NARAYAN SHREE HOMOEOPATHIC MEDICAL COLLEGE

CLINIC AND RESEARCH CENTRE

DEPARTMENT OF PHYSIOLOGY AND

BIOCHEMISTRY
SEMINAR ON “MENSTRUAL CYCLE”
GUIDED BY: SUBMITTED BY:
DR. SHAIL JAIN (HOD) IRMEEN KHAN
DR. NAVEEN JAGGI 1ST PROF. (2020-2021)
DR. RAJANI SURYAWANSHI
 CERTIFICATE

This is to certify that this project has been made by- Irmeen Khan
of BHMS 1ST Prof (2020-2021) on the topic “MENSTRUAL CYCLE”
under the guidance of our physiology teacher- Dr. Shail Jain
Ma’am and have been completed it successfully.

YOUR’s TRULY

IRMEEN KHAN TEACHER’S SIGNATURE

 Sr. No. TOPIC NAME PAGE No.
1. INTRODUCTION 2

2. PHASES OF MENSTRUAL CYCLE 3

3. OVARIAN CYCLE 4-15

4. UTERINE CYCLE 16-21

5. OTHER CHANGES 22-23

6. HORMONE REGULATION 24-28

7. QUALITY OF MENSTRUM 29

8. APPLIED PHYSIOLOGY 30-31

9. MENOPAUSE 32-33
Definition: The series of events that place in the genital tract of a female of
reproductive age usually at an interval of 28 days.

Menarche: first occurrence of menstruation; starts at age of 12-15 years.

Duration of cycle: 28 days; range from 20-40 days

Calculation: from 1st day of menstrual cycle to the 1st day of next menstrual
cycle.

Menopause: permanent cessation of menstrual cycle; at about 45-50 years.

It consists of 2 cycles/phases-

(1) Ovarian cycle- changes taking place in ovary

(2) Uterine cycle- changes taking place in the uterus

It consists of 3 phases-

(a) Follicular phase

(b) Ovulation
(c) Luteal phase
Duration: 0-14 days

(i) Ovary is lined by a single layer of cuboidal cells called ‘Germinal

epithelium’.
(ii) The next layer inside germinal epithelium is ‘Tunica albuginea’.
(iii) The peripheral part of ovary is called ‘Medulla or ovarian
stroma’.
(iv) Cortex consist of numerous follicles at different stages of
development.
STAGES OF DEVELOPMENT→
(1) PREMORDIAL FOLLICLE- Primary oocyte is covered by a single layer of follicular
epithelium. It is smallest and does not contain follicular cavity.

(2) PRIMARY FOLLICLE- (i) Increase in size of follicle.

(ii) Proliferation of granulosa cell

(3) VESICULAR FOLLICLE- (i) Primary follicle increase in size

(ii) Follicular epithelium proliferate and become multilayered
(iii) As the oocyte grow, it is surrounded by a mucopolysaccharide,
glycening translucent membrane called ‘Zona pellucida’.

(4) GRAAFIAN FOLLICLE- A fully mature follicle is called Graafian follicle.

(i) The size is large
(ii) The cuboidal cells lining the follicle multiply into several layers and
form membrane granulosa cell layer.
The stroma of the cortex condense around granulosa cell to form a sheath called
‘Theca folliculi’.
Theca folliculi consist of 2 layers-
(i) Theca interna/ Tunica vasculosa- inner layer; it is vascular.
(ii) Theca externa/ Tunica fibrosa- outer layer; it is fibrous.

The centre of the follicle develops a cavity called ‘Follicular cavity’ (antrum
folliculi).
Slowly, there is a collection of fluid in the cavity called ‘Liquor folliculi’.
The follicular cells which surround the ovum are called ‘Cumulus oophorous’.
So, there are numerous follicles in the ovary which mature every month but only
1 or 2 ruptures.
Duration: 14th day of menstrual cycle

Definition: Rupture of the follicle with the liberation of

ovum (secondary oocyte) into the peritoneal
cavity is called ‘Ovulation’.
Steps:-
Movement of graafian follicle to periphery of ovary
Formation of new blood vessels
Protrusion of blood vessels into follicular wall
Increase in blood flow to follicle
Swelling in follicle
Formation of stigma in ovarian capsule
Rupture of graafian follicle
Release of Ovum
OOGENESIS:-
It is the process by which a primary egg
cell(ovum) becomes a mature ovum.

Primordial germ cell → Oogonium → Primary

oocyte → Secondary oocyte + 1st polar body →
Ovum + 2nd polar body

Primary oocyte undergoes 1st meiotic division

and secondary oocyte and 1st polar body.
This secondary oocyte is discharged from the
ovarian stigma into the peritoneal cavity.
It contain haploid(22X) number of chromosomes.

It is taken up by the fimbriated end of fallopian

tube.
Even now, there are certain cells which surround
the secondary oocyte and they are called ‘Corona
radiata’.
Ovulation Test-

Detection of ovulation-
1. Increase in basal body temperature by 1 degree C.
2. LH surge- sudden and sharp mid cycle rise of LH is known as LH surge. Ovulation generally
occurs within 24 hrs of LH surge.
3. SPINN BARKEIT TEST- It is a test to detect the stretchability of the cervical mucus.
Stretchability increases at time of ovulation.
4. FERN TEST- Cervical and vaginal secretions are inspected under microscope.
Disappearance of fern pattern indicates ovulation.
5. Determination of hormone excretion in urine.
6. Determination of hormone level in plasma.
7. Midline cycle
8. Endometrial biopsy- It shows secretory changes in ovulation.
9. Ultrasonography.
Duration:15th-28th day

Ruptured graafian follicle is also called ‘Corpus Haemorrhagica’.

