postmenopausal dutch Flashcards
(42 cards)
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
