Hormonal Cycles Fertilization and Early Fetal Development

Hormonal cycles: fertilization and
Embryo and fetal development

By Adem Gemechu, B.Sc, M.Sc fellow
06/23/2023 By Adem Gemechu 1

Objectives
• By the end of this session, you will be able to:
 Explore the events that occur during the
ovarian and menstrual cycles
 Describe the process of fertilization followed
by the subsequent development of the
conceptus into the pre-embryonic period
Puberty
• Puberty is a period of rapid change in the lives

of boys and girls during which the reproductive
systems mature and become capable of
reproduction
• Puberty ends when mature sperm are formed
or when regular menstrual cycles occur
Changes in girls during puberty
• Growth spurt
• Increase in the transverse diameter of the pelvis
• Breast development
• Growth of pubic hair
• Onset of menstruation
• Growth of axillary hair
• Vaginal secretions
Changes in boys
• Increase in weight
• Growth of testes
• Growth of face, axillary, and pubic hair
• Voice changes
• Penile growth
• Increase in height
• Spermatogenesis (production of sperm)
Introduction
• The female reproductive process involves the central
nervous system (primarily hypothalamus), the pituitary
gland, the ovary, and the uterus (endometrium)
• All must function appropriately for normal reproduction to
occur
• These organs undergo tightly regulated cyclical changes
( the menstrual cycle) which represents a complex
interaction between them.
Neuroendocrinology
 This term refers to the linkage between neural function
and endocrine function.
 In reproductive physiology the hormonal control
begins from the neurons in the hypothalamus, and
continues with the pituitary gland and the ovaries.
 The hormonal control is brought about by the
hypothalamic-pituitary- ovarian axis

The Hypothalamus
• It is a small neural structure situated at the bases of the
brain above the optic chiasm and below the third ventricle.
• It is connected directly to the pituitary gland and is the
source of many pituitary secretions .
• The hypothalamus has many nuclei( groups of neural cell
bodies) responsible for secreting hormones and sending
impulses.

The hypothalamus cont...
• The hypothalamus secretes hormones known as pituitary
releasing hormones. These are
 GnRH ( Gonadotropin release hormone)-controls the secretion of LH and
FSH
 GHRH(Growth hormone releasing hormone)-Controls secretion of GH
 CRH ( corticotropin releasing hormone)- Controls secretion of
ACTH(adenocorticotropic hormone)
 TRH( thyroid releasing hormone)- controls the secretion of TSH
• The hypothalamic neurons secrete these hormones into a special

circulation known as the hypophyseal portal system

The Pituitary Gland
• The pituitary gland lies below the hypothalamus at the base of the
brain within a bony cavity (sella turcica) and
• is separated from the cranial cavity by a condensation of dura
mater overlying the sella turcica
• The pituitary gland has two portions.
a. Adenohypophysis(anterior pituitary)-develops from ectoderm.
b. Neurohypophysis(Posterior pituitary)- develops as a continuation of the
hypothalamus.
• The anterior pituitary has d/t types of cells responsible for the
secretion for 6 hormones ( GH, TSH, FSH, LH, prolactin and
ACTH)
• The posterior pituitary secretes AVP(arginine vasopression) and
oxytocin
Hypothalamic Hormones
• The hypothalamic hormones are the signals for the production
of pituitary hormones.
• GnRH ( gonadotropin releasing hormone) effects the release

of gonadotropins(FSH and LH) from the pitutary.
• GnRH is secreted in a pulsatile manner for its normal

function.
• If it was secreted constantly it would result in down

regulation by the pituitaryBygonadotrophs.
06/23/2023 Adem Gemechu 13
Pituitary Hormones
• Gonadotropins(FSH and LH)
– These hormones are responsible for ovarian follicular stimulation
– They are glycoproteins with two subunits alpha and beta
– Their alpha subunits are similar
– TSH and hCG also have a similar alpha subunit to that of FSH and LH

Cont…
• Prolactin
– Secreted by anterior pituitary
– Stimulates milk production by the breast
– Action on gonads
– Is under tonic inhibition by dopamine( prolactin inhibiting
factor)
– Prolactin release is stimulated by stress, exercise, breast
manipulation, VIP,
• TSH(thyroid stimulating hormone)
– Stimulate the thyroid gland for secretion of thyroid
hormones
– TSH is produced after the stimulation of pituitary by the
TRH from the hypothalamus
– TRH is a major stimulus for the release of prolactin
Cont…
• AVP and Oxytocin
– These are secreted from the posterior pituitary (by neurons
that extend from the hypothalamus)
– AVP is involved in the regulation of fluid balance, blood
pressure and osmolality
– Oxytocin stimulates two specific types of muscular
contractions
1. Uterine contractions during childbirth
2. Myoepthelial cell contraction in the lactiferous ducts of the
breast resulting in milk expression
– Oxytocin secretion is stimulated by different factors.

