Physiology of Menstrual

cycle

P R E PA R E D BY
MRS. SARU KRISHNA
A
A S S I S TA N T
PROFESSOR
KIMS CON
DEFINITION

Menstrual cycle is defined as cyclic events that take place in a

rhythmic fashion during the reproductive period of a woman's life.

 The commencement of menstrual cycle ?

Menstrual cycle ceases at the age of ?

Permanent cessation of menstrual cycle in old age ?

CHANGES DURING MENSTRUAL CYCLE

• 1. Ovarian changes

• 2. Uterine changes

• 3. Vaginal changes

• 4. Changes in cervix
OVARIAN CHANGES DURING MENSTRUAL
CYCLE

• A. Follicular phase

• B. Luteal phase

Ovulation occurs in between these two phases

 FOLLICULAR PHASE
• Follicular phase extends from the 5th day of the cycle until the time of
ovulation

• Maturation of ovum with development of ovarian follicles

Different follicles:

• 1.Primordial follicle 3. Vesicular follicle

• 2 Primary follicle 4. Matured follicle or graafian follicle

 Primordial Follicle

 At the time of puberty, both the ovaries contain about 400,000

primordial follicles, which is incompletely surrounded by the
granulosa cells.
 Granulosa cells secrete the oocyte maturation inhibiting factor.

 All the ova present in the ovaries are formed before birth.

 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.

• i. Proliferation of granulosa cells and increase in size of the follicle

• ii. Increase in size of the ovum

• 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.

Graafian Follicle

• Graafian follicle is the matured ovarian follicle with maturing ovum.

• On the 14th day of menstrual cycle, graafian follicle is ready for the
process of ovulation.
 OVULATION

 Ovulation is the process by which the graafian follicle ruptures with

consequent discharge of ovum.
 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.
Stages of Ovulation

• Graafian follicle moves towards the periphery of Ovary

• New blood vessels are formed in the actions of LH and

progesterone

• This increases the blood flow to the follicle

• Prostaglandin is released from granulosa cells of the follicle

 Stages of Ovulation
• Just before ovulation the follicle swells and protrudes against the
capsule of the ovary. This protrusion is called stigma

• Progesterone activates the proteolytic enzyme which weaken the

follicular capsule and cause degeneration of the stigma

• After about 30 minutes, fluid begins to ooze from the follicle through
the stigma
Stages of Ovulation

• It decreases the size of the follicle causing rupture of stigma

• Ovum is released from the follicle along with fluid and plenty of
small granulosa cells.
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
• Development of Corpus Luteum

 Soon after the rupture of graafian follicle and release of ovum, the
follicle is filled with blood - corpus hemorrhagicum.
 The blood clots slowly.

 Corpus hemorrhagicum does not degenerate immediately -

transformed into corpus luteum.
 Blood clot is gradually replaced by a serous fluid containing fibrin
 Functions of Corpus Luteum
• 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.
 Functions of Corpus Luteum
• 2. Maintenance of pregnancy

 If pregnancy occurs, corpus luteum remains active for about 3

months.
 Hormones secreted by corpus luteum during this period maintain the
pregnancy.
 Abortion occurs if corpus luteum becomes inactive or removed before
third month of pregnancy
UTERINE CHANGES DURING MENSTRUAL CYCLE

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.
 Desquamated endometrium is expelled out through vagina
along with blood and tissue fluid.
 The process of shedding and exit of uterine lining along with
blood and fluid is called menstruation or menstrual bleeding.
Menstrual phase

 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.
 Decreased level of these two hormones is responsible for
menstruation.
 Menstrual phase

• Changes in Endometrium during Menstrual Phase

• i. Lack of estrogen and progesterone causes sudden involution of endometrium.

• ii. It leads to reduction in the thickness of endometrium, up to 65% of original

thickness

• ii. During the next 24 hours, the tortuous blood vessels in the endometrium
undergo severe constriction
Menstrual phase

• iv. Vasoconstriction leads to hypoxia, which results in necrosis

of the endometrium

• v Necrosis causes rupture of blood vessels and oozing of blood

• vi. Outer layer of the necrotic endometrium is separated and

passes out along with blood

• vii. This process is continued for about 24 to 36 hours.

 Menstrual phase

• viii. Within 48 hours after the reduction in the secretion of estrogen

and progesterone, the superficial layers of endometrium are completely
desquamated

• ix. Desquamated tissues and the blood in the endometrial cavity initiate
the contraction of uterus

• x. Uterine contractions expel the blood along with desquamated uterine

tissues to the exterior through vagina
 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.

 At the end of menstrual phase, only a thin layer (1 mm) of

endometrium remains, as most of the endometrial stroma is
desquamated.
 Secretory phase

• Secretory phase extends between 15th and 28th day of the menstrual
cycle.

 After ovulation, corpus luteum is developed in the ovary.

