Endocrine Gynaecology

Hormones orchestrate every stage of a woman’s reproductive life. When the hormonal balance is disrupted, understanding the cause is the first step toward effective treatment and restored wellbeing.

What is endocrine gynaecology?

Endocrine gynaecology is the branch of gynaecology that deals with hormonal disorders affecting the female reproductive system. It encompasses a broad range of conditions related to the hypothalamic-pituitary-ovarian axis — the communication system between the brain and the ovaries that regulates the menstrual cycle, fertility, and secondary sexual characteristics.

From puberty through menopause, hormonal fluctuations are a normal part of female physiology. Problems arise when this delicate balance is disturbed, leading to irregular cycles, abnormal bleeding, fertility difficulties, or systemic symptoms.

The hormonal assessment

A thorough hormonal evaluation is the foundation of endocrine gynaecology. Blood tests are typically drawn on day 2–5 of the menstrual cycle (early follicular phase) for the most accurate results. The standard panel includes:

  • FSH (follicle-stimulating hormone) — evaluates ovarian reserve and function; elevated levels may suggest diminished reserve or premature ovarian insufficiency
  • LH (luteinising hormone) — an elevated LH/FSH ratio may suggest PCOS
  • Oestradiol (E2) — assesses ovarian oestrogen production
  • AMH (anti-Müllerian hormone) — a marker of ovarian reserve, can be measured at any point in the cycle
  • Progesterone — measured in the mid-luteal phase (day 21–23) to confirm ovulation
  • Testosterone, DHEA-S, androstenedione — androgens assessed when hyperandrogenism is suspected
  • Prolactin — elevated levels (hyperprolactinaemia) can suppress ovulation and cause amenorrhoea
  • TSH — thyroid disorders commonly affect the menstrual cycle and must be excluded
  • 17-hydroxyprogesterone — screens for congenital adrenal hyperplasia
Note: Timing matters. Incorrect timing of blood tests can lead to misleading results. If your cycles are irregular or absent, your gynaecologist will advise on the most appropriate moment for testing.

Menstrual cycle disorders

A normal menstrual cycle lasts 21–35 days, with bleeding lasting 3–7 days. Deviations from this pattern may signal an underlying hormonal or structural problem:

  • Amenorrhoea — absence of menstruation. Primary amenorrhoea (no period by age 15–16) requires investigation of puberty and anatomical development. Secondary amenorrhoea (cessation of periods for 3+ months in a previously menstruating woman) may be due to pregnancy, PCOS, hypothalamic dysfunction, thyroid disease, hyperprolactinaemia, or premature ovarian insufficiency
  • Oligomenorrhoea — infrequent periods (cycle length >35 days), often related to anovulation or PCOS
  • Menorrhagia — excessively heavy periods, which may be hormonal (anovulatory cycles, thyroid dysfunction) or structural (fibroids, polyps, adenomyosis) in origin
  • Dysmenorrhoea — severe menstrual pain, either primary (no underlying cause) or secondary (endometriosis, adenomyosis, fibroids)
  • Intermenstrual bleeding — bleeding between periods, which may be benign (hormonal fluctuations, contraceptive-related) or warrant further investigation (cervical or endometrial pathology)

Premature ovarian insufficiency (POI)

Also known as premature menopause, POI affects approximately 1% of women before the age of 40. The ovaries stop functioning normally, leading to oestrogen deficiency and loss of fertility.

  • Presentation — irregular or absent periods, hot flushes, vaginal dryness, mood changes, and difficulty conceiving
  • Diagnosis — confirmed by elevated FSH levels (>25 IU/L) on two occasions at least 4 weeks apart, in a woman under 40
  • Causes — often idiopathic (unknown), but may be autoimmune, genetic (Turner syndrome, fragile X), or iatrogenic (chemotherapy, radiotherapy, surgery)
  • Management — hormone replacement therapy (HRT) or the combined pill is essential to protect bone health, cardiovascular health, and urogenital function until the average age of natural menopause (~51). Fertility options including egg donation are discussed with a reproductive specialist

Hyperprolactinaemia

Elevated prolactin levels can disrupt the menstrual cycle by inhibiting GnRH secretion, leading to anovulation, irregular periods or amenorrhoea, and sometimes galactorrhoea (unexpected breast milk production).

  • Causes — prolactinoma (a benign pituitary tumour, the most common cause), certain medications (antipsychotics, antidepressants, antiemetics), hypothyroidism, or stress
  • Diagnosis — confirmed by blood test; pituitary MRI is performed to assess for a prolactinoma
  • Treatment — dopamine agonists (cabergoline, bromocriptine) are highly effective at normalising prolactin levels and restoring cycles. Surgery is rarely needed

Thyroid disorders and gynaecological health

The thyroid gland has a profound influence on reproductive function. Both hypothyroidism and hyperthyroidism can cause menstrual irregularities:

  • Hypothyroidism — may cause heavy, prolonged, or frequent periods, anovulation, and difficulty conceiving. Associated with hyperprolactinaemia
  • Hyperthyroidism — may cause light or absent periods and can affect early pregnancy

TSH screening is a standard part of any hormonal assessment. Treatment of the underlying thyroid condition typically restores normal menstrual function.

Dr. Maazouzi’s approach: Endocrine gynaecology often requires detective work — piecing together symptoms, blood test results, and imaging findings to identify the root cause. Treatment is always tailored to the individual, with regular monitoring to track the response and adjust as needed.

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