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 Q23: Calculations

Menopause Mastery (The Institute of Bioidentical Medicine) Calculating Bi-Est potency Quiz Q23: Calculations

NOTE: select ALL right answers! If more than one answer sounds correct to you, select them both. If three sound correct… yep, select all three!

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Question 1 of 12

1. Question
Bi-est potency:
- Needs to be broken down to the sum of the potency of it's constituent E3 and E2
- E3 is 1/8th as potent as E2
- Traditional physicians are familiar with prescribing E2, and thus could have some sense of how potent 1 mg of E2 might be, or 2 mg of E2
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Question 2 of 12

2. Question
To do the potency math:
- E2, being the most potent of the estrogens, we arbitrarily assign it a potency of "1"
- Since E3 is 1/8th or 0.125 x as potent as E2, we assign it a potency of 0.125
- Therefore a Bi-est formulation has a potency of 1 + 0.125 = 1.125
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Question 3 of 12

3. Question
Working with our original Rx of Bi-est 30 mg/ml 80:20
- The amount of E3 present in a ml = 80% x 30 mg/ml = 24 mg/ml
- The amount of E2 present in a ml = 20% x 30 mg/ml = 6 mg/ml
- 24 mg/ml + 6 mg/ml = 30 mg/ml
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Question 4 of 12

4. Question
The “milligrams of estradiol equivalency,” the “mgeeq”
- E2: 6 mg/ml x 1 mgeeq/mg = 6 mgeeq/ml
- E3: 24 mg/ml x 0.125 mgeeq/mg = 3 mgeeq/ml
- This makes sense because E3 is 1/8th as potent as E2
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Question 5 of 12

5. Question
Thus, Bi-est 30 mg/ml 80:20…
- contains 6 mgeeq of E2 plus 3 mgeeq of E3, thus a grand total of 9 mgeeq /ml
- 9 mgeeq/ml can be understood as "each ml of Bi-est 30 mg/ml 80:20 contains estrogens with a potency equivalent to 9 mg of estradiol"
- Bi-est 30 mg/ml 80:20 is equivalent in potency to estradiol 9 mg/ml
Correct

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Question 6 of 12

6. Question
Thus, Bi-est 30 mg/ml 80:20…
- We know by testing that each ml of Bi-est contains 20.7 drops in our MM bottle and orifice reducer design.
- 9 mgeeq/ml ÷ 20.7 drops/ml = 0.44 mgeeq/drop
- thus each drop of Bi-est 30 mg/ml 80:20 contains 0.44 mgeeq/drop
Correct

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Question 7 of 12

7. Question
Or, calculating Bi-est 30 mg/ml 80:20 in another way:
- E2: 6 mg/ml ÷ 20.7 drops/ml = 0.29 mg/drop. 0.29 mg/drop x 1 mgeeq/mg = 0.29 mgeeq/drop
- E3: 24 mg/ml ÷ 20.7 drops/ml = 0.15 mg/drop. 0.15 mg/drop x 0.125 mgeeq/mg =. 0.15 mgeeq/drop
- 0.29 mgeeq/drop. +. 0.15 mgeeq/drop. =. 0.44 mgeeq/drop
Correct

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Question 8 of 12

8. Question
Changing ratios in Bi-est formulations and doing the math:
- A change in ratio from 80:20, for example, to 50:50, changes the potency of each drop very little
- A change in ratio from 80:20, for example, to 50:50, changes the potency of each drop by a majorly significant amount
- Bi-est 30 mg/ml 80:20 delivers 0.44 mgeeq/drop. Bi-est 30 mg/ml 50:50 delivers 0.8 mgeeq/drop…almost twice as strong per drop
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Question 9 of 12

9. Question
Never change the ratio from 80:20 unless you see 24 hour urine hormone test results that suggest the need to change the ratio
- TRUE
- FALSE
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Question 10 of 12

10. Question
Young healthy women’s ovaries put out between 0.07 – 0.5 mgeeq/day of estradiol depending on day of month in the cycle
- Though the amount might sound low compared to applying, let's say, 1.7 mgeeq of Bi-est per day applied topically, it illustrates the difference between direct output from the ovary into the blood stream vs skin application and absorption
- A smallish percentage of topically applied hormones makes it into the bloodstream
- A woman in menopause needs more hormones that a young woman
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Question 11 of 12

11. Question
A Bi-est prescription requires:
- a potency descriptor in "mg/ml"
- a ratio descriptor, for example "80:20"
- a base descriptor, for example, "in the organic oils
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Question 12 of 12

12. Question
A Bi-est prescription requires:
- the number of ml to dispense (D.T.D)
- the number of drops per ml
- instructions on how patient shoud administer the dosage ("Sig") (example i – iii drops b.i.d. as directed)
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