Background:The ovaries produce mainly two types of hormones, estrogens and progestins. The production is regulated by feedback interaction with the two pituitary hormones, FSH and LH. Under the effect of FSH the growing ovarian follicle releases increasing amounts of estrogen until ovulation, when the release declines. Increasing LH release from the pituitary causes ovulation and increased progestin secretion. This makes the feedback interaction between estrogens and the pituitary cyclical, and pituitary FSH and LH thereby regulate the menstrual cycle, ovulation, and establishment of pregnancy. Increasing estrogen production by the ovaries initiate puberty. Estrogen production during puberty closes the growth zones of the extremities. The time of puberty when growth zones close will determine the body height. Estrogens have effects on gene expressions in many organs of the body. It acts by stimulation of several hormone producing glands in the body. It stimulates bone formation and appears to affect bowl function. It has effects on blood vessels, blood pressure, mental functions and general wellbeing.
Symptoms:Abnormal estrogen production have profound effects on the body. Six to eight percent of Caucasian women have irregular ovulations or no ovulations because of abnormal cyclical synthesis of estradiol from testosterone (PCOS). They often have male type hair distribution and infertility along with increased risks of obesity, sleep apnea, Type 2 diabetes, and fatty liver disease. Increased estrogen production may be a result of tumor growth in the ovaries or in the adrenals. At menopause the estrogen production in the ovaries ceases. This decrease will cause increased production of the pituitary hormones LH and FSH. Postmenopausal symptoms of decreased estrogen production may initially be hot flashes and sleep disturbances. In the following years after menopause, increased body weight, development of type 2 diabetes, osteoporosis, atherosclerosis, changes in skin and hair texture, and changes in mental function may develop. Symptoms vary greatly among individuals.
Diagnosis:Careful registration of the menstrual pattern is important for evaluation of ovarian function. PCOS is diagnosed by ultrasound examination and analysis of hormones in blood samples. Gen analyses may be important in certain cases. Menopause may be diagnosed by measurement of FSH and LH in blood samples.
Treatment:The reduced fertility often occurring with PCOS may be treated with induction of ovulation by specific medical inhibition of estradiol synthesis or by specifically blocking estrogen receptors or with contraceptive pills. Abnormal release of pituitary hormones may be treated by specific hormones. The increased risk of obesity and diabetes in PCOS may be reduced by treatment with specific antidiabetic medicine. Premenstrual dysphoria is treated by antidepressant medication. The initial symptoms of menopause may be treated effectively by two treatment modalities: 1) estrogen alone (preferably as gel on a skin patch) or 2) estrogen and progestin in combination. However, both modalities increase the risk of deep vein thrombosis, gall disease, and cognitive impairment and slightly increase the risk of stroke. Estrogen alone does not increase the risk of breast cancer or coronary heart disease. The combination of estrogen and progesterone increases the risk both of breast cancer and of coronary heart disease slightly. Because of the risks of side effects, patients without severe postmenopausal symptoms should not be treated with either estrogen alone or in combination with progestin. Because of the risks of side effects, estrogens and progestins should not be used for the prevention of osteoporosis, which is treated effectively by other specific medications.