Category Archives: Women’s Health

Kidney, Liver, and Thyroid Health, Women's Health

Why is hypothyroidism more common in women?

Posted on by dnaserver

Thyroid problems can affect men, women, children, and even infants. However, by far the most commonly affected group is middle-aged and older women, with one in eight women likely to develop a thyroid disorder during her lifetime. This rate is five to eight times higher than the rate in men (1). So, the question is, why are rates so much higher in women?

First, let’s quickly go over the functions of the thyroid
The thyroid gland is a small organ located just under the skin in the neck. This bow tie-shaped organ is usually only about 5 cm across and normally can’t be felt or seen. The thyroid releases specific hormones (chemical messengers) that act on almost every tissue in the body (2). These thyroid hormones help regulate so many vital body functions, including:

  • Heart rate
  • Skin maintenance
  • Heat production
  • Fertility
  • Growth
  • Digestion
  • Rate at which calories are burned

What happens when the thyroid isn’t functioning properly?
Thyroid hormones influence so many different parts of the body, so when they are out of balance, lots of different symptoms can occur.

Hypothyroidism is an underactive thyroid, so it does not release enough thyroid hormones. This causes many of the body’s functions to slow down, causing symptoms like fatigue, slow heart rate, constipation, weight gain, and constantly feeling cold (3).

Hyperthyroidism is an overactive thyroid, so too many thyroid hormones are released into the bloodstream. This speeds up many of the body’s functions, causing symptoms like weight loss (even though appetite is increased), rapid or irregular heart rate, frequent bowel movements, sweating, and shaky hands (4).

To learn more about things that can affect your thyroid health, read our previous article here.

So, why are thyroid problems more common in women?
The risk of thyroid problems, in particular hypothyroidism, increases as a woman ages, as well as during pregnancy and the postpartum period (5). This is thought to be linked to the female hormone fluctuations that occur during each menstrual cycle, during pregnancy and the postpartum period, and especially the major hormonal changes that occur around menopause (6). Read our previous article here to learn more about the changes that occur at menopause.

Another reason for the increased risk of thyroid problems in women is because thyroid problems are often triggered by autoimmune responses, and these autoimmune responses are more common in women than in men (6).

What health problems in women are linked to thyroid disorders?
Thyroid problems in women are not only more common than in men, but they also can cause multiple additional symptoms. These symptoms can include:

  • Delaying or speeding up of puberty
  • Affecting period regularity and flow
  • Fertility issues
  • Premenstrual syndrome (PMS)
  • Increasing risk of ovarian cysts
  • Complications during pregnancy, including severe morning sickness, premature labour, or miscarriage
  • Earlier menopause

How can I get my thyroid function checked?
Checking the function of your thyroid is simple with a range of tests offered by us. Take our simple Thyroid Stimulating Hormone (TSH) Test for TSH alone, our Thyroid Health Panel to also include T4 and T3 along with TSH, or opt for the Thyroid Health, Complete Panel to also include Anti-Tg and Anti-TPO.

References:
1. General Information/Press Room. American Thyroid Association.
2. Hershnan JM. (Modified Oct 2020). Overview of the Thyroid Gland. Merck Manual Consumer Version
3. Hypothyroidism (Underactive Thyroid). National Institute of Diabetes and Digestive Kidney Diseases. NIH. Reviewed March 2021.
4. Hyperthyroidism (Overactive Thyroid). National Institute of Diabetes and Digestive Kidney Diseases. NIH. Reviewed August 2021.
5. Dunn D & Turner C (2016). Hypothyroidism in Women. Nursing for Women’s Health. 20(1): 93-98.
6. Why Women Are More Prone to Thyroid Problems? The Harley Street Ear Nose & Throat Clinic. (March 2018).

Women's Health

The importance of luteinizing hormone (LH)

Posted on by dnaserver

What is luteinizing hormone?
Luteinizing hormone (LH) is a crucial hormone in both males and females. In females, it regulates the function of the ovaries, while in males, LH regulates the function of the testes (1).

Why is luteinizing hormone so important in females?
In the first half of each menstrual cycle, LH stimulates the ovarian follicles of the ovary to produce estradiol. At mid-cycle (around day 14), there is a sharp increase in LH levels (known as the “LH surge”), which causes ovulation–the rupture of the ovarian follicle and release of an egg from the ovary. LH then stimulates the corpus luteum (formed from the ruptured ovarian follicle) to produce progesterone. Progesterone is needed to support a pregnancy if fertilization of the egg has occurred (1).

Why is luteinizing hormone so important in males?
LH is essential for testosterone production by the stimulation of the Leydig cells in the testes. This testosterone is needed for sperm production, as well as other effects all around the body, including increased muscle mass, growth of facial and body hair, and generation of a deeper voice (1).

