Menstrual cycle Physiology

• Dr. Atef Abood

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Ovaries
• Primordial follicle – one layer of squamouslike follicle cells surrounds the oocyte • Primary follicle – two or more layers of cuboidal granulosa cells enclose the oocyte • Secondary follicle – has a fluid-filled space between granulosa cells that coalesces to form a central antrum • Graafian follicle – secondary follicle at its most mature stage that bulges from the surface of the ovary • Ovulation – ejection of the oocyte from the ripening follicle • Corpus luteum – ruptured follicle after ovulation 2

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one activated primary oocyte produces two haploid cells – The first polar body – The secondary oocyte • The secondary oocyte arrests in metaphase II and is ovulated • If penetrated by sperm the second oocyte completes meiosis II.Oogenesis • At puberty. yielding: – One large ovum (the functional gamete) – A tiny second polar body 4 .

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Ovarian Cycle • Monthly series of events associated with the maturation of an egg • Follicular phase – period of follicle growth (days 1–14) • Luteal phase – period of corpus luteum activity (days 14–28) • Ovulation occurs midcycle 6 .

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• The primordial follicle. • It starts by activation of several. directed by the oocyte. primordial follicles. becomes a primary follicle • Primary follicle becomes a secondary follicle – The theca folliculi and granulosa cells cooperate to produce estrogens – The zona pellucida forms around the oocyte – The antrum is formed 8 . • At the 6th day only one follicle starts to grow rapidly becoming a dominant follicle called the Graffian follicle while the others regress.Follicular Phase • This phase is under the effect of FSH and to a little extent LH.

and the stage is set for ovulation 9 .Follicular Phase (Cont.) • The secondary follicle becomes a vesicular follicle – The antrum expands and isolates the oocyte and the corona radiata – The full size follicle (vesicular follicle) bulges from the external surface of the ovary – The primary oocyte completes meiosis I.

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Ovulation • Ovulation occurs when the ovary wall ruptures and expels the secondary oocyte • Mittelschmerz – a twinge of pain sometimes felt at ovulation • 1-2% of ovulations release more than one secondary oocyte. which if fertilized. results in twins 11 .

the corpus luteum produces hormones until the placenta takes over that role (at about 3 months) 12 . the ruptured follicle collapses. the corpus luteum degenerates in 10 days. and along with internal thecal cells. granulosa cells enlarge.Luteal Phase • After ovulation. leaving a scar (corpus albicans) • If pregnancy does occur. form the corpus luteum • The corpus luteum secretes progesterone and estrogen • If pregnancy does not occur.

Uterine (Menstrual) Cycle • Series of cyclic changes that the uterine endometrium goes through each month in response to ovarian hormones in the blood • : Menstrual phase Days 1-5– – uterus sheds all but the deepest part of the endometrium • Days 6-14: Proliferative (preovulatory) phase – endometrium rebuilds itself • Days 15-28: Secretory (postovulatory) phase – endometrium prepares for implantation of the embryo 13 .

Endometrium • Has numerous uterine glands that change in length as the endometrial thickness changes • Stratum functionalis: – Undergoes cyclic changes in response to ovarian hormones – Is shed during menstruation • Stratum basalis: – Forms a new functionalis after menstruation ends • Does not respond to ovarian hormones 14 .

15 . • As the thickness increases. but they do not become convoluted or secrete to any degree.5mm → 5mm • Under the influence of estrogens from the developing follicle. These endometrial changes are also called the preovulatory or follicular phase of the cycle.Proliferative phase • Duration: 2 weeks • Thickness: 0. the uterine glands are drawn out so that they lengthen. the endometrium increases rapidly in thickness from the fifth to the fourteenth days of the menstrual cycle.

• Late in the luteal phase. and they begin to secrete a clear fluid. like the anterior pituitary. this phase of the cycle is called the secretory or luteal phase. 16 . but the function of this endometrial prolactin is unknown. Consequently. • The glands become coiled and tortuous. produces prolactin. the endometrium becomes more highly vascularized and slightly edematous under the influence of estrogen and progesterone from the corpus luteum.Secretory phase • Duration: 2 weeks • Thickness: 5-6mm • After ovulation. the endometrium.

Menses • If fertilization does not occur. the first day of menstrual bleeding is consideredy by day 1 • Shedding: 30-50 ml 17 . duration: 2-6 days. depriving the endometrium of hormonal support • Spiral arteries kink and go into spasms and endometrial cells begin to die • The functional layer begins to digest itself • Spiral arteries constrict one final time then suddenly relax and open wide • The rush of blood fragments weakened capillary beds and the functional layer sloughs • Nonclotting menstrual blood mainly comes from artery (75%) • Interval: 24-35 days (28 days). progesterone levels fall.

