18.8 Menstrual Cycle

Created by CK-12 Foundation/Adapted by Christine Miller

18.8.1 Menstruation Awareness
Figure 18.8.1 It’s healthy to talk about menstruation.

Taboo Topic

The banner in Figure 18.8.1 was carried in a 2014 march in Uganda as part of the celebration of Menstrual Hygiene Day. Menstrual Hygiene Day is an awareness day on May 28 of each year that aims to raise awareness worldwide about menstruation and menstrual hygiene. Maintaining good menstrual hygiene is difficult in developing countries like Uganda because of taboos on discussing menstruation and lack of availability of menstrual hygiene products. Poor menstrual hygiene, in turn, can lead to embarrassment, degradation, and reproductive health problems in females. May 28 was chosen as Menstrual Hygiene Day because of its symbolism. May is the fifth month of the year, and most women average five days of menstrual bleeding each month. The 28th day was chosen because the menstrual cycle averages about 28 days.

What Is the Menstrual Cycle?

The  refers to natural changes that occur in the female reproductive system each month during the reproductive years. The cycle is necessary for the production of ova and the preparation of the for . It involves changes in both the ovaries and the uterus, and is controlled by pituitary and ovarian hormones. Day 1 of the cycle is the first day of the menstrual period, when bleeding from the uterus begins as the built-up lining the uterus is shed. The endometrium builds up again during the remainder of the cycle, only to be shed again during the beginning of the next cycle if  does not occur. In the ovaries, the menstrual cycle includes the development of a , ovulation of a secondary oocyte, and then degeneration of the follicle if pregnancy does not occur. Both uterine and ovarian changes during the menstrual cycle are generally divided into three phases, although the phases are not the same in the two organs.

Menarche and Menopause

The female reproductive years are delineated by the start and stop of the menstrual cycle. The first menstrual period usually occurs around 12 or 13 years of age, an event that is known as . There is considerable variation among individuals in the age at menarche. It may occasionally occur as early as eight years of age or as late as 16 years of age and still be considered normal. The average age is generally later in the developing world, and earlier in the developed world. This variation is thought to be largely attributable to nutritional differences.

The cessation of menstrual cycles at the end of a woman’s reproductive years is termed . The average age of menopause is 52 years, but it may occur normally at any age between about 45 and 55 years of age. The age of menopause varies due to a variety of biological and environmental factors. It may occur earlier as a result of certain illnesses or medical treatments.

Variation in the Menstrual Cycle

The length of the menstrual cycle — as well as its phases — may vary considerably, not only among different women, but also from month to month for a given woman. The average length of time between the first day of one menstrual period and the first day of the next menstrual period is 28 days, but it may range from 21 days to 45 days. Cycles are considered regular when a woman’s longest and shortest cycles differ by less than eight days. The menstrual period itself is usually about five days long, but it may vary in length from about two days to seven days.

Ovarian Cycle

The events of the menstrual cycle that take place in the ovaries make up the . It consists of changes that occur in the of one of the . The ovarian cycle is divided into the following three phases: follicular phase, ovulation, and luteal phase. These phases are illustrated in Figure 18.8.2.

18.8.2 Ovarian Cycle
Figure 18.8.2 The phases and days of the ovarian cycle are shown in this diagram. The ovarian cycle depicted in the diagram represents a cycle in which fertilization does not occur so the corpus luteum degenerates during the luteal phase.

Follicular Phase

The  is the first phase of the ovarian cycle. It generally lasts about 12 to 14 days for a 28-day menstrual cycle. During this phase, several are stimulated to begin maturing, but usually only one — called the Graafian follicle — matures completely so it is ready to release an egg. The other maturing follicles stop growing and disintegrate. Follicular development occurs because of a rise in the blood level of (FSH), which is secreted by the . The maturing follicle releases , the level of which rises throughout the follicular phase. You can see these and other changes in hormone levels that occur during the menstrual cycle in the following chart.