What issues are related to elevated luteinizing hormone levels?
Both too much or too little LH can affect fertility. High levels of LH are associated with polycystic ovary syndrome (PCOS) in women, which is estimated to affect 6–12% of U.S. women of reproductive age (2). PCOS is characterized by an imbalance in LH and follicle-stimulating hormone (FSH) levels, which leads to higher-than-normal levels of testosterone causing irregular periods and ovulation issues (1). Elevated LH levels have also been linked to an increased risk of miscarriage (3).

High LH levels can also be caused by decreased sex steroid production (estrogen from the ovaries), which can occur in premature ovarian failure, where the ovaries stop working earlier than the normal menopause age of 40–58 years (1).

There are also genetic conditions that cause high LH levels, including Klinefelter’s syndrome in males and Turner syndrome in females. Generally, people affected by these conditions are infertile (1).

What issues are related to low luteinizing hormone levels?
Healthy LH levels are required for normal testicular and ovarian function, so if there is not enough LH, infertility can occur.

Kallmann’s syndrome is an example of a male condition associated with low LH levels. This occurs due to lower levels of gonadotrophin-releasing hormone and therefore reduced stimulation of the pituitary gland to synthesize and release LH (1).

Low LH levels in females can result in irregular periods and an absence of ovulation, therefore meaning that egg fertilization is impossible (1). Various conditions can contribute to low LH levels, including eating disorders, hyperprolactinemia, and hypopituitarism (4).

How can I check my LH levels?
We offer a Luteinizing Hormone test to measure your LH levels from a small blood sample self-collected from a finger prick. LH is also included in several of our larger Women’s Health panels: Women’s Fertility Panel, Women’s Hormone Panel, Women’s Health Hormone Panel, and Women’s Perimenopause Panel.

Please note that due to fluctuating LH levels in women of reproductive age, the blood sample should be collected on the third day of your menstrual cycle for optimal results.

References:
1. Luteinising hormone. You and your hormones, an education resource from the Society for Endocrinology. Reviewed Feb 2018.
2. PCOS (Polycystic Ovary Syndrome). CDC. Reviewed March 2020.
3. Homburg R, et al. (1988). Influence of serum luteinising hormone concentrations on ovulation, conception, and early pregnancy loss in polycystic ovary syndrome. BMJ. 297 (6655), 1024-1026.
Ross GT. (1985). Disorders of the ovary and female reproductive tract. In: Wilson JD, Foster DW, editors. Williams Textbook of Endocrinology, 7th ed. Philadelphia: WB Saunders Co. 206-258.

Women's Health

Perimenopause and postmenopause: what are they?

Posted on by dnaserver

Menopause is that time in a woman’s life when menstruation ceases and various hormonal changes occur. It signals the end of the reproductive part of a woman’s life. This normal, natural life event usually occurs between ages 40 and 58, with an average age of 51.

Menopause is defined as the final menstrual period and is confirmed after 12 consecutive months of no menstruation. However, the whole transition period, sometimes known as “the change”, can actually last for several years. This period is more technically called perimenopause, which translates to “around menopause”.

Perimenopause can last for 4 to 8 years, so that means that most women enter this life stage in their 40s. However, some women start to notice changes as early as their mid-30s. Perimenopause starts with variation in the length of time between periods and ends 1 year after the final menstrual period. So, although some people may consider perimenopause as the time prior to menopause, it actually includes the time of the last menstrual period (menopause) (1).

What changes occur during perimenopause?
Irregular menstrual periods occur in every woman during perimenopause. The time between periods can vary, as well as the length of each period, and the flow may be lighter or heavier. In some women, this is the only physical change that they notice.

Most women experience hot flashes–a sudden wave of heat usually in conjunction with sweating, skin reddening, and a faster heart rate. These hot flashes are severely problematic in about 1/3 of women, with some suffering from them for a decade or more (2).

Poor sleep is common during perimenopause. This is often due to hot flashes occurring during the night, known as night sweats (1). Depressed mood and increased anxiety are other relatively common changes during perimenopause (2).

Vaginal dryness is another common symptom, especially in the later stages of perimenopause (2). This can cause vaginal tightness during sex, along with pain or burning. Vaginal lubricants and moisturizers are often required to improve comfort during sex (1).

What hormonal changes occur during perimenopause?
The major hormonal changes are a gradual decrease in estrogen levels (although often in an irregular fashion), and increased follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. These hormonal changes can all be detected in our Women’s Perimenopause Panel (E2, FSH, LH).

