The Pituitary Gland

Pituitary Gland

Location of Pituitary Gland
Location of Pituitary Gland

Your Pituitary gland is the main endocrine (hormone producing) gland that sits just beneath the base of the brain. It is very small in size (only about the size of a pea).

It produces hormones that controls the function of many other hormone glands in your body (especially the thyroid, adrenals, ovaries and testicles). Therefore, the pituitary gland is often called the master gland of the endocrine system.

How does the Pituitary gland Work ?

The pituitary gland controls the function of several other hormone glands by producing and releasing number of hormones into the bloodstream. In turn, the pituitary gland is controlled by the hypothalamus, a small region of the brain that lies just above the pituitary.

The Pituitary gland takes messages from the hypothalamus (in the form of hormones) and uses these messages for stimulating all the other hormone glands to produce their own hormones.

Parts of Pituitary gland

The pituitary gland can be divided into two different parts:

  • Front (anterior) lobe, which accounts for 80% of the pituitary gland’s weight.
  • Back (posterior) lobe.

These lobes are connected to the hypothalamus by a stalk that contains blood vessels and nerve cell projections (nerve fibers). The hypothalamus controls the anterior lobe by releasing hormones through the connecting blood vessels. It controls the posterior lobe through nerve impulses.

The Pituitary gland and its target organs:

pituitary gland and its targeted organs image

Hormones produced by Pituitary gland

The pituitary gland secretes hormones from both the front part (anterior) and the back part (posterior) of the gland.

Anterior lobe hormones:

The anterior lobe of the pituitary gland produces and releases eight main hormones:

  • Growth hormone (GH): Growth hormone regulates growth and physical development. It has important effects on body shape by stimulating muscle formation.
  • Adrenocorticotropic hormone (ACTH): This hormone is also called corticotropin, which stimulates the adrenal glands to produce cortisol and other hormones.
  • Follicle-stimulating hormone (FSH): Follicle-stimulating hormone is involved with estrogen secretion and the growth of egg cells in women. It’s also important for sperm cell production in men.
  • Luteinizing hormone (LH): Luteinizing hormone is involved in the production of estrogen in women and testosterone in men.
  • Prolactin (PRL): Prolactin stimulates the mammary glands of the breasts to produce milk.
  • Endorphins: Endorphins have pain-relieving properties and are thought to be connected to the “pleasure centers” of the brain.
  • Beta-melanocyte-stimulating hormone: This hormone helps to stimulate increased pigmentation of your skin in response to exposure to ultraviolet radiation.

Posterior lobe hormones:

The posterior lobe of the pituitary gland also secretes hormones. These hormones are usually produced in your hypothalamus but are stored in the posterior lobe until they’re released.

Hormones stored in the posterior lobe include:

  • Vasopressin (ADH): Vasopressin (also called antidiuretic hormone) regulates the amount of water excreted by the kidneys and is therefore important in maintaining water balance in your body.
  • Oxytocin: This hormone stimulates the release of breast milk. It also stimulates contractions of the uterus during labor.

Pituitary gland disorders

Several conditions can affect your pituitary gland. Most are caused, when a tumour develops in or around the pituitary gland.

Pituitary tumors are abnormal growths that develop in or around your pituitary gland. Some pituitary tumors may begin to produce too much of one or more pituitary hormones. However, some tumors may start pressing your normal pituitary gland. Due to this pressure, your pituitary gland produce lower levels of hormones, a condition called hypopituitarism.

In addition to the above, pituitary tumors that make hormones are called “functioning” tumors and pituitary tumors that don’t make hormones are called “non-functioning” tumors.

Furthermore, most pituitary tumors are noncancerous (benign), also called an adenoma. It can remain in your pituitary gland or surrounding tissues and don’t spread to other parts of your body. The Pituitary tumours are not “brain tumours” according to The Pituitary Foundation. The term benign is used by doctors to describe a swelling which is not cancerous.

Most common pituitary gland conditions:

  • Acromegaly: In most cases, it is caused by a tumor of the pituitary gland, that produces too much growth hormone (GH).

    This can lead to excessive growth of bones, especially of your hands and feet, because an excessive amount of growth hormone is released by the pituitary tumor.

    Kindly note, In children, the condition is called gigantism. In adults, it is called acromegaly.
  • Cushing’s disease: In this condition, the pituitary gland produces large amounts of Adrenocorticotropic hormone (ACTH). This can lead to easy bruising, high blood pressure, weakness, and weight gain. It’s often caused by a tumor near or in the pituitary gland.
  • Hyperprolactinemia: In this condition, the prolactin hormone levels are elevated in your blood. This can lead to infertility and a decreased sex drive. The tumor causes the pituitary gland to produce too much prolactin leading to hyperprolactinemia.
  • Non-functioning tumours: is an abnormal growths that develop in your pituitary gland. Non-functioning tumours are usually noncancerous (benign). However, it can cause headaches and visual problems by pressing other areas of your brain. It can also press your normal pituitary gland, causing your pituitary gland to produce lower levels of hormones, resulting a condition called hypopituitarism.
  • Diabetes insipidus: This condition is caused due to problem in release of hormone vasopressin. It usually happens due to a head injury, surgery, or a tumor. In this condition, your body can’t properly balance fluid levels.

