Physiology of the normal menstrual cycle
- Corrine K Welt, MD
Corrine K Welt, MD
- Professor of Medicine
- University of Utah School of Medicine
- Section Editors
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K. Podolsky Professor of Medicine
- Harvard Medical School
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
The normal menstrual cycle is a tightly coordinated cycle of stimulatory and inhibitory effects that results in the release of a single mature oocyte from a pool of hundreds of thousands of primordial oocytes. A variety of factors contribute to the regulation of this process including hormones and paracrine and autocrine factors that are still being identified. The cyclic changes in the major pituitary and gonadal hormones are illustrated in the figure (figure 1 and figure 2).
The physiology of the normal menstrual cycle will be discussed here. Detection of ovulation and ultrasound evaluation of the menstrual cycle are reviewed separately. (See "Ultrasound evaluation of the normal menstrual cycle" and "Evaluation of the menstrual cycle and timing of ovulation".)
PHASES AND DURATION OF THE MENSTRUAL CYCLE
By convention, the first day of menses represents the first day of the cycle (day 1). The cycle is then divided into two phases: follicular and luteal.
●The follicular phase begins with the onset of menses and ends on the day before the luteinizing hormone (LH) surge.
●The luteal phase begins on the day of the LH surge and ends at the onset of the next menses.
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- PHASES AND DURATION OF THE MENSTRUAL CYCLE
- EARLY FOLLICULAR PHASE
- Ovaries and endometrium
- MID-FOLLICULAR PHASE
- Ovarian and endometrial changes
- LATE FOLLICULAR PHASE
- Ovarian, endometrial, and cervical mucus changes
- LUTEAL PHASE: MID-CYCLE SURGE AND OVULATION
- Ovarian changes
- MIDDLE TO LATE LUTEAL PHASE
- Endometrial changes