This NCLEX review will discuss the female reproductive cycle (menstrual cycle). In maternity nursing, you will learn the menstrual cycle.
As a nursing student, you must be familiar with each phase, what occurs during the phase, the role of the hormones, and what happens if pregnancy occurs. These type of questions may be found on NCLEX and definitely on nursing lecture exams in maternity.
After you review these notes on the menstrual cycle, don’t forget to take the menstrual cycle quiz.
Lecture on the Menstrual Cycle
Maternity Nursing Review: Menstrual Cycle
Purpose of the Menstrual Cycle: is to release an egg for potential fertilization (from the ovary) so it can implant into the endometrium…hence help develop a baby. If this doesn’t happen, the 28 day cycle starts all over (note cycle days vary among women).
Two structures that play a vital role in the woman’s reproductive cycle:
- Ovary & Uterus (they work together)
- Each structure has three cycles (and these cycles correspond with each other)
Ovarian Cycles: Follicular (occurs during the menstrual and proliferative phase), Ovulation, Luteal Phase
Uterine Cycles: Menstrual & Proliferative (both occur during the follicular phase), Secretory Phase
Easy Recap of these Phases:
1. Follicular Phase (cycle day 1-13…ovarian changes) happens during Menstrual (cycle days 1-6…uterine changes) & Proliferative Phase (cycle days 7-14….uterin changes)
2. Ovulation (day 14…the mid-point of the 28 day cycle)
3. Luteal Phase (cycle days 15-28….ovarian changes) happens during Secretory Phase (cycle days 15-28….uterine changes)
*Typical menstrual cycle is 28 days
Cycle Day: 1-13: First Part of the Menstrual Cycle
- Menstrual (Cycle days 1-6)
- Follicular Phase (Cycle days 7-13)
- Proliferative Phase (Cycle days 7-14)
MENSTRUAL Phase: (uterine changes…cycle days 1-6)
Goal: shed the stratum functionalis layer of the endometrium
Woman has bleeding (consists of 1-6 days) where she is shedding the stratum functionalis (functional layer) of the endometrium. If pregnancy did not occur during the last cycle, the progesterone and estrogen levels drop which causes the layer to shed.
During this same time, there are OVARY CHANGES known as the:
FOLLICULAR PHASE: (ovarian changes…..cycle days 1-13)
Goal: prepare a follicle to release a mature egg (ovum)
How does it do this? When hormone levels from the previous cycle drop (specifically progesterone and estrogen) the hypothalamus releases Gonadotropin-Releasing Hormone (GnRH) and this causes the anterior pituitary gland to release FSH (follicle stimulating hormone) and LH (luteinizing hormone).
The FSH released from the anterior pituitary gland stimulates the follicles in the ovary to grow. A woman has two ovaries (right and left) and each contains MANY follicles.
Follicles are fluid-filled sacs in the ovary that contain an immature egg known as an oocyte. NOTE: FSH will cause several follicles to develop but only ONE turns into a Graafian follicle (mature follicle) that will release a mature egg (ovum). The other follicles that didn’t release an egg will die.
As the follicle matures, it will produce hormones such as ESTROGEN. The estrogen will steadily increase as the egg reaches maturity. There will be a small dip in the production of FSH and LH because the body senses the extra estrogen which represents that the egg must be mature and the follicle doen’t need to be stimulated to grow. This is the negative feedback loop where the estrogen will signal to the hypothalamus to decrease production of GnRH so the anterior pituitary gland will quit releasing so much FSH and LH.
However, the mature follicle is producing massive amounts of estrogen and the estrogen secretion from the follicle will peak to a VERY HIGH POINT. This will actually cause the anterior pituitary gland to release a surge of LH (luteinizing hormone)…hence positive feedback loop and this is what is called an LH surge (cycle day 11-13).
LH plays a huge role in causing the egg to be released from the follicle (which causes ovulation to happen). LH causes the egg to mature and breaks down the wall of the Graafian follicle allowing the follicle to release the egg which is now called an ovum. 24-36 hours after the LH surge the ovary will release the ovum (usually happens mid-cycle…hence day 14).
