Gynecology Book

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Endocrinology

Menstrual Disorders

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Menstrual CycleAka: Follicular Phase, Ovulatory Phase, Luteal Phase

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  1. See Also
    1. Cervical Mucus
    2. Basal Body Temperature
  2. Follicular Phase (Proliferative phase in Early Cycle)
    1. Follicle Stimulating Hormone (FSH) stimulates ovary
      1. Dominant ovarian follicle emerges days 5-7 of cycle
      2. Vascularity doubles for dominant follicle
      3. Twin Gestation prone generate 2 dominant follicles
      4. Ovarian follicle produces Estrogen
    2. Endometrium proliferative of glands and stroma
    3. Mean Duration: 10.8 days
    4. Hormones low
      1. Follicle Stimulating Hormone (FSH) low but rising
      2. Luteinizing hormone (LH) low but rising
      3. Progesterone remains low
  3. Ovulatory Phase (Mid-Cycle)
    1. Hormone Surge
      1. Estrogen rapidly peaks Days 10-15, then decreases
      2. Follicle Stimulating Hormone (FSH) with small surge
        1. Stimulates Ovulation
        2. Results in start of Progesterone increase
      3. Luteinizing hormone (LH) large surge
    2. Mid-cycle Symptoms Include
      1. Spotting
      2. Increased vaginal secretions
      3. Increased libido
      4. Nausea
      5. Abdominal Pain (Mittelschmerz)
  4. Luteal Phase (Secretory phase in Late Cycle)
    1. Endometrium secretive
    2. Mean Duration: 13.3 days
    3. Hormonal changes
      1. Estrogen continues to be high days 16-24
      2. Progesterone surges and remains until days 16-24
        1. Progesterone depletes Estrogen receptors
        2. Progesterone level falls to 0 at end of cycle
        3. Bleeding from Progesterone withdrawal occurs
      3. Luteinizing hormone (LH) returns to normal
      4. Follicle Stimulating Hormone (FSH) returns to normal
  5. Menstrual Phase (Bleeding)
    1. Demise of corpus luteum
    2. Estrogen and Progesterone withdrawal
    3. Sloughing of endometrium
    4. Normal Menstrual Bleeding per cycle
      1. Duration: 2-8 days (mean: 4 days)
      2. Blood Loss: 20-80 ml (mean 35 ml), 13 mg iron loss
      3. Intervals: 21-35 days (mean 28 days)

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