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  • 1. PHSIOLOGY OF MENSTRUAL CYCLE DEFINITIONVISIBLE MENIFESTATION OF CYCLICPHYSIOLOGIC UTERINE BLEEDING DUE TOSHEDDDING OF ENDOMETRIUMDUE TO INVISIBLE INTERPLAY OFHORMONES THROUGH HPO AXIS
  • 2. PRE REQUISITESHPO AXIS SHOULD BE INTACT AND WELL COORDINATED ENDOMETRIUM RESPONSIVE OUTFLOW TRACT PATENT
  • 3. • MENSTRUAL CYCLE-BEGINNING OF A PERIOD TO THE NEXT• MENARCHE- APPEARANCE OF FIRST MENSTRUATION• USUALLY 11-15 YRS OF AGE(MEAN AGE-13)• CYCLE-28-35 DAYS• BLOOD LOSS-20-80 ML• DURATION-4-5 DAYS• PHYSIOLOGICALLY ABSENT-PREGNANCY AND LACTATION AND MENOPAUSE• MENSTRUAL DISCHARGE-DARK ALTERED BLOOD,VAGINAL EPITHELIAL CELLS,MUCUS,FRAGMENTS OF ENDOMETRIUM,PGS,ENZYMESAND BACTERIA
  • 4. INCLUDESOVARIAN CYCLEUTERINE CYCLECERVICAL CYCLE
  • 5. GERM CELLS• ORIGIN-MIGRATE FROM ENDODERM OF YOLK SAC• MULTIPLICATION- AT 20 WEEKS-7 MILLION 7 MONTHS-SOME ENTER PROPHASE OF FIRST MEOTIC DIVISION- PRIMARY OOCYTES SURROUNDED BY FLAT CELLS K/A PRIMORDIAL FOLLICLE AT BIRTH-2 MILLION AT PUBERTY-400000 DURING ENTIRE REPRODUCTIVE PERIOD ONLY 400 OVULATE• MATURATION PRIMARY OOCYTE complete the meosis DIVIDE INTO SECONDARY OOCYTE AND FIRST POLAR BODY in the mid cycle due to LH surge 2ndary oocyte is arrested in the metaphase of 2nd meotic division –completed only after fertilisation.
  • 6. Morphology of oocyte• Measures 130 microns• Nucleus 20-25 microns• Surrounded by corona radiata-radially by granulosa cells• Outer envelope k/a zona pellucida-glycoprotein layer• Cytoplasm k/a vitellus limited by vitelline membrane• Periviteline space between ZP & VM
  • 7. OVARIAN CYCLE• RECRUITMENT OF GROUPS OF FOLLICLES• SELECTION OF DOMINANT FOLLICLE AND ITS MATURATION• OVULATION• CORPUS LUTEUM FORMATION• DEMISE OF CORPUS LUTEUM
  • 8. RECRUITMENT-TAKES 85 DAYS• UNLESS RESCUED BY FSH UNDERGO ATRESIA• SELECTION OF THE DOMINANAT FOLLICLE- ONE WITH HIGHEST ANTRAL CONC. OF OESTROGEN LOWEST ANDROGEN ESTROGEN RATIO MAX RECEPTORS FOR FSH• FSH INDUCES LH RECEPTORS ON THE GRANULOSA CELLS OF DOMINANT FOLLICLEK/A GRAFFIAN FOLLICLE
  • 9. OVULATIONo DOMINENT FOLLICLE REACHES THE SURFACE OF OVARY.o CUMULUS DETACHED FROM THE WALL SO OOCYTE WITH SURROUNDING CORONA RADIATA FLOATS IN THE LIQUOR FOLLICULIo OOCYTE COMPLETES ITS FIRST MEOTIC DIVISIONo WALL AT THE SURFACE BECOMES THINNER AND STIGMA DEVELOPS AS A CONICAL PROJECTIONo CUMULUS ESCAPES OUT OF THE FOLLICLE AS A SLOW OOZING PROCESSo STIGMA IS SOON CLOSED BY A PLUG OF PLASMAo CAUSES OF OVULATION: ENDOCRINAL CAUSES-LH SURGE FSH RISE STRETCHING FACTOR-NECROBIOSIS OF THE OVERLYING TISSUE CONTRACTION OF THE MICROMUSCLES IN THECA EXTERNA AND OVULAR STROMA DUE TO INCREASED PG’So EFFECTS:FOLLICLE IS CHANGED TO CL OVUM PICKED UP BY THE FALLOPIAN TUBE FOR MATURATION OR DEGENERATUION