18.8.3 Pituitary and Ovarian Hormones
Figure 18.8.3 FSH and estrogen increase during the first half of the menstrual cycle. LH surges shortly before ovulation occurs due to the rise in estrogen.


 is the second phase of the . It usually occurs around day 14 of a 28-day menstrual cycle. During this phase, the Graafian follicle ruptures and releases its ovum. Ovulation is stimulated by a sudden rise in the blood level of (LH) from the . This is called the LH surge. You can see the LH surge in the top hormone graph in Figure 18.8.3. The LH surge generally starts around day 12 of the cycle and lasts for a day or two. The surge in LH is triggered by a continued rise in estrogen from the maturing follicle in the ovary. During the , the rising estrogen level actually suppresses LH secretion by the pituitary gland. However, by the time the follicular phase is nearing its end, the level of estrogen reaches a threshold level above which this effect is reversed, and stimulates the release of a large amount of LH. The surge in LH matures the ovum and weakens the wall of the follicle, causing the fully developed follicle to release its secondary .

Luteal Phase

The  is the third and final phase of the ovarian cycle. It typically lasts about 14 days in a 28-day menstrual cycle. At the beginning of the luteal phase, and cause the Graafian follicle that ovulated the egg to transform into a structure called a . The corpus luteum secretes , which in turn suppresses FSH and LH production by the pituitary gland and stimulates the continued buildup of the in the uterus. How this phase ends depends on whether or not the ovum has been fertilized.

  • If fertilization has not occurred, the falling levels of FSH and LH during the luteal phase cause the corpus luteum to atrophy, so its production of progesterone declines. Without a high level of progesterone to maintain it, the endometrium starts to break down. By the end of the luteal phase, the endometrium can no longer be maintained, and the next menstrual cycle begins with the shedding of the endometrium (menses).
  • If  has occurred so a forms and then divides to become a , the outer layer of the blastocyst produces a hormone called (HCG). This hormone is very similar to LH and preserves the corpus luteum. The corpus luteum can then continue to secrete progesterone to maintain the new pregnancy.

Uterine Cycle

The events of the that take place in the uterus make up the . This cycle consists of changes that occur mainly in the , which is the layer of tissue that lines the uterus. The uterine cycle is divided into the following three phases: menstruation, proliferative phase, and secretory phase. These phases are illustrated in Figure 18.8.4.

18.8.4 Uterine cycle
Figure 18.8.4 The uterine cycle begins with menstruation, which starts on day 1 of the cycle. The relative thickness of the endometrium in each phase is indicated in pink.


(also called menstrual period or menses) is the first phase of the uterine cycle. It occurs if has not taken place during the preceding menstrual cycle. During menstruation, the of the uterus, which has built up during the preceding cycle, degenerates and is shed from the , flowing through an opening in the cervix, and out through the external opening of the vagina. The average loss of blood during menstruation is about 35 mL (about 1 oz or 2 tablespoons). The flow of blood is often accompanied by uterine cramps, which may be severe in some women.

Proliferative Phase

The  is the second phase of the uterine cycle. During this phase, secreted by cells of the maturing causes the lining of the uterus to grow, or proliferate. Estrogen also stimulates the of the uterus to secrete larger amounts of thinner mucus that can help  swim through the cervix and into the uterus, making fertilization more likely.

Secretory Phase

The  is the third and final phase of the . During this phase, produced by the in the ovary stimulates further changes in the so it is more receptive to implantation of a . For example, progesterone increases blood flow to the uterus and promotes uterine secretions. It also decreases the contractility of tissue in the uterine wall.


Bringing it All Together

It is important to note that the pituitary gland, the ovaries and the uterus are all responsible for parts of the ovarian and uterine cycles.  The pituitary hormones, LH and FSH affect the ovarian cycle and its hormones.  The ovarian hormones, estrogen and progesterone affect the uterine cycle and also feedback on the pituitary gland.  Look at Figure 18.8.5 and look at what is happening on different days of the cycle in each of the sets of hormones, the ovarian cycle and the uterine cycle.

