Reproductive hormone disorders

Reproductive hormone disorders can affect fertility and may have long-term effects on metabolic, cardiovascular and bone health. The reproductive hormones include estrogen and progesterone in women and testosterone in men. They originate from the primary reproductive glands (ovaries in women and testes in men) and are regulated by hormone signals from the pituitary gland; luteinizing hormone (LH) and follicle stimulating hormone (FSH).

Ovarian insufficiency (sometimes called premature menopause) occurs when the ovaries either do not develop or are damaged and no longer function normally. Ovaries can be surgically removed, or damaged by the immune system, or from chemotherapy, or radiation treatments for certain types of cancer.

The premature loss of ovarian function (before the age of 40) can result in infertility and the loss of the beneficial effects of estrogen and progesterone, including benefits to bone and heart health, which are usually not lost until the natural age of menopause (approximately age 50). Symptoms of low estrogen can develop in many, but not all, women with ovarian dysfunction. These can include hot flashes, night sweats, poor sleep, and vaginal dryness.

Women with ovarian insufficiency that occurs before the natural age of menopause usually benefit from estrogen and progesterone replacement. In such cases, the benefits of hormone treatment usually outweigh the risks, which may include blood clots, and an increased long-term risk of breast cancer. The decision regarding the type and duration of estrogen and progesterone replacement in women with ovarian insufficiency should be made in consultation with a reproductive hormone specialist (endocrinologist or gynecologist). Although fertility cannot usually be restored in this setting, women have the option of utilizing in-vitro fertilization with egg donation to achieve pregnancy.

Menopause (the normal loss of the menstrual cycle) is a natural part of female aging and occurs at about the age of 50 years in most women. In some women, menopause can be associated with symptoms of low estrogen including hot flashes, night sweats, poor sleep, and vaginal dryness. The post-menopausal period may also be associated with a gradual loss of bone density, which can result in osteoporosis in some women.

Post-menopausal estrogen and progesterone therapy (otherwise called HRT - hormone replacement therapy) can reduce menopausal symptoms. However, because of the risks associated with estrogen treatment, HRT is not recommended for most women after menopause. The risks of HRT depend on a number of factors, including age, health, family history and other risk factors. Women with significant symptoms and no other risk factors may benefit from HRT. The decision about whether to use post-menopausal HRT should be made on an individual basis, weighing risks and potential benefits for each person, in conjunction with a physician or a reproductive hormone specialist.

Polycystic ovary syndrome (PCOS) is a metabolic condition that occurs in some women of reproductive age. Symptoms can include irregular menstrual periods, loss of fertility, increased hair growth on the face, chest, or abdomen, acne, and a tendency toward weight gain and insulin resistance (diabetes). One of the primary features of PCOS is the appearance of small cysts in the ovaries that can be seen on a pelvic ultrasound. The cause of PCOS is unclear, but it is associated with complex metabolic and hormonal changes that require multiple treatment approaches.

Most women with PCOS benefit from diet, exercise and weight loss, which tends to improve metabolism and underlying hormone balance. Other treatments are directed toward specific symptoms. If fertility is the major concern, certain medications may be used to improve fertility, but this should only be done with the supervision of a fertility expert (reproductive endocrinologist or gynecologist).  If hair growth is the primary concern, then other medicines and/or the birth control pill can sometimes reduce male-pattern hair growth. Finally, women with PCOS are at increased risk of complications such as diabetes and cardiovascular disease (heart attack and stroke). In the long-term, preventing these complications is an important part of the treatment of PCOS.

Testosterone, the male hormone (produced in the testes), has an important role in maintaining fertility, energy, strength and metabolism. Men with low testosterone can have symptoms of low energy and mood as well as reduced strength and libido (sex drive). In the long term, they are also at risk for low bone density (osteoporosis). The causes of low testosterone can be testicular trauma, radiation or chemotherapy for certain types of cancer, infection or loss of blood supply to the testes. Also, the loss of normal hormone signalling (luteinizing hormone) from the pituitary gland can lead to reduced testosterone production. Testosterone normally declines slowly with age and in most cases does not require treatment. Testosterone is not recommended for men with normal age-related decline in testosterone levels.

Men with testosterone levels that are clearly below the normal range may benefit from testosterone supplementation. The benefits can include improved energy, mood, strength and libido. Testosterone can be given by injection, or by patch or gel that is applied to the skin. Each of these forms of testosterone therapy has advantages and disadvantages, which should be discussed with a physician or specialist (usually an endocrinologist or urologist) to determine which is the best choice for each man.

For more information about reproductive hormone disorders, please see the links to the Endocrine Society and CEMCOR in the Endocrine Links section.