Figure showing the progression of the menstrual cycle and the different hormones contributing to

it.

The menstrual cycle is the regular natural change that occurs in the female reproductive system
(specifically the uterus and ovaries) that makes pregnancy possible.[1][2] The cycle is required for
the production of oocytes, and for the preparation of the uterus for pregnancy.[1] The menstrual
cycle occurs due to the rise and fall of estrogen.[3] This cycle results in the thickening of the
lining of the uterus, and the growth of an egg, (which is required for pregnancy).[3] The egg is
released from an ovary around day fourteen in the cycle; the thickened lining of the uterus
provides nutrients to an embryo after implantation.[3] If pregnancy does not occur, the lining is
released in what is known as menstruation.[3]

Up to 80% of women report having some symptoms during the one to two weeks prior to
menstruation.[4] Common symptoms include acne, tender breasts, bloating, feeling tired,
irritability and mood changes.[5] These symptoms interfere with normal life and therefore qualify
as premenstrual syndrome in 20 to 30% of women. In 3 to 8%, they are severe.[4]

The first period usually begins between twelve and fifteen years of age, a point in time known as
menarche.[6] They may occasionally start as early as eight, and this onset may still be normal.[3]
The average age of the first period is generally later in the developing world and earlier in
developed world. The typical length of time between the first day of one period and the first day
of the next is 21 to 45 days in young women and 21 to 35 days in adults (an average of 28 days[3]
[7][8]
). Menstruation stops occurring after menopause which usually occurs between 45 and 55
years of age.[9] Bleeding usually lasts around 3 to 7 days.[3]

The menstrual cycle is governed by hormonal changes.[3] These changes can be altered by using
hormonal birth control to prevent pregnancy.[10] Each cycle can be divided into three phases
based on events in the ovary (ovarian cycle) or in the uterus (uterine cycle).[1] The ovarian cycle
consists of the follicular phase, ovulation, and luteal phase whereas the uterine cycle is divided
into menstruation, proliferative phase, and secretory phase.

Stimulated by gradually increasing amounts of estrogen in the follicular phase, discharges of

blood (menses) flow stop, and the lining of the uterus thickens. Follicles in the ovary begin
developing under the influence of a complex interplay of hormones, and after several days one or
occasionally two become dominant (non-dominant follicles shrink and die). Approximately mid-
cycle, 24–36 hours after the luteinizing hormone (LH) surges, the dominant follicle releases an
ovocyte, in an event called ovulation. After ovulation, the ovocyte only lives for 24 hours or less
without fertilization while the remains of the dominant follicle in the ovary become a corpus
luteum; this body has a primary function of producing large amounts of progesterone. Under the
influence of progesterone, the uterine lining changes to prepare for potential implantation of an
embryo to establish a pregnancy. If implantation does not occur within approximately two
weeks, the corpus luteum will involute, causing a sharp drop in levels of both progesterone and
estrogen. The hormone drop causes the uterus to shed its lining in a process termed menstruation.
Menstruation also occurs in closely related primates (apes and monkeys).[11]
Cycles and phases

Menstrual cycle

Flowchart of the hormonal control of the menstrual cycle

The menstrual cycle can be described by the ovarian or uterine cycle. The ovarian cycle
describes changes that occur in the follicles of the ovary whereas the uterine cycle describes
changes in the endometrial lining of the uterus. Both cycles can be divided into three phases. The
ovarian cycle consists of the follicular phase, ovulation, and the luteal phase, whereas the uterine
cycle consists of menstruation, proliferative phase, and secretory phase.[1]

Ovarian cycle

Follicular phase

Main article: Follicular phase

The follicular phase is the first part of the ovarian cycle. During this phase, the ovarian follicles
mature and get ready to release an egg.[1] The latter part of this phase overlaps with the
proliferative phase of the uterine cycle.
Through the influence of a rise in follicle stimulating hormone (FSH) during the first days of the
cycle, a few ovarian follicles are stimulated.[83] These follicles, which were present at birth[83] and
have been developing for the better part of a year in a process known as folliculogenesis,
compete with each other for dominance. Under the influence of several hormones, all but one of
these follicles will stop growing, while one dominant follicle in the ovary will continue to
maturity. The follicle that reaches maturity is called a tertiary or Graafian follicle, and it contains
the ovum.[83]

