月經(jīng)周期是一個(gè)荷爾蒙的交響樂(lè)，協(xié)調(diào)產(chǎn)生一個(gè)卵子，并為懷孕做好子宮和乳腺組織的準(zhǔn)備。對(duì)大多數(shù)婦女來(lái)說(shuō)，懷孕的周期比例時(shí)間非常少。

然而，從初潮開(kāi)始到絕經(jīng)結(jié)束的每月荷爾蒙的激增和下降會(huì)影響女性的大腦、乳房和子宮，并可能在整個(gè)月中導(dǎo)致多種癥狀。

初潮----開(kāi)始

月經(jīng)周期開(kāi)始時(shí)平均年齡為12.5歲左右，而大約100年前是17歲左右^[1]。大多數(shù)年輕女孩開(kāi)始時(shí)的周期非常不規(guī)律，在2-7年內(nèi)進(jìn)入正規(guī)周期，盡管無(wú)排卵周期并不少見(jiàn)，特別是在初潮時(shí)^[2]。在初潮早期，下丘腦、垂體和卵巢軸的協(xié)調(diào)正在成熟，卵巢開(kāi)始充分發(fā)育。正在建立負(fù)反饋循環(huán)和正反饋循環(huán)，刺激周期性的荷爾蒙激增或下降，特別是下丘腦和腦下垂體激素。

月經(jīng)周期分為四個(gè)主要部分：

1. 月經(jīng)期或“經(jīng)期”

2. 卵泡期

3. 排卵期

4. 黃體期

月經(jīng)期-“經(jīng)期”

在月經(jīng)期間，子宮內(nèi)膜脫落（約2湯匙）。黃體化激素（LH）和促卵泡激素（FSH）的預(yù)期比例約為1:1。荷爾蒙水平都處于每月最低水平，身體組織從高水平的荷爾蒙水之后而得到休息。在此期間，卵巢經(jīng)歷了“卵泡選擇”，當(dāng)一小部分大約5-10毫米大小的卵泡變得對(duì)荷爾蒙敏感。其余的卵泡退化或閉鎖。

在此期間常見(jiàn)的癥狀：

1. 偏頭痛和頭痛

2. 月經(jīng)來(lái)潮

3. 大量出血或月經(jīng)不足

4. 疲勞

5. 盆腔壓力

6. 情緒失調(diào)-抑郁

 卵泡期-卵巢和子宮內(nèi)膜的生長(zhǎng)

在這個(gè)階段，雌激素的上升起到了阻止月經(jīng)的作用。子宮內(nèi)膜增厚，10天內(nèi)由約4毫米增至10毫米。LH和雌激素在一個(gè)正反饋回路中循環(huán)，有助于主導(dǎo)卵泡每天增大2-3毫米，在排卵時(shí)生長(zhǎng)到大約18-25毫米大小。雌激素和LH顯著增加。在這段時(shí)間內(nèi)的癥狀通常是最小的。但隨著雌激素的增加，偏頭痛和頭痛很常見(jiàn)。

在此期間常見(jiàn)的癥狀：

1. 偏頭痛和頭痛

2. 持續(xù)的發(fā)現(xiàn)或長(zhǎng)時(shí)間的月經(jīng)出血

3. 子宮內(nèi)膜生長(zhǎng)不足

4. 卵泡生長(zhǎng)不足

排卵期-釋放卵子

在這個(gè)周期的雌激素和LH峰值階段，預(yù)示著卵子的到來(lái)。在LH峰值的10-12小時(shí)內(nèi)（暴增開(kāi)始后的34-36小時(shí)），卵子從顯性卵泡中釋放出來(lái)。排卵經(jīng)常在左右卵巢之間交替進(jìn)行，有些（但不是全部）女性可能注意到排卵時(shí)的疼痛，稱(chēng)為排卵痛，是德語(yǔ)中的“中間疼痛”。女性可能也會(huì)注意到“排卵粘液”，這種粘液往往和蛋白一樣，有彈性，有水分，而且很豐富。

這期間的癥狀包括：

1. 偏頭痛和頭痛

2. 性欲增強(qiáng)

