Menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age females. Overt menstruation (where there is blood-flow from the vagina) occurs primarily in humans and close evolutionary relatives such as chimpanzees. The females of other species of placental mammal have estrous cycles, in which the endometrium is completely reabsorbed by the animal (covert menstruation) at the end of its reproductive cycle.
The menstrual cycle is under the control of the hormone system and is necessary for reproduction. Menstrual cycles are counted from the first day of menstrual flow, because the onset of menstruation corresponds closely with the hormonal cycle. The menstrual cycle may be divided into several phases, and the length of each phase varies from woman to woman and cycle to cycle.
Subscribe in a reader During the follicular phase the lining of the uterus thickens, stimulated by gradually increasing amounts of estrogen. Follicles in the ovary begin developing under the influence of a complex interplay of hormones, and after several days one or occasionally two follicles become dominant (non-dominant follicles atrophy and die). The dominant follicle releases an ovum or egg in an event called ovulation. (An egg that is fertilized by a spermatozoon will become a zygote, taking one to two weeks to travel down the fallopian tubes to the uterus. If the egg is not fertilized within about a day of ovulation, it will die and be absorbed by the woman's body.) After ovulation the remains of the dominant follicle in the ovary become a corpus luteum; this body has a primary function of producing large amounts of progesterone. Under the influence of progesterone, the endometrium (uterine lining) changes to prepare for potential implantation of an embryo to establish a pregnancy. If implantation does not occur within approximately two weeks, the corpus luteum will die, causing sharp drops in levels of both progesterone and estrogen. These hormone drops cause the uterus to shed its lining in a process termed menstruation.
Phases of the menstrual cycle Menstruation Menstruation is also called menstrual bleeding, menses, a period or catamenia. The flow of menses normally serves as a sign that a woman has not become pregnant. (However, this cannot be taken as certainty, as sometimes there is some flow of blood in early pregnancy.) During the reproductive years, failure to menstruate may provide the first indication to a woman that she may have become pregnant.
Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal).The average blood loss during menstruation is 35 millilitres with 10–80 ml considered normal; many women also notice shedding of the endometrium lining that appears as tissue mixed with the blood. An enzyme called plasmin — contained in the endometrium — tends to inhibit the blood from clotting. Because of this blood loss, women have higher dietary requirements for iron than do males to prevent iron deficiency. Many women experience uterine cramps during this time (severe cramps or other symptoms are called dysmenorrhea), as well as other premenstrual syndrome symptoms. A vast industry of sanitary products is marketed to women for use during their menstruation.
Follicular phase Through the influence of a rise in follicle stimulating hormone (FSH), five to seven tertiary-stage ovarian follicles are recruited for entry into the next menstrual cycle. These follicles, that have been growing for the better part of a year in a process known as folliculogenesis, compete with each other for dominance. Under the influence of several hormones, all but one of these follicles will undergo atresia, while one (or occasionally two) dominant follicles will continue to maturity. As they mature, the follicles secrete increasing amounts of estradiol, an estrogen.
The estrogens that follicles secrete initiate the formation of a new layer of endometrium in the uterus, histologically identified as the proliferative endometrium. The estrogen also stimulates crypts in the cervix to produce fertile cervical mucus, which may be noticed by women practicing fertility awareness.
Ovulation When the egg has matured, it secretes enough estradiol to trigger the acute release of luteinizing hormone (LH). In the average cycle this LH surge starts around cycle day 12 and may last 48 hours. The release of LH matures the egg and weakens the wall of the follicle in the ovary. This process leads to ovulation: the release of the now mature ovum, the largest cell of the body (with a diameter of about 0.5 mm). Which of the two ovaries — left or right — ovulates appears essentially random; no known left/right co-ordination exists. The egg is swept into the fallopian tube by the fimbria - a fringe of tissue at the end of each fallopian tube. If fertilization occurs, it will happen in the fallopian tube.
In some women, ovulation features a characteristic pain called mittelschmerz (German term meaning 'middle pain') which may last a few hours. The sudden change in hormones at the time of ovulation also causes light mid-cycle blood flow from the vagina of some women. An unfertilized egg will eventually disintegrate or dissolve.
Luteal phase The corpus luteum is the solid body formed in the ovaries after the egg has been released into the fallopian tube which continues to grow and divide for a while. After ovulation, the residual follicle transforms into the corpus luteum under the support of the pituitary hormones. This corpus luteum will produce progesterone in addition to estrogens for approximately the next 2 weeks. Progesterone plays a vital role in converting the proliferative endometrium into a secretory lining receptive for implantation and supportive of the early pregnancy. It raises the body temperature by 0.25 °C to 0.5 °C (0.5 °F to 1.0 °F), thus women who record their basal body temperature on a daily basis will notice that they have entered the luteal phase. If fertilization of an egg has occurred, it will travel as an early blastocyst through the fallopian tube to the uterine cavity and implant itself 6 to 12 days after ovulation. Shortly after implantation, the growing embryo will signal its existence to the maternal system. One very early signal consists of human chorionic gonadotropin (hCG), a hormone that pregnancy tests can measure. This signal has an important role in maintaining the corpus luteum and enabling it to continue to produce progesterone. In the absence of a pregnancy and without hCG, the corpus luteum demises and inhibin and progesterone levels fall. This will set the stage for the next cycle. Progesterone withdrawal leads to menstrual shedding (progesterone withdrawal bleeding), and falling inhibin levels allow FSH levels to rise to raise a new crop of follicles.
Fertile window The length of the follicular phase — and consequently the length of the menstrual cycle — may vary widely. The luteal phase, however, almost always takes the same number of days for each woman: Some women have a luteal phase of 10 days, others 16 days, while the average is 14 days. Normal sperm life inside a woman ranges from 1-5 days, though a pregnancy resulting from sperm life of 8 days has been documented. The most fertile period (the time with the highest likelihood of pregnancy resulting from sexual intercourse) covers the time from some 5 days before ovulation until 1–2 days after ovulation. In an average 28 day cycle with a 14-day luteal phase, this corresponds to the second and the beginning of the third week of the cycle. Fertility awareness methods of birth control attempt to determine the precise time of ovulation in order to find the relatively fertile and the relatively infertile days in the cycle.
People who have heard about the menstrual cycle and ovulation often mistakenly assume, for contraceptive purposes, that menstrual cycles regularly take 28 days, and that ovulation always occurs 14 days after beginning of the menses. This assumption may lead to unintended pregnancies. Note too that not every event of blood flow counts as a menstruation, and this can mislead people in their calculation of the fertile window.
If a woman wants to conceive, the most fertile time occurs between 19 and 10 days prior to the expected menses. Many women use ovulation detection kits that detect the presence of the LH surge in the urine to indicate the most fertile time. Other ovulation detection systems rely on observation of one or more of the three primary fertility signs (basal body temperature, cervical fluid, and cervical position).
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