PHYSIOLOGY OF THE FEMALE REPRODUCTIVE ORGANS

Puberty - the age of sexual maturation: This is the stage of life at which secondary sexual

characteristics appear. Girls begin dramatic development and maturation of reproductive organs

at approximately age 12 to 13 years, Although the mechanism that initiates this dramatic change

is not well understood, the hypothalamus under the direction of the central nervous system may

initiate or regulate mechanism set to “turn on” gonadal functioning at this age. There is a wide

variation in the times that adolescents move through developmental stages; however, the

sequential order is fairly constant. In girl’s pubertal changes typically occur in the order of:

- Marked physical growth

- Increase in the transvers diameter of the pelvis

- Breast development

- Growth of pubic and axillary hair

- Vaginal secretion /Menarche

THE MENSTRUAL CYCLE

A menstrual cycle (also termed a female reproductive cycle) can be defined as periodic uterine

bleeding in response to cyclic hormonal changes or a series of changes that occur on the ovary,

uterus, and cervix in response to hormonal change. The average age at which menarche (the first

menstrual period) occurs at the average age of 12.8 years.

This may occur as early as age 9 or as late as age 17 years. The purpose of a menstrual cycle is to

bring an ovum to maturity and renew a uterine tissue bed that will be responsive to its growth

and development. The period (length) of menstrual cycles is within the range of 21 to 35 days.
The accepted average length is 28 days. The length of the menstrual flow is within the range of

1-9 days and the average length is 5 days. Amount of flow is from spotting to 80 ml on average.

Four body structures that are involved in the normal physiology of the menstrual cycle are:

- The hypothalamus

- The pituitary gland

- The ovaries and

- The uterus.

- Cervix

Some women have symptoms of anxiety, fatigue, abdominal bloating, headache, appetite

disturbance, irritability and depression in pre-menstrual period. Some women may experience

abdominal pain during ovulation and the release of accompanying prostaglandins. Some even

notice irritation when a drop or two of follicular fluid or blood spills in to the abdominal cavity.

This pain, called mitlelschmerz may range from a few sharp cramps to several hours of

discomfort. It is typically felt on either side of the abdomen (near an ovary) and may be

accompanied by scant vaginal spotting. It is known as Mittelschmerz.

Phases of Menstrual Cycle

• The cycle can be conveniently divided into phases based on changes occurring in the

ovaries and in the endometrium.

• From the changes that occur in the endometrium the menstrual cycle is divided into

menstrual, proliferative and secretory phases. While that occur in the ovary we have

follicular, ovulatory and luteal phases.

The Ovarian Cycle

Follicular Phase: The ovarian cortex contains about 200,000 primordial follicles at birth. The
later become graafian follicles. From puberty onwards certain follicles enlarge and one matures

each month to librate an ovum.

FSH stimulates the primodial follicles in the ovary, which respond by secreting oestrogen. (This

prepares the uterine lining for arrival and implantation of the ovum).’

The increasing level of oestrogen signals the hypothalamus to stop producing FSH, hence

progesterone surge takes place which results in production of LH.

Ovulatory Phase: LH enhances the maturation of the follicles which causes rupture of the

follicle on the 14th day results in ovulation. Graafian follicle matures and moves to the surface of

the ovary. It bursts and discharges an ovum. As ovulation approaches, rising oestrogen level

causes the cervical mucus to become thin, clear and elastic, this elasticity (spinnbarkheit)

enhances the sperms motility and increases the female’s fertility.

Luteal Phase: which begins with ovulation and ends with the start of the menstrual flow. The

ruptured follicle continues to produce LH, it becomes, yellowish, increases in size to form the

corpus Luteum (Yellow body). Progesterone level remains high. If the ovum is not fertilized by

48 hrs the hormonal levels drop and the endometrium begins to shed, this signals menstrual flow.

However if fertilization takes place, the corpus luteum continue to secrete progesterone and

oestrogen which maintain the endometrium until the placenta takes over.
The uterine Cycle

Uterine cycle is described in phases.

Proliferative Phase (Resting Stage)

This phase begins immediately the menstruation stops. The first 2-3 days is a stage of repair of

the endometrium sometimes referred to as Regenerative Phase, during this stage new

endometrium is reformed. Proliferative phase last until ovulation. The endometrium is ready to

received ovum. It is under the control of oestrogen released during follicular phase. Oestrogen

causes the endometrium to become thick, so at the end of this phase, the structure of the

endometrium consists of three layers:

Basal layer, Functioning layer (surface layer), and Cuboidal ciliated epithelial layer.

Secretory Phase: This follows ovulation and is under the influence of progesterone and
oestrogen. Increase in the progesterone level and development of corpus luteum further increases

thickening of the endometrium and become softer. The lining become more vascular and ready

to received fertilized ovum - layer increases to 3.5mm. If fertilization and implantation occurs,

progesterone level continues to increase. This inhibits the maturation of another follicle. When

the level of progesterone reaches its peak and no fertilized ovum, production of LH is inhibited.

The corpus luleum degenerates and atrophies resulting in sudden drop in the progesterone level

which brings about menstrual flow as a reaction to shrinking and shedding from the uterine wall.

Menstrual Phase: This phase is characterized by uterine bleeding and shedding of the

endometrial lining. After 14 days of corpus luteum and no fertilization result in sudden drop of

progesterone and oestrogen, the functioning layer is shed off with the epithelial layer and

expelled by the muscular contraction of the uterine muscle. This tissues plus bleeding from the

ruptured blood vessels form the menstrual flow. It last for about 35 days. Total blood loss 50-100

mls. The fibrinolysis present in the blood prevents clotting.

The contents of menstrual blood are endometrial lining, blood from capillaries mucus and dead

ovum. Regularity of menses depends on hormonal changes associated with ovulation, which are

under the influence of changes in the anterior pituitary gland and some emotional factors. The

life span of the ovum is 24-48hrs. Women are in the most fertile state about 14 days before the

next menses. The secretary phase is more or less constant in length but the proliferative and

menstrual phases may vary.

HORMONE SITE OF TIME OF FUNCTIONS

PRODUCTION PRODUCTION

FSH-follicle Pituitary Gland Days 1-5 of Stimulates egg production within Graafian follicles
stimulating menstrual cycle Sometimes used in fertility treatment to stimulate

hormone egg production.

Graafian follicles secrete oestrogen.

Oestrogen Graafian Days 5-14 of Development of endometrium.

follicle menstrual cycle Inhibits FSH so no new eggs develop.

Stimulates the release of LH (luteinising hormone)

LH- Pituitary Gland Day 14 of Causes ovulation.

leuteinising menstrual cycle Causes Graafian follicle to develop into the corpus

hormone luteum. The corpus luteum makes progesterone.

Progesterone Corpus luteum Days 14-28 of Maintains endometrium.

menstrual cycle Inhibits FSH so no new eggs develop.

Inhibits LH so no new ovulations occur.

Prevents contractions of the uterus.