Sie sind auf Seite 1von 22

PHYSIOLOGY OF THE

MENSTRUAL CYCLE
Dr.dr.Kms.Yusuf Effendi, SpOG(K)
LEARNING OBJECTIVES

To review the different phases of the menstrual


cycle and its physiology, and
To understand the sequence of events
occurring during the menstrual cycle
INTRODUCTION
Menstruation
The occurrence of bleeding when progesterone is withdrawn
from an estrogen- and progestin-primed uterus.

The functionalis layer of the endometrium undergoes


extensive changes, resulting in complete tissue breakdown.

With each menstrual cycle, most of the endometrium is


completely shed at menses and subsequently regenerated.
Hypothalamic-Pituitary-Ovarian AXIS
Elevated estrogen
reaches critical point
positive feedback
mechanism on GnRH,
FSH, and LH
secretion.

Negative Estrogen
Feedback FSH
Mechanism LH

Stimulates
Inhibits
OVARIAN CYCLE

Follicular phase
Theca and granulosa cells responds to LH and FSH
stimulation produce oestrogen, progesterone,
inhibin and activin.

As the follicles grow & oestrogen secretion


negative feedback on the pituitary to FSH
secretion.

One follicle is selected to continue in its


development towards ovulation (the dominant
follicle) while smaller ones will undergo atresia.
OVARIAN CYCLE

Ovulation
The dominant follicle grow to 18-22 mm at 14 days

Oestrogen until exert a positive feedback effort on


the hypothalamus & pituitary LH surge.
OVARIAN CYCLE

Luteal phase
After the release of the oocyte, the remaining
granulosa and theca cells on the ovary form the
corpus luteum.

Highest level of progesterone of all phase

In the absence of HCG, the corpus luteum will


regress & disappear from ovary (luteolysis)

The withdrawal of progesterone shedding of the


endometrium & menstruation.
UTERINE CYCLE

Menstrual phase

In this phase, a plane of separation appears


between the superficial endometrium and
the basal layer.

Abrupt decline of E2 and P sloughing of


endometrium.

Enzymatic degradation of the functional


layer of the endometrium with its
subsurface capillary plexus menstruation.
During the menstrual cycle, the stratum functionalis expands and
vascularizes and is subsequently sloughed off during the process of
menstruation, whereas the stratum basalis remains relatively constant.
UTERINE CYCLE

Proliferative phase

Early phase straight, narrow glands with


cubo-columnar epithelium.

Late phase the glands increase in size


with pseudostratification of the epithelium

Estradiol, produced by the ovaries on day 4


or 5 of the cycle, induces growth and
proliferation of the endometrium
UTERINE CYCLE

Secretory phase

Secretion of progesterone after ovulation


causes complete cessation of endometrial
epithelial proliferation

Progressive distension of the glands, lined


by low columnar cells.

Peak secretory activity of progesterone is


seen by D2021
Normal limits of menstrual cycle
Frequent: <24 d
Frequency of
Normal: 24 38 d
menses (days)
Infrequent: >38 d

Absent
Regularity of
Irregular: Variation >20 d
menses
Regular: Variation 2 20 d

Prolonged: >8 d
Duration of
Normal: 4.5 8 d
flow (days)
Short: <4.5 d

Volume of Heavy: >80


monthly blood Normal: 5 80
loss (ml) Light: <5
ROLE OF FSH

The granulosa Activates LH


cell receptors on
proliferation & the dominant
differentiation follicle

Induces the Enhances the


estrogen synthesis of
production inhibin
ROLE OF LH

Triggers Responsible for Induces the


ovulation & the disruption resumption of
oocyte meiotic
follicular of the
maturation &
rupture 36 cumulus- the luteinization
hours after the oocyte of granulosa
surge. complex. cells
LH surge
Positive feedback from
dominant follicle results in
increased LH (and also, but
lesser, FSH) levels.

2 important effects:
- Primary oocyte of dominant
follicle completes meiosis
- After meiosis 1 is complete
ovulation.
ROLE OF ESTRADIOL

Mid-late follicular Suppresses the secretion of FSH due to a negative feedback


phase mechanism selection of a dominant follicle.

Mid-cycle Triggers the LH surge due to a positive feedback mechanism.

Follicular phase It is responsible for an increase of thickness of the endometrium.

Stimulates the glands of the cervix to secrete a particular type of


Ovulatory period
mucus.
ROLE OF PROGESTERONE

Induces a secretory endometrium, Maintains the endometrium


capable to enhance embryo throughout the first weeks of
implantation pregnancy

Modifies the endometrial glandular Interfere in the expression of genes


structure (more number, more needed for implantation at the
tortuous) endometrium level
SUMMARY

An endometrium, receptive to embryo implantation, is


prepared and shed each month during the menstrual cycle.
Precisely regulated tissue degradation, controlled
hemorrhage, and rapid hemostasis and repair are required
for normal menstruation.
A thorough understanding of the mechanisms that underlie
this process is important to understand the basis and
treatment of disorders in this complex physiologic process.
Thank You

Das könnte Ihnen auch gefallen