menstruating females Flashcards
In cycling females, estradiol is predominantly made in the ovaries. Estradiol levels are highest during the ____ phase and lowest in the early _____ phase.
ovulatory. follicular
Low E2 in cycling females may result in hot flashes, night-sweats, insomnia, joint pain, skin issues, low ___ ____, mood disturbance, brain fog, vaginal dryness, weight gain, decreased ____ _____ density, and increased cardiovascular disease risk.
sex drive, bone mineral
Low E2 in cycling females is often associated with high stress (HPA axis dysfunction), _____ disorders, high prolactin, _____, perimenopause, downregulated aromatase activity
thyroid, breastfeeding
Elevated E2 in cycling females may be normal if E2 and _____are balanced. In cycling females, where E2 and Pg are not balanced, elevated E2 can
lead to ____ ____, cramping, fibroids, tender or fibrocystic breasts, mood disturbances, fatigue, acne, headaches, and weight gain. E2 that is not balanced with Pg may increase endometrial cancer risk, and elevated endogenous estrogen is a risk factor for breast cancer.
progesterone (Pg) . heavy bleeding
Elevated E2 in cycling females may be normal or may be associated with obesity, insulin resistance, diabetes, _____, stress, ____ elevated androgens, perimenopause, poor detoxification, endocrine disrupting chemicals (EDCs), high ____ intake, gut dysbiosis, DHEA/T/E2 supplementation, upregulated aromatase activity5,
inflammation, PCOS, alcohol
Of the 3 estrogen pathways list
1) preferred
2) potentially harmful
3) proliferative
1) 2-OHE1
2) 4-OHE1
3) 16-OHE1
the following are signs of what dominance?
heavy bleeding, menstrual cramping, breast tender, mood swing, PMS, irritability, anxiety, sleep issues, irregular cycle, wt gain, acne, fertility issues, fatigue
estrogen dominance
Estrogen dominance can also arise when progesterone and the parent estrogens, estradiol (E2), and estrone (E1) are balanced but ____ estrogen metabolites are elevated.
phase 1
what are the two progesterone metabolites measured in the urine via dutch test
1- a-pregnanediol
2- b-pregnanediol
a-Pregnanediol modulates ____ receptors in the central nervous system (CNS) and can lead to improvements in mood and ____
(b-pregnanediol does not)
GABA . sleep.
In cycling females, progesterone’s primary role is to stabilize the ____ for conception, but also supports sleep, mood, and ____
endometrium
memory
In premenopausal and postmenopausal females, progesterone, in addition to estradiol, supports optimal ____ ____ ____
bone mineral density.
Adrenal progesterone increases in response to ____ and increased cortisol output
stress
In cycling females, progesterone is predominantly made in the ____ by the corpus luteum during the ____ phase.
ovaries , luteal
Low Pg in cycling females may contribute to fatigue, _____, irritability, anxiety, weight ____, infertility, and increase endometrial cancer risk. When Pg is low relative to E2 (relative estrogen dominance), some females may experience PMS, heavy bleeding, and breast tenderness.
insomnia. gain,
Support considerations with low Pg:
In addition to assessing and treating the underlying root cause, other considerations include ___ axis support with chasteberry extract, _____, evening primrose oil or borage oil, B6, stress reduction, _____ support, or bioidentical Pg. Antioxidant support has also been shown to improve Pg levels by improving ovarian cell health.
HPO, antioxidant , maca
Elevated Pg in cycling females may be normal and asymptomatic or can result in fatigue, increased _____ , irritability, premenstrual dysphoric disorder (PMDD), breast tenderness, and _____ before menses. Slightly elevated progesterone is typically not problematic.
appetite, bloating ,
Oral micronized progesterone (OMP) age-dependent reference ranges for females:
* a-Pregnanediol: ____-_____
* b-Pregnanediol: 580-____ ng/mg
2,000-9,000 ng/mg
b- 3,000
standard dose of progesterone
100 mg
Progesterone is metabolized into a-pregnanediol by ________ and b-pregnanediol by 5b-reductase. It may be helpful to know if there is a 5a or 5b preference because the _____ progesterone metabolites modulate GABA receptors and may help with mood and sleep. When assessing for an alpha or beta preference, compare the direction of the dials rather than the numbers within the dials.
5a-reductase, alpha
Alpha metabolites on the DUTCH Test include a-pregnanediol, _____, 5a-DHT, 5a-androstanediol, and ____ Beta metabolites on the DUTCH Test include b-pregnanediol, _____, 5b-androstanediol, b-THF,
and b-THE.
androsterone, a-THF.
etiocholanolone,
The DUTCH Test reflects bioavailable testosterone. Testosterone’s activity may be evaluated by looking at its downstream metabolites, ____, 5a-androstanediol, and _______
5a-DHT, 5b-androstanediol
in target tissues, testosterone is activated to _____ by the enzyme 5a-reductase. 5a-DHT is three times more potent than testosterone and is made and metabolized locally in the tissues to 5a-androstanediol. Therefore, urinary _______ may be a better marker of tissue 5a-DHT activity than urinary 5a-DHT. In addition to the 5a-DHT and 5a-androstanediol, the downstream alpha metabolite of _____ (androsterone) can additionally be used to evaluate tissue androgen activity.
