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Physiology of Menstrual Cycle &
ovulation
King Khalid University Hospital
Department of Obstetrics & Gynecology
Course 482
Menstrual Cycle
• Complex interactions among hypothalamus,
pituatary gland , ovaries & endometrium
• Ovary: functional & morphologic changes
resulting in follicular maturation, ovulation
and corpus luteum formation
• Endometrium: functional and morphologic
changes, either to prepare it for conception or
shedding of the menstrual endometrium
• Pituitary Gland:
- Below the hypothalamus
- within a bony cavity ( sella turcica)
- above it, dura matter ( diaphragma sellae)
- divided into 2 portions
Pituitary Gland
• FSH and LH: synthesized and stored in
gonadotrophs
- glycoproteins: alpha and beta subunits
- alpha: similar ( FSH, LH and TSH)
- beta: variable
- half-life: LH: 30 min, FSH: several hrs
Gonadotropin Secretory patterns
Steroidogenesis
• Two gonadotropin-two- cell theory
Two gonadotropin-two- cell theory
Hypothalamus
• GnRH: decapeptide
• In the arcuate nucleus
• Responsible for the synthesis and release of
FSH & LH
• Reaches anterior pit via hypophyseal portal
vessels
• Its receptors are present in other sites beside
pituitary gland e.g., ovary
GnRh
• Secreted in a pulsatile fashion
- early follicular phase: Q 90 mins
- preovulatory: Q 60-70 mins
- luteal: variable
• Continuous → downregulation/desensitization
- GnRh agonist: endometriosis, fibroids, hirsutism
GnRh release pattern
Ovarian Cycle
• Estrogens:
- gradually increase during follicular phase
- remember: 2 gonadotropin-two - cell theory
Steriodogenic pathways in the ovary
Progestins
• Follicular phase: very little from the ovary
• The bulk: peripheral conversion of adrenal
pregnenolone and P sulfate
• High production: after ovulation/ CL
• Corresponds with ↑ basal body temperature
• Max: 5-7 days after ovulation
Follicular development
Follicular development
• Primordial follicle
• Primary follicle
• Secondary follicle
• Cohort of follicles is recruited each cycle
• Only one continues differentiation and
maturation
• Others: atresia
• Maturation depends on: FSH and LH receptors
Ovulation
• Most important event: LH surge
• Proteolytic enzymes → dissolution of follicular
wall
• Stigma formation
• Ovulation: rupture of the stigma
• Oocyte + corona radiata + cumulus cells
• Gradual: several minutes → an hour
Ovulation
Ovulation
Corpus luteum formation
• Lutenization of granulosa cells ( LH)
• CL: luteinized GC + theca cells + capillaries +
connective tissue
• Major source of ovarian progesterone
• Lives 9-10 days if no pregnancy
• It gradually regresses → corpus albicans
Endometrial physiology
• Responsive to E, P and A
• Results in: menstruation,?Implantation
/pregnancy
• 2 zones:
1- functional layer ( outer)
2- basal layer (inner)
Histophysiology of the Endometrium
1- Menstrual phase: disruption of endometrial tissues, WBC
infiltration, RBCs extravasation
2- Proliferative phase: E-induced proliferation
3- Secretory phase: P- induced secretion of glycogen, mucus & other
substances

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13820523.ppt

  • 1. Physiology of Menstrual Cycle & ovulation King Khalid University Hospital Department of Obstetrics & Gynecology Course 482
  • 2. Menstrual Cycle • Complex interactions among hypothalamus, pituatary gland , ovaries & endometrium • Ovary: functional & morphologic changes resulting in follicular maturation, ovulation and corpus luteum formation • Endometrium: functional and morphologic changes, either to prepare it for conception or shedding of the menstrual endometrium
  • 3.
  • 4.
  • 5. • Pituitary Gland: - Below the hypothalamus - within a bony cavity ( sella turcica) - above it, dura matter ( diaphragma sellae) - divided into 2 portions
  • 6.
  • 7.
  • 8.
  • 9. Pituitary Gland • FSH and LH: synthesized and stored in gonadotrophs - glycoproteins: alpha and beta subunits - alpha: similar ( FSH, LH and TSH) - beta: variable - half-life: LH: 30 min, FSH: several hrs
  • 11.
  • 14. Hypothalamus • GnRH: decapeptide • In the arcuate nucleus • Responsible for the synthesis and release of FSH & LH • Reaches anterior pit via hypophyseal portal vessels • Its receptors are present in other sites beside pituitary gland e.g., ovary
  • 15. GnRh • Secreted in a pulsatile fashion - early follicular phase: Q 90 mins - preovulatory: Q 60-70 mins - luteal: variable • Continuous → downregulation/desensitization - GnRh agonist: endometriosis, fibroids, hirsutism
  • 17. Ovarian Cycle • Estrogens: - gradually increase during follicular phase - remember: 2 gonadotropin-two - cell theory
  • 19. Progestins • Follicular phase: very little from the ovary • The bulk: peripheral conversion of adrenal pregnenolone and P sulfate • High production: after ovulation/ CL • Corresponds with ↑ basal body temperature • Max: 5-7 days after ovulation
  • 21. Follicular development • Primordial follicle • Primary follicle • Secondary follicle • Cohort of follicles is recruited each cycle • Only one continues differentiation and maturation • Others: atresia • Maturation depends on: FSH and LH receptors
  • 22. Ovulation • Most important event: LH surge • Proteolytic enzymes → dissolution of follicular wall • Stigma formation • Ovulation: rupture of the stigma • Oocyte + corona radiata + cumulus cells • Gradual: several minutes → an hour
  • 25. Corpus luteum formation • Lutenization of granulosa cells ( LH) • CL: luteinized GC + theca cells + capillaries + connective tissue • Major source of ovarian progesterone • Lives 9-10 days if no pregnancy • It gradually regresses → corpus albicans
  • 26. Endometrial physiology • Responsive to E, P and A • Results in: menstruation,?Implantation /pregnancy • 2 zones: 1- functional layer ( outer) 2- basal layer (inner)
  • 27. Histophysiology of the Endometrium 1- Menstrual phase: disruption of endometrial tissues, WBC infiltration, RBCs extravasation 2- Proliferative phase: E-induced proliferation 3- Secretory phase: P- induced secretion of glycogen, mucus & other substances