Reducing The Cancer Risks Of Hormone Therapy
If you and your doctor decide that MHT is the best way to treat symptoms or problems caused by menopause, keep in mind that it is medicine and like any other medicine its best to use it at the lowest dose needed for as short a time as possible. And just as you would if you were taking another type of medicine, you need to see your doctor regularly. Your doctor can see how well the treatment is working, monitor you for side effects, and let you know what other treatments are available for your symptoms.
All women should report any vaginal bleeding that happens after menopause to their doctors right away it may be a symptom of endometrial cancer. A woman who takes EPT does not have a higher risk of endometrial cancer, but she can still get it.
Women using vaginal cream, rings, or tablets containing only estrogen should talk to their doctors about follow-up and the possible need for progestin treatment.
For women who have had a hysterectomy , a progestin does not need to be a part of hormone therapy because theres no risk of endometrial cancer. Adding a progestin does raise the risk of breast cancer, so ET is a better option for women without a uterus.
Women should follow the American Cancer Society guidelines for cancer early detection, especially those for breast cancer. These guidelines can be found in;Breast Cancer Early Detection.
Potential Roles Of The Hypothalamus And Pituitary In Menopause
In rodents, ovaries from old donors undergo folliculogenesis and ovulation when transplanted to young ovariectomized hosts, providing evidence for a central contribution to reproductive failure with aging in rodents. Further studies have pointed to the importance of age-related alterations in estrogen positive feedback on GnRH secretion as at least one contributing mechanism. An important question is whether similar central mechanisms contribute to reproductive failure in women.
Studies in younger and older postmenopausal women suggest that there are effects of aging on the hypothalamus and pituitary that are independent of the loss of steroid feedback. After menopause there is a 3040% decrease in LH and FSH between the ages of 50 and 75, . Underlying these gonadotropin changes are complex effects of aging on GnRH secretion with a 22% decrease in GnRH pulse frequency that is partially compensated by a 14% increase in the overall amount of GnRH secreted over that due to the loss of ovarian function alone. There are also age-related effects at the pituitary with a 30% decrease in both LH and FSH responses to GnRH in older compared to younger postmenopausal women.
Ovarian Aging In Women
In women, the finite pool of resting follicles in the ovary reaches its maximum in neonatal life. Thereafter, there is a steady decline due to atresia such that, at birth, only one million follicles remain with a further reduction to 250,000 by the time of puberty . During and after puberty, follicles will leave the pool of resting follicles by activation of further growth or by degeneration. Rising levels of FSH provide a critical stimulus for recruitment of resting follicles into the growing follicle pool while antimullerian hormone , produced in granulosa cells from small growing follicles, restrains this effect of FSH within the ovary. Throughout early reproductive life the number of growing follicles is highly correlated with the size of the resting pool. However, between the ages of 30 and 35, the percentage of growing follicles increase and the trajectory of follicle loss is accelerated until the pool of resting follicles is reduced to between 100 and 1000 when there is cessation of reproductive cycles. Age-related changes in oocyte quality parallel the decrease in follicle number with reported decrease in fertilization and conception rates and higher rates of pregnancy loss. Chemotherapy, radiation and smoking are all factors that accelerate follicle loss through damage to the oocyte and/or dividing granulosa cells.
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Integration Of Hormonal Changes With Aging In Women
Our clinical and mechanistic understanding of the process of ovarian aging has progressed dramatically since the classic studies of Block in the 1950s demonstrated follicle loss across the reproductive lifespan in women and markers of ovarian aging have also changed. FSH levels are increased in older women even before their FMP and for many years the selective rise in FSH on day 3 of the menstrual cycle was the only clinically available marker of fertility potential. Although the discovery of inhibin B elucidated its critical roles in ovarian negative feedback on FSH and as a marker of ovarian aging, , measurement of inhibin B was unable to serve as a better marker of fertility potential than FSH itself. However, since that time anti-mullerian hormone has been established as an unexpected marker of the number of ovarian follicles and AMH and antral follicle count have been used as prognostic markers in infertility programs . Our understanding of these new ovarian factors has not only contributed to fertility prognosis, but has also provided important insights into the integretated changes that occur with reproductive aging.
