Menstruation :

The cyclic , physiologic discharge through vagina of blood and mucosal

tissues from the non-pregnant uterus under hormonal control and
normally recurs usually 28 days / 20-45 days
Menstrual cycle :
Cyclic hormone production and parallel proliferation of the uterine lining
prepare for implantation of the embryo

Ovarian cycle

Follicular phase

uterine cycle

luteal phase

proliferative phase luteal phase menstrual phase

Ovarian cycle
Follicular phase
Childhood:
Granulosa cell provide nourishment for ovum & secrete an oocyte
maturation-inhibiting factor[ F: to keep ovum suspended in primordial
state in prophase stage of meiotic division]

Puberty:
FSH & LH from anterior pituitary gland begin secreted in significant
quantities

Ovaries & some follicles within them begin to grow

st
1 stage follicular growth:
moderate enlargement of ovum , which increases in diameter twofold to
threefold

growth of additional layers of granulosa cells in some follicle : primary

follicle

first few days of each monthly menstruation:

FSH & LH are secreted increase slightly to moderately

FSH secrete slightly > LH

FSH cause:
Accelerated growth of 6 12 primary follicles each month
Initial effect : rapid proliferation of granulosa cells rise of many more
layer of this cells give rise of second mass of cells called theca

Theca divided into 2 layers:

1. theca interna : cells epitheliod characteristic similar to granulosa
cells & develop ability to secrete steroid hormone[progesterone &
estrogen]
2. theca externa : develop into high vascular connective tissue capsule
become capsule of developing follicle

proliferative phase of growth for few days

mass granulosa cells secrete follicular fluid[contain high conc. of

estrogen]

accumulation of follicular fluid cause formation of antrum within

mass of granulose cells
from primary follicle antral stage growth of primary follicle is
mainly stimulated by FSH alone

greatly accelerated growth occur larger follicle : vesicular

follicle
cause by:
1. estrogen secreted into follicle granulosa cells form
increasing number of FSH receptor positive feedback
effect[granulose cells more sensitive to FSH]
2. FSH & estrogen combine promote LH receptor more
rapid increase in follicular secretion
3. Increasing estrogen & increasing LH proliferation of
follicular thecal cells & increase their secretion as well

at the same time of Antral follicle grow , ovum also enlarge in

diameter of another thereefold to fourfold total ovum
diameter increase to 10-fold and mass increase to 1000-fold

Follicle enlarges , ovum remains embedded in a mass of

granulose cells located at one pole of follicle

Each month only one follicle fully matures and remainder

undergo atresia[process of 5 11 developing follicle involute
and said become atretic]


F: Allows only one follicle to growth large enough each month
to ovulate

Single follicle reaches diameter of 1 1.5 centimeters at time

of ovulation : mature follicle

Ovulation:
Shortly before ovulation :
1. protruding outer wall of follicle swell rapidly
2. small area in center of follicular capsule [ stigma ] protrudes like nipple

another 30 mins :
1. fluid begins to ooze from follicle through stigma

2 min later :
stigma ruptures , allow more viscous fluid occupy the central portion
of follicle , to evaginate outward

this viscous fluid carry with it ovum surrounded by thousand

granulosa cells = corona radiata

2 days before ovulation :

1. rate of secretion of LH by anterior pituitary gland increase
markedly
2. rising 6 10 fold & maxi 16 hrs before ovulation

at same time :
FSH increase 2 3 fold , FSH & LH cause rapid swelling of follicle
in last few days before ovulation

LH cause :
Converting granulosa and theca cells to progesterone secreting
cells

Cause rate of secretion of estrogen fall 1 day before ovulation

&
increasing amount of progesterone

checkpoint :
because of :
1. large quantity LH secreted by anterior pituitary gland
2. lH cause rapid secretion of progesterone

2 events in ovulation :

theca externa
[capsule of follicle]

proteolytic enzymes
lysosomes
dissolution of follicular
wall weakened

follicular hyperemia
&prostaglandin secretion

plasma transudation
into follicle

release
from

follicle swelling
capsular
follicle wall
degeneration of stigma

follicle
rupture
discharge

evagination of ovum
luteal phase :
luteinization: depend mainly on LH secreted by pituitary gland
first few hours after expulsion of ovum

remaining granulosa & theca interna cells change rapidly into

lutein cells

they enlarge in diameter two or more times & filled with lipid
inclusion cause yellowish appearance
called corpus luteum

