Menstrual Irregularity in Women With Acromegaly

Introduction:

The causes of menstrual irregularity are due to medications, stress, and many health conditions. The menstrual cycle length varies monthly, especially when the woman approaches puberty, menopause, and breastfeeding. Menstrual irregularity, also called oligomenorrhea, happens for many reasons. The hormones that regulate the menstrual cycle are follicle-stimulating hormone, progesterone, and estrogen. Hormonal imbalance can cause irregular periods. The other factors involved in hormonal imbalance are stress, endurance exercise, weight loss, and natural hormonal shifts. During perimenopause, the period before menopause also called the first stage of menopause, the person will become prone to menstrual irregularities. It is found that women with acromegaly have menstrual irregularities and have high growth hormone levels.

What Are the Hormones of Menstruation?

• The menstrual cycle is a part of the reproductive system that prepares the body for pregnancy. The cycle lasts between 25 to 40 days. Menstruation is the shedding of the lining of the uterus. The hormones cause the ovaries to release the egg to prepare for pregnancy.

• The uterus lining builds up, and the uterine wall sheds during menstruation. When the uterine lining is no longer needed, it sheds through the vagina. Menstruation contains a combination of mucus, blood, and tissues from the uterus.

• During the menstrual cycle, the egg is released from the uterus. Each and every phase of the menstrual cycle is influenced by hormones such as progesterone, estrogen, luteinizing hormone (LH), and follicle-stimulating hormone (FSH).

• The anterior pituitary gland secretes two hormones: The follicle-stimulating hormone estrogen and the corpus luteum secretes progesterone. Progesterone plays an important role in the reproductive system, and these hormones are chemical messengers that tell the body how to work.

• Progesterone is a menstrual hormone that supports menstruation and helps early stages of pregnancy. Progesterone helps in the thickening of the uterus lining and prepares the uterus for the fertilized egg to implant. The progesterone aims to prepare the endometrium for the egg to implant.

• The estrogen stimulates the egg follicle, maintains the vagina's thickness, and promotes lubrication. The estrogen hormone maintains the uterus wall and aids breast tissue formation.

• The FSH plays an important role in sexual development and reproduction.

• A special group of hormones called androgens affect its growth. Luteinizing hormone in the body handles important processes of reproduction in the body. The pituitary gland of the brain secretes the luteinizing hormone.

• The luteinizing hormone changes the function of the testes in the male and ovaries in the female, which allows reproduction to function effectively. The FSH stimulates the follicle development that secretes estrogen. Luteinizing hormones and follicle-stimulating hormones are two important hormones.

• Estrogen helps develop secondary sexual characteristics such as menopause, menstruation, and pregnancy because of estrogen. The types of estrogen are Estriol (E3), Estrone (E1), and Estradiol (E2). Estrogens play an important role in reproductive and sexual health.

• Thinking and emotional responses are related to hormonal changes in women. The connection between mood and hormones has always been there. Estrogen is linked to women's emotions and well-being.

• Estrogen is linked to mood disruptions in women, like premenstrual dysphoric disorder and postpartum depression. At puberty, the women's ovaries start releasing estrogen with each monthly menstrual cycle. Rest of the month, the estrogen levels fall gradually. The normal estrogen levels vary, including many parts of the brain that controls emotion.

• A women's ovaries release estrogen with the menstrual cycle monthly. The levels spike suddenly, triggering the release of the egg (ovulation).

What Is Acromegaly?

Acromegaly is a rare and serious condition that affects the bones and tissues where the person has high growth hormone levels. Growth hormone is a natural hormone that promotes growth in children. After growth, the growth hormone helps to maintain cartilage, bone, and metabolism, which helps to maintain blood glucose levels in a healthy range. In this condition, too much growth hormone is produced, which causes the bones and tissues to grow more, leading to abnormally large feet and hands. The symptoms are:sues to grow more leading to abnormally large feet and hands. The symptoms are -

• Tiredness.

• Sleep apnea (stop breathing while asleep).

• Numbness and weakness in the hands.

• Gradual changes in the lower jaw, facial features, and brow.

How Does Acromegaly Cause Menstrual Irregularity in Women?

Acromegaly is a rare disease with possible manifestation during the menstrual cycle due to higher prolactin levels and estrogen deficiency. The growth hormone facilitates the uterus's development and the egg's implantation. The growth hormone receptors are expressed in non-pregnant and pregnant women. Growth hormone deficiency also causes a delay in puberty. Studies show that showed that 60 percent of patients with acromegaly experienced amenorrhea (absence of periods), 15 percent had oligomenorrhea (irregular and inconsistent blood flow), and 5 percent had polymenorrhea (periods occur in less than 21 days). Data from the studies reported that hypogonadism (failure of the ovaries to function properly) was observed in more than half of women with acromegaly. Also, PCOS (polycystic ovarian syndrome) is reported as a frequent manifestation of women with active acromegaly.

What Are the Diagnostic Tests for Acromegaly?

The diagnostic tests for acromegaly are:

• Physical Examination - The doctor looks for an enlarged tongue or prominent facial bones.

• Medical History - The doctor learns more about the current symptoms and family history that help determine the additional tests.

• Blood Tests - Both gigantism and acromegaly have high blood levels of insulin growth factor-1 (IGF-1) and growth hormone.

• Imaging Tests - Magnetic resonance imaging (MRI) or CT (computed tomography) scan will show any tumors of the pituitary gland, and it will also show the location and size of the tumor of the pituitary gland.

What Is the Treatment for Acromegaly?

The treatment goal is to lower the growth hormone levels. If acromegaly is due to a tumor, surgery is done to remove it. A neurosurgeon will insert a camera into the nose to remove all the tumor parts, which helps lower growth hormone production. The medications that help control the production of growth hormones are dopamine agonists, somatostatin, and growth hormone receptor antagonists.

If surgery is not effective, then the doctor may recommend radiation therapy. Radiation can destroy cancer cells by using radiation. The radiation options include:

• External Radiation - It is used to treat acromegaly and involves smaller doses of radiation where the patient will receive radiation every 4 to 6 weeks.

• Stereotactic Irradiation - The radiation is used for acromegaly and gigantism. It applies high doses of radiation to the tumor. This type of radiation does not destroy the surrounding tissues. It takes 18 months to lower the growth hormone levels.

• Conventional Radiation - The radiation uses a beam of radiation that targets cancer that is used in stereotactic radiotherapy. This means this treatment can damage the surrounding pituitary gland and brain tissue.

Conclusion:

Balanced hormones are necessary for both a healthy body and a healthy mind. The hormones released from the endocrine systems regulate body processes because they control sexual health, mood, and reproductive function. The decrease in estrogen hormones shows signs of menstrual irregularity. Estrogen and progesterone hormone therapy, anti-depressants, and mood-stabilizing medications help relieve symptoms of low and high estrogen levels.