Postmenopause is the stage of a woman’s life after 12 consecutive months of no menstruation. The perimenopause symptoms described above usually occur for 1-2 years after menopause, but some women suffer from symptoms for 10 years or longer (2).

Are there any other changes that occur in postmenopause?
Two major hormonal changes that occur in postmenopause are very low levels of estrogen and progesterone. These hormonal changes can be detected in our Women’s Postmenopause Panel (E2, P4), and can increase the risk of various health complications in postmenopausal women, including (3):

  • Heart disease. Before menopause, women make plenty of estrogen to help keep blood vessels in good health and maintain a healthy balance of “good” and “bad” cholesterol. However, in postmenopause, estrogen levels are a lot lower and the risk of heart disease increases.
  • Stroke. Lower estrogen levels in postmenopause may also increase the risk of cholesterol build-up in the blood vessels supplying the brain.
  • Osteoporosis. Low estrogen increases the breakdown of bone, which can lead to brittle and weak bones and an increased risk of bone fractures.
  • Lead poisoning. The increased breakdown of bones also releases lead into the blood that has been stored in the bones over a woman’s lifetime. This lead can increase the risk of high blood pressure, atherosclerosis, kidney issues, and cognitive impairments.
  • Urinary incontinence. Lower estrogen may weaken the urethra, increasing the risk of urinary incontinence.
  • Oral issues. The risk of cavities and dry mouth increases after menopause.

References:
1. Menopause 101: A primer for the perimenopausal. The North American Menopause Society.
2. Santoro N. (2016) Perimenopause: From Research to Practice. J Women’s Health (Larchmt). 25(4):332–339.
3. Menopause and your health. Office of Women’s Health, U.S. Department of Health & Human Services. Updated September 2018.

HPV

Why should I take an HPV test?

Posted on by dnaserver

Cervical cancer is the 4th most common cancer in women. Luckily, it is one of the most successfully treatable forms of cancer, but ONLY if detected and treated early (1). And this is where the problem lies—early cervical cancer often doesn’t cause any symptoms, so how can it be detected?

More than 99% of cervical cancer cases are linked to a persistent infection with one of the high-risk human papillomavirus (HPV) genotypes. And these infections can be simply detected by lab analyses of a cervical swab (1).

What is HPV?
Human papillomavirus (HPV) is a common sexually transmitted DNA virus. It is transmitted through vaginal, anal, or oral sex, and can be spread even when an infected individual does not show any symptoms. Although most women effectively clear HPV infections within 6 to 12 months (2), there are specific HPV genotypes that increase the risk of cervical cancer (1).

Which HPV genotypes are high-risk for cervical cancer?
There are more than 100 genotypes of HPV, of which 14 are considered high-risk for cervical disease – genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Women who have persistent infection with one of these pathogenic genotypes have an increased risk for cervical carcinoma or severe dysplasia (3).

What will an HPV test tell me?
The HPV test that we offer here detects the presence of nucleic acids from the 14 high-risk HPV genotypes. If any high-risk HPV nucleic acids are detected in your cervical swab (a positive test result), it means you have an active HPV infection. However, this does not mean that you have cervical cancer.

Follow-up testing is recommended for any positive results, with protocols varying based on the results of recent pap smears. Another HPV test and/or pap smear in a shorter time period from routine testing may be all that is required. Alternatively, a colposcopy to further examine the cervix, vagina, or vulva can be used to detect abnormal cells or blood vessels. Other options include tissue biopsies, removal of abnormal cervical cells, and referral to a gynecologist (4).

How often should I take an HPV test?
HPV testing for the 14 high-risk HPV genotypes is recommended for screening for cervical cancer in women aged 30 years and older. Routine screening for HPV is not recommended for women under 30 years of age, as HPV is very common in young people, and will often clear without intervention within one to two years. However, women should still start getting Pap tests from age 21 to look for any cell changes on the cervix that might become cervical cancer if not treated correctly (5).

There are different cervical cancer screening options available for women aged 30–65 years. Pap tests alone are generally recommended once every three years (assuming results are normal), while HPV tests alone are recommended once every five years (assuming results are normal). Often an HPV test is conducted at the same time as a Pap test (called co-testing) and if both results are normal, further screening is generally not required for another five years (5).

Although HPV testing is often conducted at the same time as a routine Pap test, self-collected cervical swabs (like available here) are an efficient alternative with many studies showing similar diagnostic test accuracies as clinician-sampled HPV tests (6).

