anti-Müllerian hormone (AMH): About eight weeks after conception the human fetus has two sets of ducts, one of which can develop into the male reproductive tract and the other into the female reproductive tract. If the fetus is genetically male (XY chromosomes) then the embryonic testes will produce anti-Müllerian hormone. This causes the Müllerian (female) ducts to disappear – hence the term anti-Müllerian hormone, whilst testosterone produced by the testes causes the male (Wollfian) ducts to survive. The Wollfian ducts go on to develop into the different parts of the male reproductive system: the epididymis, the vas deferens, the seminal vesicles and the prostate gland. In a female fetus (XX chromosomes) the Wollfian ducts disappear (because of the lack of testosterone) and the Müllerian ducts develop into the fallopian tubes, uterus (womb), cervix and the upper part of the vagina.
Anti-Müllerian hormone may also have a role in regulating sex steroid production in puberty and in the adult ovaries and testes. In the ovaries, anti-Müllerian hormone appears to be important in the early stages of development of the follicles, which contain and support the eggs prior to fertilization. The more ovarian follicles a woman has, the more anti-Müllerian hormone her ovaries can produce, and so AMH can be measured in the bloodstream to assess how many follicles a woman has left in her ovaries: her ‘ovarian reserve’.
Baseline: hormone blood work (Estrogen, Progesterone, Luteinizing Hormone, Follicle-Stimulating Hormone and a pregnancy test) and transvaginal ultrasound to confirm your ovaries and uterus are at a ‘baseline’ stance.
Benign: Not Cancer
Cervix: The lower, narrow end of the uterus at the top of the vagina.
Chronic Pelvic Pain: Persistent pain in the pelvic region that has lasted for at least 6 months.
Cyst: A sac or pouch filled with fluid.
Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.
Endometriosis: A condition in which tissue that normally lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.
Estrogen, Estradiol (E2) or Oestradiol: a steroid hormone made from cholesterol and is the strongest of the three naturally produced oestrogens. It is the main oestrogen found in women and has many functions, although it mainly acts to mature and maintain the female reproductive system. A natural increase in blood oestradiol concentrations during the menstrual cycle causes an egg to mature and be released; that is, to be ovulated. Another important role of oestradiol is to thicken the lining of the uterus so that the egg can implant if it becomes fertilised. Oestradiol also promotes development of breast tissue and increases both bone and cartilage density.
In premenopausal women, oestradiol is mostly made by the ovaries. Oestradiol levels vary throughout the monthly menstrual cycle, being highest at ovulation and lowest at menstruation. Oestradiol levels in women reduce slowly with age, with a large decrease occurring at the menopause when the ovaries ‘switch off’. In pregnant women, the placenta also produces a lot of oestradiol especially towards the end of the pregnancy.
Men also produce oestradiol; however, the amounts produced are much lower than in women. Within the testes, some testosterone is changed into oestradiol and this oestradiol is essential for the production of sperm. In both sexes, oestradiol is also made in much smaller amounts by fat tissue, the brain and the walls of blood vessels.
Fibroids: Growths, usually benign, that form in the muscle of the uterus.
Follicle Stimulation Hormone (FSH): Follicle stimulating hormone is produced by the pituitary gland. It regulates the functions of both the ovaries and testes. Lack or insufficiency of it can cause infertility or subfertility both in men and women.
General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.
Gonadotrophin-releasing hormone (GnRH): hormone produced and secreted by specialized nerve cells in the hypothalamus of the brain. It is released into tiny blood vessels that carry this hormone from the brain to the pituitary gland, where it stimulates the production of two more hormones – follicle stimulating hormone and luteinising hormone. These hormones are released into the general circulation and act on the testes and ovaries to initiate and maintain their reproductive functions. Follicle stimulating hormone and luteinising hormone control the levels of hormones produced by the testes and ovaries (such as testosterone, oestradiol and progesterone), and are important in controlling the production of sperm in men and the maturation and release of an egg during each menstrual cycle in women.
