These panels provide measurements of six key hormones: progesterone, estradiol, estrone, estriol, testosterone and DHEA. The inclusion of FSH and LH in the extended panels, expands the interpretation to include pituitary involvement. Complex patient data is reported in an easy-to-read, customized and individualized report as explained below.

Why use salivary testing?

Saliva hormone levels reflect the active tissue fraction and they correlate more closely with clinical symptoms than serum hormone levels.

Significant Perimenopausal Hormone Changes

Just as gonadal hormone levels begin to cycle long before the initiation of menses, there are substantial shifts in hormone levels prior to the onset of menopause. Some of the most important changes are summarized below.

Neuroendocrine Hormone Changes
Follicle stimulating hormone (FSH) and Luteinizing hormone (LH) levels increase progressively (3-7 fold their prior average values).
Increases in FSH levels appear to correlate with an increased severity in hot flashes, a higher rate of bone loss and poor sleep quality.

Ovarian Changes
There is a gradual decrease in the number of functional follicles.
The follicles are less responsive to regulation by FSH and LH.
Estradiol fluctuations are exaggerated.
Progesterone production gradually declines and eventually flattens out.

Other Changes
As ovarian function declines, the adrenal androgen contribution approaches 90% of the total.
Adipose tissue estrogen becomes a larger fraction of
the total circulating estrogen.

What is in the report?

1 - Data and Ranges

6-8 measured
hormone values
(specific hormones listed under each panel on next page)
reference ranges
BHRT
target ranges

2 - Health Risk Indexes

Each report includes separate breast and uterine Proliferation Potential Indices. The proliferative effects of the three estrogens on breast and uterine tissue, and their balancing antagonists, testosterone and progesterone are interpreted into a
visual format.

3 - Restoration Plan

An example of an integrated restoration plan is included with the test results. This plan may include BHRT, dietary supplements and lifestyle changes based on scientific literature and relevant publications.

Perimenopause Panel™ (PeriM™)

Two saliva samples
Each sample is tested for 6 hormones:
Estrone (E1), Estradiol (E2), Estriol (E3), Progesterone (P1), Testosterone (TTF) and DHEA
First sample collected any time and then frozen; 13-15 days later, second sample collected and both submitted for testing.
Clinical Applications:
In perimenopausal women with regular or irregular cycles
When collecting 11 specimens over a full cycle is impractical
Therapeutic Monitoring or Hormone Challenge in postmenopausal women
Risk assessment of breast/uterine proliferative diseases
Information on fees, billing, insurance and medicare assignment is available to healthcare providers.
Note: In perimenopause, one specimen is minimally representative of the hormone status,
while the 11 specimen mapping is impractical, due to an absent or irregular cycle.

Postmenopause Panel™ (PostM™)

One saliva sample tested for 6 hormones:
Estrone (E1), Estradiol (E2), Estriol (E3), Progesterone (P1), Testosterone (TTF) and DHEA
Clinical Applications:
Measurement of hormone baselines or monitoring bioidentical hormone replacement therapy (BHRT) in:
Menopausal women and women with total hysterectomy
Cycling women using birth control pills
Risk assessment of breast/uterine proliferative diseases and osteoporosis
Investigation of libido changes and emotional vulnerability problems
Information on fees, billing, insurance and medicare assignment is available to healthcare providers.

Expanded Postmenopause Panel™ (ePostM™)

One saliva sample
8 hormones tested:
Estrone (E1), Estradiol (E2), Estriol (E3), Progesterone (P1), Testosterone (TTF) DHEA, FSH and LH
Clinical Applications:
Same as PostM™
To examine FSH & LH abnormalities
For a more definitive diagnosis of menopause in younger women
FSH and LH values can help track severity of hot flashes, bone loss and insomnia
Information on fees, billing, insurance and medicare assignment is available to healthcare providers
*Hormone assessment of cycling women from puberty to perimenopause is done by
cycle mapping using the 11 sample FHP Panel™.

Case Study

Estrogen Overdose

PURPOSE
To present an example of estrogen overdose in a postmenopausal woman as a result of attempts to control hot flashes.

BACKGROUND
The recent Women’s Health Initiative Study (JAMA 2002; vol 228(3):321-333) on HRT helps confirm the futility of hormone treatment based only on symptoms, without ongoing monitoring. Many women are given large doses of estrogen to control hot flashes. The hormone levels in a typical hot flash consist of a high FSH with a rapid drop in estrogen coupled with a low progesterone. There is no decrease in the baseline value of estrogen. High dose estrogen treatment, as usually prescribed, will overdose the woman while it mitigates symptoms. It overrides estrogen fluctuations, but increases the risk of proliferative diseases of the breasts and uterus.

PATIENT HISTORY and DATA
Age and Sex: 50 year old female
Last Period: 3 years prior
Bone density changes: Sub-clinical or minimal
Initial Symptoms: Hot flashes, emotional and concentration problems
initial Treatment: Placed on estrogen patch with no hormone monitoring done
Outcome: Control of somatic symptoms, increased aggression and irritability, and breast tenderness
Patient sought further help and a Diagnos-Techs PostM™ panel was ordered.

PostM™ REPORT SUMMARY
Patient Values Reference
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 100-300pg/ml

REMARKS
The report showed normal 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% and patient was given 20mg BID of sublingual liquid pro-gesterone. Retesting 30 days later, using the PostM™ showed that the hormone levels were acceptable and all symptoms were under control.