References:
1. Cervical Cancer. WHO.
2. Cuschieri KS, Whitley MJ, & Cubie HA. (2004). Human papillomavirus type-specific DNA and RNA persistence–implications for cervical disease progression and monitoring. J Med Virol, 73 (1), 65-70.
3. Kjaer SK, et al. (2002). Type-specific persistence of high-risk human papillomavirus (HPV) as an indicator of high grade cervical squamous intraepithelial lesions in young women: population-based prospective follow-up study. BMJ, 325 (7364), 572-579.
4. Human Papillomavirus (HPV) Treatment and Care. (July 2021). CDC.
5. What should I know about screening? Cervical Cancer, Basic Information. (January 2021). CDC.
6. Ogale Y, Yeh PT, Kennedy CE, Toskin I, & Narasimhan M. (2019). Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Global Health, 4, e001349.

Posted in HPV
Men's Health, Women's Health

What is estradiol?

Posted on by dnaserver

Estradiol is the strongest of the three estrogen hormones and is one of the most important hormones in a woman for a healthy and normal menstrual cycle, ovulation, and fertility. Estradiol is naturally produced in both genders with much higher levels in females. It is predominantly produced within the ovarian follicles, but also in other tissues, such as the adrenal glands, fat, liver, breasts, brain, testes, and placenta (during pregnancy) (1).

What are the roles of estradiol in females?
The primary function of estradiol in females is to mature and maintain the reproductive system, including the mammary glands, uterus, and vagina. During each menstrual cycle, estradiol levels increase to trigger the maturation and release of the egg, and the thickening of the uterus lining to allow a fertilized egg to implant (1).

Other roles for estradiol include the development of female secondary sexual characteristics, (such as breasts, female fat distribution, and pubic hair) and increasing both bone and cartilage density. In addition, estradiol affects skin health, the brain, and the musculoskeletal and cardiovascular systems (2).

What are the roles of estradiol in males?
Although estradiol is considered a female sex hormone, it is also important in males. Within the testes, some testosterone is changed into estradiol to aid in the development of healthy sperm, as well as modulate libido, and for normal erectile function (3). It also has many of the same effects in males as it does in females, including an influence on skin health, the brain, and the musculoskeletal and cardiovascular systems (2).

What are normal estradiol levels?
Estradiol levels vary throughout a person’s lifetime, so there are wide variations in what is considered the normal reference levels.

Both girls and boys have low estradiol levels during childhood, although girls do have higher levels than boys even before physical signs of puberty. Prepubertal girls have estradiol levels of 1.6 +/- 2.6 pg/mL, while prepubertal boys have estradiol levels of 0.4 + 1.1 pg/mL (4). At puberty, estradiol levels gradually increase.

In females of reproductive age, estradiol levels rise and fall twice during each menstrual cycle. At the beginning of the follicular phase of the cycle (when menstruation occurs), estradiol levels are low (25–75 pg/mL). Levels gradually increase, until a rapid increase to 150–750 pg/mL just before ovulation occurs (when an egg is released), followed by a rapid decrease. During the luteal phase, estradiol levels gradually increase again to around 30–450 pg/mL, preparing the uterus for possible fertilization. If the released egg is not fertilized, estradiol levels decrease again to basal levels and menstruation begins (5). However, if the egg is fertilized for a pregnancy, estradiol levels keep increasing, until they reach levels as high as 40,000 pg/mL during the third trimester (6).

As females age, their estrogen levels slowly decrease, until a large decrease at menopause. Postmenopausal women generally have estradiol levels less than 20 pg/mL (5).

Normal estradiol levels in adult males are 10–50 pg/mL (5).

What happens if estradiol levels are too high?
In females, elevated estradiol is associated with (1):

  • Acne
  • Constipation
  • Decreased libido
  • Depression
  • Weight gain
  • Fertility issues
  • Increased risk of uterine and/or breast cancer

In males, elevated estradiol can cause (1):

  • Sexual dysfunction
  • Loss of muscle tone
  • Increased body fat
  • Development of breast tissue

What happens if estradiol levels are too low?
Low estradiol is associated with (1):

  • Skeletal issues (e.g., inadequate bone growth and osteoporosis)
  • Delayed puberty, disrupted menstrual cycle, and infertility in females
  • Fertility issues in males
  • Depression
  • Fatigue
  • Mood swings

How can I measure my estradiol levels?
We offer several different tests to measure your estradiol levels. These tests just require a small blood sample collected from a simple finger prick in the privacy of your own home. Test results are available through our online portal, thereby avoiding the need to make any doctor or lab appointments. Of course, you may also wish to discuss your results with your healthcare professional, and this is highly recommended if you receive any results that fall outside the normal range.

The Estradiol (E2) test measures just your estradiol levels. For females of reproductive age, it is helpful to know what stage of your menstrual cycle your sample was collected at, as normal levels vary throughout each cycle.

