The Hypothalamic-Pituitary-Ovarian Axis and Regulation of the Menstrual Cycle
This chapter presents a focused, comprehensive, and rational framework for cataloging, considering, and assessing normal female reproductive function, developmental changes, abnormalities, and downstream effects of normal and abnormal menstrual function. It also furnishes a trellis upon which diagnostic methods and treatments may develop and be applied.
While the menstrual cycle has many “moving parts,” it is the rational outcome of a straightforward, hierarchical series of feedback loops. This chapter mainly exposes the neuroendocrine limbs of gonadotropins feedback control but cannot do so without tying them to the target organs, the ovaries. Understanding these feedback loops allows expectation of the function of the female reproductive system and forecasts the effects of breaks in the loops.
Downstream targets of the ovarian steroids such as the uterus, breasts, bones, metabolic tissues, central nervous system, and immune system are most affected by breaks in the menstrual cycle. However, none of the systems in the body are indifferent to the sex steroids. Some of the most obvious effects of breaks in the neuroendocrine feedback will be cited as examples of normal/abnormal function.
Although comprehensive, this introductory chapter has constraints of detail and scope; these will be addressed by the chapters that follow.
KeywordsMenstrual cycle Hormones Gonadotropin Estrogen Progesterone Feedback Positive feedback
We appreciate the assistance of Dina Ali with the figures.
- 3.Blakemore J, Naftolin F. Aromatase: contributions to physiology and disease in women and men. Physiology (Bethesda). 2016;31(4):258–69.Google Scholar
- 4.Hall JE. Neuroendocrine control of the menstrual cycle. In: Yen and Jaffe’s reproductive endocrinology (eighth edition). Amsterdam: Elsevier; 2019. p. 149–66.Google Scholar
- 6.Naftolin F, Garcia-Segura LM, Horvath TL, Zsarnovszky A, Demir N, Fadiel A, Leranth C, Vondracek-Klepper S, Lewis C, Chang A, Parducz A. Estrogen-induced hypothalamic synaptic plasticity and pituitary sensitization in the control of the estrogen-induced gonadotrophin surge. Reprod Sci. 2007;14(2):101–16.CrossRefGoogle Scholar
- 11.McNamera HC, Kane SC, Craig JM, Short RV, Umstad MP. A review of the mechanisms and evidence for typical and atypical twinning. Am J Obstst Gynecol. 2016;214(2):172–91.Google Scholar
- 14.Naftolin F, Zreik TG, Garcia-Segura LM, Horvath TL. Neuroendocrine control of reproduction. In: Seifer DB, Samuels P, Kniss DA, editors. The physiologic basis of gynecology and obstetrics. Philadelphia: Lippencott, Williams and Wilkins; 2001. p. 63–74.Google Scholar
- 15.Seifer DB, Samuels P, Kniss DA. The physiologic basis of gynecology and obstetrics. Philadelphia: Williams & Wilkins; 2001. p. 64–74.Google Scholar
- 18.Nilsen J, Horvath TL, Levy A, Chowen J, Garcia-Segura LM, Naftolin F. Fetal hypothalamic development events presage adult function. In: Bourguignon JP, Plant TM, editors. Proceedings of the 5th international conference on the control of the onset of puberty, September 26–28, 1999 Liege, Belgium: V. Amsterdam: Elsevier Science B.V; 2000. p. 233–46.Google Scholar
- 21.Hall JE. Guyton and Hall textbook of medical physiology e-book. Amsterdam: Elsevier Health Sciences; 2015.Google Scholar
- 24.Seminara SB, Messager S, Chatzidaki EE, Thresher RR, Acierno JS Jr, Shagoury JK, Bo-Abbas Y, Kuohung W, Schwinof KM, Hendrick AG, Zahn D, Dixon J, Kaiser UB, Slaugenhaupt SA, Gusella JF, O’Rahilly S, Carlton MB, Crowley WF Jr, Aparicio SA, Colledge WH. The GPR54 gene as a regulator of puberty. N Engl J Med. 2003;349(17):1614–27.CrossRefGoogle Scholar
- 30.Santoro N, Crawford SL, El Khoudary SR, Allshouse AA, Burnett-Bowie SA, Finkelstein J, Derby C, Matthews K, Kravitz HM, Harlow SD, Greendale GA. Menstrual cycle hormone changes in women traversing menopause: study of women’s health across the nation. J Clin Endocrinol Metab. 2017;102(7):2218–29.CrossRefGoogle Scholar