As an obstetrician gynecologist, it is not uncommon to hear my patients complain of their hormones “being off.” To figure out what is abnormal, one needs to understand the normal menstrual cycle and how your hormones normally fluctuate on a day to day basis.
Your menstrual cycle revolves around the development of an egg, its release and subsequent demise. Egg development actually starts before you get your menstrual cycle. While you may think your menstrual cycle is the completion of the cycle, it is actually the beginning of the next cycle. During your menstrual cycle a dominant egg is chosen from a group of eggs that were rescued from dying. As the dominant egg develops, its container or follicle makes estrogen. Estrogen rises as the egg matures and gets ready to be released.
At approximately 2 weeks from your menstrual cycle, estrogen is at its highest level, culminating in follicular rupture and release of the egg. The part of your ovary where the egg was released then makes progesterone. Progesterone rises in the second half of your menstrual cycle. As the egg reaches the end of its life, estrogen and progesterone fall. This fall in hormones causes breakdown of the uterine lining and menstrual flow. The whole cycle then repeats itself, over and over again.
So, how do you know your hormones are off? Anything that interrupts the cyclic development and release of an egg is considered to interfere with your hormones.
The most common reason your hormones are off is because your ovaries have failed and there are no more eggs remaining within the ovary. This is called menopause and is defined by no menses for one year. Typically, it occurs between 51-52 years of age. Since the ovaries are depleted of eggs, there is no longer production of estrogen and progesterone. This causes symptoms of hot flashes, night sweats, vaginal dryness and a host of other symptoms.
- Irregular Menses.
Another common reason your hormones are off is that you don’t have regular menses. Usually this is caused by disruption of normal egg development and release. Any disruption in this arena will cause very irregular menses and unpredictability of your menstrual flows. You may have heard of one of the most common etiologies of irregular menses called polycystic ovarian syndrome.
Premenstrual syndrome is a common hormonal problem and can last 2 weeks out of every menstrual cycle. Some women are very sensitive to the fall in estrogen after egg release or the rise in progesterone. Unfortunately, a definitive reason for PMS has yet to be proven. Symptoms of PMS include abdominal bloating, anxiety or tension, breast tenderness, crying spells, depression, fatigue, lack of energy, unprovoked anger or irritability, difficulty concentrating, appetite changes and varying degrees of edema.
Pregnancy interrupts the normal menstrual cycle and the typical cyclic hormonal production of the developing egg. Upon fertilization of an egg by a sperm, estrogen and progesterone rise and continue to rise well into the third trimester of pregnancy. At about 10 weeks of gestation, the placenta becomes the primary hormonal factory in pregnancy. Experts say that your estrogen and progesterone levels are about a 100 times higher than when you are not pregnant!
While the causes of infertility are usually split up between the woman and the man, the uterus and the fallopian tube, one of the most common reasons for infertility is the failure of the ovary to release an egg. The selection of a dominant egg and its development can take several weeks in some woman and does not occur over the typical 2 week time period. This leads to a certain randomness of egg release and an inability to time sexual intercourse to capture egg release.
This is a brief discussion of some hormonal issues that women face. Deciphering normal and abnormal hormonal production can be difficult at times. To improve your chance that your ovaries work correctly, maintaining a healthy lifestyle and normal weight are crucial. More on this topic later…
Rindo Sironi, M.D. is an obstetrician gynecologist with Billings OB-GYN Associates. Dr. Sironi, who is named after his Italian grandfather, completed his undergraduate degree at Washington University in St. Louis and earned his medical degree from the Medical College of Wisconsin. He completed his residency at The University of TN in Memphis, TN and then continued in solo practice for 12 years in Butte, MT. Dr. Sironi joined Billings OB-GYN Associates in March, 2015.
Dr. Sironi and his wife, Amy have two children, Rynn and Sawyer. Both Dr. Sironi and his wife have siblings in Billings. Dr. Sironi is an avid runner and dreams of completing the Hawaii Ironman someday.