7b. Women's Health - Pathologies Flashcards
Non-physical signs/symptoms of PMS
Mood swings
Irritability
Anxiety
Poor concentration
Food cravings
Increased appetite
Physical signs/symptoms of PMS
Bloating
Breast tenderness
Headaches
Acne
GIT upset
Signs/symptoms and causes of PMS-A (anxiety)
Anxiety, irritability
High oestrogen:progesterone ratio
Signs/symptoms and causes of PMS-C (craving)
Sugar cravings, increased appetite
Blood glucose imbalance, low Mg
Signs/symptoms and causes of PMS-D (depression)
Depression, teary
Low oestrogen:progesterone ratio, low serotonin
Signs/symptoms and causes of PMS-H (hyperhydration)
Weight gain, breast tenderness, bloating
Increased water retention due to excess salt intake, excess oestrogen, stress, Mg def
Causes/triggers of PMS symptoms
Interactions between progesterone, oestrogen and neurotransmitters
Progesterone inhibits GABA receptors
Deficient serotonin functioning due to progesterone and oestrogen modifying serotonin availability (also poss nutrient def - tryptophan, gut dysbiosis)
Reduced cortisol awaking response
Smoking
Obesity
Alcohol (negative association with anxiety, mood changes, headaches during PMS)
High intake of dairy/refined sugars; low protein intake
High O6:O3 ratio increasing inflammation and aromatisation
Naturopathic approach to PMS
Avoid/minimise high GI foods, caffeine, alcohol, smoking, table salt, dairy, red/processed meats
Balance oestrogen:progesterone ratio - B vits, cruciferous, Mg, high fibre, increased phytoestrogens, remove endocrine disruptors
Optimise weight
Address stress
Balance blood glucose
Reduce inflammation
Balance neurotransmitters - tryptophan, tyrosine, B6, 9, 12, Zn, Mg, L-theanine, St John’s Wort
Reduce fluid retention - reduce Na/increase K-rich foods, B6 to help regulate aldosterone, seed cycling, diuretics - celery, dandelion, nettle
Why is B6 important for PMS?
Co-factor for GABA, serotonin, dopamine
Modulates oestrogen
Corpus luteum development
Oestrogen-progesterone imbalance can lead to B6 def - reduced dopamine = increased prolactin which affects breast tissue, promotes water retention
OCP can deplete B6
Why is Mg important for PMS?
GABA/serotonin synthesis
Why is Ca important for PMS?
Co-factor for tryptophan-serotonin conversion
Why is vit D important for PMS?
Neurotransmitter function
Why is Zn important for PMS?
Proper functioning of sex hormones
Controls prolactin
Why are EFAs important for PMS?
Women with PMS shown to have EFA/prostaglandin abnormalities e.g. low GLA
GLA is a precursor to PG1 which inhibits prolactin
Why is vitex agnus castus important for PMS?
Binds to dopamine receptors to reduce secretion of prolactin
Reduces mood changes, irritability, headaches and breast tenderness
Why is gingko biloba important for PMS?
Breast pain/tenderness
Why is rosemary important for PMS?
AO effects
Neutralises quinones by reducing 16-OH-E1 and increasing more 2-OH-E1
Why is ashwagandha important for PMS?
Adaptogen
Nervine
Thyroid support
Why is ginger tea good for PMS?
Improves blood circulation
Reduces cramping
Reduces bloating
Which herbal teas are good for PMS-A?
Chamomile
Passionflower
Why is green tea good for PMS?
L-theanine content to calm NS
Why is peppermint tea good for PMS?
Antispasmodic
Eases bloating
Why is St John’s Wort tea good for PMS?
Mood enhancer
What is PCOS?
An endocrine metabolic condition
What are the signs and symptoms of PCOS?
Irregular/absent periods
Weight gain
Hirsutism
Thinning hair/hair loss
Oily skin
Acne
Infertility
What are the complications of PCOS?
T2D
Gestational diabetes
Hypertension
Dyslipidaemia
NAFLD
Metabolic syndrome
Endometrial cancer
AI
Depression/anxiety
What is the pathophysiology of PCOS?
Increased LH = increased androgens
Reduced FSH reduces aromatisation of androgens to oestrogen, leading to anovulation
Suppressed SHBG = increased free circulating androgens/testosterone
What is the most common mediator in the majority of PCOS cases?
Insulin resistance
How does insulin resistance lead to PCOS?
Decreases SHBG synthesis = increased free circulating androgens/testosterone
Increases ovarian androgen production
Increases adrenal androgen secretion
Leads to leptin resistance
What increases the risk of PCOS?
Obesity
Chronic low-grade inflammation
Gut dysbiosis
Chronic stress
Genetics
Smoking
Vit D def
Why can obesity lead to PCOS?
