Physiology of Menstrual

Cycle

By : Ashlesha Chaudhary
SPECIFIC OBJECTIVES:-
● Introduce and define menstrual cycle.
● Enlist the purposes of menstrual cycle.
● Describe ovarian changes
● Explain the uterine changes
● State the role and action of hormones in regulation of
menstrual cycle.
● Discuss the applied physiology of menstrual cycle.
INTRODUCTION:
The reproductive system of a female, unlike men, shows regular
cyclic changes that teleologically may be regarded as periodic
preparation for pregnancy and fertilization. In primates and
humans, the cycle is a menstrual cycle, and
its most conspicuous feature is the periodic
vaginal bleeding that occurs with the
shedding of uterine mucosa (menstruation).
DEFINITION :-
Menstrual cycle is defined as cyclic events that take place in a
rhythmic fashion during the reproductive period of a woman’s
life. Menstrual cycle starts at the age of 12 to 15 years, which
marks the onset of puberty.

Menstrual Cycle – periodic uterine bleeding in response to

cyclic hormonal changes. A process that allows for conception
and implantation of new life.
 The commencement of menstrual cycle is called menarche.
 It begins at puberty, ranging from the ages of 10 to 16.
 Menstrual cycle ceases at the age of 45 to 50 years.
Permanent cessation of menstrual cycle in old age is called
menopause.
 Menstruation – is the periodic discharge of blood, mucus and
epithelial cells from the uterus.
 It is usually determined by counting as day 1 the 1st day of a
menstrual period until the last day before the next menstrual
period.
PURPOSES
Ovarian changes during
menstrual cycle
Changes in the ovary during each menstrual cycle occur
in two phases:
A. Follicular phase
B. Luteal phase.

Ovulation occurs in between

these two phases.
 FOLLICULAR PHASE
This phase extends from the 5th day of the cycle until the time of ovulation,
which takes place on 14th day. Maturation of ovum with development of
ovarian follicles takes place during this phase.

 OVARIAN FOLLICLES
Ovarian follicles are glandular structures present in the cortex of ovary. Each
follicle consists of the ovum surrounded by epithelial cells, namely
granulosa cells.
Different follicles:
1. Primordial follicle 2. Primary follicle
3. Vesicular follicle 4. Matured follicle or graafian follicle.
PRIMORDIAL FOLLICLE :-

At the time of puberty, both the ovaries contain about 400,000 primordial
follicles. Each primordial follicle has an ovum, which is incompletely
surrounded by the granulosa cells.

At the onset of puberty, under the influence of FSH

and LH the primordial follicles start growing through
various stages.
PRIMARY FOLLICLE:-

Primordial follicle becomes the primary follicle, when ovum is completely

surrounded by the granulosa cells.
Changes taking place during development of primary follicle
i. Proliferation of granulosa cells and increase in size of the follicle
ii. Increase in size of the ovum
iii. Onset of formation of connective tissue capsule around the follicle.

Primary follicles develop into vesicular follicles.

VESICULAR FOLLICLE:-

Under the influence of FSH, about 6 to 12 primary follicles start growing

and develop into vesicular follicles.

Changes taking place during the development of

vesicular follicle
i. Changes in granulosa cells
ii. Changes in ovum
iii. Formation of capsule. P
GRAAFIAN FOLLICLE:-

Graafian follicle is the matured ovarian follicle with maturing ovum. It is named after the Dutch physician and
anatomist, Regnier De Graaf.

