The

Menstrual
Cycle

PreTest...?????
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Definisi menstruasi ?
Fase-fase menstruasi?
Hormon yang berperanan?
Ovulasi ?
Macam Gangguan menstruasi?

Menstruation

What.?
Who..?
When?
Where..?
Why..?
How?

menarche
First menstrual cycle
Ascociated with puberty
Maturation Hipothalamus-hypofiseovarium axis
Depend on : nutritional state, general
health, geographic location, exposure to
light, and psychological state

The Menstrual Cycle: Two Phases

Ideally 14 days each
Follicular and Luteal
Describe changes in the ovary

Proliferative and Secretory

Describe changes in the endometrium

Hormones in the Menstrual Cycle

* From Up to Date: The Normal Menstrual Cycle 2008

Follicular phase
Begins with the onset of menses and ends on the day of
the luteinizing hormone (LH) surge
During late luteal phase/ early follicular phase:
withdrawal of estrogen and progesterone in late luteal phase
In early follicular phase, ovary is least hormonally active low
serum estradiol and progesterone
release from negative feedback effects of estrogen +
progesterone increase in GnRH pulse frequency in early
follicular phase
Increased GnRH pulse 30% increase in serum FSH
concentrations

FSH release from the pituitary stimulates growth of 5-15

primordial follicles
By late follicular phase, a single dominant follicle has been
selected.

Follicular Phase
The developing dominant follicle produces
estrogen in a 2-cell process
Theca interna cells produce androstenedione in
response to LH stimulation
Granulosa cells convert androstenedione estradiol
when stimulated by FSH

Estrogen causes the uterine lining to thicken /

proliferate
GnRH pulse frequency increase rise in LH
Rise in LH also stimulates androgen synthesis
androgens are converted to estrogens

Follicular Phase
Serum estradiol concentrations peak
approximately 1 day before ovulation
Midcycle (~day 14) there is an LH spike in
response to this estrogen surge
Ovulation occurs as increase in LH level
causes the follicle to rupture and release
mature ovum

LH Surge
Involves a poorly-understood
neuroendocrine phenomenon in which
there is a switch from negative feedback
control of LH secretion by estradiol and
progesterone to positive feedback
Rising estradiol levels at the end of the
follicular phase result in a 10-fold increase
in serum LH concentration

LH Surge: Effect on the Ovary

In response to LH:
Oocyte in the dominant follicle completes 1st meiotic
division
Increase in local secretion of plasminogen activator
and cytokines required for ovulation
Oocyte released from follicle at ovarian surface ~ 36
hrs after LH surge.
Even before oocyte is released, granulosa cells
around it begin to luteinize and produce
progesterone. Progesterone slows LH pulses/
decreases LH pulse frequency

Ovulation

LH spike stimulates ovulation, the release of the ovum from the follicle

After ovulation, the luteal phase begins, and remnants of the follicle left
behind in the ovary develop into the corpus luteum

Ovulation
Ovum usually passes into adjoining
fallopian tube and is swept down to the
uterus by the cilia lining the tube
Takes 3-4 days for ovum to travel down
tube to the uterus
Fertilization must occur within 24 hrs of
ovulation or ovum degenerates

Luteal Phase
After ovulation, granulosa and theca
interna cells lining the wall of the follicle
form the corpus luteum cyst (stimulated by
LH)
The corpus luteum synthesizes estrogen
and large amounts of progesterone
Progesterone stimulates the endometrium to
become more glandular/secretory in
preparation for implantation of fertilized ovum

Luteal Phase
If fertilization occurs:
developing trophoblast synthesizes human
chorionic gonadotropin (hcg)
hcg maintains the corpus luteum so it may
continue producing estrogen and
progesterone to support the endometrium

By ~ 8-10 weeks gestation, the placenta is

developed, and takes over production of
estrogen and progesterone

Luteal Phase
If fertilization does not occur:
corpus luteum is not maintained by hcg
Corpus luteum degenerates after ~ 14 days
Estrogen and progesterone levels fall
Withdrawal of progesterone causes secretory
endometrium to slough
FSH levels slowly rise again in absence of negative
feedback

MENSTRUATION