postmenopausal dutch Flashcards
Postmenopausal females are the most common type of patient that providers order DUTCH tests for, often as a ____ measure or used in conjunction with monitoring various forms of hormone replacement therapy (HRT).
baseline,
Some of the common reasons for ordering include understanding _____ symptoms, ensuring that estrogen metabolism is efficient before starting estrogen replacement therapy (ERT), evaluation of symptoms of estrogen dominance, and monitoring therapy to ensure that the patient is in an ____ _____
hormonal , ideal range.
3 primary estrogens
1- estrone (e1)
2- estradiol (E2)
3- Estriol (E3) aka 16-OHE2
_____ has the strongest stimulatory effect on estrogen receptors while ____ has the weakest effect. Estrone and estradiol can interconvert via 17b-hydroxy steroid dehydrogenase (HSD) and estriol is an estradiol and 16-OH-E1 downstream metabolite.
Estradiol (E2),
estriol (E3)
In postmenopausal females, estradiol is beneficial for bone health, _____ sensitivity, healthy weight-management, neurotransmitter balance, sleep, ____, _____, memory, hair, skin, vaginal pH, vaginal lubrication, and cardiovascular health.
insulin, mood, concentration,
Estradiol excess, or estradiol that is not well balanced with ______, may have adverse health consequences, which includes endometrial cancer, gallstones, _____ issues, breast tenderness, and abnormal uterine bleeding (AUB).
progesterone, clotting
Low E2 in PMP females may result in ____ ____, night-sweats, insomnia, joint pain, skin issues, low ____ ____, mood issues, brain fog, vaginal _____, weight gain, decreased bone mineral density, and increased cardiovascular disease risk.
hot flashes, sex drive, dryness,
In PMP females, E2 is made from _____ ____ thus low E2 can be associated with low adrenal DHEA and ______ production, and down regulated aromatase activity
adrenal androgens, androstenedione
It is plausible that low E2 may occur secondary to extremely low ___ ____ percentages, low cholesterol (LDL < 40mg/dL), poor _____ function, or diindolylmethane (DIM
body fat, mitochondrial
PMP females on estrogen replacement therapy (ERT) may experience high E2 symptoms (estrogen dominant symptoms), e.g., AUB, tender breasts, ____ ____ acne, ____ issues, and swelling.
weight gain, mood
____ and ___ can interconvert within estrogen metabolism
estrone (E1) and Estradiol (E2)
E3 (estriol) is made from _____
Estradiol (E2)
Estrone (E1) can metabolism into one of the three pathways
1- preffered=
2- Potentially harmful=
3- Proliferative (growing and incr in #s rapidly)=
4th metabolite=
1- 2-OHE1
2- 4-OHE1
3- 16-OH E1
4= 2 MeOE1
Estrogen dominance” is a term used to describe the hormonal imbalance that arises when estrogen levels are relatively higher than _____ levels in the body. Estrogen dominance can occur in a postmenpausal female when estrogen is in excess, phase ___ estrogen metabolites are elevated, or when a female uses estrogen replacement therapy (ERT) without (or inadequate) progesterone therapy
progesterone, 1
Overall, the progesterone to estrogen (Pg/E2) ratio tends to be ___
Low
Some signs and symptoms of estrogen dominance in PMP females include:
* Endometrial hyperplasia
* ___ _____ ____
* Possible fibroid growth
____ _____
* Mood issues *
Weight gain * Acne
* Fatigue
Abnormal uterine bleeding (AUB)
* Breast tenderness
Estrogen dominance can occur when estrogen (E1, E2) and progesterone are within the PMP range, but ___ ___ ___ ____ are above the PMP range
phase 1 estrogen metabolites (2-OH, 4-OH and 16-OH phase 1 estrogen metabolites can actively bind to estrogen receptors.)