Ovulation

Main article: Ovulation

An ovary about to release an egg

Ovulation is the second phase of the ovarian cycle in which a mature egg is released from the
ovarian follicles into the oviduct.[84] During the follicular phase, estradiol suppresses release of
luteinizing hormone (LH) from the anterior pituitary gland. When the egg has nearly matured,
levels of estradiol reach a threshold above which this effect is reversed and estrogen stimulates
the production of a large amount of LH. This process, known as the LH surge, starts around
day 12 of the average cycle and may last 48 hours.[85]

The exact mechanism of these opposite responses of LH levels to estradiol is not well
understood.[86] In animals, a gonadotropin-releasing hormone (GnRH) surge has been shown to
precede the LH surge, suggesting that estrogen's main effect is on the hypothalamus, which
controls GnRH secretion.[86] This may be enabled by the presence of two different estrogen
receptors in the hypothalamus: estrogen receptor alpha, which is responsible for the negative
feedback estradiol-LH loop, and estrogen receptor beta, which is responsible for the positive
estradiol-LH relationship.[87] However, in humans it has been shown that high levels of estradiol
can provoke 32 increases in LH, even when GnRH levels and pulse frequencies are held
constant,[86] suggesting that estrogen acts directly on the pituitary to provoke the LH surge.
The release of LH matures the egg and weakens the wall of the follicle in the ovary, causing the
fully developed follicle to release its secondary oocyte.[83] If it is fertilized by a sperm, the
secondary oocyte promptly matures into an ootid and then becomes a mature ovum. If it is not
fertilized by a sperm, the secondary oocyte will degenerate. The mature ovum has a diameter of
about 0.2 mm.[88]

Which of the two ovaries—left or right—ovulates appears essentially random; no known left and
right co-ordination exists.[89] Occasionally, both ovaries will release an egg;[89] if both eggs are
fertilized, the result is fraternal twins.[90]

After being released from the ovary, the egg is swept into the fallopian tube by the fimbria,
which is a fringe of tissue at the end of each fallopian tube. After about a day, an unfertilized egg
will disintegrate or dissolve in the fallopian tube.[83]

Fertilization by a spermatozoon, when it occurs, usually takes place in the ampulla, the widest
section of the fallopian tubes. A fertilized egg immediately begins the process of embryogenesis,
or development. The developing embryo takes about three days to reach the uterus and another
three days to implant into the endometrium.[83] It has usually reached the blastocyst stage at the
time of implantation.

In some women, ovulation features a characteristic pain called mittelschmerz (German term
meaning middle pain).[91] The sudden change in hormones at the time of ovulation sometimes
also causes light mid-cycle blood flow.[92]

Luteal phase

Main article: Luteal phase

The luteal phase is the final phase of the ovarian cycle and it corresponds to the secretory phase
of the uterine cycle. During the luteal phase, the pituitary hormones FSH and LH cause the
remaining parts of the dominant follicle to transform into the corpus luteum, which produces
progesterone. The increased progesterone in the adrenals starts to induce the production of
estrogen. The hormones produced by the corpus luteum also suppress production of the FSH and
LH that the corpus luteum needs to maintain itself. Consequently, the level of FSH and LH fall
quickly over time, and the corpus luteum subsequently atrophies.[83] Falling levels of
progesterone trigger menstruation and the beginning of the next cycle. From the time of
ovulation until progesterone withdrawal has caused menstruation to begin, the process typically
takes about two weeks, with 14 days considered normal. For an individual woman, the follicular
phase often varies in length from cycle to cycle; by contrast, the length of her luteal phase will be
fairly consistent from cycle to cycle.[93]

