Convenience
This panel requires 11 saliva samples that are collected at the patient's convenience. Patient samples are collected and mailed to the laboratory without involving clinic staff and with no biohazard risks; no blood, no mess. The test also avoids the inconvenience of women performing a 24 hour urine collection in a gallon sized container.

Economical
This eleven sample profile of estradiol and progesterone plus cycle averages of testosterone and DHEA costs less than 2 estradiol and progesterone blood tests, or a single steroid urine analysis.

Correlation with Free Bioactive Fraction in Blood
The general consensus is that the unbound or free fraction of steroid hormones exerts the biological influence on tissue. The bioactive fraction accounts for most of the extravascular hormones in the tissue space (4). Recent work indicates that salivary estradiol, progesterone, DHEA and testosterone levels correlate well with their respective serum free fractions (5, 6, 16, 17).

Superior to Serum Progesterone & Body Temperature Records
In a study comparing saliva progesterone values to body temperature records and serum progesterone over 3 consecutive menstrual cycles in 41 women, the conclusion was: "Basal body temperature records or mid luteal serum progesterone measurements were less satisfactory indices of luteal function than a salivary progesterone profile." Finn, M.M., et al. Gynecol. Endocrinology 3:297-308 (1989).

Ovarian Output & Reserve Estimation
Since the output of both progesterone and estrogens varies with the day of the cycle, the single serum or urine samples preclude the ability to estimate ovarian cycle output and reserves. The FHP™ hormone mapping includes ovarian output and reserve estimates.

Luteal Phase Defects (LPD) & PMS
The term LPD describes abnormalities in the luteal phase of the female cycle which includes defects in hormone concentrations and balance. Luteal phase defects are common and affect between 8% (7) and 35% (8) of patients, depending on the sub-population studied. Luteal phase defects show abnormalities in progesterone output and can be classified into 3 subclasses: LPD-I, LPD-II, LPD-III.

1. LPD-I: The luteal defect related to shortening or lengthening of the luteal phase. The normal luteal phase length is 12-18 days. Clinically, LPD-I is associated with inability to conceive, scant/heavy menstrual flow, increased risk of proliferative diseases, insomnia and various emotional problems.
2. LPD-II: The luteal defect related to reduction in overall progesterone output due to an underdeveloped corpus luteum or suboptimal pituitary stimulation (weak LH pulse). Clinically, LPD-II is associated with water retention, breast tenderness, spotting, increased irritability, headaches, insomnia and a constellation of cognitive and emotional problems.
3. LPD-III: The luteal defect related to uneven distribution of progesterone throughout the luteal phase. Women with this defect usually show low progesterone in the last 5-7 days before menstrual flow. Clinically, in LPD-III the symptoms (same as LPD-II) are often confined to the last 5-7 days before menstrual flow.

Our FHP™ report will make the distinction and suggest guidelines for therapy in all LPD subclasses.

Urine and serum hormone concentration in mid-luteal phase are practically useless in LPD detection. The inadequacy has been worded as follows: "We reject the notion that a single mid-luteal phase progesterone assay is sufficient to make the diagnosis of luteal phase defect (7)." The mid-luteal phase progesterone assay "is of little or no assistance in establishing a diagnosis" of luteal phase deficit [Wentz, A.C. Clinical Obstet. Gynecol. 22:169 (1979)].

In summary, mid-luteal testing is a technique shown to have poor or minimal correlation with luteal insufficiency on a patient-by-patient basis (7,8,9).

Anovulation
The salivary FHP™ can be used to detect anovulatory cycles (6) which may occur in about 22% of young women age 20-31 years (12). This is a common cause of in- fertility and may result from excessive and chronic stress. We have verified this notion over the years through the use of the salivary Adrenal Stress Index™ performed at our laboratory.

Other Applications
The FHP™ can be successfully used in investigating the following problems: Ovulation problems, sexual differentiation problems, estrogen-progesterone imbalance, pituitary-ovarian axis dysregulation, functional infertility and miscarriage, polycystic ovarian disease, recurring headaches and hot flashes, libido problems and hirsutism.

Customizing Hormone Therapy
Presently, hormone therapy is very empirical and a one-size-fits-all approach is applied to most women. Due to variability among women, a more customized and scientific approach is required. The FHP™ panel report analyzes hormone production trends and functional inter-relationships which facilitates customized treatments. Then, hormone replacement therapy can go beyond package insert protocols. For example, the optimal treatment plan for a 25 year old is not likely the best therapy for a 48 year old approaching menopause.

Risk assessment of Breast and Uterine diseases
The relation of estrogen dominance to increased risk of proliferative diseases in breast & endometrial tissue is universally accepted. The FHP™ & e-FHP™ report includes the Follicular Estrogen Priming Index (E fi) that quantifies the impact of excess estradiol in menstruating women. Patient-specific recommendations are routinely included in the report. Please note that certain estrogen metabolites are falsely promoted as markers for breast cancer risk. A recent study which compared 2/16 Hydroxyestrone ratio in women with breast cancer to a control group of cancer-free women, concludes that there is no support for the hypothesis that the ratio of 2/16 hydroxyestrone is an important risk factor for breast cancer (J Nat'l Cancer Inst 1999 Jun 16:91(12):1067-72).

The FHP™ allows an in-depth functional analysis of hormone relationships that affect long-term health.