Ovarian Function_Final

>> 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.