What Is A Follicle
This test measures the level of follicle-stimulating hormone in your blood. FSH is made by your pituitary gland, a small gland located underneath the brain. FSH plays an important role in sexual development and functioning.
- In women, FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation.
- In men, FSH helps control the production of sperm. Normally, FSH levels in men do not change very much.
- In children, FSH levels are usually low until puberty, when levels begin to rise. In girls, it helps signal the ovaries to make estrogen. In boys, it helps signal the testes to make testosterone.
Too much or too little FSH can cause a variety of problems, including infertility , menstrual difficulties in women, low sex drive in men, and early or delayed puberty in children.
Other names: follitropin, FSH, follicle-stimulating hormone: serum
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Does A High Fsh Level Signal The Onset Of Menopause
It was an FSH level of 42, at age 42, that according to fertility specialists placed me among the irreversibly infertile. Which is why Ive engaged with the subject of FSH levels such as: The link between high FSH levels and menopause, so called Premature Ovarian Failure, the likelihood of pregnancy in spite of rising FSH, and every;related questionmore than any other fertility linked;diagnosis.
Having heard thousands of women in my workshops and private practice report mixed messages about high FSH from their fertility specialists ;and surprisingly also from their fertility acupuncture sessions, the subject begs for a deeper discussion. Here is what I have learned as a result of direct observation in the laboratory of my own body, and from reports and observations of ;countless women who, with the help of the Fertile Heart Ovum tools ;have turned their high FSH crisis;into a journey of self discovery. For many of them;it became an opportunity to strengthen their bodies and hearts and quite possibly give birth to healthier children than they would have without the sobering diagnosis.
The only time your goal is to lower FSH is if you want to fool your endocrinologist and sneak into an IVF program in spite of your rising levels. Or your doctor is choosing to do you a great favor and push for performance when your body is screaming for help.
PO Box 767, Woodstock, NY 12498 ;;Phone: 845-679-5469 ;;Email:
Signs And Symptoms Of Menopause
The hypoestrogenic state seen at menopause is manifested in many women by signs and symptoms of hormonal deficiency in tissues containing estrogen receptors, including the ovary, endometrium, vaginal epithelium, urethra, hypothalamus, and skin. The most common complaints are vasomotor disturbances characterized by hot flushes, genital atrophy, and psychologic symptoms. The decline in estrogen also causes an increased risk of osteoporosis.
Vasomotor instability appears to arise not from a lack of estrogen but rather from its withdrawal. Estrogen-deficient patients with gonadal dysgenesis fail to develop hot flushes unless given estrogen replacement therapy that is subsequently withdrawn.22 Castrated women with androgen insensitivity experience vasomotor symptoms after the discontinuation of estrogen. Similarly, premenopausal women treated with the antiestrogen clomiphene and postpartum women with very low estrogen levels often complain of hot flushes.
There is a subjective awareness of an impending hot flush, with an aura that may be perceived as a headache accompanied by heart palpitations occurring up to 4 minutes before the actual flush. The subjective sensation of the flush is followed by a change in skin conductance. There is then a rise in finger temperature that reflects cutaneous vasodilation .32,33,34 The pulse rate increases an average of nine beats per minute, and a rapid rise is seen in blood flow to the hand before the flush35 .
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Is There Anything Else I Need To Know About An Fsh Levels Test
There is an at-home test that measures FSH levels in urine. The kit is designed for women who want to find out if certain symptoms such as irregular periods, vaginal dryness, and hot flashes may be due to menopause or perimenopause. The test can show whether you have high FSH levels, a sign of menopause or perimenopause. But it doesn’t diagnose either condition. After taking the test, you should talk with your health care provider about the results.
Age Influences The Association Between Fsh And Renal Dysfunction In Post
We stratified the post-menopausal women into two equal-sized groups according to median age and conducted a multivariate logistic stepwise regression analysis for each group. After adjusting for age, years since menopause, LH, E2, BMI, dyslipidaemia, diabetes, hypertension, smoking, and drinking, the ORs of declined eGFR increased across FSH quartiles in both age groups; moreover, they were higher for each FSH quartile in the older group than for the corresponding quartile in the younger group .
