PHYSIOLOGY OF

MENSTRUAL CYCLE
Objectives
Understand hormonal changes in menstrual
cycle
Understand ovarian changes in menstrual
cycle
Understand endometrial changes in
menstrual cycle
Stages of menstrual cycle
Follicular phase (Proliferative phase)
Day 1 to 13
Ovulation phase
Day 14
Luteal phase (Secretory phase)
Day 15 to 28
Organs involved in menstrual
cycle
Hypothalamus
Anterior pituitary gland
Ovary
Uterus (Endometrium)
Hormones in menstrual cycle
Gonadotrophin Releasing Hormone (GnRH)
Follicle Stimulating Hormone (FSH)
Luteinising Hormone (LH)
Estrogen
Progesterone
Inhibin
Pituitary and Hypothalamic events
Atrophy of the corpus luteum with falling
progesterone and estrogen levels initiates the
menstrual cycle
Low estrogen and progesterone levels cause
GnRH secretion by the hypothalamus
GnRH acts on the pituitary to secrete FSH and LH
LH in theca cells
FSH in granulosa cells
FSH causes development of 18-20 follicles
Developing follicles produce estrogen through
action of FSH and LH
One follicle becomes dominant follicle
Largest and most developed follicle
Most efficient aromatase activity and highest
concentration of FSH-induced LH receptors
Produce greatest amount of oestradiol and inhibin
Ovarian events
Ovarian events
Rising estrogen levels inhibit FSH and LH
All follicles except dominant follicle undergo
atresia
Rising estrogen levels and also progesterone from
dominant follicle cause LH surge
LH surge brings about ovulation
Breakdown of follicular wall by proteolytic enzyme
Post ovulatory events
Corpus luteum (CL) is formed after
ovulation
Granulosa and theca cells
CL produces progesterone and estrogen
Hormones from CL maintain endometrium
until CL undergoes atresia
Atresia of CL leads to withdrawal of
estrogen and progesterone
Shedding of endometrium (menses)
Initiation of another cycle

Clinical features of normal
menstrual cycle
Usual duration of menstrual flow is 3-10
days
28 days menstrual cycle (normal range: 21-
35 days)
Normal volume of menstrual loss is 30ml to
80ml per month
Menstrual disorders
Dysmenorrhea
Menorrhagia
Amenorrhea
Menstrual disorders
Amenorrhea: absence of menstruation
during the reproductive years
Primary amenorrhea: Absence of
menstruation by 16 years of age OR fail to
develop secondary sexual characteristics by
14 years of age
Secondary amenorrhea: cessation of
menstruation for more than six months in a
normal female of reproductive age
Causes of primary amenorrhea
Turners syndrome
CNS tumours
Androgen insensitivity
(Testicular feminisation
syndrome)
Hyperprolactinaemia
Congenital adrenal
hyperplasia

Vaginal atresia
Imperforate hymen
Mullerian abnormalities
Hyperthyroidism
Late development
Stress
Low body weight
Adrenal tumours

Causes of secondary amenorrhea
Pregnancy
Anovulation
PCOS
Intrauterine synechiae
Secondary Vaginal atresia
Hyperprolactinaemia
Pituitary tumours
Cushings syndrome


Hyperthyroidism
Premature ovarian failure
Hypothalamic pituitary
dysfunction
Stress
Severe weight loss
General medical disorders
Adrenal tumours
Vaginal Atresia