GINECO

Menstrual Cycle
--- By Ems ---
Osmosis notes
Follicular Phase
 1st day of menstruation;
 Weeks 1 & 2 of a 4 week cycle;
 The hypothalamus releases Gonadotropin-releasing hormone (GnRH)  stimulates the anterior
pituitary gland to release Follicule Stimulating Hormone (FSH) & Luteining Hormone (LH);
 Before puberty, GnHR is released in a steady rate, but when puberty starts, GnRH is released in
pulses;
 The frequency and magnitude of the GnRH release determines how much FSH and LH will be produced
by the pituitary  Follicular phase: GnRH pulses  High frequency and low amplitude;
 These pituitary hormones control the maturation of the ovary follicules (primary oocyte), which is
formed by Theca and Granulosa cells;
 Eventually, these follicules grow and compete for a chance of ovulation;
 During the first 10 days, Theca cells develop receptors and bind to LH, and, in response, they secrete
Androstenedione; similarly, granulosa cells develop receptors and bind to FSH, and, in response,
produce the enzyme aromatase;
 Aromatase converts Androstenedione to 17β-estradiol;

 During days 10 – 14, granulosa cells also start developing LH receptors;

 As the follicules grow, estrogen levels go up and it acts as a negative feedback signal to the anterior
pituitary, which releases less FSH; as a consequence, some of the follicules in the ovary will stop
growing, they regress and die off; the follicule that has more FSH receptors survive and eventually
will undergo ovulation, and it is the dominant follicule;
 This follicule continues to produce estrogen, and the higher leves of estrogen makes the pituitary
overresponsive to GnRH pulses and estrogen from the dominant follicule becomes a positive feedback
signal, which makes the pituitary releases loads of FSH and LH in response to the GnRH – these higher
levels of FHS and LH usually occurs 1-2 days before ovulation, and it’s responsible for the rupture of
the ovarian follicule and release of the oocyte.
Menstrual Phase
 The last endometrial lining (previous function layer) is expelled from the uterus through the vagina
and menstruation period begins – it has an average of 5 days.

Proliferative Phase
 The high estrogen levels stimulates the thickening of the endometrium, the growth of the
endometrium glands and the emergence of spinal arteries to the basal layer to feed the functional
endometrium; Rising of estrogen also changes the consistency of cervical mucus, making it more
hospitable for coming sperm; So, the peak of estrogen optimizes the chances for fertilization and it
happens between day 11 and 15 of an average 28 cycle.

Luteum Phase
 Following the ovulation, the remnant of the ovarian follicule becomes the corpus luteum, which is
made of Theca, lutenized and granulosa cells; Lutenized theca cells keep secreting androstenedione
and the lutenized granulosa cells keep forming estradiol, but lutenized granulosa cells also respond
to low levels of LH as in the end of the cycle, and this increases the activity of P450cc, whih converts
cholesterol to pregnenolone. So, lutenized granulosa cells produce more progesterone than estrogen
during luteum phase.
 Progesterone (from theca cells) acts as a negative feedback signal in the pituitary, decreasing the
release of FSH and LH; in the same time, granulosa cells secrete inhibin, which similarly inhibits the
pituitary gland to release FHS; Both these processes result in the decline of estrogen levels 
 progesterone is the dominant hormone in this phase of the cycle  signals that the endometrium is
receptive to implantation of a fertilized gamete.
 GnRH  Low frequency and High amplitude.

Secretory Phase
 Under progesterone action, the uterus go through the secretory phase of the endometrial cycle:
spinal arteries continue to grow and uterine glands secrete more mucus;
 After day 15 of the cycle, the optimal window for fertilization starts to close, the cervical mucus
thickens and becomes less hospitable;
 Over time, the corpus luteum degenerates and it is replaced for the non function corpus albicans –
doesn’t produce hormones  estrogen and progesterone levels slowly decrease;
 The low estrogen is a signal to FSH levels to go high  it’s important to start a new cycle with high
FSH;
 When progesterone reaches its lowest levels, the spinal arteries collapse and the functional layer of
the endometrium prepares to shed through menstruation.