  • 10. CORPUS LUTEUM• RUPTURED GRAFFIAN FOLLICLE DEVELOPS INTO CORPUS LUTEUM• 4 STAGES1. PROLIFERATION-GREYISH YELLOW DUE TO LIPIDS2. VASCULARISATION-WITHIN 24 HRS OF OVULATION3. MATURATION-DISTINCT YELLOW DUE TO CAROTENE4. REGRESSION-STARTS ON 22nd -23rd day k/a Corpus Albicans• CORPUS LUTEUM OF PREGNANCY IF OVUM IS FERTILISED-SECRETE PROGESTERONE REACHES PEAK AT 8th WEEK LUTEO PLACENTAL SHIFT-7th -10th WEEK LOOKS BRIGHT ORANGE DEGENERATES AT 6th MONTH OF GESTATION
  • 11. ENDOMERIAL/UTERINE CYCLE• Lining epithelium of uterine cavity• Consists of:surface epithilium,glands,stroma, blood vessels.• Basal zone:1/3rd depth, In contact with the myometrium no hormonal /cyclic changes take place measures 1mm• Functional zone:2/3rd under the influence of hormones.
  • 12. 4 stages• Regenerative phaseStarts before the menstruation ceases & completed 2-3 days after the end of menstruationEpithelium cubicalNew blood vessels grow,Glands are regenerated but parallel to the surface,Stroma rexpandsThickness-2mm• Proliferative phase5th or 6th-14th dayEpithelium columnar,nuclie at the base,Glands tubular and perpendicular to the surface,Blood vessels spiral and form loose capillary network,Stromal cells spindle shaped,Thickness 3-4mm,Effect is due to estrogen
  • 13. Secretory phase• Begins on 15th day -5-6 days prior to mens•Epithelium-columnar ciliated•Glands increase in size,sub nuclear vacuolation dueto deposition of glycogen is the earliest change ofprogesterone effect lasts till 21st day,Sawtoothed glandular epithelium, corkscrew shapedglands•Blood vessels show marked spiralling•Stromal cells swollen,large and polyhedral•Thickness 6-8mm•Due to the effect of estrogen and progesterone
  • 14. Menstrual phase• Regressive changes seen if no fertilisation• Starts 5-6 days prior to mens• More pronounced 24-48 hrs before mens• Due to degeneration of corpus luteum and fall in estrogen and progesterone• Degeneration and casting of the endometrium prepared for pregnancy
  • 15. Cervical cycleFollicular phase Luteal phase• Internal os –funnel shaped • Tightly closed• Mucus - thin and watery • Thick and vicid• Strecthability-increased to • Lost beyond 10mm• Fern tree pattern-present • Lost• Glycoprotien network- • Interlacing bridges ,prevent parallel,facilitate sprem sperm penetration penetration• Glandular epithelium-taller • Glands –more branched
  • 16. Vaginal cycleFollicular phase Luteal phase• Cytology-prepondrance of • Prepondrance of superficial large cornified intermeidate cells with cells with pyknotic nuclie folded edges(navicular cells)• Background of the smear- • Dirty due to the presence of clear leucoytes and bacilli
  • 17. GENERAL CHANGESPREOVULATORY OVULATORY• NO SYMPTOMS • PAIN IN ABDOMEN ON ITHER ILIAC FOSSA • SLIGHT VAGINAL BLEEDING • MUCOID VAGINAL DISCHARGE