Problem no.

1
Task question no.1
What is menarche?
How does it differ from usual
menstrual cycle?
Definition of Menarche:
Define as the period which is the first cycle occurs.
Consider as first sign of puberty.

Definition of Puberty:
Define as period that endocrine & gametogenic
functions of the gonads have first develop to the point
where reproduction is possible.
There are skeletal and neurological maturation resulting
from increase secretion of Estrogen.
Other terms associated with Puberty:
Thelarch: the event that occur in girls which the
breast is developed.
Pubarcha: the development of axillary & pubic hair.
Menarche: is the last event in the consequent of
puberty.
Menarche
Men= Menses
arche =beginning
Adolescence: the period of final maturation
& refers to the period between childhood &
maturity.
We have many theories that explain the
puberty as: Set point, relation to
Leptin……etc.
Age of menarche: differs from girl to girl may
start in age 8 years old to 17 years without
being disquiet.
Control of the onset of menarche
By increasing the sensitivity of the gonads
(ovaries) to pulsatile secretion of GnRH
from hypothalamic-pituitary axis.
Then Menarche is occurs.
 Differences between menarche &
regular menstrual cycle
Menarche Regular menstrual
cycle
Not repeated. Repeated cycle.
Anovultary cycle. Ovultary cycle.

No midcyclic pain. Mid cyclic pain is

present.
Fewer in amount. More in amount.
Shorter in period. Longer in period.
 Question 2
 What is menstrual cycle,how does it
occur?
 Cyclic changes that occur in ovaries,
uterus, cervix, vagina & breasts.
 These changes occur under the influence
of hormones.
 Cervical changes:
 No desquamation.
 Estrogen --- thin alkaline mucus.
 Progesterone --- thick cellular mucus
 Vaginal changes:
 Estrogen --- cornified epithelium.
 Progesterone --- secretion, leukocyte infiltration.

 Breast changes:
 Estrogen --- ducts and stroma proliferation.
 Progesterone --- lobules and alveoli development.

 Breast is swollen, tender and painful

 Changes regress with menstrual cycle.
 Lactation occurs only at the end of pregnancy.
 Question 3
 What is the mechanisms which control the
menstrual cycle?
 Under hormonal control:
Hypothalamus
GnRH

Pituitary gland

FSH LH

Ovaries
 FSH:  LH:
 Proliferation of follicles  Convert cholesterol to
 Convert androgens to androgen.
estrogen.
 Inhibin production.
 Induce LH receptors
production.
 Question 4
 Describe the ovarian cycle?
 * At puberty the females begins to undergo
reguler monthly cycles
 *GnRH (from hypothalamus) acts on the
cells of anterior pit gland which secretles LH
& FSH that stimulate and contro cyclic
changes in the ovary .

 . These sexual cycles are controlled by the

hypothalamus.
 *The ovarian cycle is the normal process
whereby ova mature and are released
during the menstrual cycle .
 * it is hormonally regulated in two phases .
The follicle secretes estrogen before
ovulation ; the corpus luteum secrete both
estrogen and progestrone after ovulation .
 * at the beginning of each ovarian cycle
 several primordial follicles begin to
enlarge, with cavitation occuring to
form an antrum . 15-20 primary stage
follicle are stimulated to grow by FSH .
Normally one of the follicles become
dominant ; and only one oocyte is
discharged , and others degenerat and
become atretic . this maturing follicle at
this stage is called agrafian follicle ; the
cells of the theca interna of this
structure produce estrogens..
 n.b: FSH is not necessary to promote
devolopmentof primordial follicle to the
primary follicle stage , but without it ,
 these primary follicle die and become atretic
 When afollicle becomes atretic , the oocyte
and surrounding folliclular cells degenerate
and replaced by connective tissue , forming
acorpus atrectium .
 FSH also stimulates maturation of follicular
( granulosa ) cells surrounding the oocyte .
 In cooperation granulosa and theca cells
produce estrogens that :
 A. proliferate the uterine endometrium .
 B. thining of cervical mucus to allow passage of
sperm .
 C. stimulate the pit gland to secret LH
( midcyclic LH surge ) that :
 A. stimulate production of progesterone by
folliculer stromal cells ( luteinization ) .
 B. causes folliculer rupture and ovulation .
 N.b :the number of the antral follicles did not
vary signficantly with stage of ovarian cycle ,
although the follicle size distribution was
cyclic-stage dependant .
 * Ovulation occurs at 14 of the cycle ( of a 28
day cycle ) , with the rupturing of the follicle .
 * the follicle itself fills with blood ( brief pain )
 # After ovulation the theca and granulosa cells
proliferate and luteal cells forms the yellow body
or corpus luteum . These cells secretes
progesterone and estrogens .
 * If prgnency does not occur progesterone from
corpus luteum will inhibit the production of LH .
The lower level of LH will cause the corpus
luteum to degenerate( about four days prior to
menses ) and the level of estrogen and
progesterone will dropoff .
 Question 4
 Describe the endometrial cycle?
 Endometrial changes
 Proliferative (postmenstrual,preovulatory):
 All but deep layers are sloughed.
 Estrogen __ growth of stratum functionale and
spiral arteries and glands (10 folds).
 Secretory phase:
 Mainly by progesterone.
 Provide nutrients to fertilized ovum.
 Short active glands
 Mucus, glycogen, amino acids & enzymes.
 Differentiation of the endometrium into:
 Stratum compactum.
 Stratum spongiosum.
 Stratum basalis.

 Under control of estrogen and

progesterone.
 Menstrual phase:
 Regression of corpus luteum.
 Thinning of endometrium + necrosis foci.
 PGF2α

 Menses blood:
 Usually doesn’t clots unless flow is excessive.
 Usual duration is 3-5 days (1-8)
 Usual amount is 30-35 mL (spots-80).
 Question 5
 What is ovulation?
 Definition
 Expulsion of oocyte from mature follicle at
midcycle usually once in the cycle during the
reproductive life--- 1 to 2 years after
menarche to few years before menopause.
 Mechanisms:
 Physical: increase in the hydrostatic pressure result in
distension of the follicle and ultimately its rupture.
 Hormonal: LH surge occurs which stimulate antral
filling and proteolytic activity through chemical
mediators (MCP-1,IL-8,PGs, metalloproteinases).
 9-36 hours after the surge
 Cannot occur in pregnancy but may occur after
peurperium.
 Control is hormonal: FSH, LH.

 Multiple ovulations may occur.

 Question 6
 What are the diagnostic methods for
ovulation?
 Rise in basal body temperature.
 Thermometer with wide gradations (oral or
rectal).
 Increase in blood hormone levels.
 Midcyclic pain due to irritation.
 Question 8
 What are conditions associated with
menstruation?
 Fever--- progesterone
 Pain--- irritation.
 Headache.
 Fatigability
 Vomiting.