Female hormones and sports performance
Authors:
Len Kravitz, PhD, Afton Cazares, Christine Mermier, PhD.
Translation
— S. Strukov.
Do estrogens affect muscle damage and repair? What effect does hormone replacement therapy have on performance? Is weight gain inevitable during menopause? We will answer these and other questions related to women, hormones and performance.
What hormonal changes occur in boys and girls during puberty?
During puberty, girls develop more adipose tissue due to estrogen, while boys develop more muscle due to testosterone (Isacco, Duché & Boisseau, 2012).
What is the “female-athlete triad”?
The components of the female athlete triad: cessation of menstruation, decreased bone density and eating disorders. The triad occurs in women with training load levels that exceed their available energy levels. Health disorders are noted, which are manifested by complications from the cardiovascular, endocrine, reproductive, musculoskeletal, central nervous and excretory systems. Psychological problems include low self-esteem, depression and anxiety.
Treatment of the female athlete's triad begins with improving energy supply by increasing food intake and/or decreasing energy expenditure. Women with eating disorders or eating patterns require consultation with a dietitian (Nattiv et al. 2007).
What is menopause?
Menopause is a period of profound transformation of the female body after the cessation of menstruation. The etiology of menopause is based on a complex relationship between estrogen metabolism and the autonomic nervous system. As a rule, the first symptom is irregular menstrual cycle.
During perimenopause (the transition to menopause, which begins 8 to 10 years before menopause), there is a decrease in fertility, which is due to a significant decrease in estrogen levels. Vaginal atrophy is observed - inflammatory processes in the vagina as a result of thinning tissue, as well as a decrease in hydration caused by estrogen deficiency.
Hot flashes are a sudden feeling of heat in the upper body that can start in the face, neck or chest, and then spread up or down (depending on where they started). The skin on the face, neck or chest may become red, and the woman usually begins to sweat. The heart rate usually increases sharply and may become irregular or faster than usual. Hot flashes often occur during the first year after the onset of the final period in a woman's life. Sleep problems occur, usually associated with night sweats, insomnia or anxiety.
When women go through menopause, they have trouble falling asleep and staying asleep. Also during this period, problems with urination are likely. Moodiness often goes hand in hand with sleep disturbances. Hair thinning or loss is possible during menopause (Nordqvist, 2009).
Does the risk of cardiovascular disease increase in women after menopause?
Yes. Due to decreased production of female sex hormones, the risk increases during peri- and postmenopausal periods.
Is walking as effective as more intense exercise in preventing cardiovascular disease in women?
Manson et al. (2002) compared walking and more intense exercise versus spending several hours sitting as predictors of the incidence and total number of heart problems in 73,743 postmenopausal women in the Women's Health Initiative observational study program. initiative). The results show that vigorous exercise and walking are associated with significant reductions in heart problems in postmenopausal women, regardless of race or ethnic group, age, or body mass index. Prolonged sitting leads to increased cardiovascular risks.
Do estrogens influence skeletal muscle damage, inflammation and repair?
Yes, estrogen can reduce skeletal muscle damage and inflammation after exercise. Theoretical evidence suggests that estrogens may help repair and repair muscle damage. These data are preliminary and further research is required to explore the mechanism and practical application (Tiidus, 2003).
Does hormone replacement therapy affect physical performance?
Green et al. (2002) found this effect only during high-intensity aerobic exercise. Systolic blood pressure at peak exercise in women taking hormones was lower than in those not taking them, with similar levels of oxygen consumption and cardiac output. More research is needed in this area.
Can weight gain during menopause be prevented or is it inevitable?
Years of menopause are associated with weight gain and a trend toward “central” obesity. Hormonal changes and loss of muscle mass during the menopausal transition may be responsible for the redistribution of body fat and changes in body composition. There is only one factor most closely associated with weight gain during menopause: physical inactivity. To avoid weight gain, women need to make regular physical activity a priority (Simkin-Silverman et al. 2003).
For a more in-depth study of female physiology, its connection with metabolism and energy expenditure, study the articles from the list of sources at: “Women, Hormones, Metabolism and Energy Expenditure.”