The Normal Menstrual cycle
• Menstruation is the visible manifestation cyclic uterine
bleeding as result of interaction of different hormones.
• It is a reflection the cyclic hormonal production
• Menstruation requires:
– Intact hypothalamic-pituitary-ovarian axis
– Responsive endometrium
– Patent outflow tract
• The menstrual cycle is the period extending from
beginning of menses to the beginning of the next

Cont..
• Age of first menstruation is called menarche and
• occurs between 11-15 years, average being 13 years

 A normal menstrual cycle lasts from 21 to 35 days,
 with 1 to 8 days of flow (avg 5 days) and
 blood loss of 10-80 ml(avg 50ml).

Cont.…
• Monthly physiological changes take place in the
ovaries and the uterus, regulated by hormones
produced by the hypothalamus, anterior pituitary gland
and ovaries
• These monthly cycles occurs at puberty and occur
simultaneously and together are known as the female
reproductive cycle
The functions of the female reproductive
cycle
• To prepare the egg for fertilization by the spermatozoon

(sperm) and
• To prepare the uterus to receive and nourish the fertilized
oocyte
o If fertilization has not taken place the inner lining of the
uterus or endometrium and the oocyte are shed and
bleeding occurs per vagina, and the cyclic events begin
again.
Before puberty
• luteinizing hormone (LH) and follicle stimulating hormone
(FSH) levels are low
• Pulsatile increases in gonadotrophin releasing hormone

(GnRH), particularly at night, cause increase in LH secretion.
• This increasing surge of LH is established prior to menarche
• It is also thought that the interaction of leptin with GnRH

may have a role in the initiation of puberty
Menarche
• Is the first menstrual bleeding
• The average age of menarche is 12 years, although between
the ages 8 and 16 is considered normal
• The onset of menstrual bleeding (‘periods’ or menses) is a
major stage in a girl’s life, representing the maturation of the
reproductive system and physical transition into womanhood

Menstrual cycle
• The average cycle is normally 28 days long,
and recurs regularly from puberty to the
menopause except when pregnancy intervenes

The ovarian cycle
• is the name given to the physiological changes that occur
in the ovaries essential for the preparation and release of
an oocyte
• The ovarian cycle consists of three phases:
 The follicular phase
 Ovulation
 The luteal phase

The follicular phase
• Following puberty FSH and LH further

stimulate the development of primordial
follicles into primary and secondary follicles
and subsequently into large preovulatory or
Graafian follicles by a process known as
folliculogenesis
The follicular phase cont. …
• Low levels of oestrogen and progesterone

stimulate the hypothalamus to produce GnRH
• This releasing hormone causes the production
of FSH and LH by the anterior pituitary gland
• FSH controls the growth and maturity of the
Graafian follicles
• The Graafian follicles begin to secrete oestrogen, which
comprises oestradiol, oestrone and oestriol
• Rising levels of oestradiol cause a surge in LH
• When oestradiol reaches a certain peak, the secretion of FSH

is inhibited
• The reduced FSH secretion causes a slowing in follicle

growth and eventually leads to follicle death, known as atresia

• The largest and dominant follicle secretes inhibin, which
further suppresses FSH
• This dominant follicle prevails and forms a bulge near the

surface of the ovary, and soon becomes competent to ovulate
• The time from the growth and maturity of the Graafian

follicles to ovulation is normally around 1 week.

