PHYSIOLOGY OF

MENSTRUATION CYCLE
DR.A .RATHNA ., M.S ( O&G )

MENSTRUAL CYCLE

Normal cycle length is considered 28 days

varies from female to female (21-35

days)

Ovarian cycle: 1-follicular ,2-luteal

Uterine cycle: 1-proliferative ,2-secreatory

Normal menstrual
cycle

21-35 days
2-6 days of flow
Average blood loss:20-60
ml

1 Follicular phase

Development dominant follicle,

mature at midcycle, ovulation
Average length:10-14 days
Variability in length: variations in
total cycle length

2-luteal phase

Ovulation to menses
Average length: 14 days

1-Proliferative phase

First day of vaginal bleeding :day 1 of

the menstrual cycle
Progressive mitotic growth of decidua
functionalis, preparation for
implantation of embryo
Thin endometrium (1-2 mm); straight,
narrow, short endometrial glands
become longer, tortuous structures

OVULATION

Occurs at the 14th day.

Due to action of LH,the graffian
follicle ruptures and ovulates
forming CORPUS LUTEUM.

2-Secretory phase

48 to 72 hours following ovulation,

progesteron secretion: eosinophilic
protein-rich secretory product in
glandular lumen
Postovulatory day 6-7,maximal
secretory activity: optimal for
implantation of blastocyst
Stromal edema in late secretory phase

Menses

Absence of implantations, glandular

secretion ceases, irregular break-down
of decidua fuctionalis
Destruction of corpus luteum and its
productions estrogen and progesteron:
cause of shedding
Withdrawal of sex steroids: spiral art
spasm, endometrial ischemia, lysosoms
breakdown, proteolytic enzymes release

Reproductive hormones:
GnRH

GnRH: decapeptide, by neurons in

arcuate nucleus of hypothalamus
Regulate secretion of two hormones:
FSH and LH
Pulsatile secretion
Extremely short half-life: only 2-4 min

Gonodotropins

LH &FSH: by ant pituitary

gonadotroph cells
Ovarian follicular stimulation
Glycoproteins, alpha &beta subunit

Prolactin

Poly peptide, by ant pituitary

lactotroph
Primary trophic factor responsible for
the synthesis of milk by breast
PRL secretion is under tonic inhibitory
control by hypothalamic secretion of
dopamine
PRL stimulation: breast manipulation,
drugs, stress, exercise, certain foods

TSH

By ant pituitary thyrotrophs in

response to TRH
TRH:by arcuate nucleus ,portal
circulation, pituitary
TRH: TSH & PRL release
Hypo- and hyperthyroidism:
ovulatory dysfunction

Oxytocin

9 aa peptide, by paraventricular
nucleus of hypothalamus
Uterine muscular contraction,
breast lactiferous duct
myoepithelial contraction

Hormonal variations
1.

2.

At the beginning of cycle: levels of

gonadal steroids are low
Demise of corpus luteum, FSH
levels rise, cohort of growing
follicles is recruited, rise in
estrogen: stimulus for uterine
endometrial proliferation

Hormonal variations
3.

Rising estrogen levels: negative

feedback on pituitary FSH secretion;
growing follicle produce inhibin-B:
suppresses pituitary FSH secretion;
Rising estrogen levels: LH initially
decreases
but late in follicular phase LH levels
increased dramatically

Hormonal variations

4.

At the end of follicular phase

(just before ovulation) FSHinduced LH receptors on
granulosa cells;
with LH stimulation, modulate
secretion of progesterone

Hormonal variations

5.

After sufficient degree of

estrogenic stimulation; pituitary
LH surge triggered, proximate
cause of ovulation occurs 24 to
36 hours later

Hormonal variations

6.

Estrogen level decreases

through the early luteal phase
from just before ovulation until
midluteal phase, rise again as a
result of corpus luteum
secretion

Hormonal variations
7.

8.

Progesteron levels rise after

ovulation; presumptive sign
of ovulation
Progesteron;estrogen and
inhibin-A : suppress
gonadotropin secretion and
new follicular growth

Cyclic changes of the

Endometrium

Decidua functionalis: 2/3

superficial, proliferate and shed
each cycle
Decidua basalis: deepest region,
source of endometrial regeneration
after each menses

Oogonia: only one final daughter

cell (oocyte), three polar body
Oocyte arrested in prophase
(diploten) until time of ovulation

Two-cell two-gonadotropin
theory

with LH stimulation, the

ovarian theca cells produce
androgens that convert by
granulosa cells into estrogens
under the stimulus of FSH

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