NORMAL

MENSTRUAL CYCLE
Prepared by LORRAINE PATAL
CLINICAL TUTOR O&G
2019
LEARNING OUTCOME
• AT THE END OF THE SESSION THE LEARNERS WILL
• DEFINE MENSTRUAL CYCLE
• DESCRIBE THE OVARIAN AND ENDOMETRIAL CYCLE
• DESCRIBETHE CHANGES THAT OCCUR WITHIN
DIFFERENT PHASES OF A MENSTRUAL CYCLE
• DETERMINE
THE OVULATION PEAK DAY IN A
MENSTRUAL CYCLE
Introduction
• Menstrual cycle.
• Menstruationis a normal physiological change that every woman
experiences beginning at puberty and throughout her reproductive
and ends at menopause when she stops seeing her menstrual
periods at about the age of 51 years. It is influenced by hormonal
interaction.
• Menarche :The first menstruation that a girl experiences.
• Fromthen on she develops cyclic (monthly) bleeding from the
vagina termed menstruation.
• Normal menstruation indicates a woman’s fertility status.
 DEFINE MENSTRUAL CYCLE
• Menstrual cycle is defined as the time from onset of a menstrual period to
onset of the next menstrual period or bleeding days
• The menstrual cycles vary in length for each woman, from short cycles 21
days to longer cycles of 35 days. On average a normal cycle length is 28
days,
• Duration of a menstrual period : 3 to 7 days
• Average menstrual blood loss : 30 to 80ml
• Average age of menopause: 51 years ( normal range = 45 to 55 years of
age).
 Hormonal interaction and menstruation
The menstrual cycle and ovulation is
regulated by interaction between
hormones which then signal targeted
tissues or organs within the body to
act in certain ways.

ORGANS AND HORMONES

INVOLVED.
1. Hypothalamus- GnRH(
Gonadotropin Releasing Hormone)
2. Anterior pituitary – FSH & LH
3. Ovaries – Estrogen & Progesterone
4. Uterus – reconstruction and
shedding of endometrium.
Hormones responsible for the
menstrual cycle
1.GnRH- Gonadotropin Releasing Hormones
2.FSH – Follicle Stimulating Hormones
3.LH – Luteinizing Hormones
4.Oestrogen
5.Progesterone
 Endometrial and ovarian cycles
• The changes occurring within the menstrual cycle can further be divided into two
separate cycles
• 1. OVARIAN CYCLE
• THE ENDOMETRIAL CYCLE
• 2. The hormones control the menstrual cycle. During each cycle, the brain's
hypothalamus and pituitary gland send hormone signals back and forth with the
ovaries.
• These signals get the ovaries and uterus ready for a pregnancy resulting in the
two cycles.
PHASES OF THE OVARIAN CYCLE
• The ovarian cycle is further divided into two phases describing the
changes which occur within the ovaries during a menstrual cycle.
• A) FOLLICULAR PHASE
• B) LUTEAL PHASE
 Follicular phase and the Luteal phase
• FOLLICULAR PHASE
• FSH levels increase and stimulates
follicular development.
• As the dominant follicle begins to
grow, estradiol and inhibin production
rises and results in a decline of
follicular-phase FSH. This drop in
• FSH levels is responsible for the
failure of other follicles to reach
preovulatory status—the Graafian
follicle stage—during any one cycle.
LUTEAL PHASE
This phase is constant at 14 days from
ovulation peak day
LH stimulates increase in progesterone. At
the end of the luteal phase, progesterone
send a negative feed back to the anterior
pituitary to decrease the levels of FSH and
LH and subsequently 17 estradiol and
progesterone.
Changes
increase vascular supply, more mucus
secretions
Of glycogen,mucin,etc
Luteal phase
• Luteinizing hormonal levels increase
• After ovulation, the corpus luteum produces amounts of progesterone
to maintain the thickened endometrium. This corpus luteum regresses
after 14 days causing both estrogen and progesterone levels to drop
at the end of the cycle.
Ovulation
• Ovulation always occurs s14 days before the next menses. At the end of
the proliferative 17 -beta estradiol levels are high due to follicle
maturation. 17 beta estradiol produces a positive feedback for FSH and
LH
• 17 estradiol reaches its peak and high levels of FSH and LH are present.
The sudden rise in LH in called the LH surge which stimulates ovulation

• EVENTS OCCURRING IN OVULATION

• Matured follicle ruptures and the ovum released
• Increase cervical mucus
• The levels of 17 beta estradiol decrease at the end of ovulation.
PHASES OF THE ENDOMETRIAL CYCLE
• The endometrial cycle is further divided into two
phases describing the changes that occur within the
uterus /endometrium.

• A) PROLIFERATIVE PHASE
• B) SECRETORY PHASE
PROLIFERATIVE AND THE SECRETORY PHASES
• A) Proliferative phase B) Secretory phase –Glands become
dilated and tortuous.
• Estrogen receptor content
Blood vessels become more coiled
increases
Glycogen accumulation reaches peak
• Proliferation
of glandular, under the influence to both Estrogen and
stromal and vascular Progesterone.
endothelial cells. The endometrium is prepared to embed
an embryo. If no fertilization occurs, the
• INFLUENCED BY levels of estrogen and progesterone
ESTROGEN drops and the endometrium sheds as a
menstrual period.
INFLUENCED BY PROGESTERONE
 Proliferative phase and secretory
phase
• The preparation and
reconstruction of the
endometrium is
influenced by the
hormones estrogen
• The secretory phase is
influenced by the
hormones progesterone.
• The alteration in estrogen and progesterone levels are responsible
for the dramatic changes in the endometrium throughout the cycle.
Under influence of the rising levels of estrogen, the endometrium is
further thickened.
• The dramatic drop in circulating estradiol and progesterone levels
initiate molecular events that lead to menstruation.
Menses
• Atthe end of the secretory phase the corpus luteum
degenerates. In turn the spiral arteries undergo
vasoconstriction few hours before menstrual bleeding. This
ischemic reaction leads to necrosis of endometrial cells
which the slough off as menses(menstrual period) The cycle
then restarts at Day “0”.
• Primordial
follicles begin to develop and start the follicular
phase again in hopes of a pregnancy.
• SUMMARY
• A normal regular menstrual cycle indicates that a woman is
fertile . The average cycle length is 28 days but this may
vary. Regardless of the length of the cycle, the secretory
phase is always constant at 14 days before the next cycle
begins.
• There are two separate cycles within a menstrual cycle
known as the endometrial cycle and the ovarian cycle
within which changes occur within the ovaries and the
uterus as hormones send signal to and fro, causing certain
tissue and organs to behave in certain ways. The menstrual
cycles completely come to an end at 45 to 51 years of age.
This is called menopause.
Ref.
• Dhanalakshmi K. et al (2019). Physiology, Menstrual Cycle. Retrieved on
11th July 2019 from https://www.ncbi.nlm.nih.gov/books/NBK500020/.
• Padubidri, V. et al (2015).Shaw’s Textbook of gynaecology,16th Ed, Elsvier
India Private Ltd: New Delhi
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