First, let’s acknowledge that losing weight is difficult for almost everyone, including men, and it’s not just a matter of “trying harder,” or simply taking in fewer calories than we expend, because our bodies fight back. The human body has evolved to avoid starvation, which is why most diets don’t work: the metabolism slows, appetite and cravings increase, and a variety of other physiological mechanisms kick in to resist significant and sustained weight loss.

While this is true for anyone who wants to lose a few pounds and keep them off, obesity complicates the picture even further. Obesity is an extremely complex multifactorial disease that is associated with more than 200 medical conditions, and scientists are still working to untangle many of these intertwined, mutually reinforcing associations. But although we don’t yet understand all the factors involved, some of them do have clear connections with differences in male and female biology.

So — to return to the original question — yes, it’s actually a well-documented phenomenon: women often do have a harder time losing weight.

The many-sided role of estrogen

Not surprisingly, sex hormones are likely a significant contributor to this difference. Estrogen, in particular, affects a wide range of physiological processes.

On the positive side of the ledger, estrogen increases energy expenditure, and, through neurobiological pathways in the central nervous system, it also plays a role in suppressing appetite, leading to changes in food intake at different phases of the menstrual cycle. Interestingly, studies have shown that women are more likely to report cravings for sweet foods and men savory foods, and that age, for women but not men, is inversely correlated to cravings for fat and carbohydrates.

Most significant to the issue at hand, though, is estrogen’s contribution to the accumulation of fat in subcutaneous tissue, where it is more likely to be stored long term rather than used for fuel. This means that premenopausal women tend to have a greater percentage of body fat than men, and that this fat is harder to lose. Compounding the impact of body composition, women also typically have less muscle mass, which burns more calories than fat tissue, even at rest.

In contrast, men and postmenopausal women tend to accumulate more visceral fat, which wraps around internal organs. Although visceral fat is more readily used for energy needs — and thus easier to lose — it’s also considered more dangerous, as it is associated with increased risk of both insulin resistance and cardiovascular disease.

Visceral fat expands by adipocyte hypertrophy (the fat cells increase in size), while subcutaneous fat expands by adipocyte hyperplasia (the cells increase in number). Smaller subcutaneous fat cells can store more lipids such as triglycerides. In visceral fat, when the adipose cells reach maximum size and can no longer store more lipids, these lipids are deposited in other tissues, leading to insulin resistance. Visceral fat promotes insulin resistance via other mechanisms as well, such as the secretion of proinflammatory cytokines. The increased inflammation and higher blood lipid levels associated with excess visceral fat also contribute to many other conditions, including atherosclerosis, which can lead to heart attacks and strokes.

The increased health risk posed by visceral fat is the origin of the old rule of thumb about apple-shaped bodies (more belly fat) being more at risk than pear-shaped bodies (more fat in the hips and thighs). In fact, waist circumference is highly correlated with increased risk of type 2 diabetes and cardiometabolic disease. The risk threshold is generally considered to be 35 inches for women and 40 inches for men, with different thresholds for different populations. While people with obesity generally have excess fat in both subcutaneous and visceral tissue, those without metabolic complications often have a larger proportion of subcutaneous fat, especially in the thighs.

Other contributing factors

Genetic factors affect body weight and fat distribution as well, but the sex-specific impact is less well understood. One study, for example, showed that among mice whose sex organs had been removed, those with female sex chromosomes (XX, XXY) gained more body weight than those with male chromosomes (XY, XO), suggesting that sex chromosomes themselves play a role that is separate from the effects of sex hormones. In addition, large-scale genome-wide studies have identified a number of single-nucleotide polymorphisms (variations at a single position in a DNA sequence) associated with fat accumulation or distribution that were either significant in females but not in males or had larger effects in females than in males. These sex-specific differences account for a very small fraction of the genetic heritability of obesity (general body shape and natural “set point” weight range are highly influenced by genetics as well), but they do represent a promising avenue for further study.

Obesity is also affected by an enormous range of additional variables, including lifestyle, other physical and mental health conditions, medications, socioeconomic circumstances, sleep patterns, previous weight-loss experience, social and psychological pressures, and on and on. And while some of these factors may involve sex- or gender-related differences, the collective impact of all the factors is usually more significant than any one dimension.

