The Female Sex (Menstrual)

Cycle
By Aiah Lebbie
M.B.Ch.B
 Introduction
• The menstrual cycle begins when a girl reaches the age of
puberty
• It is the reproductive cycle that produces eggs for
fertilization
• During the menstrual cycle the uterus (endometrium)
prepares itself for implantation of a fertilized egg
• if fertilization does not occur the uterine lining is shed from
the body in a process known as menstruation or a "period".
• On average the menstrual cycle lasts between 28-35 days
• Day 1 of the cycle begins on is the first day of bleeding
(bleeding can last for 3-7 days) and the cycle ends just
before the next menstrual period
• The menstrual cycle is carefully regulated by
several hormones
• Gonadotropin releasiing hormone (GnrH)
• Luteinizing Hormone (LH)
• Follicle-stimulating Hormone (FSH)
• Female sex hormones, estrogen and Progesterone
• The cycle can be divided into three phases
• follicular (before the egg is released
• ovulatory (egg is released)
• luteal (after release of the egg)
 Follicular Phase
• This phase begins on the first day of bleeding
• The key aspect of this phase is the
development of follicles in the ovaries 
• At the start of the follicular phase, the lining of
the uterus is thick with fluids and nutrients
intended to nourish an embryo (fertilised egg)
• If no embryo is present, estrogen and
progesterone levels are low
• This causes the uterus lining to shed and
menstrual bleeding occurs
• The pituitary gland increases its’ production of follicle-
stimulating hormone (FSH)
• FSH stimulates 15 to 20 primary follicles to develop in
the ovaries  
• The levels of FSH hormone decreases and the follicles
begin to secrete estrogen
• The follicle that develops first (the dominant follicle)
secretes the most amount of estrogen, and this
secretion subsequently suppresses the development
of the other follicles
• The follicular phase roughly lasts about 13 or 14 days
• The phase ends when the level of luteinizing hormone
(LH) surges dramatically.
 Ovulatory Phase
• This phase begins with the luteinizing hormone
surge (LH surge)
• The level of FSH increases to a lesser extent
• LH stimulates enzymes in the dominant follicle
and along with the increased pressure causes
the follicle to rupture and release the egg
(ovulation)
• The egg travels into the fallopian tube, ready for
fertilization
• The egg can survive for 12 to 24 hours after
ovulation
• The LH surge can be used as a measurement to
determine when a woman is fertile
• Around 12 to 24 hours after the egg is released,
the LH surge can be detected by measuring the
level of this hormone in urine
• The ovulatory phase usually lasts 16 to 32 hours
and ends when the egg is released
 Luteal Phase
• This phase begins after ovulation
• It lasts about 14 days and ends just before a
menstrual period, unless of course fertilization occurs
• In this phase the egg travels along the fallopian tube
by wave like motions caused by the finger-like
projections in the walls of the fallopian tube
• The remainder of the ruptured follicle in the ovary
closes after releasing the egg and forms a structure
called a corpus luteum
• The corpus luteum secretes large quantities of
progesterone and oestrogen and prepares the
uterus for implantation
• Progesterone causes the endometrium to
thicken, filling with fluids and nutrients to
nourish the potential embryo
• it also causes the mucus in the cervix to
thicken, so that sperm and bacteria are less
likely to enter the uterus
• Progesterone also causes body temperature to
increase slightly during the luteal phase and
remain elevated until a menstrual period begins
• This increase in temperature can be used to
estimate whether ovulation has occurred 
• LH and FSH levels fall back to low and steady
levels
• Estrogen levels fall a little after the LH/FSH
surge, but rise due to continued secretion of
oestrogen and progesterone by the corpus
luteum
• The increase in estrogen and progesterone levels causes
milk ducts in the breasts to dilate
• In turn the breasts sometimes swell and become tender
• If the egg is not fertilized, the corpus luteum shrinks
and begins to degenerate after 14 days
• the corpus luteum is designed to die after 14 days
• The unfertilized egg also dies and passes out of the
uterus with the menstrual bleeding
• Estrogen and progesterone levels fall, bleeding starts
and the uterine lining is shed
• A new menstrual cycle begins
• If the egg is fertilised the cells around the
developing embryo begin to produce a hormone
called human chorionic gonadotropin (hCG)
• This hormone rescues the corpus luteum and
allows it to continue secreting progesterone and
estrogen, until the growing fetus can produce
its’ own hormones
• Pregnancy tests are based on detecting an
increase in the human chorionic gonadotropin
level
• Controlled by hypothalamic pulse generator in
arcuate nucleus
• Pulse generator signal = Gonadotropin releasing
hormone (GnRH
• Release is pulsatile in nature, once every 75
minutes
• GnRH causes pituitary to release follicle stimulating
hormone (FSH) and luteinizing hormone (LH)
• GnRH and LH one-to-one: each pulse of GnRH
causes simultaneous pulse of LH
• FSH more complex, regulated by both GnRH and
ovarian peptide inhibin