The Ovaries

The ovaries lay on the pelvic side wall in the angle between the interior and exterior iliac arteries. The ovaries contain follicles in various stages of the ovarian cycle. The ovaries are paired, oval organs, each one about the size of an almond that sits at the ends of the fallopian tubes. Female germ cells (eggs or ova) mature in the ovaries and are regularly released in a process known as ovulation. Each month 10 or more follicles, the protective casing surrounding each egg, start to ripen, but usually just one releases its egg from either the right or the left ovary – the right ovary is favored 60% of the time. The egg travels down the fallopian tube to the uterus and is shed from the body along with the uterine lining during the woman’s next menstrual period.

The reproductive cycle is controlled by two hormones from the pituitary gland in the brain. Follicle stimulating hormone (FSH) which causes ovarian follicles to ripen them produces estrogen. When estrogen levels are high enough a surge of luteinizing hormone (LH) from the pituitary prompts final maturation of the egg and its release from the ovary. After ovulation as estrogen levels fall, FSH production increases to repeat the cycle. Estrogen also stimulates endometrial thickening. This is temporarily maintained by progesterone from the corpus luteum, but it is shed as levels fall.

Estrogen starts its increase at about day 5 of the menstrual cycle with its peak around day 11; progesterone starts its increase on about day 15 with its peak around day 22 of the menstrual cycle.

After fertilization, progesterone from the corpus luteum in the ovary prompts endometrial thickening in readiness to receive the fertilized egg. A few days after implantation, the trophoblast produces human chorionic gonadotropin (hCG), a hormone that stimulates the corpus luteum to produce more progesterone and estrogen. Estrogen keeps the uterus growing, stimulates fetal development and breast enlargement, and boosts blood circulation. It also prompts uterine contractions along with the hormone oxytocin. Progesterone which maintains the uterine lining and placenta tends to relax the uterus. In the second trimester, progesterone is produced by the placenta, and acts with the hormone relaxin to soften cartilage and loosen joints and ligaments easing pelvic expansion in preparation for birth. The huge surge of hCG during early pregnancy is what causes a pregnancy test to register as positive.

The ovaries produce the following hormones:

  • Estrogen and progesterone -which stimulate egg production, regulate menstrual cycle, maintain pregnancy, prepare breast for lactation, and promote development of the secondary sexual characteristics at puberty.
  • Relaxin – which makes the pubic symphysis more flexible during pregnancy, helps cervix to widen during labor and delivery
  • Inhibin – which inhibits secretion of follicle stimulating hormone from the pituitary gland.


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Estrogen

Overview

Estrogens (English), oestrogens (British), are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal. Like all steroid hormones, estrogens readily diffuse across the cell membrane. Once inside the cell, they bind to and activate estrogen receptors which in turn modulate the expression of many genes.
The three major naturally occurring estrogens in women are estrone (E1), estradiol (E2), and estriol (E3). Estrone is produced during menopause, estradiol is the predominant form in nonpregnant females, and estriol is the primary estrogen of pregnancy. In the body these are all produced from androgens through actions of enzymes.

  • From the first menstrual cycle to menopause the primary estrogen is estradiol. In postmenopausal women the primary estrogen is estrone.
  • The enzyme aromatase converts testosterone to estradiol. Aromatase also converts androstenedione to estrone.
  • Estrone is weaker than estradiol.

Estrogens are produced primarily by developing follicles in the ovaries, the corpus luteum, and the placenta. Luteinizing hormone (LH) stimulates the production of estrogen in the ovaries. Some estrogens are also produced in smaller amounts by other tissues such as the liver, adrenal glands, and the breasts. These secondary sources of estrogens are especially important in postmenopausal women. Fat cells also produce estrogen, potentially the reason why being underweight or overweight are risk factors for infertility.

In females, synthesis of estrogens starts in theca interna cells in the ovary, by the synthesis of androstenedione from cholesterol. Androstenedione is a substance of moderate androgenic activity. This compound crosses the basal membrane into the surrounding grandulose cells, where it is converted to oestrone or oestradiol, either immediately or through testosterone. The conversion of testosterone to oestradiol, and of androstenedione to oestrone, is catalyzed by the enzyme aromatase.

Oestradiol levels vary through the menstrual cycle, with levels highest just before ovulation.

Since estrogen enters all cells, its action is dependent on the presence of the estrogen receptor in the cell. The estrogen receptor is expressed in specific tissues including the ovary, uterus and breast.