Personalization is key

For this reason, an effective weight management program needs to take into account all the factors contributing to an individual’s weight gain, and the interactions between them, and provide personalized guidance based on those specific factors. Fortunately, the field of obesity medicine has made great strides in recent years, allowing us to draw on vast quantities of data to identify which combinations of interventions — including diet, physical activity, behavioral modifications, pharmacotherapy, devices, procedures and surgery — are likely to be most successful given an individual’s unique situation.

Losing weight may be hard, but biology isn’t destiny. We have the tools to alter the outcome. For those who want to take that next step, effective treatment options do exist.

The post It’s not an urban legend: Losing weight is often harder for women appeared first on Medika Life.

To understand how these hormones are manufactured we need to look more closely at the ovaries, the site of production of estrogen and progesterone in women. The ovaries produce and release the two groups of sex hormones—progesterone and estrogen.

Estrogens

Estrogens are broken down into three groups, known as

• Estradiol (E2) the most common type in women of childbearing age
• Estrone (E1) the only estrogen your body makes after menopause (when menstrual periods stop)
• Estriol (E3) the main estrogen during pregnancy

These substances work together to promote the healthy development of female sex characteristics during puberty and to ensure fertility. Estrogen also has other functions: 

• Keeps cholesterol in control
• Protects bone health for both women and men
• Affects your brain (including mood), bones, heart, skin, and other tissues

Estrogen (estradiol, specifically) is instrumental in breast development, fat distribution in the hips, legs, and breasts, and the development of reproductive organs.  The ovaries also release two other hormones, relaxin (released prior to giving birth) and inhibin (used to inhibit follicle-stimulation hormone secretion)

Progesterone and estrogen are necessary to prepare your uterus for menstruation. The hypothalamus, a small region located at the base of your brain, triggers their release. Once you reach puberty, the ovaries release a single egg each month —this is called ovulation.

If a woman is pregnant, the pregnancy will trigger high levels of estrogen and progesterone, which prevent further eggs from maturing. More hormones are released during pregnancy than at any other time of a woman’s life, but during menopause—which marks the end of fertility—estrogen levels fall fast. This can lead to a range of menopausal symptoms. 

How Estrogen levels affect you

Low Estrogen: 

Women. The most common reason for low estrogen in women is menopause or the surgical removal of the ovaries. Estrogen supplementation is often prescribed to alleviate menopausal symptoms. Symptoms of low estrogen include:

• Menstrual periods that are less frequent or that stop
• Hot flashes (suddenly feeling very warm) and/or night sweats
• Trouble sleeping
• Dryness and thinning of the vagina
• Low sexual desire
• Mood swings
• Dry skin

Some women also get menstrual migraines, a bad headache right before their menstrual period, because of the drop in estrogen.

Men. Low estrogen in men can cause excess belly fat and low sexual desire.

High Estrogen: 

Women. Excess estrogen can lead to these problems, among others:

• Weight gain, mainly in your waist, hips, and thighs
• Menstrual problems, such as light or heavy bleeding
• Worsening of premenstrual syndrome
• Fibrocystic breasts (non-cancerous breast lumps)
• Fibroids (noncancerous tumors) in the uterus
• Fatigue
• Loss of sex drive
• Feeling depressed or anxious

Men. High estrogen in men can cause:

• Enlarged breasts (gynecomastia)
• Erectile dysfunction
• Infertility

Testing Estrogen Levels

This is easily done with a simple blood test that will allow your doctor to check any one of the three forms of the hormone. Estrogen testing must be coordinated with a doctor as the interpretation of the results is often misunderstood.

Progesterone

Progesterone is a steroid hormone belonging to a class of hormones called progestogens. It is secreted by the corpus luteum, a temporary endocrine gland that the female body produces after ovulation during the second half of the menstrual cycle.

Synthetic steroid hormones with progesterone-like properties are called progestins. Progestin is often combined with estrogen in oral contraceptive pills. Progesterone is used as a single hormonal contraceptive in the Depoprovera shot and certain intrauterine devices.