    As a result, people with Diabetes insipidus pass large amounts of heavily diluted urine.
  • Hypopituitarism: This condition causes your pituitary gland to produce very little or none of one or more of pituitary hormones. Hence, hypopituitarism can affect many of your body’s routine functions, such as growth, blood pressure or reproduction.

Rare pituitary gland conditions:

  • Empty Sella Syndrome (ESS): It is a rare condition, in which your pituitary gland shrinks or gets flattened. The pituitary gland sits in sella turcica (a bony structure that holds and protects your pituitary gland).

    People with ESS have a defect/weakness in the membrane that normally keeps the spinal fluid around the brain separate from the sella turcica. As a result of the weakened membrane, spinal fluid can leak into the sella turcica and apply pressure on the pituitary gland. This pressure causes the gland to shrink or flatten.

    In addition to the above, when your pituitary gland shrinks or becomes flattened, it cannot be seen on an MRI scan. Hence, your sella turcica looks like empty. This is called as empty sella syndrome.
  • Kallmann Syndrome (KS): In this condition, your hypothalamus fails to make enough of a hormone called gonadotrophin-releasing hormone (GnRH). The role of GnRH is to stimulate the testicles in males and the ovaries in females, to make sex hormones. If not enough of these hormones are made, the child will not enter puberty and will not be able to have children of their own without special treatment. 

    Furthermore, children with Kallmann syndrome also have either very poor or no sense of smell. KS occurs in both sexes but males are more commonly diagnosed with this condition.
  • Rathke’s Cleft Cysts: It is an abnormal fluid-filled sac (cyst) that usually is found between the two lobes of the pituitary gland (anterior lobe and posterior lobe).

    During fetal development, the anterior lobe of the pituitary gland develops from a sac like structure known as Rathke’s pouch. This pouch normally closes early in fetal development. If this pouch does not close completely, this leaves a space that can fill with fluid and grow over time. As a result, Rathke cleft cyst can form. 
  • Multiple Endocrine Neoplasia Type 1: MEN1 is a rare disorder that causes tumors in the endocrine glands and parts of the small intestine and stomach. MEN1 is sometimes called Wermer’s syndrome, after one of the first doctors to recognize it.

    In people with MEN1, multiple endocrine glands (usually the parathyroids, pancreas and pituitary) grow tumors and release excessive amounts of hormones that can lead to disease. 
  • Wolfram Syndrome: It is an inherited condition, that leads to many different abnormalities including diabetes insipidus (inability to concentrate the urine), diabetes mellitus (the usual type of diabetes), blindness and deafness.

    Patients usually also suffer from severe abnormalities of the nervous system that can be accompanied by behavior problems, psychiatric hospitalizations.

    Furthermore, Wolfram syndrome is sometimes referred to as “DIDMOAD” (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness).
  • Septo-Optic Dysplasia (SOD): It is a disorder of early brain and eye development. The most common features of SOD are underdevelopment of the eye (optic) nerve, abnormal formation of structures along the midline of the brain, and a small pituitary (pituitary hypoplasia).
  • Sheehan’s Syndrome (SS): Sheehan’s Syndrome is a condition that affects women who lose excess amount of blood in childbirth or who have severe low blood pressure during or after childbirth, which can deprive the body of oxygen. This lack of oxygen that causes damage to the pituitary gland is known as Sheehan’s syndrome.

    Hence, this condition causes the pituitary gland to not produce enough pituitary hormones (hypopituitarism).
  • Lymphocytic Hypophysitis (LH): is a condition in which your pituitary gland is harmed by lymphocytes (a types of white blood cells), resulting in pituitary enlargement and weakened function. It most often occurs in women in late pregnancy or the postpartum period, but can also occur in prepubertal or post-menopausal women, and in men.

    Symptoms of LH may include headache, visual field impairment and more rarely, double vision (diplopia). The exact cause of this condition is unknown but is thought to be autoimmune-related.
  • Nelson’s Syndrome: It is a rare disorder that occurs in some patients with Cushing’s disease. In Nelson’s syndrome, the pituitary tumor continues to grow and release excess amount of the hormone ACTH. As a result, both the adrenal glands (located on top of each kidney) have to remove surgically from a patient.

    Moreover, this enlargement of tumor, often cause visual loss, pituitary failure and headaches.

Symptoms of Pituitary gland disorders

The following list shows many of the symptoms associated with pituitary gland conditions in adults.

  • Headaches 
  • Vision problems 
  • Unexplained weight gain 
  • Reduced sex drive
  • Feeling dizzy and nauseous 
  • Pale complexion 
  • Weakening, loss of Muscle
  • Enlarged hands and feet 
  • Excessive sweating and oily skin 
  • Mood changes 
  • Inappropriate breast growth or production of breast mil
  • Erectile dysfunction

Please make sure you tell your doctors about all symptoms that you regularly notice. This will help them to treat you.

The following list shows some of the symptoms of pituitary gland conditions in children.

  • Poor growth
  • Loss of vision
  • Excessive drinking
  • Excessive frequency of passing urine
  • Tiredness
  • Overweight
  • Late puberty
  • Early puberty
  • Milk secretion

Please make sure you tell your doctors about all symptoms that you regularly notice in your child. This will help them to treat your child.

