MENSTRUAL CYCLE##

Menstrual Cycle
Female reproductive cycle
Periodic uterine bleeding in response to cyclical hormonal changes

BODY STRUCTURES ##INVOLVE IN THE ##MENSTRUAL CYCLE

1. Hypothalamus##2. Anterior pituitary gland # (APG)##3. Ovary##4. Uterus#

#Hormone Feedback Controls in the Female Reproductive Cycle#

HYPOTHALAMUS
The ultimate initiator of the menstrual cycle by secreting Gonadotropin Releasing
Hormones (GnRH) that governs the PG by hormonal pathways, w/c in turn governs the
ovary in the same manner.
THE GnRH are:
A. Follicle Stimulating Hormone Releasing Hormone (FSHRH)
Triggered by ↓ serum estrogen level, it stimulates the APG to release FSH

HYPOTHALAMUS
B. Luteinizing Hormone Releasing Factor (LHRF)
Triggered by ↓ serum progesterone level
Stimulates APG to release Luteinizing hormone (LH)

ANTERIOR PITUITARY GLAND (APG)

In response to stimulation from the hypothalamus and ↓ serum Estrogen and
Progesterone levels, the APG releases the ffg Gonadotropin hormones (GRH)
A. Follicle Stimulating Hormones (FSH)
This is triggered by FSHRF and ↓ E level, it stimulates the development of several
graafian follicles in the ovary and the production of Estrogen.
It is inhibited by high serum estrogen level

ANTERIOR PITUITARY GLAND (APG)

B. Luteinizing Hormone (LH)
Triggered by ↓ serum progesterone and LHFH
It stimulates the corpus luteum to produce progesterone and some estrogen.
Responsible for ovulation

Ovary
Known as female gonad
Produces estrogen during the first half of the cycle and progesterone during the
second half of the cycle.
Within the cortex of the ovary
The follicles at the different phases of the dev’t are found:
Primodial follicles
Graafian follicles
Corpus luteum
Corpus albicans

Primodial Follicles
Formed during intrauterine life
Most of them regress before birth
Immature follicles inside the ovary that contain immature ova
During a menstrual cycle, several of these follicles develop under the influence of
FSH.
Graafian Follicles
Derived from the name of Regner de Graaf, the Dutch anatomist who 1st described it
in 1672.
After puberty, several follicles develop under the influence of FSH
This developng promodial follicle is termed Graafian follicle.

Graafian Follicles
Described as a blister like structure barely visible to the naked eye. As it
develops, the oocyte within it matures
Secret large amount of estrogen and under the influence of FSH.

Corpus Follicles
After ovulation, the Graafian follicles undergoes certain changes.
Cells inside, now empty follicle proliferate and enlarge until it becomes a dense
mass of cells about 1 to 3 mm in diameter that produce a yellow fluid called
lutein.

Corpus Follicles
Lutein fills the space that was once occupied by the ovum giving it a yellow
coloration. This is why the follicle is termed corpus luteum after ovulation w/c
means yellow body
The primary hormone produced is progesterone, although seret some estrogen.

Corpus Follicles
Has life span of 7-8 days only. After which it regresses
If fertilization occurs, the trophoblast cells of the zygote secret HCG w/c
prolongs the life of corpus luteum & stimulates it to continue producing
progesterone.

Corpus Follicles
Not only secrets progesterone durin pregnancy but also, relaxin, activins, inhibins
and sometime oxytocin.
Produce P until 8 - 12 wks gestation
It usually regresses after 6 months

Corpus Albicans
Complete regression of the corpus luteum occurs before menstruation, later it will
be seen as a white fibrous tissue, called corpus albicans or corpus albicantia.