Figure 3 Odds ratios of declined eGFR with increasing FSH quartiles in postmenopausal women stratified by median age . Dependent variable: declined eGFR; independent variable: FSH quartiles . Data are expressed as adjusted odds ratio , standard error . Multivariate logistic stepwise regression model: adjusted for age, years since menopause, LH, E2, BMI, dyslipidaemia, diabetes, hypertension, smoking, drinking. FSH, follicle-stimulating hormone; eGFR, estimated glomerular filtration rate; declined eGFR, eGFR<90 mL/min/1.73m2.
Table 5 Logistic stepwise regression of FSH quartiles for the presence of declined eGFR in postmenopausal women stratified by median age.
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Breast Cancer And Menopause
Estrogen therapy is known to benefit postmenopausal women in a multitude of ways, mostly through the relief of vasomotor symptoms associated with postmenopause. Estrogen is also beneficial for the prevention and treatment of osteoporosis.
Much controversy exists about the use of estrogen and breast cancer. Some studies show an increased risk of breast cancer with postmenopausal estrogen use; others show a decrease. A possible link to cancer is also suggested by the finding that breast cancer risk is increased in women with an earlier age at menarche and a later age at menopause. However, a reduction in risk is observed with early age at pregnancy and the interruption of menstrual hormonal changes. The role of estrogen in the development of breast cancer continues to be studied.
In the Womens Health Initiative , the incidence of breast cancer increased in the estrogen-plus-progestin versus placebo arm of the study ; however, the incidence of breast cancer decreased in the estrogen-only versus placebo arm of the study .
Additional follow-up in patients from the WHI suggested similar results: Breast cancer incidence and mortality were increased in the estrogen-plus-progestin group as compared with the placebo group. The role of combined estrogen-plus-progesterone therapy continues to be puzzling in the development of breast cancer.;
What Does Fsh Do The Functions Of Follicle
FSH has important roles in human sexual development and function. FSH levels are usually low in children and increase once puberty starts. During puberty, FSH levels rise, stimulating ovaries to secrete estrogen and testicles to secrete testosterone. These initial changes are responsible for the multiple effects that puberty has on the body.
FSH levels vary throughout the menstrual cycle. FSH plays a vital role in stimulating follicular development so that ovulation can occur.;
The follicular phase of the menstrual cycle is the stage between the first day of menstruation and ovulation. During this phase, FSH stimulates several follicles inside the ovaries, which causes them to start maturing. FSH levels are highest during the first week of this phase.
The growing follicles compete for dominance until a single follicle becomes dominant. At that point, this follicle begins to secrete estradiol and inhibin, which suppress FSH secretion. The highest level of FSH coincides with an LH peak, which leads to ovulation.
The drop in FSH levels causes the remaining follicles which didnt become dominant to degrade and die. FSH remains low during the luteal phase, which prevents new follicles from maturing.
Since FSH plays such a vital role in follicle development and ovulation, its easy to see why abnormal levels of FSH are often associated with infertility. FSH can also play a role in alterations of the menstrual cycle, low male sex drive, and delayed or early onset of puberty.
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Maintenance Of Follicle Development And Estrogen Secretion In Early Ovarian Aging
The existence of compensatory hormonal and intra-ovarian mechanisms that are operative in the early stages of ovarian aging is evidenced by continued follicle development and maintenance of estradiol levels well beyond the time at which other markers indicate declining ovarian function . The age-related decrease in the number of follicles in the ovary reviewed above is reflected in the number of antral follicles seen on ultrasound, in declining levels of AMH which is expressed only in small growing follicles, and in decreased levels of inhibin B which is constitutively secreted from granulosa cells in FSH-dependent growing follicles.
