1. PHSIOLOGY OF MENSTRUAL
CYCLE
DEFINITION
VISIBLE MENIFESTATION OF CYCLIC
PHYSIOLOGIC UTERINE BLEEDING DUE TO
SHEDDDING OF ENDOMETRIUM
DUE TO INVISIBLE INTERPLAY OF
HORMONES THROUGH HPO AXIS

2. PRE REQUISITES
HPO 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. INCLUDES
OVARIAN CYCLE
UTERINE CYCLE
CERVICAL 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.

7. 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

8. OVARIAN CYCLE
• RECRUITMENT OF GROUPS OF FOLLICLES
• SELECTION OF DOMINANT FOLLICLE AND ITS
MATURATION
• OVULATION
• CORPUS LUTEUM FORMATION
• DEMISE OF CORPUS LUTEUM

9. 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

11. OVULATION
o DOMINENT FOLLICLE REACHES THE SURFACE OF OVARY.
o CUMULUS DETACHED FROM THE WALL SO OOCYTE WITH SURROUNDING CORONA
RADIATA FLOATS IN THE LIQUOR FOLLICULI
o OOCYTE COMPLETES ITS FIRST MEOTIC DIVISION
o WALL AT THE SURFACE BECOMES THINNER AND STIGMA DEVELOPS AS A CONICAL
PROJECTION
o CUMULUS ESCAPES OUT OF THE FOLLICLE AS A SLOW OOZING PROCESS
o STIGMA IS SOON CLOSED BY A PLUG OF PLASMA
o 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’S
o EFFECTS:FOLLICLE IS CHANGED TO CL
OVUM PICKED UP BY THE FALLOPIAN TUBE FOR MATURATION OR
DEGENERATUION

12. CORPUS LUTEUM
• RUPTURED GRAFFIAN FOLLICLE DEVELOPS INTO CORPUS LUTEUM
• 4 STAGES
1. PROLIFERATION-GREYISH YELLOW DUE TO LIPIDS
2. VASCULARISATION-WITHIN 24 HRS OF OVULATION
3. MATURATION-DISTINCT YELLOW DUE TO CAROTENE
4. 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

13. 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.

14. 4 stages
• Regenerative phase
Starts before the menstruation ceases & completed 2-3 days after the end of
menstruation
Epithelium cubical
New blood vessels grow,
Glands are regenerated but parallel to the surface,
Stroma rexpands
Thickness-2mm
• Proliferative phase
5th or 6th-14th day
Epithelium 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

15. Secretory phase
• Begins on 15th day -5-6 days prior to mens
•Epithelium-columnar ciliated
•Glands increase in size,sub nuclear vacuolation due
to deposition of glycogen is the earliest change of
progesterone effect lasts till 21st day,
Sawtoothed glandular epithelium, corkscrew shaped
glands
•Blood vessels show marked spiralling
•Stromal cells swollen,large and polyhedral
•Thickness 6-8mm
•Due to the effect of estrogen and progesterone

16. 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

17. Cervical cycle
Follicular 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

18. Vaginal cycle
Follicular 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

19. GENERAL CHANGES
PREOVULATORY OVULATORY
• NO SYMPTOMS • PAIN IN ABDOMEN ON
ITHER ILIAC FOSSA
• SLIGHT VAGINAL BLEEDING
• MUCOID VAGINAL
DISCHARGE