Each menstrual cycle begins on the first day
The menstrual cycle refers to the regular
changes in the activity of the ovaries and
the endometrium that make reproduction
possible.
The endometrium is the layer of tissue lining
the inside of the uterus.
This lining consists of a functional layer,
which is subject to hormonal changes and is
shed during menstruation, and a thin basal
layer which feeds the overlying functional
layer.
The menstrual cycle actually consists of two
interconnected and synchronized processes:
the ovarian cycle, which centers on the
development of the ovarian follicles and
ovulation, and the uterine or endometrial cycle,
which centers on the way in which the
functional endometrium thickens and sheds in
response to ovarian
activity.
Menarche, which refers to the onset of the
first menstrual period, usually occurs during
early adolescence as part of puberty.
Following menarche, the menstrual cycle recurs
on a monthly basis, pausing only during
pregnancy, until a person reaches menopause,
when her ovarian function declines and she
stops having menstrual periods.
The monthly menstrual cycle can vary in
duration from 20 to 35 days, with an average of
28 days.
of menstruation, and this is referred to as
day one of the cycle.
Ovulation, or the release of the oocyte from
the ovary, usually occurs 14 days before the
first day of menstruation (i.e., 14 days before
the next cycle begins).
So, for an average 28-day menstrual cycle,
this means that there are usually 14 days
leading up to ovulation (i.e., the preovulatory
phase) and 14 days following ovulation (i.e.,
the postovulatory phase).
During these two phases, the ovaries and the
endometrium each undergo their own set of
changes, which are separate but related.
As a result, each phase of the menstrual cycle
has two different names to describe these
two different parallel processes.
For the ovary, the two weeks leading up to
ovulation is called the the ovarian follicular
phase, and this corresponds to the menstrual
and proliferative phases of the endometrium.
Similarly, the two weeks following ovulation
is referred to as the ovarian luteal phase,
which also corresponds to the secretory phase
of the endometrium.
So, let’s first focus on the preovulatory
period, starting with the ovarian follicular
phase.
This phase starts on the first day of
menstruation
and represents weeks one and two of a four-
week cycle.

The whole menstrual cycle is controlled by
the hypothalamus and the pituitary gland,
which are like the masterminds of reproduction.
The hypothalamus is a part of the brain that
secretes gonadotropin-releasing hormone, or
GnRH, which causes the nearby anterior
pituitary
gland to release follicle stimulating hormone,
or FSH, and luteinizing hormone, or LH.
Before puberty, gonadotropin-releasing
hormone
is released at a steady rate, but once puberty
hits, gonadotropin-releasing hormone is
released
in pulses, sometimes more and sometimes less.
The frequency and magnitude of the
gonadotropin-releasing
hormone pulses determine how much follicle
stimulating hormone and luteinizing hormone
will be produced by the pituitary.
These pituitary hormones control the
maturation
of the ovarian follicles, each of which is
initially made up of an immature sex cell,
or primary oocyte, surrounded by layers of
theca and granulosa cells, the hormone-
secreting
cells of the ovary.
Over the course of the follicular phase, these
oocyte-containing groups of cells, or follicles,
grow and compete for a chance at ovulation.
During the first ten days, theca cells develop
receptors and bind luteinizing hormone, and
in response secrete large amounts of the
hormone androstenedione, an androgen
hormone.
Similarly, granulosa cells develop receptors
and bind follicle stimulating hormone, and
in response produce the enzyme aromatase.
Aromatase converts androstenedione from the
theca cells into 17β-estradiol, which is
a member of the estrogen family.
During days 10 through 14 of this phase,
granulosa cells also begin to develop luteinizing
hormone receptors, in addition to the follicle
stimulating hormone receptors they already
have.
As the follicles grow and estrogen is released
into the bloodstream, increased estrogen levels
act as a negative feedback signal, telling
the pituitary to secrete less follicle stimulating
hormone.
As a result of decreased follicle stimulating
hormone production, some of the developing
follicles in the ovary will stop growing,
regress and die off.
The follicle that has the most follicle stimulating
hormone receptors, however, will continue
to grow, becoming the dominant follicle that
will eventually undergo ovulation.