There are various combination tests available for females that include estradiol along with other important hormones:

Males may wish to order the Estradiol (E2) test (estradiol alone) or the Men’s Health Hormone Panel (6 biomarkers), which includes estradiol along with other hormones that are important for male health.

References:
1. Oestradiol. You and your Hormones, an education resource from the Society for Endocrinology. Reviewed Mar 2018.
2. Estrogen’s Effects on the Female Body. John Hopkins Medicine.
3. Schulster M, Bernie AM, Ramasamy R. (2016) The role of estradiol in male reproductive function. Asian J Androl. 18(3):435-40.
4. Janfaza M, Sherman TI, Larmore KA, Brown-Dawson J, Klein KO. (2006). Estradiol levels and secretory dynamics in normal girls and boys as determined by an ultrasensitive bioassay: a 10 year experience. J Pediatr Endocrinol Metab. 19(7):901-9.
5. Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic & Laboratory Test Reference. 14th ed. St. Louis, Mo: Elsevier; 2019.
6. Speroff L, Glass RH, and Kase NG. (1994). The Endocrinology of Pregnancy. In: Mitchell C, editor. Clinical Gynecologic Endocrinology and Infertility, 5th ed. Baltimore: Williams and Wilkins. 251-289.

Vitamins and Minerals, Women's Health

Pregnant? Here are the most important vitamins and minerals for your developing baby

Posted on by dnaserver

Pregnancy can be a demanding time for a mother-to-be. Many women suffer from morning sickness (or probably “all-day sickness” is more accurate for some!). Women can suffer from weird food cravings, which are more often than not an unhealthy food choice. Tiredness is often an issue, hip and back pain, and of course the constant need to pee too!

Despite all these obstacles, it is essential that women have a good nutritious intake during pregnancy. They need to not only maintain their own health and weight but also provide all the nutrients needed to grow another little person.

Should I “eat for two”?
“Eat for two” is a popular saying during pregnancy, but in reality, is not actually the best option. Now, doctors recommend instead eating twice as healthy. Yes, added calories are needed during pregnancy but definitely not twice as many calories as a pre-pregnancy diet. A woman carrying a single fetus requires an extra 340 calories per day in the second trimester and a bit more in the third trimester (1). That is equivalent to about a glass of skim milk and half a sandwich.

What are the most important vitamins and minerals during pregnancy?
Prenatal vitamins combined with a healthy diet are the best way to ensure adequate vitamin and mineral intake during pregnancy. The most important vitamins and minerals are folate (or the synthetic equivalent – folic acid), iron, calcium, vitamin D, choline, omega-3 fatty acids, B vitamins, and vitamin C. The table below shows the recommended amounts (obtained from The American College of Obstetricians and Gynecologists (1).

Nutrient Daily recommended amount Why it is required Best food sources
Folate (folic acid) 600 mg Helps prevent birth defects of the brain and spine (e.g. spina bifida)

Supports the general growth and development of the fetus and placenta

 Fortified cereal, enriched bread and pasta, peanuts, dark green leafy vegetables, orange juice, beans.

A daily prenatal vitamin with 400 mg of folic acid is also recommended during pregnancy.
Iron 27 mg Helps red blood cells deliver oxygen to the fetus Red meat, poultry, fish, dried beans and peas, iron-fortified cereals
Calcium 1000 mg (19+ years)

1300 mg (14-18 years)

 For strong bones and teeth Dairy products, sardines, green leafy vegetables
Vitamin D 600 international units Builds the fetus’s bones and teeth

Helps promote healthy eyesight and skin

 Sunlight, fortified milk, fatty fish such as salmon and sardines
Choline 450 mg Important for development of the fetus’s brain and spinal cord Milk, beef liver, eggs, peanuts, soy products
Vitamin B6 1.9 mg Helps form red blood cells

Helps body use protein, fat, and carbohydrates

 Beef, liver, pork, ham, whole-grain cereals, bananas
Vitamin B12 2.6 mg Maintains nervous system

Helps form red blood cells

 Meat, fish, poultry, milk (vegetarians should take a supplement)
Vitamin C 80 mg (14-18 years)

85 mg (19+ years)

 Promotes healthy gums, teeth, and bones Citrus fruit, broccoli, tomatoes, strawberries
Vitamin A 750 mg (14-18 years)

770 mg (19+ years)

 Forms healthy skin and eyesight

Helps with bone growth

 Carrots, green leafy vegetables, sweet potatoes
Iodine 220 mg Essential for healthy brain development Iodized table salt, dairy products, seafood, meat, eggs

References:
1. Nutrition During Pregnancy. ACOG. Updated March 2021.