Tests for Pituitary Tumors

To diagnose a pituitary tumor, your doctor will take your complete health history and perform a physical exam. He or she might order:

  • Blood tests: These tests can determine whether you have an overproduction or deficiency of pituitary hormones. Your doctor will look for abnormal hormone levels in your body for example. cortisol and thyroid hormone.
  • Urinalysis: This involves collecting a sample of urine for chemical analysis. Because hormone levels naturally go up and down during the day and night, it may be necessary to do a 24-hour urine collection.
  • Vision testing: These tests can help determine if a pituitary tumor is impacting your vision, especially your peripheral vision.
  • Pituitary MRIs: The best way to look at tumors or other abnormalities of the pituitary gland is magnetic resonance imaging (MRI). 

    In addition to the above, a pituitary gland MRI is different than a regular MRI of the brain. It creates high resolution images that allow doctors to see the pituitary region better. It can show the location, size, and shape of your pituitary tumor.
  • Computed tomography (CT) scan: A CT scan uses x-rays to create detailed cross-sectional images of part of your body. CT scans can find a pituitary tumour, if it’s large enough. However, MRI scans are used much more often to look at the brain and pituitary gland.
  • Pituitary tissue samples: A biopsy (removing a sample of the tumor to examine under a microscope) is usually the only way to be certain about the diagnosis. In many cases, doctors won’t treat a tumor until a biopsy has been done.

    But a biopsy isn’t usually needed before treating a pituitary tumor. One reason is that the hormone tests for some types of adenomas are very accurate, so a biopsy isn’t likely to provide much more information on pituitary tumor. 

Note: Your doctor can usually diagnose a pituitary tumor with one or all of these tests, but that’s not always the case. If you need additional testing, your doctor may refer you to an endocrinologist.

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Treatments for Pituitary gland disorders

Most pituitary tumors are noncancerous (benign). However, many tumors still require treatment. The treatment involves a team of medical experts, possibly including a brain surgeon (neurosurgeon), endocrine system specialist (endocrinologist) and a radiation oncologist.

Doctors generally use Surgery, Radiation therapy and Hormone replacement therapy, either alone or in combination, to treat a pituitary tumor and return hormone production back to normal levels.

Surgery: Surgical removal of a pituitary tumor is necessary if the tumor is pressing the optic nerves (to the eyes) or if the tumor is overproducing certain pituitary hormones. The two main surgical techniques for treating pituitary tumors are:

  • Endoscopic transnasal transsphenoidal approach: This usually enables your doctor to remove the tumor through your nose. No other part of your brain is affected, and there’s no visible scar by using this procedure. 

Endoscopic Transnasal Approach
  • Transcranial approach (craniotomy): The tumor is removed through the upper part of your skull via an incision in your scalp. It’s easier to reach large tumors by using this procedure.
Craniotomy Image

Radiation therapy uses high-energy sources of radiation to destroy pituitary tumors. It can be used after surgery or alone if surgery is not an option. Radiation therapy can be beneficial if a tumor persists or returns after surgery. Methods of radiation therapy include:

  • Stereotactic radiosurgery
  • External beam radiation
  • Intensity modulated radiation therapy (IMRT)
  • Proton beam therapy

Furthermore, the benefits and complications of these forms of radiation therapy often are not immediate and may take months or years to be fully effective. Your radiation oncologist will evaluate your condition and discuss the pros and cons of each option with you.

Hormone replacement therapy: If your pituitary gland is not functioning properly, you may not produce hormones that are essential for your well being and for vital bodily functions. You may need to take hormone replacement therapy, which will be prescribed to you by your doctor.

Moreover, in this therapy, a patient takes hormones to replace the hormones, not being produced by his/her pituitary gland. Such hormones include (cortisol, thyroid hormone, vasopressin, sex hormones and growth hormone). 

Follow-up treatment for pituitary condition: Most people with a pituitary tumour or with pituitary condition will have regular check-ups at doctor’s clinic for the rest of their life. These check-ups enable your doctor to monitor your condition and pick up any changes as soon as possible.

In most patients their condition remains stable after initial treatment(s). However, regrowth of a pituitary tumour can occasionally occur. The chance of this happening is lower, if you had radiation therapy after your surgery. If regrowth does occur, your doctor may suggest you another surgery, or radiation therapy.

Tips for Pituitary gland health

Eat a balanced, healthy diet: A balanced diet is good for your health. General tips for healthy eating include:

  • Eating a diet rich in fruits and vegetables, which are great sources of fiber, vitamins, and minerals
  • Choosing good sources of fats, such as those that contain omega-3 fatty acids and monounsaturated fats.
  • Opting for whole grains over refined grains.
  • Reducing sodium intake.
  • Avoiding refined sugars.
  • Drinking at least four to six cups of water a day.

Reduce your stress: The stress causes your body to release several stress hormones, such as cortisol and adrenaline, into your bloodstream. These hormones increase your concentration, ability to react, and strength. After you have dealt with your short term stress, your body returns to normal.

However, a long term stress can cause health problems, because your body is constantly producing higher levels of stress hormones and does not have time to recover. In other words, the constant production of stress hormones can cause serious health problems. For example:

Too much cortisol (a stress hormone) can sometimes lead to:

  • insomnia
  • weight gain
  • anxiety
  • depression

Therefore, try to spare some time to get at least 45 minutes per day of exercise or work on a relaxing hobby.

