Figure 3.

Association between psychological stress, HPA, HPO and SAM axes and metabolic disorder in regulating ovarian function. Psychological stress leads to the activation of the HPA and SAM axes, while concurrently suppressing the HPO axes. In response to stress, activation of the paraventricular nucleus region stimulates the secretion of CRH and AVP into the pituitary portal system, stimulating the pituitary gland to release ACTH into the circulation, which triggers cortisol release from the adrenal gland. Simultaneously, the locus coeruleus is activated, resulting in a surge of systemic sympathetic nervous excitement along with increased release of epinephrine from the adrenal medulla. The activation of HPA and SAM axes disrupts neuroendocrine homeostasis, triggering a cascade of metabolic disorders such as glucose metabolism abnormality and obesity. This dysregulation, coupled with the suppression of the HPO axis, impairs ovarian function. Figure created with BioRender.com. HPO, hypothalamic-pituitary-ovarian; HPA, hypothalamic-pituitary-adrenal; SAM, sympathetic-adrenal-medullary; GnRH, gonadotropin-releasing hormone; FSH, follicle-stimulating hormone; LH, luteinizing hormone; E₂, estradiol; P, Progesterone; CRH, corticotropin-releasing hormone; AVP, arginine vasopressin; CNS, central nervous system.