Women's Health

All about follicle-stimulating hormone (FSH)

Posted on by dnaserver

What is follicle-stimulating hormone?
Follicle-stimulating hormone (FSH) is a hormone produced in the pituitary gland in both females and males. It helps regulate development, growth, pubertal maturation, and reproductive processes (1).

What are the roles of follicle-stimulating hormone?
FSH plays important roles in both females and males (2):

  • In females, FSH stimulates ovarian follicular growth and production of estrogen and initiates the release of an egg at ovulation.
  • In males, FSH signals for the Sertoli cells of the testes to produce sperm (spermatogenesis).

What controls follicle-stimulating hormone levels in females?
Gonadotrophin-releasing hormone (GnRH) released from the hypothalamus (region of the brain) stimulates the synthesis and release of FSH from the pituitary along with another important hormone called luteinizing hormone (LH). FSH and LH travel through the blood to act on the ovaries (3).

The FSH stimulation of ovarian growth results in increased estrogen levels, which is detected by the hypothalamus and results in less GnRH release; hence less stimulation of FSH synthesis. However, when levels of estrogen reach a “tipping point”, it stimulates a surge in FSH and LH, which is what causes the release of an egg (ovulation). After ovulation, the ruptured follicle forms a corpus luteum that produces progesterone, which inhibits the release of any more FSH. During a normal menstrual cycle, this corpus luteum then breaks down, progesterone levels decrease again, and FSH starts to slowly increase once again (3).

How is follicle-stimulating hormone controlled in males?
In males, a similar negative feedback system occurs. FSH stimulates the production of testosterone in the testes, which is then detected by the hypothalamus. As testosterone levels increase, less GnRH is released and consequently, less FSH is synthesized and released. As testosterone levels fall, more GnRH is released to stimulate FSH synthesis to then act on the testes to initiate testosterone production (3).

What happens in females with low estrogen?
Low estrogen in females, can occur in primary ovarian failure, which is common in females with Turner syndrome. This low estrogen means there is no feedback loop to control FSH levels, and FSH can be significantly elevated (3).

There is of course also a perfectly natural estrogen decline in females too. As females age, their quantity and quality of eggs decrease. This means that the normal FSH stimulation of the ovaries doesn’t result in the same increases in estrogen that were occurring at a younger age. This is why FSH levels naturally rise around the menopausal period and remain higher during postmenopause (3).

Are FSH levels linked to male infertility?
Yes, FSH is required for proper sperm production. If FSH levels are too low, normal puberty and sperm production does not occur. In addition, elevated FSH levels are also a sign of infertility, as raised FSH is a sign of testicular failure, as there is not enough testosterone for the normal feedback control of FSH levels. This condition occurs in conditions such as Klinefelter’s syndrome in males (3).

How do FSH levels predict ovarian reserve?
Ovarian reserve refers to the quality and quantity of a woman’s eggs. Different tests are available to predict a women’s ovarian reserve, one of which is the day 3 FSH test. FSH levels fluctuate throughout the menstrual cycle with levels gradually increasing in the first half of the cycle until reaching a peak at ovulation before decreasing again. This is why measuring the basal FSH levels at day 3 (the third day of your period) is important to gain the most benefit from an FSH ovarian reserve test.

An FSH level of <10 mIU/mL at day 3 is considered normal for ovarian reserve testing. Higher basal FSH levels are indicative of a reduced ovarian response and lower ovarian reserve. However, a single elevated FSH reading may not be sufficient, so it is often recommended to also measure day 3 FSH levels in one or more subsequent cycles too (4).

References
1. Ulloa-Aguirre A, Reiter E, & Crépieux P. (2018). FSH Receptor Signaling: Complexity of Interactions and Signal Diversity. Endocrinol, 159 (8), 3020-3035.
2. Knudtson J. (2019) Female Reproductive Endocrinology. Merck Manual Professional Version.
3. Follicle-stimulating hormone. You and your hormones, an education resource from the Society for Endocrinology. (Reviewed Feb 2018).
4. Roudebush WE, Kivens WJ, Mattke JM. (2008) Biomarkers of Ovarian Reserve. Biomark Insights. 3, 259-268.

Women's Health

What is progesterone?

Posted on by dnaserver

Progesterone is a female sex hormone that is primarily produced in the corpus luteum in normally menstruating women. The corpus luteum is a temporary structure that forms after the ovarian follicle ruptures and releases an egg at ovulation (around day 14 of the menstrual cycle). The main role of progesterone is to prepare the body for pregnancy (1).

