Dear Readers,
This article will discuss the functions and dysfunctions of Ovaries (Part-1) and in a subsequent article we will highlight the scientific evidence of how mindful yoga and meditation can help us to balance the dysfunctional ovaries (Part-2).
The TL;DR
The Ovaries are the female gonads, they secrete several hormones, like estrogen, progesterone, testosterone.
These hormones regulates mensural cycle, pregnancy, lactation and menopause. Besides, they also play important role in reproductive organ development, breast development, bone health, and cardiovascular disease
The basic plan of menopause is laid before birth. Menopause has evolutionary significance
Dysregulation of ovarian hormones can result in diverse range of diseases, like PCOS, Hirsutism, Virilization, Breast cancer, Sexual dysfunction, Bone loss, PMS, Primary ovarian insufficiency and Vaginal atrophy
Thought for the day: Your awesomeness is unrelated to your estrogen
Let’s dive deeper….
1.1 Ovaries
(According to Kundalini Yogis: Svadhisthana or sacral chakra)
This chakra is said to be blocked by fear, especially the fear of death. Opening this chakra can boost creativity, manifested desire and confidence.
The Ovaries are the female gonads, or reproductive glands. They are located on both sides of the uterus, below the opening of the fallopian tubes (tubes that extend from the uterus to the ovaries).
1.2 Endocrine Functions of Ovaries
These glands produce and secrete the hormones, including estrogen, testosterone, and progesterone—which are vital to reproductive organ development, breast development, bone health, pregnancy, and fertility. The ovaries respond to the control of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are secreted by the anterior pituitary. Both of these anterior pituitary hormones are secreted in response to the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus.
Women have testosterone too but in much smaller amounts than in men about 1/10th to 1/20th the amount in men. In women’s bodies, testosterone is produced in the ovaries, adrenal glands, fat cells, and skin cells. It is quickly converted to estrogen in female bodies. Testosterone helps in menstrual health, fertility, breast health, sex drive and also to maintain bone health.
Ovarian hormones have both organizing and activating effects on physiology, anatomy, and psychology. Let’s go through them in detail here:
Puberty
It is the period of growth and development in which children and adolescents develop adult physical features, such as breasts or pubic hair, and become able to reproduce. For girls, puberty usually begins at age 8½ to 10 years and lasts about 4 years. Weight, Nutrition, Race and Genetics are some of the factors which governs the age of puberty onset. Puberty starts when hormones released by the brain cause ovaries development which then release estrogen resulting in physical and physiological changes. These changes include development of Breasts (usually happens between ages 8 and 13), growth of hair in the armpits and genital area, growth spurt in height happens, menstruation (start about 2 to 3 years after the start of breast growth).
The Menstural Cycle
Female baby is born with three hundred thousand of the primordial follicles which remain quiet until puberty, when complex signalling from the brain (HPG axis) starts the process of ovulation. There are several developmental steps taken by the follicle along the way to ovulation, developing follicles make two kinds of estrogen, estradiol and estrone in significant amounts that stimulates the brain and also the lining of the uterus to develop. The first half of the menstrual cycle is called the follicular phase: one follicle dominates-the one which is best suited for pregnancy and the rest disappears. When the estrogen levels are maximum, ovulation phase starts, where a mature egg (ovum) is released and travels to fallopian tube. The left over tissue from the follicle organises itself into corpus luteum, which produces the hormone progesterone. This hormone stabilises the uterine lining and makes other changes for implantation. If implantation occurs, hormonal signalling from embryo ensures that corpus luteum keeps on producing progesterone until the placenta can take over.
If there is no implantation, corpus luteum after 14 days (range of 12 to 16) luteal phase, shrinks becoming small scar called the corpus albicans and levels of progesterone falls which destabilised uterine lining and starts mensuration.
Pregnancy
Pregnancy begins with fertilisation of ovum and spermatozoa, the fertilized egg then travels and implants in the uterus. On average, a full-term pregnancy lasts 40 weeks. There are many hormones which play important role in successful pregnancy, progesterone, estrogen, Human chorionic gonadotropin hormone and Human placental lactogen (produced by placenta).
Progesterone is referred as pro-gest-ation hormone. It is produced by the ovaries to prepare for and then by placenta to maintain healthy pregnancy. Progesterone stimulates the thickening of the uterine lining in anticipation of implantation of a fertilized egg.
