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Glossary

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AAE: or anovulatory androgen excess.

Abdominal visceral fat: a layer of fat surrounding abdominal organs that increases with obesity, especially in those with insulin resistance. It is the major contribution to increased waist circumference.

Acne: another name for pimples. It is caused by increased oil formation in hair follicles that plug and cause inflammation, especially on the face and upper back. Acne is common in puberty for both young women and men but normally goes away after that. It is also a common androgenic sign of anovulatory androgen excess.

Adenomyosis: when endometrial glands are present in the wall of the uterus where they would not normally be present. These glands undergo growth along with the normal growth of the rest of the uterine materials during the menstrual cycle. However, when the uterus sheds its lining, the lining and blood get trapped in the uterine muscle by the extra endometrial glands which could be a reason for painful menstrual cramps. The trapped blood is slowly released causing extended spotting throughout the rest of the cycle. Perimenopausal women in their 40s are more likely to suffer from adenomyosis. 50% of adenomyosis is asymptomatic.

Adrenal Glands: small triangular shaped glands that sit on top of the kidneys and make four different kinds of hormones: cortisol, aldosterone, androgens, and catecholamines.

Adrenalin: a kind of hormone called a catecholamine that is made by nerves and in the centre of the adrenal gland. Adrenaline is released in large amounts with the "fight or flight" response to threat or stress. It causes the heart to beat faster and blood vessels in arms and legs to constrict. It is also called epinephrine.

Aldosterone: a hormone made in the adrenal glands that causes the kidneys to retain sodium and water and get rid of potassium. High levels can cause high blood pressure or hypertension. A medication that can block the effects of aldosterone is called spironolactone.

Alendronate: a powerful form of bisphosphonate treatment for osteoporosis that prevents spine and hip fracture. It is expensive and may have serious negative effects on the esophagus and stomach. It may be taken once a week.

Alkaline Phosphatase: a chemical made in the bone and liver. Levels will be elevated with some kinds of bone and liver diseases.

Alopecia: (see also androgenic alopecia) loss of head hair.

Alzheimer's: decreased memory, reasoning and ability to care for ones self that makes a person unable to function. It is a kind of dementia that occurs with damage to the brain with aging and with many strokes.

Amenorrhea: the absence of menstrual bleeding for six months or longer. This is normal before menarche, during pregnancy, and for the first year or two of lactation. Amenorrhea is also normal in late perimenopause and after menopause.

Androgen: a name for a 'male sex hormone', the most important of which is testosterone. Androgens are also a normal part of women’s reproduction. Besides testosterone, other important androgens are DHEA and androstenedione. All androgens increase skin oil production, thicken and darken hair and tend to cause head hair loss in the temple regions. Androgen levels are often high in women with anovulatory androgen excess. Androgenic means male hormone-like.

Androgenic Alopecia: male-like head hair loss or thinning starting at the temples and extending back from the forehead. It is related to family inheritance and to higher androgen levels.

Androgenic Progestins: synthetic forms of progesterone that are made from testosterone and act a little like androgens as well as like progesterone.

Androgen Receptor blocker: a medicine, like spironolactone, that blocks the action of male-type hormones in cells in the body.

Androstenedione: an androgen normally made in the ovary and which, like testosterone and DHEA, is converted into estrogen in fat and muscle tissues.

Anemia: occurs when there are too few red blood cells to carry oxygen to the body. In menstruating women the most common cause for anemia is heavy menstrual flow causing iron deficiency. By the time anemia develops the bone marrow no longer has any stores of iron. Iron therapy then needs to be taken daily for a full year to rebuild normal reserves. Anemia from inadequate Vitamin B 12 may occur in vegetarians who are not taking B 12 supplements.

Anemic: describes a person with anemia.

Anorexia: a condition in which a person doesn’t eat normally. This severe eating disorder is associated with a need for control and severe weight loss, amenorrhea, high cortisol levels, bone loss and the metabolic effects of undernutrition.

Anorexic: describes a person with anorexia.