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Location of Hypothalamus Gland
Location of Hypothalamus Gland

The hypothalamus is a small but an important area of the brain. It’s located at the base of the brain, above the pituitary gland. It plays an important role in hormone production and controls many important processes in the body.

In humans, the hypothalamus is approximately the size of an almond and less than 1% of the brain’s weight.

Functions of the Hypothalamus

One of the major functions of the hypothalamus is to maintain your body’s internal balance, which is known as homeostasis.

Homeostasis means a healthful, stable, balanced body condition.

Therefore, to maintain homeostasis, the hypothalamus controls many of your bodily functions, including:

  • releasing hormones
  • body temperature
  • hunger
  • thirst
  • Heart rate and blood pressure
  • Sleep cycles
  • managing of sexual behavior
  • regulating emotional responses
  • Production of substances that influence the pituitary gland to release hormones.

As different systems and parts of the body send signals to the brain, they alert the hypothalamus about any unbalanced factors that need attention. The hypothalamus then responds by releasing the right hormones into the bloodstream to balance the body.

  • One example of this is the ability of a human being to maintain an internal temperature of 98.6 °Fahrenheit (ºF).

Anatomy of the Hypothalamus

The hypothalamus can be divided into three main regions.

  • Anterior region
  • Middle region
  • Posterior region

Each region contains several nuclei (neuron clusters). These clusters of neurons perform vital functions, such as releasing hormones.

1. Anterior region: This region of the hypothalamus is also known as the supraoptic region. The main nuclei of anterior region include the supraoptic and paraventricular nuclei. There are several other smaller nuclei in the anterior region as well.

In addition, the supraoptic nucleus functions as the main source of vasopressin hormone, also known as the antidiuretic hormone (ADH), which plays a key role in the absorption of salts and glucose and maintaining water balance in your body.

Kindly note, the nuclei in the anterior region are largely involved in the secretion of various hormones. Many of these hormones interact with the pituitary gland to produce additional hormones.

2. Middle region: This region of the hypothalamus is known as the tuberal region. The main nuclei of middle region is the ventromedial and arcuate nuclei.

The ventromedial nucleus controls the appetite, while the arcuate nucleus is involved in releasing growth hormone-releasing hormone (GHRH). GHRH stimulates the pituitary gland to produce growth hormone. This is responsible for the growth and development of the body.

3. Posterior region: This area is also called the mammillary region. The main nuclei of posterior region include the posterior hypothalamic nucleus and mammillary.

The posterior hypothalamic nucleus helps regulate body temperature by causing shivering and blocking sweat production.

Hormones of the Hypothalamus

The hypothalamus is responsible for creating and controlling many hormones in the body. It works with the pituitary gland, which makes and sends other important hormones around the body.

Moreover, the hypothalamus uses bloodstream to communicate with the pituitary gland. These connections of the hypothalamus are called the endocrine connections.

Kindly note, when the hypothalamus receives a signal from the nervous system, it secretes hormones known as neurohormones. Theses neurohormones, further activates the pituitary gland, to start and stop the release of hormones in the body. 

Together, the hypothalamus and pituitary gland control many other glands that produce hormones of the body. For example: Adrenal cortex, Gonads, and Thyroid gland.

Important hormones secreted by the hypothalamus include:

  • Anti-diuretic hormone (ADH): This hormone increases water absorption into the blood by the kidneys.
  • Corticotropin-releasing hormone (CRH)This hormone sends a signal to the pituitary gland, to further stimulate the adrenal glands to produce corticosteroids. Corticosteroids helps to regulate metabolism and immune response.
  • Gonadotropin-releasing hormone (GnRH): GnRH instructs the pituitary gland to release the reproductive hormones, such as follicle stimulating hormone (FSH) and luteinizing hormone (LH), which work together to ensure normal functioning of the ovaries and testes.
  • Growth hormone-releasing hormone (GHRH): GHRH instructs the pituitary gland to release the growth hormone (GH). In children, GH is essential to maintaining a healthy body composition.
  • Oxytocin: This hormone controls many important sexual and social behavior, such as orgasm, trust, body temperature, sleep cycles and the release of a mother’s breast milk.
  • Prolactin-releasing hormone (PRH): PRH tell the pituitary gland to either start or stop breast milk production in lactating mothers.  
  • Thyrotropin releasing hormone (TRH): TRH activates the pituitary gland to produce thyroid stimulating hormone (TSH). TSH regulates metabolism, energy, heart rate, growth and development.
  • Somatostatin: Somatostatin works to stop the pituitary gland from releasing certain hormones, including growth hormones and thyroid-stimulating hormones.

Hypothalamus Disorders

If the hypothalamus is not functioning properly, this is known as hypothalamus disorder.

Kindly note, these disorders are very hard to diagnose because the hypothalamus and pituitary gland are so tightly connected that, it’s often difficult for doctors to understand whether the disease is associated with the hypothalamus or pituitary gland.

As it is difficult for doctors to diagnose a specific, incorrectly functioning gland, these disorders are often called hypothalamic-pituitary disorders.

However, there are some hormone tests that make clear the root cause of the disease.