IR increases adipogenesis and decreases lipolysis
IR increases androgen production
IR sensitises thecal cells to LH and increases androgen production
Why can low-grade inflammation lead to PCOS?
Western diet
Obesity
Lack of exercise
Metabolic endotoxaemia
High levels of oxidative stress
All adds to IR
Why can gut dysbiosis lead to PCOS?
Alters hormone secretions
Alters gut-brain mediators
Alters inflammatory pathways
Alters islet b-cell proliferation
Why can chronic stress lead to PCOS?
Increased production of adrenaline/cortisol = increase in IR
Stimulates production of DHEA which converts to testosterone in peripheral tissues
Why can genetics lead to PCOS?
Polymorphisms in CYP11/CYP17
Why can vit D deficiency lead to PCOS?
Reduces insulin sensitivity
Examples of hormones/markers elevated during PCOS?
Testosterone with DHT
DHEA
Androstenedione
Oestrogen
Prolactin
LH
Insulin
HbA1c
TNF
Examples of hormones/markers low during PCOS?
Progesterone
FSH
SHBG
What are the therapeutic aims for supporting PCOS?
Decrease insulin resistance
Balance blood glucose
Decrease central obesity
Reduce inflammation and oxidative stress
Reduce stress/cortisol levels
Liver detoxification for oestrone clearance
Protocols for supporting blood glucose balance, insulin sensitivity and weight loss in PCOS
Low GI foods
Low saturated fat
No trans fats/processed foods
Increase fibre
Limit snacking
Quality protein from vegs, eggs, fish
Optimise O6:3 ratio
Include chromium-rich foods - cinnamon, berberine, ALA, vit D, Mg, CoQ10
HIIT/interval training
Protocols for supporting hormone balance in PCOS
Seed cycling
Liquorice
Spearmint tea
Nettle root
Green tea
Saw palmetto
Protocols for supporting HPA axis in PCOS
Ashwagandha
Mg
Chamomile, passionflower, lemon balm teas
Limit caffeine
Sleep hygiene
Yoga
Protocols for supporting microbiome, detoxification and elimination in PCOS
Probiotics/prebiotics/fermented foods/increased fibre – for gut microbiome balance
Cruciferous veg, B complex, Mg, NAC, silymarin – for detoxification/elimination
Why can myo-inositol be used to support PCOS?
Improves insulin sensitivity
Positive effect on elevated androgens
Decreases serum testosterone
Helps regulate menstrual cycle
Typical dosage of myo-inositol for PCOS
1g/day
Food sources of myo-inositol
Whole grains
Beans
Nuts
Fruit
What is endometriosis?
Presence of endometrial tissue outside uterus
Where can endometrial tissue end up outside of the uterus?
Ovaries
Fallopian tubes
Rectum
What is the pathophysiology of endometriosis?
Endometrial tissue follows the menstrual cycle causing it to grow, break down and bleed
The blood has no outlet, leading to inflammation, pain, formation of scar tissue
Signs/symptoms of endometriosis
Dysmenorrhoea
Heavy menstrual bleeding
Dyspareunia
Chronic pelvic pain
Lower back pain
Migraines
Anxiety
Depression
Complications of endometriosis
Infertility
Bowel obstruction
Ovarian cancer
Why is histamine implicated in endometriosis?
Oestradiol (E2) is needed for endometrial tissue growth
Mast cells contain oestrogen and progesterone receptors
Oestrogen triggers histamine degranulation
Histamine induces ovarian E2 synthesis
High histamine drives inflammation and angiogenesis = endometriosis proliferation
While progesterone has an inhibitory effect on histamine, it is overridden by oestrogen
Causes/risk factors for endometriosis
Immune dysfunction - inability to recognise endometrial tissue outside uterus
Surgical scar implantation
Endometrial cell transport via lymphatics
Prolonged oestrogen exposure (early period, OCP)
Obesity
Poor oestrogen detox/elimination
Environmental toxin exposure
Emotional trauma
Microbial infections
Consumption of fats, red meat, alcohol
Diet low in fibre, O3, Se, vit D
How can microbial infections be a risk factor for endometriosis?
