Major Diseases in Which Menstrual Hormonal Changes Affect Symptoms
Female physiology has multiple interactions and influences on major medical disease processes and is similarly affected by these diseases. Many disease processes act directly; for example, renal failure commonly induces abnormal uterine bleeding. Other diseases act indirectly through their therapies, such as cancer chemotherapy, which may lead to ovarian failure. In general, the impact of female physiology on medical disease is primarily via the effects of estrogen and to a lesser extent progesterone. Other hormones, such as prolactin, oxytocin, and gonadotropins, play minor roles. Estrogen and progesterone affect almost all major organ systems in both tonic and cyclic modes. The effects of the female hormones are mediated directly through receptors (estrogen alpha, estrogen beta, progesterone) and indirectly through their effects on other organ systems, such as smooth muscle relaxation and changes in prostaglandin levels. The responses induced by estrogen and progesterone may be theorized, in a teleologic sense, as promoting successful reproduction. Pathology occurs when the normal hormonal effects overlap a disease process that is already present. Medical diseases affect female physiology at all levels of the hypothalamic-pituitary-ovarian-genital axis, from anovulation to vaginal atrophy. Medical diseases also affect female physiology in a horizontal manner, throughout every stage of a woman’s life. Thus medical diseases must be seen in both a vertical and a horizontal context (i.e., a three-dimensional manner). Because the gynecologist commonly acts as a consultant to other health professionals, we are often asked to help with complications stemming from gynecologic issues. Though different clinicians direct the treatment of lupus, multiple sclerosis, or epilepsy, modulating the effects of female physiology on these disease processes is the role of the gynecologist.
