Menopause Mastery (The Institute of Bioidentical Medicine)

The importance of Estriol (E3) and an introduction to receptor sites.

1 Quiz

Quiz Q21: Importance of Estriol

Prescribing Bi-est: Understanding the E3/E2 ratio. “mgeeq”: the oh-so-important math on potencies and ratios.

1 Quiz

Quiz Q22: Potencies and Ratios

Calculating Bi-Est potency

1 Quiz

Quiz Q23: Calculations

All about bases

1 Quiz

Quiz Q24: Bases

Individualization. Dose Determination by titration. Receptor site sensitivity and dormancy.

1 Quiz

Quiz Q25: Sensitivity and Dormancy

Aiming for optimum: balancing drops, concentrations and ratios.

1 Quiz

Quiz Q26: Optimum Doses

Window of Opportunity: Cardiovascular Risk Considerations

And now we're on to Progesterone!

Treat early on!

1 Quiz

Quiz Q27: Treating Early

The effect on Thyroid, Bone, Sleep and Brain

1 Quiz

Quiz Q28: The effects

Breast Cancer risk, SHBG issues.

1 Quiz

Quiz Q29: Progesterone Poignancies

Progesterone Poignancies. Transdermal dosage limits. Dermal Fatigue. TVUS.

1 Quiz

Quiz Q30: Optimal Dosing

Excessive Progesterone Dosages: receptor sites. Unusual Symptoms

1 Quiz

Quiz Q31: Unusual Symptoms

Common Starting Dosages

1 Quiz

Quiz Q32: Starting Dosages

Progesterone. Prescribing and applying Bi-Est and Progesterone: Prescription

Writing Your First Prescription. Four Distinct Dosing Schedules in the Dose Determination Process.

1 Quiz

Quiz Q33: First Prescription

Topical hormone application: the how and the when for Bi-est and progesterone.

1 Quiz

Quiz Q34: Topical Hormone Applications

Topical hormone application: Absorption, dermal fatigue, transmucosal and transmission

1 Quiz

Quiz Q35: More on Applications

Getting to right-dose

Some important factors

1 Quiz

Quiz Q36: Important Factors

Optimal dose ranges

1 Quiz

Quiz Q37: Ranges

Variations in Total Potent Estrogens

1 Quiz

Quiz Q38: Variations

Supra-physiologic dosages… watch out!

1 Quiz

Quiz Q39: Supraphysiologic Dosages

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Quiz Q21: Importance of Estriol

Menopause Mastery (The Institute of Bioidentical Medicine) The importance of Estriol (E3) and an introduction to receptor sites. Quiz Q21: Importance of Estriol

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Question 1 of 17

1. Question
Estrogen biochemistry:
- 2 hydroxy estrone (2OHE1) and 16 alphahydroxyestrone (16aOHE1) are the two principle metabolites of E2
- 2 hydroxy estrone (2OHE1) and 16 alphahydroxyestrone (16aOHE1) are the two principle metabolites of E1
- E3 is the principle metabolite of 16aOHE1
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Question 2 of 17

2. Question
Estrogen biochemistry:
- The three principle hormonally active estrogens are estradiol (E2), estrone (E1) and estriol E3)
- E2 is more potent than E3 which is more potent than E1
- E2 is more potent than E1 which is more potent than E3
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Question 3 of 17

3. Question
Estrogen biochemistry:
- A healthy liver will methylate estrogen metabolites 2OHE1 & 16aOHE1 for excretion
- A healthy liver will methylate estrogen metabolites 2OHE1 & 4 hydroxyestrone (4OHE1) for excretion
- 4OHE1 is the least favorable of the estrogen metabolites
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Question 4 of 17

4. Question
Estrogen potency:
- E1 is 40% as potent as E2
- E2 is 80% as potent as E1
- E1 is 80% as potent as E2
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Question 5 of 17

5. Question
Estrogen potency:
- E3 is 13% as potent as E2
- E3 is 25% as potent as E2
- E3 is 50% as potent as E2
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Question 6 of 17

6. Question
Estrogen prevalency:
- E1 is over twice as prevalent E2 in a 24 hour urine sample of a young healthy woman
- E3 is about 6 times as prevalent E2 in a 24 hour urine sample of a young healthy woman
- E3 is 1 – 2 times as prevelant as the sum of E2 + E1 in a 24 hour urine sample of a young healthy woman
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Question 7 of 17

7. Question
Estrogen math:
- We refer to the sum of E2 + E1 in a 24 hour urine sample of a young healthy woman as "the total potent estrogens" (TPE's)
- E3/TPE's is referred to as the "Estrogen Fraction" (EF) or the "Estrogen Prevalence forulation" (EPF)
- E3/TPE's is referred to as the "Estrogen Quotient" (EQ) or the "Estrogen Ratio" (ER)
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Question 8 of 17

8. Question
Estrogen math:
- We prefer to have the EQ to be >1
- We prefer to have the EQ to be between 1 – 4
- We prefer to have the EQ to be <1
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Question 9 of 17

9. Question
Estrogen receptor sites:
- Estrogen receptor site alpha (ERa) engagement encourages the proliferation of breast glandular cells in preparation for possible pregnancy and the beginning of preparation for lactation
- Estrogen receptor site beta (ERb) engagement encourages the proliferation of breast glandular cells in preparation for possible pregnancy and the beginning of preparation for lactation
- Estrogen receptor site beta (ERb) is prominent during the first half of the cycle
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Question 10 of 17

10. Question
Estrogen receptor sites:
- Estrogen receptor site alpha (ERa) engagement encourages the deproliferation via apoptosis of breast glandular cells should there be no fertilization
- Estrogen receptor site beta (ERb) engagement encourages the deproliferation via apoptosis of breast glandular cells should there be no fertilization
- Deproliferation of breast glandular cells takes place in the second half of the cycle
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Question 11 of 17

11. Question
Breast glandular proliferation involves:
- Increase in breast fullness as the cycle progresses
- Cell proliferation via mitosis
- Cell expansion via increasing potentiation
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Question 12 of 17

12. Question
Estrogen receptor sites:
- ERa enhances proliferation and is stimulated primarily by E2
- ERb is deproliferative and is stimulated primarily by E3
- Highest priorities in treating women in menopause: do not cause mitosis or breast glandular cell proliferation
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Question 13 of 17

13. Question
Estrogen receptor sites:
- ERa enhances proliferation and is stimulated primarily by E2
- ERb is deproliferative and is stimulated primarily by E3
- Highest priorities in treating women in menopause: do not cause mitosis or breast glandular cell proliferation
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Question 14 of 17

14. Question
Estrogen treatment formulations for women in menopause:
- Should contain adequate E3 to ultimately result in an EQ >1
- Best practice is to formulate in a way that "copies nature" producing a 24 hour urine profile that alligns with that of a young healthy woman
- To copy nature, a formulation containing both E3 and E2 will be required, with, most commonly, a marked prominence of E3
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Question 15 of 17

15. Question
Estrogen treatment formulations for women in menopause:
- Estrone is needed as well in the formulation to copy nature
- Estrone is not needed as in the formulation to copy nature
- Optimal formulation for treating a woman in menopause is Bi-est
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Question 16 of 17

16. Question
Estrogen treatment formulations for women in menopause:
- Estradiol is not needed
- Estriol alone is sufficient
- You will not be able to replicate nature's estrogen balance without including both E3 + E2.
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Question 17 of 17

17. Question
Estrogen treatment formulations for women in menopause:
- Estradiol is not needed
- Estriol alone is sufficient
- You will not be able to replicate nature's estrogen balance without including both E3 + E2.
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