Several conditions that cause hypothalamus disorders, including:

  • Head injuries
  • Surgery involving the brain
  • Brain tumors
  • Tumors in or around the hypothalamus
  • Radiation
  • Eating disorders, such as anorexia or bulimia
  • Excessive bleeding
  • Certain genetic disorders, such as growth hormone deficiency
  • Birth defects involving the brain
  • Autoimmune conditions

Hypothalamus disorders plays a role in many conditions, including:

  • Hypopituitarism: It is a disorder in which your pituitary gland doesn’t produce enough hormones. It is usually caused by damage to the pituitary gland, however, hypothalamus disorder can also cause it. Because, many hormones produced by the hypothalamus, directly affect those produced by the pituitary gland.

    Furthermore, the hormone deficiencies can affect number of your body’s routine functions, such as growth, blood pressure or reproduction.
  • Diabetes insipidus: This is an uncommon disorder that causes an imbalance of fluids in the body. When your hypothalamus doesn’t produce and release enough vasopressin hormone, the kidneys can remove too much water. This causes increased urination and thirst.

    There’s no cure for diabetes insipidus. But treatments can relieve your thirst and decrease your urine output.
  • Prader-Willi syndrome: This is a rare genetic disorder. It causes the hypothalamus to not register, when someone is full after eating.

    People with PWS have a constant urge to eat, which leads to obesity. Additional symptoms include a slower metabolism and decreased muscle.

Symptoms of Hypothalamus disorders

Symptoms that indicate hypothalamus disorders include:

  • Sensitivity to heat
  • Weight gain or loss
  • Anxiety
  • Difficulty sleeping
  • Tiredness 
  • Frequent urination
  • Diarrhea
  • Lack of sex drive
  • Fluctuations in body temperature
  • High or low blood pressure
  • Constant thirst
  • Delayed puberty
  • Infertility
  • Itchiness

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Tests for Hypothalamus disorders

If your doctor suspects a problem, he or she will perform a physical examination and ask about your symptoms. In addition, your doctor may also order Blood or urine tests to check hormone levels in your body such as:

  • Prolactin
  • Estrogen
  • Pituitary hormones
  • Cortisol
  • Growth hormone
  • Testosterone
  • Thyroid
  • Sodium

Other possible tests include:

  • Hormone injections followed by timed blood samples 
  • MRI or CT scans of the brain

How to make Hypothalamus healthy?

Some hypothalamus conditions are unavoidable, however, there are a few things you can do to keep it healthy.

1.) Eat a healthy diet: Eating a healthy diet is important for hypothalamus. Healthy dietary choices to support the hypothalamus include:

  • Fruits and Vegetables: Both fruits and vegetables contain lots of vitamins, minerals and antioxidants that is beneficial for the hypothalamus.
Fruits and Vegetables
Fruits and Vegetables
  • Vitamins B1- A good source of vitamin B1 is actually Sunflower Seeds. You should put approximately a handful of sunflower seeds to your daily meal to boost up your hypothalamus health.
Whole Grains
Whole Grains

Moreover, pork and whole grain are also good source of Vitamin B1.

  • Vitamin C:  It plays an important role in brain functions associated with hypothalamus. Vitamin C is also beneficial to protect your Hypothalamus from toxins.
Citrus Fruits
Citrus Fruits

Foods rich in vitamin C include lemons, oranges, grapefruits, strawberries and red bell peppers.

2.) Sleep Enough: When you get enough sleep, it keep your hypothalamus working properly.

3.) Exercise regularly: Like eating a healthy diet and getting enough sleep, a regular exercise also boosts your overall health. Therefore, a regular exercise can also improve your hypothalamus functions.

Kindly note, even a mild amount of regular exercise can improve your hypothalamus function.

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Symptoms of Menopause

Menopause is the time in life when your monthly period stops. In other words, it is the permanently end of your menstrual cycles. It is diagnosed, when you have not had a period for one year. Menopause happens because the function of your ovaries stops. As a result, no hormones (estrogen and progesterone) are produced by your ovaries, which control your period and the release of eggs.

Menopause is a natural biological process. It usually begins between the ages of 40 and 55, but can develop before or after this age range. There is no reliable lab test to predict when a woman will experience menopause.

Furthermore, menopause is not a health problem. However, hormonal changes and other factors can cause uncomfortable symptoms, such as hot flashes and weight gain.

Stages of Menopause

Did you know that, natural menopause is not just one phase, it is actually divided into three stages:

  • perimenopause
  • menopause
  • postmenopause

Stage 1- Perimenopause : This phase usually begins several years before menopause, when your ovaries slowly make less estrogen. In the last 1 to 2 years of this stage, the estrogen levels fall faster. Moreover, perimenopause can start up to 10 years before you enter menopause. It often begins in your 40s, but some women enter perimenopause in their 30s.

During perimenopause, your period may become more unpredictable. It may even stop for several months and resume. It’s important to note that you can become pregnant during perimenopause by taking medicines directed by your doctor.

Stage 2- Menopause: The definition of menopause is not having your period for 12 months. At this stage, your ovaries have stopped releasing eggs and reproductive hormones (estrogen and progesterone). Menopause is diagnosed when a woman has gone without a menstrual period for 12 consecutive months.

Stage 3- Postmenopause refers to the years after menopause has occurred. In other words,  postmenopause refers to women who have already reached menopause.

