1.

INTRODUCTION
The menstrual cycle is the set of physiological phenomena of the
woman preparing her organism for a possible fertilization. The usual
length of the menstrual cycle is 28 days, but it can be longer or
shorter and is not always regular. Strong emotions, travel, among
other causes, play a significant role in rhythm changes.
It begins at puberty and ends at menopause.
2.CARACTERRISTICS OF NORMAL MENSTRUATION
 Menarche : 10-16 years. Average 13 years
 Duration : 2-7 days ( <2 days is hypomenorrhea and >7 days is
menorrhagia
 Amount : 30-80ml . , uses 3 napkins per day , >80ml. is
menorrhagia and <30ml. is hypomenorrhea.
 Normally menstrual blood doesn’t coagulate by fibrinolysin
enzyme secreted by the endometrium.
 Menstrual molimina refres to minld symptoms of 7-10 days.
3. PHYSIOLOGY
At the beginning of the follicular phase, the increase in FSH
stimulates the development of four to five follicles per ovary.
These then secrete estradiol, the Concentration gradually increases,
resulting in return an inhibition of GnRH secretion and therefore of
FSH and LH.
This decrease in FSH blocks the growth of all follicles except one, the
dominant follicle Which is more sensitive to FSH and expresses many
FSH receptors. During the second part of the phase follicle, FSH
allows the expression of receptors for LH on the granulosa cells of
this follicle. There is Synergy of action between FSH and LH, resulting
in a sudden increase in estradiol secretion which forms the pre-
ovulatory peak.
And at this precise moment, begins the progesterone secretion.
When the estradiol concentration is sufficiently High, there is a
sudden increase in sensitivity Gonadotropic cells to GnRH, which
releases FSH and LH.
It is this sudden increase in LH that triggers Ovulation, especially due
to the massive release prostaglandins it induces.
After ovulation, during the luteal phase, the corpus luteum Grows
and secretes increasing amounts of estrogen and especially
progesterone.
Its activity is maximum Seven to eight days after ovulation. So the
concentrations elevated levels of progesterone and estradiol inhibit
secretion GnRH, FSH and LH.
As the LH concentration decreases, the corpus luteum regresses and
degenerates.
Thus, the secretion of progesterone and estradiol decreases, which
will then lead to the resumption of the secretion of Pituitary
hormones, primarily FSH.
Finally, the decrease in sex hormones leads to the Constriction of the
spiral arterioles and the expression of a Collagenase that triggers
menstruation.

Theoretically, the menstrual cycle is simply the period of blood loss,

but the description of the menstrual cycle also includes the ovarian
cycle, passage from the primary follicle to ovulation and to the
corpus luteum which delivers progesterone.
During the menstrual cycle, the uterine lining thickens in order to
accommodate an embryo. At the same time, the ovarian cycle
occurs, during which a female sex cell, or oocyte, matures in
preparation for fertilization.
By convention, the first day of the cycle corresponds to the first day
of menstruation. Endometrial growth begins again on the 5th day
and continues throughout the cycle : from 0.5 mm at the end of
menstruation, it increases to 3 mm at the time of ovulation to reach 5
mm on the 28th day of the cycle.
Ovarian cycle
 Follicular phase and
 Luteal phase

Ovarian cycle
Cyclical changes in the ovaries occur in response to two anterior
pituitary hormones: Follicle-stimulating hormone (FSH) and
Luteinizing hormone (LH). The follicular phase is controlled by FSH,
encompasses days 1 to 14 of a 28-day cycle.
 Follicular phase :
At the begening of earch menstrual cycle , the Hypothalamus
secretes the GnRh in a pulsatile manner to stimulate ant.Pit.glande
to secretes FSH and LH is responsible for the growth of several
primary follicle only one follicle on one of the ovaries reaches
maturity which secretes oestrogen.
Cont.
The Oestrogen peak stimulates secretion of LH peaks leads to the
follicle to burst open, releasing the mature ovum into the
abdominal cavity a process called ( OVULATION ). And corpous
lluteum formation .
Ovulation occurs on days 14 day of a 28-day cycle
 Luteal phase :
After ovulation , LH levels remain elevatedd and cause the
remnants of the follicle to develop into a yellow body called the
corpus luteum. In addition to producing oestrogen, the corpus
luteum secretes a hormone called Progesterone.
Cont.
When progesterone reaches a high level it inhibits the secretion of
LH leads degeneration of the corpous luteum and so oestrogen
and progesterone drop and separation of the endometrium and
stimulate the hypothalamus to secrete more GnRH, a new cycle is
started.

Uterine cycle :
The uterine cycle refers to the changes that are found in the
uterine lining of the uterus. These changes come about in
response to the ovarian hormones oestrogen and progesterone.
 Phases of uterine cycle : 
 Menstrual
 Proliferative
 Secretory
 Ischemic

 Menstrual phase
Day 1 of the menstrual cycle is marked by the onset of menstruation.
Durring the menstrual phase of the uterine cycle, the uterine lining is
shed because of low leves of progesterone and oestrogen. At the
same time, a follicle is beginning to develop and starts producing. The
menstrual phase ends when the menstrual period stops on
approximately day 5.
 Proliferative phase
When oestrogen levels are high enough, the endometrium begins to
regenerate. Estrogen stimulates blood vessels to develop. The blood
vessels in turn bring nutrients and oxygen to the uterine lining, and it
bening to grow and become thicker . The prolifertaivephase ends
with ovulation on day.
 Secretory phase
After ovulation, the corpus luteum begins to produce progesterone.
This hormone causes the uterine lining to become rich in nutrients in
preparation for pregnacy. Estroen levels also remain high so that the
linning is maintained. If pregnancy doesn’t occur, the corpus luteum
gradually degenerates, and the woman enters the ischemic phase of
the menstrual cycle.
 Ischemic phase
On day 27 and 28, oestrogen and progesterone levels fall because the
corpus luteum is no longer producing them. Without thes hormones
to maintain the blood vessels network, the uterine linning becomes
ischemic.
When the lining starts slough, the woman has come full cycle and is
once again at day 1 of the menstrual cycle.