Menopause is caused by a gradual change in the ovarian sensitivity to neurohormones (FSH & LH), and disruption in the negative feedback loop. These changes are re?ected as imbalances in ovarian hormone output and manifested as cessation of menstrual ?ow. Often several somatic, cognitive, and emotional manifestations precede and accompany the menopause, which usually occurs between ages of 40 and 56 years.

Pre-Onset Changes: Perimenopause
Several years before the onset of menopause, estradiol variations during the cycle are accentuated while progesterone output shows a signifcant decline despite the persistence of ovulation. The dramatic fluctuations in estradiol are believed to be caused by a reduction in negative feedback in the hypothalamic-pituitary-ovarian axis. Observed FSH elevations refect the reduced follicle sensitivity to the trophic effects of FSH and GnRH. The perimenopause is clinically characterized by several manifestations shown below.

Perimenopause-manifestations
Endocrine:
bleeding irregularities
hot fashes
urogenital atrophy

Nervous System:
insomnia
headache
irritability
mood swings
depression
memory problems

Metabolism:
osteoporosis
altered lipid metabolism|atherosclerosis

In menopause, the fractional adrenal contribution to estrogen activity increases to about 95%. This is due to enhanced conversion of circulating adrenal androgens into estrone in adipose and muscle cells, and to increased fractional conversion of estrone to estradiol. As women progress into the menopausal years, estrone becomes the dominant estrogen.

Why use salivary testing?
Saliva contains the free fraction of the hormones which refects the bioactive tissue levels. Free Fractions in saliva correlate more closely with clinical symptoms than total serum hormone levels(which mostly refect the bound fraction).

Salivary tests included in the Post Menopause Panels™
Free fractions of salivary: Estrone (E1), Estradiol (E2), Estriol (E3), Progesterone (P1), DHEA, Testosterone (TTF), plus Luteinizing Hormone (LH) & Follicle Stimulating Hormone (FSH).

Two panels are offered:

SHORT POST MENOPAUSE PANEL™ (PostM)
One saliva sample
Panel Includes 6 hormones: E1, E2, E3, P1, DHEA & TTF

Clinical Applications:
Measurement of hormone baselines
Monitoring natural hormone replacement therapy (HRT)
Risk assessment of breast/uterine proliferative diseases and osteoporosis .
Investigation of hormone related libido and emotional vulnerability, vaginal atrophy...and other symptoms as listed in Table 1.
LONG POST MENOPAUSE PANEL™ (PHP-2™)
2 saliva samples
1st sample is tested for: E1, E2, E3, P1, DHEA & TTF
2nd sample: Repeat of the 6 hormones

Clinical Applications, of ePHP ™ :
Irregular Cycles in women where menstrual flow is unpredictable, and performing a complete 11 specimen hormone mapping is impractical.
Perimenopause where hormones fluctuate causing irregular menstrual flow. In these cases, one specimen is minimally representative of the hormone status, while the 11 specimen mapping is impractical. Note: the first sample is collected any time and then frozen; 20 days later the second sample is collected and both are submitted for testing.
Therapeutic Monitoring/Hormone Challenge in postmenopausal women, on HRT, or for HRT modification; the PHP-2™ can be used to test hormone baseline levels and efficacy of adjustments in HRT dosage and administration route.
EXPANDED POST MENOPAUSE PANEL™ (ePHP™)
One saliva sample
Panel includes: E1, E2, E3, P1, DHEA, TTF, FSH & LH

Clinical Applications:
Same as PHP-1™
To correlate FSH & LH to ovarian hormone response
More de?nitive diagnosis of menopause in younger women
Who can benefit from these panels*:
PHP-1™ » Non-cycling women with intact ovaries who have had no menstrual flow or spotting for two consecutive years
» Non-cycling women with total hysterectomy
» Cycling women currently on birth control pills

ePHP™ » Non-cycling women with intact ovaries who have had no menstrual flow or spotting for 6 months to 2 years
» Non-cycling women with hysterectomy where one or both ovaries are intact
» Perimenopausal women: irregularly cycling women with less than 8 cycles per year

* The above panels are not intended for cycling women. Hormone assessment of cycling women from puberty to perimenopause is done by cycle mapping using the 11 sample FHP Panel.™

LH & FSH
The pituitary Luteinizing hormone(LH) & Follicle stimulating hormone(FSH) are gonadotrophins which regulate ovarian function. Both FSH & LH are stimu- lated by hypothalamic GnRH (Gonadotrophin Releasing Hormone). LH has a pulsatile rhythm which varies throughout the cycle. Stress and high cortisol have an adverse effect on LH but not on FSH. Stress renders women more estrogenic and less fertile, and more prone to proliferative diseases.

