MENSTRUAL CYCLE

Learning Objectives

At the end of the tutorial, the student

should be able to :
Define menstrual cycle.

Tell us the duration of menstrual cycle.

Describe the physiologic changes that occur in the

female reproductive organs during the menstrual cycle.

Explain the regulation of menstrual cycle.

Express the applied physiology.

Menstrual Cycle
Definition:
Periodic vaginal bleeding that occurs with the
shedding of the uterine mucosa (menstruation).
 Menstruation
Indicate periodic shedding of the stratum
functionale of the endometrium, which becomes
thickened prior to menstruation under the
stimulation of ovarian steroid hormones.

A : Functional Layer.
B: Basal layer.
Duration of the cycle
Variable,
an average figure is
28 days from the start
of one menstrual
period to the start of
the next.
First day of
menstruation day
one of the cycle.
 Timing events in the menstrual cycle.
1. Onset of menstruation

Day 1 Day 1

0 4 8 12 16 20 24 28
Menstruation
 Phases of the menstrual Cycle
Changes in ovary :

THE FOLLICULAR PHASE:

From first day of menstruation until day of ovulation.
LUTEAL PHASE:
After ovulation is luteal phase until first day of menstruation
 Phases of the menstrual Cycle
Changes in the endometrium:
Menstrual ,
Proliferative and
Secretory Phase.
 Ovarian Cycle
Follicular Phase ( Day 1 to
Day 13 ):

Menstruation lasts from 1 to

day 4 or 5 of the average
cycle.
Secretion of Ovarian steroid
hormones are at their lowest.
Ovaries contain only primary
follicles.
 Ovarian Cycle
Follicular Phase ( Day 1 to Day 13 ):
Some primary follicles grow, and become secondary follicles.
Towards the end , one follicle in one ovary reaches maturity and reaches
graffian follicle.
As follicles grow, the granulosa cells secrete estradiol ( the principal estrogen),
which reaches its highest concentration in the blood at about day 12 of the
cycle, 2 days before ovulation.
 :Growth of follicles

Antral follicle Graafian

follicle

Primordial
follicle

Oocyte Antrum
Ovulation
fluid filled)
Granulos (space
a cells Thecal
cells
 Ovarian Cycle
Follicular Phase ( Day 1 to Day 13 ):
Growth of follicles and secretion of estradiol
are stimulated by FSH.
FSH in early follicular phase is slightly greater
then in late follicular phase.
Towards the end , FSH and estradiol also
stimulate the production of LH receptors in the
graffian follicle.
Graafian follicle is prepared for the next major
event.
 Key events in the ovarian
cycle
Ovulation. 2

Follicular. 1 Luteal. 3
Day 1 growth function
Lute
regres

0 4 8 12 16 20 24 28

Menstruation Progesterone
Oestradiol
)and oestradiol(
OVULATION
LH Surge
Begins about 24 hours before ovulation.
Reaches its peak 16 hours before ovulation.
LH surge acts to trigger ovulation.
Positive feedback effect of estradiol on the pituitary , an
increase in LH secretion in late follicular phase culminates
in an LH s.
 Timing events in the menstrual cycle.
2. LH surge
LH
Days before Days after

Day 1 Day 1
Follicular Luteal
phase phase

0 4 8 12 16 20 24 28

Menstruation
OVULATION
 Ovulation
LH Surge causes graafian follicle to rupture at about
day 14.
Secondary oocyte arrested at metaphase II of meiosis ,
is released from ovary into the uterine tube.
Ovulation occurs.
Luteal phase
After Ovulation, the empty
follicle is stimulated by LH
to become corpus luteum.
Corpus luteum secretes
both estradiol an
progesterone.
Progesterone levels in the
blood are negligible before
ovulation but rise rapidly to
a peak level during the
luteal phase, approximately
one week after ovulation.
Luteal phase
Progesterone with estradiol
during the luteal phase exert an
inhibitory, or negative feedback
effect on FSH n LH secretion.
Corpus luteum produces inhibin
which may help to suppress FSH
secretion.
This retards the development of
new follicles.
Further ovulation does not occur.
Multiple ovulations and possible
pregnancies on succeeding days
of cycle are prevented.
 Luteal phase
New follicles develop towards the end
of one cycle in preparation for the
next.

Inhibin production is decreased at the

end of luteal phase.

Estrogen and progesterone levels also

fall during the late luteal phase
( starting about day 22) because
corpus luteum regresses and stops
functioning.