Source:
https://www.ideafit.com/
Many hormones affect body weight
What role do hormones play in our body, is it possible to gain weight because of them, are there any risks with hormone replacement therapy, and how to live with diabetes?
Galina Afanasyevna, many years ago you were the author of the Health magazine. What would you write about today?
Over the past 30 years, endocrinology has developed in our country and in the world at a faster pace than other areas of medicine. The endocrine system is one of the three (together with the nervous and immune) main integrative systems of the body, but we did not even realize the degree of this integration before. Just 10 years ago, only the work of the classical endocrine glands was assessed. And today we already know that even bone is an endocrine organ, and not only a victim of a lack of hormones (for example, in postmenopausal women), but also a powerful producer of hormones, just like adipose tissue and vascular endothelium.
For many years, our Center has been headed by Academician Dedov, and on his initiative, the classical institutes of our center (Institute of Diabetes, Clinical Endocrinology, Pediatric Endocrinology) received new divisions - interventional cardiology, neurosurgery, pediatric surgery, radioisotope methods of diagnosis and treatment.
The center now has departments specializing not only in neuroendocrine diseases, but also in diseases of bone tissue, as well as an institute for reproductive medicine. With the development of the concept of personalization in endocrinology and the improvement of genetic research methods, today we can give the happiness of having a healthy child to infertile couples, including those with endocrine pathology.
That is, endocrinology is integrated into all areas of medicine?
Since hormones affect all cells of the body, any specialist should know the basics of endocrinology. The dentist understands that periodontal disease may be the first manifestation of diabetes. The ophthalmologist who operates cataracts realizes the same thing. If a gynecologist treats infertility, he must first exclude endocrine causes.
Continuing this thought, is it true that problems with the heart and blood pressure can be a consequence of problems with the thyroid gland?
Let's remember US President George HW Bush. At the most inopportune moment in history, his heart rhythm was disrupted and so-called atrial fibrillation appeared (we used to call this condition atrial fibrillation). Any cardiologist in the world should know: the first step is to look at the thyroid hormones. At that time there were no modern tests for determining thyroid-stimulating hormone, but there were tests for the hormones T3 and T4. After 72 hours, the doctor said: George, you have an overactive thyroid gland, take a capsule of radioactive iodine, your gland will stop stimulating your heart. And for the next 30 years until his recent death at 94, he received replacement therapy with the hormone thyroxine, and the arrhythmia that threatened his life was eliminated.
Another US president, Dwight Eisenhower, suffered from hypertension. He died of a hypertensive crisis, but at the autopsy he was found to have a pheochromocytoma, a tumor of the adrenal medulla that secretes adrenaline and norepinephrine and thereby increases blood pressure. Modern technologies make it possible to diagnose it, and it can be operated on very well.
Another case from the practice of Serbian doctors. The woman complained to the doctor about changes in appearance and pressure surges. The doctor began to fight her hypertension, and attributed the external decline to age. But the veterinarian husband suggested that his wife had a tumor of the adrenal cortex. He said: “You have become like my dogs with such tumors.” And he was right.
All of the above examples are a variety of forms of arterial hypertension caused by tumors of endocrine origin. But just one correct examination of the patient at the onset of hypertension is enough - and the cause will be found, hypertension will be eliminated. And today, thanks to genetic research, we can predict the risk of developing the disease in the offspring of people with pre-existing endocrine arterial hypertension.
Is it important for patients themselves to be able to understand the symptoms of endocrine diseases in order to see a doctor in time?
When I talk about diseases in the media, I have doubts: that if I scare someone, people will start looking for diseases in themselves, they will think about it. But, on the other hand, if even one patient thinks about it, comes to us with a suspicion of a problem and the diagnosis is confirmed, we will cure him and, therefore, it was not in vain that we talked about it.
Are thyroid hormones to blame for the fact that an overweight person cannot lose weight, even if he is on a diet?
The most common disease of the thyroid gland with hyperfunction is called Graves' disease (diffuse toxic goiter) - in excess, gland hormones destroy the heart, bones, brain and reduce body weight. But there is a term “fat-based” (“fat-based”), because these same hormones increase appetite, and some people, even with an excess of thyroid hormones, eat more and gain weight. This scenario for the development of the disease is less common than the classic one with weight loss, but we emphasize once again that hormones are hormones and cakes are cakes.
