is caused by a gradual change in the
ovarian sensitivity to neurohormones
(FSH & LH), and disruption in
the negative feedback loop. These
changes are re?ected as imbalances
in ovarian hormone output and manifested
as cessation of menstrual ?ow. Often
several somatic, cognitive, and emotional
manifestations precede and accompany
the menopause, which usually occurs
between ages of 40 and 56 years.
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Pre-Onset Changes: Perimenopause
Several years before the onset of menopause, estradiol variations
during the cycle are accentuated while progesterone output shows
a signifcant decline despite the persistence of ovulation. The dramatic
fluctuations in estradiol are believed to be caused by a reduction
in negative feedback in the hypothalamic-pituitary-ovarian axis.
Observed FSH elevations refect the reduced follicle sensitivity
to the trophic effects of FSH and GnRH. The perimenopause is clinically
characterized by several manifestations shown below.
altered lipid metabolism|atherosclerosis
the fractional adrenal contribution to estrogen activity increases
to about 95%. This is due to enhanced conversion of circulating
adrenal androgens into estrone in adipose and muscle cells, and
to increased fractional conversion of estrone to estradiol. As women
progress into the menopausal years, estrone becomes the dominant
Why use salivary
Saliva contains the free fraction of the hormones which refects
the bioactive tissue levels. Free Fractions in saliva correlate
more closely with clinical symptoms than total serum hormone levels(which
mostly refect the bound fraction).
included in the Post Menopause Panels™
Free fractions of salivary: Estrone (E1), Estradiol (E2), Estriol
(E3), Progesterone (P1), DHEA, Testosterone (TTF), plus Luteinizing
Hormone (LH) & Follicle Stimulating Hormone (FSH).
POST MENOPAUSE PANEL™ (PostM) by
One saliva sample
Panel Includes 6 hormones: E1, E2, E3, P1, DHEA & TTF
Measurement of hormone baselines
Monitoring natural hormone replacement therapy (HRT)
Risk assessment of breast/uterine proliferative diseases and osteoporosis
Investigation of hormone related libido and emotional vulnerability,
vaginal atrophy...and other symptoms as listed in Table 1.
MENOPAUSE PANEL™ (ePHP™)
2 saliva samples
1st sample is tested for: E1, E2, E3, P1, DHEA & TTF
2nd sample: Repeat of the 6 hormones.
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Applications, of ePHP ™ :
Irregular Cycles in women where menstrual flow is unpredictable,
and performing a complete 11 specimen hormone mapping is impractical.
Perimenopause where hormones fluctuate causing irregular menstrual
flow. In these cases, one specimen is minimally representative of
the hormone status, while the 11 specimen mapping is impractical.
Note: the first sample is collected any time and then frozen; 20
days later the second sample is collected and both are submitted
Therapeutic Monitoring/Hormone Challenge in postmenopausal women,
on HRT, or for HRT modification; the PHP-2™ can be used to
test hormone baseline levels and efficacy of adjustments in HRT
dosage and administration route.
EXPANDED POST MENOPAUSE PANEL™ (ePHP™)
One saliva sample
Panel includes: E1, E2, E3, P1, DHEA, TTF, FSH & LH
Same as PHP-1™
To correlate FSH & LH to ovarian hormone response
More de?nitive diagnosis of menopause in younger women
Who can benefit from these panels*:
PHP-1™ » Non-cycling women with intact ovaries who have
had no menstrual flow or spotting for two consecutive years
» Non-cycling women with total hysterectomy
» Cycling women currently on birth control pills
ePHP™ » Non-cycling women
with intact ovaries who have had no
menstrual flow or spotting for 6 months
to 2 years
» Non-cycling women with hysterectomy where one or both ovaries
» Perimenopausal women: irregularly cycling women with less
than 8 cycles per year
The above panels are not intended for cycling women. Hormone
assessment of cycling women from puberty to perimenopause is
done by cycle mapping using the 11 sample FHP Panel.™
LH & FSH
The pituitary Luteinizing hormone(LH) & Follicle stimulating
hormone(FSH) are gonadotrophins which regulate ovarian function.
Both FSH & LH are stimu- lated by hypothalamic GnRH (Gonadotrophin
Releasing Hormone). LH has a pulsatile rhythm which varies throughout
the cycle. Stress and high cortisol have an adverse effect on LH
but not on FSH. Stress renders women more estrogenic and less fertile,
and more prone to proliferative diseases.
there is a growing scarcity in ovarian follicles. LH & FSH production
show respectively, a three and seven fold increase over the values
found in young menstruating women.
