The Normal Menstrual Cycle

With Lynae Brayboy, M.D.

Learning Objectives

• You will learn the different phases of oocyte

maturation.

• You will be able to describe the hormonal constituents

of each phase of the menstrual cycle.

• You will be able to recognize abnormal menstrual

cycles.

• You will be able to discuss the etiologies of

dysfunctional uterine bleeding.
Inspirational Quote

If sometimes you feel little useless, offended and

depressed, always remember that you were once the
fastest and most victorious sperm out of hundreds of
millions.

Anonymous
Oogenesis

1st trimester 2nd trimester Adult life

Oogonium Zygotene Pachytene First Second

polar polar
body body

Mitosis
1st 2nd
meiotic meiotic
division division

Oogonium Oogonium Leptotene Diplotene Secondary Mature

oocyte oocyte

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The Normal Menstrual Cycle

Ovulation
Follicular Luteal
900 18
800 16
700 14
600 12
500 High-yield
10
400 8
300 6
200 4
100 2
0 0
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Progesterone Estradiol LH FSH

Development of an Egg Physiology

How long does it take to make an egg?

How Long Does it Take to Make an Egg?

Jerome F. Strauss & Robert L. Barbieri, Yen & Jaffe's Reproductive Endocrinology, 7th Edition, 2014, p. 160 & p. 168, Saunders (Elsevier)
Granulosa Cell Signalling

LH receptor
LH

Ovulation!

Luteinized granulosa cell

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Granulosa Cell Signalling

Cholesterol

LH receptor
LH

cAMP Estradiol Progesterone

Luteinized granulosa cell

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Fertilization and Implantation

Ovum

Ovulation

© by Lecturio
Rogerio A. Lobo & David Gershenson & Gretchen M Lentz & Fidel A Valea, Comprehensive Gynecology, 7th Edition, 2017, p. 7, Elsevier
Fertilization and Implantation

Fertilization

Ovum

Ovulation

© by Lecturio
Rogerio A. Lobo & David Gershenson & Gretchen M Lentz & Fidel A Valea, Comprehensive Gynecology, 7th Edition, 2017, p. 7, Elsevier
Fertilization and Implantation

2 cells

Fertilization

Ovum

Ovulation

© by Lecturio
Rogerio A. Lobo & David Gershenson & Gretchen M Lentz & Fidel A Valea, Comprehensive Gynecology, 7th Edition, 2017, p. 7, Elsevier
Fertilization and Implantation

4 cells
2 cells

Fertilization

Ovum

Ovulation

© by Lecturio
Fertilization and Implantation

8 cells
4 cells
2 cells

Fertilization

Ovum

Ovulation

© by Lecturio
Rogerio A. Lobo & David Gershenson & Gretchen M Lentz & Fidel A Valea, Comprehensive Gynecology, 7th Edition, 2017, p. 7, Elsevier
Fertilization and Implantation

Morula 8 cells
4 cells
2 cells

Fertilization

Ovum

Ovulation

© by Lecturio
Fertilization and Implantation
Blastocyst
Morula 8 cells
4 cells
2 cells

Fertilization

Ovum

Ovulation

© by Lecturio
Rogerio A. Lobo & David Gershenson & Gretchen M Lentz & Fidel A Valea, Comprehensive Gynecology, 7th Edition, 2017, p. 7, Elsevier
Ovum Penetration

Tronicum, PD
Normal Fertility

LH Ovulation Fertilization isthmus- Morula in the uterus Implantation

surge ampulla junction
Cycle
days
14 15 16 17 18 19 20 21 22
Implantation

Endometrial gland
Endometrial capillary

Endometrial stroma

Endometrial epithelium
Endometrial
Inner cell mass pole

Blastocyst cavity
Trophoblast Uterine
cavity
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Implantation

Syncytiotrophoblast
Hypoblast

Cytotrophoblast

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Implantation

Syncytiotrophoblast
Cytotrophoblast
Amniotic cavity
Exocoelomic membrane Embryonic
epiblast

Embryonic hypoblast

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Implantation

Amnion
Embryonic disc
Primary yolk sac

Maternal blood
in lacunae

Extraembryonic
mesoderm
© by Lecturio
Learning Outcomes

 You learned the different phases of oocyte maturation.

 You are able to describe the hormonal constituents of

each phase of the menstrual cycle.

 You are able to recognize abnormal menstrual cycles.

 You are able to discuss the etiologies of dysfunctional

uterine bleeding.