Anovulation: a menstrual cycle in which an egg is not prepared and released. Because a corpus luteum is not formed, the levels of progesterone will remain low in the second half of the cycle and the cycle will have no luteal phase.

Anovulatory Androgen Excess (AAE): a more accurate term for what is often called “Polycystic Ovary Syndrome” (PCOS). AAE is diagnosed when a woman has clinical evidence of androgen excess (usually hirsutism or acne) and evidence past or present ovulation disturbances (anovulatory or short luteal phase cycles). AAE is associated with both infertility and risk for insulin resistance and Diabetes Mellitus Type 2.

Antihistamine: a kind of medicine to block the effects of allergy on the body. Older kinds have a useful side-effect to cause drowsiness and are therefore used to help sleep. They may also decrease nausea.

Anti-prostaglandin: refers to medicines that block the actions of the small fatty hormones called prostaglandins. They are used to treat menstrual cramps. To be effective they must be taken before symptoms become severe and repeated as soon as the cramps start to return. Ibuprofen is one of this group of medicines that also decrease menstrual flow by about twenty-five percent.

Areola: the darker and sometimes wrinkly circle in front of the breast that holds the nipple.

Aromatase: an enzyme that helps change male-type hormones into estrogen.

Atherosclerosis: a degenerative disease of the arteries caused by the accumulation of fatty plaques that interfere with the normal flow of blood and increase the chance of heart attack and stroke.

Atypia: a term used to describe abnormal cells that carry a higher likelihood of becoming cancerous.

Aura: sense that something will happen soon. Usually refers to a sense that a migraine, or seizure or hot flush will start.

Axillary tail of the breast: the portion of the breast that extends into the arm-pit. Tenderness here without any other breast soreness indicates ovulation. See molimina.

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Basal Temperature: is the lowest temperature the body reaches after falling into a deep sleep. It extends to the person's usual time of getting up in the morning. It is usually measured in the mouth on first awaking. Basal temperature values increase 0.2 to 0.3 degrees Celsius after ovulation as evidence of the action of progesterone in the hypothalamus.

Bell-shaped curve: the hill-like shape with valleys on either side. It is a way of sorting things so that the most common size is in the middle with the few extremely small or extremely large sized objects in the valleys on either side.

Benign: a term used to mean that something is not a cancer.

Beta-blocker: a kind of medicine used for high blood pressure, hyperthyroidism, heart disease, fast heart rates, migraine prophylaxis, and performance anxiety that prevents the action of catecholamines like adrenalin and noradrenalin. People with asthma should not take beta-blocker medicines. Propranolol is a kind of beta-blocker.

Bio-identical: a hormone that is exactly like the one made by the human body. For example, progesterone is bio-identical but medroxyprogesterone, a progestin is not (Also spelled bioidentical). For more information on bioidentical hormones, see Ask Jerilynn: What Are Bioidentical Hormones?

Bipolar affective disease: a mental or emotional illness characterized by extreme mood changes from severe depression to inappropriate hyperactivity and elation. Also called manic-depression. It tends to run in families and is treated differently than other kinds of depression.

Bisphosphonate: the general name for a family of bone-seeking medicines that slow the action of osteoclasts, decrease bone resorption and slow bone loss as well as decreasing risks for fracture. All bisphosphonates must be taken at least an hour away from food and two hours away from calcium, vitamins and iron. Members of the bisphosphonate family include etidronate, clodronate, alendronate and risedronate. Currently available medicines in the biphosphanates family include etidronate, clodronate, alendronate, risedronate, zoledronate, pamidronate and ibandronate.

Black cohosh: an herb that seems to help with hot flushes and night sweats. It is contained in a medicine called Remiferin®.

Blood: the liquid containing red cells, other blood cells and many nutrients that fills arteries and veins.

Blood clots: are clumps formed by certain blood cells. Blood clots stop cuts from continuing to bleed, but are harmful if formed within the blood stream because they can travel to the lungs or block off a blood vessel.

