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CNM Nutrition 2 S1 > Womens Health > Flashcards

Womens Health Flashcards

1
Q

Name the 3 main oestrogens?

A
  1. Oestradiol - active form (main one)
  2. Oestrone - acrylic (high in people with PCOS)
  3. Oestroil - weak form for excretion (high in pregnancy)
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2
Q

State oestrogens main role?

A

Increase growth of cells in places where there are oestrogen receptors (proliferation).

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3
Q

What is aromatisation?

A

The peripheral conversation of androgens to oestrone

via aromatase.

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4
Q

What is aromatase and where is it found?

A

Phase 1 liver enzyme, CYP450 pathway enzyme
Brain, adipose tissue, placenta, blood vessels, skin, bone, endometrium. Also in tissue of endometriosis, breast cancer, uterine fibroids, endometrial cancer.

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5
Q

How is oestradiol transported?

A

Sex Hormone Binding Globulin (SHBG) in the blood stream.

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6
Q

Where is Sex Hormone Binding Globulin (SHBG) made and when is it upregulated?

A

Made in the liver.

Upregulated when there is high free oestrogens and low testosterone.

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7
Q

Explain oestradiol’s secretion and levels throughout the menstrual cycle.

A

Ovaries secrete it after menstruation as FSH starts to develop the follicles.
Some is converted to weaker from oestrone - both stimulate growth.
Reach peak just before ovulation then stay stable until a drop just prior to menstruation.

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8
Q

Name the 3 metabolites oestradiol is converted to.

A

2-hydroxyestrone - healthy
4-hydroxyestrone - less healthy
16-hydroxyestrone - less healthy
Elevated levels of 4 and 16 associated with higher risk of breast cancer.

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9
Q

What would high homocysteine levels indicate in relation to methylation? What nutrients modulate methylation?

A

It would suggest less than optimal methylation.

B vitamins modulate methylation.

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10
Q

The conversion of oestrogen occurs in what pathway?

A

CYP450 pathway via CYP1A1 (2-OH), CYP1B1 (4-OH), CYP2C / 3A4 (16-OH).
This is the phase 1 pathway.

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11
Q

Phase 2 pathways do what to the oestrogen metabolites?

A

Covert them to a water-soluble molecule that is excreted via urine or bile.

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12
Q

Name the 3 ways phase 2 conjugation an occur.

A

Sulphation, Methylation and Glucuronidation.

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13
Q

What is Sulphration?

A

A phase 2 pathway which adds to the circulating oestrogen pool as the conjugated metabolite can be de-sulphated by sulphotransferase to be used again.

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14
Q

What is Methylation?

A

A phase 2 pathway which produces 2-methoxyoestrogen which has a protective quality.

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15
Q

What is Glucuronidation?

A

A phase 2 pathway which occurs via UGT.

Once glucuronidated the oestrogen metabolite is excreted via bile into small intestine.

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16
Q

What happens to the glucuronidated oestrogen metabolite during Glucuronidation in the presence of an imbalanced bowel flora?

A

The metabolite becomes de-conjugated and reabsorbed into enterohepatic circulation.

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17
Q

What will improve the excretion of oestrogens in the Glucuronidation pathway?

A

Symbiotic bacteria, calcium d-glucurate and fibre.

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18
Q

What eventually happens to all remaining oestrogens?

A

Pass through kidney where it is changed into oestriol (weak form) which is excreted in the urine.

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19
Q

What 3 places is Progesterone made?

A
  1. Adrenals - small amounts
  2. Ovaries - large amounts
  3. Placenta - massive amounts
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20
Q

Progesterone is a 21-carbon steroid, what is its main role?

A

Maintaining a healthy pregnancy.

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21
Q

Name 2 species of bacterial which can be helpful in the bowel flora to prevent de-conjugation of excreted oestrogens.

A
  1. Lactobacillus Acidophilus

2. Lactobacillus bifidobacterium

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22
Q

What 3 pathways in relation to liver detoxification should we make sure are working optimally to avoid de-conjugation of excreted oestrogens?

A
  1. CYP1A1 - increase with indole-3 carbinol
  2. Methylation - increase with B vits (5-MTHF, B12, B6)
  3. Glucoronidation - increase with calcium d-glucarate
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23
Q

Define a ‘hormone disruptor’.