Estrogen dominance may be observed when estrogen replacement therapy (ERT) is used ____ progesterone therapy
without (or with inadequate)
When a female has a uterus, ERT must be used in combination with progesterone to protect the ______ from hyperplasia and cancer.
endometrium
The DUTCH Test measures two progesterone metabolites in the urine:____ and _____
a-pregnanediol and
b-pregnanediol,
a-Pregnanediol modulates ____ receptors in the central nervous system (CNS) and can lead to improvements in ____ and sleep. b-Pregnanediol is the major _____ metabolite, but unlike a-pregnanediol, it does not modulate
GABA receptors.
GABA, mood. progesterone
In postmenopausal females, progesterone supports ____ , ____, memory, and bone mineral density.
sleep, mood,
In postmenopausal females, progesterone is predominantly made in the ____ glands.
adrenal
The progesterone to estrogen ratio can be calculated using b-pregnanediol (the most prominent progesterone metabolite) and E2.
- Pg/E2 ratio = b-Pregnanediol/E2
The ratio is typically 50-300 in the follicular phase,
<100 during ovulation and
100-500 in the luteal phase.
true
Low Pg in PMP females who are not prescribed MHT may result in ____ , insomnia, irritability, anxiety, weight ___ and low bone mineral density.
fatigue, gain
In PMP females with a uterus who are prescribed MHT, Pg dosing must balance ___ endometrial proliferative effects. When Pg dosing is inadequate, PMP females may be at increased endometrial cancer risk.
E2’s
In PMP females who are not prescribed MHT, HPA axis dysfunction may contribute to ___ Pg levels.
low
use of adrenal )______ with low pg may help
adaptogens
In PMP females prescribed oral/sublingual Pg or pregnenolone, Pg metabolites are typically _____ above the postmenopausal and premenopausal reference ranges
elevated
Oral micronized progesterone (OMP) age-dependent reference ranges for females:
* a-Pregnanediol: ____-____ ng/mg
* b-Pregnanediol: 580-____ng/mg
a- 2,000-9,000
b- 3,000
what are the two progesterone pathways
5a pathway
5b pathway
if someone favors the 5a pathway this regulates what?
favoring alpha progesterone metabolites modulate GABA receptors and may help with mood and sleep
what are the 2 things progesterone can be metabolized into?
a-pregnanediol
b-pregnanediol
Alpha metabolites on the DUTCH Test include a-pregnanediol, androsterone, __-___, 5a-androstanediol, and a-THF.
Beta metabolites on the DUTCH Test include b-pregnanediol, _______, 5b-androstanediol, b-THF,
and b-THE.
5a-DHT
etiocholanolone
Increased 5a-reductase activity is associated with ______, insulin resistance, obesity, _____ supplementation, and certain genetic makeups. Females supplementing with oral Pg may see improvements in mood and sleep if they favor the alpha pathway.
inflammation, DHEA
When oral Pg is supplemented, females favoring the ____ pathway may need a higher Pg dose than females favoring the alpha pathway to see similar improvements in mood and sleep.
beta
what are testosterones 3 metabolites
1- 5b-androstanediol
2- 5a-DHT
3- 5a-Androstanediol
In postmenopausal females, testosterone supports muscle, strength, ____, healthy weight, bone, skin, hair, mood, memory, sexual function, cardiovascular health, and ____ levels.
stamina, estradiol
In postmenopausal females, testosterone is mostly derived from peripheral conversion of androstenedione and DHEA. However, a small amount of androstenedione and DHEA are still synthesized in the ____ and can be peripherally converted to testosterone. Testosterone production peaks in the third and fourth decades of life (20s and 30s) and ____ thereafter.
ovary , declines
Testosterone age-dependent reference ranges for females:
* 20-39 years old: 3.2- ___ ng/mg
* 40-60 years old: 2.3-___ng/mg
* > 60 years old: 1.5-6.3 ng/mg
14
8
Low testosterone in postmenopausal females may be associated with fatigue, ____ ____, difficulty _____ muscle mass, bone loss, mood issues, brain fog, low libido, and sexual dysfunction.
weight gain, building
