Ovarian Function_Final
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>> Hi there, and welcome back.
In this lecture, we're going to talk about
the physiology of the ovaries.
This is an important topic to discuss
because it includes the production of sex hormones
by the ovaries
and the role they play in the menstrual cycle.
We'll also discuss how the process of ovulation
can be interrupted or stopped completely.
Lastly, we will be talking about
the ovarian-adrenal-thyroid axis,
a less understood hormonal feedback system
that can alter ovarian function.
We already talked about proper ovarian function
when we discussed the menstrual cycle.
We also looked at some general menstrual abnormalities.
Now let's take a more in-depth look at ovarian dysfunction
and talk about circumstances
that can interfere with the normal process of ovulation.
In general, the three main causes of anovulation
or failure to ovulate are
failure to produce a mature follicle,
hypothalamic malfunction, and pituitary malfunction.
Let's look at each of these causes a little more closely.
If the ovary fails to produce a mature follicle,
there are three potential reasons for this.
These include polycystic ovarian syndrome,
estrogen dominance, and premature ovarian failure.
The first reason is polycystic ovarian syndrome
which is the most common disorder that interferes
with the production of a mature follicle
and therefore ovulation.
When this happens, production of FSH is reduced,
while levels of LH, estrogen,
and testosterone remain normal or increase.
While the cause is not completely clear,
one theory is that the decrease in FSH results
in only partial development of ovarian follicles,
so they don't reach full maturity.
Another factor that keeps the mature follicle
from being produced is estrogen dominance.
High estrogen levels keep the brain from sending out
FSH and LH to induce follicle maturation and ovulation.
Remember, estrogen dominance is a multisystem issue
which can be caused by gut problems, stress,
thyroid hormone imbalance,
or poorly controlled blood sugar.
When these are corrected,
the estrogen and progesterone levels
will also shift and ovulation should occur.
And next, we have premature ovarian failure or POF,
which is when the body stops producing follicles
even though the woman is in a fertile age range.
With POF, FSH levels are high which indicates
that the ovaries are not responding
and the estrogen levels are low.
The most common cause of POF is follicle depletion
which is when the number of potential follicles is very low.
With follicle depletion, the follicles are still there
but they're not responding to the signal from FSH.
In the beginning, the number of follicles is still normal
but over time they begin to die off.
Causes of this include toxins, chemotherapy,
genetic disorders, and possibly autoimmune disease.
Women with POF can still conceive if it's caught early
but they'll require medical intervention to do so.
Now let's move on to the two remaining causes
of anovulatory cycles.
Hypothalamic malfunction is the second cause of anovulation.
High stress levels, severe weight loss,
excessive exercise, recent use of birth control pills,
and some genetic disorders can drive the hypothalamus
to shut down its normal pathway to the ovaries.
This results in non-fertile cycles.
The solution here is to take care
of the underlying abnormality.
Depending on your particular client,
you'll likely know what that is once you do a detailed
Health History consultation with her.
Reducing or managing stress,
establishing a healthy weight and diet,
and decreasing exercise
can all improve abnormal hormone levels.
The third cause for anovulatory cycles
is pituitary malfunction.
The most common pituitary malfunction
is pituitary adenoma, a mass in the pituitary
which is usually benign
but interferes with pituitary function.
This happens in two different ways,
a large mass may interfere with the blood supply
between the pituitary and hypothalamus,
and a small mass can produce prolactin
which is a hormone that shuts down the ovulation cycle.
Another cause for pituitary malfunction
is Sheehan's syndrome,
which destroys the blood supply to the part of the pituitary
that sends out FSH and LH,
and can also disrupt the signal
from the pituitary to the ovary.
Sheehan's syndrome is caused by severe blood loss
or extreme low blood pressure during child birth.
It can have prolonged effects
requiring lifelong hormone replacement.
All right, so to recap what we've covered so far,
the three main causes of anovulation
are an inability to produce a mature follicle,
hypothalamic malfunction, and pituitary malfunction.
Clients dealing with any of these conditions
should be under the care of a doctor.
But as a Health Coach, there is so much you can do
to improve your client's outcome with the lifestyle
and dietary interventions
we've discussed in previous lectures.
For instance, say you have a client in her 30s
who presents with irregular periods,
weight gain, and fatigue.
She tells you that she's been trying to get pregnant
for over six months but has been unable to do so.
