Feedback Mechanism

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Feedback Mechanism of Menstruation

Lecture 3
1. General Considerations
• About 300,000 to 400,000 immature oocytes
per ovary are present at birth (were formed
during the first 5 months of intrauterine life.,
a process known as oogenesis). Many of
these oocytes, however, degenerate and
atrophy ( a process called atresia). Only
about 300 to 400 mature during the entire
reproductive cycle of women.
• Menstruation is ushered in by the menarche -
very first menstruation in girls. And ends with
menopause (permanent cessation of
menstruation, i.e., there are no more
functioning oocytes in the ovaries). The age of
onset and termination vary widely on
heredity, racial background, nutrition and
even climate
• Normal period (days when there is menstrual
flow) lasts for 3 to 6 days, menstrual cycle
(from the first day of menstrual period up to
the first day of the next menstrual period) may
be anywhere from 25 to 35 days, but accepted
average length is 28 days.
• Anovulatory stage after menarche
are not unusual because immaturity
of the feedback mechanism.
• Anovulatory stage also occur during
pregnancy, lactation, and related
disease condition.
• Associated terms
- Amenorrhea temporary cessation of
menstrual flow
- Oligomenorrhea – markedly diminished
menstrual flow, nearing amenorrhea
- Menorrhagia – excessive bleeding during
regular menstruation
Metrorrhagia is bleeding at
completely irregular intervals
- Polymenorrhea is frequent
menstruation occurring at intervals
less than 3 weeks
- Dysmenorrhea is painful
menstruation
• Body Structures Involved
- Hypothalamus
- Anterior pituitary gland
- Ovary
- uterus
• Hormones which regulate cyclic
activities
- Follicle Stimulating Hormone (FSH)
- Luteinizing Hormone (LH)
Effects of Estrogen in the body

- Inhibits production of FSH


- Causes hypertrophy of the myometrium
- Stimulates growth of the ductile structures of
the breast
- Increases quantity and ph of cervical mucus,
causing it to become thin and watery and can
be stretched to a distance of 10-13 cm.
Spinnbarkett test of ovulation).
Effects of Progesterone in the Body

- Inhibits production of LH
- Increases endometrial tortuosity
- Increases endometrial secretions
- Inhibits uterine motility
- Decreases muscle tone of
gastrointestinal and urinary tract
- Increases musculoskeletal motility
- Facilitates transport of the fertilized
ovum through the Fallopian tubes
- Decreases renal threshold of lactose
and dextrose
- Increases fibrinogen levels; decreases
hemoglobin and hematocrit
- Increases body temperature after ovulation.
Just before ovulation basal temperature
decreases slightly (because of low
progesterone level in the blood) and then
increases slightly a day after ovulation
(because of the presence of progesterone)
Additional Information
1. When the ovary releases the mature ovum
on the day of ovulation, sometime a certain
degree of pain in either the right or left lower
quadrant is felt by the woman. This sensation
is normal and termed Mittelschmerz.
2. The first 14 days of the menstrual cycle is a
very variable period. The last 14 days of the
menstrual cycle is a fixed period-exactly 2
weeks after ovulation, menstruation will occur
(unless a pregnancy has taken place) because
the corpus luteum has a life span of only 2
weeks
Implication: when given options regarding the
exact date of ovulation, choose two weeks
before menstruation.
3. In a 26-day cycle, ovulation takes place on the
12th day. In a 28-day cycle, ovulation takes
place on the 14th day. In a 32-day cycle,
ovulation takes place on the 18th day (Subtract
14 days from the cycle)
4. Menstruation does not occur during
pregnancy because progesterone does
not decrease in amount. Corpus luteum
continues to produce progesterone until
the placenta takes over the production
of hormones by the 8th week of
pregnancy.
5. Menstruation can occur even without
ovulation (as in women taking oral
contraceptives). Ovulation can likewise
occur even without menstruation (as in
lactating mothers).
THE MENSTRUAL CYCLE

• The menstrual cycle refers to the changes


and preparation that a woman's body
goes through to prepare for pregnancy.
About once a month, the uterus grows a
new lining (endometrium) to get ready
for a fertilized egg.
• When there is no fertilized egg to
start the pregnancy, the uterus sheds
its lining starting off the monthly
menstrual bleeding also called
menstrual period.
• The menstrual cycle is from Day 1 of bleeding
to Day 1 of the next instance of bleeding. The
average cycle is 28 days, although it is
perfectly normal to have a cycle that is as
short as 21 days or as long as 35 days. A
regular menstrual cycle is an important
element of successful conception.
• Hormones control a woman's
menstrual cycle and this cycle is
comprised of three distinct phases.
Phase 1 - The Follicular Phase
• This phase begins on Day 1 of the menstrual period
and lasts until ovulation. The brain's hypothalamus
and pituitary gland send hormone signals that get the
ovaries and uterus ready for pregnancy. Through the
influence of a rise in follicle stimulating hormone (FSH)
during the first days of the cycle, a few ovarian follicles
are stimulated. These follicles, which were present at
birth and have been developing for the better part of a
year in a process known as folliculogenesis, compete
with each other for dominance.
• Under the influence of several hormones, all but
one of these follicles will stop growing, while one
dominant follicle in the ovary will continue to
maturity. The follicle that reaches maturity is called
a tertiary, or Graafian follicle, and it forms the ovum.
As they mature, the follicles secrete increasing
amounts of estradiol, an estrogen. The estrogens
initiate the formation of a new layer of
endometrium in the uterus, histologically identified
as the proliferative endometrium.
Phase 2 - The Ovulatory Phase

• This is the key phase in the menstrual cycle.


The level of luteinizing hormone (LH) surges
during this phase signaling the release of the
egg from the follicle into the fallopian tube. The
process is known as ovulation and the egg can
then be fertilized for up to 24-48 hours. Cervical
mucus is most receptive to sperm around this
time and a woman has the best chances of
conceiving right before and during ovulation
• It is therefore important to accurately identify when a
woman is ovulating if trying for a baby, in order to
maximize chances of getting pregnant. During this period
When a couple has intercourse, the sperms swim through
the cervical mucus, into the uterus and along the fallopian
tube, where they meet the egg. While millions of sperms
are released, only one sperm can fertilize an egg. If
fertilization does not occur, the egg passes through the
uterus, the uterine lining then breaks down and is shed
several days later as the next menstrual cycle begins.
Phase 3 - The Luteal Phase

• This is the final phase of the menstrual cycle and lasts


from the day of ovulation to the last day before the next
period. Glands in the lining of the uterus called the
endometrium secrete proteins in anticipation of
implantation of the fertilized egg (embryo). If implantation
does not occur, the endometrium starts to break down
and is eventually sloughed off leading to menstruation.
The luteal phase derives its name from the follicle that
produces the egg which then becomes a functioning gland
called the corpus luteum. The corpus luteum produces
progesterone which prepares the endometrium.
End of lecture on
feedback mechanism

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