1. Female Reproductive Cycle In-je University Medical College
인체 발생의 시작 : 제 1주
Department of Anatomy
In-je University Medical College

2. Contents
Ovarian cycle
2. Menstrual cycle
3. Contraception

3. Overview Hypothalamus – GnRH – Pituitary – Ovaries - Endometrium
Hormonal changes  functional and morphological changes in ovaries  ovulation  endometrial changes  implantation or menstruation
Ovarian cycle – series of events in ovaries that occur during and after maturation of oocyte
Menstrual (Uterine) cycle – concurrent series of changes in uterine endometrium preparing it for arrival of fertilized ovum
= Ovarian + Endometrial + Cervical + Vaginal + Breast + Psychological + Others

4. Ovarian cycle Averages 28 days, ranges from 20 to 45
Hormone cycle: hypothalamus pituitary  ovaries  uterus
Follicular phase (1~14day)
period of follicle growth
menstruation occurs (3~5day)
uterus replaces lost endometrium and follicles grow
Luteal phase (15~28day)
period of corpus luteum activity
corpus luteum stimulates endometrial thickening
endometrium lost without pregnancy

5. Ovarian cycle - Follicular phase
Menstruation (day 1) to ovulation(14) (variable)
Difficult to predict date of ovulation
Contains menstrual and preovulatory phases

6. Follicular development
primordial follicle
primary follicle
secondary(growing) follicle
mature(Graafian) follicle
Estrogene 분비
The primordial follicle, directed by the oocyte, becomes a primary follicle
Primary follicle becomes a secondary follicle
The theca folliculi and granulosa cells cooperate to produce estrogens
The zona pellucida forms around the oocyte
The antrum is formed
The secondary follicle becomes a mature Graafian follicle
The antrum expands and isolates the oocyte and the corona radiata
The full size follicle (vesicular follicle) bulges from the external surface of the ovary
The primary oocyte completes meiosis I, and the stage is set for ovulation
Follicle rupture and release ovum
Ruptured follicle luteinize and produce corpus luteum

7. Feedback mechanisms in ovarian function
Figure 27.21

8. LH surge 혈중 estrogen 치가 최고치일 때 대개 12, 13일 쯤에 나타남 Lasts for 48 hrs
Ovulation occurs after 36 hrs
Accompanied by rapid fall in estradiol level
Triggers the resumption of meiosis
Affects follicular wall  follicular rupture
Granulosa cells  lutenization  progestrone synthesis

9. Ovulation
; 14 ± 1 day
Ovulation occurs when the ovary wall ruptures and expels the secondary oocyte
midcycle LH surge
- dramatic increase prostaglandin, proteolytic enzyme
- weaken the follicular wall and then ruptured

10. Ovulation ◈ Cause ◈ ovulated mass LH surge
Graafian follicle → increase of follicular fluid
Ruptual of stigma
◈ ovulated mass
Meiotic II metaphase oocyte
The zona pellucida (; clear zone) forms around the oocyte
Graafian follicle= cumulus oophorus → corona radiata

11. Ovulation signs 관찰방법 Basal body temperature Spotted bleeding
mild abdominal cramps, 중간 통증
over-the-counter ovulation kit → LH 증가
: test your urine for the surge in hormones that takes place before ovulation
Blood, 혈액검사 → protesterone 증가
자궁경부 점액 관찰법
: clear, slippery vaginal secretions, 분비물 증가
조직 검사시, secretary phase로의 이행, 변화 관찰
질 초음파 검사법

12. Ovarian cycle - Ovulation
Mature follicle ruptures, releases oocyte influenced by LH

13. Luteal phase
After ovulation, the ruptured follicle collapses, granulosa cells enlarge, and along with internal thecal cells, form the corpus luteum
The corpus luteum secretes progesterone and estrogen
If pregnancy does not occur, the corpus luteum degenerates in 10 days, leaving a scar (corpus albicans)
If pregnancy does occur, the corpus luteum produces hormones until the placenta takes over that role (at about 3 months)

14. Ovarian cycle - Luteal phase
Corpus luteum - forms from ruptured follicle, under influence of LH;
secretes progesterone

15. Menstrual cycle Name of phase Days menstrual phase 1–5
follicular phase (also known as proliferative phase)
6–13
ovulation (not a phase, but an event dividing phases) 14
luteal phase (also known as secretory phase)
15–26
ischemic phase (some sources group this with secretory phase)
27–28

16. Uterine wall Composed of three layers
Endometrium
Composed of three layers
Perimetrium – outermost serous layer; the visceral peritoneum
Myometrium – middle layer; consists of interlacing layers of smooth muscles
Endometrium – mucosal lining of the uterine cavity. It has numerous uterine glands and consists of
Compact layer
Sponge layer
Basal layer

17. Endometrium

18. 1. Menstrual phase
; 1~5days
Blood, serous fluid and endometrial tissue are discharged
Corpus luteum → corpus albicans
Functional layer 탈락 ; menstruation
→ 1~5days, 50~150ml (20~40ml blood, 응고하지 않음)

19. 2. Proliferative phase ; 6~14days, follicular phase
Proliferation Phase starts in the anterior pituitary gland with the release of FSH.
FSH goes to the ovaries and causes the ovarian graafian follicle (ovum) to develop/mature.
Follicle begins to mature (theca cell)- releases ESTROGEN
Estrogen causes the uterine lining to thicken in preparation of the ovum (egg) and causes the ovum to ripen and enlarge. → endometrial growth reached maximum
When estrogen levels get high enough they cause the release of LH or luteinizing hormone

20. 3. Secretory phase
; 15~26days, luteal phase
After ovulation, the ruptured follicle collapses, granulosa cells enlarge, and along with internal thecal cells, form the corpus luteum
The corpus luteum secretes progesterone and estrogen
If pregnancy does not occur, the corpus luteum degenerates in 10 days, leaving a scar (corpus albicans)
If pregnancy does occur, the corpus luteum produces hormones until the placenta takes over that role (at about 3 months)

21. 5. Ischemic phase Involution of corpus luteum, progesterone falls
; 27~28days
Involution of corpus luteum, progesterone falls
corpus luteum → corpus albicans
spiral arteries constrict causes endometrial ischemia
stratum functionalis sloughs

22. Premenstrual Syndrome - PMS
PMS often occurs after ovulation.
Over 150 symptoms have been reported that have been related to PMS.
Treatment includes counseling, medications, dietary changes, regular exercise.

23. Gonadotropins, Hormones, and the Ovarian and Uterine Cycles

24. Hormonal interactions in the ovarian and uterine cycles

25. Contraception Rhythm method Contraceptives
a. estrogen + progesterone 적당량 지속적 투여
→ combined contraceptives (=COCs)
→ ovarian cycle이 block됨.
b. Emergency contraceptives (=EC)
→ 아주 많은 양의 progesterone과 estrogen 투여
→ morning-after pills
c. 임신 중절
→ progesterone inhibitor
→ dilatation & curettage (=D&C)

26. Various birth control devices