While estrogens are present in both men and women, they are usually present at significantly higher levels in women of reproductive age. They promote the development of female secondary sexual characteristics, such as breasts, and are also involved in the thickening of the endometrium and other aspects of regulating the menstrual cycle. In males, estrogen regulates certain functions of the reproductive system important to the maturation of sperm and may be necessary for a healthy libido. Furthermore, there are several other structural changes induced by estrogen in addition to other functions.

  • Structural
    • promote formation of female secondary sex characteristics
    • accelerate metabolism
    • reduce muscle mass
    • increase fat stores by increasing insulin production
    • stimulate endometrial growth
    • increase uterine growth
    • increase vaginal lubrication
    • thicken the vaginal wall
    • maintenance of vessel and skin
    • reduce bone resorption, increase bone formation
  • Protein synthesis
    • Increase hepatic production of binding proteins
  • Lipid
    • Increase HDL, triglyceride
    • Decrease LDL, fat deposition
  • Fluid balance
    • salt (sodium) and water retention
    • increase cortisol, SHBG
  • Gastrointestinal tract
    • reduce bowel motility
    • increase cholesterol in bile
  • Cancer
    • Support hormone-sensitive breast cancers

    Symptoms

    Low Estrogen

      • Hot flashes
      • Night sweats
      • Fatigue
      • Memory lapses
      • Difficulty concentrating
      • Joint pain
      • Vaginal dryness
      • Craving sweets
      • Craving carbohydrates
      • Weight gain
      • PMS
      • Depression
      • Feeling overwhelmed
      • Mood swings
      • Irritability
      • Insomnia
      • Headache
      • Low libido
      • Dry skin
      • Hair loss
      • Vaginal dryness
      • Irregular periods
      • Bone loss
      • Anxiety

    High Estrogen

      • Breast tenderness and/or breast enlargement
      • Irritability
      • Shorter menstrual cycles
      • More intense PMS symptoms
      • Weight gain
      • Migraines
      • Mood swings
      • Skin problems such as acne, psoriasis or a red flushed appearance
      • Irregular periods
      • Breakthrough bleeding
      • Cramps
      • Fibroids
      • Depression
      • Insomnia
      • Fatigue
      • Miscarriage
      • High blood pressure
      • Inflammation
      • Excessive facial hair

    Testing

    Blood tests are the best way to measure the estrogen levels. Testing should be done after ovulation, which is approximately day 19 and is called the luteal phase.

    Saliva testing can also be done for baseline estrogen levels, but once you have started taking bio identical estrogen, you need to have blood test done to check your levels.

    You should never attempt to self diagnose high or low estrogen. Too many of the symptoms overlap and the only way to know if treatment is necessary is by testing.

    Treatment

    Low Estrogen
    It is always best to start with a low dose of a compounded bio identical estrogen cream. Estriol estradiol mixtures are best to protect the body, and increase as necessary. Make sure that you have also tested progesterone and testosterone.
    High Estrogen
    Treatment for high estrogen would be to first find the cause. One of the biggest reasons for high estrogen is low cortisol. In adequate hormone replacement therapy and birth control pills can also be causes for high estrogen.


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    Progesterone

    Overview

    Progesterone also known as P4 (pregn-4-ene-3, 20-dione) is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis (the process by which the embryo is formed and develops into a fetus) of humans and other species. Progesterone belongs to a class of hormones called progestogens, and is the major naturally occurring human progestogen.
    Progesterone, is produced in the ovaries (to be specific, after ovulation in the corpus luteum), the adrenal glands and, during pregnancy, in the placenta. Progesterone is also stored in adipose (fat) tissue.
    In humans, increasing amounts of progesterone are produced during pregnancy:

    • At first, the source is the corpus luteum that has been “rescued” by the presence of human chorionic gonadotropins (hCG) from the conceptus.
    • However, after the 8th week, production of progesterone shifts to the placenta. The placenta utilizes maternal cholesterol as the initial substrate, and most of the produced progesterone enters the maternal circulation, but some is picked up by the fetal circulation and used as substrate for fetal corticosteroids. At term the placenta produces about 250 mg progesterone per day.
    • An additional source of progesterone is milk products. They contain much progesterone because on dairy farms cows are milked during pregnancy, when the progesterone content of the milk is high. After consumption of milk products the level of bioavailable progesterone goes up.