Progestin is also useful in treating common menopausal symptoms. 

How does Progesterone Work?

Progesterone prepares the endometrium (the mucous membrane lining the womb) for the potential of pregnancy after ovulation. It triggers the lining to thicken to accept a fertilized egg. It also stops the muscle contractions in the uterus that would cause your body to reject an egg. While the body is producing high levels of progesterone, you will not ovulate.

If you do not become pregnant, the corpus luteum breaks down, lowering the progesterone levels in your body. This signals your body to start menstruation. If you do conceive, progesterone continues to stimulate your body to provide the blood vessels in the endometrium that will feed your growing fetus.

Once the placenta develops it begins to secrete progesterone in place of the corpus luteum. This causes the levels to remain elevated throughout the pregnancy, so your body does not produce more eggs. It also helps prepare the breasts for milk production.

In men, progesterone is known as the calming, mood, sleep, libido, and bone-enhancing hormone. Progesterone functions as a precursor in men to produce testosterone while also acting as a balance to decrease estrogen levels. Progesterone is produced by men’s adrenal glands and testes

The Role of Progestins

Progesterone isn’t absorbed well when taken as a pill. Synthetic progestins were created to bind to progesterone receptors in the body and create similar effects as progesterone. Progestin can change the lining of the uterus and stop the lining from building up.

Progestin can also be used to treat menopause symptoms such as hot flashes and vaginal dryness. Estrogen can be used alone to treat these symptoms, or it can be combined with progestin. Women who still have a uterus must use progesterone to counter the effects of estrogen. Unopposed Estrogen increases the risk of uterine cancer. Healthcare providers may suggest an oral micronized progesterone treatment.

Progestin can also be prescribed to treat amenorrhea, endometriosis, and irregular periods.

How Progesterone levels affect you

Women with low levels of progesterone will have abnormal menstrual cycles or may struggle to conceive because the progesterone does not trigger the proper environment for a conceived egg to grow. Women with low progesterone levels who do succeed in getting pregnant are at higher risk for miscarriage or pre-term delivery because progesterone helps maintain the pregnancy.

Low progesterone in women

• Abnormal uterine bleeding
• Irregular or missed periods
• Spotting and abdominal pain during pregnancy
• Frequent miscarriages

In addition, low progesterone levels can cause elevated levels of estrogen, which can decrease sex drive, contribute to weight gain, or cause gallbladder problems.

Low progesterone in men

Symptoms of low progesterone in men include:

• Low libido
• Hair loss
• Weight gain
• Fatigue
• Depression
• Gynecomastia (“male breasts”)
• Erectile dysfunction
• Impotence· Bone loss
• Muscle loss

In addition, men with low levels of progesterone have a higher risk of developing health conditions, such as osteoporosis, arthritis, enlarged prostate, and prostate cancer.

Side effects of progestin

When taking progestin for menopausal symptoms, side effects may include:

• mood changes,
• bloating,
• headaches,
• breast tenderness.
• For newly menopausal women, breakthrough bleeding may occur.

In hormonal birth control, progestin side effects can include withdrawal bleeding and increased cramping. Other side effects may include increased blood pressure and low blood sugar.

Testing progesterone levels

Your doctor will request a serum progesterone test after drawing your blood. They may order it if you’re having trouble getting pregnant. The results can give them an indication of whether or not you’re ovulating. This can help them diagnose and manage potential fertility problems.

Your doctor might also order this test if you’re pregnant and they suspect you’re at risk of ectopic pregnancy or miscarriage. Ectopic pregnancy happens when a fertilized egg attaches itself to your fallopian tube, abdominal cavity, or cervix, rather than your uterus. Miscarriage happens when you lose a fetus during early pregnancy. Both cause low progesterone levels.

Further Reading,

Offsite Links
Please note that the links below are to information and materials not hosted on Medika’s servers and are as such, not subject to our Terms of Use

1. An overview of the Ovaries: Endocrine Web, <https://www.endocrineweb.com/endocrinology/overview-ovaries>

The post Understanding Hormones: the roles of Estrogen and Progesterone appeared first on Medika Life.