WOMAN LIFE CICLE

Tim FK UGM
• Risanto Siswosudarmo
• Bagian Obsgin FK UGM
Woman’s life cycle
1. Intrauterine
2. Childhood
3. Puberty
4. Adulthood
5. Pre menopause
6. Peri menopause
7. Post menopause
1. Intrauterine
a. Begin at the time of fertilization when an
oocyte is fertilized by a spermatozoon
containing X chromosome  female zygote
b. Female zygote doesn’t have testis
determining factor allow primitive gonad
develop into ovaries
c. At the seventh weeks of embryonic life, the
fetus contains the primordia of both female
and male genital duct.
d. Because ovary doesn’t have mullerian-
inhibiting substance (MIS) allows genital
duct develop in the female direction
 female
Spermatozoon Ovaries Mis (-) X
X X
TDF (-)

XX

Oocyte Gonad (7) Primordial

Genetic Ducts
X X
TDF (+)
X
XY

Spermatozoon Testis
Mis (+)
Y X
X
male
e. By 13-14 weeks of embryonic life, primordial
follicles are noticeable.
f. The maximal number a primordial follicles as
reached at approximately 20 weeks of
gestation, at which time six to seven millions
are present.
g. Subsequently, their number is gradually
decreased by a process term atresia so that by
the time of birth only one to two millions
primordial follicles have survive
 2. Childhood

pre
fetus childhood puberty menopause

0 10 15 300-400 ovulated
300.000-400.000 menarche
Primordial
follicles
The period between birth and puberty. By
the time of birth only one to two million
of primordial follicles have survive,
continuous through out childhood and, at
the time of puberty, 300.000-400.000
primordial follicles are present within
the ovaries. Of these, approximately
300-400 will be ovulated during the
woman’s reproductive life from
menarche to menopause, while the
remainder under go atresia.
3. Puberty

The age during which a child matures

sexually and becomes an adult and is able
to reproduce.
Development of internal sex organ, external
genitalia and sexual secondary
characteristics.
Activation of the ovary under the
dependence of the hypothalamo-pituitary
system.
Irregular menstrual cycle
 4. Adulthood
Interaction of organ systems
Hipothalamus
GnRH

Pituitary
FSH LH

ovary

Progesteron esterogen
Regular menstrual cycle
Cyclic hormonal stimulation of
endometrial growth
Average length 28 days (21-35 days)
Divided into two phases :
Follicular phase
Lutheal phase
 Follicular phase
The first part of the menstrual cycle which
extends from day 1 to ovulation
Characteristic :
• A variable length.
• A low basal temperature.
• Development of the ovarian follicles.
• Increase in the number of glandular and stoma
cells of the endometrium.
• Vascular growth of the endometrium.
• Secretion of osterogen from the ovary.
 Luteal phase
The second part of the menstrual cycle, which
extends from ovulation to the onset of menses.
Characteristic :
• A fairly constant duration of 12 to 16 days
(usually 12 days).
• A basal body temperature that is elevated
above 98oF.
• Tortuosity of endometrial glands.
• Marked edema of the endometrial stroma.
• Increased secretion of progesterone by the
ovary.
 Otak
Otak

++ +_
+_ __

Norepinefrin
Norepinefrin Dopamin
Dopamin Indolamin
Indolamin

Hipothalamus
Hipothalamus

ACTH-RH
ACTH -RH GnRH
GnRH TRH
TRH

Hipofise
Hipofise Prolactin
Prolactin

ACTH
ACTH TSH
TSH

Glandula
Glandula FSH
FSH LH
LH Glandula
Glandula
adrenal
adrenal tiroid
tiroid

Ovarium
Ovarium

T3,T4
Corticosteroid Progesteron
Progesteron Estrogen
Estrogen

Androgen
 Start at
40 years

6-8
years
Post
Pre menopause Peri menopause Menopause
Menopasue

•Pre menopausal Syndrome

•Endometrial disease
5,6. PRE MENOPAUSE AND PERI
MENOPAUSE
Menopause denotes the final menstrual bleeding.
The time closest to this event is called the peri menopause’,
before that is the pre-menopause, and after it the post-
menopause. The pre menopause does not cover the whole of
the woman’s life before the menopause, but merely the time
(a) from around 40 years of age when a woman can
reasonably be said to be approaching the menopause, or
(when a woman feels the approach of the menopause, by
experiencing pre menopausal irregularities in her menstrual
cycle or other `menopausal` or `climacteric` symptoms. The
last few years of menstrual life are usually years of varied
patterns of short and long cycles; This periods of transition
vary considerably in length, but usually to occupy about six
to eight years before menopause.
A PREMENOPAUSAL SYNDROME
The disruption of the ovulatory mechanism and
the imbalance between progesterone and
estrogen establish a characteristic syndrome of
pre menopause. Such as sweating . a certain
amount of hot flushes. D dizziness tingling
sensation the in the extremities. headaches.
sleeplessness. Worry and anxiety
• Endometrial disease
The relative estrogen dominance at
pre menopausal age is responsible
for a higher than usual incidence of
unscheduled bleeding The
estrogen's stimulations without
progesterone develops endometrial
hyperplasia. and continuous
stimulation develops atypical
hyperplasia and then endometrial
carcinoma
7. POST MENOPAUSE
A. Menstrual cycle changes

1. changes in menstrual cycle regulatory occur

as women progress through their forties
2. the remaining follicles in both ovaries become
less sensitive to gonadotropin stimulation.
There is a resultant:
a. Increase in follicle –stimulating hormone
(FSH)
b. Reduction in estrogen concentration
3. The limited follicle maturation leads to either
a decreased cycle interval or lapses of cycles
with oligomenorrhea
 B. The Cessation of Menses
1. The menses usually cease between
the ages of 50 and 52 years. The
reduced level of estrogen from the
remaining follicles is no longer
sufficient to induced endometrial
proliferative changes capable of
producing visible menstruation.
2. FSH levels rise 10- to 20-fold
above usual cycle levels.
 C. Circulating Estrogen in Postmenopausal
Women

1. Estrogenic activity is evident for many years

after the menopause but at much reduced
levels.
2. Estrone, the principal estrogen in a
postmenopausal woman, is produced from the
androgen precursor, androstenedione, via
extraglandular and extrahepatic aromatization.
a. Most of the androstenedione comes from
adrenal gland.
b. Ovarian stroma secretes androstenedione for
a short time before that tissue becomes
quiescent
3. Obesity is a factor in postmenopausal estrogen
levels.
a. In Obese women, there is an increased
conversion of androstenedione to estrone.
b. The conversion reflect the ability of fat cells
to aromatize androgens.

4. The extraglandular source of estrogen is

sustained for several years and maintains
reasonably normal function of such estrogen-
dependent tissues as breasts, urethra, vagina and
vulva.
 Reference

ADT Govan, Colin Hodge,Robin Callander,Gynecology

Illustrated, Churchill Livingstone Edunbary, London Melbourne,
New York, 1985, 124-127.

Vesna Dramusic, SS Ratnam, Clinical Approach to Paediatric and

Adolescent Gynaecology, Oxford University Press Singapore,
1998, 1-11.

William W.Beck VR,Obstetrics and Gynecology, Harval

Publishing Company, Pensylvania, 1986, 189-195.

Allan Rossenfield and Mahmud F. Futhaha, The FIGO. Manual of

Human Reproduction Vol.I Reproductive The Trustee of
Columbia University,New York, 1990, 22-54.

PA Van Keep, VH Utian, A.Vermulan, The Controversial

Climateric, MTP Press Limited, Lancaster The Hague, 1985, 1-9.