Why is progesterone so important for pregnancy?
Straight after ovulation, progesterone starts preparing the body for pregnancy. It stimulates an increase in the lining of the womb and the secretion of nutrients to provide the perfect environment for the implantation of a fertilized egg. Progesterone also inhibits muscular contractions of the uterus that would prevent a fertilized egg from implanting (2).

After a fertilized egg becomes implanted, the placenta forms and takes over the production of progesterone at around 6-12 weeks. The placenta continues to produce progesterone for the remainder of the pregnancy, with progesterone levels steadily rising throughout pregnancy (3).

Throughout the pregnancy, progesterone is important for the development of the fetus, as well as stimulating the growth of maternal breast tissue in preparation for breastfeeding and strengthening the pelvic wall muscles in preparation for labor (3).

What happens if an egg is not fertilized?
If egg fertilization and implantation do not occur, the corpus luteum breaks down and progesterone production falls. This causes the growth of the womb lining to cease and start to break down and menstruation occurs again (2).

Does progesterone have any other roles?
Yes, progesterone is also important for non-pregnancy-related health. Progesterone acts in non-reproductive tissues, often in partnership with estradiol. Examples include estradiol reduction of bone resorption and progesterone stimulation of bone formation, and coordinated increases in nitric oxide activity to improve blood flow (4).

What are normal progesterone levels?
Progesterone levels fluctuate during each menstrual cycle. They are low (<0.5 ng/mL) during the follicular phase, with a rapid rise following the luteinizing hormone (LH) surge at ovulation to 10-25 ng/mL. If no conception occurs, progesterone levels decline, and menstruation beings. If an egg is fertilized, the corpus luteum maintains progesterone levels until around week six. The placenta produces progesterone for the remainder of the pregnancy, with levels increasing up to 45 ng/mL in the first trimester, and 230 ng/mL in the third trimester (5).

What are the risks of low progesterone?
Abnormally low progesterone levels are observed in the mid-luteal phase in females who have disorders of ovulation. This luteal phase deficiency is associated with infertility and spontaneous abortion and is estimated to occur in approximately 10% of infertile women (6). Low progesterone levels during the first 10 weeks of pregnancy are indicative of threatened abortion and ectopic pregnancy (7).

References:
1. Weigel NL, & Rowan BG. (2001). Estrogen and progesterone action. In L. J. DeGroot, & J. L. Jameson, Endocrinology (Vol. 3, 2053-2060). Philadelphia: WB Saunders Co.
2. Progesterone. Encyclopedia Britannica. (Edited August 2020)
3. You and Your Hormones. An education resource from the Society of Endocrinology. (Reviewed July 2021)
4. Prior JC. (2011). Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn, 3 (2), 109-120.
5. Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic & Laboratory Test Reference. 14th ed. St. Louis, Mo: Elsevier; 2019.
6. Rosenberg SM, Luciano AA, & Riddick DH. (1980). The luteal phase defect: the relative frequency of, and encouraging response to, treatment with vaginal progesterone. Fertil Steril, 34, 17-20.
7. Witt BR, Wolf GC, & Wainwright CJ. (1990). Relaxin, CA-125, progesterone, estradiol, Schwangerschaft protein, and human chorionic gonadotropin as predictors of outcome in threatened and nonthreatened pregnancies. Fertil Steril, 53, 1029-1036.

Vitamins and Minerals, Women's Health

The importance of folate

Posted on by dnaserver

What is folate? And folic acid?
Folate is an important nutrient that is naturally present in many foods. Folic acid is the synthetic version (lab-made version) of folate that is added to enriched foods and is available as a dietary supplement.

Folate functions as a coenzyme. Enzymes are biological molecules that speed up reactions in the body and coenzymes are important for the full functionality of these enzymes. Without enough coenzymes (e.g. folate), multiple reactions in the body would slow down and things won’t function how they should.

Folate is important for the formation of DNA and RNA, the formation of neurotransmitters, the metabolism of amino acids, and the proper formation of the nervous system (1). So, in other words, absolutely essential for a healthy normally functioning body!

What are common sources of folate?
Folate is naturally present in a wide variety of foods, including vegetables, fruits, nuts, beans, seafood, eggs, dairy products, poultry, and grains. Folic acid is obtained as a dietary supplement and also from enriched bread, cereals, flours, cornmeal, pasta, rice, and other grain products, due to mandatory folic acid fortification programs in the United States (2).

How much folate do I need?
Folic acid has higher bioavailability than food folate, which means that the body can utilize a larger proportion of folic acid compared to food folate. At least 85% of folic acid is estimated to be bioavailable, while only approximately 50% of food folate is bioavailable (3). For this reason, recommended folate intakes are listed as dietary folate equivalents (DFE). 1 mcg DFE is equal to 1 mcg of folate from a food source, or 0.5-0.6 mcg folic acid from fortified foods or supplements.

