Reproductive health of women
Reproductive health include health of a female body and mind from beginning of menstruation at puberty [menarche] to menopause. A healthy nutritious diet is very important during reproductive years or even while planning pregnancy and at menopause. Beyond nutrition reproductive health includes various other factors also which are discussed below.
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Reproductive health of women & Nutrition
Female reproductive system &their functions
The reproductive system in female has internal and external sex organs. The vulva describes the external female genitalia that includes labia majora, labia minora, clitoris, vulvar vestibule, urethral meatus, and vaginal orifice. The internal sex organs are the vagina, uterus, fallopian tubes, and ovaries.
The vagina is the part of female reproductive system for sexual intercourse and childbirth, and is connected to the uterus at the cervix. It is also the part through which menstrual bleeding happens every month in women. Uterus is an inverted pear-shaped muscular organ of the female reproductive system, located between the bladder and the rectum in the pelvis. Uterus has three parts, cervix, body and fundus. Cervix is the lower narrow part of uterus which connects with vagina. Body and fundus continues above the cervix and this wider portion of uterus connects with fallopian tube on the upper and lateral parts of the uterus on both sides.
Fallopian tubes are a pair of long narrow ducts located on both sides of the fundus portion of uterus and they provide a suitable environment for fertilization of sperm with ova [ released by ovary after the ovulation process in the menstrual cycle.] and the fallopian tube also transport the expelled egg from the ovary to the central channel (lumen) of the uterus.
If the fertilized egg is transported to uterus [fertilization of sperm with the egg or ovum takes place in the fallopian tube after sexual intercourse] and the embryo now get attached to uterine wall .This is called implantation.
If fertilization do not happen egg or ovum dies and the transported ovum is expelled through menstruation.
Each fallopian tube is 10–13 cm (4–5 inches) long and 0.5–1.2 cm (0.2–0.6 inch) in diameter.
The uterus functions to nourish and house a fertilized egg until the fetus, or offspring, is ready to be delivered. The uterus also produces secretions which help the movement of sperm to the fallopian tubes upwards after sexual intercourse, where sperm fertilize with ova produced by ovaries.
The female reproductive system is immature at birth and develops to maturity at puberty.
The reproductive system in women has various functions such as production of ova, certain sex hormones, and maintaining fertilized ova in uterus as they develop into mature fetuses and help it grow till child birth.
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What is ovulation ?
Ovulation is the cyclical expulsion of ova from the ovary after maturation during these reproductive years.
The ova have the potential to become fertilized by the sperm if sexual intercourse happens within the period of viability of the released ova. Fertilization usually occurs in the fallopian tubes and marks the beginning of embryo formation. The zygote thus formed by fusion of ovum and sperm will then divide over to form a blastocyst, which implants itself in the wall of the uterus. This begins the period of gestation and the embryo will continue to develop until full-term.
If sexual intercourse and fertilization do not occur, the ova released from ovary dies and it is expelled through the vagina during menstruation. This cyclic expulsion of eggs is a normal part of the menstrual cycle. Menstruation usually start between age 11 and 14 and continue until menopause at about age 51. The bleeding usually last from three to five days. The menstrual blood is partly blood and partly tissue from inside the uterus.
A woman’s reproductive period is between menarche (the first menstrual cycle) and menopause (cessation of menses for 12 consecutive months).Menarche is a female’s first menstrual cycle or it is the episode of occurrence of menstrual bleeding for the first time from the vagina. Menarche occurs during puberty and it is preceded by some changes in the body of an a girl in puberty such as breast growth, axillary and pubic hair growth, and a sudden growth spurt etc. under the influence of hormones called gonadotropins.
The prime goal of reproductive health care is to improve women’s health from menarche through menopause, thus preserve health for the entire lifespan of a woman. It includes managing reproductive health through various interventions such as taking care of nutrition in young girls to menopausal and old women, awareness and management of reproductive tract infections, contraception or birth control related awareness, pregnancy care and nutrition, infertility management etc.
What is premenstrual syndrome or PMS?
Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman's monthly cycle. It might be associated with following symptoms :
Abdominal or pelvic cramping pain
Lower back pain
Bloating
painful breasts
Food cravings
Mood swings and irritability
Headache and fatigue
Premenstrual syndrome, or PMS, is a group of symptoms that start before the menstruation . It can include all these symptoms along with emotional symptoms. Some women may suffer from depressed mood also.
Role of nutrition in reproductive health of women
A healthy diet is very important for the health of women during reproductive years , particularly during pregnancy [even while planning pregnancy ]and lactation period. Eating healthy foods during pregnancy will help not only the nutritional status of the pregnant woman but also the growth and development of the baby. Nutrition is crucial for the health status of both the mother and the foetus .
A few important nutrients are listed below :
Vitamins
1. Folic acid [Vitamin B9]
Folic acid is a water-soluble B vitamin essential for all age groups including mothers and children. Folic acid is very important for producing healthy red blood cells and it is crucial during periods of rapid growth, such as during pregnancy and fetal development.