Changes taking place during the development of graafian follicle :-

i. Size of the follicle increases to about 10 to 12 mm. It extends through the whole thickness of ovarian cortex.
ii. At one point, the follicle encroaches upon tunica albuginea and protrudes upon surface of the ovary. This
protrusion is called stigma. At the stigma, the tunica albuginea becomes thin
iii. Follicular cavity becomes larger and distended with fluid
iv. Ovum attains maximum size
v. Zona pellucida becomes thick
vi. Corona radiata becomes prominent
vii. Small spaces filled with fluid appear between the cells of germ hill, outside the corona radiata. These spaces
weaken the attachment of the ovum to the follicular wall.
viii. Theca interna becomes prominent. Its thickness becomes double with the formation of rich capillary
network.
 Ovulation
Ovulation is the process by which the graafian follicle ruptures with
consequent discharge of ovum into the abdominal cavity. It is influenced
by LH.
 Ovulation occurs on 14th day of menstrual cycle in a normal cycle of 28
days.
 The ovum enters the fallopian tube.
 After ovulation, the ovum is viable only for 24 to 48 hours. So it must be
fertilized within that time. Fertilized ovum is called zygote.
 Zygote moves from fallopian tube and reaches the uterus on 3rd day
after ovulation. It is implanted in the uterine wall on 6th or 7th day.
 LUTEAL PHASE
Luteal phase extends between 15th and 28th day of menstrual cycle. During
this phase, corpus luteum is developed and hence this phase is called luteal
phase.

CORPUS LUTEUM
Corpus luteum is a glandular yellow body,
developed from the ruptured graafian
follicle after the release of ovum.
It is also called yellow body.
The life span of CL is 12-14 days.
DEVELOPMENT OF CORPUS LUTEUM
After the rupture of graafian follicle and release of ovum, the follicle is filled with blood.
Now the follicle is called corpus hemorrhagicum. The blood clots slowly. Corpus
hemorrhagicum does not degenerate immediately. It is transformed into corpus luteum.

FUNCTIONS:
1. Secretion of hormones
Corpus luteum acts as a temporary endocrine gland. It secretes large quantity of
progesterone and small amount of estrogen. Granulosa lutein cells secrete progesterone
and theca lutein cells secrete estrogen. LH influences the secretion of these two hormones.
2. Maintenance of pregnancy
If pregnancy occurs, corpus luteum remains active for about 3 months, i.e. until placenta
develops.
FATE OF
CORPUS
LUTEUM :-
Uterine changes during menstrual
cycle
During each menstrual cycle, along with ovarian changes,
uterine changes also occur simultaneously.

Uterine changes occur in three phases:

1. Menstrual phase
2. Proliferative phase
3. Secretory phase.
 MENSTRUAL PHASE
After ovulation, if pregnancy does not occur, the thickened endometrium is shed or
desquamated. The process of shedding and exit of uterine lining along with blood
and fluid is called menstruation or menstrual bleeding.
It lasts for about 4 to 5 days.
This period is called menstrual phase or menstrual period.

● The day when bleeding starts is considered as the first day of

the menstrual cycle.
● Two days before the onset of bleeding, that is on 26th or 27th
day of the previous cycle, there is a sudden reduction in the
release of estrogen and progesterone from ovary.
CHANGES IN ENDOMETRIUM DURING MENSTRUAL PHASE

i. Lack of estrogen and progesterone causes sudden involution of

endometrium.
ii. During the next 24 hours, the tortuous blood vessels in the endometrium
undergo severe constriction.
iii. Vasoconstriction leads to hypoxia, which results in necrosis of the
endometrium. Necrosis causes rupture of blood vessels and oozing of blood.
iv. Outer layer of the necrotic endometrium is separated and passes out
along with blood.
v. This process is continued for about 24 to 36 hours.
vi. Within 48 hours after the reduction in the secretion of estrogen and
progesterone, the superficial layers of endometrium are completely desquamated.
vii. Uterine contractions expel the blood along with desquamated uterine tissues
to the exterior through vagina.

During normal menstruation, about 35 mL of blood along with 35 mL of serous

fluid is expelled. The blood clots as soon as it oozes into the uterine cavity.