Hysterectomy: Removal of the uterus.
Incontinence: Inability to control bodily functions such as urination.
Infertility: A condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control.
Laparoscope: An instrument that is inserted through a small incision to view internal organs or to perform surgery.
Laparoscopic Surgery: A type of surgery that uses a device called a laparoscope to view internal organs or to perform surgery.
Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into abdomen through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.
Luteinising hormone (LH): Luteinising hormone, like follicle stimulating hormone, is a gonadotrophic hormone produced and released by cells in the anterior pituitary gland. It is crucial in regulating the function of the testes in men and ovaries in women.
In men, luteinising hormone stimulates Leydig cells in the testes to produce testosterone, which acts locally to support sperm production. Testosterone also exerts effects all around the body to generate male characteristics such as increased muscle mass, enlargement of the larynx to generate a deep voice, and the growth of facial and body hair.
In women, luteinising hormone carries out different roles in the two halves of the menstrual cycle. In weeks one to two of the cycle, luteinising hormone is required to stimulate the ovarian follicles in the ovary to produce the female sex hormone, oestradiol. Around day 14 of the cycle, a surge in luteinising hormone levels causes the ovarian follicle to tear and release a mature oocyte (egg) from the ovary, a process called ovulation. For the remainder of the cycle (weeks three to four), the remnants of the ovarian follicle form a corpus luteum. Luteinising hormone stimulates the corpus luteum to produce progesterone, which is required to support the early stages of pregnancy, if fertilisation occurs.
Malignant: A term used to describe cells or tumors that are able to invade tissue and spread to other parts of the body.
Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.
Pelvic Floor Disorders: Disorders affecting the muscles and tissues that support the pelvic organs; these disorders may result in loss of control of the bladder or bowels or cause one or more pelvic organs to drop downward (prolapse).
Pelvic Organ Prolapse: A condition in which pelvic organs, such as the uterus or bladder, drop downward. It is caused by weakening of the muscles and tissues that support these organs.
Progesterone (P4): a hormone which belongs to a group of steroid hormones called progestogens. It is mainly secreted by the corpus luteum in the ovary during the second half of the menstrual cycle. It plays important roles in the menstrual cycle and in maintaining the early stages of pregnancy.
During the menstrual cycle, when an egg is released from the ovary at ovulation (approximately day 14), the remnants of the ovarian follicle that enclosed the developing egg form a structure called the corpus luteum. This releases progesterone and, to a lesser extent, oestradiol. The progesterone prepares the body for pregnancy in the event that the released egg is fertilised. If the egg is not fertilised, the corpus luteum breaks down, the production of progesterone falls and a new menstrual cycle begins.
If the egg is fertilised, progesterone stimulates the growth of blood vessels that supply the lining of the womb (endometrium) and stimulates glands in the endometrium to secrete nutrients that nourish the early embryo. Progesterone then prepares the tissue lining of the uterus to allow the fertilised egg to implant and helps to maintain the endometrium throughout pregnancy. During the early stages of pregnancy, progesterone is still produced by the corpus luteum and is essential for supporting the pregnancy and establishing the placenta. Once the placenta is established, it then takes over progesterone production at around week 8-12 of pregnancy. During pregnancy, progesterone plays an important role in the development of the foetus; stimulates the growth of maternal breast tissue; prevents lactation; and strengthens the pelvic wall muscles in preparation for labour. The level of progesterone in the body steadily rises throughout pregnancy until labour occurs and the baby is born.
Although the corpus luteum in the ovaries is the major site of progesterone production in humans, progesterone is also produced in smaller quantities by the ovaries themselves, the adrenal glands and, during pregnancy, the placenta.
Regional Anesthesia: The use of drugs to block sensation in a region of the body.
Tubal Sterilization: A method of female sterilization in which the fallopian tubes are tied, banded, clipped, sealed with electric current, or blocked by scar tissue formed by the insertion of small implants.
Ureters: A pair of tubes, each leading from one of the kidneys to the bladder.