As you enter postmenopause, it’s a good time to reevaluate your health situation and talk to your doctor about long-term health goals. Because, your lower level of estrogen due to postmenopause, puts you at increased risk of heart disease, osteoporosis and other conditions of the heart and bones.

Causes of Menopause

A woman is born with all of her eggs, which are stored in her ovaries. Her ovaries also make the reproductive hormones estrogen and progesterone, which control her period (menstruation) and the release of eggs (ovulation). Menopause happens when the ovaries no longer release an egg every month and menstruation stops.

Age is the most common factor that cause menopause. As you approach your late 30s, your ovaries starts loosing their ability to produce hormones (estrogen and progesterone). Hence, your fertility declines.

In your 40s, your monthly periods may become longer or shorter, heavier or lighter, and less frequent. By the age of 52, the function of your ovaries stops. As a result, no hormones are produced and no egg is released by your ovaries, and you have no more periods.

However, some women can go through menopause in early age. It can be the result of surgery, like if their ovaries are removed in a hysterectomy, or damage to their ovaries from chemotherapy for cancer.

What are the symptoms of Menopause?

Menopause is the time in a woman’s life at which she can no longer reproduce. Symptoms of menopause vary from woman to woman. However,common symptoms of menopause include:

  • Sleep Disturbances: You may have insomnia— trouble falling asleep or staying asleep.
  • Vaginal changes: The lining of your vagina may become thinner, drier, or less stretchy. This can cause dryness or discomfort during sex.
  • Weaker bones: Your bones will probably weaken during menopause. If it’s really bad, it can lead to osteoporosis after menopause.
  • Mood changes: Hormone changes can make you feel anxious, irritable, and tired. Your sex drive might change, too.
  • Night sweats: Hot flashes that wake you up in the middle of the night.
  • Hot Flashes: A hot flash is a sudden, sometimes intense feeling of heat that rushes to your face and upper body.
  • Urinary tract infections (UTIs): You may have to pee more often or get more frequent urinary tract or bladder infections.
  • Weight gain: Hormonal changes that occur during menopause often contribute to weight gain. Many studies have confirmed that women in menopause are likely to gain weight and have larger midsections than women who have not gone through menopause.
  • Depression
  • Anxiety
  • Memory problems
  • Reduced sex drive
  • Dry skin, mouth, and eyes
  • Sore or tender breasts
  • Headaches
  • Racing heart
  • Reduced muscle mass
  • Hair thinning or loss
  • Increased hair growth on other areas of the body, such as the face, neck, chest, and upper back

Please note, women affected with symptoms of racing heart, urinary changes, headaches, or other new medical problems should see a doctor to make sure there is no other cause for these symptoms

How is Menopause diagnosed?

A blood test known as PicoAMH Elisa diagnostic was approved by the U.S. Food and Drug Administration (FDA). This test is used to determine whether a woman has entered menopause or is getting close to entering menopause. The test measures the amount of anti-Müllerian hormone (AMH) in the blood.

AMH is a hormone produced by a woman’s ovaries that has a role in egg release (ovulation). AMH levels fall as menopause approaches and is one of several indicators.

Furthermore, this test may be helpful to women who show symptoms of perimenopause, which can also have bad health impacts. Early menopause (before the age 45) is associated with a higher risk of osteoporosisheart disease, vaginal changes and loss of libido, and mood changes.

Kindly note, your doctor can also order another blood test that will measure the level of certain hormones in the blood, usually follicle stimulating hormone (FSH). FSH is a hormone produced by the pituitary gland. However, this test can be misleading during the beginning of menopause, because, your hormone levels are fluctuating up and down daily. 

Therefore, most doctors will diagnose menopause based on your symptoms, medical history, and menstrual information.

Menopause Treatments

Many women do not need treatment for their menopause symptoms. You may find that your symptoms go away by themselves. However, you may need treatment if your symptoms are severe or affecting your quality of life. Treatments may include:

  • Hormone therapy (HT): This therapy helps to control your symptoms of menopause (such as hot flashes and vaginal dryness). In Hormone therapy, the balance of your body’s hormone levels is maintained by providing supplemental hormones (estrogen and progesterone).

    However, using HT may increase the risk of developing certain diseases and health conditions. A person should not use hormone therapy if they have risk factors for the following health problems, or if they have a personal or family history of these issues:
    • heart disease
    • blood clots
    • gallbladder disease
    • liver disease
    • stroke
    • breast cancer

Furthermore, hormone therapy is available in various forms, including, oral (pill), skin patch and spray. But, it is important to discuss the benefits and risks of hormone therapy with your doctor before using it.

  • Vaginal estrogen: To relieve vaginal dryness, estrogen can be applied directly to the vagina using a vaginal cream or tablet. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness.
  • Low dose of antidepressants:  A low dose of certain antidepressants may be useful for management of hot flashes in menopause.
  • Medications for osteoporosis: Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis (a bone disease).
    Several medications are available that help to reduce bone loss and risk of fractures. Your doctor may prescribe vitamin D supplements to help strengthen bones.
  • Low dose of birth control pills: Oral contraceptive pills are another form of hormone therapy often prescribed for women in perimenopause, to treat irregular vaginal bleeding, relieve hot flashes, vaginal dryness and mood changes.

