MENSTRUAL CYCLE

NCM 107
 The Menstrual Cycle
Stages /Phases
A. MENSTRUAL PHASE or
menstruation/ BLEEDING
PHASE (days 1 to 4) may last
for 3 to 5 days; the terminal
phase of the menstrual cycle.

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1. Characterized by vaginal
bleeding as the uterine
endometrium is shed down to the
basal layer along with blood from
the capillaries and with the
unfertilized ovum.
2. MENSTRUATION is periodic
discharge of blood, mucus and
cellular debris from the uterine
mucosa and occurs at regular,
cyclic and predictable intervals
from menarche to menopause.
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3. The menstrual period is the
woman’s period of absolute
infertility.

4. Menarche is the 1st menstruation;

occurs between 12 to 13 years;
usually anovulatory, infertile and
irregular.

5. Duration of menstruation: variable

with usual duration of 3 to 5 days or
up to 4 to 6 days.
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6. Amount: 25 to 60 ml equivalent to
about 0.4 – 1.0 mg of iron loss for
every day of cycle.

7. Menstrual blood is incoagulable

because the blood, coagulated as it
is shed, is promptly liquefied by
fibrinolytic activity.

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B. FOLLICULAR OR PROLIFERATIVE PHASE (days 5 to
14 ending in ovulation; lasts about 9 days).

1. Regenerative Phase is the first few days of the reformation

of the endometrium.

2. Under the control of ESTROGEN (principally

ESTRADIOL) there is regrowth and
thickening/proliferation of the endometrium up to 8 to 10
fold. Proliferative changes level off at ovulation.

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 3. At the completion of the proliferative phase, the
endometrium consists of 3 layers:
a. Basal layer: 1 mm thick, lowest most layer lying
immediately above the myometrium; contains all the
necessary rudimentary structures for building up new
endometrium; never alters during the menstrual cycle.
b. Functional Layer: 2.5 mm thick; middle layer, contains
tubular glands; constantly CHANGES according to the
hormonal influences of the ovary.
c. Cuboidal ciliated epithelium layer; upper most layer;
covers the functional layer; dips down to the tubular glands

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 OVULATION
• Present in the middle of the cycle;
monthly growth and release of a
mature, non-fertilized ovum from the
ovary
• Usually happens in the middle of the
menstrual cycle; 13 to 15 days or an
average of 14 days prior to the next
menstruation in regular cycles.
• Estrogen is high while progesterone is
low.
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• OVULATION SIGNS
Breast tenderness
Slight rise in BBT ( 0.4 to 0.8 ˚F)
during ovulation which is preceded
by a slight drop (0.2˚F) 24 to 36
hour before. The most fertile time
is 3 to 4 days before ovulation and
1 to 2 days after.
Positive Spinnbarkeit test (with
stretchable mucus)

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• Mittelschmerz (left or right lower
quadrant pain corresponding to the
rupture of the Graafian follicle)
• Positive Ferning test

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 C. LUTEAL OR
SECRETORY PHASE
 (15 to 28 DAYS; Lasts about 12
days)
1. Initiated by ovulation in response to
a surge in LH that promotes the
development of CORPUS
LUTEUM from the ruptured
follicle, the yellow body that
secretes high level of progesterone
and estrogen.
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2. Progesterone stimulates the already
proliferated endometrium causing
functional layer to become thicker
(3.5 mm thick), more spongy, softer
with glands becoming mor tortuous
as the endometrial capillaries get
distended with blood in preparation
for reception/implantation and
nourishment of the fertilized ovum.

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 a. If fertilization occurs, implantation follows 6
to 9 days or 7 to 10 days (average of 7 days)
after fertilization. The corpus luteum lives
longer and secretes progesterone and estrogen
in early pregnancy later replaced by
placenta.
b. The usual life span of corpus luteum is 2
weeks or 10 to 14 days.
c. If fertilization does not occur, the yellow body
corpus luteum functions only for about 7 to 8
days after ovulation then involutes to become
a white body, the corpus albicans which
persists up to 10 to 12 days after ovulation.
This causes a drop in levels of estrogen and
progesterone causing endometrial ischemic or
premenstrual phase.
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 Reference Book:
Maternal and Newborn Care
Rosalinda Parado Salustiano RN, RM, MAN
PhD

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thank you!