Women's Health - Sex hormones

Question 1

What is the role of the hypothalamic-pituitary-ovarian (HPO) axis in the female reproductive system?

Answer 1

A: The HPO axis maintains hormonal balance by stimulating the production of LH and FSH, supporting follicle development, ovulation, corpus luteum maintenance, and the production of progesterone, oestrogen, and inhibin.

Question 2

Q: What does raised oestrogen and testosterone do in the HPO axis?

Answer 2

A: They exert negative feedback over FSH and LH secretion.

Question 3

Q: What is pregnenolone and where is it synthesised?

Answer 3

A: Pregnenolone is a hormone synthesised from cholesterol in steroidogenic tissues such as the adrenal gland, gonads, and brain by the mitochondrial enzyme CYP11A1.

Question 4

Q: What are the primary functions of progesterone?

Answer 4

A: Maintains the endometrium for implantation, increases cervical mucus, supports bone health, and aids mammary development.

Question 5

Q: What can low progesterone lead to, and what are its symptoms?

Answer 5

A: Low progesterone leads to oestrogen dominance. Symptoms include irritability, mood swings, insomnia, and an increased risk of breast cancer.

Question 6

Q: Name three types of oestrogens and their primary sites of production.

Answer 6

A: Oestrone (E1), oestradiol (E2), and oestriol (E3), produced via aromatase conversion in the ovaries, bone, breast, and adipose tissue.

Question 7

Q: What is oestrogen dominance and its associated conditions?

Answer 7

A: A state of excess oestrogenic activity. Associated with fibroids, endometriosis, PMS, infertility, breast/ovarian cancers, thyroid dysfunction, and anxiety.

Question 8

Q: What are the main pathways of phase 1 oestrogen biotransformation?

Answer 8

A: Conversion to 2-OH-E (protective), 4-OH-E (pro-carcinogenic), and 16α-OH-E (highly proliferative).

Question 9

Q: What enzymes are involved in phase 2 oestrogen metabolism?

Answer 9

A: Sulphation, methylation, or glucuronidation enzymes, including COMT, which deactivate reactive oestrogen metabolites.

Question 10

Q: What is the oestrobolome, and why is it important?

Answer 10

A: A collection of gut microbes that metabolise oestrogens, maintaining oestrogen homeostasis and reducing oestrogen load.

Question 11

Q: How can beta-glucuronidase activity be balanced in the microbiome?

Answer 11

A: Increase dietary fibre, calcium D-glucarate, probiotics, and prebiotics; focus on a healthy gut microbiome.

Question 12

Q: Where is testosterone produced, and what are its primary functions in women?

Answer 12

A: Produced in the ovaries and adrenal cortex. Functions include supporting ovarian density, libido, bone strength, mood, and cognition.

Question 13

Q: What enzyme converts testosterone to DHT, and how is this pathway regulated?

Answer 13

A: 5α-reductase converts testosterone to DHT. It is upregulated by insulin, inflammation, and obesity, and downregulated by nettle root, saw palmetto, lycopene, turmeric, and zinc.

Question 14

Q: What is the role of sex hormone-binding globulin (SHBG)?

Answer 14

A: SHBG transports oestradiol, testosterone, and DHT in the blood, ensuring only unbound hormones are biologically active.

Question 15

Q: What factors can lower SHBG levels?

Answer 15

A: Hyperinsulinemia, obesity, metabolic syndrome, T2DM, hypothyroidism, and PCOS.

Question 16

Q: What is prolactin, and what are its functions?

Answer 16

A: Prolactin is a hormone that regulates lactation, breast maturation, and menstrual inhibition.

Question 17

Q: What can cause hyperprolactinaemia in non-pregnant women?

Answer 17

A: High cortisol (stress), pituitary tumours, vitamin D deficiency, circadian disruption, and dopamine antagonist drugs like domperidone.

Question 18

Q: What stimulates the anterior pituitary to produce and release LH and FSH?

