Post Menopausal Tests - Object Oriented Case Studies
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Post Menopausal Hormone Status

Post Menopausal Hormone Status Case Study 1

Purpose
To demonstrate sufficiency of Estrogen and deficiency of Progesterone in post
menopausal women.

Background
A significant number of women in late peri-menopause & early menopause have significant levels of bioactive estrogens in spite of somatic symptoms. A number of symptoms are due to continued cycling of Estradiol. It is our experience that simultaneous assessment of E2 and P1 levels should be performed. The use of the E2 free fraction in saliva is especially important because it is the bioactive fraction of E2 and represents a miniscule 1-1.5% of the total serum
E2 content (1). The bioactive E2 concentration is not necessarily reflected in total serum E2 measurements. (2).

Remarks
DHEA, Testosterone, E1, E2, and E3 were adequate. P1 was below physiological target level. P1/E2 Ratio favors Estrogen dominance which pre-disposes women to:
1. A proliferative state affecting mammary and uterine tissue.
2. Reduced inhibitory (GABA) effect in CNS; a pro-excitatory state.
3. Tendency to reduced osteoblastic activity with bone loss.

Estrogen Overdosing Case Study 2
Purpose
To demonstrate the typical overdosing of estrogen in post menopausal women during attempts to control somatic symptoms, including hot flushes.

Patient Specific Data
Age: 50yrs Female
Last Period: 3 yrs earlier	i
Bone density changes: minimal	i
Initial Symptoms: Hot flushes, emotional iinstability, lack of concentration
Treatment: The patient was placed on Estrogen patches 3 months earlier	i
Outcome: Control of all somatic symptoms, increased aggression and irritability, with tender breasts
Lab Report
Patient salivary hormone level	Physiologic Target Ranges
DHEA: 6ng/ml	3-10 ng/ml
Testosterone: 27pg/ml	8-20 pg/nl
Estrone: 36 pg/ml	26-64 pg/nl
Estradiol: 45 pg/ml	5-13 pg/nl
Estriol: 16 pg/ml	4-10 pg/nl
Progesterone: 53 pg/ml	100-300 pg/nl

Estrogen Overdosing Case Study 2 (continued)
Background
Many late and early post-menopausal women are given estrogens of various types & preparations to control somatic symptoms, including hot flushes. The physiochemical anatomy of a hot flush consists of a rapid drop in estrogen over a few days with low progesterone. It is not a dearth in the absolute value of estrogen. Consequently, the continual estrogen treatment will overdose the woman while it mitigates somatic symptoms; it blunts the rapid fluctuations in Estrogen by overriding endogenous production.

Remarks
Sufficient DHEA and Testosterone, mild E3 excess, unacceptable
elevation in Estradiol level, P1 is below physiologic target level. The induced Estrogen excess (about 400%) coupled with low Progesterone renders women very proliferative and increases aggressive behavior
and irritability.

Case Management
Hormonal Aspect
õ Estrogen dose cut by 2/3 to prevent override.
õ 35 mg BID of isomolecular Progesterone.
õ Retested 30 days later using the PHP1; all tested hormones
xiwithin acceptable limits.

Topical Dermal Progesterone Overdosing Case Study 3
Purpose
To demonstrate the overdosing caused by presently available dermal P1 creams & gels.

Patient Specific Data
Age: 49yrs Female
Last Period: 3 1/2 yrs earlier	xxx
Bone density changes: Not available	xxx
Initial Symptoms: Extreme irratability, poor sleep habits, shortened perimenopausal cycle, low libido
Treatment: Patient was prescribed 1/4 tsp. BID of 10% P1 cream	xxx
Outcome: Control of all somatic symptoms, increased aggression and irritability, with tender breasts
Lab Report
Initial Patient salivary hormone level	Post Therapy with Cream 9 months later
DHEA: 5ng/ml	6 ng/ml
Testosterone: 21pg/ml	26 pg/nl
Estrone: 50 pg/ml	46 pg/nl
Estradiol: 9 pg/ml	14 pg/nl
Estriol: 6 pg/ml	8 pg/nl
Progesterone: 38 pg/ml	4,600 pg/nl

Topical Dermal Progesterone Overdosing Case Study 3 (continued)
Background
The wide spread use of gels and over-the-counter dermal Progesterone creams has led to an endemic hyperprogesterone state in women. The incidence of P1 overdose (reflected in free fraction P1 elevations of 400% to 20,000%) occurs within 95% of all users. The pharmaco- dynamics of the aforementioned creams & gels is not well established. It is believed that excessive subcutaneous storage followed by uncontrolled release is the underlying problem. Overdosing occurs in a dose dependent fashion and can take anywhere from 7 to 30 days with cream or gel concentrations of 20% to 1.5% respectively. The clearance of P1 and return to acceptable levels may vary from 30 to 200 days.

Remarks
Breast enlargement occurred 3 weeks into therapy. Five and one half months into treatment patient developed a progressively worsening depression. Patient was given Paxil. No association to P1 cream use was made by patient or doctor.

Case Management
Hormonal Aspect
õ Discontinued use of cream allowed for a 75 day washout period.
õ Oral micronized P1 was given 35 mg bid of isomolecular Progesterone.
õ Patient was weaned off Paxil.
x((Abstract No. 8)

DHEA Challenge Test in Breast Cancer Case Study 4
Purpose
To demonstrate the use of an objective assessment of DHEA conversion efficiency to Androgens and Estrogens as a tool to estimate suitability and dose of supplemental DHEA.

Patient Specific Data
Age: 52 yrs Female		xxx
Last period: 4yrs earlier		xxx
Breast neoplasm removed by lumpectomy 5yrs earlier, is considering HRT
Salivary DHEA Challenge Test		xxx
A baseline assessment, followed by 15mg bid DHEA bid for 5 days then a post challenge assessment is shown to the right:	PM Ranges (post menopause-no HRT)	Post Challenge Test & % Changed
DHEA: 2ng/ml	3-10ng/ml	25 ng/mlxxxxxx1150.00%
Testosterone: 19 pg/ml	5-20pg/ml	47 pg/mlxxxxxx147.00%
Estradiol, E2: 9 pg/ml	1-4pg/ml	7 pg/mlxxxxxxx147.00%

DHEA Challenge Test in Breast Cancer Case Study 4 (continued)
Background
The conversion efficiency of DHEA to Estrogens and Androgens seems to be a phenotypic expression. Short of overdosing a patient for a while and observing the side effects, there is no clinical way to figure our conversion disposition. The DCT removes the guess work and allows precise prediction of patient disposition to supplemental DHEA.

Remarks
DHEA: Patient baseline DHEA value was depressed. Estradiol and
Testosterone levels are acceptable. The post challenge DHEA shows a distinct and significant conversion to Testosterone with practically no
conversion to Estradiol.

Case Management
õ Patient was given low dose DHEA 4 mg sublingual solution
xitwice daily.
õ Repeat test showed normal DHEA with no increase in
xiEstradiol & Testosterone.

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