• Occasionally the follicular phase may take longer if the
dominant follicle does not ovulate, and the phase will
begin again
• The differing lengths of menstrual cycle reported
between individual women are as a result in the varying
timespans in this pre-ovulatory phase
• It can last 6–13 days in a 28-day cycle
Ovulation
• Ovulation is the process whereby the dominant Graafian follicle
ruptures and discharges the secondary oocyte into the pelvic
cavity
• High oestrogen levels cause a sudden surge in LH around day
12–13 of a 28 day cycle, which lasts for approximately 48 hours
• This matures the oocyte and weakens the wall of the follicle and
causes ovulation to occur on day 14

Ovulation cont.…
• Fimbrae guide it into the uterine tube where it awaits
fertilization
• During the time of ovulation, meiotic cell division resumes and
the diploid oocyte becomes haploid (with a first polar body)
• During ovulation some women experience varying degrees of
abdominal pain known as mittelschmerz, which can last several
hour

Ovulation cont.…
• There may be some light bleeding caused by the

hormonal changes taking place
• Stringy clear mucus appears in the cervix,
ready to accept the sperm from intercourse
• Following ovulation the fertilized or unfertilized
oocyte travels to the uterus
The luteal phase
• The luteal phase is the process whereby the cells of the
residual ruptured follicle proliferate and form a yellow
irregular structure known as the corpus luteum
• The corpus luteum produces oestrogen, relaxin, inhibin and

progesterone for approximately 2 weeks, to develop the
endometrium of the uterus, which awaits the fertilized
oocyte

The luteal phase cont. …
• Small amounts of relaxin cause uterine quiescence,
which is an ideal environment for the fertilized oocyte to
implant
• The corpus luteum continues its role until the placenta is
adequately developed to take over
• During the luteal phase the cervical mucus becomes
sticky and thick
• In the absence of fertilization the corpus luteum degenerates
and becomes the corpus albicans (white body), and
progesterone, oestrogen, relaxin and inhibin levels decrease
• In response to low levels of oestrogen and progesterone the
hypothalamus produces GnRH
• The rising levels of GnRH stimulate the anterior pituitary
gland to produce FSH and the ovarian cycle commences
again
• The luteal phase is the most constant part of
the ovarian cycle, lasting 14 days out of a 28
day cycle

The menstrual or endometrial cycle
• The menstrual cycle is the name given to the physiological
changes that occur in the endometrial layer of the uterus,
and which are essential to receive the fertilized oocyte
• The menstrual cycle consists of three phases:
 The menstrual phase
 The proliferative phase

 The secretory phase

The menstrual phase
• is often referred to as menstruation, bleeding, menses, or a

period
• is the terminal phase of the reproductive cycle of events and is

simultaneous with the beginning of the follicular phase of the
ovarian cycle
• Low levels of oestrogen and progesterone stimulate

prostaglandin release that causes the spiral arteries of the
endometrium to go into spasm, withdrawing the blood supply
to it, and the endometriumBy Adem
06/23/2023
dies, referred to as necrosis.
Gemechu 38
The menstrual phase cont. …
• The endometrium is shed down to the basal layer

along with blood from the capillaries, the unfertilized
oocyte tissue fluid, mucus and epithelial cells
• Failure to menstruate (amenorrhea) is an indication
that a woman may have become pregnant

The menstrual phase cont. …
• The average blood loss during menstruation is

50–150 ml
• The blood is inhibited from clotting due to the
enzyme plasmin contained in the endometrium
• The menstrual flow passes from the uterus
through the cervix and the vagina to the exterior
The proliferative phase
• Follows menstruation and simultaneous with the follicular phase
of the ovary and lasts until ovulation
• is the formation of a new layer of endometrium in the uterus,
referred to as the proliferative endometrium
• is under the control of oestradiol and other oestrogens secreted
by the Graafian follicle and consist of the re-growth and
thickening of the endometrium in the uterus.

The proliferative phase cont. …
• During the first few days of this phase the endometrium is
re-forming, described as the regenerative phase
• At the completion of this phase the endometrium consists
of three layers:
 The basal layer
 The functional layer
 The layer of cuboidal ciliated epithelium

• The basal layer lies immediately above the

myometrium and is approximately 1 mm thick.
 It contains all the necessary rudimentary
structures for building new endometrium

• The functional layer, which contains tubular

glands, is approximately 2.5 mm thick, and
lies on top of the basal layer
 It changes constantly according to the
hormonal influences of the ovary

• The layer of cuboidal ciliated epithelium
covers the functional layer
• It dips down to line the tubular glands of the
functional layer
• If fertilization occurs, the fertilized oocyte
implants itself within the endometrium.

The secretory phase
• Follows the proliferative phase and is simultaneous with
ovulation
• is under the influence of progesterone and oestrogen
secreted by the corpus luteum
• The functional layer of the endometrium thickens to
approximately 3.5 mm and becomes spongy in
appearance because the glands are more tortuous
The secretory phase cont. …
• The blood supply to the area is increased and

the glands produce nutritive secretions such as
glycogen.
• These conditions last for approximately 7
days, awaiting the fertilized oocyte.

