In the first phase of each cycle, the lining, or endometrium, of the uterus undergoes rapid proliferation of cells and venous channels in preparation for pregnancy. Midway through the cycle an ovum (egg) is released from an ovary. If, while passing through the fallopian tube the ovum is fertilized by a sperm, implantation in the uterus occurs and the thickened lining helps support the pregnancy. When the ovum is not fertilized, this tissue and blood are shed. The proliferation of the uterine wall then begins once more in expectation of the next release of an ovum, and if conception does not take place, it sloughs off again. The process continues monthly until pregnancy occurs or until ovulation ceases at menopause.
The natural rhythm of the menstrual cycle may be broken or temporarily halted by hormonal imbalance, malnutrition, illness, or emotional disturbance (see amenorrhea). Menstruation is controlled by the hypothalamus and the pituitary gland and hormones, such as estrogen, which prepares the lining of the uterus, and progesterone, which helps maintain a pregnancy.