The fibrinolysin lyses clot. 18 . with only 25% of the blood being of venous origin. and relatively large amounts of fibrinolysin from endometrial tissue. but flows as short as 1 day and as long as 8 days can occur in normal women.Menstruation • Menstrual blood composition – is predominantly arterial. prostaglandins. so that menstrual blood does not normally contain clots unless the flow is excessive. • The usual duration: 3-5 days. It contains tissue debris.

the average amount lost is 30 mL. including the thickness of the endometrium. • The amount of flow can be affected by various factors. After menstruation. a new endometfrom rium regenerates from the stratum basale. 19 . medication. Obviously.Menstruation • The amount of blood lost may range normally slight spotting to 80 mL. and diseases that affect the clotting mechanism. • Loss of more than 80 mL is abnormal.

and these coalesce. • There is in addition spasm and then necrosis of the walls of the spiral arteries. • The endometrium becomes thinner.) • When the corpus luteum regresses. 20 . hormonal support for the endometrium is withdrawn.Menses (Cont. Foci of necrosis appear in the endometrium. leading to spotty hemorrhages that become confluent and produce the menstrual flow. which adds to the coiling of the spiral arteries.

and infusions of PGF2α produce endometrial necrosis and bleeding.Menses (Cont. There are large quantities of prostaglandins in the secretory endometrium and in menstrual blood. 21 . • One theory of the onset of menstruation holds that in necrotic endometrial cells. with the release of enzymes that foster the formation of prostaglandins from cellular phospholipids.) • The vasospasm is probably produced by locally released prostaglandins. lysosomal membranes break down.

22 .Changes of other genital organs • Cervix • During follicular phase estrogen causes mucus to be thin. thin thread that may be 8-12 cm or more in length. it dries in an arborizing. fern-like pattern • During luteal phase progesterone causes mucus to be thick.clear. In addition. watery and the the midcycle a drop can be stretched into a long. opaque. tenacious and cellular and loss of ability to form fern like appearance.

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Changes of other genital organs • Cyclic changes in the vagina – Under the influence of estrogens. – Under the influence of progesterone. the vaginal epithelium becomes cornified. and the epithelium proliferates and becomes infiltrated with leukocytes. 24 . a thick mucus is secreted.

– progesterone causes growth of lobules and alveoli. and edema of the interstitial tissue of the breast.Changes of other genital organs • Cyclic changes in the breast – Estrogens cause proliferation of mammary ducts. hyperemia. along with the symptoms. 25 . during menstruation. and pain experienced by many women during the 10 days preceding menstruation are probably due to distention of the ducts. All these changes regress. – The breast swelling. tenderness.

which act on the ovaries • These events continue until an adult cyclic pattern is achieved and menarche occurs 26 . ovaries grow and secrete small amounts of estrogens that inhibit the hypothalamic release of GnRH • As puberty nears. FSH and LH are released by the pituitary. GnRH is released.Establishing the Ovarian Cycle • During childhood.

causing a sudden surge of LH • The LH spike stimulates the primary oocyte to complete meiosis I.Hormonal Interactions During the Ovarian Cycle • Day 1 – GnRH stimulates the release of FSH and LH • FSH and LH stimulate follicle growth and maturation. and the secondary oocyte continues on to metaphase II 27 . and lowlevel estrogen release • Rising estrogen levels: – Inhibit the release of FSH and LH • Estrogen levels increase and high estrogen levels have a positive feedback effect on the pituitary.

Hormonal Interactions During the Ovarian Cycle • Day 14 – LH triggers ovulation • LH transforms the ruptured follicle into a corpus luteum. which produces inhibin. and estrogen • These hormones shut off FSH and LH release and declining LH ends luteal activity • Days 26-28 – decline of the ovarian hormones • Ends the blockade of FSH and LH • The cycle starts anew 28 . progesterone.

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PGF2α appears to be a physiologic luteolysin. the estrogen and progesterone levels fall and the secretion of FSH and LH increases.Summary of hormonal control of the cycle • In an important sense. oxytocin secreted by the corpus luteum appears to exert a local luteolytic effect. Therefore it appears that at least in some species luteolysis is produced by the combined action of PGF2α and ET-1. regression of the corpus luteum (luteolysis) starting 3-4 days before menses is the key to the menstrual cycle. Once luteolysis begins. In some domestic animals. but this prostaglandin is only active when endothelial cells producing ET-1 are present. possibly by causing the release of prostaglandins. A new crop of follicles develops to start a new cycle 32 .

• Oligomenorrhea: reduced frequency of the periods. • Menorrahgia: excessive bleeding during menstruation • Hypomenorrhea: scanty or little bleeding • Metrorrahgia: bleeding between cycles. 33 .Menstrual Abnormalities • Anovulatory cycle • Amenorrhea – Primary amenorrhea: period never occurs – Secondary amenorrhea stop of the cycle after normal periods have occurred.

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