Term
| What is the major hormone released by the hypothalamus? |
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Definition
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Term
| What roles does the anterior pituitary play? |
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Definition
Blocks or stimulates release of progesterone, estrogen, and testosterone through the release of...
-FSH and LH |
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Term
| What hormone does FSH primarily affect? |
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Definition
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Term
| What hormone does LH primarily affect? |
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Definition
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Term
| What short-lived "organ" is responsible for progesterone production? |
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Definition
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Term
| In what four locations (in order of descending concentrations) can estrogen be produced? |
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Definition
- Ovaries
- Follicle around ovum
- Adrenal glands
- Fat cells |
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Term
| What three forms of estrogen are there? |
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Definition
E2 - Estradiol, most active form of estrogen made by ovaries, adrenals, and fat cells
E3 - Estriol, weakest and least active, attaches to cell receptors making up hair, nails, skin, and mucosal membranes, affects primarily vaginal walls, little effect on bones or heart
E1 - Estrone, made after menopause primarily in fat cells from testosterone derivatives, higher levels (while not definititively causative) have shown higher levels of breast cancer in certain studies |
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Term
| With the aging process, where does most of of the estrogen come from? |
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Definition
- Adrenals become main source of estrogen production
- Unused Testosterone is transformed into estrogen
- Estrogen in fat cells is called into action |
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Term
| What are the "general" affects of estrogen? Specifics? |
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Definition
- In general, estrogen makes things grow
- Specifically:
-Makes lining of uterus grow
- Grows breast tissues grow for milk production
- Causes ovum to mature for ovulation
- Supports follicle growth
- Promotes fetal growth
- Keeps vagina, vulva, and cervix well developed and moisturized
- Stimulates body fat accumulation to aid the fetus
- Prevents bone destruction by osteoclasts
- Relaxes lining of blood vessels, preventing HTN
- Stimulates production of lipoprotein lipase (breaks down fat), result is low cholesterole levels and good HDL/LDL balance
- Induces relaxation of blood vessels in heart |
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Term
| If left unchecked by progesterone, estrogen can lead to negative consequences, these include: |
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Definition
- Increased body fat
- Increased water and salt retention
- Interferenece with normal insulin release and blood sugar control
- Increased risk of overgrowth of endometrium (lining of the uterus)
- Increased risk of overgrowth of breast tissue
- Anxiousness and irritability
- Severe headaches
- Increased risk of galbladder disease
- Increased incidence of blood clot formation |
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Term
| While progesterone is the precursor of many hormones, what are its functions in the way of the estrogen-progesterone relationship? |
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Definition
- Prepare the endometrium for implantation of the fertilized ovum
- Ensure survival of the fetus in the uterus
- Prevent water retention
- Help use fat for energy at the cellular level
- Serve as a natural antidepressant (more info needed)
- Create a calming effect on the body
- Help restore regular sleep patterns
- Help keep insulin release in check and maintain even blood sugar levels
- Prevent overgrowth of the endometrium
- Prevent breast tissue overgrowth
- Maintain sex drive
- Maintain normal blood-clotting parameters
- Protect against fibricystic breasts |
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Term
| If unbalanced by estrogen, what are progesterone's negative effects? |
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Definition
- A sedating effect
- Increased spotting and changes in bleeding patterns
- Bloating, when taken in large quantities
- GI discomfort
- Acne
- Hyperpigmentation of the facial skin when exposed to sunlight |
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Term
Where is testosterone made in men?
