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Follicular phase

The follicular phase is the initial stage of the menstrual cycle in females of reproductive age, commencing on the first day of menstrual bleeding and concluding with ovulation, during which ovarian follicles mature under the regulation of follicle-stimulating hormone (FSH) to prepare for potential egg release.^[1] This phase typically spans days 1 to 14 in a standard 28-day cycle but can vary in length from 7 to 21 days depending on individual cycle duration, as the subsequent luteal phase remains relatively fixed at about 14 days.^[2] Key physiological processes include the recruitment and growth of multiple primordial follicles in the ovaries, with one dominant follicle emerging to produce increasing levels of estradiol, which stimulates the regeneration and proliferation of the endometrial lining in the uterus.^[1] Hormonal dynamics drive the follicular phase through the hypothalamic-pituitary-ovarian axis, where gonadotropin-releasing hormone (GnRH) from the hypothalamus prompts the anterior pituitary to secrete FSH and luteinizing hormone (LH).^[3] Early in the phase, the withdrawal of negative feedback from progesterone and inhibin of the previous cycle allows FSH secretion to increase, initiating follicle development; as the dominant follicle matures, it secretes higher estradiol and inhibin B, which initially exert negative feedback on FSH before shifting to positive feedback, triggering a mid-cycle LH surge that induces ovulation.^[2] Follicle growth progresses from primordial stages to mature Graafian follicles, averaging 2 mm per day and reaching 18–29 mm in diameter by ovulation, while the endometrium thickens from 2–4 mm immediately after menses to 7–12 mm by the end of the phase in a trilaminar structure to support implantation if fertilization occurs.^[1] The follicular phase overlaps with the menstrual phase in its early days, during which shedding of the previous cycle's endometrium occurs alongside initial follicle stimulation, and it sets the stage for fertility by enhancing cervical mucus quality to facilitate sperm transport.^[2] Disruptions in this phase, such as irregular FSH levels or follicular resistance, can lead to conditions like anovulation or polycystic ovary syndrome, underscoring its critical role in reproductive health.^[1] Overall, this phase exemplifies the cyclical interplay of hormones and ovarian structures essential for menstruation and reproduction.^[3]

Overview

Definition and timing

The follicular phase is the initial stage of the menstrual cycle, commencing on the first day of menstruation (day 1) and concluding with ovulation. It encompasses the maturation of ovarian follicles under the influence of follicle-stimulating hormone (FSH), culminating in the selection of a dominant follicle and the preparation for egg release. This phase is also known as the proliferative phase due to the concurrent endometrial thickening driven by rising estrogen levels.^[1]^[2]^[4] The phase begins with menstrual bleeding, triggered by the abrupt decline in progesterone levels from the preceding luteal phase, which destabilizes the endometrial lining. It ends with the rupture of the mature dominant follicle, marking the onset of ovulation typically around day 14 in a standard 28-day cycle. The duration generally spans 10 to 16 days, though it exhibits considerable inter- and intra-individual variability, often contributing most to differences in overall cycle length.^[2]^[4]^[1] Factors influencing the follicular phase length include age, with shortening observed as ovarian reserve diminishes in later reproductive years due to elevated FSH and reduced inhibin feedback; health conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders, which can prolong or disrupt the phase; and lifestyle elements affecting cycle regularity. In contrast to the more consistent 14-day luteal phase that follows, the follicular phase's variability underscores its role in adapting to physiological and environmental cues for reproductive optimization.^[2]^[1]^[4]

Relation to menstrual cycle

The follicular phase constitutes the initial segment of the menstrual cycle, commencing on the first day of menstrual bleeding and concluding with ovulation. It directly follows the luteal phase of the preceding cycle; in the absence of pregnancy, the decline in progesterone and estrogen levels from the regressing corpus luteum triggers endometrial shedding, marking the onset of menstruation and the follicular phase.^[4] This phase then progresses to ovulation, after which the ruptured follicle transforms into the corpus luteum, initiating the subsequent luteal phase.^[1] The interplay between the follicular phase and other cycle components is orchestrated by hormonal transitions that ensure reproductive readiness. The progesterone withdrawal from the prior luteal phase not only induces menstruation but also stimulates the hypothalamic-pituitary-ovarian axis to resume follicle development, setting the stage for estrogen production during the follicular phase.^[1] As estrogen levels rise toward the end of this phase, they facilitate the luteinizing hormone (LH) surge that triggers ovulation, thereby bridging to the luteal phase where the corpus luteum sustains early pregnancy support if fertilization occurs.^[4] Variability in the duration of the follicular phase significantly influences overall menstrual cycle length, with the luteal phase remaining relatively fixed at approximately 14 days. The follicular phase typically spans 10 to 16 days, but shorter durations—such as an average of 10.4 days—can result in cycles of 15 to 20 days, while longer ones averaging 26.8 days may extend cycles to 36 to 50 days.^[4]^[5] From an evolutionary and reproductive standpoint, the follicular phase serves to prepare the female reproductive tract for potential fertilization and implantation. It promotes the maturation of ovarian follicles to release a viable oocyte and stimulates endometrial proliferation, creating a receptive environment in the uterus, alongside cervical changes that facilitate sperm transport.^[1]