Answer 18

A: GnRH (gonadotropin-releasing hormone).

Question 19

Q: What hormones are produced by the corpus luteum, and what is its primary function?

Answer 19

A: Progesterone, oestrogen, and inhibin. The corpus luteum supports the endometrium for implantation and early pregnancy.

Question 20

Q: What is the “pregnenolone steal theory”?

Answer 20

A: It states that high stress increases pregnenolone use for cortisol production, reducing availability for sex hormone production.

Question 21

Q: What dietary sources support healthy pregnenolone levels?

Answer 21

A: Avocado, flax and chia seeds, olive oil, walnuts, B vitamins, vitamin K, and vitamin D3.

Question 22

Q: What are some natural ways to balance progesterone levels?

Answer 22

A: Support oestrogen detoxification, increase fibre intake, eat three balanced meals per day, avoid alcohol, and consider magnesium, vitamin C, B6, zinc, and Vitex Agnus castus.

Question 23

Q: What role does aromatase play in oestrogen production?

Answer 23

A: Aromatase converts androgens into oestrogens in tissues like the ovaries, bone, breast, and adipose tissue.

Question 24

Q: What receptor types do oestrogens bind to?

Answer 24

A: ERα, ERβ, and GPER (G-protein coupled estrogen receptor).

Question 25

Q: What are the primary functions of oestrogen?

Answer 25

A: Reproductive tract development, menstrual cycle regulation, cell proliferation, glucose homeostasis, immune robustness, and bone and cardiovascular health.

Question 26

Q: What are some causes of oestrogen dominance?

Answer 26

A: Synthetic HRT, oral contraceptives, xenoestrogens, heavy metals, obesity, poor liver detoxification, genetic mutations, intestinal dysbiosis, and chronic stress.

Question 27

Q: How does chronic stress affect the HPO axis?

Answer 27

A: Chronic stress downregulates LH and FSH, leading to decreased ovulation and hormonal imbalances.

Question 28

Q: What is the difference between 2-OH-E, 4-OH-E, and 16α-OH-E in oestrogen metabolism?

Answer 28

A:

2-OH-E: Weakest and protective form.
4-OH-E: Pro-carcinogenic metabolite.
16α-OH-E: High binding affinity with proliferative effects.

Question 29

Q: What foods support phase I oestrogen metabolism?

Answer 29

A: Cruciferous vegetables, I3C, turmeric, resveratrol, berries, rooibos tea, and celery.

Question 30

Q: Which nutrients support methylation in phase II oestrogen metabolism?

Answer 30

A: Folate, vitamins B2, B6, B12, SAMe, and choline.

Question 31

Q: What are the effects of high beta-glucuronidase activity in the microbiome?

Answer 31

A: Reactivation of oestrogens, leading to increased enterohepatic circulation and oestrogen dominance.

Question 32

Q: What conditions are associated with high beta-glucuronidase activity?

Answer 32

A: Endometriosis and oestrogen dominance.

Question 33

Q: How can testosterone levels impact women with PCOS?

Answer 33

A: High testosterone can lead to androgen dominance, causing symptoms like anovulation, hirsutism, and acne.

Question 34

Q: What factors upregulate and downregulate the conversion of testosterone to DHT?

Answer 34

Upregulate: Insulin, inflammation, and obesity.
Downregulate: Nettle root, saw palmetto, lycopene, turmeric, and green tea.

Question 35

Q: What conditions are associated with low SHBG levels?

Answer 35

A: Hyperinsulinemia, obesity, metabolic syndrome, T2DM, hypothyroidism, and PCOS.

Question 36

Q: What role does prolactin play in reproductive health?

Answer 36

A: Prolactin regulates lactation, breast maturation, and menstrual inhibition.

Question 37

Q: How can stress and high cortisol levels increase prolactin?

Answer 37

A: High cortisol affects dopamine regulation, which can lead to increased prolactin secretion.