After completing her intake and reviewing her history,
you noticed that she is only sleeping about
six hours per night
and that her job is extremely stressful.
For instance, she has anxiety on Sunday night
preparing for her day on Monday,
you ask her to begin tracking her menstrual cycles.
She returns the following month with her temperatures
and cervical fluid charted.
And you see that she had the expected rise in temperature
and cervical fluid changes, but they didn't occur
until day 21 of her cycle, way past the normal midpoint.
For this client, stress may be the number one culprit
in her difficulty getting pregnant.
She may also not even realize she should be having sex
a little later in her cycle when she actually ovulated.
While it's recommended that she track her period
for more than one month,
you can begin to work with her to mitigate her stress levels
by helping her to improve her sleep first and foremost,
and incorporating other stress busting techniques
learned in previous lectures.
Next, you can explain when in her cycle
she should be having sex in order to conceive
based on the temperature rise in her chart.
Finally, I want to remind you that as a Health Coach,
diagnosing or treating any medical condition
is always considered outside of your scope of practice.
Instead, refer your client
to a trained medical professional
for proper testing and diagnosis.
If the diagnosis is formally confirmed,
you can then offer support to improve their health
through lifestyle and dietary recommendations.
Next, we will be talking about
the ovarian-adrenal-thyroid axis
conveniently known as OAT for short.
As you know when the body is very stressed,
whether from excess exercise,
emotional or psychological stress, or lack of sleep,
the adrenal glands produce too much cortisol in response.
This can lead to estrogen dominance
which can in turn affect the ovarian-adrenal-thyroid axis.
This is a separate but similar system
from the hypothalamic-pituitary-
adrenal-thyroid-gonadal axes
that we've already talked about.
The three systems ovarian, adrenal, and thyroid
are connected to each other.
So anything that affects one,
affects the other two as well.
They are linked together through a feedback loop
that helps to keep each of them in harmony.
So how might a client present
with an ovarian-adrenal-thyroid imbalance?
A typical client might come in complaining of problems
with irregular menstrual cycles.
Periods that are longer or shorter than normal,
heavy periods, stress related acne
that is worsened by high sugar intake and severe PMS.
She may also have breast tenderness,
fatigue, hair loss, and mood swings.
The conventional medicine approach in this case
would be to look at each one of these symptoms
and treat it separately.
Western doctors might focus their workup on the pituitary
and hypothalamic systems and find that things are okay.
They will probably then recommend
some form of birth control pill
to regulate the period or reduce painful
or heavy periods.
If on the other hand the diagnosis is PCOS,
then the common recommendation would be to put them
on insulin regulating drugs like metformin
and the birth control pill.
Or perhaps, they will focus on the thyroid instead
and the client will be started
on thyroid medication and support.
In the long run, this client will probably end up
on a lot of medications that are only treating the symptoms
or a part of their issue.
To balance the hormones,
all three systems must be regulated together.
If the focus is only on balancing the thyroid system
without addressing the estrogen dominance,
then the person will not really get better.
Comprehensive testing is strongly recommended to determine
where exactly the imbalances are.
From there, you can step into help her implement practices
that will effectively support her
in reaching her health goals.
Through your training you know that it's better
to focus on the whole system
and look at the core underlying causes of these symptoms.
For the client we just described a moment ago,
her OAT axis function is disrupted.
Working with her to balance her entire endocrine system,
so that the OAT system can function properly
will be much more effective for her
than spot treating her symptoms.
We recommend you start with supporting
her adrenal glands first
because these are always at the root of OAT dysfunction.
You can also dig deep with your client
to determine her top three major health concerns
and work to address the biggest complaints first.
Okay, that wraps up our section on ovarian function.
To recap, we discussed the hormones
that are released during a normal cycle
and how they function
during each part of the menstrual cycle.
In addition, we covered ovulation,
how it should be normally and some of the ways
that it can be disrupted.
And finally, we covered the ovarian-adrenal-thyroid axis
and how it can affect the endocrine system.
We hope that you now have a better understanding
of the ways that ovarian function can go awry
and how you can help clients
who experience these issues by helping them
to balance their hormones.
Pay attention this way
to whether any of your current clients
are exhibiting any telltale signs of OAT dysfunction,
and then drop by the Facebook group to join the discussion.
That's all for today, see you soon.