A

An exogenous agent that interferes with the production, release, transport, metabolism, binding, transport or elimination or natural hormones in the body.

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24
Q

Name some of the most common hormone disruptors.

A

Bisphenol-A (BPA), fire retardants, lead, mercury.

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25
Q

Avoidance of what food category is crucial in any hormone imbalance condition and why?

A

Dairy. It contains insulin-like growth factors (ILGF) and oestrogens, although the amount is deemed ‘safe’ we shouldn’t add to the free circulation oestrogen load.

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26
Q

What is DIM and what does it do?

A

A cruciferous indole of 2 molecules of indole-3 carbinol bound together (safer and more potent than indole-3 carbinol). It inhibits the conversion of oestrone to 16-OH (the bad one).

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27
Q

Recommended therapeutic dose for DIM?

A

100-400mg per day.

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28
Q

Recommended therapeutic dose for indole-3 carbinol?

A

200-800mg per day.

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29
Q

What drugs is there a potential interaction between DIM and?

A

OCP and other oestrogen containing drugs.

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30
Q

How much DIM does 1/2 cup Brussels sprouts contain?

A

104mg.

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31
Q

What are phytoestrogens?

A

Plan-derived dietary components with structural similarity to E2 (primary female sex hormone). They can cause both pro and anti-oestrogenic effects by binding to oestrogen receptors.

32
Q

State 3 benefits of phytoestrogens and 1 potential draw back?

A
  1. Lowered menopausal symptoms
  2. Lowered risk of breast cancer
  3. Lowered risk of CVD
    However, the anti-oestrogenic actions could potentially act as endocrine disruptors.
33
Q

Where can we find phytoestrogens?

A

Isoflavones such as genistein in soya and legumes.
Prenylflavones in hops and beer.
Coumenstans in split peas, beans and alfalfa sprouts.
Lignans in flaxseeds, whole grains, fruit and veg.

34
Q

State 5 things we can do to balance hormones with diet.

A
  1. Increase fiber to promote bowel clearance of metabolites.
  2. Increase phytoestrogens from wholefood to modulate hormone production.
  3. Ensure adequate protein intake - needed for metabolism of oestrogen in the liver.
  4. East brassica family 3 times a week - upregulates CYP1A1.
  5. Eat foods rice in folate and B vits - increases methylation abilities.
  6. Eat fermented food to help bowel flora flourish.
  7. Stop/reduce alcohol consumption - interferes with liver detoxification pathways.
35
Q

3 supplements to consider to help reduce oestrogen metabolites.

A
  1. Calcium d-glucarate - increase glucuronidation pathway.
  2. Indole-3 carbinol or DIM - increase oestrogen clearance.
  3. Inositol or B6 - reduce elevated oestradoil levels.
  4. Zinc and magnesium - essential co-factors in hormone production.
36
Q

What is PCOS?

A

A condition in which women have abnormalities in the metabolism of androgens and oestrogens and with the control of androgen production.

37
Q

List 3 symptoms of PCOS.

A
  1. Amenorrhoea or Oligomenorrhea.
  2. Hirsutism.
  3. Acne.
  4. Obesity / insulin resistance.
38
Q

List 3 clinical observations of PCOS.

A
  1. Serum testosterone and other androgens raised (DHEA and aldosterone).
  2. Pearl necklace of cysts around ovary.
  3. Oestrone levels elevated.
  4. Blood glucose and insulin raised.
  5. Cholesterol levels raised.
39
Q

List 5 potential causes of PCOS.

A
  1. Insulin resistance.
  2. Ovarian dysfunction.
  3. Excess weight gain.
  4. Adrenal dysfunction.
  5. Hypothalamus-pituitary axis dysfunction.
  6. Genetic predisposition.
  7. Leptin regulation.
40
Q

What does a typical PCOS lipoprotein profile look like? State 3 things.

A
  1. Elevated total cholesterol.
  2. Elevated triglycerides.
  3. Elevated LDL (bad).
  4. Low HDL (good).
41
Q

State 3 tests you would consider when working with a client with PCOS.

