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BASIC MECHANISM OF

MENSTRUATION
Sri Kadarsih Soejono
Bagian Ilmu Faal Fakultas
Kedokteran
A menstrual cycle is a repetitive
phenomenon occurring in non-pregnant
women during their reproductive life

and

Involves a patterned sequence of


structural and functional changes in the
reproductive system
The menstrual period is in reality
determined by hypothalamic mechanisms
that regulate pituitary gonadotropin
secretion

which, in turn,

control ovarium hormones release,


ovulation, and menstruation
Menstrual cycle
 Is not menstruation
 Divided into 3 cycle :
– Endometrial
– Ovarian
– Cervical
The female life span can be divided into 3
periods that are a reflection of
development: pre-pubertal (infancy and
childhood), reproductive (aldolescence),
and post-menopausal years.

The onset of menses signals (menarche),


the start of reproductive life, and the
cessation of menses is the start of
menopause period
The morphology of the endometrium
directly correlated with coincident changes
in the ovary
The ovarian hormones (estrogen and
progesterone) control the differentiation,
the function, and the development of the
endometrium
Under the influence of estrogen that
produced by the development follicle, the
endometrium increases rapidly in
thickness from the 5th to the 14th days of
the menstrual cycle. This part of the
menstrual cycle is called the proliferative
phase
After ovulation, the endometrium becomes
more highly vascularized and slightly
edematous under the influence of
estrogen and progesterone from the
corpus luteum.

The endometrium glands become coiled


and they begin to secrete clear fluid. This
phase in the cycle is called the secretory
phase
The endometrium is supplied by two
types of arteries:

1. the superficial two third of the endometrium


that is shed during the menstruation
(stratum functional) is supplied by long
coiled spiral arteries
2. the deep layer that is not shed during the
menstruation (stratum basal), is supplied by
short straight basilar arteries
Due to the edematous in the endometrium
and vasospasm of the arteries (locally
release of prostaglandin), leads
endometrium necroses

and

when the corpus luteum regresses,


hormones support for endometrium is
withdrawn and leading to spotting
hemorrhage and become menstrual flow
The length of the secretory phase is
constant at about 14 days (the life span of
corpus luteum).
Menstrual blood is predominantly arterial
and in small amount the blood being of
venous origin.

It contains tissue debris, prostaglandins,


and relatively large amount of fibrinolysin
from endometrium tissue
 Two phases of endometrial cycle :
– Proliferative
– Secretion

 Two phases of ovarian cycle :


– Follicular
– Luteal
 Ovulation is the occurrence in the
menstrual cycle by which a selected
mature
 follicle breaks and releases a viable oocyte
from the ovary.
 This fact enables the egg to be fertilized
by the male sperm cells.
 Each month, one egg is released in
humans; but occasionally, two or more
can erupt during the menstrual cycle.
 In women with regular menstrual cycles,
the ovulation takes place
 approximately two weeks after
menstruation.
 If pregnancy does not occur, the
menstruation appears exactly two weeks
 later.
 Following ovulation, increasing concentrations of
progesterone slow
 down the frequency of LH releasing pulses.
Concentrations of LH once
 again drop to baseline levels.
 The corpus luteum maintains itself for 14
days,possessing a
 considerable intrinsic capacity of self-regulation
 The pre-ovulatory LH surge has a number
of key functions:
– It triggers ovulation and follicular rupture
about 36 hours after the surge,
– and is responsible for the disruption of the
cumulus-oocyte complex.
– Furthermore, it induces the resumption of
oocyte meiotic maturation
– and the luteinization of granulosa cells
 In the antral follicle, LH receptors are only
present in the theca layer
 while the granulosa layer only expresses FSH
receptors. Later on, due to tonic FSH
stimulation, LH and aromatase receptors appear
also on the granulosa cells in the preovulatory
follicle.
 As a consequence, FSH and LH synergize their
action for estradiol synthesis and therefore
oocyte maturation