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CNH Nutrition 2 S3 > Women's Health > Flashcards

Women's Health Flashcards

1
Q

What axis maintains hormonal balance within the female reproductive system?

A

HPO (or HPG) axis

Hypothalamic-pituitary-ovarian (or gonadal)

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2
Q

Key female hormones and their roles

A

GNRH - stimulates anterior pituitary to produce and release LH and FSH
LH and FHS - support follicle development, ovulation, corpus luteum maintenance, progesterone, oestrogen and inhibin production
Progesterone and oestrogen regulate target organs e.g uterus, mammary glands

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3
Q

What is the impact of raised oestrogen and testosterone on FSH and LH?

A

Negative feedback loop to the hyperthalamus.

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4
Q

How is pregnenolone synthesised and what is it a precursor to (x6)?

A

Pregnenolone - grandmother / base hormone

Synthesised from cholesterol in steroidogenic tissues (adrenans, gonads and brain) by CYP11A1

Precursor to:
DHEA (dehydroepiandrosterone)
Testosterone
DHT (dihydrotestosterone)
Oestradiol
Progesterone
Cortisol

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5
Q

What causes low pregnenolone and what are the symptoms?

(similar to menopause / hypothyroid)

A

Advancing age and statins

Poor memory
Declining concentration and attention
Fatigue
Dry Skin
Joint and muscle pain
Decreased libido

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6
Q

How to support healthy pregnenolone?
Think Chris Newbold

A

Think good fats, B vits, D and adaptogens

Avocado
Flax
Chia seeds
EVOO
Walnuts
B vitamins
Vit K
BD
Maca
rhodiola

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7
Q

Key points about ‘pregnenolone steal theory’

A

High stress increases = more pregnenolone for cortisol reducing sex hormones

However,

  • no giant pregnenolone pool
  • Stress down regulates LH and FSH to reduce ovulation
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8
Q

Progesterone synthesis & functions

A

Made in corpus luteum after ovulation, in the adrenals and placenta during pregnancy

Lack of ovulation = lack of progesterone

Functions:
Maintains the endometrium for pregnancy
Increased cervical mucus
Promotes GABA by modulating receptors to relax smooth muscle
Bone health
Mammary development

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9
Q

What causes progesterone imbalance or low progesterone?

A

Imbalance: perimenopause, PCOS and infertility
Low: stress, synthetic progesterone (OCP and some MHT (menopause hormone therapy, updated term for HRT)), xenoestrogens.

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10
Q

Signs and symptoms of low progesterone and how to balance

A

(low GABA symptoms) Irritability, mood swings, insomnia, increases breast cancer risk

Balance - support oestrogen detox (fibre, balanced meals, avoid snacking and alcohol)
Magnesium, vitamin C, B6, Zn, vitex agnus castus, Australian Bush Flower essence She Oak, exercise and box breathing.

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11
Q

What are the three types of oestrogen?

A

Oestrone (E1) - post menopause
Oestradiol (E2) - most active during reproductive years
Oestriol (E3) - produced in pregnancy by placenta

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12
Q

How is oestrogen produced and what receptors does it bind to?

A

Conversion of androgens via aromatase (aromatisation) in the ovaries, bone, breasts and adipose tissue.

note: tamoxifen is an aromatase inhibitor.

Binds to ER alpha
ER beta
GPER (oestradiol) E2

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13
Q

Key functions of oestrogen?

A

Reproductive tract development
Menstrual cycle
Cell proliferation (esp breasts)
glucose homeostasis
Immune, bone and cardiovascular health

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14
Q

What is oestrogen dominance and how is it characterised?

A

Excess oestrogenic activity
Elevated oestrogen to progesterone (so oestrogen can be normal)
Elevated oestrogen due to poor detox/elimination
Overexpression of alpha and beta receptors

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15
Q

What conditions is oestrogen dominance associated with?

A

Fibroids
Endometriosis
PMS
Fibrocystic breasts
Breast/ovarian and endometrial cancers
Insulin resistance
Thyroid dysfunction
Brain fog
Anxiety and depression

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16
Q

Factors that can cause oestrogen dominance (aetiology on the slide)

A

Synthetic hormones - HRT/MHT OCP
Xenoestrogens
Heavy metals
Obesity - increased aromatisation of testosterone to oestrogen
Poor liver detox / methylation
Constipation
Genetic - COMP SNP
Dysbiosis
Stress (downregulates LH and FSH)

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17
Q

What 3 metabolites is E1 converted to by CYP450 enzymes?

PHASE 1 Oestrogen ‘biotransformation’

A

2-OH-E (CYP1A1) - weakest, protective form.
4-OH-E (CYP1B1) - pro-carcinogenic / neutralised by COMT
16a-OH-E (CYP3a4) - highest binding affinity / high proliferative effect. High levels associated with oestrogen dependent conditions (breast cancer/fibroids

More detail on slide 11.

18
Q

Describe Phase II oestrogen metabolism?

A

2-OH-E and 4-OH-E - methylation via COMT to become less reactive
undergo sulphation and *glucuronidation”
Excreted in urine or bile.

16a-OH-E - metabolises to E3 then sulphation

19
Q

What SNPs can impact Phase II oestrogen metabolism

A

Methylation SNPs - COMT SNP
Poor methylation increases conversion of 4-OH-E to quiones - oxidative damage to DNA.

20
Q

How do you support phase I oestrogen metabolism?

A

CYP3A4, CYP1A1, CYP1B1

I3C
Cruciferous veg
Antioxidants - turmeric, resveratrol, berries, tea, celery
Glutathione - also neuralises reactive quinones)
Support microbiome

AVOID
CYP450 inducers = paracetamol, PCBs, smoking, grapefruit

21
Q

How do you support phase II oestrogen metabolism?

