PHYSIOLOGY OF

MENSTRUATION
BY DEPARMENT OF OBSTETRICS AND
GYNAECOLOGY, BMC SAGAR
1. What is menstruation?
2. Significance
3. Which hormones play a role in
menstruation?
4. Significance of eachhormone
5. What medical conditions will arise due
to problems in hormones associated?
The process in a woman of discharging
blood and other material from the
lining of the uterus at intervals of
about one lunar month (28 days) from
puberty until the menopause, except
during pregnancy.
 Menstruation is not the same as the menstrual
cycle.
The Menstrual cycle describes thecyclic
changes in a woman’s body going through
menstruation, the follicular phase, ovulation,
the luteal phase and back to menstruation
again to begin the cycle.
Menstruation is therefore one of the 4 phases
ofthe menstrual cycle.
1. Cycleof natural changesthat occursin
the uterus and ovary as an essential part of
making sexual reproductionpossible.
2. Essential for the production of eggs.
3. Preparationof the uterus for pregnancy.
4. Fertile period of a woman’slife between
menarche and menopause.
Primary amenorrhea: Absence of menstruation
despite signs of puberty
Secondary amenorrhea: Absence of menstruation
for 3-6 months in a woman who previously
menstruated
Dysfunctional uterine bleeding: Irregular bleeding
due to anovulation or anovulatory cycle
Menorrhagia: Regular menstrual intervals,
excessive flow andduration
Metrorrhagia: Irregular menstrual intervals,
excessive flow andduration
Oligomenorrhea: Menstrual interval greater
than 35days
Anovulation / anovulatory: Menstrual cycle
without ovulation
Dysmenorrhea: Menstrualcramping/pain
1. Duration ofmenstrual flow
2. Quality of the menstruum,
3. Amount ofblood loss,
4. The flow patternand
5. Associated symptoms.
Last from 3 to 7days.
The exact duration varies from woman to woman.
It however shows little or no variation for the
same woman from cycle to cycle.
Most women do not experience cycle to cycle
changes more than 1or 2 days.
It is unusual for the same woman to have wide
swings such as 3days duration in one cycle and 7
days in another.
Menstrual blood is normally bright or light
red in color like the bleeding that occurs after
a knifecut or similar injury.
It could look brown in some few
women and still be normal menstruation.
It must not have a foul odor.
Small clots may be a normal part of menstrual
blood.
The average blood loss during normal
menstruation is about 35 ml, with a
range of 10 to 80 ml.
Usually understood from the number of
pads soaked.
Normally, as menses begin to flow, the
amount of blood loss seems to increase
gradually until it attains a maximum and
then starts diminishing as the end of the
flow draws near.
This pattern is described as crescendo-
decrescendo pattern.
Normal menstruation may be accompanied by other
symptoms suchas
Breasts fullness,
Mild lower abdominal pain or Irritability.
Fluid retention
Cramping
Mood swings
Weight gain
Breast tenderness
Diarrhea
Constipation

These symptoms are neverdebilitating.

Begins when estrogen levels are low
Anterior pituitary secretes FSH and
LH, stimulation follicle to develop
Cells around egg enlarge, releasing
estrogen
This causes this uterine lining to
thicken
LH and FSH still being released, for
another 3-4 days
Follicle ruptures, releasing ova into
the Fallopian tubes
Now empty follicle changes to a yellow
colour, becomes corpusluteum
Continues to secrete estrogen, but now
beings to release progesterone
Progesterone further develops uterine
lining
If pregnant, embryo will release
hormones to preserve corpus luteum
If no embryo, the corpus luteum begins
to disintegrate
Progesterone levels drop, uterine lining
detaches, menstruation canbegin
Tissue, blood, unfertilized egg all
discharged
Can take from 3-7 days
 Hormonal
Regulation
of Menstruation
WITHOUT
ESTROGEN AND
PROGESTERONE,
ENDOMETRIUM
BREAKS DOWN –
MENSTRUATION
OCCURS.