In hypothyroidism, on the contrary, low concentrations of thyroid hormones cause weight gain. But this increase is not as significant as the increase caused by years of unbalanced nutrition with low physical activity.
There are diseases caused by excess hormones of the adrenal cortex, they affect the redistribution of fat - the cheeks and stomach are rounded, and the limbs remain thin.
Both in the case of hypertension and obesity in its initial stage, we exclude endocrine causes (such as hypothyroidism or hypercortisolism) and find out whether obesity is associated with hypofunction of the gonads. Doctors have clear algorithms for how to rule out endocrine pathology in obesity. But, unfortunately, patients often feverishly research the hormones they like in the nearest laboratory, not even suspecting that in the conditions of obesity that has already set in, the indicators of many hormones will be changed... Changed for the second time, as a consequence of obesity - but not as its cause.
An obese person is unlikely to be able to “go on a diet” - when the word diet is said, compensatory deafness usually occurs (as Professor A.M. Mkrtumyan says). The best thing is to learn to eat wisely and modify your lifestyle.
They talk about hormonal imbalance when a woman cannot get pregnant, although according to her gynecology everything is fine.
Approximately 20-30% of all cases of infertility are endocrine infertility. It is diverse, and in the vast majority of cases all problems can be solved.
For example, there is polycystic ovary syndrome - a multifaceted disease that can be cured by different methods. Another example is hyperprolactinemic infertility; previously we did not even suspect that its frequency was so high.
We basically didn’t know that a person has prolactin. When I started working at the institute in 1975, there were only 15 case histories in the archives where this issue was at least somehow raised. Fifty years ago, an article was published abroad in a small scientific journal about the ability of ergot alkaloid to reduce prolactin production. In essence, a new era in neuroendocrinology was opened.
When we received a drug based on ergot alkaloid (this happened 10 years earlier than the Americans), and our first women became pregnant, we couldn’t believe it! When the hormone prolactin is elevated, we lower it, and the woman becomes pregnant. Today my students are examining the grandchildren of these women, who were born without any help from endocrinologists - although once upon a time their parents could not have been born without our participation.
What can you say about hormone replacement therapy during menopause? Doesn't the risk of cancer increase?
For some, menopause begins at 40 years old, for others at 55. Time is unfair: we somehow have to live the rest of our long lives without the hormones we need. In addition to the unpleasant symptoms of menopause, more serious problems are added: bone fractures, coronary heart disease. That is, hormone replacement therapy (HRT) is needed. The question is: will we increase the risk of tumors and which ones? At different periods of history, different answers were given to this question, depending on examination methods and drugs. At the present level, the most famous American study is WHI, which has caused considerable confusion in the minds of doctors and women.
In this study, postmenopausal women (55–80 years) were given two arms of HRT: estrogens with progestins or estrogens without a uterus. The study was huge but failed because the age chosen was too old to start HRT. It confirmed, on the one hand, a decrease in the number of intestinal cancers and bone fractures in this group, but, on the other hand, an increase in the number of women with venous thrombosis, heart attacks and breast cancer (the latter only in the group where there was combination estrogen therapy and progestins).
Now we say that the optimal time for HRT is the “therapeutic window” period: early perimenopause or menopausal transition. And just during this period, systemic hormone replacement therapy is very important, it saves from unwanted clinical manifestations (“hot flashes”, bouts of heat, sweating, facial redness). In many ways, the use of HRT in this early period will help maintain the normal functioning of the pelvic organs, prevent the development of bone tissue lesions, and even delay the onset of heart damage. But the decision on whether to use HRT or not should be made individually, after consulting with a doctor, and after a thorough examination .
In men, testosterone decreases with age. Can they, like women, take therapy?
Androgen replacement therapy is carried out according to indications. If a man has obesity, alcoholism, heart attack or stroke, then why should he receive testosterone? Or a businessman or politician begins to take testosterone as an anabolic steroid and a stimulant of muscle strength and activity.