    Progesterone like all other steroid hormones is synthesized from pregnenolone, which in turn is derived from cholesterol.Progesterone in turn is the precursor of the mineralocorticoid aldosterone, and after conversion to 17-hydroxyprogesterone (another natural progestogen) of cortisol and androstenedione. Androstenedione can be converted to testosterone, estrone and estradiol.

    But when ones Endocrine system is out of balance, these steroid hormones do not follow the normal pathways.

    Supplementing progesterone is not necessary if you have had a hysterectomy.

    Progesterone helps to prevent the thickening of the uterine lining and decreases the risk of developing uterine cancer.

    Symptoms

    Low Progesterone

    • Mood swings
    • Depression
    • Insomnia
    • Appetite changes
    • Weight gain
    • Loss of pregnancy
    • Infertility
    • Irritability
    • Lack of concentration
    • Anxiety
    • Fatigue
    • Frequent menstruation
    • Irregular menstruation
    • Low sex drive
    • Migraines
    • Vaginal dryness
    • Painful intercourse
    • Dizziness
    • Bloating
    • PMS
    • Breast tenderness

    High Progesterone

      • Breast tenderness
      • Mood swings
      • Anxiety
      • Depression
      • Bloating
      • Loss of libido
      • Acne
      • Greasy skin
      • Weight gain
      • Hot flashes
      • Urinary infections
      • Headaches
      • Incontinence
      • Inflammation

    Testing

    Blood tests are the best way to measure the progesterone levels. Testing should be done after ovulation, which is approximately day 19 and is called the luteal phase.

    Saliva testing can also be done for baseline progesterone levels, but once you have started taking bio identical progesterone, you need to have blood test done to check your levels.

    You should never attempt to self diagnose high or low progesterone. Too many of the symptoms overlap and the only way to know if treatment is necessary is by testing.

    Treatment

    Low Progesterone
    It is always best to start with a low dose of a compounded bio identical progesterone cream and increase as necessary. Most doctors start patients on too high a dose of progesterone (100mg). You also have to make sure that you have tested estrogen and testosterone.
    High Progesterone
    The treatment for high progesterone would depend on the cause for the high progesterone. The progesterone will normally be higher at ovulation and with pregnancy. Also you can see higher levels with inadequate hormone replacement therapy and birth control pills.

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    Testosterone

    Testosterone belongs to a class of male hormones called androgens. But women also have testosterone.
    The ovaries produce both testosterone and estrogen. Relatively small quantities of testosterone are released into the bloodstream by the ovaries and adrenal glands. In addition to being produced by the ovaries, estrogen is also produced by fat tissue in the body. These sex hormones are involved in the growth, maintenance, and repair of reproductive tissues. They influence other body tissues and bone mass as well.
    If your body produces too much testosterone, you may have irregular or absent menstrual periods. You may also have more body hair than the average woman. Some women with high levels of testosterone develop frontal balding. Other possible effects of high levels of testosterone include acne, an enlarged clitoris, increased muscle mass, and deepening of the voice.
    High levels of testosterone can also lead to infertility.
    At menopause, women experience a decline in testosterone. That decline may be correlated to a reduced libido. Testosterone replacement is not advised in women with breast or uterine cancer.
    Symptoms

    Low testosterone

      • Loss of sexual desire
      • Tiredness and fatigue
      • Mood changes
      • Sleep disturbances
      • Reduced motivation and
      • Body shape changes
      • Loss of body hair including pubic and underarm
      • Poor muscle tone, inability to increase muscle mass
      • Insulin resistance due to poor musculature

    High testosterone

      • Obesity
      • Apple-shaped body
      • Excessive or thinning head hair growth
      • Acne
      • Menstrual irregularity
      • Being more masculine
      • Deepening of the voice
      • Male pattern baldness
      • Insulin resistance
      • Excess or inappropriate body hair growth

    Testing

    Blood tests are the best way to measure the testosterone levels. Testing can be done any time in the menstrual cycle and should include both total and free testosterone.

    Saliva testing can also be done for baseline testosterone levels, but once you have started taking bio identical testosterone, you need to have blood testing done to check your levels.

    You should never attempt to self diagnose high or low testosterone. Too many of the symptoms overlap and the only way to know if treatment is necessary is by testing.

    Treatment

    Low testosterone
    It is always best to start with a low dose of a compounded bio identical test testosterone cream and increase as necessary. Also have to make sure that you have tested estrogen and progesterone.
    High testosterone
    Treating high testosterone would depend on the cause. Metformin is one drug that is used to reduce high testosterone levels in women.

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