3. 卵巢疼痛

4. 食欲下降

5. 更富精力

6. 白帶增多

7. 體溫升高

8. 少量陰道出血

黃體期-豐富子宮內(nèi)膜

卵子的釋放（卵細(xì)胞）觸發(fā)黃體的退化。黃體本質(zhì)上是排卵創(chuàng)傷后在卵巢上留下的荷爾蒙活性疤痕。正是黃體會(huì)在周期的第二階段產(chǎn)生黃體酮和大量雌激素。卵子在排卵后，通過(guò)輸卵管運(yùn)動(dòng)，要么受精，要么不受精。同時(shí)，子宮內(nèi)膜的厚度正在變化到大約10-16毫米。黃體酮的上升阻止了內(nèi)襯的增厚，取而代之的是開(kāi)始分泌階段。黃體酮的急劇上升增加了子宮和子宮內(nèi)膜的血流。子宮內(nèi)膜腺增加并開(kāi)始分泌糖原，果糖和葡萄糖到子宮內(nèi)膜，以滋養(yǎng)可能形成的受精卵。子宮內(nèi)膜內(nèi)的血管開(kāi)始盤(pán)繞。如果懷孕發(fā)生，人絨毛膜促性腺激素（HCG）從發(fā)育中的胎盤(pán)上升將維持黃體。但是，在大多數(shù)情況下，黃體會(huì)開(kāi)始退化，黃體死亡，子宮內(nèi)壁完全脫落。雌激素和黃體酮急劇下降，下一個(gè)周期的開(kāi)始。黃體期從婦女到婦女的長(zhǎng)度非常一致，平均14天。    這是月經(jīng)周期的階段，通常會(huì)產(chǎn)生大部分有問(wèn)題的癥狀。

這段時(shí)間內(nèi)常見(jiàn)的癥狀通常被歸類(lèi)為月經(jīng)前綜合癥(PMS)：

l 偏頭痛和頭痛

l 持久斑點(diǎn)

l 情緒失調(diào)-易怒，經(jīng)前煩躁癥（PMDD）

l 痤瘡

l 食欲不振，食物攝入量增加

l 纖維囊性乳房變化與乳房疼痛

l 水腫

l 腹脹

l 體重增加

圍絕經(jīng)期-最后的狂歡

圍絕經(jīng)期很少是經(jīng)期立刻停止并不再發(fā)生的快速事件，對(duì)大多數(shù)女性來(lái)說(shuō)，在絕經(jīng)前10年，月經(jīng)周期不排卵是經(jīng)常發(fā)生的，黃體產(chǎn)生的黃體酮較少，無(wú)排卵周期發(fā)生得更頻繁。與生育高峰期相比，黃體酮相對(duì)缺乏，女性開(kāi)始發(fā)現(xiàn)更多雌激素占優(yōu)勢(shì)的癥狀。在月經(jīng)周期中，黃體期可能縮短，顯示整體黃體酮產(chǎn)量減少，黃體酮較早下降。這定義了通常稱(chēng)為黃體期缺陷的條件。在黃體期早期出現(xiàn)和出現(xiàn)更多的PMS癥狀。與此同時(shí)，隨著卵泡不能產(chǎn)生更多的雌激素，大腦試圖彌補(bǔ)其不足，雌激素開(kāi)始慢慢波動(dòng)。這將開(kāi)始導(dǎo)致更多的癥狀，最初只是在雌激素已經(jīng)波動(dòng)的時(shí)候，然后最終到整個(gè)月。雌激素的波動(dòng)最有可能導(dǎo)致陰道萎縮和干燥，性欲低下，潮熱，盜汗，記憶改變，焦慮和失眠。當(dāng)大腦試圖維持一致的雌激素水平時(shí)，LH水平開(kāi)始上升。LH（和FSH）將變得多變，但在絕經(jīng)真正到來(lái)之前幾年達(dá)到了很高水平。

絕經(jīng)--生殖章節(jié)的結(jié)束

絕經(jīng)是指40歲以上的女性在一年內(nèi)沒(méi)有經(jīng)血（40歲以下沒(méi)有周期的女性一般都要處理其他潛在的健康狀況、藥物或自身免疫疾?。Ｂ殉猜炎觾?chǔ)備已經(jīng)耗盡。卵巢停止對(duì)現(xiàn)在很高的LH水平作出反應(yīng)。黃體酮水平大幅下降至基本不存在。睪酮繼續(xù)從卵巢產(chǎn)生，但是腎上腺皮層會(huì)在女性的余生中產(chǎn)生少量雌激素和黃體酮，盡管其水平遠(yuǎn)低于生殖高峰期的卵巢水平。

