NORMAL MENSTRUAL CYCLE

By
Hossam Abdel-Mageed,MD
Helwan University
 Introduction
Ovarian cycle :
Cyclic Changes occurring in the ovary.
Follicular phase : Grafian follicle
Ovulation : 14 days before next cycle
Luteal phase : corpus luteum (14 days fixed)

Menstrual cycle : (endometrial cycle)

Cyclic Changes occurring in the endometrium.
Menses : 2-7 days
Proliferative : proliferation of endometrium
Secretory : fully active endometrium
 Introduction

Menses proliferative Secretory

Folloicular Luteal

Ovulatioon
 Hypothalamus

GnRH

Pituitary

FSH LH

Ovary

Estrogen / Progesterone
 Hormones
Gonadotrophin releasing H :
Chemistry: It is a decapeptide (10 a.a).
Source: hypothalamus.
Action:-Secreted in pulses every 60-90 minutes →secretion of FSH & LH
GnRH Agonist:
- Causes persistent activation of GnRH receptors → initial release
followed by profound suppression → marked ↓ in
gonadotrophins.
- Uses of GnRH Agonists anti estrogen
1. Controlled ovulation induction
2. Treatment of precocious puberty .
3. ↓the size of fibroids before surgery.
GnRH Antagonist:
-Bind to the GnRH receptors but it doesn't cause initial activation
(flare up) of receptors → immediate down regulation of the pituitary
 Hormones
GonadotrophinFSH
releasing hormones: LH
Chemistry Water soluble glycoprotein
Chemistry: It is a decapeptide (10 amino acids).
Structure α subunit 92 aa α subunit 92 aa
Source: anterior pituitary
β subunit 118 .aa β subunit 121 aa
Action:-Secreted
Source in pulses every 60-90
Basophil cellsminutes →secretion
of anterior pituitary of FSH & LH
GnRH
Level Agonist:
2 peaks ; day 3 day 13 1 peak, day 13
- Causes
Receptors
persistent activation of GnRH
On granulosa cell membrane
receptors → initial release
On theca cell membrane
followed by profound suppression → marked ↓ in
gonadotrophins.
Action 1-Growth, ripening , maturation 1-With FSH → ripening of the
- Uses ofofGnRH Agonists
The ovarian anti estrogen
follicles ovarian follicles
1. Controlled ovulation
2-(++) aromatase induction
activity of 2-(++) androgen synthesis by
2. Treatment
granulosa of precocious
cells puberty
→ E2 production . cells
theca
3. ↓the size LH
3-With → ovulation.
of fibroids 3-LH surge → ovulation.
before surgery.
4-(++) formation of LH receptors. 4-(++) corpus luteum → estrogen &
GnRH Antagonist: progesterone.
-Bind to the GnRH receptors but it doesn't cause initial activation
Uses(flare up) of receptors
Treatment → immediate
of anovulation down regulation
& hypogonadotrophic of the pituitary
amenorrhea
Hormones