With the declining function of corpus

luteum, esterogen and progesterone
fall to very low levels by day 28 of the
cycle.
Luteal phase

WITHDRAWL OF OVARIAN STEROIDS

CAUSES MENSTRUATION AND
PERMETS A NEW CYCLE OF FOLLICLE
DEVELOPMENT TO PROGRESS.
 Cyclic changes in the Endometrium

Development of the endometrium is timed by the cyclic

changes in the secretion of estradiol and progesterone
from the ovarian follicles.
Three phases can be identified:
The proliferative phase.
The secretory phase.
The menstrual phase.
The proliferative Phase
occurs while the ovary is in follicular phase.
Increasing amounts of estradiol stimulate
proliferation of stratum functionale of the
endometrium.
Spiral arteries develop in the endometrium.
Estradiol stimulates the production of
receptor proteins for progesterone at this
time, in preparation for the next phase of the
cycle.
The secretory phase
Occurs when ovary is in its luteal phase.
Increased progesterone secretion
stimulates the development of uterine
glands.
Endometrium becomes thick, vascular and
spongy in appearance.
Uterine glands becomes engorged with
glycogen during the phase following
ovulation.
Endometrium is well prepared to accept
and nourish an embryo
 Uterine changes in the menstrual
cycle.
Endometria
l depth More secretion from
the glands hence
Oestradiol
the term secretory
causes an
phase
increase in
thickness (the
proliferative
phase)

0 4 8 12 16 20 24 28

Menstruation OVULATION
The menstrual Phase
Occurs as a result of fall in ovarian
hormone secretion during the late luteal
phase .
Necrosis and sloughing of the stratum
functionale may be produced by
constriction of spiral arteries.
It seems spiral arteries are responsible for
menstrual bleeding.
 Terminal differentiation of
stromal cells
decidualisation
Characteristic spiral arteries

0 4 8 12 16 20 24 28
Optimal time for
Menstruation implantation
Cyclic changes in the female
reproductive tract

High levels of estradiol secretion cause

cornification of vaginal epithelium. ( the
upper cells die and become filled with
keratin.
During luteal phase, high levels of
progesterone cause the cervical mucus to
thicken and become sticky after ovulation
has occured.
 CLINICAL
ABNORMAL MENSTRUATION :
Most common disorders of female
reproductive tract.

Amenorrhea: Absence of Menstruation.

Dysmenorrhea : Painful menstruation
which may be marked by severe
cramping.
Menorhagia: Excessively profuse or
prolonged bleeding.
References
Human Physiology.
Stuart Ira Fox. Seventh Edition.

Human Phsiology.
Lauralee Sherwood. From Cells to Systems.
Fifth Edition.
Hormone involve in
Pregnancy and Parturition

Research/Teaching
Associate
Normal Pregnancy
Pregnancy
The course that the embryo and the fetus
grow in the maternal body
Stages of pregnancy
1. Early pregnancy: 12 weeks
2. Mid pregnancy: 13 weeks,27 weeks
3. Late pregnancy:28 weeks
4. Term pregnancy:37 weeks,<42 weeks
 Human Chorionic Gonadotropin Functions

Prevents degeneration of corpus luteum

Stimulates corpus luteum to secrete E + P
which, in turn, stimulate continual growth of
endometrium.
hCG stimulates leydig cells of male fetus to
produce testosterone in conjunction with
fetal pituitary gonadotrophins.Thus indirectly
involved in development of external
genitalia.
Suppresses maternal immune function &
reduces possibility of fetus immunorejection
Stimulates maternal thyroid gland and
development of fetal adrenal glands.
 Human Chorionic
HCG
Gonadotropin
prevent involution of CL
(pregesterone, estrogen)
effect on the testes of
male fetus -
development of sex
Human
organs Chorionic
HCS Somatomammotropin
effect on latation
(HPL) ?
growth hormone effects
decreases insulin
sensitivity - more
glucose for the fetus
 Estrogen (E)
FORMS-estriol,estradiol &estrone .
Estriol most important .
Levels increase throughout pregnancy
90% produced by placenta.
(syncytiotrophoblast)
Placental production is transferred to both
maternal and fetal compartments
 Main effects are:
Stimulate growth of the myometrium
and antagonize the myometrial-
suppressing activity of progesterone. In
many species, the high levels of estrogen
in late gestation induces myometrial
oxytocin receptors, thereby preparing the
uterus for parturition.
Stimulate mammary gland
development. Estrogens are one in a
battery of hormones necessary for both
ductal and alveolar growth in the
mammary gland.
Inhibition of Prolactin secretion.
 Progesterone (P)
Levels increase throughout pregnancy
80-90% is produced by placenta and
secreted to both fetus and mother
 Progestins, including progesterone, have two major
roles during pregnancy:
Support of the endometrium to provide an environment
conducive to fetal survival. If the endometrium is deprived
of progestins, the pregnancy will inevitably be terminated.
Suppression of contractility in uterine smooth
muscle, which, if unchecked, would clearly be a disaster.
This is often called the "progesterone block" on the
myometrium. Toward the end of gestation, this
myometrial-quieting effect is antagonized by rising levels
of estrogens, thereby facilitating parturition.
 Progesterone and other progestins also
potently inhibit secretion of the pituitary
gonadotropins luteinizing hormone and
follicle stimulating hormone. This effect
almost always prevents ovulation from
occurring during pregnancy