In women? |
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Definition
Men: Testes and adrenals
Women: Adrenals, ovaries, and corpus luteum in women |
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Term
| Name the different androgens |
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Definition
Testosterone
Androstenediol
Dihydrotestosterone (DHT)
androstanediol
androstenedione
dihydroepiandrosterone (DHEA)
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Term
| What are the positive effects of testosterone in men and women? |
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Definition
- Promotes muscle strength and exercise endurance
- Improves libido
- Increases energy levels
- Improves sense of well being
- Increases body hair production
- Produces enlargement of penis and testes as well as clitoris
- Improves sexual desire and fantasy
- Improves bone desnity |
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Term
| What are the negative effects of testosterone? |
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Definition
- Male pattern baldness
- Increased facial hair
- Aggressive behavior/irritability
- High cholesterol levels
- Too much clitoral enlargement
- Involution of testis and penis
- Growth of breast tissue in men
Some effects of too much testosterone are similar to estrogen because this hormone is converted TO estrogen when too abundant |
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Term
| What are symptoms of hormone inbalance in adolescent years? |
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Definition
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Term
| What are symptoms of hormone inbalance in a person's twenties/child bearing years? |
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Definition
- Postpartum depression
- Night sweats
- Infertility
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Term
| What are symptoms of hormone inbalance in a person's thirties? |
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Definition
- Bloating
- PMS
- Migraines
- Breast tenderness
- Decreasing attention span
- Weight gain
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Term
| Why do women in their thirties experience symptoms similar to PMS? |
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Definition
| - The quality of progesterone produced by their corpeus luteum decreases greatly, causing an overabundance of estrogen effects |
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Term
| How does estrogen cause migraines, decreased attention spans, and weight gain? |
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Definition
Migraines - widening and dilation of blood vessels in the scalp
Decreased attention -
Weight gain - Estrogen stimulates fat accumulation, and also spikes insulin levels (progesterone tempers insulin) |
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Term
| What is the connection between depression and hormones? |
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Definition
Normal levels of estrogen and progesterone stimulate the production of serotonin
Unopposed levels of estrogen cause the pituitary gland to pulse LH (to produce more progesterone) and keep us from staying asleep at night |
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Term
| What is the dose of natural progesterone, and where can the cream be applied (usually)? |
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Definition
- 4-6mg/kg a day
- Upper chest, neck, and inner wrists |
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Term
| What is the dose of natural estradiol? Where is the cream applied? |
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Definition
- 0.006-0.008mg/kg a day
- The cream is applied to the upper chest, inner arms or wrists, or neck; generally areas that are warm and have good circulation
- The dosing is generally cycled to follow the woman's natural cycle
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Term
| What is the dose of natural testosterone? Where are some areas of application? |
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Definition
Dose: 0.01mg/kg a day
Can be applied on bicep, 3-4 times weekly, or to the area around the labia or clitorus |
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Term
| Dispell the following myth: Hormone treatments are risky and can increase morbidity and mortality from breast cancer, cervical cancer, stroke, and cardiovascular disease |
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Definition
- WHI of 1991 only focused on synthetic hormones for study
- Focused on estrogen ONLY, no progesterone
- The following statement was released after that part of the study was halted in 2004
"After careful consideration of the data, NIH has concluded that with an average of nearly 7 years of follow-up completed, estrogen alone does not appear to affect (either increase or decrease) heart disease, a key question of the study. It has not increased the risk of breast cancer during the time period of the study." |
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Term
| Dispell the following myth: if a hormone supplement (example, estrogen 2.4mg/gram, 0.5 grams bid) doesn't appear to be resolving symptoms, titrate the dose upwards |
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Definition
| - No, there are various overlaps in hormone symptoms, and one symptom of hormone excess can be the same as a symptom of another hormone's deficiency |
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Term
| Dispell the following myth: Saliving testing is the only acceptable form of hormone testing |
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Definition
| - Each test; saliva, blood spot, urine, and serum all have their advantages and disadvantages |
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Term
| What is significant in regards to estrone? |
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Definition
- 50-70% less active than estradiol
- Produced by oxidation of estradiol and, in the peripheral tissues, of androstenedione
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Term
| What is significant in regards to estradiol? |
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Definition
- Most potent and active estrogen
- binds most tightly to estrogen receptors |
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Term
| What is significant regarding estriol? |
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Definition
- 10% of the activity of estradiol
- produced from the hydration of estrone
- Cannot be converted INTO estrone or estradiol
- Can impede binding of estradiol |
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Term
