PHYSIOLOGY OF THE

MENSTRUAL CYCLE
?What is the menstrual cycle
The process in which females ripen or
release one mature egg.

The average menstrual cycle will repeat

itself about every 28 days, but normal
menstrual cycles can range from 21 to 35
days.

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Definition:
 Menarche: is the age of onset of menstruation. it is ranged
between 10-16 years.
 Menstruation: is the monthly shedding of a portion of
endometrium. It recurs regularly from puberty to menopause
except during pregnancy.
 Interval of menstruation: is the period extends from the
onset of one menstruation to the onset of the following one.
It ranges between 21-35 days with an average of 28 days.
 Duration of menstruation: ranged between 3-5 days with
average 2-7 days.
 Cycle: is 28 days; more than 21 and less than 35 days can be
accepted normal.
 Amount of blood loss: ranges between 10-120 ml with an
average of 50ml.
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HYPOTHALAMIC- PITUITARY- OVARIAN AXIS

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 Thehypothalamus: the hypothalamus can either
stimulate or inhibit the secretion of the pituitary
hormones, and the hypothalamus itself is influenced
by other parts of the central nervous system.

 From the hypothalamus gonadotropin-releasing

hormone (GnRH) passes to the anterior lobe of the
pituitary gland, where it causes release of the
gonadotropins.

 Theanterior lobe of the pituitary gland controls the

ovarian function by a cyclic secretion of the
gonadotropins. The pituitary gonadotropins are:
FSH , LH, and Prolactin.
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 Follicle-stimulating hormone (FSH):
FSH begins to be secreted towards the end of the previous
menstrual cycle, and rises to a peak at about day 5 of the
new cycle, then the level falls slightly before rising to a
second peak at about day 12.

FSH is responsible for:

1. Ripening & maturation of Graafian follicle of the
ovary,
2. Stimulating estrogen secretion by the growing
Graafian follicle,
3. In combination with luteinizing hormone, it causes
ovulation.

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 Luteinizing hormone (LH):
The level of LH in the blood is fairly constant throughout
the cycle except there is a sudden peak at about the mid-
cycle (day 12 or 13).

LH is responsible for:
1. In combination with FSH, it promotes follicular
ripening,
2. LH surge brings rupture of the mature Graafian follicle
(ovulation).
3. Turning the ruptured Graafian follicle to a corpus
luteum.
4. Stimulating the corpuse luteum to secreate estrogen &
progesterone.

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Prolactine hormone:
The release of FSH& LH, inhibit the release of
prolactine.

The exact role of prolactine in the control of

ovulation is not exactly known, but may be an
agent which prevents further ovulation once
fertilization has happened.

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PHYSIOLOGY OF MENSTRUAL CYCLE

The normal menstrual cycle is divided

into:
1. The ovarian cycle.
2. The uterine cycle.

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 1. THE OVARIAN CYCLE

The changes that occur in the ovary during

each cycle can be divided into three
stages:
(1) The follicular phase (day 1 to 13),
(2) Ovulatory phase (day 13 to 15)
(3) The luteal phase (day 15 to 28).

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 The follicular phase (day 1 to 13)
 During this phase, a primordial follicle, under the effect
of FSH, changes into a full mature Graafian follicle. In
the early part of this phase up to 50 follicle or more start
to ripe & mature, but normally only one follicle matures
fully and ovulates while the others retrogress.

 Theempty follicle is known as the courpus luteum,

courpus luteum will be then atrophy and becomes the
courpus Albicans.

 As the Graafian follicle matures its cell produce estrogen

in gradually increasing amounts. This rasing estrogen
level inhibits the secreation of FSH (Negative feedback).
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 Ovulatory phase (day 13 to 15)
Ovulation is the process by which the
mature Graafian follicle ruptures. The
ovum is picked up by the fimbria of the
fallopian tube.

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 The luteal phase (day 15 to 28).
 After ovulation The empty follicle is known as the
courpus luteum. The cell of the courpus luteum produce
estrogen & progesterone.
 If the released ovum is not fertilized, the courpus luteum
degenerates to corpus albicans, and the level of estrogen &
progesteron fall, so ovarian cycle ends, and menstruation
starts.
 If the released ovum is fertilized (pregnancy), the fertilized
ovum will secretes human chorionic gonadotropins (HCG).
HCG prevents the degenerates to corpus luteum.
 corpus luteum continuous to produce estrogen &
progesterone, so menstruation dosen’t happen at the
expected time which is the early symptom suggesting
pregnancy.
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 2. The uterine cycle
1. Resting phase: 1-2 days after
menstruation
2. Proliferative phase: 9-10 days
3. Secretory phase: 12-14 days
4. Menstrual phase: menstruation starts.

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 Ovulation
 Definition: rupture of a full mature Graafian follicle
with release of ovum.

 Symptoms:

1. Regular menstruation
2. Ovulation pain
3. Ovulation bleeding (in some women)
4. Premenstrual mastalgia: pain & tenderness in the
breast after ovulation.
5. Spasmodic dysmenorrhoea: painful menstrual cycles
indicate ovulation.
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Ovulation

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Thank you

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 Ovulation
 Investigation:

1. Premenstrual Endometrial Biopsy (PMB): can be taken on

the first day of menstruation so as not to disturb a possible
pregnancy.
2. Basal body temperature: body temperayure raise by 0.2 to
0.5 C during time of ovulation due to progesterone effect.
3. Change in the cervical mucus: positive thread test “
Spinnebarkeit”.
4. Changes in the hormonal levels:
◦ LH peak
◦ Progesterone in plasma: 8-12 nanogram/L.
5. Sonar: by monitoring the growth & rupture of the Graafian
follicles
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