MENSES

Dr Sankalpa Wankhede
 DEFINITION

“IN THE ABSENCE OF IMPLANTATION,

GLANDULAR SECRETION CEASES
AND AN IRREGULAR BREAKDOWN OF
THE DECIDUA FUNCTIONALIS
OCCURS. THE RESULTANT SHEDDING
OF THIS LAYER OF THE
ENDOMETRIUM IS TERMED MENSES.”
 INTRODUCTION
• DESTRUCTION OF CORPUS LETEUM AND
PRODUCTION OF ESTROGEN AND
PROGESTRONE

• ENDOMETRIAL ISCHEMIA

• BREAKDOWN OF LYSOSOMES AND RELEASE

OF PROTOLYTIC ENZYMES

•PROSTAGLANDIUS HIGHEST DURING

MENSES
 INTRODUCTION

• PROSTAGLANDIUS IS A POTENT
VASOCONSTRICTOR

• PGF2α HELPS SLOUGHING ENDOMETRIAL

TISSUES
 OVARIAN FOLLICULAR
DEVELOPMENT
• OOCYTES PEAKS IN THE FETUS AT 6-7 MILLION
BY 20 WEEKS OF GESTATION

• ATRESIA OF OOGONIA OCCURS RAPIDLY

FOLLOWED BY FOLLICULAR ATRESIA

• AT BIRTH, ONLY 1-2 MILLION OOCYTES REMAIN

• AT PUBERTY ONLY 300,000

• 400-500 WILL BE RELEASED DURING OVULATION

 OVARIAN FOLLICULAR
DEVELOPMENT
• DURING MENOPAUSE- OVARY CONSIST OF
DENSE STROMAL TISSUE WITH
INTERSPERESED OOCYTES REMAINING

• MAMMALIAN FEMALES- NO CAPACITY FOR

OOCYTE PRODUCTION POSTNATALLY

• DIPLOTENE RESTING STAGE

• STUDIES INTO PRODUCTION OF OOCYTES

 MEIOSIS

PROPHASE METAPHASE ANAPHASE TELOPHASE

LEPTOTENE ZYGOTENE PATCHYTENE DIPLOTENE DISKENESIS

 MEIOTIC ARREST OF OOCYTE AND
RESUMPTION
• DEVELOPING OOGNIA ENTER MEIOTIC
PROPHASE-I , KNOWN AS PRIMARY OOCYTE

• 8 WEEKS OF GESTATION

• OOGNIA ENTERED MEIOSIS- SURVIVES

ATRESIA

• OOCYTES ARRESTED IN PROPHASE WILL

REMAIN TILL OVULATION

• OOCYTE MATURATION INHIBITOR (OMI)

 FOLLICULAR DEVELOPMENT
• DYNAMIC PROCESS- CONTINUES FROM
MENARCHE UNTIL MENOPAUSE

•MONTHLY RECRUITMENT OF A COHORT OF

FOLLICLES

•RELEASE A SINGLE AND MATURE DOMINANT

FOLLICLE DURING OVULATION
FOLLICULAR DEVELOPMENT

PRIMORDIAL FOLLICLES

PREANTRAL FOLLICLES
 PRIMORDIAL FOLLICLE
• INITIAL RECRUITMENT & GROWTH –
GOMADOTROPIN INDEPENDENT AND AFFECTS
A COHORT

•FSH ASSUMES CONTROL SHORTLY AFTER

INITIAL RECRUITMENT

•FOLLICULAR DIFFERENTIATION & GROWTH

CONTINUES

•SHIFT FROM GONADOTROPIN – INDEPENDENT

TO GONADOTROPIN -DEPENDENT
 PRIMORDIAL FOLLICLE
• GROWTH OF OOCYTE AND EXPANSION OF
SINGLE LAYER TO MULTI LAYER CUBOIDAL
CELLS

• DECLINE IN LUTEAL PHASE ESTROGEN,

PROGESTRONE AND INHIBIN-A

• INC IN FSH, STIMULATES FOLLICULAR

GROWTH
 PREANTRAL FOLLICLE
• GROWTH OF FOLLICLES- DRIVEN BY FSH

• ENLARGING OOCYTE SECRETES –

GLYCOPROTEIN RICH SUBSTANCE, ZONA
PELLUCIDA

• MITOTIC PROLIFERATION CONTINUES

• THECA CELLS IN THE STROMA PROLIFERATION

•ESTROGEN PRODUCED

•SELECTED FOR DOMINANCE OR UNDERGO

ATRESIA
TWO CELL, TWO-GANODOTROPIN
THEORY
 PREOVULATORY FOLLICLE
• CHARACTERIZED BY A FLUID FILLED ANTRUM
THAT IS COMPOSED OF PLASMA WITH GRANULOSA
CELL SECRETIONS

•HETEROGENEOUS POPULATION

•OOCYTE CONNECTED TO FOLLICLE BY CUMULUS

OOPHORUS

• RISING ESTROGEN LEVELS HAVE A NEGATIVE

FEEDBACK EFFECT ON FSH SECRETION

• LH UNDERGOES BIPHASIC REGULATION

 PREOVULATORY FOLLICLE
• LOWER CONCENTRATION, ESTROGEN INHIBITS
LH SECRETION

• AT HIGHER LEVELS, ESTROGEN ENHANCES LH

RELEASE

• EXPOSURE TO HIGH LEVEL OF LH

• LUTEINIZATION OF GRANULOSA CELLS
• PRODUCTION OF PROGESTRONE
• INITIATION OF OVULATION

•SEX STEROIDS REGULATES FOLLICULAR

DEVELOPMENT
 PEPTIDE
INHIBIN PEPTIDE

INHIBIN-A INHIBIN-B

• INHIBITS FSH SYNTHESIS AND RELEASE

• ACTIVE PEPTIDE
• STIMULATES FSH RELEASE AND POTENTIATES
ITS ACTION IN OVARY
 OVULATION

• INCREASE IN LOCAL CONCENTRATION OF

PROSTAGLANDIUS AND PROTEOLYTIC ENZYMES

•WEAKER FOLLICULAR WALL

• SLOW EXTRUSION OF OOCYTES THROUGH THE

OPENING

• NOT AN EXPLOSIVE EVENT

 LUTEAL PHASE

STRUCTURE OF CORPUS LUTEUM

• FOLLICULAR SHELL TRANSFORMED INTO THE

CORPUS LUTEUM

• CELLS PRODUCE PROGESTRONE AND

SUPPORTS ENDOMETRIUM OF THE LUTEAL PHASE

•IN ADDITION, ESTROGEN AND INIHIBIN-A

PRODUCED

•MEMBRANE OF CORPUS LUTEUM DEGENERATES

 LUTEAL PHASE

HORMONAL FUNCTION & REGULATION

• REGRESSION OF CORPUS LUTEUM

• CORPUS LUTEUM STEROIDS CAUSE DECREASE
IN FSH & LH SECRETION

•CONTINUED CORPUS LUTEUM FUNCTION

DEPENDS ON CONTINUED LH PRODUCTION

•IF PREGNANCY OCCUR, PLACENTAL hCG WILL

MIMIC LH ACTION & STIMULATE THE CORPUS
LUTEUM TO SECRETE PROGESTRONE
CONCLUSION