MENSTRUATION
and is responsible for maturation of the ovum
MENSTRUATION:
◦ monthly discharge of blood from the uterus
occurring from puberty to menopause wherein
about 30-60 cc of blood, epithelial cells and mucus
are being discharged
◦ The purpose of a menstrual cycle is to bring an
ovum to maturity and renew a uterine tissue bed
that will be responsible for the ova’s growth should
it be fertilized. It is the process that allows for
conception and implantation of a new life.
◦ The length of menstrual cycles differs from
woman to woman, but the average length is 28 days
(from the beginning of one menstrual flow to the
beginning of the next).
◦ It is not unusual for cycles to be as short as 23
days or as long as 35 days. The length of the average
menstrual flow (termed menses) is 4 to 6 days,
although women may have periods as short as 2
days or as long as 7 days
Physiology of Menstruation
- Four body structures are involved in the
physiology of the menstrual cycle: the
hypothalamus, the pituitary gland, the ovaries, and
the uterus.
1. Hypothalamus
◦ The release of GnRH (also called luteinizing
hormone–releasing hormone, or LHRH) by the
hypothalamus initiates the menstrual cycle.
◦ GnRH is transmitted from the hypothalamus to
the anterior pituitary gland and signals the gland to
begin producing the gonadotropic hormones FSH
and LH. Because production of GnRH is cyclic,
menstrual periods also cycle.
2. Pituitary Gland
◦ Under the influence of GnRH, the anterior lobe
of the pituitary gland (the adenohypophysis)
produces two hormones that act on the ovaries to
further influence the menstrual cycle:
◦ FSH, a hormone that is active early in the cycle
◦ LH, a hormone that becomes most active at the
midpoint of the cycle and is responsible for
ovulation, or release of the mature egg cell from the
ovary, and growth of the uterine lining during the
second half of the menstrual cycle.
3. Ovary
◦ As it grows, its cells produce a clear fluid
(follicular fluid) that contains a high degree of
estrogen (mainly estradiol) and some progesterone.
At this stage of maturation, the small ovum (barely
visible to the naked eye, approximately the size of a
printed period), with its surrounding follicle
membrane and fluid, is termed a graafian follicle.
◦ After an upsurge of LH from the pituitary,
prostaglandins are released and the graafian follicle
ruptures. The ovum is set free from the surface of
the ovary, a process termed ovulation. It is swept
into the open end of a fallopian tube
4. Uterus
- also illustrates uterine changes that occur
monthly as a result of stimulation from the
hormones produced by the ovaries.
Effects of Estrogen to the body:
▪ Inhibits production of FSH
▪ Causes hypertrophy and hyperplasia of
myometrium
▪ Stimulates the growth of ductile structures of
the breast
▪ Increases quantity and pH of cervical mucus
causing it to become watery and can be to a
distance of 10-13 cm. (Spinnbarkeit test of dilation).
Effects of progesterone in the body:
▪ Inhibits production of LH.
▪ Facilitates transport of fertilized ovum through
the fallopian tubes.
▪ Causes fluid retention
▪ Decreased hemoglobin and hematocrit levels
▪ Increased basal body temperature after
ovulation because of the presence of progesterone.
THE MENSTRUAL CYCLE:
1. On the third day of the menstrual cycle, serum
estrogen level is at lowest which stimulates the
hypothalamus to produce follicle stimulating
hormone releasing factor (FSHRF).
2. FSHRF is responsible for stimulating the anterior
pituitary gland (APG) to produce the FSH which will
act on one immature oocyte inside. a primordial
follicle, stimulating its growth.
3. In view of the FSH, estrogen is now going to be
produced in an increasing amount inside the follicle,
which is found in the ovary. Once estrogen is
present, the primordial follicle is now termed
Graafian follicle. The GF is the structure therefore
that contains high amounts of estrogen.
4. Estrogen in the GF will cause the cells in the
uterus to proliferate (grow rapidly); increasing its
thickness to about eight-fold. This is called
Proliferative/follicular phase.
5. On the 13th day of menstrual cycle, there is now
a very low level of progesterone in the blood. This
stimulates the hypothalamus to produce Luteinizing
Hormone releasing factor (LHRF).
6. LHRF is responsible for stimulating the APG to
produce LH.
7. The LH in turn, is responsible for stimulating the
ovary to produce progesterone. The increased
amounts of both estrogen and progesterone push
the new mature ovum to the surface of the ovary
until the following day (14th) the GF ruptures and
releases the mature ovum.
8. Once ovulation has taken place, the GF which
contains increased amount of progesterone will
turn to Corpus Luteum which is yellow appearance.
9. Progesterone causes the gland of the uterine
endothelium to become corkscrew or twisted in
appearance. This is the hormone of pregnancy
because it prevents uterine contractions. Once the
fertilized ovum developed finger-like projections
called TROPHOBLAST around the blastocyst, the
trophoblasts are the ones that will implant high on
the anterior or posterior surface of the uterus.
FERTILIZATION: THE BEGINNING OF PREGNANCY
◦ Fertilization (also referred to as conception and
impregnation) is the union of an ovum and a
spermatozoon. This usually occurs in the outer third
of a fallopian tube, the ampullar portion
(Crombleholme, 2009).
