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
- Diane Blake, MD
Diane Blake, MD
- Section Editor — Adolescent Medicine
- Professor of Pediatrics
- University of Massachusetts Medical School
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 figures (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.
- Treloar AE, Boynton RE, Behn BG, Brown BW. Variation of the human menstrual cycle through reproductive life. Int J Fertil 1967; 12:77.
- Sherman BM, Korenman SG. Hormonal characteristics of the human menstrual cycle throughout reproductive life. J Clin Invest 1975; 55:699.
- Sherman BM, West JH, Korenman SG. The menopausal transition: analysis of LH, FSH, estradiol, and progesterone concentrations during menstrual cycles of older women. J Clin Endocrinol Metab 1976; 42:629.
- Hall JE, Schoenfeld DA, Martin KA, Crowley WF Jr. Hypothalamic gonadotropin-releasing hormone secretion and follicle-stimulating hormone dynamics during the luteal-follicular transition. J Clin Endocrinol Metab 1992; 74:600.
- Gougeon A. Dynamics of follicular growth in the human: a model from preliminary results. Hum Reprod 1986; 1:81.
- Gougeon A. Dynamics of human follicular growth: A morphologic perspective. In: The Ovary, Adashi EY, Leung PCK (Eds), Raven Press, New York 1993. p.21.
- Welt CK, Martin KA, Taylor AE, et al. Frequency modulation of follicle-stimulating hormone (FSH) during the luteal-follicular transition: evidence for FSH control of inhibin B in normal women. J Clin Endocrinol Metab 1997; 82:2645.
- Welt CK, McNicholl DJ, Taylor AE, Hall JE. Female reproductive aging is marked by decreased secretion of dimeric inhibin. J Clin Endocrinol Metab 1999; 84:105.
- Filicori M, Santoro N, Merriam GR, Crowley WF Jr. Characterization of the physiological pattern of episodic gonadotropin secretion throughout the human menstrual cycle. J Clin Endocrinol Metab 1986; 62:1136.
- Kissell KA, Danaher MR, Schisterman EF, et al. Biological variability in serum anti-Müllerian hormone throughout the menstrual cycle in ovulatory and sporadic anovulatory cycles in eumenorrheic women. Hum Reprod 2014; 29:1764.
- Fleischer AC, Kalemeris GC, Entman SS. Sonographic depiction of the endometrium during normal cycles. Ultrasound Med Biol 1986; 12:271.
- Gipson IK, Moccia R, Spurr-Michaud S, et al. The Amount of MUC5B mucin in cervical mucus peaks at midcycle. J Clin Endocrinol Metab 2001; 86:594.
- Adams JM, Taylor AE, Schoenfeld DA, et al. The midcycle gonadotropin surge in normal women occurs in the face of an unchanging gonadotropin-releasing hormone pulse frequency. J Clin Endocrinol Metab 1994; 79:858.
- Taylor AE, Whitney H, Hall JE, et al. Midcycle levels of sex steroids are sufficient to recreate the follicle-stimulating hormone but not the luteinizing hormone midcycle surge: evidence for the contribution of other ovarian factors to the surge in normal women. J Clin Endocrinol Metab 1995; 80:1541.
- Martin KA, Welt CK, Taylor AE, et al. Is GnRH reduced at the midcycle surge in the human? Evidence from a GnRH-deficient model. Neuroendocrinology 1998; 67:363.
- Richards JS. Hormonal control of gene expression in the ovary. Endocr Rev 1994; 15:725.
- Tsafriri A, Chun SY, Reich R. Follicular rupture and ovulation. In: The Ovary, Adashi EY, Leung PCK (Eds), Raven Press, New York 1993. p.227.
- Noyes RW, Hertig AT, Rock J. Dating the endometrial biopsy. Fertil Steril 1950; 1:3.
- Stocco C, Telleria C, Gibori G. The molecular control of corpus luteum formation, function, and regression. Endocr Rev 2007; 28:117.
- Filicori M, Butler JP, Crowley WF Jr. Neuroendocrine regulation of the corpus luteum in the human. Evidence for pulsatile progesterone secretion. J Clin Invest 1984; 73:1638.
- Cella F, Giordano G, Cordera R. Serum leptin concentrations during the menstrual cycle in normal-weight women: effects of an oral triphasic estrogen-progestin medication. Eur J Endocrinol 2000; 142:174.
- 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