Hormones of Ovaries
Estrogen
Progesterone

Estrogen
FSH stimulates the Graafaian follicle to produce Estrogen
3 kinds of Estrogen:
Estradiol
Estrone and
Estriol
Estradiol is the most potent
Estriol is the one found in urine
E is metabolized by the liver and excreted in the urine

Effects of Estrogen
inhibits FHS
Known as the “Hormone of Women” bcoz it is the hormones that stimulates the devt
of the female 2º characteristics
Causes mucus to be thin transparent and highly stretchable
Stimulates the growth of ductile structure of the breasts
Menarche and menstruation

Progesterone
LH stimulates the corpus luteum to produce progesterone.
Its by product found in the urine known as pregnanediol
Known as the “Hormone of Pregnant Women”

Effects of Progesterone
Thermogenic effect: body temperature drops by 0.5 to 1 º F a day before ovulation
because of the very low progesterone level at this time, and rises 1º F once
progesterone increase in level
Remains elevated for the next 8-10 days.

Effects of Progesterone
Relaxes uterine muscles
Promotes growth of the acini cells of the breast
Causes weight gain by promoting fluid retention
Causes tingling sensation and feeling fullness in the breast
Stimulates endometrium glans to secret mucin and glycogen in preparation for
implantation.

Uterus
Changes occurs in the uterine endometrium are due to the influence of the ovarian
hormones: E & P
1st half of the cycle, proliferation of the endometrial glands and blood vessels is
due to the influence of estrogen
2nd half of the cycle, mucin and glycogen secretion of endometrial glands is due to
influence of the progesterone.

Menstrual cycle & hormones

A. Menarche
Onset or the very 1st menstruation
An event that signifies the end of puberty & the beginning of the reproductive
years of a woman
Typically occurs bet 9-17 years old (average age of onset 12 or 13 years)

MENSTRUAL CYCLE & HORMONES

B. Menstrual cycle
rhythmic reproductive cycle in females extending from the onset of a period of
uterine bleeding to the onset of the next period of bleeding
Mean cycle length is 28 days
Normal range is 20 to 45 days per cycle

MENSTRUAL CYCLE & HORMONES

B. Menstrual cycle
the rhythmic menstrual cycles begin at puberty and cease at menopause

is a monthly pattern of ovulation and menstruation

MENSTRUAL CYCLE & HORMONES

 B. Menstrual cycle
is a monthly pattern of ovulation and menstruation

Ovulation
Discharge of a mature ovum from the ovary

Menstruation
The period of uterine bleed & shedding of the endometrium & lasts an ave of 4-5
days

Often referred to as menstrual phase,

bleeding, menses or a period
Periodic shedding of:
Blood
Mucus
Epithelial cells from uterus

Average blood loss is 30-80 mL

Ovaries

Produce mature gametes & secrete the ffg hormones:

Estrogen

Progesterone

Functions of estrogen:

Hormone of the woman

Primary function is the dev’t of 2° sexual characteristics in female

Inhibits production of follicle stimulating hormone (FSH)

Responsible for hypertrophy of myometrium

Responsible for spinnbarkeit & ferning (cervical mucus or Billing’s ovulation

method)

Functions of estrogen:
Spinnbarkeit
Clear
Slippery texture (like uncooked egg white
Typical of cervical mucus during ovulation

CLOUDY - CLEAR

CLEAR

CLEAR - STRETCHY

Spinnbarkeit Test
Spinnbarkeit Test

Functions of estrogen:
Ferning
Test for the presence of estrogen in the cervical mucus
Estrogen causes cervical mucus to dry on a slide in a fernlike pattern
In pregnancy testing, the fern pattern does not appear

Functions of estrogen:
Dev’t of ductile structure of the breast
↑ osteoblastic activity of long bones causing an ↑ in height
At 12 years old, female taller than male
Early closure of epiphysis of long bones

Functions of estrogen:
↑ sexual desire in female
↑ vaginal lubrication
Responsible for Na retention therefore causing wt. gain

Functions of progesterone
Hormone of the Pregnant
1° function:
prepares the endometrium for implantation of fertilized ovum making it thick.
2° function:
inhibits uterine contraction
Inhibits prod’n of Luteinizing hormone (LH)

Functions of progesterone
↓ GIT motility leading to constipation
Dev’t of mammary gland
↑ permeability of kidney to lactose & dextrose causing (+) 1 sugar in urine.
↑ basal body temperature
Mood swing of the woman

