Frontiers in Endocrinology, 13, 893889, 2022
Adaptive, reversible, hypothalamic reproductive suppression: More than functional hypothalamic amenorrhea
Author affiliations
- Vancouver Hospital and Health Sciences Centre ROR
Abstract
OPINION article Front. Endocrinol., 19 October 2022Sec. Reproduction Volume 13 - 2022 | https://doi.org/10.3389/fendo.2022.893889
Topics
functional hypothalamic amenorrhea, hypothalamic reproductive suppression, adaptive amenorrhea, stress-related anovulation, energy deficit amenorrhea, GnRH suppression reversible, neuroendocrine regulation menstrual cycle, hypothalamic-pituitary-ovarian axis, exercise-related amenorrhea, reproductive suppression mechanisms
PMID 36339445 36339445 DOI 10.3389/fendo.2022.893889 10.3389/fendo.2022.893889
Cite this article
Prior, J. C. (2022). Adaptive, reversible, hypothalamic reproductive suppression: More than functional hypothalamic amenorrhea. Frontiers in endocrinology, 13, 893889. https://doi.org/10.3389/fendo.2022.893889
Prior JC. Adaptive, reversible, hypothalamic reproductive suppression: More than functional hypothalamic amenorrhea. Front Endocrinol (Lausanne). 2022;13:893889. doi:10.3389/fendo.2022.893889
Prior, J. C. "Adaptive, reversible, hypothalamic reproductive suppression: More than functional hypothalamic amenorrhea." Frontiers in endocrinology, vol. 13, 2022, pp. 893889.
Keywords
Luteinizing Hormone
Related articles
Menstrual CycleReproductive Endocrinology
Open Access
Chronic Stress and Ovulatory Dysfunction: Implications in Times of COVID-19
Vigil P et al., 2022·Front Glob Womens Health
Stress is known to be associated with adverse health outcomes. The COVID-19 pandemic and its associated lockdowns are examples of chronic stressors. Lockdown measures inadvertently caused significant psychological distress and became a powerful source of anxiety/stress, sleep disturbances, nutritional changes and weight gain. Stress is known to impact women's health specifically, through hypothalamic-pituitary-gonadal (HPG) axis dysfunction and resultant ovulatory dysfunction. Such dysfunction may manifest in menstrual irregularities and/or infertility due to hypothalamic hypogonadism. Here, we review the key physiological mediators of stress and associated ovulatory dysfunction. The kisspeptinergic system is comprised of sets of neurons located in the hypothalamus, the rostral periventricular region of the third ventricle (RP3V) and the arcuate nucleus (ARC). This system links nutrition, reproductive signals and stress. It plays a key role in the function of the HPG axis. During chronic stress, the kisspeptinergic system affects the HPG axis, GnRH pulsatility, and, therefore, ovulation. Leptin, insulin and corticotrophin-releasing hormone (CRH) are thought to be additional key modulators in the behavioral responses to chronic stress and may contribute to stress-related ovulatory dysfunction. This mini-review also summarizes and appraises the available evidence on the negative impact of chronic stress as a result of the COVID-19 pandemic lockdowns. It proposes physiological mechanisms to explain the observed effects on women's reproductive health and well-being. The review suggests areas for future research.
Menstrual CycleReproductive Endocrinology
Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review
Handy AB et al., 2022·Harv Rev Psychiatry
After participating in this activity, learners • Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health. A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.
Reproductive EndocrinologyMenstrual CycleDiagnostics
Open Access
The Menstrual Disturbances in Endocrine Disorders: A Narrative Review
Saei Ghare Naz M et al., 2021·Int J Endocrinol Metab
Menstrual cycle is considered the fifth vital sign among women. This study aimed to summarize the menstrual disturbances in different endocrine disorders. In this narrative review, relevant studies (up to December 2019) were searched based on the MeSH keywords diabetes, polycystic ovary syndrome, Cushing's syndrome, thyroid dysfunction, hyperprolactinemia, menstrual cycle, uterine bleeding, and menstruation. Databases used for searching articles included Google Scholar, Scopus, PubMed, and Web of science for observational, experimental, and review studies. Endocrine disorders trigger the onset of menstrual disturbance across the reproductive lifespan of women. Endocrine glands (pituitary, thyroid, pancreas, adrenal, and ovaries) have a functional role in endocrine regulation of the menstrual cycle. According to available evidence, oligomenorrhea (cycles longer than 35 days) is the most common menstrual disturbance among endocrine disorders (thyrotoxicosis, hypothyroidism, polycystic ovary syndrome, Cushing's syndrome, and diabetes). Complex endocrine pathways play an essential role in a women's menstrual calendar. The menstrual cycle length and amount of bleeding can be indicative of endocrine disorders. Further studies are needed to identify the unknowns about the association between endocrine disorders and the menstrual cycle.
Reproductive EndocrinologyMenstrual Cycle
A Clinical Approach to Catamenial Epilepsy: A Review
Frank S et al., 2021·Perm J
Catamenial epilepsy (CE) is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy. There is a paucity of literature addressing this condition from a clinical standpoint, and the literature that does exist is limited to the neurological community. This article reviews the diagnosis and management of CE for the non-neurologist. Women with CE have early touch points in their care with numerous health care providers before ever consulting with a specialist, including OB/GYNs, pediatricians, emergency department physicians, and family medicine providers. In addition, women affected by CE have seizures that are more recalcitrant to traditional epilepsy treatment regimens. To optimize management in patients affected by CE, menstrual physiology must be understood, individualized hormonal contraception treatment considered, and adjustments and interactions with antiepileptic drugs addressed. CE is a unique subset of seizure disorders affected by menstrual fluctuations of progesterone and estrogen. The diagnosis of CE has been refined and clarified. There is an ever-increasing understanding of the importance and variety of options of hormonal contraception available to help manage CE. Furthermore, antiepileptic drugs and contraception can interact, so attention must be directed to optimizing both regimens to prevent uncontrolled seizures and pregnancy. CE can be diagnosed with charting of menstrual cycles and seizure activity. Hormonal treatments that induce amenorrhea have been shown to reduce CE. Optimizing antiepileptic drug dosing and contraceptive methods also can minimize unplanned pregnancies in women affected by CE.