Menopause Mastery

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

1 Quiz

Quiz 21: Importance of Estriol

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

1 Quiz

Quiz 22: Potencies and Ratios

23. Calculating Bi-Est potency

1 Quiz

Quiz 23: Calculating Potencies and Ratios

24. All about bases

1 Quiz

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

1 Quiz

Quiz 25: Sensitivity and Dormancy

26. Aiming for optimum: balancing drops, concentrations and ratios.

1 Quiz

Quiz 26: Optimum Doses

27. Window of Opportunity: Cardiovascular Risk Considerations

And now we're on to Progesterone!

28. Treat early on!

1 Quiz

Quiz 27: Treating Early

29. The effect on Thyroid, Bone, Sleep and Brain

1 Quiz

Quiz 28: The Effects

30. Breast Cancer risk, SHBG issues.

1 Quiz

Quiz 29: Progesterone Problems

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

1 Quiz

Quiz 30: Progesterone and Optimal Dosing

32. Excessive Progesterone Dosages: receptor sites. Unusual Symptoms

1 Quiz

Quiz 31: Unusual Symptoms

33. Common Starting Dosages

1 Quiz

Quiz 32: Starting Dosages

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

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

1 Quiz

Quiz 33: First Prescription

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

1 Quiz

Quiz 34: Topical Hormone Applications

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

1 Quiz

Quiz 35: More on Application

Getting to right-dose

37. Some important factors

1 Quiz

Quiz 36: Important Factors

38. Optimal dose ranges

1 Quiz

Quiz 37: Ranges

39. Variations in Total Potent Estrogens

1 Quiz

Quiz 38: Variations

40. Supra-physiologic dosages… watch out!

1 Quiz

Quiz 39: Supraphysiologic Dosages

2 of 5

Quiz 23: Calculating Potencies and Ratios

Menopause Mastery 23. Calculating Bi-Est potency Quiz 23: Calculating Potencies and Ratios

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
Regarding Bi-est potency, which of the following statements are correct?
- 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
- All of the above
- None of the above
Correct

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Question 2 of 12

2. Question
Which of the following statements about potency math is FALSE?
- Being the most potent of the estrogens, we arbitrarily assign E2 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
- A Bi-est formulation has a potency of 1 + 0.125 = 1.125
Correct

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Question 3 of 12

3. Question
Which of the following statements are TRUE of 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
- All of the above
- None of the above
Correct

Incorrect
Question 4 of 12

4. Question
Which of the following statements about the milligrams of estradiol equivalency (mgeeq) is correct?
- E2: 6 mg/ml x 1 mgeeq/mg = 6 mgeeq/ml
- E3: 24 mg/ml x 0.125 mgeeq/mg = 3 mgeeq/ml
- E3 is 1/8th as potent as E2
- All of the above
- None of the above
Correct

Incorrect
Question 5 of 12

5. Question
Complete the statement by selecting the best answer. Bi-est 30 mg/ml with a ratio of 80:20…
- Contains 6 mgeeq of E2, plus 3 mgeeq of E3, resulting in a total of 9 mgeeq /ml
- Contains 9 mgeeq of E2, plus 3 mgeeq of E3, resulting in a total of 12 mgeeq /ml
- Is equivalent in potency to estradiol 6 mg/ml
Correct

Incorrect
Question 6 of 12

6. Question
Complete the statement by selecting the best answer. Bi-est 30 mg/ml with a ratio of 80:20…
- Contains 27 drops
- Each drop of Bi-est 30 mg/ml 80:20 contains 0.4 mgeeq/drop
- Each drop of Bi-est 30 mg/ml 80:20 contains 0.44 mgeeq/drop
Correct

Incorrect
Question 7 of 12

7. Question
Select all that apply. 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

Incorrect
Question 8 of 12

8. Question
Which of the following statements is FALSE? 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
Correct

Incorrect
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
Correct

Incorrect
Question 10 of 12

10. Question
A young healthy woman’s ovaries excrete between 0.07 – 0.5 mgeeq/day of estradiol depending on day of month in the cycle. Which of the following statements is FALSE knowing this information?
- Though the amount might sound low compared to applying 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 small percentage of topically applied hormones makes it into the bloodstream
- A woman in menopause needs more hormones than a young woman
Correct

Incorrect
Question 11 of 12

11. Question
A Bi-est prescription requires which of the following? Select all that apply.
- A potency descriptor in "mg/ml"
- A ratio descriptor, for example "80:20"
- A base descriptor, for example, "In organic oils"
Correct

Incorrect
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)
Correct

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