In perimenopause, there is a growing scarcity in ovarian follicles. LH & FSH production show respectively, a three and seven fold increase over the values found in young menstruating women.

The Expanded ePHP ™ panel simultaneously measures the levels of the two neurohormones FSH & LH and the orresponding concentrations of E2 and P1. Using this panel, progression towards menopause can be more accurately predicted before clinical symptoms set in. Early preventive treatment can be initiated to minimize bone loss, and other somatic symptoms.

Interpretive Advantage: Hormone Balance Analysis
Our Post Menopause Hormone Panel™ report allows you to examine and tailor the balance of the various hormones rather than just replacing one. The PostM ™ & ePHP ™ routinely include a full page of patient-specific interpretive data with risk assessment of proliferative diseases of breast and uterus. Our reports include the Proliferation Potential Indexes™ (PPI™) which correlate the pro-proliferative effects of the three estrogens (E1, E2, and E3) to the anti-proliferative effects of P1 and TTF. Our reports also provide suggestions which help rectify commonly observed hormone imbalances.

Notes: Natural estrogens, including estriol are proliferative; estrogens and their metabolites differ only in the degree of their proliferative potential. Certain estrogen metabolites are falsely promoted as risk markers for breast cancer. A recent multicenter study compared 2/16 Hydroxyestrone ratio in women with breast cancer to a control group of healthy women and concluded that "results do NOT support the hypothesis that the ratio of 2/16 Hydroxyestrone is an important risk factor for breast cancer, or that it is a better predictor of breast cancer risk than levels of E1, E2 and E3…". (Environ Health Perspect. 1998 Mar; 106(3):A126-7)

Case Study: Estrogen Overdosing Purpose: To demonstrate the typical estrogen overdosing in post-menopause women in attempts to control somatic symptoms, including hot ?ashes.

Background
The recent Women's Health Initiative Study (JAMA 2002; vol 228(3):321-333) on HRT re-af?rms our long held position that use of synthetic or natural hormone replacement therapies based on symptoms only, and without ongoing monitoring, carries with it grave health risks. Many late and early post-menopausal women are given estrogens of various types to control somatic symptoms, including hot Fashes. The physicochemical anatomy of a hot flash consists of a rapid drop in estrogen coupled with a low progesterone. It is not a dearth in the absolute value of estrogen. Consequently, the continual estrogen treatment, usually prescribed, will overdose the woman while it mitigates somatic symptoms. It blunts the rapid fluctuations in estrogen by overriding endogenous production.Patient History & Data Age: 50 yrs Female Last Period: 3 yrs arlier
Bone density changes: Sub-Clinical or minimal
Initial Symptoms: Hot flashes, emotional and concentration problems
Treatment: Placed on estrogen patch; no hormone monitoring done
Outcome: Control of somatic symptoms, increased aggression and irritability, with tender breasts

Patient sought further help and a Diagnos-Techs PHP-1™ was ordered. PHP-1™ Report Summary Hormone Levels Normal Ranges
DHEA: 6 ng/ml 3-10 ng/ml
Testosterone: 27 pg/ml 8-20 pg/ml
Estrone: 35 pg/ml 26-64 pg/ml
Estradiol: 45 pg/ml 5-13 pg/ml
Estriol: 42 pg/ml 14-38 pg/ml
Progesterone: 53 pg/ml 100-300 pg/ml

Remarks:
The report showed suffcient DHEA and testosterone, mild estriol excess, elevated estradiol, and very depressed P1 values. The induced estrogen excess about 400%) coupled with low progesterone increases breast tissue proliferation, and irritable/aggressive behavior.

Case Management:
Estrogen dose was cut by 65% to prevent override.

20mg BID of sublingual liquid progesterone was given.

Retested 30 days later using the PHP1,™ hormone levels were acceptable and all symptoms were under control.

The Menopause Panel identifies deficiencies (or excesses) of important sex hormones estradiol, estrone, estriol, progesterone, and testosterone. It can provide guidance in the therapeutic intervention of several conditions associated with sex hormone imbalances in women:

Endometriosis
Breast Cancer
Hypertension and Heart Disease
Osteoporosis
Low libido

All lab tests can be done through the mail in the privacy of your own home, except blood tests, we send you to a lab to have your blood drawn for these. After you pay for the test we mail you the kit, the results take two weeks, the test results will be mailed to us and we will call you to go over the results, its that easy! All tests include the consultation for the report of findings.

Click on test of interest on the right for more information or call our office for details: 
800-956-7083 OR 818-707-3126.