PHYSIOLOGY OF

MENSTRUAL CYCLE

Elsie P. Miguel, RN MN
MENSTRUATION

a periodic uterine bleeding

that begins approximately
14 days after ovulation
 Menarche
MENSTRUATION • 1st menstrual period in
girls;
• may occur as early as age 8
or 9, or as late as age 17
and still be within normal
limits
 Menstrual Cycle
MENSTRUATION • also termed as female
reproductive cycle;
• defined as episodic uterine
bleeding in response to
cyclic hormonal changes
MENSTRUAL CYCLE
Purpose of Menstrual Cycle
• To bring an ovum to maturity and renew a
uterus that will be responsible for its growth,
should it be fertilized
• The process that allows for conception and
implantation of a new life
• Prepares the uterus for pregnancy
MENSTRUAL CYCLE
• Good to include health teaching information on
menstruation to both girls and their parents as
early as 4th grade as part of routine care
• First day of bleeding is day 1 of the menstrual
cycle
MENSTRUAL CYCLE
• Length varies - average length is 28 days (from
the beginning of one menstrual flow to the
beginning of the next)
• As short as 23 days or as long as 35 days
• Length of the average menstrual flow
(menses): 4 – 6 days; short – 2 days; long – 7
days
MENSTRUAL CYCLE
Amount of menstrual flow:
• difficult to estimate;
• average of 30 – 80 mL per menstrual period;
• saturating pad or tampon in less than an hour is
heavy bleeding
MENSTRUAL CYCLE
Color:
• dark red
• a combination of blood, mucus, and
endometrial cells
PHYSIOLOGY OF MENSTRUATION
4 body structures involved in the physiology of
the menstrual cycle:
1. Hypothalamus All 4 structures must contribute
their part for a menstrual cycle
2. Pituitary Gland
to be complete; inactivity of any
3. Ovaries part results in an incomplete or
4. Uterus ineffective cycle
Hypothalamic-Pituitary HYPOTHALAMUS
Releases GnRH; initiates menstrual cycle

stimulates
ANTERIOR PITUITARY GLAND
to release
Cycle

LH
FSH Gonadotrophic
• Ovulation (mid-
Hormones cycle)
maturation of • Growth
ovum endometrium
acts on OVARIES (2nd half)
OVARIAN CYCLE
OVARIAN CYCLE
UTERUS ENDOMETRIAL CYCLE
UTERUS ENDOMETRIAL CYCLE
UTERUS ENDOMETRIAL CYCLE
Proliferative Phase
• From approximately day 5 – day 14
• Increase (thickness) – continues for the 1st half
of the menstrual cycle
• Also termed – proliferative, estrogenic,
follicular, or postmenstrual phase
UTERUS ENDOMETRIAL CYCLE
Proliferative Phase
 estrogen and  progesterone

Follicle Stimulating Hormone releasing hormone (FSHRh)

Follicle Stimulating Hormone (FSH)

Follicle to mature (primordial – Graafian)

Estrogen (follicular fluid)

Endometrium proliferates – increase thickness (eightfold)
UTERUS ENDOMETRIAL CYCLE
Secretory Phase
• Day 15 to 21
• After ovulation, the formation of progesterone in the
corpus luteum (under the direction of the LH) causes
the glands of the uterine endometrium to become
“corkscrew” or twisted in appearance
• Endometrium also becomes dilated w/ quantities of
glycogen (elementary sugar) and mucin (protein)
UTERUS ENDOMETRIAL CYCLE
Secretory Phase
• Capillaries of the endometrium increase in amount
until lining takes on the appearance of rich, spongy
velvet – ready for implantation
• Also termed – progestational, luteal, premenstrual, or
secretory phase
UTERUS ENDOMETRIAL CYCLE
Secretory Phase
UTERUS ENDOMETRIAL CYCLE
Ischemic Phase
• If fertilization does not occur, corpus luteum in the
ovary begins to regress after 8 – 10 days
• Progesterone and estrogen decreases = endometrium
begins to degenerate at approximately day 24 or day
25 of the cycle
UTERUS ENDOMETRIAL CYCLE
Ischemic Phase
UTERUS ENDOMETRIAL CYCLE
Ischemic Phase
Corpus luteum degenerates

 estrogen and  progesterone

Capillaries rupture, minute hemorrhages

Endometrium slough/ shed off
UTERUS ENDOMETRIAL CYCLE
Menstrual Phase
• Days 1 - 4
• The following products are discharged from the uterus
as the menstrual flow or menses:
• Blood from the ruptured capillaries
• Mucin from glands
• Fragments of endometrial tissue
• Microscopic, atrophied, and unfertilized ovum
PRE-MENSTRUAL SYNDROME
• Occurs in the Luteal Phase
• Relieve by onset of menses
• Symptoms:
a. Neurologic : migraine , vertigo , syncope
b. Psychologic : lethargy , irritability , depression ,sleep disorders , tearfulness/crying
spells , anxiety , hostility
c. Respiratory : asthma , coryza , hoarseness
d. Gastrointestinal : nausea , vomiting , constipation , bloating , craving for sweets and
salty foods
e. Mammary : swelling, breast fullness and tenderness
f. Urinary : oliguria , retention
g. Dermatologic : acne
THANK YOU!