◦ Usually only one of a woman’s ova will reach
maturity each month. Once the mature ovum is
released, fertilization must occur fairly quickly
because an ovum is capable of fertilization for only
24 hours (48 hours at the most).
◦ After that time, it atrophies and becomes
nonfunctional. Because the functional life of a
spermatozoon is also about 48 hours, possibly as
long as 72 hours, the total critical time span during
which sexual relations must occur for fertilization to
be successful is about 72 hours (48 hours before
ovulation plus 24 hours afterward).
◦ The ovum and these surrounding cells (which
increase the bulk of the ovum and serve as
protective buffers against injury) are propelled into
a nearby fallopian tube by currents initiated by the
fimbriae—the fine, hair like structures that line the
openings of the fallopian tubes. A combination of
peristaltic action of the tube and movements of the
tube cilia help propel the ovum along the length of
the tube.
◦ At the time of ovulation, there is a reduction in
the viscosity (thickness) of the cervical mucus, which
makes it easy for spermatozoa to penetrate it.
Sperm transport is so efficient close to ovulation
that spermatozoa deposited in the vagina generally
reach the cervix within 90 seconds and the outer
end of a fallopian tube within 5 minutes after
deposition.
◦ Spermatozoa move through the cervix and the
body of the uterus and into the fallopian tubes,
toward the waiting ovum by the combination of
movement by their flagella (tails) and uterine
contractions.
◦ Capacitation is a final process that sperm must
undergo to be ready for fertilization. This process,
which happens as the sperm move toward the
ovum, consists of changes in the plasma membrane
of the sperm head, which reveal the sperm-binding
receptor sites.
◦ Hyaluronidase (a proteolytic enzyme) is released
by the spermatozoa and dissolves the layer of cells
protecting the ovum. One reason that an ejaculation
contains such a large number of sperms is probably
to provide sufficient enzymes to dissolve the corona
cells. Under ordinary circumstances, only one
spermatozoon is able to penetrate the cell
membrane of the ovum. Once it penetrates the cell,
the cell membrane changes composition to become
impervious to other spermatozoa.
 ◦ Immediately after penetration of the ovum, the
chromosomal material of the ovum and
spermatozoon fuse to form a zygote.
◦ Because the spermatozoon and ovum each
carried 23 chromosomes (22 autosomes and 1 sex
chromosome), the fertilized ovum has 46
chromosomes.
◦ If an X-carrying spermatozoon entered the ovum,
the resulting child will have two X chromosomes and
will be female (XX).
◦ If a Y-carrying spermatozoon fertilized the ovum,
the resulting child will have an X and a Y
chromosome and will be male (XY).
IMPLANTATION
◦ Once fertilization is complete, a zygote migrates
over the next 3 to 4 days toward the body of the
uterus, aided by the currents initiated by the
muscular contractions of the fallopian tubes. During
this time, mitotic cell division, or cleavage, begins.
◦ The first cleavage occurs at about 24 hours;
cleavage divisions continue to occur at a rate of
about one every 22 hours. By the time the zygote
reaches the body of the uterus, it consists of 16 to
50 cells. At this stage, because of its bumpy outward
appearance, it is termed a morula (from the Latin
word morus, meaning “mulberry”).
communication network with the blood system of
the endometrium.
The following method will help you find out your
fertile window.
1. For 8 to 12 months, record the day you start your
menstrual period and count the total number of
days in that cycle. Note that the first full flow day of
your menstrual period is day one.
2. Then write down the longest and shortest
number of days from your monthly tracking.
3. Find out the first day of your fertile window by
subtracting 18 days from the length of your shortest
cycle. For example, if your shortest cycle was 27
days, subtract 18 from 27, and write down day 9.
4. Find out the last day of your fertile window by
subtracting 11 from your length of the longest cycle.
For example, if it was 30 days, you’d get day 19.
5. The time between the shortest and longest day is
your fertile window. In the above example, it would
be between days 9 and 19. If you’re trying to avoid
pregnancy, you’d want to avoid having unprotected
sex during those days.

◦ Large cells tend to collect at the periphery of the

ball, leaving a fluid space surrounding an inner cell
mass. At this stage, the structure becomes a
blastocyst. It is this structure that attaches to the
uterine endometrium. The cells in the outer ring are
trophoblast cells.
◦ Implantation, or contact between the growing
structure and the uterine endometrium, occurs
approximately 8 to 10 days after fertilization.
◦ The structure brushes against the rich uterine
endometrium (in the second [secretory] phase of
the menstrual cycle), a process termed apposition.
It attaches to the surface of the endometrium
(adhesion) and settles down into its soft folds
(invasion).
◦ The blastocyst is able to invade the endometrium
because, as the trophoblast cells on the outside of
the structure touch the endometrium, they produce
proteolytic enzymes that dissolve any tissue they
touch. This action allows the blastocyst to burrow
deeply into the endometrium and receive some
basic nourishment of glycogen and mucoprotein
from the endometrial glands. As invasion continues,
the structure establishes an effective