Follicular development

Recruitment and selection

The recruitment phase of follicular development begins shortly after the regression of the corpus luteum at the end of the previous menstrual cycle, marking the onset of the early follicular phase. Following menstruation, a cohort of small antral follicles—typically 10-20 in number—is recruited into active growth primarily through the stimulatory effects of rising follicle-stimulating hormone (FSH) levels from the pituitary gland.^[6] This FSH-dependent recruitment activates the transition of these follicles from a quiescent state, promoting granulosa cell proliferation and the formation of antral cavities, while primordial follicles continue their ongoing, gonadotropin-independent activation in the ovarian pool.^[7] The process ensures a selectable pool of follicles available for further development. Selection of the dominant follicle occurs within this recruited cohort during days 1-7 of the menstrual cycle, driven by differential sensitivity to FSH among the follicles. The follicle that exhibits the highest responsiveness to FSH undergoes enhanced growth, leading to increased expression of aromatase and subsequent estrogen production, which in turn exerts negative feedback on pituitary FSH secretion.^[8] Paracrine factors such as inhibin, secreted by the granulosa cells of the growing follicle, further suppress FSH action on subordinate follicles, promoting their atresia through apoptosis and degeneration.^[9] This competitive mechanism ensures that only one follicle typically emerges as dominant, while the majority of the cohort (approximately 90%) undergoes atresia by day 7.^[10] Key intraovarian regulators, including activin and follistatin, modulate these FSH effects during recruitment and selection. Activin, a member of the transforming growth factor-beta family, enhances FSH-stimulated granulosa cell proliferation and follicular recruitment in early antral stages, promoting the initial growth phase.^[11] In contrast, follistatin acts as an antagonist by binding and neutralizing activin, thereby fine-tuning the balance to prevent excessive recruitment and support selective dominance.^[11] These proteins contribute to the paracrine environment that influences follicle fate without direct dependence on systemic gonadotropins.

Growth and maturation

During the follicular phase, the selected dominant follicle undergoes progressive enlargement, typically growing from an initial diameter of 2-10 mm to 20-25 mm by the time of ovulation. This expansion is driven primarily by the proliferation of granulosa cells, which form multiple layers around the oocyte, and the development of the surrounding theca cell layers. Concurrently, follicular fluid accumulates within the developing antrum, a fluid-filled cavity that expands and contributes to the follicle's overall size increase, reaching volumes up to 7 ml in the preovulatory stage.^[12]^[13] The maturation of the dominant follicle progresses through distinct stages, beginning from the preantral phase—where the follicle lacks a fluid-filled cavity—and advancing to the antral and ultimately the mature Graafian follicle. In the Graafian stage, the antrum fully encompasses the oocyte, which is suspended by the cumulus oophorus, a cluster of granulosa cells that expands significantly in the final days before ovulation to facilitate oocyte release. This process, spanning approximately 15-20 days for the dominant follicle, ensures the structure is primed for ovulation.^[12]^[13]^[8] At the cellular level, theca interna cells differentiate and proliferate to produce androgens, primarily androstenedione, under stimulation from luteinizing hormone (LH). These androgens diffuse to the granulosa cells, where they are aromatized into estrogens, such as estradiol, via the enzyme P450 aromatase, enhancing the follicle's endocrine function. Simultaneously, the oocyte within the dominant follicle acquires meiotic competence, growing to about 200 μm and becoming capable of resuming meiosis, though it remains arrested at the diplotene stage of prophase I until the preovulatory LH surge.^[12]^[13]^[8] While the dominant follicle matures, approximately 99% of the other recruited follicles undergo atresia, a degenerative process characterized by apoptosis of granulosa cells and subsequent follicular collapse. This selective attrition ensures that only the most responsive follicle proceeds to ovulation, with atresia occurring predominantly in antral-stage follicles larger than 2 mm due to insufficient follicular stimulating hormone (FSH) support.^[12]^[13]

