Hormonal Black Box: Women’s Health Research and Innovations

While we recognize the important role of sex hormones in women’s health, research around them has been primarily tied to fertility and pregnancy. At the same time, an estimated 80% of women worldwide experience hormonal imbalances, which can take years to diagnose and treat.

At least from my perspective, healthcare systems also tend to view sex hormones mostly in connection with fertility. No doubt that fertility is a topic of great importance, but why we are missing out on the opportunity (or the right) for women to be conscious of their hormonal health as a part of their overall wellbeing? For example, estrogen and progesterone fluctuate across each monthly cycle in women, but the data on these fluctuations remains largely a black box for healthcare systems.

Why should we pay more attention to sex hormones management in women?

Research says that:

• hormone ratios may play an important role in modulating the effect of myocardial infarctions, according to a population-based cohort study by the UK Biobank that recruited over 500,000 (aged 40–69?years) women and men between 2006 and 2010. So far there has been conflicting research on the association of sex hormones and myocardial infarction?and more studies are needed to provide a clearer picture. For example, on free testosterone, that could also be a factor when it comes to cardiovascular disease risk.
• sex hormone concentrations were strongly associated with several established or suspected risk factors for breast cancer, and may mediate the effects of these factors on breast cancer risk (cross-sectional analyses of breast cancer risk factors and circulating hormone concentrations in more than 6000 postmenopausal women controls in 13 prospective studies)
• higher free testosterone (per 1SD) is associated with a greater prevalence of tooth loss (this cross-sectional study included 5649 participants aged 45–84)
• There is clear evidence for the role of sex steroids in the immune disturbances that result in autoimmune diseases
• steroid hormones affect both neurons and glia, thus affecting the risk and resilience for Alzheimer’s?
• exposure to estrogen level fluctuations across the lifespan of women correlates with the higher risk of Parkinson’s (French researchers compared the reproductive characteristics of nearly 1,200?women with Parkinson’s disease with those of other women)
• intensity and character of ADHD symptoms correlate with hormonal changes during the menstrual cycle due to the direct correlation between estrogen and dopamine levels (a survey of 685 women with ADHD). No longitudinal studies exist that chart the relationship between hormonal fluctuations and ADHD symptom characteristics and severity across the lifespan. No definitive research exists on how hormones affect ADHD in women
• estrogens and progesterone play important roles in altering both sleep and memory performance across the adult female lifespan. Moreover, sex hormone fluctuations may mediate or moderate the relationship between sleep and memory changes. However, research in the area is still in the nascent phase.
• there is a connection between gut bacteria and sex hormones: certain gut bacteria produce gas that stimulates other bacteria to convert glucocorticoids, a type of steroid, into progestins, however, the exact mechanisms by which gut bacteria modify these hormones and the resultant impact on health are not well understood.
• there are more known correlations of sex hormones with skin problems, mood disorders, fatigue, PCOS and many others.

In the meantime, innovative solutions are emerging to address the gap and collect previously unaccessible data:

• Hormona (raised $2.8M from from?Nascent Invest,?Techstars, and?SFC Capital) combines at-home tests (estrogen, progesterone, FSH) and an app to to track, understand and optimise their hormonal cycles. Since we launched it in 2023, the app has collected over 2M anonymous health data points from women all around the world from the users in more than 185 countries.
• Eli Health (raised $3.6M in 2023 led by Led Muse Capital, total funding $6.6M) real-time insights into hormone levels through saliva testing, which can be continuously tracked over time to the difference of single-point tests.
• The Essence App (raised $600K from Berkeley SkyDeck Fund and others) optimises the schedules, fitness routines, and diets of women as per each phase of their hormonal cycle. Essence claims to be able to boost women’s performance by up to 33%. While I am unsure about the workplace productivity, the approach of providing women with hormonal insights to be able to optimize their activities and schedules accordingly sound definitely like a great idea.?

I hope we see more innovations related to sex hormones management. Together with already outlined ones, there are various other undererved areas with a big need for innovation:?

• Tracking sex hormones for patients with a specific condition or at a risk of a specific condition based on the correlations for this condition.
• Tracking, management and prevention of side effects from hormonal contraception or therapies. For example, researchers have earlier assumed that women taking oral contraceptives have stable levels of sex hormones over each monthly cycle, while there is new evidence of the opposite.
• Finally, giving each women an understanding of how her hormones work, how it affects her wellbeing and schedule and how to spot any imbalances.

For more updated on women's health, don't forget to download my digest on Q1-Q3 2024.