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If no fertilized egg is implanted into the uterus, the corpus luteum degenerates and the levels of estrogen and progesterone decrease. The endometrium begins to degenerate as the progesterone levels drop, initiating the next menstrual cycle. The decrease in progesterone also allows the hypothalamus to send GnRH to the anterior pituitary, releasing FSH and LH and starting the cycles again. [link] visually compares the ovarian and uterine cycles as well as the commensurate hormone levels.

Art connection

The menstrual cycle encompasses both an ovarian cycle and a uterine cycle. The uterine cycle is divided into menstrual flow, the proliferative phase and the secretory phase. The ovarian cycle is separated into follicular and luteal phases. At day zero the uterine cycle enters the menstrual phase and the ovarian cycle enters the follicular phase. Menstruation begins, and the follicle inside the uterus begins to grow. The level of the pituitary hormone FSH rises slightly, while LH levels remain low. The levels of ovarian hormones estradiol and progesterone remain low. After menses the uterine cycle enters the proliferative phase and the follicle continues to grow. The level of the ovarian hormone estradiol begins to rapidly rise. Toward the end of the proliferative phase, levels of the pituitary hormones FSH and LH rise as well. Around day fourteen, just after the levels of estrogen, progesterone and estradiol reach their peak, ovulation occurs. The follicle ruptures, releasing the oocyte. The ovarian cycle enters the luteal phase. The follicle grows into a corpus luteum and then degenerates. The uterus enters the secretory phase. Progesterone levels increase and estradiol levels, which had dropped after ovulation, increase as well. Toward the end of the secretory phase estrogen and progesterone levels decrease, reaching their baseline levels around day 28. At this point menstruation begins.
Rising and falling hormone levels result in progression of the ovarian and menstrual cycles. (credit: modification of work by Mikael Häggström)

Which of the following statements about the menstrual cycle is false?

  1. Progesterone levels rise during the luteal phase of the ovarian cycle and the secretory phase of the uterine cycle.
  2. Menstruation occurs just after LH and FSH levels peak.
  3. Menstruation occurs after progesterone levels drop.
  4. Estrogen levels rise before ovulation, while progesterone levels rise after.

Menopause

As women approach their mid-40s to mid-50s, their ovaries begin to lose their sensitivity to FSH and LH. Menstrual periods become less frequent and finally cease; this is menopause    . There are still eggs and potential follicles on the ovaries, but without the stimulation of FSH and LH, they will not produce a viable egg to be released. The outcome of this is the inability to have children.

The side effects of menopause include hot flashes, heavy sweating (especially at night), headaches, some hair loss, muscle pain, vaginal dryness, insomnia, depression, weight gain, and mood swings. Estrogen is involved in calcium metabolism and, without it, blood levels of calcium decrease. To replenish the blood, calcium is lost from bone which may decrease the bone density and lead to osteoporosis. Supplementation of estrogen in the form of hormone replacement therapy (HRT) can prevent bone loss, but the therapy can have negative side effects. While HRT is thought to give some protection from colon cancer, osteoporosis, heart disease, macular degeneration, and possibly depression, its negative side effects include increased risk of: stroke or heart attack, blood clots, breast cancer, ovarian cancer, endometrial cancer, gall bladder disease, and possibly dementia.

Career connection

Reproductive endocrinologist

A reproductive endocrinologist is a physician who treats a variety of hormonal disorders related to reproduction and infertility in both men and women. The disorders include menstrual problems, infertility, pregnancy loss, sexual dysfunction, and menopause. Doctors may use fertility drugs, surgery, or assisted reproductive techniques (ART) in their therapy. ART involves the use of procedures to manipulate the egg or sperm to facilitate reproduction, such as in vitro fertilization.

Reproductive endocrinologists undergo extensive medical training, first in a four-year residency in obstetrics and gynecology, then in a three-year fellowship in reproductive endocrinology. To be board certified in this area, the physician must pass written and oral exams in both areas.

Section summary

The male and female reproductive cycles are controlled by hormones released from the hypothalamus and anterior pituitary as well as hormones from reproductive tissues and organs. The hypothalamus monitors the need for the FSH and LH hormones made and released from the anterior pituitary. FSH and LH affect reproductive structures to cause the formation of sperm and the preparation of eggs for release and possible fertilization. In the male, FSH and LH stimulate Sertoli cells and interstitial cells of Leydig in the testes to facilitate sperm production. The Leydig cells produce testosterone, which also is responsible for the secondary sexual characteristics of males. In females, FSH and LH cause estrogen and progesterone to be produced. They regulate the female reproductive system which is divided into the ovarian cycle and the menstrual cycle. Menopause occurs when the ovaries lose their sensitivity to FSH and LH and the female reproductive cycles slow to a stop.

Art connections

[link] Which of the following statements about hormone regulation of the female reproductive cycle is false?

  1. LH and FSH are produced in the pituitary, and estradiol and progesterone are produced in the ovaries.
  2. Estradiol and progesterone secreted from the corpus luteum cause the endometrium to thicken.
  3. Both progesterone and estradiol are produced by the follicles.
  4. Secretion of GnRH by the hypothalamus is inhibited by low levels of estradiol but stimulated by high levels of estradiol.

[link] C

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[link] Which of the following statements about the menstrual cycle is false?

  1. Progesterone levels rise during the luteal phase of the ovarian cycle and the secretory phase of the uterine cycle.
  2. Menstruation occurs just after LH and FSH levels peak.
  3. Menstruation occurs after progesterone levels drop.
  4. Estrogen levels rise before ovulation, while progesterone levels rise after.

[link] B

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Source:  OpenStax, Biology. OpenStax CNX. Feb 29, 2016 Download for free at http://cnx.org/content/col11448/1.10
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