MENSTRUAL CYCLE

Anatomy and Physiology

Post RM- BSc.M 2021
Aga Khan University –Kampala –Uganda Campus
Kyakuwaire Hellen
12th.August.2019
 Learning objectives

By the end of this session student should be able to

• Define menstrual and ovarian cycles
• Describe the phases of the menstrual and the
ovarian cycles
• Discuss the fertile days of the menstrual cycle
• Outline the overview of fertilization and
implantation
• Explain the importance of knowledge of the
menstrual cycle to midwifery practice
 Definition of menstrual and ovarian cycles

• The menstrual (uterine) cycle is a series of

changes in the endometrium lining of the uterus.

• The ovarian cycle is a series of events that are

involved in the maturation of an ovum, or egg.
 Definition of terms

• Menstruation is the shedding of the endometrium

accompanied by bleeding.
• Menstruation starts during puberty (at menarche) or
first menstruation, takes place between the ages of
12 and 14 years
• Menopause or cessation of menstruation
permanently takes place between the age of 45 and
50 years.

• The term female reproductive cycle refers to

both the ovarian and uterine cycles
 Menstruation cycle

• Menstruation occurs every month in women of

childbearing
• Menstrual cycle begins with the first day of bleeding,
which is counted as day 1.
• The cycle ends just before the next menstrual
period.
• The most common cycle length is 28 days but a
cycle may be as short as 21 days or as long as 35
days without being abnormal
• Blood loss per cycle is 30ml average (normal range
13-80 mls)
 Physiological changes during Menstrual
cycle
• During childhood the sexual components of the
hypothalamus and the pituitary gland are in an
immature and resting state.
• At puberty some unknown stimulus acts on the
hypothalamus causing it to produce a releasing
substance (GnRH) which stimulates the pituitary
gland in the female
• The pituitary gland then produces two hormones;
the follicular –stimulating hormone (FSH) and the
luteinizing hormone (LH).
• These two hormones are known as tropic sex
hormones because they influence the sex glands.
 Physiological changes during Menstrual
cycle
• Normal menstruation and pregnancy depends on
events occurring at four different places in the body.
The places include:
– The hypothalamus
– The anterior pituitary gland
– The ovaries
– The uterine endometrium
 The hypothalamus

• This is part of the brain

• At puberty it becomes active and produces the
releasing substance (GnRH) which stimulates
the pituitary gland.
 Anterior pituitary gland

• This is at the base of the brain

• The gland produces two types of hormones
• Follicle –stimulating hormone (FSH) and
• Luteinizing (LH). These hormones stimulate
the ovarian follicles.
 Ovaries
• Two hormones produced in the anterior pituitary
gland stimulate the ovarian follicles
• The follicular –stimulating hormone (FSH) stimulates
the development of the ovarian follicle to become a
mature egg or ovum.
• This growing follicle produces another hormone,
oestrogen during the first 14 days in the 28 day cycle
 Ovaries

• Luteinizing hormone stimulates the growing ovarian

follicle to rupture at mid-cycle, on the 14th day. This is
known as ovulation
• LH also stimulates the remainder of the follicle, after
the egg (ovum) has left to become a corpus luteum
and produce the hormones progesterone and
estrogen
• Progesterone and estrogen the steroid hormones are
responsible for the decidualization of the endometrium
(its development) and maintenance, respectively.
 The uterine endometrium

• This is a garden that is prepared for the reception

and future growth of the fertilized egg.
• The endometrium grows in two phases although
the menstrual cycle is divided into 3 phases with
the menstrual phase inclusive
– Phase 1 - the proliferative phase
– Phase 2 - the secretory phase
 The proliferative phase

• The endometrium grows and thickens

• Uterine secreting glands increase in size and

produce mucus.

• Uterine blood vessels begin to grow.

• This phase is controlled by oestrogen

• It lasts until mid-cycle approximately 14 days from

the first LNMP
 The proliferative phase

• The length of this phase varies in different women

• It is this variation that makes some women to have

short cycles of 21 or 24 days and others long
cycles of 32 days or more.

• Ovulation occurs in the ovaries at the end of this

stage, usually around day 14, triggered by a surge
in luteinizing hormone (LH) from the AP gland.
 The secretory phase

• This phase is from ovulation to the start of the next

menses.
• The endometrial glands increase in size and length
and secrete the foodstuff
• That is why it is called secretory phase
• The events are controlled by progesterone
• What follows will depend on whether the ovum is
fertilized or not
 If the ovum is not fertilized

• It dies and degenerates 36-48 hrs after its release.

• The corpus luteum will also degenerate about 10
days later and stop producing hormones
• The endometrium which had been prepared for
pregnancy will break down and be shed.
• Bleeding or menstruation follows and takes
approximately the 28th day, that is 14 days after
ovulation.
 If the ovum is fertilized
• The corpus luteum will continue growing and producing
hormones to support the pregnancy

• The fertilized ovum will get implanted on the

endometrium

• The endometrium will continue growing and feeding the

embryo under the influence of hormones coming from
the corpus luteum

• Menstruation will stop for nine months. This is pregnancy.