Blood pressure: the pressure created by the heart's pumping power and the resisting of blood vessels. When the heart contracts it creates the systolic or top blood pressure number. The diastolic pressure, the bottom blood pressure number, is the resting pressure between heart contractions. The ideal, healthy blood pressure is lower than 135/85. It is written as systolic/diastolic and reported in mm, which is the height of a column of mercury that was originally used for measurement blood pressure. It is abbreviated as BP.

Blood stream: includes all the arteries carrying oxygen-rich blood from the heart to the body, and veins bringing blood without oxygen back to the heart.

Blood sugar: the natural energy, also called glucose, which is carried in the blood stream and provides energy for the cells of the body. Usually it is measured as fasting glucose.

Body Mass Index: is weight in kilograms divided by height in meters squared (kg/m2). It is used to assess general nutrition. The normal range is 18.5 to 25lower values mean undernutrition and higher numbers are overweight. Is is abbreviated BMI.

BMI: abbreviation for body mass index.

Bone formation: the process that uses osteoblasts to build new bone protein matrix. Bone formation is slow and any one spot takes about three months. Progesterone and PTH stimulate bone formation and cortisol inhibits it.

Bone Mineral Density (BMD): a measure of the amount of bone and its mineral. There are several kinds but one called DXA uses very low doses of X-rays to make an accurate assessment. The two sites of BMD usually measured are in the lower spine (lumbar vertebrae numbers 1-4) and in the total hip. BMD should be repeated in the same season and no more frequently than every two years to obtain an accurate estimate of change. Standard deviations below average BMD for young women are called T Scores. A T Score lower than –2.5 is considered osteoporosis, and lower than –1.0 to -2.4 is called osteopenia.

Bone marrow: the collection of cells in the middle of many cortical bones in which new blood cells are made and from which special bone cells are formed. Iron for making hemoglobin is stored here.

Bone remodeling: the process of renovation for bone in which old bone is resorbed by osteoclasts and replaced with new bone by osteoblasts.

Bone resorption: the process by which old bone tissue is broken down and removed by special cells called osteoclasts. Bone resorption is very fast and any one spot takes only about three weeks to be removed. Any weight loss, for reasons that are not clear, causes increased bone loss as does excess stress, caffeine (in women with low calcium intakes) and colas (because the body uses calcium to help excrete the phosphoric acid colas contain). Bone resorption is normally in balance with bone formation. Increased calcium and vitamin D control resorption rates.

BP pill: a common way of describing medicines used for high blood pressure.

Breast cancer: a form of cancer arising in the epithelial or ductal cells of the breast.

Breast density: a characteristic on the mammogram in which the breast tissue is more closely packed together. Those with the highest breast density have about a five times increased risk for breast cancer. Breast density normally increases with age in premenopausal women, is maximal in perimenopause and decreases with menopause. Estrogen therapy increases breast density.

Breast hormone receptor status: describes which of the ovarian hormones, estrogen or progesterone, makes breast cancer cells grow.

Bulimia: a kind of eating disorder with binge eating followed by guilt and often by self-induced vomiting or diarrhea. OR an eating disorder in which people tend to over-eat (binge) and then vomit (purge) or cause diarrhea to control weight.

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Calcium: the most abundant mineral in the body with many important functions. It makes up the hard basic constituent of bone. The main dietary sources include dairy products and green, leafy vegetables.

Calcium citrate: a kind of calcium supplement in which elemental calcium is combined with citrate. This is the only kind of calcium a person who has had kidney stones should take.

Calories: describes the amount of energy from foods, or energy spent during exercise.

CaMOS: the abbreviation for the Canadian Multicentre Osteoporosis Study, a nine-centre national epidemiological study of risk factors for osteoporosis, fracture and bone mineral density. It includes over 9,000 women and men ages 25 to 80+ with two thirds of the participants being women.

Cancellous bone: the kind of bone that has a honey comb-like structure to provide strength without extra weight. It is more responsive to ovarian hormones and cortisol than to exercise.

Candidiasis: infection with yeast named "Candida"—may be in the vagina or in the mouth (where it is called thrush).

Carcinoma in situ: abnormal cancer cells that are limited to one spot, without any spread.