18.8.8 Overview of ovarian and uterine cycle
Figure 18.8.5 The pituitary gland, ovarian cycle and uterine cycle are all interrelated in their regulation and participation in the monthly reproductive cycles of women.


18.8 Summary

  • The refers to natural changes that occur in the female reproductive system each month during the reproductive years, except when a woman is pregnant. The cycle is necessary for the production of ova and the preparation of the for . It involves changes in both the and uterus, and is controlled by hormones ( and ) and ovarian hormones ( and ).
  • The female reproductive period is delineated by , or the first menstrual period, which usually occurs around age 12 or 13; and by , or the cessation of menstrual periods, which typically occurs around age 52. A typical menstrual cycle averages 28 days in length but may vary normally from 21 to 45 days. The average menstrual period is five days long, but may vary normally from two to seven days. These variations in the menstrual cycle may occur both between women and within individual women from month to month.
  • The events of the menstrual cycle that take place in the ovaries make up the . It includes the (when a and its ovum mature due to rising levels of FSH), (when the is released from the ovary due to a rise in estrogen and a surge in LH), and the (when the follicle is transformed into a structure called a corpus luteum that secretes progesterone). In a 28-day menstrual cycle, the follicular and luteal phases typically average about two weeks in length, with ovulation generally occurring around day 14 of the cycle.
  • The events of the that take place in the make up the uterine cycle. It includes , which generally occurs on days 1 to 5 of the cycle and involves shedding of endometrial tissue that built up during the preceding cycle; the , during which the endometrium builds up again until occurs; and the , which follows ovulation and during which the endometrium secretes substances and undergoes other changes that prepare it to receive an .

18.8 Review Questions

  1. What is the menstrual cycle? Why is the menstrual cycle necessary in order for pregnancy to occur?
  2. What organs are involved in the menstrual cycle?
  3. Identify the two major events that mark the beginning and end of the reproductive period in females. When do these events typically occur?
  4. Discuss the average length of the menstrual cycle and menstruation, as well as variations that are considered normal.
  5. If the LH surge did not occur in a menstrual cycle, what do you think would happen? Explain your answer.
  6. Give one reason why FSH and LH levels drop in the luteal phase of the menstrual cycle.

18.8 Explore More

Why do women have periods? TED-Ed, 2015.

Girl’s Rite of Passage | National Geographic, 2007.



Figure 18.8.1

WaterforPeople_Uganda by WaterforPeople_Uganda on Wikimedia Commons is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

Figure 18.8.2

Ovarian Cycle by CNX OpenStax on Wikimedia Commons is used and adapted under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 18.8.3

Figure_43_04_04 by CNX OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license. (Original: modification of work by Mikael Häggström)

Figure 18.8.4

Ovarian and menstrual cycle by OpenStax College on Wikimedia Commons is used under a  CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 18.8.5

1000px-MenstrualCycle2_en.svg by Isometrik on Wikimedia Common is used under a CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) license.


Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 27.15 Hormone levels in ovarian and menstrual cycles [digital image].  In Anatomy and Physiology (Section 27.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/27-2-anatomy-and-physiology-of-the-female-reproductive-system

National Geographic. (2007, May 31). Girl’s rite of passage | National Geographic. YouTube. https://www.youtube.com/watch?v=5B3Abpv0ysM&feature=youtu.be

OpenStax. (2016, May 27) Figure 4 Rising and falling hormone levels result in progression of the ovarian and menstrual cycles [digital image]. In Open Stax, Biology (Section 43.4). OpenStax CNX. https://cnx.org/contents/GFy_h8cu@10.53:Ha3dnFEx@6/Hormonal-Control-of-Human-Reproduction

TED-Ed. (2015, October 19). Why do women have periods? YouTube.  https://www.youtube.com/watch?v=cjbgZwgdY7Q&feature=youtu.be


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Human Biology by Christine Miller is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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