5a-DHT, 5a-androstanediol.
DHEA
In females, if DHEA-S or total DHEA is high, the source of excess androgens is likely the _____ glands. Conversely, if these are within range, but testosterone and its metabolites are high, the source may be _____
adrenal, ovarian.
In cycling females, testosterone supports _____ , _____ stamina, healthy weight, bone, skin, hair, mood, memory, sexual function, fertility, cardiovascular health, and estradiol levels (though it contributes to estradiol levels more in postmenopausal females).
muscle, strength,
In cycling females, testosterone is made in the ovaries (about ___) and the adrenals (about ___), and the remaining 50% is aromatized in peripheral tissues (primarily ____ ) from androstenedione and DHEA. Testosterone production peaks in the third and fourth decades of life (20s and 30s) and declines thereafter.
25%, 25%, fat
Testosterone age-dependent reference ranges for females:
* 20-39 years old: 3.2-14 ng/mg
* > 60 years old: ____-6.3 ng/mg
* 40-60 years old: ___ -___ng/mg
> 60: 1.5
40-60 2.3-8
Low testosterone in cycling females may be associated with fatigue, weight ___, difficulty building muscle mass, bone loss, mood issues, brain fog, low____ and sexual dysfunction.
gain, libido,
Low testosterone in cycling females may be associated with aging, elevated sex hormone binding globulin (SHBG), low ____ output (HPA axis dysfunction), poor ovarian production, surgically removed ovaries, diabetes, hypothyroidism, sleep disturbances, EDCs, ____ deficiencies, certain medications, and upregulated aromatase activity.
adrenal, zinc
Elevated testosterone in cycling females has been associated with ____, oily skin, increased body/facial hair, _____ _____hair, androgenic alopecia, and mood disturbance (aggression, irritability, etc.).
acne, thinning scalp
w/ high estrogen
tx underlying cause, other considerations include addressing inflammation, regulating blood sugar, weight loss if appropriate, supporting the ____ ____, supporting liver detoxification, flaxseeds, _______, herbal anti-androgens, and medications such as metformin and spironolactone
HPA axis, myo-inositol,
The DUTCH Test measures three DHEA metabolites: DHEA-S, ____, _____
etiocholanolone, and androsterone,
DHEA is considered a ___-_____ as most is converted at the tissue level to
more potent androgens and estrogen
pro-hormone,
DHEA in the adrenal gland is sulfated to _____ , a form that is more stable in serum and can act as a DHEA reserve. The best way to assess the total adrenal androgen production is to add up the DHEA-S, etiocholanolone, and androsterone metabolites, to equal the total DHEA production, also known as the total ____ _____production.
DHEA-S, adrenal androgen
DHEA supports muscle, bone, sexual function, _____, brain health, immune function, and cardiovascular health.
fertility
Total DHEA age-dependent reference ranges for females:
* 20-39 years old: 1300-3000ng/mg
* 40-60 years old: ____-____
> 60 years old: 500-____
750-2000ng/mg
-1200ng/mg
Low DHEA in cycling females may be associated with fatigue, low ____, _____, infertility, diabetes, heart disease, inflammation, and immune disorders.
libido, depression,
For low DHEA, In addition to treating the underlying cause, other considerations include DHEA replacement therapy22, addressing chronic inflammation, regulating blood sugar, supporting ____ detoxification, HPA axis support, and ____ reduction, which may include calming _____ support, parasympathetic nervous system (PNS) support, and GABA support.
liver , stress , herbal
Elevated DHEA in cycling females has been associated with androgen excess symptoms including____ ____, acne, sleep problems, headaches, and
mood disturbances.
oily skin,
It may be helpful to know if there is a 5a
or 5b androgen preference because a
beta preference may exacerbate signs and symptoms of low androgens such as low libido, fatigue, and ____ ____
weight gain.
with 5b-Reductase Preference
–Consider upregulating 5a-reductase activity with ____, weight resistance exercises, and supplements such as ____ and pine pollen. Low androgen symptoms associated with low DHEA and/or testosterone may improve by directly addressing DHEA and testosterone levels.
high intensity interval training (HIIT), forskolin
certain birth controls such as pill, patch, ring, implant, injection may lower _____
progesterone
In males and females, the 5a-reductase inhibitors, ____ and dutasteride, may cause irreversible sexual dysfunction and _____
finasteride
infertility.
Medications that may contribute to low testosterone include _______, opioids, Accutane, _______, and some oral contraceptive pills.
glucocorticosteroids, spironolactone
Testosterone should always be evaluated and confirmed in the _____ before initiating testosterone replacement therapy (TRT) for low testosterone.
serum (clear pt of the blood)
Use caution with oral DHEA supplementation, as it may elevate ____ in addition to increasing____
estrogens. testosterone.