Catecholamines: hypothalamic, nerve and adrenal produced hormones that act on blood vessels and the heart. Catecholamines include adrenaline (epinephrine) and noradrenalin (norepinephrine).

CeMCOR: abbreviation for the Center for Menstrual Cycle and Ovulation Research. A virtual research and education center for women founded in May 2002. The CeMCOR website was launched in October 2003 (http://www.cemcor.ubc.ca/). An international advisory council includes women and men from many disciplines and seven countries.

Cervix: the neck of the uterus (womb), which projects onto the upper part of the vagina. It contains a central canal for passage of sperm and menstrual blood and for childbirth.

Chamomile tea: an herbal tea from the chamomile that is believed to be soothing and assist with a good sleep.

Chance Health Locus of Control: see Health Locus of Control.

Chest X-rays: a test using X-rays of the chest to see heart, lung, or blood vessel changes.

Chronic bronchitis: a form of lung disease in which a person coughs up phlegm for several months every year. It is associated with cigarette abuse.

Chronic fatigue syndrome: is the name used for a complex and poorly understood condition that involves low energy, sleep disturbances and often depression.

Cholesterol: a fatty substance found in all human cells. It is transported in the blood attached to proteins. LDL cholesterol is the bad form as it forms the basis for atherosclerosis. HDL cholesterol is the good form as high levels of HDL can reduce the risk of atherosclerosis.

Climacteric: a rather old-fashioned term for perimenopause.

Clodronate: an early form of bisphosphonate that can be given intravenously. It decreases bone resorption but hasn’t been shown to prevent fractures. It may decrease bone and other metastases in breast cancer.

Cognitive dietary restraint: worry that certain foods will cause weight gain. It is also called "eating restraint." It is associated with higher cortisol production and short luteal phase cycles. It is the mildest kind of "eating disorders," of which anorexia is the most severe.

Collagen: a tough fibrous protein that forms an important part of connective tissue as well as tendons and bones.

Complex carbohydrates: a kind of food in whole grains like rice, wheat, corn and barley.

Compounding pharmacy: a store in which medicines are created by a pharmacist rather than a place where manufactured drugs are simply being sold.

Conjugated equine estrogens: a pill form of estrogen created from the urine of pregnant horses with the brand name Premarin®. Contains a mixture of unique horse estrogens and predominantly estrone, a common type of estrogen.

Conjugated estrogens: a kind of estrogen that is joined to other chemicals to improve its stability. Conjugated estrogen sulfate (CES) is “vegetarian premarin.” Conjugated equine estrogen (Premarin®) is the historically important mixture of estrogens derived from pregnant mare’s urine used for so called “HRT.” These oral forms of estrogen have been repeatedly shown to cause over a 200% increased risk for thrombosis and should be avoided in favor of transdermal estrogen.

Corpus luteum: a temporary structure in the ovary that arises after an egg is released from the follicle (ovulation). It secretes estrogen and progesterone. If the egg is not fertilized, the corpus luteum stops secreting progesterone and decays - this triggers the shedding of the endometrium (menstruation). If fertilization does occur, the corpus luteum continues secreting progesterone to support implantation of the embryo in the endometrium.

Cortical bone: one of the two kinds of bone. It is the very hard outer "shell" of bone, often shaped like a tube or drumstick. Cortical bone responds to exercise, the pull of working muscles and gravity by increasing strength and density.

Cortisol: a natural steroid hormone made by the adrenal glands in response to stress, including dieting, cognitive dietary restraint, situational stress, illness, and intense exercise. High estrogen levels amplify the stress-related production of cortisol. OR a stress hormone made by the adrenal glands. An essential hormone, it functions to maintain blood pressure, assist with fighting infections and preserving health. However, when cortisol levels are too high, as a result of stress, illness, or undernutrition, bone loss results. Cortisol causes increased bone resorption and decreased bone formation. Progesterone competes for the cortisol receptor on the osteoblast, possibly preventing cortisol from stopping bone growth.

Cramps: see Menstrual Cramps

Creatinine level: the concentration of a protein in blood that reflects the health of the kidneys. Often is used to correct urine tests of hormone and bone resorption for the person's kidney function.