Systems responsible for menstruation

1. CNS
2. Endocrine system
3. Reproductive
system

CNS response
Hypothalamus
Stimulates the anterior pituitary gland “master clock of the body” (APG) by
secreting gonadotropin-releasing hormone (GnRH)
APG secretes 2 gonadotropins:
FSH
prompts the ovary to develop ovarian follicles
The developing follicles secrete estrogen w/c feeds back to APG to supress FSH &
trigger a surge of LH
LH
Acts w/ FSH to cause the ovulation & enhance corpus luteum formation

Ovarian response
An oocyte grow w/in the primodial follicle in 2 phases
2 PHASES
1. Follicular phase
Days 1-14
The follicle matures as a result of FSH.

2. Luteal phase
days 15-22
Corpus luteum develops from ruptured follicle

Endometrial response
4 PHASES
1. Menstrual phase
Days 1-5
Estrogen level is ↓
Cervical mucus is scanty

2. Proliferation (Follicular) phase

days 6-14
Estrogen level is ↑
Endometrium and myometrium thicken
Cervical mucus changes
Note: average ovulation 14-28 days cycle

Endometrial response
4 PHASES
3. Secretory phase
Days 14-26
After release of the ovum, Estrogen level drops
Progesterone level ↑
↑ uterine vascularity

4. Ischemic phase
days 27-28
Estrogen & progesterone levels recede
Endometrium prepares to shed
Menstruation begins

Cervix & cervical response

Before ovulation
Estrogen levels ↑
Causing cervical os dilation
Abundant liquid mucus
High spinnbarkeit
Excellent sperm penetration
After ovulation
Progesterone levels ↑
Resulting cervical os constriction
Scant viscous mucus
Low spinnbarkeit
No ferning
Poor sperm penetration

Cervix & cervical response

During pregnancy
Cervical circulation (blood supply) increases & a protective mucus plug forms

Climacteric period & menopause

Climacteric is a transitional period during w/c ovarian fxn & hormones prod’n
decline
Menopause refers to woman’s last menstrual period
Ave age 51 with ave range 40-55

MS IS DIVIDED INTO 3 MENSTRUAL STAGES

MS IS DIVIDED INTO 3 MENSTRUAL STAGES

STAGES
DURATION
CHARACTERISTICS
HORMONES
FIRST (MENSTRUATION OR MENSES)
-LASTS FOR 4-6 DAYS
-ENDOMETRIAL BLEEDING AND FLOWING OUT THRU VAGINA
-E & P BLOOD LEVELS ARE LOW
-FSH LEVEL IS ELEVATED
COMBINED W/ LOW LEVEL OF LH SECRETION
SECOND (FOLLICULAR OR PROLIFERATIVE
-LASTS 8-10 DAYS
-ENDOMETIUM REGENERATES & PROLIFERATES IN PREPARATIONS FOR POSSIBLE IMPLANTATION &
SINGLE OVARIAN FOLLICLE APPROACHES FULL MATURATION AS THE CONCENTRATION OF
ESTRADIOL (THE PRINCIPAL ESTROGENIC HORMONE) IN THE BLOOD RISES; ESTRADIOL EXERTS
AS A NEGATIVE FEEDBACK ON FSH SECRETION AND A POSITIVE FEEDBACK ON THE LH SECRETION
(THE LATTER HORMONE INDUCES OVULATION; ESTRADIOL’S EFFECTS ARE EXERTED ON THE
HYPOTHALAMIC SECRETION OF FSH-REALEASING HORMONE AND LH RELEASING HEORMKONE (W/C
CONTROL THE HYPOPHYSEAL SECRETION OF FSH AND LH)

MENSTRUAL DISORDER VOCABULARY

• meno = menstrual related
• metro = time
• oligo = few
• a = without, none or lack of
• rhagia = excess or abnormal
• dys = not or pain
• rhea = flow

Amenorrhea
Dysmenorrhea
Metrorrhagia
Menorrhagia
Polymenorrhea
Hypomenorrhea
hypermenorrhea