Estrogen is normally formed in the ovaries. It is also made by the placenta during pregnancy to help maintain a healthy pregnancy. The organizing effects of estrogen emerge during the third month of gestation. When estrogen is present in greater levels than the male sex hormone, the fetus will develop the characteristics of a female. The feminizing effect of estrogen not only modifies the reproductive organs, but also the development of the hypothalamus, the endocrine control center that modulates sexual responses. Abnormal response to circulating sex hormones, and the introduction of artificial hormones can alter the normal balance and effects of sex hormones on the developing and mature human brain.
Another organizing effect of estrogen includes the increased tendency for nurturing, maternal behavior. This hormone also gets triggered when in love or in response to an attractive potential partner.
Lactation
The combination of estrogen and progesterone circulating in the blood during pregnancy, blocks the release of prolactin from the pituitary gland and this inhibits milk secretion from the mammary gland cells. By the expulsion of the placenta at the end of pregnancy, the supply of hormone declines which favours lactation.
The stimulus of nursing or suckling then supports continued lactation. It acts in two ways: it promotes the secretion of prolactin, and it triggers the release of yet another hormone from the pituitary gland—oxytocin, which causes the contraction of special muscle cells around the alveoli in the breast and ensures the expulsion of milk. Beyond its action on the mammary glands, oxytocin also affects uterine muscle, and it also released during sexual intercourse.
Menopause
Menopause is not a disease--it's a planned change, like puberty—Dr Jen Gunther.
It is an evolutionary adaptation that is part of the survival of the species, like mensural periods or the ability to suppress immune system during pregnancy so the body doesn’t attack the foetus. Menopause occurs when there are no more follicles in the ovaries capable of ovulating, meaning there are no more eggs. The average age when this happens is 50-52 years.
Menopause begins after a period of menopause transition (or pre-menopause). The length of pre-menopause varies significantly in women, many factors control these changes-aging, follicular health, brain signals, environmental factors, diet and lifestyle, etc. Basically, it is a complicated process involving multiple mechanisms. It can be broadly divided into two stages: early (cycle lengthens by >7 days, symptoms possible) and late (lasts for 1-3 years, cycle lengthens by 60 days and symptoms like hot flushes, insomnia likely).
The final menstural period (FMP) marks the menopause-at this point there are 100-1000 primordial follicles which are incapable of ovulation. Timing of the FMP is a complex interplay of genetics, environment, and social factors. Menopause at 40-45 years can increase your chances of cardiovascular disease and osteoporosis as well as increase your chances of death. Smoking can reduce the age of menopause by approx two years; other factors include surgical removal of ovaries, chemotherapy or hormonal therapy for the treatment of breast cancer.
Your sister’s menopause age is more predictive than your mother’s age.
One of the defining features is the dramatic drop in estrogen levels as follicles are the main source of estrogen. The hormonal fluctuations can trigger a variety of symptoms: hot flushes, night sweats, sleep disturbances, vaginal dryness, pain with sex, decreased libido and joint pain. These symptoms are signs of underlying medical conditions (like, heart diseases, osteoporosis, dementia and Alzheimer’s, depression, metabolic disease, genitourinary syndrome, urinary tract infections) associated with menopause in some women and should not be ignored.
**Book recommendations: The Menopause Manifesto and The Vagina Bible by Dr Jen Gunther
Observational studies indicate that testosterone has favourable cardiovascular effects measured by surrogate outcomes. Clinical trials suggest that exogenous testosterone enhances cognitive performance and improves musculoskeletal health in postmenopausal women.
Evolutionary advantage of Menopause: It played an essential role in evolution!!
Women evolved to live beyond their ovulation function because it benefited society. Grandmothers confer a survival advantage for their grandchildren.
Some toothed whales, like killer whales also experience menopause and grandmother whales are essential for survival of their grand calves.
1.3 Ovarian Abnormalities
Hirsutism is very common, affecting 5% - 10% of all women. It refers to excess dark, thick hair in areas where women usually don’t have much hair. It is usually a sign of an underlying endocrine disorder, most commonly, polycystic ovary syndrome (PCOS) which results in elevated levels in androgens (male hormones).