The loss of the corpus luteum is prevented by fertilization of the egg. The syncytiotrophoblast,
which is the outer layer of the resulting embryo-containing structure (the blastocyst) and later
also becomes the outer layer of the placenta, produces human chorionic gonadotropin (hCG),
which is very similar to LH and which preserves the corpus luteum. The corpus luteum can then
continue to secrete progesterone to maintain the new pregnancy. Most pregnancy tests look for
the presence of hCG.[83]

Uterine cycle

The uterine cycle has three phases: menses, proliferative, secretory.[94]

Menstruation

Main article: Menstruation

Menstruation (also called menstrual bleeding, menses, catamenia or a period) is the first phase of
the uterine cycle. The flow of menses normally serves as a sign that a woman has not become
pregnant. (However, this cannot be taken as certainty, as a number of factors can cause bleeding
during pregnancy; some factors are specific to early pregnancy, and some can cause heavy flow.)
[95][96][97]

Levels of estradiol (the main estrogen), progesterone, luteinizing hormone, and follicle-
stimulating hormone during the menstrual cycle, taking inter-cycle and inter-woman variability
into account.

Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days,
but anywhere from 2 to 7 days is considered normal).[91][98] The average blood loss during
menstruation is 35 milliliters with 10–80 ml considered normal.[99] Women who experience
menorrhagia (heavy menstrual bleeding) are more susceptible to iron deficiency than the average
person.[100] An enzyme called plasmin inhibits clotting in the menstrual fluid.[101]

Painful cramping in the abdomen, back, or upper thighs is common during the first few days of
menstruation. Severe uterine pain during menstruation is known as dysmenorrhea, and it is most
common among adolescents and younger women (affecting about 67.2% of adolescent females).
[102]
When menstruation begins, symptoms of premenstrual syndrome (PMS) such as breast
tenderness and irritability generally decrease.[91] Sanitary products include pads and tampons, and
are essential items for use during menstruation.

Proliferative phase

The proliferative phase is the second phase of the uterine cycle when estrogen causes the lining
of the uterus to grow, or proliferate, during this time.[83] As they mature, the ovarian follicles
secrete increasing amounts of estradiol, and estrogen. The estrogens initiate the formation of a
new layer of endometrium in the uterus, histologically identified as the proliferative
endometrium. The estrogen also stimulates crypts in the cervix to produce cervical mucus, which
causes vaginal discharge regardless of arousal, and can be tracked by women practicing fert

ility awareness.[103]

Secretory phase

The secretory phase is the final phase of the uterine cycle and it corresponds to the luteal phase
of the ovarian cycle. During the secretory phase, the corpus luteum produces progesterone,
which plays a vital role in making the endometrium receptive to implantation of the blastocyst
and supportive of the early pregnancy, by increasing blood flow and uterine secretions and
reducing the contractility of the smooth muscle in the uterus;[104] it also has the side effect of
raising the woman's basal body temperature.[105]

Ovulation suppression
Birth control
What is menstruation?

Menstruation describes the female period. The menstruation cycle begins when a woman gets her
periods. The menstrual blood which leaves her body are products shed from the uterus (the
uterine lining also called the endometrium). During the remainder of the menstrual cycle the
uterine lining regrows. It does so in preparation for pregnancy, which occurs if the egg (oocyte) a
woman releases about half way through her menstrual cycle is fertilised. When fertilisation
occurs, the lining stays in place to nourish the fertilised egg. When fertilisation does not occur
the menstrual cycle continues and the uterine lining is shed marking the start of the woman’s
next menstrual period. Women begin menstruation at an average age of 13 (called menarche) and
on average continue menstruating till age 51 (called menopause).
Menstruation involves highly complex hormonal interactions. The key hormones involved in
menstruation are oestrogen and progesterone (produced by the ovaries) and luteinising hormone
and follicle stimulating produced by the pituitary gland, under the influence of hormones
secreted by the hypothalamus. The interactions between these organs are referred to as the
hypothalamic-pituitary-ovarian axis (HPO axis).

