Women’s health is more than the health of their reproductive systems; it encompasses the unique variations in a woman’s endocrine and nervous systems, her metabolism, immunity, and everything in between.

Health is often broken down into systems and treated as if those systems are siloed and independent, but really health is all about holism, balance, and the interlinkages between these networks of systems that make up a human.

What is so fascinating about women’s health is the flexibility to change dependent upon the reproductive cycles, needs, and stages that a woman will go through as she ages. The health of which is defined as the optimisation and interrelationship of these synergistic networks.

Fertility and the bigger picture

Following on from this, human fertility requires more than the optimisation of the female reproductive system in isolation.

It is influenced by:

• our metabolic health
• our endocrine system
• our gut’s microbiome
• our nervous system
• our immunity
• not to mention all those aspects in the male’s body as well

Impaired fertility affects around 1/6 couples and seems to be slowly increasing throughout different parts of the world over the last few decades. With so many different causes, this article will focus its attention on the metabolic and whole systems approach to offer the reader a broad and fresh interpretation of how lifestyle medicine and the use of personalised data can be used to aid a more comprehensive approach to enhancing fertility and optimising reproductive health.

PCOS as a metabolic syndrome

A condition that has been described in the literature for thousands of years is what modern medicine calls polycystic ovary syndrome, or PCOS. It implies the source of the problem pertains to the ovaries, but this is not correct.

PCOS is a metabolic syndrome, impacting the body as a whole. It is underpinned by:

• insulin resistance
• poor nutrition
• genetic and environmental predisposition

Its incidence is continuing to rise, as high as 20% of the female population in developed countries and rising faster in populations with genetic predispositions such as indigenous people, Māori, and Indian women. 

Symptoms and root causes

PCOS is characterised as having 2 out of 3 symptoms, which include:

• irregular periods (beyond 35 days)
• high androgen levels, which result in hirsutism
• acne or greasy skin and/or polycystic ovaries on ultrasound.

It is essentially an evolutionary mismatch, meaning our modern lifestyles are causing this condition to be expressed more frequently.

Contributing issues include:

• being sedentary
• high levels of stress
• high processed food intake
• poorly diverse gut biomes
• exposure to endocrine-disrupting chemicals

But the real issue with PCOS is its association with an increased lifetime risk of Type 2 diabetes, fatty liver, obesity, metabolic syndrome, and infertility. Women with PCOS also have double the risk of developing gestational diabetes during pregnancy, thereby potentially impacting their offspring’s health.

So, to treat early and to treat holistically offers a woman the opportunity to turn this risk around and to learn about a whole-system approach to health.

For more evidence-based strategies on managing PCOS, check out our guide to PCOS treatment, which covers practical tips on diet, lifestyle, and personalised health approaches.

When standard advice doesn’t work

So how can data help? Imagine a condition that is driven by a slow metabolism, which:

• impacts your energy and food preferences
• causes fatigue, brain fog and moodiness
• and easy weight gain.

For many women, simply living an “ordinary” existence is making them sick and confused; it feels like the standard nutritional and lifestyle advice is not enough for these women, and they often cite that they feel gas-lit by health care professionals telling them to eat less, exercise more, and lose weight. Most have already tried this hundreds of times over!

Tracking glucose for better energy, fertility, and balance

Using and tracking glucose data by way of using a continuous glucose monitor can help the user see in real time the impact of:

• their food choices
• their exercise habit
• their sleep
• their response to stress.

Research shows that women with PCOS have abnormal postprandial glucose excursions, despite having normal glucose tolerance testing in the lab, meaning that by using CGM, more sensitive and comprehensive data can be gathered prior to the diseases of glucose dysregulation being detected.

Data can reveal which foods and lifestyle choices result in the abnormal glucose excursions, therefore giving women an opportunity to choose otherwise and support their baseline physiology.

Steady glucose levels are associated with:

• better energy
• better fertility
• stabilisation of the nervous system
• and better weight management.

Optimal glucose regulation is also important for sperm motility and fertilisation, giving rise to the importance of lifestyle factors in men who are wanting to conceive. Insulin, alongside testosterone and FSH, is fundamental to this process, and when impaired, low fertility may result.

In addition, high glucose levels over a period of time can impact the health of the testis. Using a CGM in men can allow them insight into which meals and activities are likely to result in increased glucose dysregulation and potentially support new behaviours based on these learnings.

Understanding the impact of gestational diabetes

Gestational diabetes is characterised by glucose dysregulation that begins during pregnancy. It is a common issue among pregnant women, affecting roughly 1 out of every 5 pregnancies, with the incidence doubling between the years 2016 and 2021. 

If left untreated or if severe, gestational diabetes can result in a raft of significant short- and long-term negative health outcomes, including:

• large babies, which increases the risk of difficult deliveries including shoulder dystocia
• neonatal ICU admission
• preterm labour
• foetal distress
• pre-eclampsia
• premature rupture of membranes.

In the offspring of mothers with gestational diabetes, we see an increased lifetime risk of Type 2 diabetes, obesity, and cardiovascular complications, and also a higher risk of neurodevelopmental conditions, such as autism. Other associations include a higher risk of eating disorders, sleep apnoea, epilepsy, and cerebral palsy.

Using CGM in pregnancy and placental health

Continuous glucose monitoring during pregnancy is an emerging technology that can assist a woman in accurately measuring her glucose response to a variety of lifestyle choices, including meal choice, exercise, and timing.

The targets set for glucose regulation in women diagnosed with gestational diabetes are stringent during pregnancy to lessen both the short and long-term impacts, so tight control is ideal, especially in the latter parts of pregnancy as insulin absorption varies day-to-day.

Research shows that the use of a CGM in women with Type 1 diabetes was associated with improved neonatal outcomes. As this is a non-invasive data-gathering tool, consideration could be made for all women with gestational diabetes and those with PCOS.

The role of nutrition and the placenta

Nutrition and glycaemic control also play a role in the health of the placenta, the key organ that supplies blood and nutrients to the growing baby. It is a magnificent organ that on average weighs 500 grams, bigger than most people’s kidneys.

When the placenta is not adequately nourished, it can impact both the baby’s and the mother’s health. For example:

• it can impair the growth of the foetus
• it can grow through the uterine lining, which can lead to emergency hysterectomy
• it can result in pre-eclampsia, a complex condition that causes:
  
  • high blood pressure
  • fluid retention
  • seizures in the mother

Way back in 1957, a research gynaecologist named Alan Hewson published a paper on the role of dietary fibre in the incidence of pre-eclampsia, showing a healthy, fibre and vegetable-rich diet is associated with lower pregnancy-related problems; yet sadly, modern medicine fails to emphasise these simple things during pregnancy.

Fibre is highly recommended as a food component associated with better glucose regulation and gut biome diversity.

Whole systems medicine, technology such as CGMs, and understanding the synergistic links between systems—like the metabolism, the digestive system, and the nervous, endocrine, and reproductive systems—allow for creative and personalised interventions. These approaches help people see, witness, experience, and learn in real time how to steady a critical homeostatic response.

This can not only prevent disease but also support the management of crucial aspects of fertility and pregnancy. Altogether, it holds the potential to influence both short and long-term health outcomes for the mother and her offspring.