Virilization is a condition in which women develop male-pattern hair growth and other masculine physical traits. It results from imbalance in sex hormones, including male sex hormones such as testosterone. Potential symptoms of virilization include, male pattern baldness, excessive facial hair, usually on your cheeks, chin, and upper lip, deepening of your voice, small breasts, enlarged clitoris, irregular menstrual cycles and increased sex drive. Medical conditions like adrenal cortical carcinoma (tumor of adrenal glands), congenital adrenal hyperplasia and cushing’s syndrome can affect your adrenal glands and result in virilization. Other potential causes include the use of male hormone supplements or the use of anabolic steroids to increase muscle mass.
PCOS: Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of male sex hormones (androgens) that are usually present in women in small amounts. Also the levels of progesterone hormone decreases resulting in missed menses for long time or have trouble predicting when they’ll come. The ovaries may develop numerous small collections of fluid-filled sacs (small cysts) and fail to regularly release eggs.
Symptoms include irregular or absent menstrual periods and/or infertility. Acne, unwanted facial hair, obesity, an increased risk of diabetes and high blood pressure are also common in women with PCOS. PCOS affects 7–10% of women of childbearing age and is the most common cause of infertility.
Breast Cancer: Genes, hormones, lifestyle, and environment all play a role in how breast cancer develops. Estrogen and progestin (a synthetic form of progesterone) can cause breast tissue to grow faster than normal. Long-term use of estrogen/progestins during menopause could increase breast cancer risk. However, contraceptive use in women with low or moderate dose estrogen does not increase breast cancer risk. Monthly self-examination, mammogram, MRI can be done to identify any changes in breast. That can help in early detection of breast cancer.
Bone Loss: Estrogen increases bone density (size and strength), prevents bone loss, and lowers the risk of fractures. Surgical removal of ovaries, chemotherapy and certain types of hormonal therapy decreases estrogen levels which can in turn leads to weak and brittle bones.
An X-ray scan (bone mineral density test) checks the strength of bones by assessing bone mineral density. The test can show early bone loss before the more serious condition of osteoporosis develops.
Female Sexual Dysfunction: Many women have either low sexual desire, trouble becoming aroused, trouble having an orgasm or pain during sex. There can be several medical reasons underlying FSD, however the hormonal misbalance can be one of the cause. Menopause (natural or surgical) or premature ovarian failure (when the ovaries stop working before age 40) results in a drop in estrogen levels which can cause vaginal dryness and painful intercourse. Other possible reason can be a drop in levels of testosterone, which women produce in small amounts.
Premenstrual syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD): PMDD and PMS symptoms are the same, but the severity is different. Physical signs can include fatigue and problems with sleep, joint and muscle pain, headaches and breast tenderness. Temporary weight gain and bloating, changes in appetite and constipation or changes in bowel function can also affect women with PMS. Other symptoms include tension, anxiety, depression, anger, irritability and feelings of hopelessness.
Women with PMDD may feel depressed, extremely anxious, have high levels of irritability, and feel overwhelmed or out of control. Suicidal thoughts may occur with severe depression. PMDD affects about 3–6% of women. Changes in hormone levels are likely one cause of PMS or PMDD, as well as changes in neurotransmitters in the brain.
Primary Ovarian Insufficiency or premature ovarian failure, occurs when the ovaries have a decrease in estrogen production and ovulation before a woman turns 40. Due to the drop in estrogen levels, women with POI may also have menopause-like symptoms. Turner syndrome and fragile X premutation carriers, are more likely to develop POI. Other reasons include exposure to chemotherapy and radiation therapy and autoimmune disease.
Vaginal Atrophy is a condition in which levels of estrogen falls and results in the thinning and drying of the vaginal drying. This condition can lead to vaginal and urinary tract problems. A drop in estrogen levels may occur during peri-menopause, after menopause, breastfeeding, certain medications, smoking, surgical removal of both ovaries, radiation or chemotherapy as a treatment for ovarian or uterine cancer or breast cancer.
If you found the article of interest or have thoughts about what you’ve read here, please do share in the comments section below. It will help guide my future posts.
In the next article (3.7/n - Part 2), I will cover the science behind the effects of Yoga on the Ovaries. Until then, Stay healthy and happy :)
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