Information on re-publishing of our images

Phases of the menstrual cycle

The menstruation cycle refers to the cycles in which a woman’s uterus grows and sheds a lining
(the endometrium) which could support the development of a fertilised egg. It typically occurs in
28 day cycles, so a woman generally gets her period every 28 days. However, cycle length may
be as short as 21 days or as long as 40 days in some women. The inner lining of the uterus (the
endometrium) goes through three phases during the typically 28 day menstrual cycle: the
menstrual phase (days 1-5), the proliferative phase (days 6-14) and the secretory phase (days 15-
28).

The ovarian cycle, refers to the cycle in which a woman’s ovaries prepare an egg to be released
during ovulation. It is divided into two phases: the follicular phase (days 1-14) and the luteal
phase (days 15-28), during which different levels of hormones are released. These two cycle
occur in a synchronised manner; day 1 of the ovarian cycle is always also day 1 of the menstrual
cycle.

Day 1 of the menstrual cycle coincides with the start of a woman’s period (menstrual bleeding)
in which the uterus sheds the lining (endometrium) built up in the previous menstrual cycle. The
lining of the uterus is regrown during each menstrual cycle. Menstrual bleeding typically
continues for 3-5 days in what is known as the menstrual phase of the cycle. Between 50-150ml
of blood is released during this period.

After the woman’s period, the proliferative phase of the menstrual cycle begins. The uterine
lining is regenerated in preparation for receiving a fertilised egg (should fertilisation occur). The
regrowth of the lining each month is needed to create an environment suitable for development
of a fertilised egg. If the egg released during ovulation is fertilised and the woman becomes
pregnant, the uterine lining stays in place and nourishes the fertilised egg.

If the egg is not fertilised then the menstrual cycle continues for another 14-15 days (the
secretory phase). This period is usually the same length, regardless of the total length of the
woman’s menstrual cycle. Levels of oestrogen, progesterone, luteinising hormone and follicle
stimulating hormone all decline. This causes the blood vessels supplying the uterine lining to
deprive the endometrium of the nutrients and oxygen it needs to survive. The cells of the
endometrium begin to die and shed, resulting in menstrual bleeding and the commencement of a
new menstrual cycle.

As the uterus is preparing its lining in the proliferative phase, the woman’s ovaries are preparing
an egg for release. Her oestrogen levels rise stimulating the growth of several ovarian follicles.
Each of the follicles contains one egg (oocyte) which matures as the follicle grows. Usually only
one follicle (known as the dominant follicle) fully matures and releases the egg it contains. The
release of the egg is referred to as ovulation. Rarely a woman will develop and release two or
more eggs, and this is when multiple pregnancy occurs (e.g. triplets, depending on the number of
eggs released).
In a typical 28 day cycle, ovulation or the release of a mature egg occurs on Day 14, marking the
end of the follicular phase. Ovulation will occur earlier in shorter cycles and later in longer
cycles. Ovulation occurs when levels of luteinising hormone (a hormone secreted by the pituitary
gland in the brain) in the woman’s body rise rapidly. The surge in luteinising hormone signals
the ovaries to release the mature egg/s and marks the beginning of the luteal phase of the ovarian
cycle. Once released from the ovaries an egg may be fertilised by male sperm, in which case it
will be nourished by the uterine lining and establish a pregnancy. Pregnancy changes the
woman’s hormonal balance and interrupts the menstrual and ovarian cycles. If the egg is not
fertilised it will exit the woman’s body and the ovarian and menstrual cycles continue.
The average length of the menstrual cycle is 28–29 days, but this can vary between women and
from one cycle to the next. The length of your menstrual cycle is calculated from the first day of
your period to the day before your next period starts.

Girls get their first period (menarche), on average, between the ages of 11 and 14 years. By this
stage, other sexual characteristics have developed, such as pubic hair and budding breasts.

Hormones and the menstrual cycle

The menstrual cycle is complex and is controlled by many different glands and the hormones
that these glands produce. A brain structure called the hypothalamus causes the nearby pituitary
gland to produce certain chemicals, which prompt the ovaries to produce the sex hormones
oestrogen and progesterone.