Follicular waves

Follicular waves represent the sequential emergence of cohorts of antral follicles during the ovarian cycle, where groups of follicles ≥5 mm in diameter grow synchronously before regressing or, in one case, becoming dominant. In humans, antral folliculogenesis occurs in a wave-like pattern, with most women exhibiting two waves per interovulatory interval (approximately 68%) and the remainder showing three waves (32%). These waves typically emerge in association with transient rises in follicle-stimulating hormone (FSH) levels, which initiate recruitment from the antral follicle pool following luteal regression or interwave intervals.^[14] Waves are classified based on their developmental outcome: major waves produce a dominant follicle reaching ≥10 mm, often leading to ovulation, while minor waves result in subdominant follicles <10 mm that regress without ovulating, contributing to a multifollicular pattern within the cycle. In monofollicular cycles, the first wave usually yields the ovulatory dominant follicle, whereas in cycles with additional waves—common in longer interovulatory intervals (27 days for two-wave vs. 29 days for three-wave)—subsequent waves may produce anovulatory follicles that support estrogen production but do not progress to ovulation. This pattern contrasts with traditional views of a single dominant follicle but aligns with observations in other species, such as cattle and mares, where 2-3 waves per cycle are also prevalent, though some non-human primates exhibit a more singular dominant trajectory.^[14] Clinically, follicular waves are detected through serial transvaginal ultrasonography, monitoring follicle diameters every 1-3 days to identify cohort emergence and growth phases. The first wave, emerging early in the follicular phase, most frequently results in the dominant ovulatory follicle, while later waves in extended cycles may contribute subdominant structures. In anovulatory cycles, multiple waves persist without a successful dominant follicle, often showing cyclic recruitment of 1-3 cohorts alongside periods of continuous follicle emergence. Women with polycystic ovary syndrome (PCOS) exhibit heightened follicular dynamics, with up to ≥4 cohorts in ovulatory cycles and 1-3 in anovulatory ones, compared to 1-3 in normal controls, reflecting disordered recruitment and frequent arrest at mid-antral stages (around 7 mm). The number of major waves remains consistent (one or two) across reproductive ages, though dynamics shift in advanced age, with luteal-phase waves emerging earlier and growing larger.^[14]^[15]^[16]

Hormonal regulation

Gonadotropin dynamics

The gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), are secreted by gonadotroph cells in the anterior pituitary gland under the regulatory influence of hypothalamic gonadotropin-releasing hormone (GnRH). GnRH is released in a pulsatile manner from the hypothalamus, which is essential for stimulating the synthesis and episodic secretion of both FSH and LH. This pulsatile pattern ensures the appropriate gonadotropin profiles throughout the menstrual cycle. Following the regression of the corpus luteum in the late luteal phase, an intercycle rise in FSH occurs during the transition to the follicular phase, driven by the withdrawal of ovarian steroid and peptide feedback, thereby initiating the recruitment of ovarian follicles for the new cycle.^[17] In the early follicular phase (days 1-3), basal FSH levels elevate modestly, typically surpassing a threshold required to stimulate the growth of a cohort of small antral follicles from the ovarian reserve. This initial FSH rise, occurring approximately 4 days before menses, is triggered by declining progesterone and estrogen levels from the preceding luteal phase and promotes the transition of primordial and primary follicles into secondary and antral stages. In the early follicular phase, FSH secretion reaches its peak (around days 1-3), sustaining the proliferation and differentiation of granulosa cells in the developing follicles, particularly the future dominant follicle, and enhancing their responsiveness to subsequent hormonal signals. Toward the late follicular phase, FSH levels decline due to selective suppression by inhibin B, a dimeric peptide hormone produced by granulosa cells of the maturing dominant follicle, which preferentially inhibits FSH beta-subunit gene expression in the pituitary without significantly affecting LH. As the phase progresses into the mid-follicular period (around days 5-7), FSH levels begin to decline due to this selective suppression by inhibin B.^[18]^[19]^[20] LH maintains low tonic levels throughout the follicular phase, with minimal fluctuations until the preovulatory surge. These steady, pulsatile LH secretions primarily act on theca interna cells of antral follicles, stimulating the production of androgens such as androstenedione via upregulation of enzymes like cytochrome P450 17α-hydroxylase/17,20-lyase (CYP17A1). The androgens diffuse to adjacent granulosa cells, where they serve as substrates for aromatization into estrogens under FSH influence, supporting overall follicular estrogen biosynthesis. The pulsatile nature of LH release is governed by the underlying GnRH rhythm; in the early-to-mid follicular phase, low-frequency GnRH pulses (approximately every 90-120 minutes) preferentially drive FSH secretion over LH, but pulse frequency gradually increases (to every 60-90 minutes) in the late follicular phase in response to rising estradiol levels, enhancing LH output and priming the system for ovulation.^[21]^[22]