A
  1. Salivary Adrenal Stress Index.
  2. Glucose tolerance test / insulin resistance test.
  3. Thyroid panel.
  4. Salivary or serum expanded female hormonal panel, including testosterone and LH to FSH ratio.
  5. Blood lipid profile.
42
Q

State 2 typical hormonal disturbances associated with PCOS.

A
  1. LH elevated, FSH low, ratio 2:1.
  2. Low progesterone.
  3. Low SHBG.
  4. Androgens such as testosterone and DHEA-S low.
43
Q

List 3 common orthodox treatments for PCOS?

A
  1. Metformin - to moderate insulin resistance.
  2. OCP - to treat ache or hirsutism.
  3. Clomiphene - to improve ovulation and fertility.
44
Q

State 3 naturopathic treatment aims for a client with PCOS.

A
  1. Decrease central obesity and improve muscle composition.
  2. Decrease insulin resistance and glucose intolerance to improve hormonal profiles.
  3. Promote liver and gut oestrone clearance.
  4. Lower circulating androgens by reducing aromatase activity.
  5. Normalise cortisol levels.
45
Q

State 2 ways we can help promote oestrogen clearance.

A
  1. Evaluate bowel function and microflora of the intestine.
  2. Increase consumption of the brassica family.
  3. Support phase 2 liver clearance through supplemental or herbal support.
  4. Reduce sources of endocrine disruptors and general toxic burden.
46
Q

Where can you find myo-inositol in food and how might this beneficial for a client with PCOS?

A

Fruits, beans, grains and nuts.
It has been shown to improve insulin resistance
and induce ovulation in women with PCOS.

47
Q

State 3 supplements that may be beneficial for clients with PCOS and why?

A
  1. Inositol - improves insulin resistence and induces ovulation.
  2. Vitamin D - levels usually low with PCOS.
  3. Calcium - helpful when used with Vit D, increases number of dominant follicles.
  4. Chromium picolinate (200mcg) - improve glucose tolerance.
  5. Magnesium (100-600mg) - improves insulin resistance and reduces cardiovascular risk factors.
  6. Omega 3 fatty acids - decrease hepatic fat in women (when combined with B vitamins reduced homocystein levels associated with Metformin treatment).
48
Q

Define uterine fibroids.

A

Non-cancerous tumours of the uterus which may occur submucosally or intramurally. Their growth is stimulated by oestrogen.

49
Q

State 3 symptoms of Uuterine fibroids (note - majority are asymptomatic and are picked up due to infertility investigations).

A
  1. Heavy bleeding or flooding.
  2. Infertility and miscarriage.
  3. Increased urinary frequency.
  4. Abdominal enlargement.
50
Q

State 3 risk factors for uterine fibroids.

A
  1. Obesity.
  2. OCP.
  3. Smoking.
51
Q

State 3 naturopathic treatment aims for a client with uterine fibroids.

A
  1. Improve liver and bowel clearance of free circulating oestrogens.
  2. Reduce inflammation.
  3. Reduce aromatisation (it is higher in fibroid cells).
  4. Improve progesterone/oestrogen balance.
52
Q

What 2 ways could we help reduce heavy bleeding in clients with uterine fibroids?

A
  1. Check for anaemia and serum ferritin levels and replace iron if necessary (10-30mg) - reduced heavy bleeding tenancies.
  2. Astringent herbs such as Yarrow or Shepherd’s Purse
53
Q

State 2 ways you may reduce inflammation in a client with uterine fibroids.

A
  1. Introduce prostaglandin modulating substances such as turmeric and bromelain.
  2. Topical applications of castor oil packs (also good for pain).
54
Q

Define endometriosis.

A

The presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. 30-40% of cases result in infertility.

55
Q

State 4 symptoms of endometriosis.

A
  1. Dysmenorrhea (painful).
  2. Heavy or irregular bleeding.
  3. Lower abdominal or back pain.
  4. Bloating, nausea, and vomiting.
  5. Pain during exercise.
56
Q

3 risk factors for endometriosis.

A
  1. 15% of women ages 24-40 affected.
  2. Family history.
  3. Shorter menstrual cycles and longer duration of flow
57
Q

Explain retrograde flow as a cause of endometriosis.

A

During menses, blood flows backward and becomes seeds of implants in the pelvic cavity (but more than 90% of menstruating women have retrograde flow).

58
Q

Explain altered cell immunity as a cause of endometriosis.

