Course / Oversimplified Primer on the Endocrine System
To keep the body running smoothly, its cells need to communicate with each other. One major communication system is the endocrine system, which uses hormones—chemical messengers that travel through the bloodstream—to send signals from one part of the body to another.
For example, when your brain releases adrenaline, it prepares your body to react quickly in stressful situations.
Hormones move through the blood until they reach specific cells with matching receptors. When a hormone binds to its receptor, it triggers a response in that cell—either starting or stopping certain processes. These feedback loops can be positive (stimulating more activity) or negative (reducing activity).
If any step in this system goes wrong—say, hormones aren’t produced properly, can’t bind to their receptors, or receptors are blocked—the body can’t carry out its normal functions effectively.
Hormones are essential for reproduction. In women and people with ovaries, fertility is mainly controlled by the hypothalamic–pituitary–ovarian (HPO) axis.
Here’s how it works:
The hypothalamus in the brain releases gonadotropin-releasing hormone (GnRH).
GnRH tells the pituitary gland to release two important hormones—follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
FSH and LH then act on the ovaries, helping follicles (tiny sacs that contain eggs) grow and mature.
These hormones also lead to the production of estrogen, progesterone, and aromatase, which work together to prepare the body for ovulation, fertilization, and pregnancy.
In polycystic ovary syndrome (PCOS), the normal communication between the brain and ovaries can become unbalanced.
Normally, LH and FSH work together—LH helps make androgens (a type of hormone), and FSH converts those androgens into estrogens through an enzyme called aromatase.
However, in some women with PCOS, the brain produces too much GnRH, which leads to an overproduction of LH. This creates an excess of androgens that aren’t fully converted into estrogens. As a result, the follicles in the ovaries struggle to mature, and ovulation becomes irregular or doesn’t happen at all.
Different people with PCOS may experience different kinds of hormone imbalances. Doctors use tests and symptoms to figure out where the problem lies and how to best restore hormonal balance.
There are several medications that can help improve fertility in women with PCOS by encouraging normal ovulation.
Normally, when estrogen levels are high, the brain stops making FSH and LH. Clomiphene citrate tricks the brain by binding to estrogen receptors, so it “thinks” estrogen levels are low. This causes the brain to release more FSH and LH, which helps the ovaries develop and release a mature egg.
Letrozole blocks the enzyme that converts androgens into estrogens. With less estrogen present, the brain produces more FSH and LH, which promotes the growth of ovarian follicles and encourages ovulation.
These are synthetic versions of FSH and LH that are given as injections. They directly stimulate the ovaries to grow multiple follicles, increasing the chances of releasing mature eggs.
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