THE UTERINE CYCLE

Each month during the years between puberty and menopause, a woman’s
body goes through a number of changes to get it ready for a possible
pregnancy. This series of hormone-driven events is called the menstrual cycle.
During each menstrual cycle, an egg develops and is released from the ovaries.
The lining of the uterus builds up. If a pregnancy doesn’t happen, the uterine
lining sheds during a menstrual period. Then the cycle starts again.

The uterine cycle governs the preparation and maintenance of the lining of the
uterus (womb) to receive a fertilized egg. These cycles are concurrent and
coordinated, normally last between 21 and 35 days in adult women, with a
median length of 28 days, and continue for about 30–45 years.
The pituitary gland also controls ovulation and the menstrual cycle in women.
The length of the menstrual cycle varies from woman to woman, but the
average is to have periods every 28 days. Regular cycles that are longer or
shorter than this, from 21 to 40 days, are normal.
A healthy Uterine cycle includes; Ovulation; A healthy menstrual cycle includes
ovulation. A luteal phase of at least 10 days. The luteal phase is between
ovulation and your period of Menstrual bleeding; that is not debilitatingly painful
or prolonged.

PHASES OF UTERINE CYCLE

A woman’s menstrual cycle is divided into four phases:
1. menstrual phase
2. follicular phase
3. ovulation phase
4. luteal phase
The length of each phase can differ from woman to woman, and it can change
over time.

1. Menstrual phase: The period—the shedding of the uterine lining. Levels of

oestrogen and progesterone are low.
Location: Uterus
When: From the time bleeding starts to the time it ends.
What: Old blood and tissue from inside the uterus is shed through the vagina.
Each menstrual cycle starts with menstruation (the period). A period is the
normal shedding of blood and endometrium (the lining of the uterus) through
the cervix and vagina. A normal period may last up to 8 days (1), but on
average lasts about 5 or 6 (4).
2. Follicular phase: The time between the first day of the period and ovulation.
Oestrogen rises as an egg prepares to be released.
Location: Ovaries
When: From the start of the period until ovulation.
What: Signals from the brain tell the ovaries to prepare an egg that will be
released.
During the period, the pituitary gland (a small area at the base of the brain that
makes hormones) produces a hormone called follicle stimulating hormone (FSH).
FSH tells the ovaries to prepare an egg for ovulation (release of an egg from the
ovary). Throughout the menstrual cycle, there are multiple follicles (fluid filled
sacs containing eggs) in each ovary at different stages of development. About
halfway through the follicular phase (just as the period is ending) one follicle in
one of the ovaries is the largest of all the follicles at about 1 cm (0.4 in). This
follicle becomes the dominant follicle and is the one prepared to be released at
ovulation. The dominant follicle produces estrogen as it grows, which peaks just
before ovulation happens. For most people, the follicular phase lasts 10-22 days,
but this can vary from cycle-to-cycle. After the period, the uterine lining builds
back up again. This is a stage of proliferation.

3. Ovulation phase: The release of the egg from the ovary, mid-cycle. Estrogen
peaks just beforehand, and then drops shortly afterwards.
When: About midway through the cycle, but this can change cycle-to-cycle.
Ovulation divides the two phases of the ovarian cycle (the follicular phase and
the luteal phase).
What: An egg is released from the ovary into the fallopian tube.
The dominant follicle in the ovary produces more and more estrogen as it grows
larger. The dominant follicle reaches about 2 cm (0.8 in)—but can be up to 3
cm—at its largest right before ovulation. When estrogen levels are high enough,
they signal to the brain causing a dramatic increase in luteinizing hormone (LH).
This spike is what causes ovulation (release of the egg from the ovary) to occur.
Ovulation usually happens about 13-15 days before the start of the next period.
Proliferative phase - From the end of the period until ovulation. The uterus builds
up a thick inner lining. While the ovaries are working on developing the egg-
containing follicles, the uterus is responding to the estrogen produced by the
follicles, rebuilding the lining that was just shed during the last period. This is
called the proliferative phase because the endometrium (the lining of the
uterus) becomes thicker. The endometrium is thinnest during the period, and
thickens throughout this phase until ovulation occurs. The uterus does this to
create a place where a potential fertilized egg can implant and grow.
4. Corpus Luteal phase: The time between ovulation and before the start of
menstruation, when the body prepares for a possible pregnancy. Progesterone
is produced, peaks, and then drops.
The uterine lining produces chemicals that will either help support an early
pregnancy or will prepare the lining to break down and shed if pregnancy
doesn’t occur. This is the secretory stage.
Location: Ovary
When: From ovulation until the start of the next period.
What: The sac that contained the egg produces estrogen and progesterone.
Once ovulation occurs, the follicle that contained the egg transforms into
something called a corpus luteum and begins to produce progesterone as well
as estrogen (10,13). Progesterone levels peak about halfway through this phase.
The hormonal changes of the luteal phase are associated with common
premenstrual symptoms that many people experience, such as mood changes,
headaches, acne, bloating, and breast tenderness.
If an egg is fertilized, progesterone from the corpus luteum supports the early
pregnancy. If no fertilization occurs, the corpus luteum will start to break down
between 9 and 11 days after ovulation. This results in a drop in estrogen and
progesterone levels, which causes menstruation. The luteal phase typically lasts
about 14 days, but between 9 and 16 days is common.

