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The menstrual cycle divides into follicular/proliferative and luteal/secretory phases, with cycle length measured between successive bleeding onsets. Most cycles last 25–30 days, with shorter (\u003C21 days) patterns termed polymenorrheic and longer (>35 days) patterns termed oligomenorrheic. 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ENDOTEXT.ORG © 2018  \nTHE NORMAL MENSTRUAL CYCLE AND THE CONTROL OF OVULATION  \nBeverly G. Reed, MD , Reproductive Endocrinology & Infertility Physician, IVFMD, 7501 Las Colinas Blvd, Suite 200 , Irving, Texas 75039  \nBruce R. Carr, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical center at Dallas, 5323 Harry Hines Blvd. , J6-114 , Dallas, Texas 75390. [bruce.carr@utsouthwestern.edu](bruce.carr@utsouthwestern.edu)>  \nUpdated August 5, 2018  \nABSTRACT  \nMenstruation is the cyclic, orderly sloughing of the uterine lining, in response to the interactions of hormones produced by the hypothalamus, pituitary, and ovaries. The menstrual cycle may be divided into two phases: ( 1) follicular or proliferative phase, and (2) the luteal or secretory phase. The length of a menstrual cycle is the number of days between the first day of menstrual bleeding of one cycle to the onset of menses of the next cycle. The median duration of a menstrual cycle is 28 days with most cycle lengths between 25 to 30 days ( 1-3. Patients who experience menstrual cycles that occur at intervals less than 21 days are termed polymenorrheic, while patients who experience prolonged menstrual cycles greater than 35 days, are termed oligomenorrheic. The typical volume of blood lost during menstruation is approximately 30 mL (4) . Any amount greater than 80 mL is considered abnormal (4) . The menstrual cycle is typically most irregular around the extremes of reproductive life (menarche and menopause) due to anovulation and inadequate follicular development (5-7) . The luteal phase of the cycle is relatively constant in all women, with a duration of 14 days. The variability of cycle length is usually derived from varying lengths of the follicular phase of the cycle, which can range from 10 to 16 days. For complete coverage of this and related topics, please visit [www.endotext.org](www.endotext.org).  \nTHE FOLLICULAR PHASE ( Fig.1)  \nFigure 1. Hormonal, Ovarian, endometrial, and basal body temperature changes and relations throughout the normal menstrual cycle. ( From Carr BR, Wilson JD. Disorders of the ovary and female reproductive tract. In: Braunwald E, Isselbacher KJ, Petersdorf RG, et al, eds. Harrison's Principles of Internal Medicine. 11th ed. New York: McGraw-Hill, 1987: 1818-1837.  \nThe follicular phase begins from the first day of menses until ovulation. Lower temperatures on a basal body temperature chart, and more importantly, the development of ovarian follicles, characterize this phase. Folliculogenesis begins during the last few days of the preceding menstrual cycle until the release of the mature follicle at ovulation.  \nDeclining steroid production by the corpus luteum and the dramatic fall of inhibin A allows for follicle stimulating hormone ( FSH) to rise during the last few days of the menstrual cycle ( Fig. 2)  \n(8) . Another influential factor on the FSH level in the late luteal phase is related to an increase in  \nGnRH pulsatile secretion secondary to a decline in both estradiol and progesterone levels (9) . This elevation in FSH allows for the recruitment of a cohort of ovarian follicles in each ovary, oneof which is destined to ovulate during the next menstrual cycle. Once menses ensues, FSH levels begin to decline due to the negative feedback of estrogen and the negative effects of inhibin B produced by the developing follicle ( Fig. 2) (8 , 10-12) . FSH activates the aromatase enzyme in granulosa cells, which converts androgens to estrogen. A decline in FSH levels leads to the production of a more androgenic microenvironment within adjacent follicles to the growing dominant follicle. Also, the granulosa cells of the growing follicle secrete a variety of peptides that may play an autocrine/paracrine role in the inhibition of development of the adjacent follicles.  \nFigure 2. Inhibin level changes throughout the menstrual cycle. Inhibin B dominates the follicular p","cbCaihof6i7d1jpN","https://ap.wps.com/l/cbCaihof6i7d1jpN","pdf",1140266,25,"English","# Abstract\n# The Follicular Phase\n## Hormonal and physiological characteristics\n## FSH dynamics and follicle recruitment\n## Recruitment, selection, and dominance","[{\"question\":\"How are the two phases of the menstrual cycle defined?\",\"answer\":\"The cycle is divided into the follicular/proliferative phase and the luteal/secretory phase, based on hormonal and ovarian activity. The follicular phase ends at ovulation.\"},{\"question\":\"What determines variability in menstrual cycle length?\",\"answer\":\"Variability is usually derived from differing lengths of the follicular phase, which can range from 10 to 16 days. The luteal phase duration is relatively constant at about 14 days.\"},{\"question\":\"What role does FSH play in follicle development?\",\"answer\":\"FSH rises during the late part of the menstrual cycle and recruits a cohort of ovarian follicles. It also activates aromatase in granulosa cells to support estrogen production, and changing FSH receptor numbers relate to estradiol secretion.\"}]","THE NORMAL MENSTRUAL CYCLE AND THE CONTROL OF OVULATION | PDF",1791841757,9]