1. Ku č era, E.

2.  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

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

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

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

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

7.  Polypeptid – 198 amino acids – molecular weight 23 000  Produced by the lactotropic cells in anterior pituitary lobe  Hyperprolactinaemia – stress, hypoglycemia, tactile stimulation  Lactational amenorrhea

8.  Endocrine  Oogenesis

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

10. 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, 3597-3628.e6 Copyright © 2012 Copyright © 2012, 2007, 2002, 1998, 1992, 1986, 1978, 1970, 1963, 1954 by Saunders, an imprint of Elsevier Inc.

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

12.  During follicular phase on low level  Production of progesterone Proliferative phase 2,5-5,4 mg/24 hour., Luteal phase 22-43 mg/24 hour.

13.  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

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

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

16.  Evaluation

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

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

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

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

21.  Hypothalamic dysfunction  Pituitary dysfunction  Ovarian dysfunction

22.  Hypothalamic dysfunction GnRH dysregulation GnRH supression

23.  Pituitary dysfunction Tumor Necrosis Dysregulation ( hypothalamic pituitary )

24.  Ovarinan dysfunction Ovarian failure Ovarian tumor Ovarian dysgenesis

25.  Hyper PRL  PCO sy  Hypothalamus ( CNS )

26.  Hypothalamic dysregulation  Chronic anovulation  Stress  Ovarian failure

27.  Androgen excess  Acne  Virilization  Hirsutism

28.  Hormonal substitution  Induction of ovulation  Hormonal supression

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