In addition, LH helps the Graaifan follicle that released the egg turn into the CORPUS LUTEUM. The corpus luteum will be responsible for releasing progesterone and estrogen to maintain a potential pregnancy until the placenta can take over. NOTE: the development of the corpus luteum occurs in the LUTEAL Phase…note why it is called LUTEAL…the LUTE of luteal corresponds with the word corpus LUTEum).
*The last 5 days of the follicular phase and during ovulation is the most fertile time for a woman to get pregnant…sperm live approximately 5 days and the egg lives for 24 hours (so fertile cycle days would be days 9 -16).
PROLIFERATIVE Phase (uterine changes…cycle days 7-14)
Goal: to rebuild the stratum functionalis layer that was just shed during the menstrual phase (in case the ovum is fertilized) so it can implant into the uterus.
What causes the layer to rebuild? Remember how during the follicular phase the maturing follicles are secreting estrogen? The estrogen from the secretion of the maturing follicles is ALSO causing the stratum functionalis layer to rebuild. In addition, it causes cervical mucous to thin which allows sperm to migrate easier to the egg.
OVULATION: Cycle day 14
The egg is released from the ovary. The ovum enters into the PERITONEAL CAVITY . It makes it journey to the fallopian tube with the help of the fimbria which have cilia to help sweep the ovum into the fallopian tube. If sperm are present to fertilize the egg, fertilization will occur in the fallopian tube most likely in the AMPULLA.
The egg will only live for 24 hours and disintegrate, if not fertilized. The woman will have a low basal body temperature before ovulation and then increase 0.4-1’F around ovulation.
Cycle Days 15-28: Second Part of the Menstrual Cycle
- Luteal (cycle days 15-28)
- Secretory (cycle days 15-28)
LUTEAL PHASE (ovary changes….cycle day 15-28)
Goal: prepare the endometrium for a potential fertilized egg
Begins when the egg is releases from the ovary.
The corpus luteum forms which developed from the Graaifan follicle that released the ovum. The corpus luteum acts as a temporary endocrine structure that secretes progesterone and estrogen. Progesterone prepares the endometrium for implantation of the embryo, if the ovum is fertilized.
Role of Progesterone:
- stimulates estrogen production
- allows the endometrium to receive the fertilized ovum for implantation
- stops production of LH and FSH (so possible pregnancy can be maintained) and estrogen inhibits the hypothalamus from releasing GnRH (hence new reproductive cycle….if the ovum is fertilize you want to prevent another menstrual cycle from occuring so pregnancy can occur).
- This will help prevent the hypothalamus from releasing GnRH which will prevent LH and FSH from being secreted in case fertilization has occurred.
Corpus luteum stays in place for about 14 days and if fertilization hasn’t occurred it disintegrates. It will turn into the corpus albicans. When the corpus luteum dies, estrogen and progesterone will decrease and this leads to a new reproductive cycle….the hypothalamus will release GnRH which will cause the anterior pituitary gland to release FSH and LH and the woman will shed the uterine lining and new follicle will be stimulated to produce a new egg etc.
However, if fertilization occurs the fetus will start to produce HcG Human chorionic gonadotropin (hence what a pregnancy test picks up) and this will prevent the corpus luteum from dying. So, until the placenta becomes fully functional, the corpus luteum will help maintain steady levels of progesterone and estrogen to maintain the endometrium for the fetus. The placenta will take over will progesterone and estrogen production at approximately 8 weeks.
SECRETORY Phase: (uterine changes….cycle days 15-28)
Goal: endometrium is receptive to the implantation of a fertilized ovum
The progesterone being released from the corpus luteum is allowing the endometrium to be receptive for implantation of the fertilized ovum.
The menstrual cycle | womenshealth.gov. (2010). womenshealth.gov. Retrieved 19 December 2016, from https://www.womenshealth.gov/pregnancy/menstrual-cycle