The Menstrual Cycle

Prepared by: Pauline Yves D. Iya

Mentor: Dr. Blythe Maxine Ancheta-Cabanting
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Menstrual Cycle
• Refers to the changes in the activities of the ovaries and
endometrium that make reproduction possible

• Involves 2 synchronized processes:

• OVARIAN CYCLE – concerned on follicular development and
ovulation
• UTERINE/ENTOMETRIAL CYCLE – concerned on thickening
and shedding of the endometrium
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Menstrual Cycle
• Varies:
• From woman to woman
• At various points in life

• “Typical cycle”
• It lasts for 28 ± 7 days, with menstrual flow lasting 4 ± 2 days
• Blood loss of 20-60ml

Menstrual bleeding Ovulation

11 2 3 4 5 6 7 8 9 10 11 12 13 14
14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Follicular (preovulatory) phase Luteal (postovulatory) phase

Menses Proliferative phase Secretory phase

 L: 2 to 5 cm W: 1.5 to 3 cmT: 0.5 to 1.5 cm pau

• FUNCTIONS
• Folliculogenesis, Oogenesis
• Steroid and peptide hormone production

Ovary • CELLS:
• Primary oogonia – forms follicles, ultimately give the egg
• Derived from the endoderm of the yolk sac
• Granulosa cells – produce estrogen in response to FSH
• Ovarian Stroma
• Interstitial cells  theca cells - produce androgens in
response to LH (androstenedione)
• Connective tissue cells
• Contractile cells
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Follicular (preovulatory) phase Subdivided into three periods;

1. recruitment of a cohort of antral follicles
• Only preantral follicles respond to the FSH signal
2. the selection of a dominant follicle,
• usually only one is selected to complete growth to
maturity
3. and the growth of the selected dominant follicle.

Follicles grow and • Estradiol produces (+) feedback

compete to grow fastest. on pituitary
 Depends on the # of • estradiol levels when greater
receptors
than 200 pg/mL
• LH SURGE – occurs
1-2 days before
ovulation;
• TRIGGERS
OVULATION
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Ovulation
↑Estradiol levels egg

• Positive feedback on hypothalamus  GnRH surge

• LH increases by 10-fold
• FSH increases by 4-fold
• Meiosis resumes, polar body is released; Metaphase II ruptured
follicle
• Occurs 16 hours after LH peak (Comprehensive Gynecology)
• 10-12 hours after LH peak (Williams)

↑LH surge
• Signal inflammatory-like reaction (prostaglandins) and proteolytic cascade
• CAUSES: Follicular rupture
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Luteal (postovulatory) phase

Corpus luteum
• Follicular remnant (vascularized)
• Primary function: Secrete progesterone to • In pregnancy, hCG is what sustains the corpus
maintain endometrial lining luteum. Eventually, the placenta will take over in
producing progesterone.
• Luteinized theca cells  continues to
produce androstenedione.
• Luteinized granulosa cells  keep
converting androstenedione to estradiol.
• Also responds to ↓LH  increase
activity of cholesterol sidechain
cleavage enzyme (p450scc)
• Converts cholesterol to
pregnenolone • Progesterone and Inhibin produces (-) feedback
THEREFORE: Progesterone > to the pituitary, decreasing FSH and LH release
Estrogen
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Menstrual Cycle phases
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Follicular (preovulatory) phase Luteal (postovulatory) phase

• Variable, 14 ± 7 days • Constant
• Depends on LH and FSH • Driven by the corpus luteum
• ↑LH and ↑FSH • “life span”: 11-12 days, then it will
• Faster follicles will develop involute
• Shorter interval
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Proliferative phase
Estradiol effect on endometrium
and cervix optimize chance for
Estradiol is what’s responsible for the: fertilization.
• proliferation of the endometrium “fertile window”
• growth of endometrial glands,
• emergence of spiral arteries from the basal layer

• Changes cervical mucus consistency

- more suitable for sperm
Predominant estrogen in:
Pregnancy – Estriol
Reproductive age – Estradiol
Menopause - Estrone
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Secretory phase
Progesterone predominance
• Spiral arteries grown longer window of implantation (WOI) is
typically defined as days 20 to 24
• Uterine glands secrete more mucus
• Intraglandular contents are released into the lumen
coincides well with the arrival of the free-floating
blastocyst for glycogen-rich nutrients. Corpus luteum
AFTER DAY 15 • replaced by corpus albicans
• Optimal window for fertilization closes which does not produce hormone,
• Cervical mucus thickens – less hospitable for sperm ↓estrogen and ↓progesterone

• ↓progesterone – cause spiral arteries

to collapse
• Endometrial functional
layer prepares to be
sloughed off
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Menstruation
Day 24
• IF no implantation, and hCG is not produced to maintain the corpus luteum
• corpus luteum involutes
• Progesterone withdrawal – constriction of spiral arteries  endometrial necrosis
• Inflammatory mediators  triggers prostaglandins
• Autolysis of the stratum functionale occurs, and desquamation begins.
• Prostaglandins cause the painful symptoms of menstruation
• Causes muscle contraction
• Functional layer separates from basal layer and exits through the vagina
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Steroidogenesis
Childhood Puberty-Reproductive age Menopause
LH and FSH levels are high after birth Gonadotropin levels gradually rise As follicles decrease, the amount of
but fall within the first few months of estrogen and inhibin decrease, LH
life Sleep associated LH increases is one and FSH increase.
of the first signs of puberty.

Estradiol levels rise, gives rise to

secondary sex characteristics

FSH > LH LH > FSH FSH > LH

LH – stimulates thecal
androstenedione  estrone
(major estrogen of postmenopausal)
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14
15 16 17 18 19 20 21 22 23 24 25 26 27 28

OVARIAN CYCLE
Follicular (preovulatory) phase Luteal (postovulatory) phase

UTERINE CYCLE
Menses Proliferative phase Secretory phase

n RH LH
G L
FSH
E P H E P