 It secretes a large quantity of progesterone along with a small amount

of estrogen.
 Estrogen causes further proliferation of cells in uterus, so that the
endometrium becomes thicker.
 Secretory phase

 Progesterone causes further enlargement of endometrial stroma and

further growth of glands.
 Under the influence of progesterone, the endometrial glands
commence their secretory function.
 Many changes occur in the endometrium before commencing the
secretory function.
 CHANGES IN CERVIX DURING MENSTRUAL CYCLE

Proliferative Phase

 The mucus membrane of cervix becomes thinner and more alkaline

due to the influence of estrogen.
 It helps in the survival and motility of spermatozoa.

Secretory Phase

• The mucus membrane of cervix. becomes thicker and adhesive because

of actions of progesterone.
 VAGINAL CHANGES DURING MENSTRUAL CYCLE

Proliferative Phase

• Epithelial cells of vagina are cornified due to estrogen.

Secretory Phase

 Vaginal epithelium proliferates due to the actions of progesterone.

These two changes increase the resistance of vagina for infection.

 REGULATION OF MENSTRUAL CYCLE

 Regulation of menstrual cycle is a complex process that is carried out

by a well-organized regulatory system.
 The regulatory system is a highly integrated system, which includes
hypothalamus, anterior pituitary and ovary with its growing follicle.
HORMONES INVOLVED IN REGULATION

• Hypothalamic hormone : GnRH

• Anterior pituitary hormones : FSH and LH

• Ovarian hormones :Estrogen and progesterone.

 Hypothalamic Hormone - GnRH

• GnRH triggers the cyclic changes during menstrual cycle by stimulating

secretion of FSH and LH from anterior pituitary.

• GnRH secretion depends upon two factors:

• i. External factors like psychosocial events, which act on hypothalamus

via cortex and many other brain centers

• ii. Feedback effects of ovarian changes via ovarian hormones.

 Anterior Pituitary Hormones - FSH and LH

 FSH and LH modulate the ovarian and uterine changes by acting

directly and/or indirectly via ovarian hormones.
 FSH stimulates the recruitment and growth of immature ovarian
follicles.
 LH triggers ovulation and growth sustains corpus luteum.

 Secretion of FSH and LH is under the influence of GnRH.

 Ovarian Hormones - Estrogen and Progesterone

 Estrogen and progesterone which are secreted by follicle and corpus

luteum, show many activities during menstrual cycle.
 Ovarian follicle secretes large quantity of estrogen and corpus luteum
secretes large quantity of progesterone.
 Estrogen secretion reaches the peak twice in each cycle; once during
follicular phase just before ovulation and another one during luteal
phase.
Ovarian Hormones - Estrogen and
Progesterone

 Estrogen is responsible for the growth of follicles.

 Both the ovarian hormones are under the influence of GnRH, which
acts via FSH and LH.
 In addition, the secretion of GnRH, FSH and LH is regulated by
ovarian hormones.
 REGULATION OF OVARIAN CHANGES

• Follicular Phase

• 1. The biological clock responsible to trigger the cyclic events is the

pulsatile secretion of GnRH, at about every 2 hours.

• 2. Pulsatile release of GnRH stimulates the secretion of FSH and LH

from anterior pituitary

• 3. LH induces the synthesis of androgens from theca cells of growing

follicle
REGULATION OF OVARIAN CHANGES

• Estrogen is responsible for development and growth of graafian follicle.

• Estrogen also exerts a double feedback control on GnRH

i. Initially, when estrogen secretion is moderate, it exerts a negative

feedback control on GnRH so that GnRH secretion is inhibited. This
leads to decrease in secretion of FSH and LH (negative feedback)
 REGULATION OF OVARIAN
CHANGES

ii. During later period of follicular phase, when a large amount of

estrogen is secreted by the maturing follicle, it exerts a positive
feedback effect on GnRH secretion.

iii. GnRH secretion is increased, resulting in secretion of large quantity

of FSH and LH.

LH is necessary to provide the final touches for the growth of graafian

follicle. It stimulates the secretion of estrogen and progesterone.
 Ovulation

• LH is important for ovulation. Without LH, ovulation does not occur

even with a large quantity of FSH.

• The need for excessive secretion of LH for ovulation is known as

ovulatory surge for LH or luteal surge.

• Prior to ovulation, a large quantity of LH is secreted due to positive

feedback effect of estrogen on GnRH.
 Luteal Phase

Role of LH

• 1. Induces development of corpus luteum from the follicle (devoid of

ovum) by converting the granulosa cells into lutein cells

• 2. Stimulates corpus luteum to secrete progesterone and estrogen

• 3. Necessary for the maintenance of corpus luteum.

 Luteal Phase

Role of FSH

• FSH also plays a role during luteal phase.

• 1. Maintains the secretory activity of corpus luteum

• 2. Stimulates lutein cells to secrete inhibin, which in turn inhibits FSH

secretion.