→
 Hormones
Gonadotrophin releasing H :
Chemistry: It is a decapeptide (10 a.a).
Source: anterior pituitary .
Action:-Secreted in pulses every 60-90 minutes →secretion of FSH & LH
GnRH Agonist:
- Causes persistent activation of GnRH receptors → initial release
followed by profound suppression → marked ↓ in gonadotrophins.
- Uses of GnRH Agonists anti estrogen
1. Controlled ovulation induction
2. Treatment of precocious puberty .
3. ↓the size of fibroids before surgery.
GnRH Antagonist:
-Bind to the GnRH receptors but it doesn't cause initial activation (flare
up) of receptors → immediate down regulation of the pituitary
 Hormones
Gonadotrophin releasing H :
Chemistry: It is a decapeptide (10 a.a).
Source: anterior pituitary .
Action:-Secreted in pulses every 60-90 minutes →secretion of FSH & LH
GnRH Agonist:
- Causes persistent activation of GnRH receptors → initial release
followed by profound suppression → marked ↓ in
gonadotrophins.
- Uses of GnRH Agonists anti estrogen
1. Controlled ovulation induction
2. Treatment of precocious puberty .
3. ↓the size of fibroids before surgery.
GnRH Antagonist:
-Bind to the GnRH receptors but it doesn't cause initial activation
(flare up) of receptors → immediate down regulation of the pituitary
 Hormones
Gonadotrophin releasing H :
Chemistry: It is a decapeptide (10 a.a).
Source: anterior pituitary .
Action:-Secreted in pulses every 60-90 minutes →secretion of FSH & LH
GnRH Agonist:
- Causes persistent activation of GnRH receptors → initial release
followed by profound suppression → marked ↓ in
gonadotrophins.
- Uses of GnRH Agonists anti estrogen
1. Controlled ovulation induction
2. Treatment of precocious puberty .
3. ↓the size of fibroids before surgery.
GnRH Antagonist:
-Bind to the GnRH receptors but it doesn't cause initial activation
(flare up) of receptors → immediate down regulation of the pituitary
 Hormones
Gonadotrophin releasing H :
Chemistry: It is a decapeptide (10 a.a).
Source: anterior pituitary .
Action:-Secreted in pulses every 60-90 minutes →secretion of FSH & LH
GnRH Agonist:
- Causes persistent activation of GnRH receptors → initial release
followed by profound suppression → marked ↓ in
gonadotrophins.
- Uses of GnRH Agonists anti estrogen
1. Controlled ovulation induction
2. Treatment of precocious puberty .
3. ↓the size of fibroids before surgery.
GnRH Antagonist:
-Bind to the GnRH receptors but it doesn't cause initial activation
(flare up) of receptors → immediate down regulation of the pituitary
 Hormones
Prolactin:
Chemistry: water soluble polypeptide.
Source: acidophil of anterior pituitary.
Level:
→secreted in pulsatile manner & controlled by hypothalamic
inhibiting factor (dopamine)
→ has diurnal variation: highest level during sleep lowest 9-11 am
→ in normal women level doesn't vary along menstrual cycle.
→ Inhibiting factors: dopamine, GABA
→ Releasing factors: TRH, oxytocin, serotonin, histamine, A II
→ High levels → (--) FSH & LH → amenorrhea & galactorrhea.
Action: (--) lactation
Essential for CL function

→
Ovarian cycle
Ovarian cycle
Ovarian cycle
 Menstrual cycle
Menstruation:
Definition: periodic shedding of endometrium occurring between
menarche & menopause.

Layers involved: (decidua functionalis)

1-Superficial compact layer.
2-Middle spongy layer.
(Deep compact layer is not involved & responsible for regeneration)

Contents:
1-Blood.
2-Endometrial debris.
3- + degenerated ovum.
4-Cervical mucous.
5-Vaginal epithelial cells & discharge.
6-Leukocytes.
 Menstrual cycle
Menstruation:
Characters:
1-Length: 3-5 weeks (21-35 days)
2-Duration: 2-7 days (average 5 days).
3-Amount: 30 – 80 ml (average 50 ml) 􀄺 80% occurs in 1st days.
4-Odour: offensive.
5-Colour & clots:
dark red color (acid hematin) + no clots (fibrinolytic system).

(Severe bleeding : fresh red + clots)

 Menstrual cycle
Proliferative
Gonadotrophin phase hormones
releasing Secretory
:
phase
Def Phase of building up of Phase of thickening & ripening of
Chemistry:endometrium
It is a decapeptide (10 amino endometrium
under estrogenic acids). under progesterone
Source: anterior
effect. pituitary . effect.

