As a woman, I ought to know a lot more about menstrual cycles than I do. I feel that the educational institutions in our country have repeatedly failed at educating girls and boys on how our bodies work and why. Then again, my mother never educated me, either.
Either way, I learned that menstrual cycles have phases only a few short years ago (because ADHD Research lol).
And today is “Day 8” in the Luteal Phase for me. While making coffee, I decided to look up the phases and – lo and behold – there was mention of *drumroll please* The Pituitary Gland. *gasp* I know, I know. Shock and awe, right?! 😝
Buckle up, the ADHD Research Train is leaving the station!
So Sayeth Google (in AI Deep Dive): “what hormones are involved in the menstrual cycle“
The menstrual cycle is regulated by a complex and coordinated interaction of hormones, primarily produced by the hypothalamus, pituitary gland, and ovaries. The main hormones involved are gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone.
Hormones from the brain
Gonadotropin-releasing hormone (GnRH):
- Source: Hypothalamus.
- Role: GnRH is released in a pulsatile fashion and travels to the pituitary gland to stimulate the production of FSH and LH. The frequency of these pulses changes throughout the cycle, which helps regulate the release of other hormones.
Follicle-stimulating hormone (FSH):
- Source: Pituitary gland.
- Role: During the follicular phase, FSH stimulates the ovaries to grow and mature follicles (sacs containing eggs). As follicles develop, they begin to produce estrogen.
- Fluctuation: FSH levels are highest at the beginning of the cycle and decrease as a dominant follicle begins producing more estrogen.
Luteinizing hormone (LH):
- Source: Pituitary gland.
- Role: An LH surge is triggered by high estrogen levels just before ovulation. This surge causes the dominant follicle to rupture and release its mature egg. LH is also crucial for the corpus luteum (the ruptured follicle) to produce progesterone after ovulation.
Hormones from the ovaries
Estrogen:
- Source: Ovarian follicles and later by the corpus luteum.
- Role: Estrogen’s primary role is to stimulate the thickening and proliferation of the uterine lining (endometrium).
- In the follicular phase: Rising estrogen levels cause the endometrial lining to rebuild after menstruation.
- Before ovulation: The high estrogen from the dominant follicle triggers the LH surge.
- In the luteal phase: Estrogen levels drop after ovulation but rise again along with progesterone to continue preparing the uterus for a potential pregnancy.
Progesterone:
- Source: The corpus luteum, which forms from the follicle after ovulation.
- Role: Progesterone is the main hormone of the luteal phase. It prepares the uterine lining for implantation by making it richer in blood vessels and nutrients. It also thickens cervical mucus to prevent sperm or bacteria from entering the uterus.
- Fluctuation:
- If no pregnancy occurs: Progesterone levels drop, which triggers the shedding of the uterine lining and the start of a new menstrual cycle.
- If pregnancy occurs: The embryo produces human chorionic gonadotropin (hCG), which keeps the corpus luteum active and maintains progesterone production to support the pregnancy.
How the hormones work together
The hormones operate in a feedback loop, with a change in one level triggering a change in another:
- Low estrogen and progesterone at the start of the cycle stimulate the hypothalamus to release GnRH, which signals the pituitary to release FSH and LH.
- FSH stimulates follicle growth and estrogen production in the ovaries.
- High estrogen levels trigger a surge of LH, which causes ovulation.
- After ovulation, the corpus luteum produces progesterone and estrogen, which inhibit FSH and LH production.
- If no pregnancy occurs, the corpus luteum breaks down, and the resulting drop in progesterone and estrogen causes the uterine lining to shed, starting the cycle anew.
Thoughts: Well… that was a lot of information, but I really like that it got broken down with “source” and “role” – makes it easier to distinguish, yeah? So my first thoughts are… since I had a Salpingectomy (I say I “got spayed” cuz that word is a tongue twister) – which means no more fallopian tubes – does this disrupt the process in some significant way?! Nope. It just means that the eggs can no longer travel to the uterus, and thus are reabsorbed by the body (thus, no more behbehs!). Everything else supposedly functions as normal. Though, I will note that my periods have changed. I won’t go into details (you’re welcome).