Folate requirements vary depending on age and pregnancy/breastfeeding status (1):

  • Infants under 6 months require 65 mcg DFE per day
  • Infants 7-12 months require 80 mcg DFE per day
  • Toddlers 1-3 years require 150 mcg DFE per day
  • Recommendations gradually increase through childhood until the adult value of 400 mcg DFE per day by 14 years of age
  • Pregnant women should obtain 600 mcg DFE each day
  • Breastfeeding women should obtain 500 mcg DFE each day

Why do pregnant women need more folate?
Folate is essential for the proper formation of DNA—the genetic code providing instructions for everything in our body! During pregnancy, another entire human is being created, so there are added demands for many nutrients, in particular folate.

Females with low folate intake are at increased risk of giving birth to infants with neural tube defects, low birth weights, preterm delivery, and fetal growth retardation (3).

It is recommended that the added requirement during pregnancy and breastfeeding is obtained from dietary supplements as folic acid alone or as part of a prenatal vitamin.

What happens if I don’t obtain enough folate?
The total body content of folate is estimated to be 15-30 mg, with approximately half of this stored in the liver, and the remainder in blood and other tissues (3). Folate deficiency is typically associated with serum levels less than 3.5 ng/mL or whole blood levels less than 150 ng/mL. Folate deficiency usually occurs due to poor diet, alcoholism, and malabsorptive disorders (4).

The primary clinical sign of deficiency is megaloblastic anemia. This occurs because a folate deficiency means that new red blood cells are not generating as quickly as they should be, so there are fewer red blood cells to transport oxygen around the body (1). Anemia is characterized by:

  • Weakness
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Headaches
  • Heart palpitations
  • Shortness of breath

Folate deficiency is also linked to depression and mental fatigue. This is because folate is important for the proper functioning and formation of neurotransmitters in the brain. Neurotransmitters are chemical messengers that are required to pass signals between nerve fibers in the brain.

Serotonin and dopamine are two important neurotransmitters that contribute to a feeling of well-being and happiness—“feel-good hormones”! If you’re low in folate, these “feel-good hormones” don’t work as well as they should, and there is an increased risk of psychiatric conditions like depression (5).

Research shows that folic acid supplements can be effective at reducing depressive symptoms and improving brain function (6), as well as improving the effectiveness of other antidepressants (7).

Who is at increased risk of deficiency?
Folate deficiency can be more common in certain populations. Those that drink high amounts of alcohol are at increased risk, as alcohol inhibits proper folate absorption and increases the excretion of folate from the body too (3). People who have malabsorptive disorders, such as celiac disease and inflammatory bowel disease, are also at increased risk (4).

And, the most important risk group is pregnant women. This is due to the increased demands of the developing fetus. An entire new human is getting created, so understandably demands are high, and not just for folate either. Obtaining such high levels of folate and other nutrients can be difficult during pregnancy (especially if you’re unlucky enough to suffer from nausea too!) This is why all pregnant women, as well as those trying to conceive, should take vitamin supplements that include folic acid to reduce the risk of neural tube defects and other complications (1).

Conclusions
Folate is essential for the healthy functioning of your own brain and whole body, and the healthy development of a new baby for all those pregnant females out there!

Do you know if you are getting enough? Our simple to use Folate Test can tell you if you are deficient. Or better yet, take our Nutritional Deficiency Test to measure your folate levels, as well as your vitamin B12, vitamin D, and iron levels too.

References:
1. Folate: Fact Sheet for Health Professionals. (2020, June 3). NIH
2. Food Standards: Amendment of Standards of Identity For Enriched Grain Products to Require Addition of Folic Acid. (1996, March 5). Federal Register, 61(44), 8781-8797.
3. Bailey LB, & Caudill MA. (2012). Folate. In J. W. Erdman, I. A. Macdonald, & S. H. Zeisel, Present Knowledge in Nutrition. Washington, DC: Wiley-Blackwell. 321-342.
4. Carmel R. (2005). Folic Acid. In M. Shils, M. Shike, A. Ross, B. Caballero, & R. J. Cousins, Modern Nutrition in Health and Disease. 11th ed., Baltimore: Lippincott Williams & Wilkins. 470-481.
5. Miller AL. (2008) The Methylation, Neurotransmitter, and Antioxidant Connections Between Folate and Depression. Alt Med Rev. 13(2), 216-226.
6. Folate. Mental Health America.
7. Coppen A, Bolander-Gouaille C. (2005) Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 19(1), 59-65.