Regulation of the hypothalamic--pituitary--ovarian axis in women

To account for the regulation of cyclic gonadotrophin release, the separate and interactive effects of the hormonal variable at the levels of CNS-hypothalamus, the pituitary and the ovary have been reviewed. The pituitary gonadotrophs, as target cells exhibited a remarkable cyclic change in their capacity which was correlated with the oestradiol levels. The ultimate release is determined by the relative size of the two pools' releasable gonadotrophins which are themselves regulated by the relative inputs of LH-RH and oestradiol, respectively. LH-RH appears to serve as a primary influence on the gonadotroph, stimulating gonadotrophin synthesis, storage and release. Oestradiol, for the most part, amplifies the action of LH-RH and induces the development of a self-priming effect of LH-RH, except that it impedes LH-RH-mediated gonadotrophin release. The pituitary capacity increases several-fold from the early to late follicular phase, and this is considered to be the prerequisite for the development of a mid-cycle surge. CNS-hypothalamic dopamine, norepinephrine, prostaglandins as well as LH-RH systems are involved in the negative and positive feedback effect of oestradiol. The possible steps and interactive elements in the triggering of LH-RH release for the initiation of the mid-cycle LH/FSH surge are considered.