Taken together, these data support that hypothesis that lower levels of AMH in conjunction with elevated levels of FSH drive the accelerated depletion of the resting follicle pool after age 35, that these hormonal and autocrine/paracrine changes are important for maintaining estradiol levels in the face of ovarian function and serve to extend fertility and maintain reproductive cycles and estrogen levels early in reproductive aging.
What Is The Menopause
Simply, the menopause is when the ovaries no longer respond to the hormonal messages sent from the pituitary gland in the brain. Eventually, this leads to the end of ovulation and the menstrual cycle.
During the build-up to the menopause, known as perimenopause, women’s hormones go through a transformation process. Their levels fluctuate and can alter their physical, mental and emotional wellbeing.
‘Im feeling hormonal’ can sometimes be bandied about to describe how women feel at a given moment in time, but that feeling can soon become a reality for many women entering the menopausal transition.
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Interpreting Hormone Test Results
If youre in your late 30s or early 40s and begin noticing symptoms arise, you will still want to ask your doctor to test your hormone levels particularly your;follicle stimulating hormone levels. As your ovarian function starts to wind down, your FSH levels usually start to rise.
This is especially important if youve begun skipping periods, as there is a chance that what youre experiencing isnt plain old perimenopause, but rather the onset of premature ovarian failure or early menopause.
As we mentioned though, in perimenopause your hormones can fluctuate a great deal.; This means theres a chance that when you get your blood drawn for a hormone test, your levels will appear completely normal even though you certainly dont feel; normal. So some doctors might slough off your complaints, since theyre not corroborated by your test results.
In this case, you have a few options:
;;; You might want to consider getting your FSH tested again, at least a month later. This is especially recommended if you have actually begun to skip periods.
;;; In addition, many doctors feel it best to not go by an FSH test alone, but also think testing other hormone levels can give a better picture of whether or not youre dealing with perimenopause or with POF.
You can find more helpful information regarding hormone testing on our Hormone Tests helpsheet.
Understanding Your Hormone Levels
Response To The Loss Of Ovarian Feedback
During normal reproductive life, the ovarian hormones and peptides restrain gonadotropin secretion through mechanisms that are operative at both the hypothalamus and pituitary. At the hypothalamus, progesterone has a profound inhibitory effect on LH, and therefore GnRH, pulse frequency. Estradiol does not appear to influence pulse frequency in women, but does decrease the overall quantity of GnRH secretion and thus the amount of GnRH secreted with each pulse. At the level of the pituitary, estradiol decreases the gonadotrope response to GnRH, with an effect that is greater for FSH than LH while inhibin B plays an additional pituitary role in the selective inhibition of FSH over LH.
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What Happens To Your Hormones During Menopause
All women go through menopause, but many dont really think about until it comes along. It marks a significant point in life for many women, and brings with it a host of symptoms due to changing hormone levels.; In this article we take a look at the key hormones that change during the menopause, but first, let’s define what we mean by menopause.
What Do The Results Mean
The meaning of your results will depend on whether you are a woman, man, or child.
If you are a woman, high FSH levels may mean you have:
- Primary ovarian insufficiency , also known as premature ovarian failure. POI is the loss of ovarian function before the age of 40.
- Polycystic ovary syndrome , a common hormonal disorder affecting childbearing women. It is one of the leading causes of female infertility.
- Started menopause or are in perimenopause
- An ovarian tumor
- Turner syndrome, a genetic disorder that affects sexual development in females. It often causes infertility.
If you are a woman, low FSH levels may mean:
- Your ovaries are not making enough eggs.
- Your pituitary gland is not working correctly.
- You have a problem with your hypothalamus, a part of the brain that controls the pituitary gland and other important body functions.
- You are very underweight.
If you are a man, high FSH levels may mean:
- Your testicles have been damaged due to chemotherapy, radiation, infection, or alcohol abuse.
- You have Klinefelter syndrome, a genetic disorder affects sexual development in males. It often causes infertility.
If you are a man, low FSH levels may mean you have a disorder of the pituitary gland or hypothalamus.
In children, high FSH levels, along with high levels of luteinizing hormone, may mean puberty is about to start or has already started. If this is happening before age 9 in a girl or before age 10 in a boy , it may be a sign of:
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