BASIC MECHANISM OF

MENSTRUATION
Sri Kadarsih Soejono
Bagian Ilmu Faal Fakultas
Kedokteran
A menstrual cycle is a repetitive
phenomenon occurring in non-pregnant
women during their reproductive life

and

Involves a patterned sequence of

structural and functional changes in the
reproductive system
The menstrual period is in reality
determined by hypothalamic mechanisms
that regulate pituitary gonadotropin
secretion

which, in turn,

control ovarium hormones release,

ovulation, and menstruation
The female life span can be divided into 3
periods that are a reflection of
development: pre-pubertal (infancy and
childhood), reproductive (aldolescence),
and post-menopausal years.

The onset of menses signals (menarche),

the start of reproductive life, and the
cessation of menses is the start of
menopause period
The morphology of the endometrium
directly correlated with coincident changes
in the ovary
The ovarian hormones (estrogen and
progesterone) control the differentiation,
the function, and the development of the
endometrium
Under the influence of estrogen that
produced by the development follicle, the
endometrium increases rapidly in
thickness from the 5th to the 14th days of
the menstrual cycle. This part of the
menstrual cycle is called the proliferative
phase
After ovulation, the endometrium becomes
more highly vascularized and slightly
edematous under the influence of
estrogen and progesterone from the
corpus luteum.

The endometrium glands become coiled

and they begin to secrete clear fluid. This
phase in the cycle is called the secretory
phase
The endometrium is supplied by two
types of arteries:

1. the superficial two third of the endometrium

that is shed during the menstruation
(stratum functional) is supplied by long
coiled spiral arteries
2. the deep layer that is not shed during the
menstruation (stratum basal), is supplied by
short straight basilar arteries
Due to the edematous in the endometrium
and vasospasm of the arteries (locally
release of prostaglandin), leads
endometrium necroses

and

when the corpus luteum regresses,

hormones support for endometrium is
withdrawn and leading to spotting
hemorrhage and become menstrual flow
The length of the secretory phase is
constant at about 14 days (the life span of
corpus luteum).
Menstrual blood is predominantly arterial
and in small amount the blood being of
venous origin.

It contains tissue debris, prostaglandins,

and relatively large amount of fibrinolysin
from endometrium tissue