Folic acid is very important for early fetal development, particularly neural tube and spinal cord in foetus. It is vital for the formation of DNA and RNA .Folate is also involved in protein metabolism.
Folic acid rich foods include:
. Dark green leafy vegetables
• Turnip greens, spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli ,black-eyed peas, mustard greens, green peas,
• kidney beans
• Canned tomato juice
• Fresh fruits-Oranges, Grapefruit ,Papaya, Banana, Avocado
• cantaloupe
• Beans
• Peanuts
• Sunflower seeds
• Whole grains
• Liver
• Seafood
• Eggs
• Fortified foods and supplements
Pregnant women are at risk due to excessive demand of folic acid related to pregnancy and fetal development. Deficiency may cause neural tube and spinal cord anomalies in the fetus.
RDA [The Recommended Dietary Allowance for folate]
Women 400 mcg DFE
Pregnant &lactating women 600mcgDFE &500mcg DFE respectively
Folic acid can reduce the risks of preterm birth, heart irregularities, and cleft palate.
Women planning on getting pregnant should take folic acid supplements to reduce the risk of neural tube defects (NTDs), such as spina bifida, arising in the developing fetus. Folic acid intake reduces spinal cord or neural tube defects in fetus.
• Pregnant women with spina bifida or a family history of neural tube defects should take 4,000 mcg per day. Lactating or breast feeding mothers should aim to take around 500 mcg per day.
If the expectant mother were to take 4mg of folic acid daily, it could take 20 weeks for her body to reach optimal folate levels for reducing the risk of a neural tube defect. Because of this, supplementation should be initiated 5 to 6 months before conception.
• Folic acid deficiency can result in macrocytic megaloblastic anemia. Oral folic acid supplements recommendations are 1 to 5 mg once daily, but doses up to 15 mg once daily have been recommended as well
2.Riboflavin
Riboflavin is a B vitamin which act as a co-enzyme in many metabolic pathways of the body for energy production and functions of brain.
Pure vegetarians and pregnant women are at risk of riboflavin deficiency if proper caution in following balanced diet is not taken.
The two flavoprotein coenzymes derived from riboflavin, FMN and FAD [Flavoproteins]are crucial rate limiting factors in most cellular enzymatic processes.
They are very important for the synthesis, conversion and recycling of niacin, folate and vitamin B6, and for the synthesis of all haem proteins, including hemoglobin, nitric oxide synthases, P450 enzymes, and proteins involved in electron transfer and oxygen transport and storage.
Sources of riboflavin
Dairy milk
Yogurt
Cheese
Eggs
Lean beef and pork
Organ meats (beef liver)
Chicken breast
Salmon
Fortified cereal and bread
Almonds
Spinach
RDA[recommended dietary allowance] of riboflavin is:
1.1mg for females and 1.4 mg -1.6mg during pregnancy and lactation
3.Niacin (Vitamin B3)
Niacin is a B vitamin that is essential for keeping your nervous system, digestive system and skin healthy. Niacin helps to convert nutrients into energy acting as co-enzyme, metabolism of cholesterol and fats, make and repair DNA, and exert antioxidant effects.
The recommended daily amount [RDA] of niacin for adult women is 14 mg a day.
4.Vitamin B6
Vitamin B6 pyridoxine is very important in the production of neurotransmitters such as dopamine, serotonin, γ-aminobutyric acid (GABA), noradrenaline and the hormone melatonin and hence even mild deficiency results in disordered sleep, behavior, and cardiovascular function and a loss of hypothalamus-pituitary control over hormone excretion. The deficiency may also cause dementia [memory loss] and cognitive decline.
Vitamin B6 also has a direct effect on immune function and gene transcription/expression and plays a role in brain glucose regulation.
The Recommended Dietary Allowance (RDA) of vitamin B6
Women [14-18 years] 1.2 mg
Women [19-50 years] 1.3 mg
Women [51+ years] 1.5 mg
Women-pregnancy and lactation 1.9 mg mcg and 2.0 mg, respectively.
5.Biotin – Vitamin B7
It is a water-soluble B vitamin essential for metabolizing fats, carbohydrates, and protein .It is also known as vitamin H.it is a co- enzyme for the production of fatty acids and amino acids like isoleucine and valine. Biotin plays an important role in normal foetal growth and in maintaining pregnancy
There is no recommended daily allowance for biotin. However, biotin does have adequate intake (AI) levels, which are amounts that ensure nutritional adequacy. The Institute of Medicine suggests an AI of 30 mcg per day for adults ages 19 years and over.
Sources
Beef liver
Eggs (cooked)
Salmon
Avocados
Pork
Sweet potato
Nuts, seeds.