This dominant follicle continues to secrete
estrogen, and the rising estrogen levels make
the pituitary more responsive to the pulsatile
action of gonadotropin-releasing hormone from
the hypothalamus.
As blood estrogen levels start to steadily
climb higher and higher, the estrogen from
the dominant follicle now becomes a positive
feedback signal – that is, it makes the
pituitary secrete a whole lot of follicle
stimulating hormone and luteinizing hormone
in response to gonadotropin-releasing
hormone.
This surge of follicle stimulating hormone
and luteinizing hormone usually happens a
day or two before ovulation and is responsible
for stimulating the rupture of the ovarian
follicle and the release of the oocyte.
You can think of it this way: for most of
the follicular phase, the pituitary saves
its energy, then when it senses that the
dominant
follicle ready for release, the pituitary
uses all its energy to secrete enough follicle
stimulating hormone and luteinizing hormone
to induce ovulation.
While the ovary is busy preparing an egg for
ovulation, the uterus, meanwhile, is preparing
the endometrium for implantation and
maintenance
of pregnancy.
This process begins with the menstrual phase,
which is when the old endometrial lining,
or functional layer, from the previous cycle
is shed and eliminated through the vagina,
producing the bleeding pattern known as the
menstrual period.
The menstrual phase lasts an average of five
days and is followed by the proliferative
phase, during which high estrogen levels
stimulate thickening of the endometrium,
growth of endometrial glands, and emergence
of spiral arteries from the basal layer to feed
the growing functional endometrium.
Rising estrogen levels also help change the
consistency of the cervical mucus, making
it more hospitable to incoming sperm.
The combined effects of this spike in estrogen
on the uterus and cervix help to optimize
the chance of fertilization, which is highest
between day 11 and day 15 of an average 28-
daycycle.
Following ovulation, the remnant of the ovarian
follicle becomes the corpus luteum, which
is made up of luteinized theca and granulosa
cells, meaning that these cells have been
exposed to the high luteinizing hormone levels
that occur just before ovulation.
Luteinized theca cells keep secreting
androstenedione,
and the luteinized granulosa cells keep
converting
it to 17β-estradiol, as before.

However, luteinized granulosa cells also
respond to the low luteinizing hormone
concentrations that are present after ovulation
by increasing
the activity of cholesterol side-chain cleavage
enzyme, or P450scc for short.
This enzyme converts more cholesterol to
pregnenolone,
a progesterone precursor.
So luteinized granulosa cells secrete more
progesterone than estrogen during the luteal
phase.
Progesterone acts as a negative feedback signal
on the pituitary, decreasing release of follicle
stimulating hormone and luteinizing hormone.
At the same time, luteinized granulosa cells
begin secreting inhibin, which similarly inhibits
the pituitary gland from making follicle
stimulating
hormone.
Both of these processes result in a decline
in estrogen levels, meaning that progesterone
becomes the dominant hormone present during
this phase of the cycle.
Together with the decreased level of estrogen,
the rising progesterone level signals that
ovulation has occurred and helps make the
endometrium receptive to the implantation
of a fertilized gamete.
Under the influence of progesterone, the uterus
enters into the secretory phase of the
endometrial cycle.
During this time spiral arteries continue
to grow, and the uterine glands begin to secrete
more mucus.
After day 15 of the cycle, the optimal window
for fertilization begins to close.
The cervical mucus starts to thicken and
becomes
less hospitable to the sperm.
Over time, the corpus luteum gradually
degenerates
into the nonfunctional corpus albicans.
The corpus albicans doesn’t make hormones,
so estrogen and progesterone levels slowly
decrease.
When progesterone reaches its lowest level,
the spiral arteries collapse, and the functional
layer of the endometrium prepares to shed
through menstruation.
This shedding marks the beginning of a new
menstrual cycle and another opportunity for
fertilization.
All right, so as a quick recap - the menstrual
cycle begins on the first day of menstruation.

 For an average 28-day menstrual cycle,

the changes which occur in the ovary
during the first 14 days are called the
follicular phase.

 Ovulation usually occurs at day 14, as a

result of the estrogen-induced surge in
luteinizing hormone.

 The last 14 days of the cycle are the

luteal phase, during which
progesterone becomes the dominant
hormone.

 While the length of the follicular phase

can vary, the luteal phase almost always
precedes the onset of menses by 14
days.

 The uterus also goes through its own

set of changes.

 During the first 14 days of the cycle, the

endometrium goes through the
menstrual phase and the proliferative
phase, and during the last 14 days it
goes through the secretory phase.