Clinical manifestations of hormonal changes in the menstrual cycle

The human female reproductive cycle is the result of repeated interactions--giving positive and negative feedback--of pituitary gonadotropic hormones and ovarian sex steroid hormones. If any of the pituitary or ovarian hormones becomes tonically elevated or suppressed, ovulation will cease. The charge to the clinician in evaluating disorders of ovulation is to determine which hormone(s) is tonically elevated or suppressed. Sex steroid hormones exert effects on their target tissues that can be observed directly. These changes aid the clinician in evaluating disorders of ovulation and establishing which hormone(s) is tonically elevated or suppressed. Changes in thermoregulation can be detected by the basal body temperature record. Changes in the vagina can be detected by cytologic examination. Changes in the endometrium can be observed by obtaining a biopsy specimen for histologic examination. Premenstrual molimina suggest to the woman and her clinician that ovulation has occurred. Utilization of these changes in clinical practice aids the clinician in making a specific diagnosis of the cause of anovulation and in developing a treatment plan. Moreover, when the woman is aware of these clinical changes, it makes her a more involved participant in her health care.