Physiology Of The Menstrual Cycle

By Zafirah Hani Bte Ramli

2008289204
Menstrual cycle is a cycle of periodic uterine bleeding , in response to cyclic hormonal changes
that begin with the shedding of the secretory endometrium at about 14 days after ovulation.
Menstruation is the term used to indicate the periodic shedding of the stratum functionale of
the endometrium , which becomes thickened prior to menstruation under the stimulation of
ovarian steroid hormone.

• A complex interaction between the hypothalmus , anterior pituaitary and the ovaries
eventually leads to the process of the ovulation which is repeated with an average of 28
days(range25-35 days)

• The first phase: Menstruation lasts 3-5 day

Cyclic changes in the secretion of gonadotrophic hormones from the anterior pituaitary cause
the ovarian changes during a monthly cycle. The ovarian cycle is accompanied by cyclic
changes in the secretion of estradiol and progesterone, which interact with the hypothalmus
and pituaitary to regulate the gonadotrophin secretion. This cyclic changes in ovarian
hormone secretion also cause changes in the endometrium of the uterus during the
menstrual cycle
 The menstrual cycle and endometrial
changes
It is convenient to divide the cycle into phases
based on the changes that occur :
• In the ovary: 1. follicular phase
2. ovulation
3. luteal phase
• In the endometrium: 1. proliferative phase
2. secretory phase
3. menstrual phase
 Changes in the ovary
• Follicular phase(days 1-13): At the end of menstrual cycle , estrogen levels are low. Low estrogen level stimulate
production of FSH by the pituaitary. FSH in turns acts upon the ovary to stimulate growth of ovarian follices. The
increasing levels of estrogen produced by the developing follicles act on the pituaitary to reduce FSH level by the
process of negative feedback. In the majority of cycles only one follicles, the so called dominant folliclle , is
sufficiently large and has greater density of FSH receptors to respond to the lowers FSH level and develop to the
stage of ovulation.Estrogen level continue to rise and it will reaches its highest concentrations in the blood at
about day 12 of the cycle, 2 days before the ovulations .

• Ovulation phase( day 14) : In the mid-cycle the nature of the ovarian control of pituaitary function changes.
Increasing estrogen level are requires to produce a positive feedback mechanism which cause the surge in FSH
and LH levels. This surge evoke the ovulation .

• Luteal phase(days 15-28): LH acts to increase local production of prostaglandins and proteolytics enzymes to
allow oocyte extrussion . LH is responsible for the development of corpus luteum , which produce prostglandins
Corticol –
hypothalmic-
hypophyseal-ovarian
–uterine axis
 Endometrial changes
• These alterations in estrogen and progesteron level are responsible for the dramatic changes in the endometrium
troughout the ovarian cycle. At the completion of the menstrual period the endometrium is only one or two
milimeters thick. Under the influence of increasing level of estrogen this increases until the by the day 12 of the
cycle the endomerium is 10-12 mm thick. This growth results from the increase in epithelial and stromal cells of
the superficial layer of the endomnetrium . This proliferative phase is characterized by an increase in estrogen
receptor content and increase in size of the endometrial glands.

• As ovulation approaches, the progestrone receptor content increases. Within two days of ovulation the effect of
ovarian production of progesterone become apparent as the endometrium enters the secretory phase of the
cycle. During this phase the mitotic activity in the epithelium ceases and the glands become dilated and tortuos .
The blood vessels become coiled . Glycogen accumulation in the endometrium reaches a peak under the
combined influence of estrogen and progesterone. These processses prepare the endometrium for embedding of
the embryo. If fertilization does not occur then progesterone and estrogen levels decline and menstruation occurs.
 PHYSIOLOGICAL CHANGES IN
PREGNANACY in the

-Gastrointestinal tract(GIT)
-Urinary system
-Musculoskeletal system
-Central Nervous systemCNS)

JUNAINAH BT MAT JUSOP- 2008277858

 GIT
∞High progesterone level will cause relaxation of smooth
muscle.

∞Relaxation of sphincter →regurgitation→ heartburn.

∞Slight reduction in gastric secretion and diminished gastric

motility → slow emptying→ more efficient pulping of food.