 Menstrual phase

• The cells of the uterine lining start to die, and the

lining sloughs off and causes bleeding.

• Two-thirds of the endometrial lining sheds during

menses.

• During this time the ovaries are beginning the

follicular stage.
 The ovarian cycles

While the uterus is proceeding through the 3 phases

as discussed above, the ovaries pass through the
following phases:

• Follicular phase: (about 14 days): Between 3-30

follicles, each containing 1 ovum (egg), begin to
grow, with usually 1 reaching maturity while the
others break down.

• Ovulatory phase (about 16-32 hours): The ovum

is released from the follicle and enters the fallopian
tube.
 The ovarian cycles

• Luteal phase (about 14 days): The ruptured follicle

forms a structure called the corpus luteum.

• The corpus luteum produces progesterone, which

helps to prepare the endometrium for a fertilized egg.
 Fertile days of the menstrual cycle

• A woman's fertile days depend on ovulation as well

as the life span of the egg and the sperm.
• The life span of the egg/ova is 12-24 hrs while the
sperm is 48-72 hours
• The egg and sperm are most likely to join, and
pregnancy is most likely to occur, when unprotected
sexual intercourse takes place during the 2 days
before ovulation or on the day of ovulation.
• It is also possible a day or 2 after ovulation—
although this is less likely.
Fertile days of the menstrual cycle
• Most women ovulate between 11 and 16 days
after the first day of their last period.
• This is the time when women are most fertile and
most likely to get pregnant.
• But the time of ovulation can be different from
month to month and different between different
women.
• Therefore, a woman could potentially become
pregnant if she has unprotected sex on most days
of her menstrual cycle. See diagram next slide
 Overview of fertilization and implantation
Fertilization:
• Once the egg is released from the ovary (ovulation),
it can live for about 24 hours
• At the time of ovulation the ovum is caught by the
fimbria and starts on its journey to the fallopian
tube.
• This passage take about 3 days
• The sperm can stay alive for 48-72 hours in the
vagina, cervical canal and uterine cavity
• Fertilization usually takes place in the outer distal
part of the tube (Ampulla).
 Overview of fertilization and implantation

Fertilization cont’d
• Fertilization takes place once the egg joins with the
sperm and forms the oocyte.
• The fertilized ovum is then swept down the FP by
the action of the ciliated columnar epithelium
combined with peristalsis
• The ovum leaves the tubal opening at the cornua of
the uterus on the 3rd or 4 day as a 30-cell or 40-cell
solid mass
• The fertilized oocyte then implants into the
endometrium by 5-7 days after fertilization
 Overview of fertilization and implantation

Implantation
• By this time progesterone will already have had
some effect on the endometrium: it will be like a
blood –filled sponge.
• The fertilized ovum (blastocyst now burrows into the
mucosa of the uterus.
• Once implantation has taken place a zone of cells
around the outside of the blastocyst called the
trophoblastic layer starts producing hormones
 Overview of fertilization and implantation

Implantation
• The hormones are very similar to follicular –
stimulating hormone and luteinizing hormone which
are produced by the anterior pituitary gland in a non
–pregnant woman.
• With pregnancy however, the trophoblast now takes
over from the APG to direct the corpus luteum in the
production of oestrogen and progesterone.
• The corpus luteum is now kept alive and active.
 Overview of fertilization and implantation

• By the 14th day after fertilization the formation of the

placenta begins
• Part of the trophoblast is formed in finger-like
projections called chorionic villi
• These then produce the trophic hormone (HCG)
and also oestrogen and progesterone.
• The corpus luteum persists until about 4 months of
pregnancy.
• Then the placenta has become large enough to
take over all the hormone production necessary to
maintain pregnancy.
Overview of fertilization and implantation

• If the ovum is not fertilized by a sperm, the

corpus luteum dies with the levels of oestrogens
and progesterone dropping off
• This causes the endometrium to begins to
slough off and pass through the vagina, and
menstruation begins the reproductive cycle
again
Overview of fertilization and implantation
 Importance of knowledge of the menstrual
cycle to midwifery practice
• After going through the theory related to menstrual
cycle, please contribute to how its knowledge will
benefit your practice as a midwife
Importance of knowledge of the menstrual
cycle to midwifery practice
• Family planning
• Fertility and Infertility issues
• Menstrual hygiene
 References

Jacob, A. (2012). A comprehensive textbook of

Midwifery and Gynecological Nursing: JP Medical Ltd.
Coad, J. (2012). Anatomy and Physiology for Midwives.
Elsevier Philadelphia USA.
Fraser D.M & Cooper M.A. (2010). Myles Textbook for
Midwives (15th ed.). London: Churchill Livingstone