Understanding the Menstrual Cycle

A menstrual cycle is the ovulation, uterine preparation, and follicle growth for pregnancy, which is counted from the first day of one period to the first day of the subsequent period. This dynamic process is repeated every month, and it is described by specific signs that may differ, intensify, and sometimes change over age.

Four Phases on the Menstrual Cycle

The menstrual cycle is divided into four phases: follicular phase, ovulation, luteal phase, and menstruation.

Follicular phase: This phase, also called proliferative phase starts from the first day of menstruation and last until ovulation phase. Increased secretion of follicle stimulating hormone (FSH) stimulates few ovarian follicles. The matured follicles secrete estrogen, and the estrogen forms an endometrium layer in the uterus. The egg matures inside the follicle and the secreted estrogen triggers the production of fertile cervical mucus.

Ovulation: In this phase, estradiol stimulates the production of luteinizing hormone (LH). The increased LH weakens the follicle walls and releases secondary oocyte. The released oocyte matures to become an egg. A fertilize egg from the fallopian tubes is then released. 

Luteal phase: In this phase, the follicle changes into corpus luteum, this is nothing but a formation of solid body in an ovary. This formation continuous to grow and produces progesterone. Progesterone helps the endometrium open to implantation and support the early pregnancy period. 

Menstruation: Menstruation is the bleeding period and the failure to menstruate is the first symptom of pregnancy. In this last phase, the inner lining of the uterus is shed and the corpus luteum continues to produce progesterone. The normal blood loss during this phase is about 10-80ml. 

Cycle Abnormalities 

The regular menstrual cycle takes place every 28 days ± seven days. The menstrual cycle with interval of 21 days or less is polymenorrhea. The menstrual cycle exceeding more than 35 days is oligomenorrhea. The menstrual cycle exceeding more than 180 days is amenorrhea. Heavy menstrual flow is hypermenorrhea, which is caused by hormonal imbalance and uterine abnormalities. Low menstrual flow is called hypomenorrhea. Bleeding not related to the normal bleeding period is called metrorrhagia. Bleeding irregularities caused by hormonal imbalance is called dysfunctional uterine bleeding. Women may also experience what is known as dysmenorrhea or more commonly cramps. Women who suffer from this have either sharp, intermittent pain or dull aching pain during their menstrual periods. This pain is usually felt in the pelvis or the lower abdomen.

Effects on other Body Systems 

During menstrual cycle, women with neurological problems experience increased activity of their health condition. Women with epilepsy experience catamenial epilepsy, a health condition with increased seizures. The increase in seizures is the result of increased estrogen and declined progesterone. Also, some women may experience abnormal thyroid behavior because of the low blood flow in the thyroid during the luteal phase. It is also found that woman experiencing menstruation is more probable to commit suicide. The studies also state that increased estrogen level increases the activity of nerve cells, which in turn increases seizure susceptibility and anxiety. 

Fertile Window

In a menstrual cycle, a woman fertile period lasts for about seven days before or 1-2 days after ovulation. In the average of 14 days luteal period, this fertile period begins at the end of second week or at the beginning of third week. To calculate fertile and infertile days in a menstrual cycle, a method called fertility awareness is created. This method is mainly based on the symptoms such as cervical mucus, cervical position, and basal body temperature. Fertility monitors are used to detect these symptoms.

Ovulation Suppression

Most hormonal contraceptive pills do not affect the menstrual cycle, but few decreases the pulse frequency of gonadotropin releasing hormone, which in turn decreases the follicle stimulating hormone. Few low dose progesterone-only contraceptives suppress ovulation in 50% of cycles. Intermediate progesterone-only contraceptives suppress ovulation for about 95-99%. The high dose progesterone-only contraceptives suppress complete ovulation.

There are also combined hormonal contraceptives that have both progesterone and an estrogen. These combined hormonal contraceptives are very effective as the estrogen has greater effect in reducing the release of FSH.

Based on the negative feedback, breastfeeding women experience ovulation suppression, no ovulation, or regular menstrual cycle. The regular menstrual cycle is based on frequency of breastfeeding. If the frequency of breastfeeding is higher, return of menstruation takes longer period.

Here are a few additional resources on the menstrual cycle:

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