Menstrual Disorders Related to Endocrine Diseases

Abstract

Endocrine disturbances affecting the menstrual cycle and fertility in women can interfere with the coordinated stimulatory and inhibitory effects that lead to the release of a single mature oocyte from the ovarian pool of primordial oocytes. The female reproductive system may be susceptible to dysfunction generated by internal and external forces that include disorders in alimentation, excess exercise, psychophysical stress, and pathologies. This chapter examines the influence of neuroendocrine and pituitary dysfunctions and adrenal, thyroid, local, and systemic pathologies on the female reproductive axis. These disorders can modify a variety of factors that contribute to abnormal uterine bleeding, and they include steroidal and nonsteroidal hormones and paracrine, autocrine, and intracrine factors. All these substances can alter the cyclic changes in the major pituitary and gonadal hormones and the related feedback mechanism involved in the normal menstrual cycle. Pathologies of the hypothalamus can cause pituitary dysfunction, neuropsychiatric and behavioral disorders, and resulting menstrual disorders. The anterior pituitary gland controls the secretion of essential hormones from other endocrine glands including gonads, thyroid, and the adrenal cortex, and its disorders – partial or complete – can greatly influence the normal menstrual cycle. The ovarian sex steroids and their cognate receptors regulate an array of local factors within the endometrium that lead to important paracrine, autocrine, and intracrine actions in the regulation of menstruation. Endometrial intracrinology, associated with altered expression of key enzymes within the cells, has recently opened up new routes in understanding the development of menstrual disorders mediated by endocrine diseases.KeywordsFemale reproductive axisMenstrual disordersOvaryHypothalamusPituitaryAdrenalThyroidPCOSGonadsNeuroendocrine systemLHFSHEstradiolGonadotropins