Estrogen production

During the follicular phase, estrogen production primarily involves the synthesis of estradiol through the two-cell, two-gonadotropin model in ovarian follicles. In this model, luteinizing hormone (LH) stimulates theca cells to produce androgens, mainly androstenedione, which diffuse to granulosa cells where follicle-stimulating hormone (FSH) induces the expression of aromatase enzyme to convert these androgens into estrogens, predominantly estradiol.^[1]^[23] The primary source of estrogens during this phase is the developing dominant ovarian follicle, with granulosa cells serving as the main site of aromatization; the adrenal glands provide a minor, insignificant contribution to circulating levels in women with intact ovaries.^[1]^[24] Estradiol levels gradually increase from early follicular concentrations of approximately 12–50 pg/mL to over 200 pg/mL in the late follicular phase, reflecting the growth and maturation of the dominant follicle; estrone, a secondary estrogen formed via peripheral conversion of androstenedione, circulates at lower levels throughout this period.^[1]^[25] These rising estrogens prepare the reproductive tract, including the uterus and cervix, for potential fertilization, though specific physiological effects occur downstream of production.^[4]

Feedback loops

In the early follicular phase, negative feedback mechanisms involving estradiol and inhibin B play a crucial role in suppressing follicle-stimulating hormone (FSH) secretion from the anterior pituitary, thereby facilitating the selection of a dominant follicle and preventing the maturation of multiple follicles. Estradiol, produced by growing antral follicles, exerts inhibitory effects on FSH release primarily at the pituitary level, while inhibin B, secreted by granulosa cells, provides additional suppression through direct antagonism of FSH synthesis. This coordinated feedback reduces circulating FSH levels as the phase progresses, ensuring that only follicles capable of sustained growth—those with sufficient FSH receptors—continue to develop, while subordinate follicles undergo atresia.^[26] The inhibin/activin system further refines FSH regulation during this period, with inhibin B from granulosa cells acting as a key negative regulator by competing with activin for binding to type II receptors on pituitary gonadotropes, thereby inhibiting FSHβ subunit expression and secretion. In contrast, activin, also produced by granulosa cells, promotes FSH secretion by enhancing gonadotropin-releasing hormone (GnRH)-induced FSH release through Smad2/3 signaling pathways, supporting initial follicular recruitment and growth. This oppositional dynamic, modulated by binding proteins like follistatin, maintains FSH homeostasis to balance follicular development without overstimulating the ovary.^[27] Within the hypothalamic-pituitary-ovarian (HPO) axis, estrogen modulates GnRH pulse frequency from the hypothalamus, influencing gonadotropin release throughout the follicular phase. In the early to mid-follicular phase, low levels of estradiol exert negative feedback, slowing GnRH pulse frequency to favor FSH over luteinizing hormone (LH) secretion and promoting steady follicular maturation. As estradiol rises in the late follicular phase, this feedback begins to shift toward positivity, accelerating GnRH pulses and preparing for the preovulatory surge, though the primary negative regulation dominates until the transition to ovulation.^[12] Simple mathematical models of follicle selection often represent viability based on an FSH threshold concept, where a follicle continues to grow only if circulating FSH concentrations exceed its individual sensitivity threshold, determined by granulosa cell receptor density and affinity. For instance, in population-based simulations, follicle growth is modeled such that the rate of development \frac{dF}{dt} > 0 when FSH > threshold, leading to dominance of the follicle with the lowest threshold under declining FSH levels due to feedback. This framework, without detailed derivations, illustrates how feedback-driven FSH decline selects a single dominant follicle from an initial cohort.^[28]