By Adem Gemechu, B.Sc, M.Sc fellow

Conception
• Conception, also known as fertilization, occurs when a

sperm nucleus enters the nucleus of the oocyte
• Fertilization normally occurs in the outer third of the
fallopian tube
• The fertilized oocyte is called a zygote and contains
the diploid number of chromosomes (46)

Cell Division
• The single-cell zygote undergoes mitotic cell
division known as cleavage
• Mitotic cell division or mitosis occurs when a
cell (parent cell) divides and forms two
daughter cells that contain the same number of
chromosomes as the parent cell.
Cell Division cont.…
• Three days after fertilization, the zygote has

formed into a 16-cell, solid sphere that is called
a morula
• Mitosis continues, and around day 5 the
developing human is known as the blastocyst
and enters the uterus
Cell Division cont.…
• The blastocyst is composed of an inner cell

mass known as the embryoblast, which will
develop into the embryo, and an outer cell
mass known as the trophoblast, which will
assist in implantation and become part of the
placenta
Implantation
• Implantation, the embedding of the blastocyst into the
endometrium of the uterus, begins around day 5 or 6
• Progesterone stimulates the endometrium of the uterus, which

becomes thicker and more vascular in preparation for implantation.
• Enzymes secreted by the trophoblast, now referred to as the

chorion, digest the surface of the endometrium in preparation for
implantation of the blastocyst.

Site of implantation
• Implantation normally occurs in the upper

part of the posterior wall of the uterus

Embryo
• The developing human is referred to as an embryo from
the time of implantation through 8 weeks of gestation
• Organogenesis, the formation and development of body
organs, occurs during this critical time of human
development

Embryo development cont. …
• Primary germ layers begin to develop around day 14
• These germ layers, known as the ectoderm, mesoderm,

and endoderm, form the different organs, tissues, and body
structure of the developing human
 The ectoderm is the outer germ layer
 The mesoderm is the middle germ layer
 The endoderm is the inner germ layer.

The ectoderm
• Epidermis; hair and nail follicles; sweat glands
• Nervous system; pituitary gland; adrenal medulla
• Lens and cornea; internal ear Mucosa of oral and

• nasal cavities; salivary glands

The mesoderm
• Skeletal muscles; cardiac muscles; most

smooth muscles
• Kidneys; adrenal cortex
• Bone marrow and blood; lymphatic tissue;
lining of blood vessels

The endoderm
• Mucosa of esophagus, stomach, and intestines
• Epithelium of respiratory tract, including lungs
• Liver and mucosa of gallbladder

• Thyroid gland; pancreas

Embryo development cont. …
• The heart forms during the 3rd gestational week and
begins to beat and circulate blood during the 4th
gestational week
• By the end of the 8th gestational week the developing
human has transformed from the primary germ layers
to a clearly defined human that is 3 cm in length with
all organ systems formed
Fetus
• The developing human is referred to as a fetus

from week 9 to birth
• During this stage of development, organ
systems are growing and maturing

Early development…cont’d

• The developing human is referred to as an embryo from the
time of implantation through 8 weeks of gestation
• Organogenesis, the formation and development of body organs,
occurs during this critical time of human development
• The developing human is referred to as a fetus from week 9 to
birth
 During this stage of development, organ systems are growing
and maturing
62 By Adem Gemechu 06/23/2023

0-4 week after conception Time scale of fetal development
 Rapid growth
 Formation of embryonic plate
 Primitive central nervous system forms
 Heart develops and begin to beat
 Limb bud form

Time scale of fetal… cont’d
4-8 weeks
 Very rapid cell division
 Head and fetal features develop
 All major organ laid down in primitive form
 External genitalia present but sex not distinguishable
 Early movement visible on ultrasound from 6 week

8-12 weeks
 Eyelids fuse
 Kidney begin to function & the fetus begin to pass urine from
10week
 Placenta is complete
 Fetal circulation functioning properly
 Sucking and swallowing begin
 Sex apparent
 Moves freely (not felt by the mother)
 Some primitive reflexes present

12-16 weeks
 Rapid skeletal development (visible on x-ray)
 Meconium present in gut
 Lanugo appears
 Nasal septum and palate fuse
 Heart beat is present