從12歲到50歲，女性荷爾蒙生殖的重要性對(duì)很多女性來(lái)說(shuō)只占她一生的一半左右。然而，荷爾蒙平衡的后果，或者說(shuō)荷爾蒙失衡的后果，會(huì)影響到包括大腦在內(nèi)的所有身體組織的整個(gè)周期，甚至在絕經(jīng)之后。    最佳的荷爾蒙健康需要大腦和卵巢之間的協(xié)調(diào)和平衡，而對(duì)于許多女性來(lái)說(shuō)這是不可能的。想了解整個(gè)月經(jīng)周期荷爾蒙的分泌情況，可以做女性荷爾蒙的全周期檢測(cè)并繪制月經(jīng)周期荷爾蒙曲線圖。通過(guò)整個(gè)月經(jīng)周期荷爾蒙的曲線圖，可以讓女性窺探癥狀出現(xiàn)問(wèn)題的時(shí)間。

參考文獻(xiàn)

[1] O’Grady 2008. Early puberty for girls. The new “normal” and why we need to be concerned. Canadian women’s health network. 11(1) 

[2] Zhang,K et al. 2008. Onset of ovulation after menarche in girls: a longitudinal study. J Clin Endocrinol Metab. 93(4): 1186-1194.

原文

Hormones, the Menstrual Cycle & Cycle Maps

Dr. Alison McAllister 

The menstrual cycle is a symphony of hormones coordinated to yield an egg and to prepare the uterus and breast tissue for pregnancy. For most women, pregnancy will only take place in a very small percentage of cycles.

However, the monthly surge and fall of hormones starting in menarche and ending in menopause influences the brain, breast and uterus of women and may result in numerous symptoms throughout the month.

Menarche – The Beginning

The menstrual cycle will start with menarche around the average age of 12.5 years — down from approximately 17 years of age approximately 100 years ago. [1] Most young girls will start with very irregular cycles, progressing to regular cycles within 2-7 years, although anovulatory cycles are not uncommon especially when first cycling. [2] During early menarche, the coordination of the hypothalamus, pituitary and ovarian axis is maturing and the ovaries become fully developed. The negative and positive feedback loops are being established and the amplification of cyclical surges of hormones, particularly hypothalamus and pituitary hormones, is stimulated.

The menstrual cycle is divided into 4 main sections:

1. The menses – or “period”

2. The follicular phase

3. Ovulation

4. The luteal phase

Menses – 'The Period'

During menses, the endometrial lining is shed (about 2 tablespoons). Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are expected to be in approximately a 1:1 ratio. Hormones are all at their lowest level of the month and the body tissues are given a rest from higher levels of hormones. During the period, the ovaries go through “follicular selection” when a small number of follicles approximately 5-10 mm in size become hormonally sensitive. The rest of the follicles regress or undergo atresia. 

Symptoms common during this time:

· Migraines and headaches

· Menstrual cramping

· Heavy bleeding / Lack of the menses

· Fatigue

· Pelvic pressure

· Mood disorders - depression

The Follicular Phase – Growing the Ovum and Endometrium

During this phase of the cycle, the rise of estrogen acts to stop menses. The endometrium is thickened, increasing from approximately 4 mm to 10 mm within 10 days. LH and estrogen cycle in a positive feedback loop that contributes to enlargement of the dominant follicle by 2-3 mm per day, growing it to approximately 18-25 mm in size at the time of ovulation. During this time there is a dramatic increase in estrogen and LH.  Symptoms during this time are usually minimal. But migraines and headaches are common with the rise of estrogen.

Symptoms common during this time:

· Migraines and headaches

· Persistent spotting or prolonged menstrual bleeding.

· Lack of endometrial growth

· Inadequate follicle growth

Ovulation – Releasing the Egg

During this phase of the cycle estrogen and LH peak, heralding the egg’s arrival. Within 10-12 hours of the LH peak (34-36 hours after the start of the surge), the egg is released from the dominant follicle. Ovulation often alternates between the left and right ovaries and some, but not all, women might notice ovulatory pain mid-cycle called Mittelschmerz, which is German for 'middle pain.' Women might also notice 'ovulatory mucus' which tends to have the consistency of egg-whites – stretchy, watery, and abundant. 

