ESTROGENS (Estradiol, Estrone, Estriol) Estradiol is the most potent of the three natural estrogens, which also include estrone and estriol. Estrogens play important roles in stimulating regeneration of the reproductive tissues, maintaining healthy bones, increasing the levels of neurotransmitters in the brain, and helping keep the cardiovascular system healthy.

LOW ESTRADIOL in pre-menopausal women is unusual unless they experience an anovulatory cycle (no ovulation) or are supplementing with synthetic estrogens found in birth control pills, which can suppress endrogenous (made in the body) production of estrogens by the ovaries. A low estradiol level is much more common in post-menopausal women or in women of any age who have had a hysterectomy and/or their ovaries surgically removed (oophorectomy) and/or those who have not been treated with hormone replacement, sleep disturbances, foggy thinking, vaginal dryness, incontinence, thinning skin, bone loss, and heart palpitations.

HIGH ESTRADIOL in pre-menopausal women is usually caused by excessive production of androgens (testosterone and DHEA) by the ovaries and adrenal glands, which are converted to estrogens by the "aromatase" enzyme found in adipose (fat) tissue, or by estrogen replacement therapy (ERT). When estrogen levels are high in post-menopausal women, this is usually due to insufficient progesterone (either from waning ovarian production at menopause, or from estrogen supplementation) necessary to counterbalance the cellular growth-promoting actions of the estrogens. Excess estrogen levels lead to the symptoms of "estrogen dominance," including: mood swings, irritability, anxiety, water retention, fibrocystic breasts, weight gain in the hips, bleeding changes (due to overgrowth of the uterine lining and uterine fibroids) and thyroid deficiency. Estradiol, even at normal ranges (1.5 Ð 3 pg/ml), can cause estrogen excess if not balanced by adequate progesterone. Diet, exercise, nutritional supplements, cruciferous vegetable extracts, herbs and foods that are natural aromatase inhibitors (e.g. soyfoods), and natural progesterone can help to reduce the estrogen burden naturally.

PROGESTERONE should be viewed as a hormone that governs the actions of other hormones, including estradiol, testosterone, cortisol, and thyroid. The ovaries manufacture about 10-30 mg of progesterone each day during the latter half of the menstrual cycle (luteal phase). Younger women with regular cycles generally make adequate progesterone, consistent with their having few symptoms of estrogen excess.

LOW PROGESTERONE in premenopausal woman is more commonly seen with anovulatory cycles, (no ovulation), luteal insufficiency (ovulation with low progesterone production), or use of contraceptives containing synthetic progestins. A lower level (< 100 pg/ml) of progesterone is more common in postmenopausal women who no longer ovulate, or women who have had their ovaries removed. Progesterone is usually very low (50 pg/ml) in women using synthetic progestins in contraceptives or HRT (Provera). Synthetic progestins are not detected by the highly specific immunoassays used to quantify progesterone in saliva.

HIGH PROGESTERONE in normal pre-menopausal and post-menopausal women can occur with over-supplementation, exposure (e.g. anti-aging creams, transference from someone using progesterone), and /or sluggish metabolism. When progesterone is delivered topically (through the skin) at doses of 10-30 mg, the salivary progesterone level at 12-24 hr post-supplementation is usually in the range of 500-3000 pg/ml (note: serum progesterone is within a similar range, or 0.5 to 3 pg/ml). Very high progesterone levels ( > 3000 pg/ml) can occur with progesterone used topically at doses greater than 30 mg. Note: a significant number of individuals in the range are without adverse symptoms, indicating that a high salivary progesterone level is associated with few side effects. Symptoms of high progesterone are relatively benign and include excessive sleepiness, dizziness, bloating, susceptibility to yeast infections, and functional estrogen deficiency (more problematic when estradiol levels are low-low normal).

The ideal ratio of progesterone/estradiol ranges from 150-200 in pre-menopausal women, and from 150-1000 in pre-menopause and postmenopausal women supplementing with progesterone. (Excludes postmenopausal women with low estrogen levels and women on synthetic hormones, e.g oral contraceptives or conventional hormone replacement therapyÐHRT.)