    Oral contraceptive are not recommended for women who have already reached menopause.

Kindly note, before deciding any form of treatment, talk with your doctor about the risks and benefits involved with each option of treatment. Review your options yearly, as your needs and treatment options may change.

Natural treatments for Menopause symptoms:

  • Soy: Soy has isoflavones, which are phytoestrogens (plant estrogens). Some studies have observed that soy may be effective in reducing menopausal symptoms. However, other studies have found no benefit. Only food forms of soy, like tofu and soy milk, are recommended. Soy in tablet or powder form is not advised.

    Moreover, many experts recommend that women who have a history of breast cancer avoid phytoestrogens.
  • Vitamin E: Topical vitamin E oil applied to the vagina helps to improve lubrication and may also reduce hot flashes.
  • Calcium and Vitamin D: Take calcium and vitamin D supplements to help reduce your risk for osteoporosis (a bone disease). Talk to your doctor about supplements that can help you for your individual health needs.
  • Flaxseed: Flaxseed has omega-3 fatty acids and lignans, which act as phytoestrogens. Results from studies have been mixed, but it may help to reduce menopause symptoms in some women.

    Avoid whole flaxseed because it is difficult to digest.
  • Exercises: It is important to exercise for 20 to 30 minutes a day.

Exercise can help:

    • increase energy
    • promote a better night’s sleep
    • improve mood
    • promote your general well-being

Lifestyle tips for Menopause

Tips for managing the symptoms of menopause include:

  • Practicing relaxation and deep breathing exercises.
  • Having a healthful diet that includes plenty of fresh fruits, vegetables, and whole grains.
  • Quitting smoking.
  • Limiting the intake of alcohol.
  • Good sleeping habits and getting plenty of rest.
  • It is important to do regular exercise for managing the symptoms of menopause.
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What is TSH ?

TSH stands for thyroid stimulating hormone. It is produced and released into the bloodstream by the pituitary gland (a pea-sized structure), which is located at the base of your brain. It is responsible for regulating many hormones released by the thyroid gland.

Furthermore, your thyroid gland controls different bodily functions, including metabolic rate, heart and digestive functions, muscle control, brain development, by releasing a steady amount of thyroid hormones.

Thyroid gland produces two major thyroid hormones:

In addition to the above, the production and release of thyroid hormones are controlled and regulated by thyroid stimulating hormone (TSH), which is secreted by the pituitary gland.

How TSH Levels Change ?

When levels of thyroid hormones decrease below normal, the pituitary gland releases the Thyroid stimulating hormone. This hormone binds to the receptor on the thyroid cells. This causes thyroid cells to produce more hormones (T3 and T4) and release them into the bloodstream. Once the levels of thyroid hormones rise, the pituitary gland then decreases TSH production.

In this way, the two glands work together to make sure the right amount of thyroid hormones are produced.

  1. First, your pituitary gland senses the level of thyroid hormone that is released into the bloodstream by your thyroid gland.

  2. When your thyroid gland, due to illness, stress, surgery, obstruction, or due to whatever reason, doesn’t produce enough thyroid hormone, your pituitary gland detects the reduced levels of thyroid hormones and moves into action by making more TSH, which then triggers your thyroid to make more thyroid hormones (T3 and T4).

    This is the pituitary’s effort to raise the levels of thyroid hormone and return the system to normal.

  3. If your thyroid is overactive and producing too much thyroid hormone, due to disease or taking too high a dose of thyroid hormone replacement drugs, your pituitary gland senses that there is too much of the hormone circulating and slows or shuts down TSH production.

    This drop in TSH is an attempt to return circulating thyroid hormones levels to normal.

Why do I need a TSH test?

A TSH test can be used to check how well your thyroid gland is functioning. It measures the amount of thyroid stimulating hormone that your pituitary gland is secreting. Your doctor may order a TSH test, if you’re experiencing symptoms of a thyroid disorder.

TSH Test

Thyroid diseases can be categorized as either hypothyroidism (too little thyroid hormone) or hyperthyroidism (too much thyroid hormone)

Symptoms of hypothyroidism, also known as underactive thyroid, include:

  • Hair Loss
  • Puffy Face
  • Dry Skin
  • Slow Heartbeat
  • Constipation
  • Irregular Periods in women
  • Loss of interest in sex
  • Cold Sensitivity
  • Tiredness
  • Sore Muscles
  • Joint Pain
  • Depression
  • Weight Gain
Symptoms of Hypothyroidism

Symptoms of hyperthyroidism, also known as overactive thyroid, include:

  • Bulging Eyes
  • Abnormal Heart Rate
  • Diarrhea
  • Weight Loss
  • Irritability
  • Itching
  • Heat Intolerance
  • Stress
  • Sleeplessness
  • Vision Problem
  • Frequent Sweating
  • Irregular Mensuration
  • Nervousness
Symptoms of Hyperthyroidism

TSH tests are also used to screen newborn babies for underactive thyroid, and to diagnose fertility problems in women.

This test is frequently ordered along with or prior to a free T4 test. Other thyroid tests that may be ordered include total or free T3 tests. TSH, free T4 and sometimes free T3 may be ordered together as a thyroid panel.

What does the TSH test result means ?

High TSH levels can mean your thyroid is not making enough thyroid hormones, a condition called hypothyroidism. Low TSH levels can mean your thyroid is making too much of the hormones, a condition called hyperthyroidism.