Transition to ovulation

Estrogen surge

The estrogen surge in the late follicular phase is marked by a rapid escalation in circulating estradiol concentrations, typically reaching peak levels of over 400 pg/mL approximately 24 to 48 hours prior to ovulation. This surge is primarily driven by the elevated aromatase activity within the granulosa cells of the dominant mature follicle, which converts androgens into estradiol at an accelerated rate as follicular development culminates. In humans, estradiol production during this period can exceed 380 μg per day, reflecting the follicle's heightened biosynthetic capacity.^[4]^[29] The surge initiates positive feedback mechanisms by sensitizing the hypothalamic-pituitary axis to gonadotropin-releasing hormone (GnRH), thereby amplifying the responsiveness of gonadotrophs to subsequent GnRH pulses and facilitating an enhanced luteinizing hormone (LH) output. Sustained estradiol exposure above 200 pg/mL for roughly 50 hours is critical to prime this shift from negative to positive feedback, altering gene expression in pituitary cells to promote gonadotropin secretion. This transition underscores the surge's role in synchronizing reproductive events for ovulation.^[4] The profile of the estrogen surge features a sustained elevation lasting 36 to 48 hours, with the peak occurring about 10 to 12 hours before the ensuing LH surge, after which estradiol levels begin to decline sharply. This temporal pattern ensures adequate priming without premature triggering of ovulation. Compared to rodents, where the shorter estrous cycle results in a more transient estrogen elevation, the human surge is more pronounced and prolonged, contributing to the extended follicular phase characteristic of primate cycles.^[4]^[30]

LH surge

The luteinizing hormone (LH) surge marks the culmination of the follicular phase, characterized by a rapid and substantial increase in LH secretion from the anterior pituitary gland. Typically, LH levels rise approximately 5- to 10-fold from baseline follicular phase concentrations of 2-15 IU/L to peak values ranging from 20-60 IU/L, with the ascent occurring over 24-36 hours and the duration of elevated LH lasting 12-24 hours.^[31]^[32]^[33] This surge profile exhibits inter-individual variability influenced by factors such as age and cycle regularity, but it consistently precedes ovulation by 24-36 hours from onset to follicular rupture.^[4]^[34] The primary trigger for the LH surge is the positive feedback exerted by elevated estradiol levels from the maturing dominant follicle on the hypothalamic-pituitary axis, reaching thresholds above 200 pg/mL for at least 36-50 hours to induce gonadotropin-releasing hormone (GnRH) pulses that amplify LH release.^[4] A concurrent, LH-independent rise in progesterone to around 0.5-1 ng/mL further facilitates this process by modulating pituitary sensitivity and enhancing the ovulatory signal, though estradiol remains the dominant initiator.^[35] The physiological consequences of the LH surge are pivotal for ovulation, directly stimulating the resumption of meiosis in the oocyte to achieve metaphase II arrest and extrusion of the first polar body within 12-24 hours.^[4] It also promotes expansion of the cumulus oophorus complex through hyaluronic acid synthesis, facilitating oocyte release, and induces enzymatic degradation of the follicular wall via proteases and prostaglandins, culminating in follicle rupture and ovulation approximately 34-36 hours after surge onset.^[4] Detection of the LH surge is commonly achieved through serum blood assays for precise quantification or over-the-counter urine-based ovulation predictor kits that identify a threshold rise in urinary LH (typically 20-40 IU/L), offering a practical means for fertility tracking despite potential variability in surge timing and intensity across cycles.^[31]^[4]

Uterine and systemic changes

Endometrial proliferation

The proliferative phase of the menstrual cycle synchronizes with the follicular phase, during which the endometrium regenerates and thickens under the influence of rising estrogen levels from developing ovarian follicles. Following menstruation, the endometrial thickness increases from approximately 2-4 mm to 8-12 mm by the late follicular phase, driven by mitotic activity in both glandular epithelial cells and stromal cells.^[36] This proliferation restores the functional layer of the endometrium, preparing it as a potential site for implantation should fertilization occur post-ovulation.^[37] Estrogen exerts its effects by binding to estrogen receptors in endometrial cells, stimulating DNA synthesis and cell division while enhancing vascularization to support nutrient uptake. Specifically, estrogen upregulates vascular endothelial growth factor (VEGF), which promotes endothelial cell proliferation and increases microvessel density, facilitating the delivery of oxygen and nutrients to the growing tissue.^[38] These changes ensure the endometrium's structural integrity and responsiveness to subsequent hormonal signals.^[37] The proliferative phase divides into early and late stages. In the early stage (days 1-7), post-menses regeneration occurs with lengthening of glands and initial vascularization of the stroma, accompanied by increasing mitotic activity as estrogen levels rise.^[39] The late stage (days 8-14) features accelerated growth, with maximum DNA synthesis and mitosis peaking around days 8-10, leading to further endometrial expansion and preparation for secretory transformations.^[37] Histologically, the proliferative endometrium shows straight, tubular glands lined by pseudostratified columnar epithelium with prominent mitotic figures, embedded in a compact, cellular stroma that transitions to mild edema in the late phase.^[39] The stroma consists of spindle-shaped fibroblasts with ill-defined borders and active mitosis, supporting the overall tissue proliferation without yet exhibiting secretory features.^[37] This architecture establishes a receptive base for potential embryo attachment if conception follows.^[39]