TESTOSTERONE is an anabolic hormone produced predominately by the ovaries and to a lesser extent in the adrenal glands. It is essential for creating energy, maintaining optimal brain function (memory), regulating the immune system, and building an maintaining the integrity of structural tissues such as skin, muscles, and bone. Pre-menopausal testosterone levels usually fall within the high-normal range and post-menopausal levels at low-normal range.

LOW TESTOSTERONE is most commonly caused by aging, hysterectomy and /or removal of the ovaries (oophorectomy), suppression of ovarian production by stress hormones (cortisol), use of contraceptives and synthetic HRT, and/or damage to the ovaries and adrenal glands by trauma, chemo, or radiation therapies. Chronically low/low normal salivary testosterone (20/23 pg/ml) can cause loss of bone and/or muscle mass, thinning skin, vaginal dryness, low libido, incontinence, lack of energy, aches and pains, depression, and cognitive dysfunction-memory lapses.

HIGH TESTOSTERONE is usually the result of excessive production by the ovaries and adrenal glands or supplementation with androgens (testosterone, DHEA). Slightly elevated testosterone (range 50-60 pg/ml) is often seen in women as they transition into menopause. High testosterone in both pre-menopausal and post-menopausal woman is associated with polycystic ovarian syndrome (PCOS), which in turn is caused by insulin resistance/metabolic syndrome (re: http://www.pcosupport.org). Symptoms include loss of scalp hair, increased body and facial hair, cane, and oily skin. Supplementation with topical testosterone at doses in excess of levels produced by the ovaries (0.2-1 mg) can raise testosterone to levels beyond physiological range (>50 pg/ml). Hypersensitivity to testosterone can cause side effects and above symptoms.

DHEA is a testosterone precursor shown to have direct effects on the immune system independent of testosterone. DHEA and its sulfated form, DHEAS are produced predominately by the adrenal glands. Youthful salivary levels are at the high end of the range (8-10) ng/ml), and sometimes higher (10-15 ng/ml); levels decrease with age and are usually at the lower end of normal (3-5 ng/ml) in healthy middle-aged individuals. Athletes tend to have higher than normal DHEAS levels. Low DHEAS can be caused by adrenal exhaustion and is common to accelerated aging and diseases such as cancer. High DHEAS is associated with insulin resistance/PCOS (polycystic ovaries) or DHEA supplementation (see high testosterone above).

CORTISOL is produced by the adrenal glands in response to stressors, both normal (e.g. waking up, low blood sugar) and abnormal (e.g. emotional upset, infections, injury, surgery). Cortisol levels are highest in the morning, and drop steadily throughout the day to their lowest point during sleep. Cortisol is essential in regulating and mobilizing the immune system against viral or bacterial infection, and deducing inflammation. It helps to mobilize glucose, the primary energy source for the brain. While normal levels of cortisol are essential for life and optimal functioning of other hormones (particularly thyroid hormone), chronically elevated levels can be detrimental to health. Stress and persistently elevated cortisol levels can literally burn our bodies out, causing premature aging.

LOW CORTISOL, particularly if low throughout the day indicates adrenal exhaustion, caused by some form of stressor, e.g. emotional stress, sleep deprivation, poor diet, nutrient deficiencies (particularly low vitamins C and B5), and physical or chemical insults (chemo, radiation). Chronic stress depletes cortisol with symptoms of fatigue, allergies (immune dysfunction), chemical sensitivity, cold body temp, and sugar craving. Symptoms of thyroid deficiency can also stem from low cortisol. Adequate sleep, gentle exercise, meditation, proper diet (adequate protein), natural, "bioidentical" progerserone, adrenal extrats, herbal, and nutritional supplements are often helpful in correcting low cortisol (hyoadrenia). Recommended reading: Adrenal fatigue: the 21st Century Stress Syndrome, James L. Wilson, N.D., D.C., Ph.D. and Thyroid Power, by Richard Shames, MD.

HIGH CORTISOL indicates some form of adrenal stress (see above). Heightened cortisol production by the adrenal glands is a normal response to routine stress and essential for health; when stress is chronic and cortisol output remains high over a prolonged period (months/years), breakdown of normal tissues (muscle wasting, thinning of skin, bone loss) and immune suppression can result. Common symptoms of chronic high cortisol include sleep disturbances, fatigue, depression, weight gain in the waist, anxiety. Recommended reading: The Cortisol Connection, Shawn Talbott, PhD; The End of Stress As We Know It, Bruce McEwen.