∞Reduced motility in small intestine will provide more time for

absorption.
∞Reduced motility of large intestine will increase time for water
absorption and may tends to induce constipation.

∞Growth of conceptus and uterus will increase appetite and

thirst.

∞In late pregnancy ,pressure of uterus reduces capacity for large

meals.
 RENAL SYSTEM
∞Early pregnancy: Large uterus is compressing the bladder and cause
frequency of micturition.
∞Mid-pregnancy: The uterus is lifted out of pelvis→ normal micturition.
∞At term: The head of fetus descends into the pelvis→ frequency of
micturition.
∞Urinary output on a normal fluid intake tends to be slightly diminished.
∞However there is an increase renal blood flow and also tubular
reabsorption of water and electrolytes.
∞It is estimated that extracellular water is increased by 6 to 7 litres
during pregnancy.

∞Glycosuria occurs commonly due to presents the tubules with a sugar

load which cannot be completed reabsorbed.
 ∞Anatomical changes cause the exist of a degree of
hydronephrosis and hydro-ureters.

∞These result from loss of smooth muscle tone due to

progesterone and mechanical pressure from the uterus at the
pelvic brim.

∞Vesico-ureteric reflux is also increase and will lead to

infection(UTI).

∞It will improve in the latter part of pregnancy as the uterus

grows above the pelvic brim.
 MUSCULOSKELETAL SYSTEM
∞Progressive lordosis,
mobility of sacroiliac, sacrococcygeal & pubic joints.

∞Bones & ligaments of pelvis undergo adaptation – normal

relaxation.

∞Skin- linea nigra is prominent due to increase in ACTH.

∞Palmar erythema due to increase in estrogen.

∞Facial pigmentation-chloasma.

∞Pigmentation of the areola of the nipples.

 CNS

∞Problems with attention, concentration & memory.

∞Pregnancy-related memory decline : limited to 3 rd

trimester ( transient, quickly resolved after delivery).

∞Difficulty going to sleep, frequent awakenings, fewer

hours of night sleep & reduced sleep efficiency.
THANK YOU =D
Cardiovascular adaptation
in pregnancy
Prepared by:
Mohd Aizat B Abd Aziz
2008402162
 Why the changes occur?
• Need gaseous exchange for metabolism
• metabolismexcess heat
waste product
• Supply sufficient nutrient(growth of
fetus&uterus)

Demand Increased Blood

Supply
 Changes occurred:
• Heart rate (10-20 %) :71 + 10 bpm 

• Stroke volume (10%) : 73.3 + 9 mL 

• Cardiac output ( 30-50%):4.3 + 0.9 L/min 

• Peripheral resistance (35%) :1,530 + 520

dyne/cm/sec 
 How The changes Occur?
• BP= CO x TPR
• CO=SV x HR
BP=SV x HR x TPR

• CO Blood supply

 Peripheral vascular dilatation Uterine vascular dilatation
(hormonal vasodilation:PG,NO)

Reduced peripheral resistance

Lower diastolic pressure

Stimulate adrenal cortex

(secrete aldosretention fluid+
Decreased excretion Na)

SV(73 + 9 mL /30%)
 Heart Rate
• 70 bpm(norm)
• 78 bpm @ 20 weeks gestation
• Peak at 85 bpm at late pregnancy

CO=SV x HR
CO Blood supply
 Local Vascular Changes
• CO sensitive to position of body @ >30 weeks
• Exp:
• Supine position pressure of uterus on
pelvic vein venous return

CO (supine hypotension
syndrome)
• Enlarged uterus exert pressure on pelvic vein
• varicosities/oedema of the leg
• Very prominent during daytime+upright
posture
• Oedema fluid reabsorbed(when in supine
position) venous return  renal output

Nocturnal frequency of urination

Respiratory adaptation
in pregnancy
 Mechanical Changes
– Chest circumference expands 5-7 cm

– Subcostal angle increases from 68 to 103

degrees

– Transverse diameter increases by 2cm

– Level of diaphragm elevate 4cm

 Lung volumes & capacity
• Tidal volumes (35-50%)as pregnancy
progresses.

