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Menstruation Cycle

The menstruation cycle refers to the regular changes in the activity of the ovaries and
the endometrium that make reproduction possible. There are two synchronized cycle : The
ovarian cycle (development of the ovarian follicles and ovulation) and the uterine cycle (the
functional endometrium thickens and sheds in response to ovarian activity). A new menstrual
cycle begins on the first day of menstruation and ovulation occurs fourteen days before the
beginning of a new cycle , so this means there are an average of 28 days menstrual cycle, 14
days of pre ovulatory phase and ± 14 days of post ovulatory cycle.

The two weeks before ovulation is the ovarian follicular phase, which corresponds to the
uterine menstrual and proliferative phase and two week after ovulation is the ovarian luteal
phase, which corresponds with the uterine secretory phase.
The follicular phase start on the first day of menstruation and represent 2 weeks of the
four weeks cycle. The whole menstrual cycle is controlled by the hypothalamus and the
pituitary gland. The hypothalamus is a part of the brain that secretes gonadotropin-releasing
hormone (GnRH) which causes the nearby
anterior pituitary gland to release follicle
stimulating hormone or FSH and luteinizing
hormone (LH). Pituitary hormone control the
maturation of the ovarian follicles, each of which
is initially made up of an imature sex cell or
primary oocyte surrounded by layers of theca
and granulosa cell. On the surface of the ovaries,
a couple of ovarian follicles compete with one
another to grow the fastest during each
menstrual cycle. During the first ten days, theca
cell develop LH receptors which allows them to
bind LH and in response they secrete a large
amount of androstenedione. Granulosa cells develop FSH receptors, which allow them to bind
FSH and produce an enzyme called aromatase. Aromatase convert androstenedione from the
theca cell into 17-β Estradiol, which is a member of estrogen family. As follicle grow, the level
of estrogen in the blood increases and it acts as a negative feedback signal that tells the
pituitary gland to secrete less FSH. Less FSH in the blood means there’s only enough to
stimulate one follicle. The follicle that has the most FSH receptors grows the quickest and
becomes the dominant follicle, while the rest of the follicles regress and die (atresia). During
day 10 to 14 , in addition to the FSH receptors , the granulosa cell also begin to develop LH
receptors. Meanwhile the dominant follicles keeps secreting estrogen. High estrogen levels
make the pituitary more responsive to the pulsatile action of GnRH of the hypothalamus. As
estrogen levels start to steadily climb higher and higher, the estrogen from the dominant
follicle becomes a positive feedback signal . It makes the pituitary gland secrete a whole lot of
LH in response to GnRH. This happens a day or two before ovulation, and the massive surge of
FSH and LH binds to the granulosa and theca cell, which help facilitate rupture of the ovarian
follicle and release of the oocyte. For the most of the follicular phase, the pituitary saves it’s
energy. And when it senses that a dominant follicle has really proven itself, the pituitary uses all
of it’s energy to secrete enough LH for ovulation. The spike in estrogen is aimed at optimizing
the chance of fertilization, which is highest between day eleven and a day fifteen of an average
28 days cycle. During that time, the high estrogen levels change the consistency of the vaginal
mucosa, making it more hospitable to incoming sperm. Additionally, the uterus goes through
the proliferative phase, which is when the functional layer of the uterus thickens and the
uterine glands grow. Right after ovulation, while the LH levels still high, the remains of the
follicle turn into the corpus luteum, which is made up of theca cell (theca lutein) and granulosa
cell ( granulosa lutein), later theca lutein responds to the low concentrations of LH after
ovulation by producing progesterone, but luteinized granulosa cell also secrete inhibin, which
inhibit the pituitary gland from making FSH , it makes estrogen level fall. This means that
progesterone surpasses estrogen as the dominant hormone , and it makes the endometrium
receptive to the implantation of a fertilized gamete. Progesterone acts as negative feedback
signal on the pituitary gland. It makes FSH and LH levels fall. Under the influence of
progesterone, the uterus starts to go through the secretory phase, that’s when the spiral
arteries grow even longer and the uterine glands secrete more mucus. After day fifteen, the
window for fertilization starts to close, the cervical mucus starts to thicken and becomes less
hospitable for the sperm. Over time, the corpus luteum becomes corpus albicans.

The corpus albicans doesn’t make hormones,


so estrogen and progesterone levels slowly
decrease. When progesterone reaches it’s lowest
level , the spiral arteries collapse and the functional
endometrial layers gets ready to slough off. This
leads to menstruation and the beginning of a new
menstrual cycle and another attempt of fertilization.

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