MENSTRUATION

Menstruation is the shedding of the uterine lining - endometrium. It occurs on a regular basis in reproductive-age females of certain mammal species. Overt menstruation (where there is bleeding from the vagina) is found primarily in humans and similar relatives such as chimpanzees. The females of other placental mammal species have estrous cycles, in which the endometrium is reabsorbed by the animal (covert menstruation) at the end of its reproductive cycle. Many zoologists regard this as different from a "true" menstrual cycle.

Overview

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. (Sometimes this is erroneously thought to indicate an early-term miscarriage of an embryo.)

An enzyme called plasmin — contained in the endometrium — tends to inhibit the blood from clotting. Because of this blood loss, premenopausal women have higher dietary requirements for iron to prevent iron deficiency.

Many women experience uterine cramps, also referred to as dysmenorrhea, during this time, caused largely by the contractions of the uterine muscle as it expels the endometrial blood from the woman's body. A vast industry has grown to provide drugs to aid in these cramps, as well as sanitary products to help manage menses.

Menstruation is the most visible phase of the menstrual cycle. Menstrual cycles are counted from the first day of menstrual bleeding, because the onset of menstruation corresponds closely with the hormonal cycle.

During pregnancy and for some time after childbirth, menstruation is normally suspended; this state is known as amenorrhoea, i.e. absence of the menstrual cycle.

If menstruation has not resumed, fertility is low during lactation.

The average length of postpartum amenorrhoea is longer when certain breastfeeding practices are followed; this may be done intentionally as birth control (lactational amenorrhea method).

Menstrual cycle

The menstrual cycle is a cycle of physiological changes that occurs in pubescent females. Overt menstruation (where there is blood flow from the vagina) occurs primarily in humans and other mammals such as chimpanzees.

Females of other species of placental mammal undergo estrous cycles, in which the endometrium is completely reabsorbed by the animal (covert menstruation) at the end of its reproductive cycle. This article focuses on the human menstrual cycle.

The menstrual cycle, under the control of the endocrine system, is necessary for reproduction. It may be divided into three distinct phases:

• Menstruation,
• The follicular phase and
• The luteal phase.

Ovulation defines the transition from the follicular phase to the luteal phase.

The length of each phase varies from woman to woman and cycle to cycle, though the average menstrual cycle is 28 days.

Hormonal contraception interferes with the normal hormonal changes with the aim of preventing reproduction.

Stimulated by gradually increasing amounts of estrogen in the follicular phase, menses slow then stop, and the lining of the uterus thickens.

Follicles in the ovary begin developing under the influence of a complex interplay of hormones, and after several days one or occasionally two become dominant (non-dominant follicles atrophy and die).

Approximately mid-cycle, 24-36 hours after the Luteinizing Hormone (LH) surges, the dominant follicle releases an ovum, or egg in an event called ovulation.

After ovulation, the egg only lives for 24 hours or less without fertilization while 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 involute, 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.

In the menstrual cycle, changes occur in the female reproductive system as well as other systems (which lead to breast tenderness or mood changes, for example). A woman's first menstruation is termed menarche, and occurs typically around age 12. The end of a woman's reproductive phase is called the menopause, which commonly occurs somewhere between the ages of 45 and 55.

Phases

The menstrual cycle is divided into several phases. The average length of each phase is shown below:

Name of phase	Average start day assuming a 28-day cycle	Average end day
Menstrual phase	1	4
Follicular phase (also known as proliferative phase)	5	13
Ovulation (not a phase, but an event dividing phases)	12	16
Luteal phase (also known as secretory phase)	15	26
Ischemic phase (some sources group this with luteal phase)	27	28

Menstruation

Menstruation is also called menstrual bleeding, menses, catamenia or a period. The flow of menses normally serves as a sign that a woman has not become pregnant. (However, this cannot be taken as certainty, as a number of factors can cause bleeding during pregnancy ; some factors are specific to early pregnancy, and some can cause heavy flow.) 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 milliliters with 10–80 ml considered normal. (Because of this blood loss, women are more susceptible to iron deficiency than are men.) An enzyme called plasmin inhibits clotting in the menstrual fluid. Cramping in the abdomen, back, or upper thighs is common during the first few days of menstruation. When menstruation begins, symptoms of premenstrual syndrome (PMS) such as breast tenderness and irritability generally decrease. Many sanitary products are marketed to women for use during their menstruation.

Follicular phase

This phase is also called the proliferative phase because a hormone causes the lining of the uterus to grow, or proliferate, during this time.

Through the influence of a rise in follicle stimulating hormone (FSH) during the first days of the cycle, a few ovarian follicles are stimulated. These follicles, which were present at birth and have been developing 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 stop growing, while one dominant follicle in the ovary will continue to maturity. The follicle that reaches maturity is called a tertiary, or Graafian, follicle, and it forms the ovum.

As they mature, the follicles secrete increasing amounts of estradiol, an estrogen. The estrogens initiate the formation of a new layer ofendometrium 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 nearly matured, the level of estradiol in the body has increased enough to trigger a sudden release of luteinizing hormone (LH) from the anterior pituitary gland. 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, causing the fully developed follicle to release its secondary oocyte. The secondary oocyte promptly matures into an ootid and then becomes a mature ovum. The mature ovum has a diameter of about 0.2 mm.

Which of the two ovaries—left or right—ovulates appears essentially random; no known left/right co-ordination exists. Occasionally, both ovaries will release an egg; if both eggs are fertilized, the result is fraternal twins.

After being released from the ovary, the egg is swept into the fallopian tube by the fimbria, which is a fringe of tissue at the end of each fallopian tube. After about a day, an unfertilized egg will disintegrate or dissolve in the fallopian tube.

Fertilization by a spermatozoon, when it occurs, usually takes place in the ampulla, the widest section of the fallopian tubes. A fertilized egg immediately begins the process of embryogenesis, or development. The developing embryo takes about three days to reach the uterus and another three days to implant into the endometrium. It has usually reached the blastocyst stage at the time of implantation.

In some women, ovulation features a characteristic pain called mittelschmerz (German term meaning middle pain). The sudden change in hormones at the time of ovulation sometimes also causes light mid-cycle blood flow.

Luteal phase

Corpus Luteum

The luteal phase is also called the secretory phase. An important role is played by the corpus luteum, the solid body formed in an ovary after the egg has been released from the ovary into the fallopian tube. This body continues to grow for some time after ovulation and produces significant amounts of hormones, particularly progesterone.^[2] Progesterone plays a vital role in making the endometrium receptive to implantation of the blastocyst and supportive of the early pregnancy; it also has the side effect of raising the woman's basal body temperature.

After ovulation, the pituitary hormones FSH and LH cause the remaining parts of the dominant follicle to transform into the corpus luteum, which produces progesterone and estrogens. The hormones produced by the corpus luteum also suppress production of the FSH and LH that the corpus luteum needs to maintain itself. Consequently, the level of FSH and LH fall quickly over time, and the corpus luteum subsequently atrophies. Falling levels of progesterone trigger menstruation and the beginning of the next cycle. From the time of ovulation until progesterone withdrawal has caused menstruation to begin, the process typically takes about two weeks, with ten to sixteen days considered normal. For an individual woman, the follicular phase often varies in length from cycle to cycle; by contrast, the length of her luteal phase will be fairly consistent from cycle to cycle.

The loss of the corpus luteum can be prevented by fertilization of the egg; the resulting embryo produces human chorionic gonadotropin(hCG), which is very similar to LH and which can preserve the corpus luteum. Because the hormone is unique to the embryo, mostpregnancy tests look for the presence of hCG.