Menstrual Cycle

Monthly events in uterus and ovaries (controlled by hormones) throughout reproductive phase of women is called as menstrual cycle. On an average duration of menstrual cycle is 28 (+7) days.

Phases of Menstrual cycle

Menstruation is the result of the endometrial layer (the inner layer of the uterus) coming out of uterus due to non-fertilization & non-implantation of ovum.

During menstruation, there is a 50–180 ml of menstrual discharge. It is also called as monthly vaginal bleeding/ menstruation/ menses/ periods (4 – 5 days). It is a normal biological process and it is not a disease.


Menstrual Phase
Thick superficial layer of uterine endometrium gets detached and passes through vagina. It is noticed as bleeding for 3 – 5 days. This is called Menstrual flow. Usually 50 – 180 ml of blood lost during the menstrual flow.

Follicular Phase
Follicular phase begins on first day of menstrual bleeding. Main event in this phase is development of follicles in the ovaries. Follicle-stimulating hormone (FSH) stimulates the growth of 3-30 follicles. Each follicle contains an egg. Later, only one of these follicles (called the dominant follicle) continues to grow.

Ovulatory Phase
This phase begins when the level of Luteinising hormone levels increase   LH stimulates the dominant follicle to bulge from the surface of ovary and finally rupture, releasing the egg.  The ovulatory phase usually lasts 16 to 32 hours. Fertilization is most likely when sperm are present in the reproductive tract before the egg is released.

Luteal Phase
This Phase begins after ovulation and lasts about 14 days (unless fertilization occurs) and ends after a menstrual period.

Progesterone causes endometrium to thicken.

If the egg is not fertilized, corpus luteum degenerates after 14 days and a new menstrual cycle begins. But, if the egg is fertilized; the cells around the developing embryo begin to produce called human chorionic gonadotropin (HCG). HCG maintains the corpus luteum, which produce progesterone, until the growing foetus can produce its own hormones. Pregnancy tests are based on detecting an increase in the HCG level.

The four major hormones in relation to Menstrual cycle

Menstrual Cycle is regulated by the complex interaction of hormones

1.   Follicle stimulating hormone (FSH) Stimulates formation of ova in follicles of ovary. FSH & LH are gonadotropins, secreted by pituitary gland in brain
2.   Leutinizing hormone  (LH) Release ova from ovary by breaking ovarian follicles
3.   Estrogen (Secreted by follicles) Prepares Endometrium in uterus every month Estrogen & Progesterone are female sex hormones secreted from ovaries
4.   Progesterone (Secreted by Corpus Luteum of ovary) Maintains integrity of endometrium inside uterus during pregnancy

Menstrual Cycle Related Abnormalities

Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the vagina that is due to changes in hormone levels. It is bleeding that is NOT caused by: Pregnancy or miscarriage. Medical conditions, such as cancer or fibroids. Problems with the uterus or vagina from infection or other causes

It is classified as:
Menorrhagia: Excessive menstrual loss in amount or duration     or both. This is the commonest type of DUB

Metrorrhagia: Bleeding occurs irregularly between menstrual cycle.

Dysmenorrhea:  Painful menstruation

IUCD – Intrauterine Contraceptive device

Among the contraceptive methods, IUCD is a safe one with failure rate of below 1%,
More than 100 million women around the world use this device.
The most common complication of using IUD includes increased bleeding and cramps.
Also, bleeding may be to the extent that leads to iron deficiency anaemia.
Therefore, increased amounts of bleeding have a great impact on the lives of many women

Polycystic Syndrome of the Ovary (PCOS)

Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder that affects approximately 5 to 10% of women of reproductive age. It is characterized by hyperandrogenism, polycystic ovaries, and chronic anovulation along with insulin resistance, hyperinsulinemia, abdominal obesity, hypertension, and dyslipidemia as frequent metabolic traits (metabolic syndrome) that culminate in serious long-term consequences such as type 2 diabetes mellitus, endometrial hyperplasia, and coronary artery disease. It is one of the most common causes of anovulatory infertility.

The heterogeneous clinical features of PCOS may change throughout the life span, starting from adolescence to postmenopausal age. These are largely influenced by variation in obesity and metabolic changes. They are also affected by the varied phenotype of women with PCOS, depending on the ethnic backgrounds. Irrespective of geographic locations, a rapidly increasing prevalence of polycystic ovarian insulin resistance syndrome, excess body fat, adverse body fat patterning, hypertriglyceridemia, and obesity-related disease, such as diabetes and cardiovascular disease, have been reported in Asian Indians, suggesting that primary prevention strategies should be initiated early in this ethnic group.

Obesity contributes to the increased prevalence and severity of PCOS. To treat PCOS, it is recommended to limit the total energy and dietary fat intake. Hypocaloric diets significantly led to reduced body weight and androgen levels in two groups of women with PCOS. The combination of high-protein and low-glycemic-load foods in a modified diet was found to cause a significant increase in insulin sensitivity when compared with a conventional diet.

PCOS improves with weight loss. Meal replacements are an effective strategy for the short-term management of PCOS. A moderate fat or carbohydrate restriction has been found equally effective in maintaining weight reduction and improving reproductive and metabolic variables.

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