Please note, a TSH test does not explain why TSH levels are too high or too low. If your test results are abnormal, your health care provider will probably order additional tests to determine the cause of your thyroid problem. These tests may include:

  • T4 thyroid hormone tests
  • T3 thyroid hormone tests
  • Tests to diagnose Graves’ disease, an autoimmune disease that causes hyperthyroidism
  • Tests to diagnose Hashimoto’s thyroiditis, an autoimmune disease that causes hypothyroidism

How do I get ready for TSH test?

It’s important to tell your doctor about all of the medications you’re currently taking. Many multivitamins, supplements, and prescription medications may interfere with the accuracy of the TSH test results. Therefore, their use should be discussed with your doctor, prior to testing.

You may need to avoid using these drugs before the test. However, don’t stop taking your medications unless your doctor tells you to do so.

In addition to the above, you may also need to fast (not eat or drink) for several hours before the test. Remember, TSH levels can vary throughout the day, so it’s best to have this test done early in the morning. Your health care provider will let you know if there are any special instructions to follow.

How is TSH Test Performed?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial (a small glass or plastic bottle). You may feel a little sting when the needle goes in or out.

Blood sample from a vein Image
Blood sample from a vein

The entire procedure should only take a few minutes to complete. The blood sample will be sent to a lab for analysis. Once your doctor receives the test results, they’ll schedule an appointment with you to discuss the results and explain what they may mean.

TSH Test Reference range

TSH Test reference range are only one indicator of how your thyroid is functioning. They vary by gender, age, and other factors. In general, normal, low, and high TSH levels are:

AgeReference Range
( μIU/mL)
( μIU/mL)
( μIU/mL)
0-5 Days0.70 – 15.20<0.70>15.20
6 Days – 2 Months0.70 – 11.00<0.70>11.00
3 Days – 11 Months0.70 – 8.40<0.70>8.40
1 – 5 Years0.70 – 7.00<0.70>7.00
6 – 10 Years0.60 – 4.80<0.60>4.80
11 – 15 Years0.50 – 4.70<0.50>4.70
> 20 Years (Adults) 0.27 – 4.70<0.27>4.70

Dear reader, I have also attached my Thyroid Function Test Report for your reference. (Click Here to see report)

TSH levels in women

Women are at greater risk for developing abnormal TSH levels during menstruation, when giving birth, and after going through menopause.

Furthermore, a 2017 study showed that older women are especially at risk for developing thyroid cancer if they have high TSH levels along with thyroid nodules.

TSH levels in men

Both high and low TSH can affect fertility. Men with hypothyroidism or hyperthyroidism both had fewer normally shaped sperm.

In addition, men are more susceptible than women to complications like irregular development of the genitals if they have high TSH. Taking thyroid hormone replacement therapy may be necessary for men to balance TSH.

TSH levels in children

TSH levels in children can vary based on their age. A 2008 study that closely measured TSH levels in kids from birth to as old as 18 years found wildly different TSH levels throughout their lives.

And though TSH tends to be high for the first month after they’re born, a child’s TSH levels will gradually decrease as they get closer to adulthood before rising again as they age.

TSH levels in pregnancy

Pregnancy hormones naturally increase the levels of certain thyroid hormones in the blood. This is essential for the development of the fetal brain and nervous system.


At the same time, the levels of TSH in the blood decrease. As a result, doctors use lower reference ranges for pregnant women.

Levels of TSH in the blood increase gradually during the second and third trimesters, but they remain lower than normal levels in women who are not pregnant.

Doctors carefully monitor TSH levels throughout pregnancy. Having unusually high or low levels can affect the risk of miscarriage and cause pregnancy-related complications, such as:

  • preeclampsia
  • premature birth
  • low birth weight
  • congestive heart failure

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When TSH Test alone is Not Enough ?

During diagnosis, most doctors use the thyroid stimulating hormone test to evaluate thyroid function and determine the optimal course of treatment. There are times, however, when a TSH may be insufficient.

For example, free T4 test in addition to TSH is usually ordered, if a doctor suspects thyroid dysfunction arising from disease of the pituitary gland or hypothalamus. Likewise, if the TSH is normal, but a person still has symptoms of being hyperthyroid or hypothyroid, free T4 test may be ordered.

TSH is also not necessarily sufficient to monitor hypothyroidism during pregnancy, therefore, a T4 and free T4 tests are often recommended. Depending on the clinical situation, other thyroid tests that may be ordered include triiodothyronine (T3), free T3 and thyroid antibody tests.


Doctors can use the TSH test results to diagnose thyroid conditions, such as hypothyroidism and hyperthyroidism.

Normal TSH reference range can vary widely, depending on a person’s age, gender, and other factors. A reference range can also vary between different laboratories, however, for most adults (>20 Years), the normal range falls between 0.27 and 4.70 μIU/mL.

Furthermore, make sure you get your TSH levels tested regularly, especially if you have a family history of thyroid disorders or have seen abnormal TSH levels on previous test results.

Follow all the instructions your doctor gives you to stop taking certain medications or eating certain foods before a TSH test to make sure the results are accurate. This way, your doctor can give you a treatment plan that’s best for the cause of abnormal TSH.

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