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2. Ovulation
Increasing
estrogen
secretion
by
preovulatory
follicles
onset
of
gonadotropin
surge
(good
indicator
of
ovulation)
Occurs
34-26
hours
before
the
release
of
the
ovum
from
the
follicle
LH
secretion
peaks
at
10-12
hours
before
ovulation
stimulates
the
continuation
of
meiosis
in
the
ovum
+
release
of
the
first
polar
body
Progesterone
and
Prostaglandin
production
by
the
cumulus
cells
+
GDF9
and
BMP-15
activates
expression
of
genes
essential
to
the
formation
of
the
ECM
by
the
cumulus
complex
Expansion
20-fold
increase
in
the
cumulus
complex
volume
brought
about
by
the
outward
movement
of
the
cumulus
cells
LH-induced
remodeling
of
the
ovarian
ECM
release
of
the
mature
oocyte
and
its
surrounding
cumulus
cells
through
the
surface
epithelium
The
Endometrial
Cycle
Cyclic
changes
that
occur
in
the
endometrium
in
response
to
ovarian
steroids
Phases:
o Proliferative
o Secretory
1. Proliferative
or
Preovulatory
Endometrial
Phase
The
Endometrium
o Stratum
functionalis
(superficial
layer)
Stratum
compactum
Stratum
spongiosum
o Stratum
basalis
The
deep
layer
where
the
stratum
functionalis
is
regenerated
from
Follicular
phase
estradiol
most
important
factor
in
endometrial
recovery
after
menstruation
Normal
Range
5-7
days
or
21-30
days
1st
day
of
bleeding
=
1st
day
of
the
cycle
2/3
of
the
functional
endometrium
is
shed
off
after
menstruation
5th
day
of
bleeding
epithelial
surface
of
the
endometrium
is
restored
Preovulatory
endometrium
characterized
by
glandular,
stromal,
and
vascular
endothelial
cells
Early
Proliferative
Phase
o Endometrium
is
<2
mm
thick
o Glands
are
narrow,
tubular
structures
that
pursue
an
almost
straight
and
parallel
course
from
the
basalis
layer
towards
the
endometrial
cavity
o 5th
cycle
day
mitotic
figures
in
the
glandular
epithelium
are
identified
o Mitotic
activity
persists
up
to
the
16th
or
17th
day
(approx..
2-3
days
after
ovulation)
o Absent
extravascular
or
leukocyte
infiltration
in
the
endometrium
o Re-epithelialization
and
angiogenesis
are
important
to
stop
endometrial
bleeding.
Both
are
dependent
on
estrogen-regulated
tissue
growth
3. Menstruation
In
the
absence
of
implantation,
glandular
secretion
ceases
and
the
breakdown
of
the
deciduas
functionalis
occur
Death
of
the
corpus
luteum
drop
in
progesterone
Luteal
progesterone
decrease
menstruation
is
initiated
Leukocyte
infiltration
key
to
endometrial
and
extracellular
matrix
breakdown
and
repair
of
the
functionalis
layer
Inflammatory
tightrope
ability
of
the
macrophages
to
assume
phenotypes
that
vary
from
pro-
inflammatory
and
phagocytic
to
immunosuppressive
and
reparative
Tissue
breakdown
and
restoration
occur
simultaneously
during
menstruation
Secretion
of
enzymes
by
the
leukocytes
in
addition
to
the
proteases
produced
by
endometrial
stromal
cells
initiate
matrix
degradation
Completion
of
tissue
shedding
microenvironment-
regulated
changes
promote
repair
and
resolution
Anatomical
Events
o Marked
changes
in
endometrial
blood
flow
o Spiral
artery
coiling
becomes
severe
resistance
to
blood
flow
endometrial
hypoxia
o Stasis
becomes
the
primary
cause
of
endometrial
ischemia
and
tissue
degeneration
o Vasoconstriction
precedes
menstruation
most
striking
and
constant
event
in
the
cycle
Limits
menstrual
blood
loss
Prostaglandins
and
Menstruation
o Produced
throughout
the
menstrual
cycle,
highest
during
menstruation
o Progesterone
withdrawal