Stimulates development of alveolar

tissue of the mammary gland.
Placental
hormones: During early
pregnancy, HCG
is secreted by
the syncitial
trophoblasts.

Later, the
placenta
secretes
estradiol,
progesterone,
relaxin and
somato-
mammotropin.
Function of placental hormones:
(summary)
HCG is similar to LH and maintains the corpus
luteum in a functional state for 3-4 months.
This keeps progesterone levels high and they
maintain the functional endometrium.
Relaxin increases flexibility in the pelvic joints,
as well as suppressing release of oxytocin.
Placental progesterone keeps the uterine wall
intact.
Somatomammotropin acts like prolactin and
triggers the mammary glands to develop.
Estrogen increases the sensitivity of the
myometrium to mechanical irritation, as well as
oxytocin stimulation.
Parturition
Hormones and parturition
Stimulants Relaxants
oxytocin PGE2
PGF2 relaxin
PGE2 -adrenergic
thrombin nitric oxide
endothelin
AT II
-adrenergic
vasopressin
 Hormones and parturition

Endocrine
sex steroids, oxytocin
Paracrine
amnion-chorion-decidua-myometrium
sex steroids, oxytocin, prostaglandins, etc.
Autocrine
Parturition
Parturition Labor
Process by which a First stage
baby is born Onset of regular
uterine contraction
In mother until cervix dilates to
Estrogens overcome fetal head diameter
inhibitory influence of Second stage
progesterone From maximum
Oxytocin is released cervical dilation until
baby exits vagina
In fetus Third stage
Adrenal gland is Expulsion of placenta
enlarged prior from uterus
Parturition

Estrogen in late pregnancy:

Stimulates production of oxytocin receptors in
myometrium.
Produces receptors for prostaglandins.
Produces gap junctions between myometrium
cells in uterus.
Factors responsible for initiation of labor
are incompletely understood.
Parturition (continued)

Insert fig. 20.52

Factors Influencing Parturition
Regulators of Parturition
Parturition: The Process of Childbirth
The mechanisms signaling the onset of labor are
not clearly understood, although several theories
exist.
Potential role of progesterone?:
- decreasing progesterone prior to labor would
allow uterine contractions to occur
- however, there is no decline in progesterone
before labor in humans
- some studies suggest there is a decline in
uterine progesterone receptors, resulting in
decreased progesterone action, leading to labor
Potential Role of Oxytocin in
Parturition?
Oxytocin causes uterine contraction.
However, oxytocin levels do not increase until
after labor starts, according to more recent
studies.
Oxytocin may play a role in uterine
contraction following labor, resulting in
decreased blood loss.
Potential Role of Relaxin in Parturition?
Relaxin acts on the cervix, causing dilatation and
softening.
In some animals relaxin increases before labor
starts.
In humans, relaxin is high beginning early in
pregnancy and stays elevated until labor.
Relaxin does act to soften connective tissues,
such as the ligaments connecting the pelvic
bones, to allow increase in size of the birth canal.
Relaxin also decreases uterine contractility
during pregnancy.
Potential Role of Prostaglandins in
Parturition
Prostaglandins cause dilation and softening
of the cervix.
Prostaglandins also cause uterine
contractions.
The levels of prostaglandins increase in fetal
membranes before the onset of labor.
It is believed that some (unknown) signal
from the fetus causes increased
prostaglandin production from fetal
membranes, which then act on the uterus and
cervix to initiate labor.
Parturition (continued)

Fetal adrenal cortex:

Chain of events may be set in motion through
CRH production.
Fetal adrenal zone secretes DHEAS, which
travel from fetus and placenta.
Uterine contractions:
Oxytocin.
Prostaglandins.
Thank you for
attention