Expanded ePHP ™ panel simultaneously
measures the levels of the two neurohormones
FSH & LH and the orresponding
concentrations of E2 and P1. Using
this panel, progression towards menopause
can be more accurately predicted
before clinical symptoms set in.
Early preventive treatment can be
initiated to minimize bone loss,
and other somatic symptoms.
Advantage: Hormone Balance Analysis
Our Post Menopause Hormone Panel™ report
allows you to examine and tailor the
balance of the various hormones rather
than just replacing one. The PostM ™ & ePHP ™ routinely
include a full page of patient-specific
interpretive data with risk assessment
of proliferative diseases of breast
and uterus. Our reports include the
Proliferation Potential Indexes™ (PPI™)
which correlate the pro-proliferative
effects of the three estrogens (E1,
E2, and E3) to the anti-proliferative
effects of P1 and TTF. Our reports
also provide suggestions which help
rectify commonly observed hormone
Natural estrogens, including estriol are proliferative; estrogens
and their metabolites differ only in the degree of their proliferative
potential. Certain estrogen metabolites are falsely promoted as
risk markers for breast cancer. A recent multicenter study compared
2/16 Hydroxyestrone ratio in women with breast cancer to a control
group of healthy women and concluded that "results do NOT support
the hypothesis that the ratio of 2/16 Hydroxyestrone is an important
risk factor for breast cancer, or that it is a better predictor
of breast cancer risk than levels of E1, E2 and E3…".
(Environ Health Perspect. 1998 Mar; 106(3):A126-7)
Study: Estrogen Overdosing Purpose: To demonstrate the typical estrogen
overdosing in post-menopause women in attempts to control somatic
symptoms, including hot ?ashes.
The recent Women's Health Initiative Study (JAMA 2002; vol 228(3):321-333)
on HRT re-af?rms our long held position that use of synthetic or
natural hormone replacement therapies based on symptoms only, and
without ongoing monitoring, carries with it grave health risks.
Many late and early post-menopausal women are given estrogens of
various types to control somatic symptoms, including hot Fashes.
The physicochemical anatomy of a hot flash consists of a rapid drop
in estrogen coupled with a low progesterone. It is not a dearth
in the absolute value of estrogen. Consequently, the continual estrogen
treatment, usually prescribed, will overdose the woman while it
mitigates somatic symptoms. It blunts the rapid fluctuations in
estrogen by overriding endogenous production.Patient
History & Data Age: 50 yrs Female Last Period: 3 yrs arlier
Bone density changes: Sub-Clinical or minimal
Initial Symptoms: Hot flashes, emotional and concentration problems
Treatment: Placed on estrogen patch; no hormone monitoring done
Outcome: Control of somatic symptoms, increased aggression and irritability,
with tender breasts
sought further help and a Diagnos-Techs PHP-1™ was ordered. PHP-1™
Report Summary Hormone Levels Normal Ranges
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 100-300 pg/ml
The report showed suffcient 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.
Estrogen dose was cut by 65% to prevent override.
20mg BID of
sublingual liquid progesterone was given.
days later using the PHP1,™ hormone levels were acceptable
and all symptoms were under control.
three salivary samples over a 5-day period to determine levels of
ß-estradiol, estriol, estrone, progesterone, and testosterone
for women who are menopausal. The comprehensive profile includes the
Adrenocortex Stress Profile and the Comprehensive Melatonin Profile
to reveal how the sex hormones are affected by the influences of cortisol,
DHEA, and melatonin.
Following menopause, a marked decrease in levels of estrogen and other
sex hormones produces several distinct changes in female physiology.
These changes can have a dramatic impact on a woman's physical and
emotional health. Many conditions associated with this period of a
woman's life, however, can be effectively overcome or modulated by
establishing optimal hormonal balance.
Menopause Panel identifies deficiencies (or excesses) of important
sex hormones estradiol, estrone, estriol, progesterone, and testosterone.
It can provide guidance in the therapeutic intervention of several
conditions associated with sex hormone imbalances in women:
Hypertension and Heart Disease
lab tests can be done through the mail in the privacy of your own
home, except blood tests, we send you to a lab to have your blood
drawn for these. After you pay for the test we mail you the kit,
the results take two weeks, the test results will be mailed to us
and we will call you to go over the results, its that easy! All
tests include the consultation for the report of findings.
on test of interest on the right for more information or call our
office for details:
800-956-7083 OR 818-707-3126.