Next Question: “if the pituitary gland is damaged somehow, how does this effect menstrual hormones“
A damaged pituitary gland can severely disrupt the menstrual cycle, leading to irregular, absent, or anovulatory periods. This occurs because the pituitary, often called the “master gland,” controls the hormones that regulate the menstrual cycle: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Damage can result in either underproduction (hypopituitarism) or overproduction of these or other pituitary hormones, both of which can interfere with normal menstrual function.
Damage causing low hormone production (Hypopituitarism)
When the pituitary gland does not produce enough hormones, it disrupts the entire reproductive hormone cascade.
- Low FSH and LH: A key function of the pituitary is to release FSH and LH, which signal the ovaries to develop follicles and ovulate. Damage to the gland leads to low levels of these gonadotropins, which prevents ovulation.
- Low estrogen and progesterone: Without proper stimulation from FSH and LH, the ovaries do not produce sufficient estrogen and progesterone. This hormonal deficiency prevents the uterine lining from thickening and shedding properly, causing periods to become irregular or stop completely (amenorrhea).
- Symptoms: This condition is a common cause of infertility and can lead to other symptoms such as fatigue, low libido, and changes in hair patterns.
Damage causing high hormone production
Damage to the pituitary, most often from a benign tumor called a pituitary adenoma, can cause it to overproduce certain hormones.
Prolactinomas
This is the most common type of hormone-secreting pituitary tumor.
- High prolactin: The tumor causes an excess of prolactin, a hormone primarily involved in milk production. This condition, called hyperprolactinemia, can suppress GnRH, which in turn reduces FSH and LH levels.
- Irregular or absent periods: The suppression of FSH and LH disrupts ovulation and causes irregular periods or amenorrhea.
- Other symptoms: High prolactin can also cause galactorrhea (milky nipple discharge) in non-pregnant women, vaginal dryness, and infertility.
Cushing’s Disease and Acromegaly
Less common pituitary tumors can lead to other hormonal imbalances that affect the menstrual cycle.
- Cushing’s Disease: Tumors that produce excess adrenocorticotropic hormone (ACTH) can lead to Cushing’s disease, with symptoms including menstrual irregularities.
- Acromegaly: A tumor that produces excess growth hormone can also disrupt menstrual cycles.
Other causes of pituitary damage
While tumors are a major cause, other issues can damage the pituitary gland and affect menstruation:
- Sheehan’s syndrome: Severe blood loss during or after childbirth can cause a type of hypopituitarism that leads to the loss of menstrual periods and the inability to lactate.
- Inflammation: Conditions like lymphocytic hypophysitis, an inflammation of the pituitary, can disrupt hormone production.
- Pressure from other growths: Large masses or tumors in the brain can put pressure on the pituitary, interfering with its normal function.
- Trauma or radiation: Head injuries or radiation therapy near the pituitary can also cause damage.
Thoughts: Ugh. That’s even MORE information than I was expecting, but at least it covers a lot?!
First… some background. I started my first period at age 14. This isn’t abnormal, but the average is 12-13. From then on, I never had a regular cycle (i.e. every 28 days or whatever). I remember once going 6 whole months without a period and taking pregnancy tests repeatedly to ensure I wasn’t actually pregnant. There was never any doctor visits or otherwise regarding this, as I was growing up. And, after becoming an adult, it was just my “normal” – and I was focused on all sorts of other shite like college and work and whatnot.
Second… and this one is bold of me to say: with as much unprotected sex as I had, I should’ve gotten pregnant (probably more than a couple times) well before I actually did. In fact, when I did get pregnant, it was a surprise. *shrug* After having The Son (at age 24), no period for an entire year (bc breastfeeding), then I had regular periods once I started again.
Third… if you’ve read my previous 2 ADHD Research Posts (Phase 2 and Phase 3), and recall: the Cushing’s Disease section mentions “adrenocorticotropic hormone (ACTH)” – and irregular periods. ACTH is also mentioned within my previous research about the HPA axis (and chronic stress)… How very IIIIIINTERESTIIIIING!
Finally… I’m curious about the Inflammation section and what “lymphocytic hypophysitis” might be…
So, let’s go with that, for now: “what is lymphocytic hypophysitis“
Lymphocytic Hypophysitis
Lymphocytic hypophysitis is an autoimmune condition that causes inflammation of the pituitary gland. The inflammation is primarily caused by the infiltration of lymphocytes (white blood cells) into the pituitary tissue.