1. granulosa cells develop extensive intercellular smooth

endoplasmic reticula form large amount of female sex
hormone[progesterone > estrogen]
2. theca cells form mainly androgens androstenedione &
testosterone convert by enzyme aromatase into estrogen

corpus lueteum grows about 1.5 cm in diameter, 7 8 days

after ovulation

corpus luteum involute & loss secretory function and

yellowish,lipid characteristic 12 days after ovulation

become corpus albicans

replaced by conncective tissue & over month it is absorbed
checkpoint :

corpus luteum secrete large

amount progesterone & estrogen
negative feedback to anterior
pituitary gland

to maintain low secretory

rates of FSH & LH so that no
growing of follicle

lutein cells secrete

small amount inhibin
inhibit secretion of
anterior pituitary gland
especially FSH
low conc. FSH & LH in
blood
loss these hormone finally
cause degeneration
corpus luteum ,
process : involution at 26th
day (after 12 days life)

2 days before menstruation begins :

sudden cessation of secretion of estrogen , progesterone , and inhibin by
corpus luteum

remove feedback inhibition of the anterior pituitary gland

allow it to begin secreting increase amount of FSH & LH again

FSH & LH initiate the growth of new follicle

Begin new ovarian cycle

Uterine / Endometrium cycle

Monthly cyclical production of estrogen and progesterone by overies in an
endometrial cycle in the lining of the uterus
Proliferative phase
Most of the endometrium has been desquamated [to shed] by
menstruation :
1. a thin layer of endometrial stroma remains
2. epithelial cells left located in the remaining deeper portions of the
glands and crypts of the endometrium

under influence of estrogen secreted increasingly by ovary

stromal cells & epithelial cells proliferate rapidly

checkpoint:
endometrial surface re-epithelialized within 4 7 days after begin
menstruation

next a week & half / before ovulation :

thickness endometrium increase greatly :
1. increase number of stromal cells
2. progressive growth of endometrial glands & new blood vessel


at time ovulation:
1. endometrium 3 5 mm thick
2. endometrial gland in cervical region secrete thin , stringy , mucus
along the length of cervical canal ; f(x) = help guide sperm in proper
direction from vagina into uterus

Secretory / Progestational phase

After ovulation :
Progesterone & estrogen are secreted in large quantities by corpus
luteum

1. Estrogen cause proliferation in endometrium (slight addition

only)
2. Progesterone cause marked swelling and secretory development
of endometrium

Checkpoint / endometrial changes:

1. gland increase in tortuosity [full of twist & turn]
2. excess of secretory substances accumulates in glandular
epithelial cells
3. cytoplasm of stromal cells increases
4. lipid & glycogen deposits increase greatly in stromal cells
5. blood supply in endometrium increases in proportion f(x) = to
develop secretory activity
6. blood vessel become highly tortuous
7. 1 week after ovulation , endometrium 5 6 mm thick

f(x) endometrial changes:

1. to produce highly secretory endometrium contains large
amounts of stored nutrient to provide appropriated
condition for fertilized ovum implantation
2. uterine secretions [uterine milk] provide nutrition for
early dividing ovum

Menstruation
Ovum not fertilized , 2 days before end of monthly cycle

1. Corpus luteum suddenly involutes

2. Esrogen & progesterone decrease to low level secretion

Checkpoint
Cause of menstruation :
Reduction of estrogen & progesterone

Effects:

Decreased stimulation of endometrial cells

Rapid involution of endometrium to 65% of previous thickness

involution cause Release of prostaglandin

Tortuous blood vessel become vasospastic (a sudden contration of

blood vessel)

Vasopasm (a sudden constriction of blood vessel cause reduction in

blood flow) , decrease in nutrients to endometrium & loss of
hormonal stimulation >>>>>> endometrium necrosis especially
blood vessel

1. Blood seep (to pass slowly) into vascular layer od endometrium

2. Hemorrhagic areas grow rapidly over period 24 36 hrs

Necrotic outer layers of endometrium separate from uterus at

site of hemorrhages until 48 hrs after onset of menstruation

All superficial layers of endometrium have desquamated

Initiate uterine contraction

Expel of uterine contents

4 7 days after menstruation ;

loss of blood cease
why? : endometrium has become re-epithelialized

begin new uterine cycle

Anatomy :

Follicle growth :

Endometrium :