Cycle day: the days of the menstrual cycle counted from the first day of flow, called Day One, to the day before the next flow starts.

Cyclic Etidronate: (Didrocal®, Didronal®) see Etidronate.

Cyclic progesterone therapy: progesterone or medroxyprogesterone given during cycle days 14 through 27 to mimic the normal timing and action of progesterone in ovulatory menstrual cycles. This treatment is used for absent, irregular or heavy menstrual bleeding or severe menstrual cramps. Along with spironolactone it is very helpful therapy in anovulatory androgen excess. Cyclic progestin therapy with medroxyprogesterone caused a significant increase in spinal bone density in premenopausal women with menstrual cycle and ovulation disturbances.

Cyst: a round, fluid-filled structure that is common in ovaries, thyroid glands, and breast tissue. Only rarely is a cyst caused by cancer.

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Dementia: a decreased ability to remember, to reason or speak, associated with diseases, some medicines and aging. (See Alzheimer's).

Deoxypyridiniline: a test for bone resorption that measures the excretion of this protein from bone in morning urine. It is abbreviated D-pyr.

DHEA: an androgen made in both the ovaries (about 15%) and the adrenal glands (about 85%). DHEA is attached to a sulfate and is measured in the blood as DHEAS. DHEAS is often elevated when women have acne. DHEAS levels are increased when a woman is under stress. DHEA is converted into estrogen by fat and muscle tissues, especially in menopause.

Diabetes mellitus: an often-hereditary disease in which the blood sugar becomes abnormally high because the body either doesn't make enough insulin (Type 1) or the insulin that is made is not effective (Type 2). Type 2 diabetes mellitus is associated with anovulatory androgen excess. Insulin resistance, being overweight or obese, having anovulatory androgen excess and being inactive all predispose one to diabetes.

Diagnostic mammogram: a more detailed mammogram done to rule out breast cancer—usually when a screening mammogram gives an abnormal result.

Diaphragm and jelly: a barrier method of contraception involving a rubber ring with thin rubber in the middle that fits over the cervix and blocks sperm. Jelly has a chemical that kills sperm and is most effective if a full applicator is inserted once the diaphragm is in place.

Diastolic: the lower blood pressure reading.

Differentiation: the process by which cells become more mature or grown up. The opposite of the change associated with cancer.

Digitize: to convert signals into a computer form. Used for measuring things like breast density and spine fractures.

Dihydrotestosterone: an androgenic hormone made from testosterone that changes soft silky pale hair on the face and body into coarse dark hair, makes more secretions from oil glands and causes loss of head hair or alopecia.

Dimenhydrinate: a kind of over-the-counter antihistamine that causes drowsiness and has long-lasting action for allergies. It also helps with nausea.

Diuretic: a kind of medicine used for fluid retention, swelling, edema, and for high blood pressure.

Dominant follicle: the large cyst in the ovary during each menstrual cycle. An egg is released from the dominant follicle with ovulation—it supplies the majority of estrogen and all of the progesterone for that particular menstrual cycle.

Dong quai: a Chinese herb used to improve energy and help with menopausal symptoms in women-it is still lacking scientific evidence of effectiveness.

Double blind: a kind of study in which neither the participants nor the researchers know which treatment each person is on. This is used in randomized, placebo-controlled trials.

D-pyr: see Deoxypyridinoline.

DXA: a kind of bone mineral density in which two X-ray energies are used to assess the amount of bone. It should be measured on the same machine, in the same season and no more frequently than every two years.

Dysmenorrhea: this is a medical term for menstrual cramps.

Dyspareunia: the medical term for painful sexual intercourse. Women usually call it vaginal dryness.

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Early menopause: menopause before age 40. It needs treatment with ovulatory cycle-matching doses of transdermal estrogen and cyclic progesterone until approximately age 50 when the estrogen should be tapered and stopped.

Eating disorder: means a variety of situations in which a person feels the need to control food intake. This varies from a person who is worried that eating certain foods will cause weight gain (cognitive dietary restraint, eating restraint) and extends to serious diseases such as anorexia or bulimia.

