive system (Section H.1.1.).

premenopausal period. The premenopausal period lasts from 41 years to the onset of menopause - last menstrual period in the life of a woman, which on average occurs at the age of 50 years. Decreased activity of the gonads. A distinctive feature of this period is a change in the rhythm and duration of menstruation, as well as the volume of menstrual blood loss: menstruation becomes less abundant (hypomenorrhea), their duration is shortened (oligomenorrhea), and the intervals between them increase (opsomenorrhea).

Conventionally, the following phases of the premenopausal period are distinguished:

Hypolyuteic - there are no clinical symptoms, there is a slight decrease in the secretion of lutropin by the adenohypophysis and ovaries - progesterone;
- hyperestrogen - characterized by the absence of ovulation (anovulatory menstrual cycle), the cyclicity of FSH and LH secretion, an increase in estrogen content, which leads to a delay in menstruation by 2-3 months, often with subsequent bleeding; the concentration of gestagens is minimal;
- hypoestrogenic - there is amenorrhea, a significant decrease in estrogen levels - the follicle does not mature and atrophies early;
- ahormonal - the functional activity of the ovaries stops, estrogens are synthesized in small quantities only by the adrenal cortex (compensatory hypertrophy of the cortex), the production of gonadotropins increases; clinically characterized by persistent amenorrhea.

Postmenopause. The ahormonal phase coincides with the beginning of the postmenopausal period. Postmenopause is characterized by atrophy of the internal genital organs (the mass of the uterus decreases, its muscle elements are replaced by connective tissue, the vaginal epithelium becomes thinner due to a decrease in its stratification), urethra, Bladder, pelvic floor muscles. In postmenopause, metabolism is disturbed, pathological conditions cardiovascular, skeletal and other systems.

Having become acquainted with the anatomical and physiological features of the genital organs of a woman in different age periods, it is much easier to understand biological processes that take place in the female body.

Periods of women's life

Functional age features of the female reproductive system depend on a number of factors. Important periods of a woman's life:

the period of intrauterine development;
childhood (from birth to 9-10 years);
puberty (from 9-10 to 13-14 years);
adolescence (14-18 years);
reproductive period, or puberty (18-40 years);
premenopause, transition period (41-50 years);
postmenopause, the period of aging (since the cessation of menstruation).

prenatal period

During this period, all organs and systems of the fetus are laid, develop and mature. The ovaries are also laid and develop - one of the most important links in the functioning of the female reproductive system.

Childhood

In this period reproductive system stays in relative calm. Only during the first few days of a girl's life can a sexual crisis occur (breast engorgement, bloody discharge from the vagina). It's all because of the termination hormonal action placenta. In childhood, the organs of the reproductive system gradually grow, but typical features remain: the size of the cervix prevails over the size of the uterus, the fallopian tubes convoluted, mature follicles in the ovaries are absent, etc. And there are no secondary sexual characteristics.

Puberty

During this period, the organs of the reproductive system (mainly the body of the uterus) grow rapidly. The girl begins to appear and develop secondary sexual characteristics: a female-type skeleton is formed, fat is deposited according to the female type, hair grows first on the pubis, then in armpits the first menstruation occurs.

Puberty

This period is the longest in a woman's life. As a result of the maturation of the follicle in the ovaries and further ovulation, all conditions are created in the woman's body for further pregnancy. Menstruation becomes regular - and this is the main indicator women's health childbearing age.

This period is characterized by the transition from puberty to the onset of old age. Often, various disorders of menstrual function develop, their cause can be age-related disorders in the central mechanisms that regulate the function of the genital organs.

Aging period

The aging period is characterized by the complete cessation of menstruation, the general aging of the female body. The function of the ovaries completely fades away (there are no ovulations, cyclic changes in the body, there are no menstruations), the level of estrogen decreases, which can provoke osteoporosis, atherosclerosis, cardiomyopathy.