Since the first step in prevention is understanding, let’s start with a brief overview of the most important points to remember about the fascinating systems that operate in women’s lives.
The human body is an exquisite mechanism constructed so that each system works in a delicate balance with other processes within the body. This idea of balance and interrelationship is especially important in understanding what occurs at midlife.
Your monthly cycle is controlled by certain centers in your brain. They signal appropriate body parts and systems, “telling” them when and how to operate.
Often women ask me whether they have a glandular problem. It is important to understand just how the glands work within your cycle. There are two types of glands in the body: exocrine and endocfifu. The exocrine glands release chemical substances directly to the area where they are heeded. A good example is the sweat glands, which aid in the cooling of the skin, and the sebaceous glands, which secrete oils that keep the skin pliable. When menopause arrives, these glands may not work as effectively because of the changes in their “programming.” The sweat glands may not “cool” as efficiently and the sebaceous glands may not keep the skin as soft and smooth as before. Endocrine glands, in contrast, produce and release their substances directly into the bloodstream. These substances are chemical messengers called hormones.
Before menopause, your monthly cycle is under the control of certain centers in the brain. The brain is our ultimate computer, handling billions of messages, signals, and functions, all operating simultaneously with remarkable order and purpose. Neurotransmitters are the “messengers” that activate the appropriate brain areas and systems, “telling” them when to go into operation, or when to alter their function.
Brain activity is controlled by messages from both inside and outside of the body. It is within the cerebral cortex, or higher brain areas, that we are made aware of ourselves, our surroundings, and our sense of well-being. When signals go awry in this area of the brain, the results are changed emotions, feelings, and perceptions.
Tucked in the base of the brain in the middle of the skull lies the funnel-shaped hypothalamus, one of our most important endocrine glands. It is to the human body what mission control is to space flight. Messages or impulses from our senses, such as sight, smell, hearing, taste, and touch, are eventually directed to the hypothalamus, which is strategically connected to all other areas of the brain.
The hypothalamus produces several hormones, but the one that is of importance in understanding the female monthly cycle is called the gonadotropin releasing hormone (GRH). GRH dictates action in another important gland, the pituitary, a pea-sized structure lying directly beneath the hypothalamus in a bony cave at the base of the skull. The pituitary, in turn, produces the hormones that control, amongst other glands, the all-powerful ovary. The pituitary secretes two hormones called the gonadotropins: individually called the follicle stimulating hormone (FSH) and the luteinizing hormone (LH). These are the hormones that directly affect the growth and development of the ovarian follicle. The FSH stimulates the follicle to ripen and the LH matures the egg and causes its release.
The ovary is the most powerful gland in a woman’s body, producing those two sex hormones, estrogen and progesterone, that make the differences between men and women. Women have two ovaries that have two directly interrelated functions: to produce those sex hormones and to produce eggs.
Before a female child is born, there are probably several million eggs in her ovaries, but for unknown reasons, this number reduces to about 500,000 eggs at her birth. Unlike the male, who is able to produce new spermatozoa for the rest of his life, the female ovary can only lose eggs until the supply is depleted at menopause. The supply of eggs is actually programed for exhaustion. The ovary raises hundreds of follicles each month, each containing an egg, but only one egg is expelled in the menstrual cycle (except in the rare case of multiple fraternal births). The others are lost.
Almost every part of your body is changed somewhat by the levels of estrogen and progesterone your ovary is producing. All of the sex organs, both inside and outside of the body, need estrogen in order to work properly.
Notice the reduced size of the clitoris and outer labia and the loss of pubic hair. Changes also occur inside the body as the walls of the vagina and the uterus gradually become thinner without estrogen. The bladder lies just in front of the uterus. The tube through which the bladder empties, the urethra, lies in front of the vagina. The bowel is behind the uterus, and the rectum and the opening of the bowel, the anus, are behind the vagina. This diagram will be useful for reference as we review other changes. The relationship of all these organs to the vagina is of importance when we consider the problem of prolapse, or drop, of the pelvic organs, a condition that often becomes a problem in the early postmenopausal years.
The female breast has been idolized and romanticized in poetry and prose throughout history. Although this organ has miraculous capabilities, it is important to remember that the functions of the breast are not related to their size or shape. Breasts are comprised of glandular tissue surrounded by fat, which serves as a kind of packing tissue. The ducts from the glands end in the nipple. Another important fact to remember about the breast is that these glands react to the presence or absence of hormones and also that the glands are the site for cancer when it develops in the breast.
Many patients ask why breasts droop with age. Fibrous bands known as Cooper’s ligaments run throughout the breast and are attached to firm tissue that lies like a sheet covering the chest wall. The stretching of these bands caused by weight, gravity, and aging accounts for breast sag.