Ku č era, E.

 Normal menstrual cycle  21 – 36 days interval between bleeding  duration of bleeding is 2 – 8 days  average is 5 days  blood loss doesn't exceed 80 ml  Ovulation occurs 10 – 14 days before bleeding

 Menarche  under control of the CNS  genetically determined  socioeconomical influence  affected by body mass  Menopause  genetically determined  socioeconomical influence

 Brain cortex  Hypothalamus  Pituitary gland  Ovary  Target tissues

 Isolated in 1971  Decapeptide produced pulsatively in hypothalamus  Produced in the area of nucleus arcuatus with terminals axons in the eminentia mediana

 the reason is not yet known  condition for physiological M-cycles  continual release causes inhibition of the pituitary gland

 Polypeptid – 198 amino acids – molecular weight  Produced by the lactotropic cells in anterior pituitary lobe  Hyperprolactinaemia – stress, hypoglycemia, tactile stimulation  Lactational amenorrhea

 Endocrine  Oogenesis

 Theca cells production of androgens and progesterone  Granulosa cells aromatase + estrogen production

Steroid biosynthetic pathway for mineralocorticoid, glucocorticoid, and sex steroid hormone production. Sexual Differentiation : Normal and Abnormal Diamond, David Andrew, MD, Campbell-Walsh Urology, chapter 133, e6 Copyright © 2012 Copyright © 2012, 2007, 2002, 1998, 1992, 1986, 1978, 1970, 1963, 1954 by Saunders, an imprint of Elsevier Inc.

 Low in the early follicular phase  Increase 1 week before gonadotropin release  Second increase during formation of corpus luteum

 During follicular phase on low level  Production of progesterone Proliferative phase 2,5-5,4 mg/24 hour., Luteal phase mg/24 hour.

 Main function is secretion of progesterone and oestradiol  Luteinization - granulosa lutein cells  LH essential for keeping CL in function  14. – 28. day of the luteal phase cycle  Max. production of progesterone is the 10th day after ovulation

 C – 19 – androstane core  DHEAS, androstendione, testosterone  Daily plasmatic production of testosterone – 0,23-0,34 mg/24 hour.

 Mixed production ovarial/extraovarial  Testosterone – 50% ovarial  Androstendione – 60% ovarial  Dehydroepinadrosterone – 20%

 Evaluation

 Family history  Personal history( surgeries, infections… )  Gynecological history  Obstetric / sexual history  Work environment, social status  Abusus

 Gynecological examination  Blood test – hormonal level  US, MRI  Endoscopy, biopsy

 Irregular bleeding  Infertility  Hirsutism  Early menopause  Pathological galactorrhoea

 Primary  Secondary  Physiological  Pathological  Progesteron positive  Progesteron negative

 Hypothalamic dysfunction  Pituitary dysfunction  Ovarian dysfunction

 Hypothalamic dysfunction GnRH dysregulation GnRH supression

 Pituitary dysfunction Tumor Necrosis Dysregulation ( hypothalamic pituitary )

 Ovarinan dysfunction Ovarian failure Ovarian tumor Ovarian dysgenesis

 Hyper PRL  PCO sy  Hypothalamus ( CNS )

 Hypothalamic dysregulation  Chronic anovulation  Stress  Ovarian failure

 Androgen excess  Acne  Virilization  Hirsutism

 Hormonal substitution  Induction of ovulation  Hormonal supression

 Frequent disorders  Impact on women´s health  Detailed hormonal ( medical ) analysis  Modern hormonal treatment