The menstrual cycle is a biofeedback system, which means each structure and gland is affected
by the activity of the others.

Back to top

Phases of the menstrual cycle

The four main phases of the menstrual cycle are: 

 menstruation
 the follicular phase
 ovulation
 the luteal phase.

Menstruation

Menstruation is the elimination of the thickened lining of the uterus (endometrium) from the
body through the vagina. Menstrual fluid contains blood, cells from the lining of the uterus
(endometrial cells) and mucus. The average length of a period is between three days and one
week.

Sanitary pads or tampons are used to absorb the menstrual flow. Both pads and tampons need to
be changed regularly (at least every four hours). Using tampons has been associated with an
increased risk of a rare illness called toxic shock syndrome (TSS).

Follicular phase

The follicular phase starts on the first day of menstruation and ends with ovulation. Prompted by
the hypothalamus, the pituitary gland releases follicle stimulating hormone (FSH). This hormone
stimulates the ovary to produce around five to 20 follicles (tiny nodules or cysts), which bead on
the surface.

Each follicle houses an immature egg. Usually, only one follicle will mature into an egg, while
the others die. This can occur around day 10 of a 28-day cycle. The growth of the follicles
stimulates the lining of the uterus to thicken in preparation for possible pregnancy.

Ovulation

Ovulation is the release of a mature egg from the surface of the ovary. This usually occurs mid-
cycle, around two weeks or so before menstruation starts. 

During the follicular phase, the developing follicle causes a rise in the level of oestrogen. The
hypothalamus in the brain recognises these rising levels and releases a chemical called
gonadotrophin-releasing hormone (GnRH). This hormone prompts the pituitary gland to produce
raised levels of luteinising hormone (LH) and FSH.

Within two days, ovulation is triggered by the high levels of LH. The egg is funnelled into the
fallopian tube and toward the uterus by waves of small, hair-like projections. The life span of the
typical egg is only around 24 hours. Unless it meets a sperm during this time, it will die.

When you want to have a baby you can improve your chance of getting pregnant if you know
about ovulation and the ‘fertile window’ in the menstrual cycle. Read more on ovulation and
fertility window.

Luteal phase

During ovulation, the egg bursts from its follicle, but the ruptured follicle stays on the surface of
the ovary. For the next two weeks or so, the follicle transforms into a structure known as the
corpus luteum. This structure starts releasing progesterone, along with small amounts of
oestrogen. This combination of hormones maintains the thickened lining of the uterus, waiting
for a fertilised egg to stick (implant).

If a fertilised egg implants in the lining of the uterus, it produces the hormones that are necessary
to maintain the corpus luteum. This includes human chorionic gonadotrophin (HCG), the
hormone that is detected in a urine test for pregnancy. The corpus luteum keeps producing the
raised levels of progesterone that are needed to maintain the thickened lining of the uterus.

If pregnancy does not occur, the corpus luteum withers and dies, usually around day 22 in a 28-
day cycle. The drop in progesterone levels causes the lining of the uterus to fall away. This is
known as menstruation. The cycle then repeats.

Back to top

Common menstrual problems

Some of the more common menstrual problems include: 

 premenstrual syndrome (PMS) – hormonal events before a period can trigger a range of
side effects in women at risk, including fluid retention, headaches, fatigue and irritability.
Treatment options include exercise and dietary changes
 dysmenorrhoea – or painful periods. It is thought that the uterus is prompted by certain
hormones to squeeze harder than necessary to dislodge its lining. Treatment options
include pain-relieving medication and the oral contraceptive pill
 heavy menstrual bleeding (previously known as menorrhagia) – if left untreated, this can
cause anaemia. Treatment options include oral contraceptives and a hormonal intrauterine
device (IUD) to regulate the flow
 amenorrhoea – or absence of menstrual periods. This is considered abnormal, except
during pre-puberty, pregnancy, lactation and postmenopause. Possible causes include low
or high body weight and excessive exercise.