| Describe the major components of the hormone metabolism pathway (picture) |
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Definition
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Term
| Why are synthetic estrogens not considered to be real hormones? |
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Definition
| They provide precursors to estrogens, but not the actual hormones |
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Term
| What information is important in regards to synthetic hormones compared to BHRT? |
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Definition
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Term
| What are the symptoms associated with each hormone and its corresponding level? |
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Definition
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Term
| Why test patients, instead of going by patient response? |
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Definition
- Symptoms of different imbalances overlap (imbalance of one or more hormones can mimic the effect of other imbalances)
- Too much of one hormone can create the same symptoms as too little (too much of a hormone can work initially, but ultimately will decrease benefits and increase risks)
- must validate each hormone independently, cross-reference one test level by using another (e.g, saliva vs. serum shows relatively same elevation)
- Distinguish follicular, ovulatory, and luteal phases of the menstrual cycle
- Yield results that correlate with age and symptoms
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Term
| Saliva testing is preferred when.... |
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Definition
- Testing for multiple points (e.g cortisol)
- Patients are using topical medications
- Saliva testing is subject to contamination from blood and supplements
- Not everything measured in saliva is clinically viable, such as Vitamin D (if blood present), or DHT
- NEVER do a saliva test within 24 hours of using a troche |
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Term
| Cortisol testing should be done using.... |
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Definition
| A 4-point (4x/day) method |
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Term
| Serum testing is the norm BUT.... |
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Definition
- Subject to overdosing patients who use topical medications
- needs to include binding proteins to assess the level of "free" hormones
- Some methods innaccurate at low concentrations
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Term
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Definition
- Can measure factors that are too large for saliva (thyroid, Vitamin D, glucose, insulin, DHEAS)
- more convenient than serum testing
- more reflective of tissue uptake for patients on topicals
- best for evaluating cardiovascular metabolic risk factors |
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Term
| Uring testing can be effective for baseline hormone testing BUT.... |
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Definition
- Does not show bioavailable hormone levels
- Not good for oral estrogens (progesterone)
- First pass effect clouds interpretation
- Not accurate when treating with topical progesterone |
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Term
| WHEN do you do the testing? |
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Definition
- Cycling female -> test days 18-21 during luteal phase
- Irregular cycles -> test after next menses as above or test now
- Menopausal -> test any time
- patient to take oral hormones 12 hours prior or apply topical 12-24 hours prior |
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Term
| Describe the levels of estrogen during the menstrual cycle (picture) |
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Definition
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Term
| What are the general treatment guidelines, in terms of evaluating/subsequently prescribing, that a practitioner should follow? |
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Definition
Goal: To restore hormone levels to the normal physiological levels of a younger individual, to provide the protective benefits of the hormone to the entire system
- Replenish only the hormones that are necessary
- Correct cortisol, thyroid, and progesterone first
- Use the lowest amount required to alleviate symptoms and achieve the desired physiological effect
- Start bioidentical estrogen dosage at mid-range (NEVER use unopposed estrogen)
- Start low and adjust slowly (efficacy can be improved by changing timing, application, and/or delivery route)
- Monitor symptoms (if not resolved consider other hormonal/behavioral causes)
- Re-test |
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Term
| What are some major considerations for the various dosage forms of synthetics and bioidenticals? |
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Definition
Oral synthetics
- Not well absorbed in body
- Limits to amounts that can be taken (expensive, some transdermals unpleasant, liver issues)
Compounded BHRT's
- Vaginal delivery (creams or suppositories) have excellent absorption, have been shown to be SUPERIOR over oral delivery
- Troches have fast dissolution and rapid onset, but may need to be dosed more often, also could skew saliva testing
- SR micronized caps are good alternative |
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Term
| What are the effects of a decreased estrogen level? |
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Definition
- Anxiety
- Bladder symptoms
- Cramps
- Depression
- Dry skin/hair
- Harder to climax
- Hot flashes
- memory loss
- night sweats
- sleep disturbances
- vaginal dryness |
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Term
| What are the effects of an increased estrogen level? Fluctuating? |
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Definition
- Anxiety
- Decreased sex drive
- Fibrocystic breasts
- fluid retention
- heavy menses
- irratibility
- mood swings
- weight gain
Fluctuating:
- Hair loss
- Headaches
- Hot flashes
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Term
| What are the effects of decreased progesterone levels? |
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Definition
- Anxiety
- Arthritis
- Breakthrough bleeding
- breast tenderness
- Fibrocystic breast
- fluid retention
- harder to climax
- heavy or irregular menses
- hot flashes
- mood swings
- sleep disturbances
- weight gain |
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Term
| What are the effects of INCREASED progesterone levels? Fluctuating? |
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Definition
