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YNAECOLOGY EASY NOTES
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PREPAREDBY : RNJAVERIA
ARSHAD
MENSTRUAL CYCLE/REPRODUCTIVE CYCLE
ABSTRACT :
enstrual cycle From menarche, or the first menstrual bleed during puberty, to menopause, is a
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monthly cycle that occurs naturally in the female reproductive system and facilitates conception
and pregnancy. The average cycle lasts 28 days, beginning on the first day of menstruation and
terminating the day before the next bleeding onset. It has 4 phases discussed below.
Definition:
enstrual cycle is a series of events that occur regularly in the female every 26 to 30 days
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throughout the child bearing period(that is from menarche to menopause).This is accompanied
with the cyclic changes in the ovaries and uterus stimulate by change in blood concentration
hormones.(Hormones from hypothalamus, anterior pituitary ,ovaries)
Menstrual Phase/ Bleeding Phase : (1st to 5th day)
This phase lasts for the first 5 days of the cycle.
1. During this phase 20 to 50 small secondary follicles in each ovary begin to enlarge.
. Follicular fluid accumulates in the antrum (space within the follicle) while oocyte remains near
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the edge of the follicle.
3. Follicular fluid secreted by granulosa cells and filtered from the blood.
. When ovum is not fertilized, the corpus luteum starts to degenerate. In this phase the level of
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ovarian hormones(estrogen , progesterone) falls especially progesterone.
. The declining level of estrogen snd progesterone stimulate prostaglandins this causes the
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uterine spiral arterioles to become constrict as a result there is lack of oxygen supply and cell
death start which causing the entire stratum functionais to become slough off and this lead to
menstrual bleeding.At this time endometrium is very thin about 2 - 5 mm only stratum basalis
left behind.
Composition of Menstrual Flow:
⦁ 50-150ml of blood
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⦁ Secretions from endometrial glands.
⦁ Endometrial cells
⦁ Blood from broken down capillaries
⦁ The unfertilized ovum
This Menstrual Flow passes from the uterine cavity through the cervix and vagina to the exterior.
Pre-ovulatory Phase or Proliferative Phase:(6th to 13th day)
. This is the period between the end of menstruation and ovulation. It lasts from 6 to 13 days in
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a 28 day cycle.
. Under the influence of FSH, a group of 20 secondary follicles continue to grow and secrete
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estrogens and inhibin. On day 6, a single follicle in one or two ovaries outgrow all the others ,to
become the dominant follicle.
. This dominant follicle causes a decrease in the secretion of FSH, which causes the other less
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well-developed follicles to stop growing.later on The dominant follicle becomes the nature
(Graafian follicle), which continues to enlarge until it is more than 20 mm in diameter and ready
for ovulation.
. When it is finally mature, under the influence of LH, the dominant follicle continues to
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increase its estrogen production. Before ovulation, estrogens are the main ovarian hormones
but a day or two before the ovulation, small amounts of progesterone are produced by the
mature follicle.
. The preovulatory phase produces changes in the uterus as the estrogens are liberated into
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the blood by the ovarian follicle which stimulate the repair of endometrium and produce new
stratum functionalis. This proliferation is for the reception of fertilized ovum.
ndometrium becomes thicker. In this phase, the thickness of the endometrium approximately
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doubles to about 4-10 mm.
. This phase is also termed as the proliferative phase because the endometrium proliferates. It
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ends when ovulation occurs and estrogen production declines.
Ovulation phase:(at day 14th)
" Ovulation is a process whereby a secondary oocyte is released from the ovary following
rupture of a mature Graafian follicle and becomes available for conception" Or "Ovulation is the
rupture of the mature follicle and release of the secondary oocytes into the pelvic cavity that
usually occurs on day 14th in a 28 day cycle".
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he high levels of estrogens (during the last part of ovulatory phase) put a positive feedback
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effect on cells, secrete LH and GnRH (Gonadotropin-releasing hormone) that cause ovulation
as follows:
. A high concentration of estrogen stimulates release of GnRH from hypothalamus. It also
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stimulates gonadotrophs in the anterior pituitary to secrete LH.
2. GnRH promotes the release of FSH and additional LH by the anterior pituitary.
. LH causes rupture of the dominant follicle and expulsion of a secondary oocyte about 9 hours
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after peak of the LH surge.The ovulated oocyte sweeps into uterine tubes.
. At the time of ovulation, the leakage of small amounts of blood in the pelvic cavity from the
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ruptured follicle may cause pain termed as 'mittelschmerz' meaning “Pain in the middle".
Post ovulatory phase/Secretory phase:(13 to 14 days)
. This phase is under the control of progesterone and estrogen secreted by the corpus luteum.
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Therefore, it is known as presentational or luteal phase. It is also known as (pregravid phase) as
this phase prepares the endometrium for pregnancy and implantation.
. If pregnancy does not occur, it is followed by menstruation, so it is also called premenstrual
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period. This phase lasts about 13-14 days and is accompanied by marked hypertrophy of
uterine endometrium.
. Progesterone helps the endometrium to become edematous and the secretory gland
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produces an increased amount of mucus. This helps the sperm to move through the uterus to
uterine tubes where ovum usually fertilizes. Similarly, there is increased secretion of mucus in
uterine tubes and by cervical gland, this lubricates the vagina that's why this phase is called
secretory phase.
