PENGANTAR

REPRODUKSI
MENSTRUASI
FISIOLOGI
dr.Susy Olivia
RUJUKAN
• Sherwood. Fisiologi Manusia Dari Sel keSistem
• Ganong.Review of Medical Physiology.
• Sembulingam . Buku ajar fisiologi Kedokteran Jilid 2 hal 475-517 .
• The normal menstrual cycle and the control of ovulation Beverly G reed, MD and bruce R carr, MD. Author information
Last update: august 5, 2018.
• Human Physiology: An Integrated Approach (8th Edition) by Dee Unglaub
Silverthorn Human
• Guyton and Hall. Textbook of physiology ed.13
• During each menstrual cycle, series of changes occur in
ovary and accessory sex organs. These changes are
divided into 4 groups:
1. Ovarian changes
2. Uterine changes
3. Vaginal changes
4. Changes in cervix.
All these changes take place simultaneously.
Figure 28.23 Secretion and physiological effects of estrogens, progesterone, relaxin, and
inhibin in the female reproductive cycle. Dashed red lines indicate negative feedback
inhibition.
 Regulasi hormon mengatur siklus
menstruasi

Bekerja melalui Hypothalamo – Pituitary – Ovary

Axis :
• Hypothalamus
• Anterior Pituitary
• Ovary
• Endometrium & outflow tract
Figure 28.25 The Hormonal Regulation of
Ovarian Activity

Figure 28.25
Faktor yang berperan dalam siklus
menstruasi
1. Faktor enzim
2. Faktor vaskuler
3. Faktor prostaglandin
• Development of the dominant follicle has been
described in three stages: (1) Recruitment, (2)
Selection, and (3) Dominance (Fig.3).
• The recruitment stage takes place during days 1
through 4 of the menstrual cycle.
• During this stage, FSH leads to recruitment of a
cohort of follicles from the pool of non-
proliferating follicles.
• Between cycle days 5 and 7, selection of a
follicle takes place whereby only one follicle is
selected from the cohort of recruited follicles to
ovulate, and the remaining follicles will undergo
atresia.
• Anti-Müllerian hormone (AMH), a product of
granulosa cells, is believed to play a role in the
selection of the dominant follicle.
• By cycle day 8, one follicle exerts its dominance
by promoting its own growth and suppressing the
maturation of the other ovarian follicles thus
becoming the dominant follicle.
Kontrol umpan balik FSH dan
sekresi LH selama fase folikel
• GnRH merangsang hipofisis anterior
mengeluarkan FSH dan LH
• Selama fase folikel, folikel ovarium
mengeluarkan estrogen karena pengaruh
FSH
• Kadar estrogen yang awalnya rendah tapi
terus meningkat akan menghambat sekresi
FSH.
• LH terus meningkat selama fase folikel.
• Kadar estrogen mencapai puncak, akan
merangsang lonjakan sekresi LH pada
pertengahan siklus
• Lonjakan LH menyebabkan ovulasi pada
folikel matang
Kontrol lonjakan LH pada ovulasi
Endocrine Control of Menstrual Cycle:
Follicular Phase and Ovulation
FaseLuteal:
• Sel folikel diubah menjadi korpus luteum yang
mengeluarkan progesteron serta estrogen pada fase luteal.
( kadar progesteron> kadar estrogen)
• Kadar progesteron tinggi menghambat FSH dan LH,
sehingga pada fase luteal FSH dan LH turun
• Jika ovum tidak dibuahi maka korpus luteum berdegenerasi,
maka kadar estrogen dan progesteron menurun
• Kadar estogen dan progesteron yang menurun akibat
degenerasi korpus luteum menyebabkan inhibisi terhadap
FSH dan LH hilang, sehingga kadarnya meningkat daan
terbentuk folikel baru (kembali ke fase folikel)
Kontrol Umpan balik fase luteal
• Peran LH pada fase luteal:
• Pembentukkan dan pemeliharaan korpus
luteum
• Menstimulus korpus luteum mensekresi
progesteron dan estrogen

• Peran FSH pada fase luteal:

• Mempertahankan aktivitas korpus luteum
• Merangsang sekresi inhibin di sel lutein untuk
menghambat sekresi FSH
Lonjakan LH (LH Surge) menimbulkan perubahan
pada folikel :
1. Menghentikan sintesis estrogen oleh folikel
2. Memulai kembali meiosis di oosit pada folikel yang
sedang berkembang
3. Memicu pembentukan prostaglandin spesifik yang
kemudian menginduksi ovulasi dengan mendorong
perubahan-perubahan vaskuler yang menyebabkan
pembengkakan folikel dengan cepat sementara
mengiduksi pencernaan dinding folikel oleh enzim-
enzim.
4. Menyebabkan diferensiasi sel-sel folikel menjadi sel
luteal.
FIGURE : Process of ovulation
• Changes in Endometrium during Menstrual Phase
i. Lack of estrogen and progesterone causes sudden involution of endometrium
ii. It leads to reduction in the thickness of endometrium, up to 65% of original thickness
iii. During the next 24 hours, the tortuous blood vessels in the endometrium undergo severe
constriction.
Endometrial vasoconstriction is because of three reasons:
a. Involution of endometrium
b. Actions of vasoconstrictor substances like prosta glandin, released from tissues of involuted
endometrium
c. Sudden lack of estrogen and progesterone (which are vasodilators)
iv. Vasoconstriction leads to hypoxia, which results in necrosis of the endometrium
v. Necrosis causes rupture of blood vessels and oozing of blood
vi. Outer layer of the necrotic endometrium is separated and passes out along with blood
vii. This process is continued for about 24 to 36 hours
viii. Within 48 hours after the reduction in the secretion of estrogen and progesterone, the
superficial layers of endometrium are completely desquamated
ix. Desquamated tissues and the blood in the endometrial cavity initiate the contraction of uterus
x. Uterine contractions expel the blood along with desquamated uterine tissues to the exterior
through vagina.
Perubahan serviks:
• Selama siklus ovarium terjadi perubahan di serviks
akibat pengaruh hormon.
• Dibawah pengaruh estrogen, fase folikel  mukus
serviks bertambah, jernih dan encer.
• Perubahan paling jelas ketika kadar estrogen berada di
puncaknya dan ovulasi akan terjadi, sehingga
mempermudah sperma melewati kanalis servikalis.

• Setelah ovulasi, di bawah pengaruh progesteron,

mukus menjadi kental dan lengket  sumbat yang
menutupi lubang serviks.
• Ini merupakan mekanisme pertahanan penting untuk
mencegah masuknya bakteri dari vagina ke uterus yang
dapat mengancam kehamilan sekiranya terjadi konsepsi
dan sperma juga tidak dapat menembus mukus yang tebal
ini.