After sometime, it converts into ‘Corpus Luteum’.
The corpus luteum grows.

If ovum is fertilised, the growth of corpus luteum continues and release

progesterone(responsible for changes in pregnancy).

But if fertilisation does not occur, the corpus luteum degenerates and forms corpus
albicans.

After ovulation, the granulosa cell layer proliferate into lutin cell layer which secrete
progesterone.
The theca interna grows into paralutin cell layer which secrete estrogen.
The change that take place
in the uterus during
menstrual cycle constitute
uterine cycle.

STAGES:
(i) Proliferative phase
(ii) Secretory phase
(iii) Menstruating phase
Duration: from 5th day of menses to 14th day
Cause: Increasing level of estrogen
Corresponds with: follicular phase and ovulation
Characteristics: This phase starts when endometrium is completely
degenerated and is only 1mm thick and represents as stratum basale layer.

(a) It is very rapid

(b) Stroma, glands and new vessels sprout
(c) The mucosa thickens and become 3-4mm thick
(d) Endometrial glands become longer, narrow, tortuous and straight “cork
screw shaped”
(e) The cell proliferate
(f) The uterine movements increases..
 Duration: 15th - 28th day
Cause: progesterone
Corresponds with: luteal phase of ovarian cycle.
Characteristics:
(a) Uterine gland starts secretion and secrete mucus
(b) Coiled arteries become spiral
(c) Stroma becomes loose and edimetus
(d) The thickness of endometrium becomes 5-6mm
(e) The irritability of myometrium is decreased or uterine
movements decreases.
BY 24TH DAY->
The progesterone level starts decreasing and therefore-
(a) Glands shrink
(b) Secretions decreases and stops
(c) Cork-screw gland becomes saw toothed glands
(d) Coiled arteries becomes spiral
(e) Now 3 zones of endometrium can be seen-- (i) stratum compactum
(superficial layer)
(ii) stratum spongiosum (middle layer)
(iii) stratum basal (innermost layer)
 Duration: 0-5 days
Cause: lack of estrogen and progesterone
Characteristics:
(a) The superficial 2/3rd layer of endometrium is shed off.
(b) The coiled arteries undergoes vasoconstriction and
ischemia causing necrosis of endometrium.
(c) Straight arteries also undergoes same changes and they
pour the blood into the uterine cavity
(d) The uterine surface becomes raw and petulous
Changes in cervix mucus:
{I} FOLLICULAR PHASE->
It is due to FSH(Follicle stimulating hormone).
It causes (a) maturation of Graafian follicle
(b) ovulation
(c) Liberation of estrogen.

{II} OVULATION->
It is due to LH(Luteinizing hormone) and LTH(Luteotrophic hormone/prolactin).
LH cause ovulation.

{III} LUTEAL PHASE->

It is due to LH.
LH causes formation of corpus luteum and liberation of progesterone.
(1) Proliferative phase: It is due to estrogen which is controlled
by FSH of anterior pituitary.
(2) Secretory phase: It is due to progesterone which is controlled
by LH and LTH.
(3) Menstruating phase: It is due to lack of estrogen and
progesterone.
Menstrual blood is normally bright or light red in color like the bleeding
that occurs after a knife cut or similar injury.
It could look brown in some few women and stil be normal menstruation.
It must not have a foul odour.
Small clots maybe a normal part of menstrual blood.

AMOUNT OF BLOOD LOSS-

The average blood loss during normal menstruation is about 35ml, with a
range of 10 to 80ml.
(1) MENSTRUAL SYMPTOMS:
Symptoms experienced by woman during menses:
(i) Abdominal pain
(ii) dysmenorrhoea
(iii) headache
(iv) migraine
(v) nausea and vomiting
(vi) irritability

(2) PREMENSTRUAL SYNDROME:

Symptoms experienced by woman before onset of menstruation (Premenstrual
tension), are:
(i) Mood swings
(ii) Anxiety
(iii) Irritability
(iv) Emotional instability
(v) Abdominal cramps
(3) ANOVULATORY CYCLE:
Menstrual cycle in which ovulation doesn’t occur.
When-
(i) During puberty
(ii) Before menopause
(iii) If child bearing age- infertility- requires treatment.

(4) ABNORMAL MENSTRUATION::

(i) Amenorrhoea: absence of menstruation

(ii) Hypomenorrhoea: decreased menstrual bleeding
(iii) Menorrhagia: excessive menstrual bleeding
(iv) Oligomenorrhea: cycles longer than 35 days
(v) Polymenorrhea: cycles shorter than 21 days
(vi) Dysmenorrhoea: painful menstruation
(vii) Metorrhagia: uterine bleeding in between menstruation.
Definition: It is defined as the period when permanent cessation
of menstruation takes place.

Age: It occurs at 45-55 age { avg. 50 age}

Cause: (a) atrophy of ovaries due to advancement of age.

(b) ovariectomy- surgical removal of ovaries
(c) Hysterectomy- surgical removal of uterus
POST MENSTRUAL SYNDROME->
It is group of symptoms that appears in woman immediately after menopause.
Cause: Due to lack of estrogen and progesterone,
Symptoms:
(a) Hot flushes- extreme flushing of skin and face and sweating
(b) Fluctuation of BP
(c) Fatigue
(d) Emotional outburst - crying and anger
(e) Mental depression
(f) Insomnia
(g) Palpitation
(h) Osteoporosis
(i) atherosclerosis

Treatment: Usually no treatment is required but if symptoms overincreased then Hormone

replacement therapy(combination of estrogen and progesterone) is recommended.