- Breast tenderness
- Depression
- Fatigue
Fluctuating:
- hair loss
- headaches
- Irritability
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Term
| What are the effects of a DECREASED testosterone level? Increased? |
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Definition
- Arthritis
- Bladder symptoms
- Decreased sex drive
- Depression
- Fatigue
- harder to climax
- headaches
- loss of memory
- vaginal dryness
Increased:
- Hair loss
- Sleep disturbances |
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Term
| What are the effects of a DECREASED cortisol level? Increased? Fluctuating? |
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Definition
- Decreased sex drive
- Fatigue
Increased:
Depression
Fluctuating:
- Night sweats |
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Term
| What are the effects of a DECREASED thyroid level? |
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Definition
- Decreased sex drive
- Depression
- Fatigue
- Headaches
- Weight gain
Fluctuating levels cause hair loss |
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Term
| What levels of what hormones can cause anxiety? |
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Definition
- Decreased OR increased estrogen
- Decreased progesterone |
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Term
| What levels of what hormones can cause arthritis-like symptoms? |
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Definition
- Decreased Progesterone
- Decreased Testosterone |
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Term
| What levels of what hormones can cause bladder symptoms? |
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Definition
- Decreased estrogen
- Decreased testosterone |
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Term
| What levels of what hormones can cause breakthrough bleeding? |
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Definition
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Term
| What levels of what hormones can cause breast tenderness? |
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Definition
| - Decreased OR increased progesterone |
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Term
| What levels of what hormones can cause cramps? |
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Definition
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Term
| What levels of what hormones can cause decreased sex drive? |
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Definition
- Increased estrogen
- Decreased testosterone
- Decreased cortisol
- Decreased Thyroid |
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Term
| What levels of what hormones can cause depression? |
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Definition
- Increased progesterone
- Increased cortisol
- Decreased estrogen
- Decreased testosterone
- Decreased thyroid |
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Term
| What levels of what hormones can cause dry skin/hair? |
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Definition
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Term
| What levels of what hormones can cause fatigue? |
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Definition
- Increased progesterone
- Decreased Testosterone
- Decreased cortisol
- Decreased thyroid |
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Term
| What levels of what hormones can cause fibrocystic breast? |
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Definition
- Increased estrogen
- Decreased progesterone |
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Term
| What levels of what hormones can cause fluid retention? |
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Definition
- Increased estrogen
- Decreased progesterone |
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Term
| What levels of what hormones can cause hair loss? |
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Definition
- Fluctuating levels of estrogen, progesterone, and thyroid.
- Increased testosterone |
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Term
| What levels of what hormones can cause difficulty in climaxing? |
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Definition
| - decreased estrogen, progesterone, and testosterone |
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Term
| What levels of what hormones can cause headaches? |
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Definition
- Fluctuating estrogen and progesterone
- Decreased testosterone
- Decreased thyroid |
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Term
| What levels of what hormones can cause heavy or irregular menses? |
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Definition
- Increased estrogen
- Decreased progesterone |
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Term
| What levels of what hormones can cause hot flashes? |
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Definition
- Decreased OR flucuating levels of estrogen
- Decreased progesterone |
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Term
| What levels of what hormones can cause irritability? |
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Definition
- Increased estrogen
- Fluctuating progesterone |
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Term
| What levels of what hormones can cause memory-loss? |
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Definition
- Decreased estrogen
- Decreased progesterone |
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Term
| What levels of what hormones can cause mood swings? |
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Definition
- Increased estrogen
- Decreased progesterone |
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Term
| What levels of what hormones can cause night sweats? |
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Definition
- Decreased estrogen
- Fluctuating cortisol |
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Term
| What levels of what hormones can cause sleep disturbances or insomnia? |
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Definition
- Decreased estrogen
- Decreased progesterone
- Increased testosterone |
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Term
| What levels of what hormones can cause vaginal dryness? |
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Definition
- Decreased estrogen
- Decreased testosterone |
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Term
| What levels of what hormones can cause weight gain? |
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Definition
- Increase estrogen
- Decreased progesterone
- Decreased thyroid |
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