Broader physiological effects

During the follicular phase, rising estrogen levels stimulate the transformation of cervical mucus, making it thinner, clearer, and more elastic to facilitate sperm transport toward the uterus. This fertile-type mucus, often described as stretchy and slippery, peaks in quantity and quality in the late follicular phase just prior to ovulation, enhancing fertility by providing an optimal medium for sperm survival and motility.^[4]^[40] Basal body temperature (BBT) remains relatively low and stable throughout most of the follicular phase, typically ranging from 97.0°F to 98.0°F (36.1°C to 36.7°C), reflecting the dominance of estrogen without significant progesterone influence. Toward the end of this phase, a slight rise in BBT may occur due to increasing estrogen levels, followed by a subtle pre-ovulatory dip—known as the thermal nadir—immediately before ovulation, which is attributed to the estrogen surge. This dip, though not universal, helps identify the fertile window when tracking BBT for natural family planning.^[41] Estrogen fluctuations during the follicular phase can also induce mild breast tenderness or sensitivity, particularly as levels rise toward mid-cycle, due to increased glandular activity and fluid retention in breast tissue. This symptom, while more pronounced in the luteal phase for some women, contributes to cyclical discomfort around ovulation.^[42] The rising estrogen in the follicular phase often correlates with positive shifts in mood and energy, as it enhances serotonin synthesis, promoting improved cognition, emotional well-being, and vitality compared to the luteal phase. Women may experience heightened alertness and reduced fatigue, supporting overall physiological readiness for ovulation.^[43] Estrogen plays a protective role in bone health throughout the reproductive years, including the follicular phase, by inhibiting osteoclast activity and bone resorption, thereby helping maintain bone mineral density.^[44]^[45] Additionally, increased libido is commonly reported during the follicular and periovulatory periods, driven by peak estrogen levels that heighten sexual interest and responsiveness, aligning with evolutionary adaptations for reproduction. This surge in sexual motivation peaks around ovulation, distinguishing it from lower levels in other cycle phases.^[46]

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15 May 2021 · The rise in estrogen prior to ovulation supports the secretion of increasing quantity and estrogenic quality of cervical mucus, and the ...
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Physiology, Ovulation And Basal Body Temperature - NCBI - NIH
... basal body temperature during the follicular phase (before ovulation) averages between 97.0 and 98.0 F.[1] One study with a wrist wearable sensor found the ...
[42]
Breast Pain (Mastalgia) | Johns Hopkins Medicine
The most common type of breast pain is linked to the menstrual cycle. It is nearly always hormonal. Some people begin to have pain around the time of ovulation.
[43]
Dynamic Shifts in Neurotransmitter Levels during Menstruation
Nov 19, 2024 · During the follicular phase, rising estrogen levels increase serotonin synthesis, enhancing mood, cognition, and pain tolerance. Estrogen may ...Missing: energy | Show results with:energy
[44]
Minimal levels of serum estradiol prevent postmenopausal bone loss
... follicular phase of the menstrual cycle. We suggest that oral or percutaneous ERT should induce a minimal value of 60 pg/ml to prevent postmenopausal bone loss.
[45]
Bone health in estrogen-free contraception - PMC - NIH
May 7, 2020 · Estrogens and progestogens influence the bone. The major physiological effect of estrogen is the inhibition of bone resorption whereas ...Missing: menstrual | Show results with:menstrual
[46]
The relationship between the menstrual cycle and female sexual ...
Sexual interest was found to be significantly higher in the follicular and ovulatory phases, than in the luteal, premenstrual, or menstrual phases. Sexual ...Missing: increased | Show results with:increased