Symptoms during this time include:

· Migraines and headaches

· Increased libido

· Ovarian pain

· Ovulatory spotting

The Luteal Phase – Enriching the Endometrium

The release of the egg (ovum) triggers the involution and development of the corpus luteum. The corpus luteum is essentially a hormonally active scar left on the ovary after the trauma of ovulation. It is the corpus luteum that will produce the progesterone and much of the estrogen in the second phase of the cycle. The ovum, after ovulation, moves through the fallopian tubes and is either fertilized or not. Meanwhile, the endometrium is changing reaching approximately 10-16 mm in thickness. The rise in progesterone stops the thickening of the lining and instead initiates the secretory phase. The dramatic rise in progesterone increases the blood flow to the uterus and endometrium. The endometrial glands in the uterine lining increase and start secreting glycogen, fructose and glucose into the endometrium to nourish any fertilized ova. The blood vessels within the endometrium become coiled. If pregnancy occurs, the rise in human chorionic gonadotropin (hCCG) from the developing placenta will maintain the corpus luteum. But, in most cases, the corpus luteum will start to degenerate, the ovum dies and the lining of the uterus is completely shed. Estrogen and progesterone drop dramatically and the start of the next cycle begins. The luteal phase is very consistent in length from woman to woman and averages 14 days.

This is the stage of the menstrual cycle which generally produces the majority of problematic symptoms.

Symptoms common during this time — often just grouped as Pre-Menstrual Syndrome (PMS):

· Migraines and headaches

· Persistent spotting

· Mood disorders – irritability, premenstrual dysphoric disorder (PMDD)

· Acne

· Change in appetite – cravings, increased food intake

· Fibrocystic breast changes and breast pain

· Water retention

· Bloating

· Weight gain

Peri-Menopause – The Last Hurrah

Menopause is rarely the quick event of periods stopping and never having them again.  For most women, up to 10 years prior to menopause, ovulation stops being so dynamic, with less progesterone being produced from the corpus luteum and anovulatory cycles occurring more often.  The progesterone becomes relatively deficient compared to the peak reproductive years and women start noticing more symptoms of estrogen dominance.  In the cycle, the luteal phase may shorten showing less overall progesterone production and an earlier drop in progesterone.  This defines the condition commonly known as the luteal phase defect.  More PMS symptoms appear and arise earlier in the luteal phase.   Meanwhile, estrogen will slowly start to fluctuate more and more as the follicles fail to produce as much and the brain tries to compensate for the deficiency.  This will start to contribute to more symptoms, initially only at the times when estrogen already fluctuates and then eventually to the entire month.  It’s the fluctuations in estrogen that most likely contribute to vaginal atrophy and dryness, low libido, hot flashes, night sweats, memory changes, anxiety and insomnia.  LH levels start to rise as the brain tries to maintain consistent estrogen levels.  LH (and FSH) will become variable, but reach high levels years before menopause has truly arrived.

Menopause – The Conclusion of the Reproductive Chapter

Menopause is the absence of menstrual bleeding for a year in women over the age of 40 (Women who have no cycles under the age of 40 are generally dealing with other underlying health conditions, medications or autoimmune disorders). The ovarian egg reserves have been depleted. The ovaries stop responding to the now very high levels of LH. Progesterone levels have dropped dramatically and are basically non-existent.  Testosterone production continues from the ovaries, but the adrenal cortex will produce estrogen and progesterone for the rest of the woman’s life although at levels far lower than the ovaries did during the peak reproductive years.

The importance of a woman’s hormones from approximately age 12 until age 50 will for many women only cover approximately half of her lifetime. Yet, the consequences of hormone balance, or alternatively hormone imbalance, can influence every bodily tissue including the brain throughout the cycle and even after menopause.

Optimal hormone health requires a coordinated and elegant communication between the brain and ovaries that for many women does not occur. Testing the menstrual cycle throughout the month can allow women a peek into the times where symptoms are problematic.  ZRT’s Menstrual Cycle Mapping profile gives you that peek into those levels.

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