Which phase of the menstrual cycle involves the shedding of the endometrium?
Follicular phase
Ovulation
Luteal phase
Menstrual phase
The Correct Answer is D
The menstrual cycle is divided into the menstrual, follicular, ovulatory, and luteal phases, regulated by hormonal fluctuations of estrogen, progesterone, FSH, and LH. The menstrual phase begins on day 1 of the cycle and lasts about 3–7 days, during which the functional layer of the endometrium is shed due to a sudden drop in progesterone (from normal mid-luteal values of 5–20 ng/mL to <1 ng/mL) after corpus luteum regression. FSH (normal: 3–20 IU/L) begins to rise to recruit new follicles. Blood loss ranges from 30–80 mL, and prostaglandins contribute to uterine contractions and cramping.
Rationale for correct answer
D. The menstrual phase involves the shedding of the functional layer of the endometrium due to the withdrawal of progesterone and estrogen. It marks the beginning of a new cycle.
Rationale for incorrect answers
A. The follicular phase follows menstruation and involves regeneration of the endometrium under the influence of rising estrogen levels from developing follicles.
B. Ovulation is the release of an ovum due to the LH surge, around day 14. The endometrium is not shed during this phase; it continues to thicken in preparation for implantation.
C. The luteal phase occurs after ovulation and is marked by progesterone secretion from the corpus luteum to maintain the endometrium. Shedding occurs only if implantation does not happen.
Take home points
- The menstrual phase is when endometrial shedding occurs due to hormonal withdrawal.
- Estrogen and progesterone drop sharply, triggering menstruation.
- The follicular phase is for endometrial regeneration, not shedding.
- Luteal phase maintains the endometrium; shedding starts only if it ends.
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Related Questions
Correct Answer is C
Explanation
The endometrial cycle aligns with the ovarian cycle and consists of three main phases: menstrual, proliferative, and secretory. The secretory phase coincides with the luteal phase of the ovarian cycle and spans approximately days 15–28. It is regulated primarily by progesterone (normal mid-luteal: 5–20 ng/mL) secreted by the corpus luteum. Progesterone stimulates the endometrial glands to secrete glycogen and other nutrients, making the endometrium thick, vascular, and receptive to implantation. Without fertilization, progesterone levels fall, leading to endometrial breakdown and the start of menstruation.
Rationale for correct answer
C. The secretory phase is driven by progesterone from the corpus luteum and prepares the endometrium for possible implantation. It occurs during the luteal phase of the ovarian cycle.
Rationale for incorrect answers
A. The menstrual phase coincides with the early follicular phase, not the luteal phase. It involves shedding of the functional layer of the endometrium due to hormone withdrawal.
B. The proliferative phase occurs during the follicular phase of the ovarian cycle. It is estrogen-driven and involves rebuilding the endometrium after menstruation.
D. The regenerative phase is not a standard term in the clinical classification of the endometrial cycle. The correct phases are menstrual, proliferative, and secretory.
Take home points
- The secretory phase matches the luteal phase and prepares the uterus for implantation.
- Progesterone from the corpus luteum drives the secretory changes.
- The proliferative phase aligns with follicular phase and is estrogen-dependent.
- Menstrual phase begins with hormone withdrawal and marks the end of the luteal phase.
Correct Answer is D
Explanation
The secretory phase follows ovulation and spans days 15–28 of a typical 28-day menstrual cycle. It is driven by progesterone secreted by the corpus luteum. Progesterone transforms the previously estrogen-primed proliferative endometrium into a thick, vascular, and glandular lining capable of supporting implantation. Endometrial glands become coiled and secrete glycogen-rich fluid to nourish a potential embryo. Progesterone levels typically peak at 5–20 ng/mL in the mid-luteal phase. If implantation does not occur, progesterone falls sharply, leading to menstruation.
Rationale for correct answer
D. Progesterone is the main hormone that prepares the endometrium during the secretory phase. It induces glandular secretion, stromal edema, and vascularization to support early pregnancy if fertilization occurs.
Rationale for incorrect answers
A. Estrogen plays a primary role in the proliferative phase, promoting regeneration of the endometrium but not in its secretory transformation. It works before ovulation, not after.
B. FSH stimulates follicular development and estrogen secretion during the follicular phase, but it does not act on the endometrium directly and is not dominant in the luteal/secretory phase.
C. LH triggers ovulation and supports the formation of the corpus luteum, which secretes progesterone, but LH itself does not directly act on the endometrium during the secretory phase.
Take home points
- Progesterone transforms the endometrium into a receptive state during the secretory phase.
- Estrogen prepares the endometrium in the proliferative phase, not the secretory.
- FSH and LH regulate ovarian activity but have no direct endometrial action in the luteal phase.
- Secretory changes include gland coiling, glycogen secretion, and stromal edema.
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