Action:-Secreted in of
Structure -From end pulses every
bleeding till 60-90
day 14minutes →secretion
-Last 14 of FSH
days of the cycle (in&28LH
day
(in 28 day cycle). cycle).
GnRH Agonist:
- Causes
Glands persistent
-Straight narrowactivation of GnRH
short become receptors
tortuous + filled→ initial
with release
secretions in
followed
long by profound
& tortuous suppression →
& increase themarked ↓ in
lumen + subnuclear glycogen
gonadotrophins.
Number of mitotic cells containing vacuoles.
- Uses of GnRH Agonists anti estrogen
1. Controlled ovulation
-Epithelial lining: induction
Low columnar
2. Treatment of precocious puberty .
become pseudostratified
3. ↓the size of fibroids before surgery.
columnar.

GnRH Antagonist:
stroma -dense & compact + infrequent edema + arteries become spiral
-Bind to the GnRH receptors but it doesn't cause initial activation
vascular
(flare up) structures.→ immediate down
of receptors long &regulation
coiled of the pituitary
 Menstrual cycle
Proliferative
Gonadotrophin phase hormones
releasing Secretory
:
phase
Thickness -Early in this phase 1-2 mm -Late in this phase 4-8 mm
Chemistry: -Only
It is a basal
decapeptide (10 amino -Is
compact layer. acids).
differentiated into :
Superficial compact layer
Source: anterior pituitary .
Middle spongy layer
Action:-Secreted in pulses every 60-90 minutes Deep→secretion
compact layer.of FSH & LH
GnRH Agonist:
Hormone ESTROGEN PROGESTERONE
- Causes persistent activation of GnRH receptors → initial release
followed by profound suppression → marked ↓ in
gonadotrophins.
-Straight narrow short become tortuous + filled with secretions in
- Uses of GnRH
long Agonists
& tortuous anti estrogen
& increase the lumen + subnuclear glycogen
1. Controlled
Number ofovulation
mitotic cellsinduction containing vacuoles.
2. Treatment of precocious puberty .
3. ↓the size of lining:
-Epithelial fibroids before
Low surgery.
columnar
become pseudostratified
GnRH Antagonist:
columnar.
-Bind to the GnRH receptors but it doesn't cause initial activation
(flare up) of receptors
-dense & compact → immediate down
+ infrequent edema regulation of thespiral
+ arteries become pituitary
vascular structures. long & coiled
 LNMP/EDD/Gestational age
LNMP :
-1st day of LMP
-To be LNMP :
1-Regular preceded by 3 regular cycles
2-Normal in characters
3-no hormonal contraception

EDD :
-Means the end of the calculated duration of pregnancy
-Add 7 days & 9 months
 LNMP/EDD/Gestational age
Calculate the EDD :
LNMP : 15-3-2024
EDD : 22-12-2024
LNMP : 10-4-2024
EDD : 17-1-2025
LNMP : 3-7-2024
EDD : 10-4-2025
LNMP : 25-8-2024
EDD : 2-6-2025
LNMP : 23-5-2024
EDD : 1-3-2025
 LNMP/EDD/Gestational age
Calculate the gestational age :
Today 22-12-2024
LNMP : 15-3-2024 EDD : 22-12-2024
40 weeks
LNMP : 10-4-2024 EDD : 17-1-2025
36 weeks
LNMP : 11-6-2024 EDD : 17-3-2025
27 weeks
LNMP : 13-8-2024 EDD : 20-5-2025
14 weeks
LNMP : 23-5-2024 EDD : 1-3-2025
30 weeks
 LNMP/EDD/Gestational age

LNMP 3M 6M EDD

0 13 W 26 W 40 W

15-3 15-6 15-9 22-12

0 13 W 26 W 40W
38 W
 Take home message
-Difference ( ) ovarian & menstrual cycle
-3rd day of cycle.
-Duration of luteal phase
-Luteal phase defect
-Luteal phase support
-severe bleeding
-GnRh is anti estrogen
-B HCG
-Ovulation induction FSH then HCG
-Progesterone day 21
-FSH day 3
-Theca /granulosa
-LNMP/EDD/Gestational age
Thank You