Androgen replacement therapy should be used in men if testosterone deficiency is laboratory proven and the disturbing symptoms can be explained by this deficiency.
In the same way, possible contraindications should be taken into account. Androgen replacement therapy comes in various forms - injections, gels, tablets. But first you need to make sure that there are no contraindications, first of all, prostate cancer. However, today it has been practically proven that this therapy does not increase the risk of prostate cancer.
Previously, vitamin D was given only to infants to prevent rickets. What is its role for an adult?
Vitamin D has long been considered as a hormone that affects various organs and systems, including not only bone but also muscle tissue. It is hardly possible to say with confidence that there are specific symptoms of D deficiency; they are nonspecific. But there are situations in which the doctor may suggest an appropriate study. For example, if you are planning a pregnancy, or you are 50 years old and at risk for osteoporosis, or you are taking medications that can negatively affect bone function, or you have asthma and are receiving glucocorticoids.
Has the problem of iodine deficiency been solved in our country today?
We and Ukraine still remain on the list of countries with unresolved iodine deficiency. For example, Belarus, Kazakhstan and Armenia coped with this. We still have a shortage because only 20-25% of the population uses iodized salt. Meanwhile, iodine deficiency is the cause of goiters, mental retardation, even cretinism; it increases the risk of miscarriages and the formation of nodules in the thyroid gland. And all this can be avoided if you cook food with iodized salt. But, having heard about iodine deficiency, some people sometimes rush to extremes, forgetting about the fundamental differences between the physiological need for iodine and pharmacological doses. Micrograms are a physiological need, and milligrams are pathologically high doses. By systematically lubricating the skin with iodine, making iodine nets, and dripping iodine into milk, you get gigantic doses. This can destroy the thyroid gland and put it in a state of blockage.
Today, following the ideology of proper nutrition, many do not add salt to their food at all.
A complete rejection of sodium in food can hardly be considered reasonable - sodium is also a vital element, and in order to preserve it, the body will have to sharply activate the work of the adrenal glands. But it is quite possible to combine reasonable salt limitation with the concept of iodization - there should be little salt, but it should be iodized. Simple rule.
Type 2 diabetes mellitus is a pandemic of the 21st century. Do excess sweets and alcohol increase the risk of disease?
Type 2 diabetes is associated with obesity in 90% of cases, and therefore everything that contributes to obesity also contributes to diabetes - sugar, alcohol, fat. Jules Verne, Louis XIV, Giacomo Puccini, Claude Monet died from diabetic gangrene. That is, they were not poor people at all, they could “feed” diabetes on themselves. There were few such patients before.
Until the 70s, the diagnosis of diabetes was based on symptoms and urine analysis. Then the diagnostic principles changed and it became enough for blood glucose to exceed a certain value for diabetes to be established. The first classification appeared in 1979, the second in 1999. At the same time, your grandmother would not have been diagnosed with diabetes at the level of sugar at which her grandson would be diagnosed today. Because diabetes used to be perceived solely as something that made you “pee a lot with sugar.” It is now clear that diabetes is the soil on which heart attack and stroke will grow. And, apparently, the crayfish are growing. The sooner we identify this, the better it will be. And treatment begins with sugar levels that have never been treated before. The worst thing is that diabetes and obesity have shifted to the group of children and adolescents.
Is it true that diabetes can be cured through physical activity?
Physical activity helps compensate for all diabetes. That is, we have brought sugar to a certain moderately increased level and are adding physical activity. If we ran with a sugar level of 20 mmol/l, we will run to the point of coma.
The man may have been in the “honeymoon” of type 1 diabetes. Diabetes debuts when approximately 90% of beta cells have died, the patient is given insulin and these remaining 10% of cells work for some time. By all indicators, diabetes has disappeared. But this is not so, it cannot be overcome with the help of sports, but it can be well compensated for. Footballer Pele is a person with type 1 diabetes who has lived a sporting life, although he has been on insulin since the age of 14. Among artists and athletes there are many people with type 1 diabetes, but this does not interfere with them, they compensate for diabetes. Knowing how to manage diabetes, a person can play sports even professionally.
Author:
Elena Chudnaya Published: March 25, 2021
