Anthony Testa: Today we're going to be talking about the female menstruation cycle.
As an acupuncturist, one of the issues that'll walk into your office will be gynecological
issues, specifically that are regarding fertility.
One of the ways that a lot of women get affected negatively is through menstruation.
This is what a healthy female menstruation cycle looks like, what the hormone levels
should be at, and the four in particular that have an effect on it.
In looking at it initially like this, it can be quite overwhelming.
When you break it down on how each hormone has an effect on the next, it actually isn't
that overwhelming, and it can help you in the future regarding maybe on how treatment
might be allocated.
The four hormones that we'll be working with today are follicle stimulating hormone, estrogen,
luteinizing hormone, and progesterone, and their effect on each other over the 28-day
cycle, which is a normal menstruation period, and the rise and fall of those hormones as
time goes on.
What also I'll be doing within this lecture is, we'll be breaking away and I'll be showing
you a model and then we'll be coordinating what's happening anatomically in the ovary
and in the uterus and how these hormones have an effect on both those anatomical structures.
When we come back we're going to see that all the insides of this graph won't be there,
and we're going to build it together.
You see this looks a little bit different now.
All four lines have been cut out of the graph and we just incorporated the first one, which
is follicle stimulating hormone.
It does what's in its name, it stimulates the follicle, specifically the Graafian follicle.
FSH increases Graafian follicle development.
Like most things we should know where they come from, so follicle stimulating hormone
is secreted from the anterior pituitary located at the
base of the brain just below the hypothalamus.
The follicle stimulating hormone, aside from increasing Graafian development, has another
important function.
It increases estrogen and begins to repair the endometrium lining.
How this affects and how we're looking at the graph.
We're seeing here from days four to six, and these are always just approximations, you
get an increase in follicle stimulating hormone.
The female goes through menstruation, so that means that the endometrium lining has now
separated from the uterus and that's what causes the bleeding.
That needs to be repaired for future potential of a fertilized egg getting implanted in the
uterine lining, the endometrium lining.
How that has to happen is it needs to get repaired, follicle stimulating hormone begins
this process once menstruation takes place.
Once we get back we're going to take a look at estrogen and how it's affected by follicle
stimulating hormone and then what it goes on to affect.
But first I want to take a look at this model.
We see here this is a Graafian follicle, it gets affected by follicle stimulating hormone,
inside is an oocyte, and then as time moves on and the Graafian follicle matures it gets
released.
You can see this is the release point and it gets released out of the ovary.
This is the corpus luteum, and we're going to discuss this shortly and its effect on
estrogen.
Next we've added estrogen to this graph.
As follicle stimulating hormone starts to fall, estrogen starts to rise.
Estrogen's main job is to keep the process going.
An increase in estrogen results in an increase in luteinizing hormone.
Luteinizing hormone is essential in the development of this process continuing to keep going.
We're going to discuss that next.
As you can see here now we've added luteinizing hormone.
At the beginning it's low, with the rise of estrogen causes the rise of luteinizing hormone.
It's important to note that with the rise of luteinizing hormone we get ovulation.
You can see this is the Graafian follicle, right?
We get the release of the ovum out of the ovary going into the oviduct.
This is what the Graafian follicle looks like once it's released the ovum.
It's important to look, when we look at this diagram, we have the corpus luteum and ovarian
follicles.
Follicle stimulating hormone at its peak causes an increase in estrogen.
This estrogen is produced by the corpus luteum.
Once the estrogen hits its height and luteinizing hormone is released, it's also released from
the corpus luteum.
At its height we get ovulation.
The next hormone we're going to introduce is progesterone and its effect on these structures
as well as on these hormones.
Now we've added progesterone and as we see, as we get an increase in follicle stimulating
hormone we're getting a decrease in progesterone.
At the height of luteinizing hormone, we get an increase in progesterone.
Now two things can happen because progesterone is important for maintaining the endometrium
lining.
As you know, that once the corpus luteum has concluded releasing luteinizing hormone and
the Graafian follicles have released the ovum from the ovary into the oviduct to get fertilized
it's like a switch, and the corpus luteum no longer produces estrogen, no longer releasing
luteinizing hormone, it starts to release progesterone.
Like I'd said, I don't know if I'd said it, I don't recall, but progesterone's responsible
for maintaining the endometrium lining.
This is a uterus.
Along the border is the endometrium lining.
It's at this location that a fertilized egg will implant in itself, and it’s that implantation
that this dictates whether progesterone stays elevated so that it maintains the health of
the endometrium lining, so that the ovary can continue to grow and eventually form a
baby, or if there is no implantation, what happens is the endometrium lining begins to
deteriorate because there's a decrease in progesterone, the corpus luteum begins to
deteriorate.
What happens is, look, we start getting progesterone decreasing, follicle stimulating hormone increasing,
menstruation occurs, that endometrium lining leaves, and the whole process starts over
again.
What I'm going to do is I'm going to erase all this and I'm going to show you something
called a feedback loop and the differences that occur with implantation or no implantation.
To sum it up succinctly we're going to create a feedback loop.
As we started before, this whole thing starts with follicle stimulating hormone.
Follicle stimulating hormone is released and we get
a positive relationship between follicle stimulating hormone and estrogen.
Increased follicle stimulating hormone, you get an increase in estrogen.
As estrogen increases, this will be one, this will be two, as estrogen increases, we get
an increase in luteinizing hormone.
Luteinizing hormone had a positive effect on progesterone.
Luteinizing hormone created in the corpus luteum.
Once Graafian follicles have released the ovum from the ovary into the oviduct, once
they've done that it's like a switch flicks and the luteinizing hormone is no longer created
in the corpus luteum, because the corpus luteum is busy producing progesterone.
We saw that on the chart as well.
Now progesterone's main job is maintaining the endometrium lining.
With the ovary on the oviduct waiting to get inseminated what happens is, if it does and
it implants in the endometrium lining, so implantation, you get an increase in progesterone
to maintain the endo lining.
That fertilized egg needs to stay somewhere.
Sounds like a good place for it to stay.
If the egg does not get fertilized and the endometrium lining is not maintained, this
is negative feedback, high progesterone, low FSH, low progesterone, high FSH, this is the
outlier in this feedback look.
Positive feedback, positive feedback, positive feedback, negative feedback.
So I hope you have a better understanding of that complicated graph.
If you break it down it becomes much simpler.
Any questions, we'll talk about it in class.