Physiology of the menstrual cycle

The menstrual cycle: Is the regular natural change that occurs in

the female reproductive system (specifically the uterus and
ovaries) that makes pregnancy possible.

The average adult menstrual cycle lasts 28 to 35 days, with

approximately 14 to 21 days in the follicular phase and 14 days in
the luteal phase.

There is significantly more cycle variability for the first five to

seven years after menarche.

And for the last 10 years before cessation of menses.

The average age of menarche in humans is 12–13 years.

But is normal anywhere between ages 8 and 16.

Factors such as heredity, diet and overall health can accelerate or

delay menarche.

The cessation of menstrual cycles at the end of a woman's

reproductive period is termed menopause.

The average age of menopause in women is 52 years, with

anywhere between 45 and 55 being common.

1
Hypothalamic regulation:-

Gonadotropin hormone releasing hormone (GnRH) is

decapeptide produced by arcuate nucleus of hypothalamus.

Released into hypothalamo – hypophyseal portal circulation

every 60 -120 min lead to release of gonadotropin from anterior
pituitary.

2
Pituitary regulation: -
Follicular stimulating hormone and luteinizing hormone (F.S.H & LH) are
glycoprotein.

Released from the basophil cells of anterior pituitary.

Released into systemic circulation to reach the ovary.

3
4
Ovarian Cycle:
The ovarian cycle consists of the follicular phase, ovulation, and
luteal phase

5
1. Follicular phase:
A. follicular growth (F.S.H effect)

Primordial follicle (ovum surrounded by single layer of

granulose cells) ↓

Pre-antral follicle (ovum surrounded by several layer of

granulose cells) ↓

Antral follicle (antrum forms in granulose cells)

↓

Pre-ovulatory follicle (mature graffian follicle = 18-20mm).

The graffian follicle consist of (from inside out ) ovum about 120
microns in diameter→Zona pellucida→Corona radiata→Cumulus
oophorus→Granulosa cells & antrum containing liquor folliculi →
theca interna&theca externa.

6
b. Estrogen formation by follicle:-
*in the theca cells, F.S.H induces LH receptor. LH then acts on
these receptors to stimulate the theca cells to produce
androstenedione.

*in the granulose cells: androgens are converted by aromatase to

estrogens.

C. Selection of the mature dominant follicle:

*the growing follicle releases increasing amounts of estrogen &

inhibin, which inhibit F.S.H.

*The dominant follicle contains the highest amount of F.S.H

receptor& grows, while the other follicles become atretic.

7
2. OVULATION:-
Is release of the ovum into the peritoneal cavity”

* The high estrogen at midcycle leads to an L.H peak which

releases.

.progestrone in the follicle, that leads to stimulation of

proteolytic enzyme.

.prostaglandin, causes smooth muscles contraction which

leads to increased intra-follicular pressure.

*It occurs at midcycle 34- 36 hours after the start of the L.H
surge and 10 -12 hours after L.H surge reaches the peak.

3. Luteal Phase:
. The corpus luteum is the follicle after ovulation.

.phases:
.proliferation:

.vascularization (the blood supplies cholesterol, phospholipid

to the cell &the granulose and theca are called lutein cell)

.maturity: excess progesterone is secreted at day 21- 22 of the

cycle.

Degeneration:

If pregnancy occurs, H.C.G (Like L.H) maintains the corpus

luteum

If NO pregnancy: the corpus luteum starts to degenerate at 23

-24th day.

Life span of corpus luteum is 14 days.

8
Endometrial cycle:
Uterine cycle is divided into menstruation, proliferative phase,
and secretory phase

The endometrium consists of (gland, stroma, & blood vessels)

The endometrial layer are:

*superficial layer, consist of spongy& a compact layers.

*basal layer, which is not response to hormones.

9
Endometrial arterioles are:

Spiral arterioles .which supply the superficial endometrium.

Basal arterioles, which supply the basal endometrium.

10
Phases:

a. Proliferative phase :

Start just after the menstruation.

End with ovulation.
Duration: is variable (in 28 day cycle it is 9 – 11 days)
It is regulated by estrogen secreted by follicles
The thickness of endometrium before the ovulation is 3 -6 mm
The gland are straight & tubular.
Stromal cells increase in size and number.
Vascularity increase gradually.

B. secretory phase:

Start with ovulation.

End with onset of menstruation.
Duration fixed 14 days.
It is regulated by progesterone aided by estrogen.
Endometrial thickness is 6 - 12 mm.
The gland are tortuous with secretions rich in glycogen&mucin.
The first sign of ovulation in the endometrium is a sub nuclear
vacuole.
The stroma is edematous .lecucocytic infiltration occurs just
before menstruation.
Vascularity increase.

11
 Proliferative phase luteal phase
Start just after menses with ovulation.
End with ovulation with Menes
Duration variable 9- 11days fixed 14 days.
Control estrogen from follicle progesterone from corpus luteu
Thickness 3 -6 mm 6 – 12 mm
Gland straight&tubular tortuous rich in glycogen
Stroma cell↑∈number∧¿ ¿
Vascularity increase gradually increase markedly.

Menstrual phase:

Menstruation: is cyclic shedding of secretory endometrium

associated by blood loss.
Normal menses;
Duration 3 -7 days.
Inter menstrual period the average 4 weeks (28 days)
Amount is 35 -80 ml.
The menstrual blood clots in the uterus but later the clot dissolve
by fibrinolysins released from necrotic endometrium.
Presence of clots mean excessive cycle.
Odour: offensive.
Content : R.B.C & W.B.C &NECROTIC endometrium &cervical
mucus and vaginal discharge.

12
 Mechanism of menstruation:
Degeneration of corpus luteum leads to estrogen& progesterone
withdrawal so the endometrium shrinks.
The spiral arterioles are shortened by increasing their coils
causing stasis.
This causes ischemic necrosis of the superficial layer of
endometrium.

Control of menstrual blood:

Necrotic endometrium releases prostaglandin F2α leading to
vasoconstriction &myometrial contraction.
Hemostasis.
Regeneration of the endometrium from the basal layer.

OTHER CYCLIC CHANGES:

A. Cervical mucus :

Follicular phase luteal phase

(Due to estrogen) (Due progesterone)
Volume profuse scanty.
Viscosity ↓thin ↑viscid.

Ferning present absent.

Spinnbarkiet thread 7 -10 cm thread 3 – 4 cm
Cells ↓ ↑ (leucocyte)

Ferning → cervical mucusif ¿ dry on slide arborization occur due ¿ dryingof ss

13
Of sodium &chloride is present in mucus.

Spinnbarkiet test is +ve when cervical mucus can be drawn

between two slide up 10 cm in length due to high mucus content.

Vaginal cytology:
The vaginal epithelium is compose of:
Basal layer.
Intermediate.
Superficial cell (mature)

Follicular phase luteal phase

((E)) ((P))
Shedding of superficial cells shedding of intermediate cells
Showing: showing:
Pyknotic nucleus vesicular nucleus
Eosinophilic cytoplasm basophilic cytoplasm.

14
15
16
17