16-20 weeks
 ‘Quickening’- mother feels fetal movements
 Fetal heart heard on auscultation
 Vernix caseosa appears
 Fingernail can be present
 Skin cells begin to be renewed

20-24 weeks
 Most organ become capable of functioning
 Period of sleep and activity
 Respond to sound
 Skin appear red and wrinkled
24-28 weeks
 Survival may be expected if born
 Eyelids reopen
 Respiratory movement

28-32 weeks
 Begins to store fat and iron
 Testes descend in to scrotum
 Lanugo disappear from face
 Skin become paler and less wrinkled

32-36 weeks
 Increased fat makes the body more rounded
 Lanugo disappear from the body
 Head hair lengthens
 Nails reach tips of fingers
 Ear cartilage become soft
 Plantar creases visible

36-40 weeks after conception (38-42 weeks after LNMP)

 Term reached and birth is due
 Contours rounded
 Skull firm

Fetal Circulation
• The cardiovascular system begins to develop

within the first few weeks of gestation
• The heart begins to beat during the 4th
gestational week

Unique features of fetal circulation
• High levels of oxygenated blood enter the fetal
circulatory system from the placenta via the umbilical
vein
• The ductus venosus connects the umbilical vein to the
inferior vena cava
 This allows the majority of the high levels of oxygenated
blood to enter the right atrium
Unique features of fetal circulation cont. …
• The foramen ovale is an opening between the right and

left atria
 Blood high in oxygen is shunted to the left atrium via the
foramen ovale.
 After delivery, the foramen ovale closes in response to
increased blood returning to the left atrium
 It may take up to 3 months for full closure.
Unique features of fetal circulation cont. …
• The ductus arteriosus connects the pulmonary artery

with the descending aorta
 The majority of the oxygenated blood is shunted to the
aorta via the ductus arteriosus with smaller amounts
going to the lungs
 After delivery, the ductus arteriosus constricts in
response to the higher blood oxygen levels and
prostaglandins
Placenta, membranes, amniotic fluid,
and umbilical cord
Placenta
• The placenta is formed from both fetal and maternal tissue
• The chorionic membrane that develops from the trophoblast
along with the chorionic villi form the fetal side of the placenta
• The chorionic villi are projections from the chorion that embed
into the decidua basalis and later form the fetal blood vessels of
the placenta.

Placenta cont. …
• The endometrium is referred to as the decidua and consists
of three layers:
 decidua basalis
 decidua capsularis, and
 decidua vera
• The decidua basalis, the portion directly beneath the

blastocyst, forms the maternal portion of the placenta
Placenta cont. …
• The maternal side of the placenta is divided into

compartments or lobes known as cotyledons.
• The placental membrane separates the maternal
and fetal blood and prevents fetal blood mixing
with maternal blood, but allows for the
exchange of gases, nutrients, and electrolytes
Function of the Placenta
• Metabolic and gas exchange
 In the placenta, fetal waste products and CO2 are transferred
from the fetal blood into the maternal blood sinuses by
diffusion
 Nutrients, such as glucose and amino acids, and O2 are
transferred from the maternal blood sinuses to the fetal blood
through the mechanisms of diffuse and active transport.

Function of the Placenta cont. …
• Hormone production
 The major hormones the placenta produces are
progesterone, estrogen, human chorionic
gonadotropin (hCG), and human placental
lactogen (hPL), also known as human chorionic
somatomammotropin
• Progesterone facilitates implantation and

decreases uterine contractility
• Estrogen stimulates the enlargement of the
breasts and uterus

• Human chorionic gonadotropin (hCG) stimulates the corpus
luteum so that it will continue to secrete estrogen and
progesterone until the placenta is mature enough to secrete
these hormones
 This is the hormone assessed in pregnancy tests
 hCG rises rapidly during the first trimester and then has a
rapid decline
• Human placental lactogen (hPL)

 Promotes fetal growth by regulating glucose
available to the developing human
 Stimulates breast development in preparation
for lactation

• The placenta becomes fully functional

between the 8th and 10th weeks of gestation.
• By the ninth month, the placenta is between 15
and 25 cm in diameter, 3 cm thick, and weighs
approximately 600 g