Virus e.g. EBV, E. coli or parasite
Dysbiosis can lower DAO enzyme activity
Compromised mucosal barrier - increase in LPS contributing to inflammation
Naturopathic approach to endometriosis
Immune support
Reduce histamine load
Reduce exposure to hormone disruptors
Optimise liver function for detox/elimination
Optimise intestinal microflora
Reduce inflammation
Nutrients to support endometriosis
Turmeric, ginger, ALA, resveratrol, O3 - inflammation
Probiotics/prebiotics - microbiome support/bacterial contamination
B6, B9, B12, choline - methylation
B vits, Mg, glutathione, NAC - liver support
Green tea, quercetin - histamine lowering
Cruciferous veg, onions, garlic - aromatase inhibitors
Vit D, vit C, Zn - immune support
What are uterine fibroids
Benign tumours that originate from the myometrium and connective tissue
Signs/symptoms of fibroids
50-80% are asymptomatic
Heavy/prolonged menstrual bleeds
Pelvic pain
Abdominal bleeding
Frequent urination
Constipation
Complications of fibroids
Iron def anaemia
Infertility
Miscarriage
Obstructed labour
Causes/risk factors of fibroids
Genetics - SNPs on CYP1A1
Hypertension - may cause smooth muscle cell injury
Poor oestrogen metabolism
Chronic stress
Heavy metals - cadmium and lead active oestrogen receptors
Diet/lifestyle - low fibre, high sat fats, refined carbs, caffeine, alcohol, low physical activity
Vit D deficiency - needed to inhibit fibroid cell proliferation
Naturopathic approach to fibroids
Support oestrogen balance and detoxification
Regulate excessive bleeding
Reduce inflammation
Why is it important to reduce oestrogen levels in fibroids?
Fibroids are oestrogen dependent
Oestrogen receptors are over-expressed in fibroid tissue
Excess aromatisation also seen
IGF and cytokines also promote fibroid growth
Protocols for supporting oestrogen balance and detoxification in fibroids
Eliminate caffeine and alcohol – for liver support
Support liver detoxification – cruciferous veg, B-complex, Mg, NAC
Choleretics/cholagogues - globe artichoke, turmeric
Increase phytoestrogen foods – chickpeas, flaxseed – for oestrogen balance
Increase fibre-rich wholefoods to improve oestrogen excretion
Green tea – epicatechins shown to inhibit fibroid cell growth Sage – for oestrogen balance
Red clover – for oestrogen balance
Vitex Agnus castus – prolactin inhibitor
Avoid endocrine disrupters/xenoestrogens
Address stress – to reduce cortisol/inflammation
Protocols to regulate excessive bleeding in fibroids
Fe-rich foods - spirulina, apricots, nettle leaf tea
Vit C - to enhance absorption
Astringent herbs to control blood flow - yarrow, cranesbill
Check Fe/ferritin levels
Protocols to reduce inflammation in fibroids
Eliminate all sources of arachidonic acid - refined sugars, red meat, eggs
O3
Ginger
Curcumin
Bromelain
Serrapeptase
What are the 5 stages of menopause (plus ages)?
Premature menopause (<40)
Early menopause (40-45)
Perimenopause (45-50)
Menopause (50-55)
Post-menopause (55+)
What are the hormonal changes during perimenopause?
FSH and LH levels rise due to reduced negative feedback
O:P ratio fluctuates a lot
What are the hormonal changes during menopause?
Low oestrogen
Persistently high FSH and LH
What are the hormonal changes post menopause?
Insufficient testosterone from adrenal glands to sustain libido
(assess adrenal health)
What factors can affect the smooth transition through to menopause?
Obesity
Smoking
Chronic stress
Gut microbiome changes
Family history
Lead exposure
Signs/symptoms of menopause
Hot flushes (spicy food, alcohol, stress, smoking, caffeine)
Weight gain/obesity (genetic factors, hormonal)
Sleep disturbance (night sweats)
Mood disturbances (irritability, mood swings, anxiety, depression)
Genitourinary (dry/sore vagina, dysuria)
Joint/muscle pain
Headaches
Dry skin
Low libido
Poor memory/concentration
Natural approach to supporting menopause
Increase AO/fibre
Include 1x phytoestrogen source day (flax, fermented soy, sage)
Plant protein over animal
Prebiotic/probiotic foods
Drink at least 1.5 l water/day
Low GI diet
O3
Avoid food/beverages aggravating hot flushes - alcohol, caffeine, spicy food
Lose weight
Balancing blood glucose
Protocols for reducing fracture risk in menopause
Ca
Vit C, D, K2
Mg
Black cohosh
Weight bearing exercise
Protocols for managing stress/anxiety in menopause
Mg
L-theanine
B vits
Ashwagandha
Bach flowers
Yoga
Acupuncture
Breathing exercises
Protocols for improving sleep in menopause
Passionflower
Valerian
Mg
Why is black cohosh good for menopause?
Oestrogen modulating
Energetically cooling
Reduces hot flushes
Supports bone density
Why is shatavari good for menopause?
Testosterone effects
Adaptogen
Relieves vaginal dryness
Which herbs are good for calming in menopause?
Chamomile
Valerian root
Passionflower
Why is St John’s Wort good for menopause?
Reduces hot flashes
Improves sleep
Improves mood
Relieves anxiety
Why is liquorice root good for menopause?
Mildly oestrogenic
Why is maca good for menopause?
Improves libido
Improves sleep
Improves hot flushes
Improves mood
Interferes with androgen receptors