A

Implants of tissue sometimes found in odd locations (nose, lungs). Some believe the implants to be of embryologic origin, when pieces of the uterus were left
behind during development. Immunologic alterations may exist - suppressed NK cell activity, high levels of IgG and IgM, and high levels of autoantibodies against ovary and endometrial cells.

59
Q

2 orthodox medical treatment for endometriosis.

A
  1. Anti-inflammatory pain killers

2. Hormone treatments designed to shrink endometrial tissues - Danazol

60
Q

What is the link between PCB’s and endometriosis.

A

High levels of PCB’s found in women with endometriosis.

61
Q

3 things which can help alleviate endometriosis/reduce the risk.

A
  1. Regular exercise - 40-80% reduction in risk.
  2. Healthy diet, omega 3’s, vit d etc assocaited with lower risk.
  3. Pycnogenol - improves symptoms.
62
Q

State 3 aims for a client with endometriosis.

A
  1. Normalise the immune response.
  2. Optimise liver function to conjugate and metabolise hormones.
  3. Reduce exposure to hormone disruptors.
  4. Reduce inflammatory process and oxidative stress.
63
Q

Define PMS.

A

Recurrent signs and symptoms that develop during the late luteal phase of the menstrual cycle and disappear by the end of the full flow of menses.

64
Q

What is the principal neurotransmitter implicated in the

pathogenesis of PMS?

A

Serotonin.

65
Q

Which 3 things may help alleviate the symptoms of PMS when supplemented?

A
  1. B6
  2. Calcium
  3. Magnesium
66
Q

State 5 dietary changes you would suggest to a client with PMS.

A
  1. Reduce high GI foods - especially prior to menses.
  2. Avoid caffeine and alcohol.
  3. Limit/eliminate dairy products.
  4. Increase oily fish.
  5. Increase leafy green vegetables.
  6. Reduce salt intake.
67
Q

Define menopause.

A

The time which menstruation and reproductive potential ceases.

68
Q

Why does menopause happen?

A

Results from loss of ovarian sensitivity to gonadotropin
stimulation. Menopause is thought to occur when there are no viable eggs left in the ovaries. Both
oestrogen and progesterone decline gradually over time.

69
Q

What happens post menopause? How is this relation to cancer?

A

Cessation of ovulation = oestrogen production by the aromatisation of androgens in the
ovarian stroma and oestrogen production in extragonadal sites continues unopposed by progesterone production by a corpus luteum. Perimenopausal and menopausal women are often exposed to unopposed oestrogen for long periods, and this exposure can lead to endometrial hyperplasia, a
precursor of endometrial cancer.

70
Q

What two things would a doctor look at to diagnose menopause?

A
  1. No periods for 12 months.

2. FSH level of over 30 IU/L

71
Q

What 2 tests might you run or suggest a client has their GP done if they are going through the menopause or have gone through it?

A
  1. Adrenal function - body relies on adrenals to produce sex hormones once ovaries stop producing the majority and conversion happens via aromatisation in the muscle and adipose tissue – support adrenal function to make for a smoother transition.
  2. Thyroid function - commonly changes around menopause.
72
Q

Why should you consider bone density and cardiovascular health when working with a client who is going through the menopause or have gone through it?

A

Osteoporosis risk increases due to the lack of oestrogen - monitor bone density and levels of calcium, magnesium, boron, vitamin K and D.
Lack of oestrogen increases a woman’s risk for CVD - Vitamin C reduces elevated C-reactive protein (risk factor for CVD).

73
Q

What vitamin may be helpful in reducing hot flushes associated with the menopause?

A

Vitamin E.

74
Q

What is black cohosh and what condition might it be used for?

A

A phyto-oestrogen - used to improve symptoms of menopause.

75
Q

3 dietary recommendations for someone going through the menopause.

A
  1. 2 fruit and 5 vegetables - antioxidants.
  2. Wholegrains - gamma-oryzano shown to reduce hot flushes.
  3. More vegetarian and less animal protein - reduce endocrine disruptors.
  4. Increase fibre to support healthy hormone metabolism.
  5. Eat phytoestrogen rich foods - organic tofu, tempeh, beans etc.
  6. 2 litres of water.

CNM Nutrition 2 S1 (10 decks)

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