Menstruation stops between 3rd and 7th day of menstrual cycle. At the end of
menstrual phase, the thickness of endometrium is only about 1 mm. This is
followed by proliferative phase.
 PROLIFERATIVE PHASE
Proliferative phase extends usually from 5th to 14th day of menstruation, i.e. between the day
when menstruation stops and the day of ovulation. It corresponds to the follicular phase of
ovarian cycle.

i. Epithelium reappears on the surface of endometrium within the first 4 to 7 days.

iii. Uterine glands start developing within the endometrial stroma. Blood vessels appear in the
stroma.
iii. Proliferation of endometrial cells occurs continuously, so that the endometrium reaches the
thickness of 3 to 4 mm at the end of proliferative phase.

All these uterine changes during proliferative phase occur because of the influence of estrogen
released from ovary. On 14th day, ovulation occurs under the influence of LH. This is followed
by secretory phase.
 SECRETORY PHASE
• Secretory phase extends between 15th and 28th day of the menstrual cycle, i.e.
between the day of ovulation and the day when menstruation of next cycle
commences.
• Under the influence of progesterone, the endometrial glands commence their
secretory function, secretory phase is the preparatory period, during which the
uterus is prepared for implantation of ovum.
• Estrogen is responsible for repair of damaged endometrium and growth of the
glands.
• Progesterone is responsible for further growth of these structures If the
implanted ovum is unfertilized or if pregnancy does not occur, menstruation
occurs after this phase and a new cycle begins.
 Role and Action of Hormones
Hormones involved in the regulation of
menstrual cycle are:
 Hypothalamic hormone: GnRH
 Anterior pituitary hormones:
FSH and LH
 Ovarian hormones:
Estrogen and progesterone.
1. GONODOTROPIN-RELEASING HORMONE
(GNRH)

Stimulates release of FSH and LH

Initiating puberty and
sustaining menstrual cycle.
2) Follicle-stimulating Hormone (FSH)
• secreted by anterior pituitary gland during the 1st half of menstrual cycle
• stimulate growth and maturation of graafian follicle before ovulation
• thins the endometrium

3) Luteinizing Hormone (LH)

• secreted by the anterior pituitary gland
• stimulates final maturation of graafian follicle
• surge of LH about 14 days before next menstrual
period causes ovulation
• stimulates transformation of graafian follicle into corpus luteum
• thickens the endometrium
4) Estrogen
• secreted primarily by the ovaries, corpus luteum, adrenal
cortex and placenta in pregnancy
• considered the Hormone of Women
• stimulates thickening of the endometrium;
• causes suppression of FSH secretion
• responsible for the development of secondary sex characteristics
• stimulates uterine contractions
• increases water content of uterus
• high estrogen concentration inhibits secretion of FSH and Prolactin but
stimulates secretion of LH7.
• low estrogen concentration after pregnancy stimulates secretion of Prolactin
5) Progesterone
• secreted by the ovary, corpus luteum and placenta during pregnancy
• inhibits secretion of LH
• has thermogenic effect (increases body temperature)
• relaxes smooth muscles thereby decreases contractions of uterus
• causes cervical secretion of thick mucus
• maintain thickness of endometrium
• allows pregnancy to be maintained
Hence it is also called Hormone of Pregnancy
• prepares breasts for lactation
 APPLIED
PHYSIOLOGY
 BIBLIOGRAPHY
● Annamma Jacob’s ‘A Comprehensive Textbook Of Midwifery And
Gynaecological Nursing’, 5th edition Elsevier Publication 2018; Pp: 567-
580.
● DC Dutta’s ‘ Textbook Of Obstetrics’, 9th edition Jaypee Brother
Publication 2013; Pp: 90-96
● K Sembulingam’s ‘essentials of medical physiology’, 6th edition Jaypee
Brother Publication 2012; Pp: 482-490.
● www.ncbi.nlm.nih.gov
● www.healthline.com
● www.mayoclinic.com
 ASSIGNMENT
1. Explain in brief the uterine changes occurring in menstrual cycle.
2. Enlist the function of hormones involved in regulation of
menstrual cycle.