Maintaining Women’s Health – across all stages of life
Written by Phoebe Wynne-Lewis, BHSc, Dip Nat Med, Dip Herb Med – FxMed Technical Support
The Female Reproductive System
The female reproductive system plays such an important role throughout the life of a woman. It includes the uterus, fallopian tubes, ovaries, cervix and external genitalia. Due to the complexity of the reproductive system, a woman can experience a number of problems ranging from vaginal yeast infections to uterine fibroids or ovarian cysts.
In essence, hormones are “chemical messengers”. Some hormones are of special concern to women. The sex hormones produced by the ovaries are not only involved in the growth, maintenance and the repair of the reproductive tissues, but they also influence other body tissues, including bone mass as well. This can be a problem for women who strive for lower body fat. Women with low body fat often do not produce sufficient amounts of sex hormones. They can, therefore, experience a cessation of menstruation, osteoporosis (thinning of the bones), fractures and other conditions similar to those faced by many post-menopausal women.
Hormonal problems for women are not confined to those involving the sex hormones. For example — thyroid disorders such as hyperthyroidism and hypothyroidism are also very common in females.
Diseases More Common in Women
Many diseases affect both women and men alike, but some diseases occur at a higher frequency in women. For example, gallstones and migraine headaches (three to four times more common in women). Also more common is: IBS, UTI’s, hypertension, osteoporosis and autoimmune disorders (e.g. Multiple Sclerosis and Lupus). Autoimmune disorders afflict 15.4% of Americans and 3/4 of them are women (according to American Autoimmune & Related Disorders Association). It is safe to assume that our rates are similar in NZ and Australia.
Certain cancers are of specific concern to women. These include not only cancer of the female organs, such as the breast, cervix, uterus and ovary but also of the pancreas, large bowel (colorectal cancer) and lung. Globally, cardiovascular disease, often thought to be a ‘male’ problem, is the number one killer of women. It is now described as an “equal opportunity killer.”
Approximately 70%-90% of women suffer from premenstrual syndrome. PMS symptoms include irritability, nervousness, cramps, bloating and headaches. Every step of a woman’s menstrual cycle is controlled by hormones. The production of these hormones is dependent on the general good health of the woman. However, stress, over taxed adrenals, estrogen dominance, diet, social issues and many other factors affect the production of hormones and can result in PMS symptoms.
Healthy blood sugar metabolism in PCOS & post menopause
Polycystic ovarian syndrome (PCOS) is a highly prevalent hormonal and metabolic disorder among reproductive aged women worldwide. In addition to concern for menstrual cycle function, ovulation, hirsutism and acne, many PCOS women have abnormal glucose metabolism. While diabetes mellitus and impaired glucose tolerance are easily diagnosed, the diagnosis of and concern for insulin resistance as a precursor disorder is underappreciated. Insulin resistance may be the first important marker of metabolic disease in PCOS women at risk for metabolic syndrome and coronary artery disease.
Although estimates vary, about 30%-80% of women with PCOS have insulin resistance.
Hyperinsulinemia produces hyperandrogenism (excessive levels of male hormones such as testosterone) by stimulating ovarian androgen production and by reducing serum sex-hormone binding globulin (SHBG). This can make PCOS symptoms a lot worse. Therefore, measures to decrease this condition may have to be considered earlier to decrease the potential risks of developing diabetes mellitus and coronary artery disease at later ages of life in both overweight and normal weight women who have PCOS.
During and after menopause, three common clinical challenges are;
1. Getting restful sleep — The circadian clock is one of the most powerful regulators of metabolism. It is also one of the most easily disrupted systems, particularly at menopause. Located in the hypothalamus and in cells throughout the body, the circadian clock rhythmically prepares the gut, liver, pancreas, muscle and fat cells to anticipate caloric energy in daylight hours, when metabolism of glucose, fat and other nutrients is optimal.
2. Maintaining insulin and glucose homeostasis — In post menopausal women estrone is the dominant estrogen produced. However this is a lot weaker than the most active form estradiol. Hence the estrogen effect is greatly diminished. Estrogen and estrogen receptors (ERs) are wellknown regulators of glucose homeostasis and several studies associate estrogen to various aspects of the metabolic syndrome. Estrogen actions in the hypothalamus control food intake, energy expenditure, and white adipose tissue distribution. Estrogen actions in skeletal muscle, liver, adipose tissue and immune cells are involved in insulin sensitivity as well as prevention of lipid accumulation and inflammation. Estrogen actions in pancreatic islet ?-cells also regulate insulin secretion and nutrient homeostasis.
Estrogen deficiency promotes metabolic dysfunction and therefore postmenopausal women are more likely to develop visceral obesity, insulin resistance and are at high risk for type 2 diabetes.
3. Maintaining a healthy body weight — With the loss of estrogen, post menopausal women may have a lower metabolic rate and become more insulin resistant, so higher levels of insulin are secreted, causing increased fat storage.
Healthy Estrogen metabolism in Breast health & Menopause
Each of the three types of estrogens have particular functions.
Estriol (E3) is secreted in large quantities by the placenta during pregnancy.
Estradiol (E2) is the predominant form in reproductive females and primarily aids in the release of eggs from the ovaries. E2 has beneficial effects on the heart, bone, brain & colon. Reduction in the level of E2 as women age causes common menopausal symptoms such as hot flashes & night sweats.
Estrone (E1) is the dominant estrogen in postmenopausal women.
It is common however, for the ratios of these estrogens to be disrupted through various ways; synthetic estrogens, estrogens in animal products, xenoestrogens, phytoestrogens and endogenous estrogens. Once estrogen is produced and released into the bloodstream, it reaches its target tissues and the liver. Some researchers now believe that the liver’s ability to metabolize estrone is the key to understanding estrogen-related cancer risk. During Phase I metabolism, estrone is converted into various metabolites including 2-hydroxyestrone, a very weak estrogen, and 16-alphahydroxyestrone, a very potent estrogen. If the conversion process favours the stronger form rather than the weaker form, then tissue that has an abundance of estrogen receptors, such as the breasts and uterus, may be more vulnerable to excessive estrogen activity, potentially leading to the formation of fibroids or the stimulation of estrogen-sensitive cancers. Research suggests that endogenous estrogen levels are positively associated with postmenopausal breast cancer.
More than 50% of the metabolism and conjugation of estrogens takes place in the liver, therefore targeting the liver becomes central when it comes to affecting the circulating estrogen ratio. The liver metabolizes hormones & other substances using the Phase I and Phase II pathways.
Estrogen metabolism is also accomplished by the gastrointestinal system. Approximately 50% of the estrogen conjugates, eventually pass into the intestine and are hydrolyzed by intestinal bacteria. The hydrolysis of estrogen-glucoronides is accomplished by the bacterial enzyme called beta-glucuronidase. Certain nutritional supplements and diet can enhance the level of activity of this enzyme.
Beneficial modulation of estrogen metabolism can be accomplished through dietary and lifestyle modifications. Adopting a primarily plant-based diet provides phytochemicals, antioxidants, fibers and essential nutrients to support the health of epithelial cells, which are particularly sensitive to hormones and environmental exposures. Supplements may help support breast health and the stage of menopause through multiple pathways involving detoxification, estrogen metabolism, cellular signalling and gene expression.