A

Conjugation pathway support - cruciferous
Alliums
Magnesium
Antioxidants
Methylation support - folate, B12, SAMe, Choline

AVOID
OCP, high alcohol, high cortisol, mould

22
Q

What is the oestrobolome and what bacteria can it produce?

A

A collection of microbes that can metabolise oestrogens.

These bacteria produce beta-glucuronidase, bacteroides fragilis, bacteroides vulgatus, escherichia coli, clostridium perfringens

23
Q

What is beta-glucuronidase and what is its role in oestrogen metaboism?

A

A enzyme which deconjugates oestrogens that were already conjugated for elimination.

These oestrogens can be reabsorbed via enterohepatic circulation

A healthy gut produces the right amount of beta-glucuronidase to maintain oestrogen homeostasis. Too low or too high can be a problem.

24
Q

What other factors also negatively impact the oestrobolome?

A

Dysbiotic microbiome
Low fibre
Poor bile flow

25
Q

What conditions are imbalances in oestrobolome associated with?

A

Endometriosis - may have larger numbers of beta-glucuronidase producing bacteria
PCOS - lower beta-glucuronidase

Also - oestrogen associated cancers

26
Q

How do you maintain healthy beta-glucuronidase levels?

A

Optimise the micro-biome - probiotics / prebiotics

If high - increase fibre,
calcium D-glucarate (inhibitor)
Glucaric acid-rich foods - mung bean sprouts, apples, cruciferous veg, milk thistle
Consider 5R protocal

If low - focus on commensal support e.g. probiotics

27
Q

How is testosterone produced and what are its key functions in women?

A

In the ovaries and adrenal cortex
Converted to E2 via aromatase and DHT

Functions: ovarian density, libido, bone strength, mood, cognition.

28
Q

What is the impact of androgen dominance in PCOS?

A

Anovulation
hirsutism
Acne vulgaris

Driven by insulin resistance

29
Q

What is the impact of 5a-reductase on testosterone? What upregulates and down regulates?

A

It converts testosterone into more potent DHT

Upregulated - insulin, inflammation, obesity

Downregulated: nettle (esp root), saw palmetto, lycopene, zinc (shortened list)

30
Q

What is SHBG role, what is it and where is it produced?

A

Sex homones are not water-soluble so need to be transported in blood bound to SHBG

Glycoprotein synthesised by the liver

31
Q

When do you see lower and high levels of SHBG?

A

Lower - higher circulating free/ active hormone levels - hyperinsulinemia, obesity, metabolic syndrome, T2DM, hypothyroidism, PCOS

High - anorexia, pregnancy, androgen deficiency, hyperthyroidism

32
Q

Which hormones control prolactin and what are its functions?

A

Oestrogen (increases prolactin) and dopamine (reduces prolactin)

Functions:
Lactation
Breast maturation
Inhibits menstruation

33
Q

What is increased prolactin associated with? (think what happens post childbirth)

A

Infertility
Menstrual irregularities
Low libido
Breast pain and vaginal dryness

Hyperprolactinaemia - occurs naturally in pregnancy and lactation but can also occur in non-pregnant women.

34
Q

What increases prolactin?

A

Cortisol
Pituitary tumours
Circadian disruption
Renal failure
Vitamin D deficiency
Dopamine antagonist drugs (domperidone)

35
Q

What are endocrine disrupting chemicals (EDC) and give some examples?

A

Exogenous agents that interfere with the production, release, transport, metabolism, binding, action or elimination of hormones

Examples: BPA
Phthalates
Heavy metals
Perticides
Herbicides
Fire retardants
Some drugs (NSAIDs)
Tap water (contains many of the above)

36
Q

Mechanism for endocrine disrupting chemicals, what health effects are they linked to and what are the critical windows of susceptibility?

A

Alter hormone receptor signalling, sex hormone production, secretion and metabolism

Induce oxidative stress, mitochondrial damage and epigentic alterations

Increased risk of: cancer, PCOS, early puberty, infertility, cognitive deficits.

Window of susceptibility - in utero, neonatally, childhood and puberty.

37
Q

What are xenoestrongers, where to they bioaccumulate and typical sources of exposure?

A

Sub-category of EDC (endocrine disrupting chemicals), structurally similar to oestrogen that can bind to oestrogen receptors.

E.g. pesticides, herbicides, dioxins, parabens, BPAs, tap water (chlorine, pharmaceuticals)

Build up in fat - human fat cells or meat/fish and dairy

Exposure - mainly food. Small amounts inhaled, absorbed through skin or mucus membranes.

38
Q

Considerations/concerns with dairy milk?

A

From pregnant cows
E1, E2 and E3 found in milk - higher in whole milk.
Plus other hormones - IGF, PCBs, dioxins, insecticides, bovine growth hormone (growth hormones banned in EU/UK)

Add to overall oestrogen load and should be avoided in hormonal imbalances.

39
Q

What are phytoestrogens and their key benefits?

A

Plant compounds structurally similar to 17b-oestradiol (E2) - oestrogen-modulators.

High oestrogen - weak anti-oestrogenic effect by reducing circulating bioavailable E2

Low oestrogen- weakly oestrogenic effect.

Disrupt aromatase

Benefits: lower menopause symptoms, CVD, obesity, metabolic syndrome, T2DM, breast cancer.

40
Q

3 key types of phytoestrogens and plant foods they are found in

A

Flavonoids (isoflavones, genisten, daidzein) - soybeans, legumes, lentils, chickpeas

CNH Nutrition 2 S3 (8 decks)

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