Secretory Phase - From ovulation until the start of the next period. The lining of
the uterus releases or secretes chemicals that will either help an early
pregnancy attach if an egg was fertilized, or help the lining break down and
shed if no egg was fertilized. During this phase, the endometrium prepares to
either support a pregnancy or to break down for menstruation. Rising levels of
progesterone cause the endometrium to stop thickening and to start preparing
for the potential attachment of a fertilized egg. The secretory phase gets its
name because the endometrium is secreting (producing and releasing) many
types of chemical messengers. The most notable of these messengers are
the prostaglandins, which are secreted by endometrial cells and cause
changes to other cells nearby.
FURTHER EXPLANATIONS

1. Menstrual phase
The menstrual phase is the first stage of the menstrual cycle. It’s also when you
get your period. This phase starts when an egg from the previous cycle isn’t
fertilized. Because pregnancy hasn’t taken place, levels of the hormones
estrogen and progesterone drop. The thickened lining of your uterus, which
would support a pregnancy, is no longer needed, so it sheds through your
vagina. During your period, you release a combination of blood, mucus, and
tissue from your uterus.

You may have period symptoms like these:

• cramps (try these home remedies)
• tender breasts
• bloating
• mood swings
• irritability
• headaches
• tiredness
• low back pain

On average, women are in the menstrual phase of their cycle for 3 to 7

days. Some women have longer periods than others.

2. Follicular phase
The follicular phase starts on the first day of your period (so there is some overlap
with the menstrual phase) and ends when you ovulate.
It starts when the hypothalamus sends a signal to your pituitary gland to
release follicle-stimulating hormone (FSH). This hormone stimulates your ovaries to
produce around 5 to 20 small sacs called follicles. Each follicle contains an
immature egg. Only the healthiest egg will eventually mature. (On rare
occasions, a woman may have two eggs mature.) The rest of the follicles will be
reabsorbed into your body.
The maturing follicle sets off a surge in estrogen that thickens the lining of your
uterus. This creates a nutrient-rich environment for an embryo to grow.
The average follicular phase lasts for about 16 days. It can range from 11 to 27
days, depending on your cycle.
 3. Ovulation phase
Rising estrogen levels during the follicular phase trigger your pituitary gland to
release luteinizing hormone (LH). This is what starts the process of ovulation.
Ovulation is when your ovary releases a mature egg. The egg travels down the
fallopian tube toward the uterus to be fertilized by sperm.
The ovulation phase is the only time during your menstrual cycle when you can
get pregnant. You can tell that you’re ovulating by symptoms like these:
• a slight rise in basal body temperature
• thicker discharge that has the texture of egg whites
Ovulation happens at around day 14 if you have a 28-day cycle — right in the
middle of your menstrual cycle. It lasts about 24 hours. After a day, the egg will
die or dissolve if it isn’t fertilized.

4. Luteal phase
After the follicle releases its egg, it changes into the corpus luteum. This structure
releases hormones, mainly progesterone and some estrogen. The rise in
hormones keeps your uterine lining thick and ready for a fertilized egg to
implant.
If you do get pregnant, your body will produce human chorionic gonadotropin
(hCG). This is the hormone pregnancy tests detect. It helps maintain the corpus
luteum and keeps the uterine lining thick.
If you don’t get pregnant, the corpus luteum will shrink away and be resorbed.
This leads to decreased levels of estrogen and progesterone, which causes the
onset of your period. The uterine lining will shed during your period.
During this phase, if you don’t get pregnant, you may experience symptoms
of premenstrual syndrome (PMS). These include:
• bloating
• breast swelling, pain, or tenderness
• mood changes
• headache
• weight gain
• changes in sexual desire
• food cravings
• trouble sleeping
The luteal phase lasts for 11 to 17 days. The average length is 14 days.
Identifying common issues
- Because sperm can live up to five days, pregnancy can occur if a woman has
sex as much as five days prior to ovulation.
- Every woman’s menstrual cycle is different. Some women get their period at
the same time each month. Others are more irregular. Some women bleed
more heavily or for a longer number of days than others.
Your menstrual cycle can also change during certain times of your life. For
example, it can get more irregular as you get close to menopause.
One way to find out if you’re having any issues with your menstrual cycle is to
track your periods. Write down when they start and end. Also record any
changes to the amount or number of days you bleed, and whether you
have spotting between periods.

- Any of these things can alter your menstrual cycle:

• Birth control. The birth control pill may make your periods shorter and
lighter. While on some pills, you won’t get a period at all.
• Pregnancy. Your periods should stop during pregnancy. Missed periods
are one of the most obvious first signs that you’re pregnant.
• Polycystic ovary syndrome (PCOS). This hormonal imbalance prevents an
egg from developing normally in the ovaries. PCOS causes irregular
menstrual cycles and missed periods.
• Uterine fibroids. These noncancerous growths in your uterus can make
your periods longer and heavier than usual.
• Eating disorders. Anorexia, bulimia, and other eating disorders can disrupt
your menstrual cycle and make your periods stop.

- Here are a few signs of a problem with your menstrual cycle:

• You’ve skipped periods, or your periods have stopped entirely.
• Your periods are irregular.
• You bleed for more than seven days.
• Your periods are less than 21 days or more than 35 days apart.
• You bleed between periods (heavier than spotting).

- If you have these or other problems with your menstrual cycle or periods, talk to
your healthcare provider.

Every woman’s menstrual cycle is different. What’s normal for you might not be normal
for someone else. It’s important to get familiar with your cycle — including when you
get your periods and how long they last. Be alert for any changes, and report them to
your trusted healthcare giver.