Embryonic Membranes
• Two membranes (amnion and chorion) form the amniotic sac (also
referred to as the bag of waters).
• The chorionic membrane (outer membrane) develops from the

trophoblast.
• The amniotic membrane (inner membrane) develops from the

embryoblast.
• The embryo and amniotic fluid are contained within the amniotic sac.
• The membranes stretch to accommodate the growth of the developing

fetus and the amniotic fluid
Amniotic Fluid
• Amniotic fluid is the fluid contained within the

amnion
• Amniotic fluid is clear and is mainly composed of
water
• It also contains proteins, carbohydrates, lipids,
electrolytes, fetal cells, lanugo, and vernix caseosa

Amniotic Fluid cont. …
• Amniotic fluid during the first trimester is produced from
the amniotic membrane
• During the second and third trimesters, the fluid is
produced by the fetal kidneys
• Amniotic fluid increases during pregnancy and peaks
around 34 weeks at 800 to 1,000 mL and then decreases
to 500 to 600 mL at term.
Function of Amniotic Fluid
• Acts as a cushion for the fetus when there are sudden
maternal movements
• Prevents adherence of the developing human to the
amniotic membranes
• Allows freedom of fetal movement which aids in
symmetrical musculoskeletal development
• Provides a consistent thermal environment
Umbilical Cord
 Connects the fetus to the placenta
 Consist of two umbilical arteries and one
umbilical vein
 Arteries carry deoxygenated blood
 The vein carries oxygenated blood.
 The vessels are surrounded by Wharton’s
jelly, a collagenous substance, which protects
the vessels from compression
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Hormonal cycles: fertilization and

Embryo and fetal development

06/23/2023 By Adem Gemechu 1

• Puberty is a period of rapid change in the lives

06/23/2023 By Adem Gemechu 8

06/23/2023 By Adem Gemechu 9

• The hypothalamic neurons secrete these hormones into a special

06/23/2023 By Adem Gemechu 10

• GnRH ( gonadotropin releasing hormone) effects the release

• GnRH is secreted in a pulsatile manner for its normal

• If it was secreted constantly it would result in down

06/23/2023 By Adem Gemechu 14

06/23/2023 By Adem Gemechu 16

06/23/2023 By Adem Gemechu 17

• Age of first menstruation is called menarche and

• occurs between 11-15 years, average being 13 years

 with 1 to 8 days of flow (avg 5 days) and

 blood loss of 10-80 ml(avg 50ml).

06/23/2023 By Adem Gemechu 18

• To prepare the egg for fertilization by the spermatozoon

• Pulsatile increases in gonadotrophin releasing hormone

• This increasing surge of LH is established prior to menarche

• It is also thought that the interaction of leptin with GnRH

• Is the first menstrual bleeding

• The average age of menarche is 12 years, although between

the ages 8 and 16 is considered normal

• The onset of menstrual bleeding (‘periods’ or menses) is a

major stage in a girl’s life, representing the maturation of the

reproductive system and physical transition into womanhood

06/23/2023 By Adem Gemechu 22

06/23/2023 By Adem Gemechu 23

 The luteal phase

• Following puberty FSH and LH further

• Low levels of oestrogen and progesterone

• Rising levels of oestradiol cause a surge in LH

• When oestradiol reaches a certain peak, the secretion of FSH

• The reduced FSH secretion causes a slowing in follicle

06/23/2023 By Adem Gemechu 27

• This dominant follicle prevails and forms a bulge near the

• The time from the growth and maturity of the Graafian

06/23/2023 By Adem Gemechu 28

06/23/2023 By Adem Gemechu 30

06/23/2023 By Adem Gemechu 31

• There may be some light bleeding caused by the

• The corpus luteum produces oestrogen, relaxin, inhibin and

06/23/2023 By Adem Gemechu 33

06/23/2023 By Adem Gemechu 36

 The menstrual phase

 The proliferative phase

06/23/2023 By Adem Gemechu 37

• is often referred to as menstruation, bleeding, menses, or a

• is the terminal phase of the reproductive cycle of events and is

• Low levels of oestrogen and progesterone stimulate

• The endometrium is shed down to the basal layer

06/23/2023 By Adem Gemechu 39

• The average blood loss during menstruation is

of the ovary and lasts until ovulation

• is the formation of a new layer of endometrium in the uterus,

referred to as the proliferative endometrium

• is under the control of oestradiol and other oestrogens secreted

by the Graafian follicle and consist of the re-growth and

thickening of the endometrium in the uterus.

06/23/2023 By Adem Gemechu 41