• Total lung capacity is (4-5%) (d/t elevation of

diaphragm)

• Large tidal volume and small residual volume

 alveolar ventilation (65%)
&
 • Tidal volume

Increased Increased
inspiration expiration

High arterial Low maternal pCO2

O2

Improved supply Easy CO2 exchange

to fetus
 Changes In Reproductive Organs
Uterus

• Body of uterus affected >than isthmus/cervix

• Oestrogenhypertrophy/hyperplasia of muscle fibers

• No of connective tissue,elastic tissue,blood vessel,nerve

increases.

• Its weight can increase from 50g1000g

 Cervix
• Oestrogen vascularity,changes in
connective tissuesoftens

• secretion of mucusform protective plug

in cervical os(operculum)
 Breast
• Oestrogen+progesteroneproliferation of
gland & duct
• size of breast
• Veins may become visible
• Nipple will grow and darken.
• Secretion of colostrum may begin in 1st
trimester
 Vagina and Pelvic Floor

• vascularity,muscular hypertrophy,softening
connective tissue

Allow distention at birth

 Pelvic Ligament
• Oestrogensoftening of the ligament

Pelvis more mobile and capacity

HORMONAL CHANGES
DURING PREGNANCY

MUHAMAD HAZMI BIN JUAIDI

2007294732
 Hormones Produced within the pregnant
uterus
• Pregnancy specific
 hCG
 hPL
• Hypothalamus related
 GnRH
 CRF
• Pituitary related
 Prolactin
 hGH
 ACTH
• Other peptides
 IGF
 Calcitriol
 PTH-related peptide
 Renin
 Angiotensin 2
• Steroids
 Estradiol
 Progesterone
 Human chorionic gonadotrophin
( hCG )
• Secreted by the trophoblast cells within 9 days of
conception-positive urine beta hCG
• Peaked at 10 weeks of gestation
• Declined by 12 weeks of gestation-placenta take over the
function over the later weeks of first trimester
• Composed of alpha and beta subunit, beta is pregnancy
specific, alpha unit is simmilar to a unit of FSH,LH, and
TSH-can interact with the receptors
• Function is to maintain the corpus luteum, so that it will
continue to secrete estrogen and progesterone-maintain
the endometrium & prevent menstruation
 ESTROGEN
• Secreted by corpus luteum in early part of pregnancy
then by placenta
• Concentration rises substantially from earlier part of
pregnancy-about 30 times than normal
• Main actions are:
 On the uterus-it stimulates myometrium cells
hypertrophy-uterine enlargement for fetal growth and
inhibit menstruation
 Breast enlargement-ducts grow and branch
 Widen the pubic symphsis- by altering the chemical
comp. of the connective tissues
 Progesterone
• Secreted by the corpus luteum and then
placenta
• Main actions are :
 Supress the FSH and LH to inhibit follicular
development
 Prevents menstruation and thickens the
endometrium
 Stimulate development of acini in the breast
• Other actions are :
• 1. Relaxes the smooth muscle tone leading to
discouragement of uterine contraction, GIT
symptoms like nausea and constipation
• 2. Reduces the vascular tone-venous
dilatation-reduced diastolic bp
• 3. raises temperature
 Prolactin

• Secreted from the anterior pituitary

• Concentration increases throughout pregnancy
• Stimulates milk production
• But does not cause lactation during pregnancy
because the effect is antagonized by the estrogens
• Only after delivery when the estrogen level
decreases due to placental separation, lactation is
promoted
 Insulin like growth factor 1 &2
• Produced by fetal cells in the liver and
maternal cells in the uterus
• Function is to regulate fetal growth
• Fetal growth is not influenced by the growth
hormone
 Human placental Lactogen
• Produced by the palcenta
• Lactogenic
• Antagonistic to insulin actions
 Calcium Metabolism
• 40% of calcium in the circulation is bound to albumin
• During pregnancy the level of albumin decreases
• So, the total plasma calcium decreases
• Fetal demand is high during pregnancy
• Parathyroid hormone will released and stimulate the
production of calcitriol
• Calcitriol will absorp more calcium in the GIT and reduces
its excretion
• Reaching an equilibrium between mother and fetus
 Corticosteroids
• Placenta produces the corticotopin-releasing
hormone (CRH)
• leads to increase in ACTH
• Mother adrenal cortex will secerete cortisols
• Cortisol causes increase in blood sugar
• CRH also stimulate the fetal adrenal cortex to
release cortisol-stimulates maturation of lung
tissues
 The onset of human labour-
placental clock theory

