MENSTRUAL CYCLE

 Menstrual Cycle:- 

⦁ Menstrual cycle duration -(21 To 35 Days )   28days

⦁ Blood flow (2 To 6 Days )   3 days

⦁ Blood loss (20 To 60 Ml)  35 ml

→ Menstrual cycle is the visible manifestation of cyclic physiologic uterine bleeding due to shedding of the endometrial following invisible interplay of hormones mainly through - H- P- O

Hypothalamus-pituitary- ovarian axis

Hypothalamus

↓ Ghrh

Anterior Pituitary Gland

↓

  ↓                         ↓

FSH                          LH

  ↓                          ↓

Ovarian Follicles                 Corpus Luteum

    ↓                          ↓

Estrogen             Progesterone] Ovarian Hormone

Changes During Menstrual Cycle :-

Change occur in ovary & uterus, vagina, cervix

These Main Changes Are -----

⦁ Ovarian Changes 

⦁ Uterine Change

Ovarian Changes:- 

During each menstrual cycle the changes in the ovary occurs in 2 phases:- 

(A) Follicular phase

(B) Luteal phase

Follicular Phase:- (5 To 14 Days)

⦁ This phase extends from 5th day of the cycle till the time of ovulation take place about 14 days. 

⦁ During this phase the primary follicle of the ovary develop in to a graffian follicles.

⦁ The follicles consists of ovum surrounding by epithelial cell names granulosa cells .

⦁ These follicles gradually draw into a matured follicles through various stage.

Primordial germ follicle

↓

Primary follicle 

↓

Vescular follicles

↓

Mature  graffian  follicles

Note:- Graffian follicles is the mature ovarian follicles  on the 14days of menstruation the graffian follicles is ready to release ovum.

(A)Ovulation:- 

Process In these is rupture of graffian follicle discharge of ovum in to the abdominal cavity.

⦁ The ovulation occurs usually on 14th days of menstrual cycle if cycle duration is 28 days

(B) Lacteal Phase:- 15 To 28 Days { AIIMS  2017 }

⦁ This phase extends from 15th days to 28 days of menstrual cycle 

⦁ After ovulation the ruptured follicles develop into a yellow body called corpus luteum.

⦁ The corpus Latium act as a temporary endocrine gland & secrete large quantity of Progesterone & Small Amount Of Estrogen

⦁ The corpus Latium degenerates as corpus Albicans if fertilization has not occurred on 26 to 28 days.

Germinal Epithelium (On Ovary)

↓

Primary follicles

↓

Vesicular follicles

↓

Graffian follicles

↓

        Ovulation

                                     ↓

↓                                                                              ↓

If not  fertilization                                       If fertilization occurs

↓        ↓

Carpus luteum change                 carpus luteum not change in carpus  albicans                                   carpus albicans                                    ↓

Destroy after 26th day of cycle 

↓

New cycle start

Uterine Changes :- (I) Proliferative  Phase (5 To 14 Days)

         (II) Secretary Phase (15 To 28 Days)

         (III) Menstrual Phase\ Bleeding Phase (1-5 Days)

(1) Proliferative Phase:- 

⦁ During Proliferative Phase The Ovary Secretes Oestrogen .

⦁ Oestrogen Act As the endometrial  cells.

⦁ These endometrial cells proliferate rapidly under the influence of Oestrogen 

⦁ Epithelium Re-Appear In 4 To 7 days of proliferative phase 

⦁ New blood vessels also Appear in the endometrium At the end of Proliferative phase the endometrial in 3 To 4 mm thick.

(2) Secretary Phase:-

⦁ After ovulation corpus luteum is develop in the ovary .

⦁ It Secretes large quantity of progesterone a smalls quantity of estrogen.

⦁ Estrogen causes proliferation enlargement of endometrium

⦁ At the end of secretary phase the thickness of endometrium is 5 to 6 mm.

⦁ Actually the secretary P-phase is preparatory period during which the uterus is prepared for the implantation of ovum 

⦁ If fertilized  ovum is implanted menstruation  occur .

⦁ If the ovum is not fertilized menstruation occur after this phase new cycle start.

(3) Menstrual Phase (Bleeding Phase):- (1 to 5 days)

⦁ This is the phase during  the bleeding occur & its duration last about first 4 to 5 days.

Causes:-

Two days before the onset of bleeding (26 to28 ) there is sudden reduction in the release of estrogen & progesterone from ovary this is responsible for bleeding. 

CHANGES IN THE ENDOMETRIUM:- 

due to lack of hormones estrogen & progesterone 

↓

construction of blood vessels of Endometrium

↓

             hypoxia of Endometrium

                                                ↓

necrosis in the Endometrium

↓

                                Blood vessels ruptured in uterus

↓

shredded endometrim stimulate nerve receptor of uterus .

↓

stimulate hypothalamus

↓

release oxytocin through post. Pituitary gland 

↓

contract uterus

↓

bleeding through vagina

⦁ Along this blood the outer  layer of  endometrium is separate &  shed off.

⦁ this process is continuing for about 24 to 36 hours.

⦁ end of menstrual phase the thickness of endometrium is only 1 mm.

SPECIAL POINTS:-

⦁ an enzyme "plasmin " inhibit clotting in M.C. blood.

⦁ FSH is responsible for follicular growth.

⦁ LH is important for ovulation   (LH-surge).

⦁ LH & FSH both are essential for luteal phase become they stimulate carpus luteum to release  progesterone , estrogen 

⦁ luteal phase is longest phase of menstrual cycle .

⦁ proliferative phase - estrogen is essential.

⦁ secretary phase- progesterone is essential

⦁ menstrual phase - estrogen & Progesterone ↓

⦁ maximum level → estrogen -12th days 

⦁ Progesterone → 24days 

⦁ temperature 0.1 to 0.60  increase during ovulation at ovulation temp. up to [37.3 to 37.60 c]

⦁ M.C. duration  21 - 35 days 

⦁ blood flow -2 to 6 days 

⦁ blood loss 20-60 ml

OLIGOMENORRHEA:- infrequent, irregular timed episodes of bleeding occurring at intervals of more then 35 days.

POLYMENORRHEA:-  frequent but  regularly  timed episodes of bleeding occurring  at intervals of   21 or less days.

MENORRHAGIA:- 

regularly timed episodes of bleeding that are excessive amount (>80ml) and (>7 days)

HYPOMENORRHAGIA:-

regularly timed bleeding that is decrease amount (<20ml) or (<2).

METORRSHAGIA:- 

Irregularly timed bleeding .

MENOMETORRHAGIA:-

excessive prolonged bleeding that occur at Irregularly timed frequent intervals.

DYS MENORRHOEA:-

painful menstrual bleeding .

AMNORRHEA:- 

absence of menstrual cycle.

EUMENORRHOEA:- 

normal menstrual cycle.