6.Vitamin B12
Vitamin B12 intake must be enough during pregnancy for the healthy growth of foetus and its nervous system especially during the first trimester of pregnancy. Both vitamin B12 and folic acid intake is essential for mothers to prevent miscarriage and neural tube defect in the baby. Researchers conclude the fact that vitamin B12 deficiency is associated with a significantly increased risk for neural tube defects. The recommendations for vitamin B12 intake before becoming pregnant is >300ng/L..
Sources of vitamin B12
• Milk
• Cheese
• Yogurt
• meat
• fish-salmon, trout
• eggs
• clams
• shiitake mushroom
Minerals for women's health
Iodine
Iodine is an important mineral that is required for the health of women particularly during pregnancy. It is a component of the thyroid hormone and is required for normal thyroid function. The Recommended Dietary Allowance (or RDA of iodine is 150 micrograms.
Iodine deficiency can cause brain damage, mental retardation, hypothyroidism, goiter, and other health problems as Iodine plays a key role in mental and physical health of the body. During pregnancy, the dietary deficiency of iodine can induce severe cerebral dysfunction, eventually leading to cretinism in children.
Iodine is found naturally in seafood, dairy products, grains, eggs, and poultry. Additionally, salt is fortified with iodine to prevent deficiencies in the population.
Iron
Iron is
another important minerals essential for supporting the health of women.
Iron-deficiency anemia affects women particularly during pregnancy. In women
the body uses iron to make hemoglobin, the protein of the blood that carries
oxygen to all the tissues and muscles.
In women with iron deficiency the body
can't get adequate amount of oxygen. Menstrual blood loss, abnormal uterine
bleeding and pregnancy put women at risk of developing iron deficiency which
can lead to severe fatigue, reduced exercise capacity and poor work
performance.
Iron deficiency and anaemia during pregnancy are associated with
adverse effects for both mother and the baby or growing foetus. There may be
neurocognitive deficits or brain and memory problems in children born to
iron-deficient mothers. Iron is very much essential for oxygenation and to produce energy in the cerebrum of brain and for the synthesis of neurotransmitters and myelin.
Iron concentrations in the umbilical artery are critical during the development of the foetus , and in relation with the IQ in the child.
The Recommended Dietary Allowance [ RDA of iron for women 18 mg, and for pregnant women 27 mg].
Good sources of iron include:
o legumes
o Spinach.
o Sweet potatoes.
o Peas.
o Broccoli.
o String beans.
o Beet greens.
o Dandelion greens.
o Collards
Mental health of women of reproductive age
Depression is common in women during and before menstruation along with some physical or somatic symptoms which are altogether included in premenstrual syndrome.
Pregnant women can develop depression during any stage of pregnancy. Post delivery depression also is common after childbirth. It is called postpartum depression.
Menopausal problems of women
Menopause is the time in a woman's life when her period stops. It usually occurs naturally, most often after age 45. Menopause happens because the woman's ovaries stop producing the hormones estrogen and progesterone.
Menopause has following symptoms associated with the transition in hormones:
Menstrual periods become shorter or longer, lighter or heavier.
Hot flashes and/or night sweats
Insomnia or loss of sleep
Dryness of vagina
Mood swings or emotional instability
Difficulty in focusing or concentration
Hair loss
Menopause is associated with osteoporotic changes in bones due to declining estrogen hormone. this may lead to fractures also.
Nutritious diet is very important in women at all ages including menopause. Include more calcium, iron, magnesium and phosphorus and vitamin D rich foods in the diet plan.
Sources of Vitamin D
Cod liver oil
Salmon
Swordfish
Tuna fish
Sardines
Mackerel
Blue fish
Cat fish
Oysters
Beef liver
Egg yolk
Orange juice fortified with vitamin D
Dairy and plant milks fortified with vitamin D
Fortified cereals.
Exposing your skin to sunlight for 15-20 minutes a day may also help to increase your vitamin D levels
Calcium
The recommended dietary allowance of calcium is 1000-1200 mg/day for adults.
Milk and other dairy foods, fruits, leafy greens, beans, nuts, and some starchy vegetables are good sources of calcium.
Summary :
It is very crucial for women to understand that nutrition plays a significant role in their health. Therefore it is recommended that women have to take nutrients rich foods in adequate quantities.
Proteins also are important for women's health along with various other vitamins, minerals and polyunsaturated and monounsaturated fatty acids. Eat healthy and stay active !
References
1.
https://www.ncbi.nlm.nih.gov/books/NBK537132/
https://pubmed.ncbi.nlm.nih.gov/33682105/
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Reproductive health of women
Reproductive health include health of a female body and mind from beginning of menstruation at puberty [menarche] to menopause. A healthy nutritious diet is very important during reproductive years or even while planning pregnancy and at menopause. Beyond nutrition reproductive health includes various other factors also which are discussed below.
Habitual abortion or recurring miscarriage
It is defined as three or more consecutive pregnancy losses before 20 weeks of gestation. Habitual abortion may occur due to multiple factors.
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