• Initiation of labour is not well understood

• Theory suggest that labour in all mammals is
initiated by the activation of fetal adrenal
cortex
• Upon stimulation by CRH
• Outer part secrete cortisol
• Inner part secrete DHEAS
( dehydroepiandosterone )
• DHEAS from fetus travel to placenta and stimulate
coversion of progesterone to estrogen
• Level of estrogen increases and stimulate the uterus to :
1. produces receptors for oxytocin
2. produces receptor for prostaglandin
3. produce gap junctions between
myometrial cells in the uterus
• * uterus becomes more sensitive to pros. And oxytocin,
contractions begin and increasing in intensity
 GASTROINTESTINAL SYSTEM
• High progesterone level leads to :
 Relaxation of sphincter -> regurgitation -> heartburn
 Diminished gastric motility result in slow emptying ->
causes nausea
 Reduced motility in small intestine -> more time for
absorption-> more nutrition
 Reduced motility in large intestine -> more time for
water absorption -> constipation
 Late pregnancy -> pressure of uterus -> reduces
capacity for large meal-> frequent small snacks
NOR AKMA BINTI
SULAIMAN
2008402192
 WEIGHT INCREASE

• Increase in weight around 25% COMPONENT AMOUNT (KG)

(~12.5kg)
• Rate: around 0.5kg per week UTERUS 1
FETUS ~3.4
• Due to: PLACENTA 0.7
- Growth of the conceptus AMNIOTIC 0.8
FLUID 3.5
- Enlargement of maternal FAT 1.3
organs,maternal storage of fat BLOOD 0.4
and protein BREAST 1.5-4.5
- Increase in maternal blood ECF
volume and interstitial fluid TOTAL 12.5 KG
 CARBOHYDRATE METABOLISM
• Increase demand on the part
of the fetus for an easily
convertible source of energy

• Future demands –
lactation,increasing growth of
pregnancy,provide a more
steady source of energy

•Sensitivity of insulin reduced

due to an increase in specific
antagonists to insulin- Human
Placental Lactogen (HPL)
 PROTEIN METABOLISM
• There is on average a 20% increase in dietary protein intake.
- Growth of the fetus,placenta,uterus,mother’s breasts and other
tissue.
• Both chorionic gonadotrophin and the placental lactogen tend to reduce
the deamination process  blood & urine urea reduced
 FAT METABOLISM
• Fat is the major form of stored energy during pregnancy
- Abdominal wall,back,thighs and breast (modest amount)
Hematological changes of
normal pregnancy
Hematological changes of normal pregnancy
Blood volume
# The maternal blood volume increases
# results from an increase in both plasma and erythrocytes.

# However, plasma volume increase in greater rate than red cell

mass.
# there are increase in red cell mass about 18% while plasma
volume increases by 40- 45%.
# Thus there is a reduction in red cell count per milliliter.

# Toward the term as the plasma volume diminishes the red cell
count increase slightly which also cause rise of haematocrit
The factors contributing to increase of plasma volume
including:

 Increase sodium retention.

 Decrease in plasma osmotic pressure.
 Decrease in thirst threshold.
• Volume change during pregnancy
Why ?
Meet the demands of the enlarged uterus with it greatly
hypertrophied vascular system.
.
To safeguard the mother against the adverse effects of blood
loss associated with parturition.
HYPERCOAGULABLE STATE:
 Increase in fibrinogen and factor VII and X
 To meet the sudden hemostatic demand during placenta
separation

INCREASE LEUKOCYTES:
 due to increase in neutrophil cells
 WCC may rise markedly during labour

DECREASE PLASMA FOLATE:

 Due to ↑ in renal clearance of folate in pregnancy

DECREASE TOTAL IRON STORES:

 Even though absorption from gut is ↑, but there is
increasing demand for iron due to increase in blood volume.
Hematological changes

Decrease in:
o red cell count.
o hemoglobin concentration.
o haematocrit.
o Plasma folate concentration

Increase in :
o white cell count.
o fibrogen concentration.