Haid : pengeluaran darah atau

perdarahan secara periodik dan siklik

dari uterus disertai pelepasan
(deskuamasi) endometrium

Panjang siklus haid normal:

28 ± 7 hari (21-35 hari)
Jumlah 40-80 ml(2-5
pembalut/hari)
Lama haid antara 3-7 hari
MENSTRUAL CYCLE
Ovarian cycle
• Follicular phase
• Ovulatory phase
• Luteal phase

Uterus ( Endometrial cycle )

• Proliferative phase
• Secretory phase
• Menstrual phase
Ovarian cycle
• Follicular phase
• Ovulatory phase
• Luteal phase
FOLLICULAR PHASE
Early in the menstrual cycle, the release
of GnRH from the hypothalamus
increases, and sensitivity of the anterior
pituitary to GnRH increases.

Stimulate the production and release of a

small amount of FSH and LH by the
anterior pituitary

FSH and LH stimulate follicular growth

and maturation and an increase in
estradiol secretion by the developing
follicles
FSH exerts its main effect on the
granulosa cells

FSH stimulates the granulosa cells to

convert androgens to estrogen

FSH gradually increases LH receptors

in the granulosa cells

Estrogen produced by the granulosa

cells increases LH receptors in the
theca interna cells
 LH initial effect on the cells of the
theca interna and later on the
granulosa cells

LH stimulates the theca interna cells

to produce androgens, which diffuse
from these cells to the granulosa cells

After LH receptors in the granulosa

increased, LH stimulates the cells to
produce some progesterone, which
diffuses from the granulosa cells to
the theca interna cells, where it is
converted to androgens
The gradual increase in estrogen levels,
especially late in the follicular phase, begins
to have a positive-feedback effect on LH and
FSH release from the anterior pituitary

In response to this positive feedback effect, LH

and FSH secretion increase rapidly and in large
amounts just before ovulation

The increase in blood levels of both LH and FSH is

called the LH surge, and the increase in FSH is called
the FSH surge

The LH surge occurs

several hours earlier
and to a greater
degree than the FSH
surge, and the LH
surge can last up to 24
hours
FOLLICULAR
PHASE
FOLLICULAR
PHASE
LUTEAL PHASE

Shortly after ovulation, production

of estrogen by the follicle decreases,
and production of progesterone
increases as granulosa cells
are converted to corpus
luteum cells

After the corpus luteum forms,

progesterone levels become much
higher than before ovulation, and
some estrogen is produced also
 The increased progesterone and
estrogen have a negative-feedback
effect on GnRH release from the
hypothalamus

LH and FSH release from the anterior

pituitary decreases

Estrogen and progesterone

cause down-regulation of GnRH
receptors in the anterior
pituitary, and the anterior
pituitary cells become less
sensitive to GnRH
 The decreased secretion
of GnRH and decreased
sensitivity of the anterior
pituitary to GnRH, the
rate of LH and FSH
secretion declines to very
low levels after ovulation
 If fertilization of the ovulated
oocyte does take place, the
developing embryonic mass
begins to secrete the LH-like
substance human chorionic
gonadotropin (HCG), which keeps
the corpus luteum from
degenerating
Blood levels of estrogen
and progesterone do
not decrease, and
menses does not occur
If fertilization does
not occur, HCG is
not produced
The corpus luteum
begin to atrophy after
day 25 or 26, and the
blood levels of
estrogen and
progesterone decrease
rapidly, which results
in menses
Uterus ( Endometrial cycle )
• Proliferative phase
• Secretory phase
• Menstrual phase
ENDOMETRIAL CYCLE

Functional Layer :
It undergoes cyclic changes in response to
ovarian hormones and is shed during
menstruation

Basal layer of the endometrium :

• Adjacent to the miometrium
• Unresponsive to hormonal stimulation
• Remains intact throughout
the menstrual cycle
PROLIFERATIVE PHASE (FOLLICULAR PHASE)

Estrogen

Mitotic activity in
the glands & stroma

 Endometrial thickness from

2 to 8 mm (from basalis to
opposed basalis layer)
SECRETORY PHASE (LUTEAL PHASE)

Progesterone

•Endometrial glands produce

then secrete glycogen rich
fluid
•Spiral arterioles develop,
lengthen & coil
MENSTRUAL PHASE
Estrogen and progesterone
levels decrease, the
endometrium undergoes
involution.

Days 25-26 of the menstrual

cycle, endothelin and
thromboxin begin to mediate
vasoconstriction of the spiral
arteries

Ischemia may cause

some early menstrual
cramps.
The spiral arteries rupture secondary
to ischemia, releasing blood into the
uterus, and the endometrium is
sloughed off

The stratum functionalis is

completely shed.

Arterial and venous blood,

remnants of endometrial
stroma and glands,
leukocytes, and red blood
cells are all present in the
menstrual flow.
 KESIMPULAN
• Estrogen dihasilkan oleh folikel yang
berkembang di ovarium
• Peningkatan kadar estrogen pertengahan
siklus menyebabkan lonjakan LH.
• Ovulasi terjadi jika terjadi lonjakan LH.
• Korpus luteum terbentuk hanya jika terjadi
ovulasi.
• Korpus luteum menghasilkan progesteron dan
estrogen
• Fase folikulogenesis ovarium menyebabkan fase
proliferasi endometrium
• Fase luteal ovarium menyebabkan fase sekresi
endometrium
• Fase luteal/sekresi relatif tetap berkisar 14 hari
• Fase folikulogenesis / proliferasi bervariasi 7-21
hari.