Causes:
The exact cause of lymphocytic hypophysitis is unknown, but it is believed to be an autoimmune disorder. This means that the body’s immune system mistakenly attacks the pituitary gland, leading to inflammation.
Symptoms:
Symptoms of lymphocytic hypophysitis can vary depending on the severity of the inflammation and the pituitary hormones affected. Some common symptoms include:
- Headache
- Visual field defects
- Fatigue
- Hormonal imbalances (e.g., hypothyroidism, adrenal insufficiency)
- Diabetes insipidus
Diagnosis:
Lymphocytic hypophysitis is typically diagnosed based on clinical symptoms, imaging studies (such as magnetic resonance imaging), and blood tests. A pituitary biopsy may also be performed to confirm the diagnosis.
Treatment:
Treatment for lymphocytic hypophysitis typically involves:
- Corticosteroids: To suppress the inflammation
- Hormone replacement therapy: To replace any pituitary hormones that are not being produced adequately
- Immunosuppressant medications: To prevent the immune system from attacking the pituitary gland
Prognosis:
The prognosis for lymphocytic hypophysitis varies depending on the severity of the condition and the response to treatment. In some cases, the condition may resolve on its own, while in others, it may require ongoing treatment.
Additional Information:
- Lymphocytic hypophysitis is more common in women than in men.
- It can occur at any age, but it is most common in young adults and pregnant women.
- Lymphocytic hypophysitis can sometimes be associated with other autoimmune conditions, such as Hashimoto’s thyroiditis.
Thoughts: First off, omg – pituitary biopsy?! That sounds terrible. *shudder*
Second… I get really tired of seeing: “The exact cause for <insert thing> is unknown, but…” In all my years of ADHD Researching, I’ve come across that fucking shit so often that I wonder what the medical community as a whole is even doing. Like… why are we not figuring these things out?! And then I get angry because… damn, if we figured out the source for a bunch of shit, instead of just treating the symptoms, imagine how much better off people would actually be. Buuuuut… what do I know, I’m just some middle-aged lady trying to figure out why the fuck her body is slowly failing because I have to do all the leg-work in order to get medical personnel to actually do their jobs. Sorry… lemme step off my soap box…
Third… I’m checking all those “symptoms” boxes except… what the hell is “diabetes insipidus”?!
Let’s go with that, I guess: “what is diabetes insipidus”
Diabetes insipidus (DI) is a rare endocrine disorder that affects the body’s ability to regulate fluid balance, leading to excessive thirst and urination.
Causes:
- Central DI: Caused by a deficiency or dysfunction of the pituitary gland, which produces the hormone antidiuretic hormone (ADH).
- Nephrogenic DI: Occurs when the kidneys are unable to respond to ADH.
- Idiopathic DI: The cause is unknown.
Symptoms:
- Extreme thirst (polydipsia)
- Frequent urination (polyuria)
- Dehydration
- Weakness
- Fatigue
- Bedwetting (especially in children)
Diagnosis:
Physical exam, Blood tests to measure ADH levels, Urine tests to assess urine concentration, and Water deprivation test (under medical supervision).
Treatment:
- Central DI: Replacement of ADH with synthetic hormone injections or nasal spray.
- Nephrogenic DI: Medications that stimulate the kidneys to respond to ADH.
- Idiopathic DI: May require a combination of treatments.
Complications:
dehydration, electrolyte imbalances, and kidney damage.
Note: Diabetes insipidus is different from diabetes mellitus, a condition that affects blood sugar levels.
Thoughts: There’s a whole new list of symptoms I’m definitely dealing with. But, I’m not going to be doing any self-diagnosis. I really just need to get in to see an Endocrinologist.
Side Note? I received a message on my patient portal about getting referrals to see a Dermatologist (moles and such) and an ObGyn (because remember, my Primary Physician said that’s who deals with hormones, Endocrinologists deal with pituitary and other glands… *heavy eyeroll*). I guess we’ll just have to go through the red-fucking-tape (yet again). Makes me wonder if whatever ObGyn I go to will also wonder why I’m there and not an Endocrinologist…
Who IS EnchiPants?! 