Eating restraint see cognitive dietary restraint.

Edema: means swelling of the legs and feet, and occasionally the fingers caused because the body keeps too much salt and water. Often associated with high blood pressure. It is treated with a low salt diet or diuretics.

EEG: a test that measures brain waves.

Elemental calcium: means the weight of the calcium is itself in mg, without the weight of the carbonate or citrate that calcium must be combined with to be used by the body.

Emphysema: a chronic lung disease in which small air sacks become damaged so that the person has difficulty breathing, especially with increased exercise. Emphysema is caused by cigarettes or by poorly treated, long-standing asthma.

Endocrinology: the area of medicine concerned with distance hormonal messengers and glands and the study of hormones.

Endogenous: means coming from within the body. It is the opposite of exogenous, for example in perimenopause a woman can be on the Pill and still have high endogenous estrogen levels.

Epinephrine: see adrenaline.

“Endogenous Perimenopausal Ovarian Hyperstimulation”: a phrase used to describe the disturbance of normal feedback control resulting in higher estrogen levels in perimenopause. Lower levels of inhibin B that are unable to control production of FSH are probably responsible.

Endometrial ablation: a kind of day surgery in which heat, pressure, a sharp instrument or laser is used to destroy the lining of the uterus (endometrium). It is used to treat heavy flow (menorrhagia), especially in perimenopause.

Endometrial biopsy: an office procedure in which the cervix is made larger and a tool is used to cut out a small piece of the endometrium. Is a test used to see whether endometrial cancer is present.

Endometrial Cancer: cancer of the endometrium. Endometrial cancer is caused by estrogen without sufficient progesterone. Being overweight, having anovulatory androgen excess and diabetes mellitus are risk factors. Estrogen treatment without progesterone therapy as well is a major cause. It is usually preceded by persistent endometrial proliferation and endometrial hyperplasia (both of which are reversible with progesterone therapy).

Endometrial thickness: the thickness or depth of the endometrium seen in pelvic or vaginal ultrasound.

Endometriosis: An abnormal state in which bits of the endometrium grow outside the uterus. This tissue is normally stimulated by estrogen and inhibited by progesterone—this is similar to the endometrium. Before and during menstruation, these bits of tissue bleed causing abdominal pain and increased dysmenorrhea or menstrual cramps. It is treated by suppression of estrogen, high levels of progesterone or both.

Endometrium: a specialized tissue that lines the uterus and undergoes changes during the menstrual cycle. It builds up (proliferates) under the influence of estrogen during the follicular phase before ovulation. Following ovulation, under the influence of progesterone as well as estrogen, it becomes more mature (secretory) and ready for egg implantation. Endometrial shedding occurs normally with a decrease in estrogen and progesterone levels but occurs with decreases in estrogen levels in anovulatory cycles and also despite continued high levels of estrogen. Estrogen stimulates and progesterone inhibits the endometrium. OR the inner lining of the uterus that is stimulated by estrogen to become thicker, and is caused by progesterone to become mature and ready to support a fertilized egg.

Endorphins: are natural brain chemicals with morphine-like qualities. They are believed to control mood, emotion and motivation, as well as pain perception and other functions.

Error of measurement: every test has variability that must be known to accurately interpret the result. This variability adds to the error of measurement.

ESR: stands for erythrocyte sedimentation rate. It is a general test used to detect inflammation, or infection, such as arthritis or a bone infection.

Estradiol: the most powerful form of bio-identical estrogen. Estradiol is made in the ovaries, the placenta and by conversion in fat and muscle cells from androgens into estrogens. It causes growth or proliferation of most cells in the body, especially in the breasts, uterus, and vagina.

Estradot®: a form of bio-identical estradiol that is transdermal and delivered as a small patch that has a lower risk for blood clots than oral estrogen.

Estragel®: a form of bio-identical estradiol as an alcohol-based gel for rubbing on the skin. This transdermal form of estrogen has decreased risks for blood clots than oral estrogen.

Estriol: a weak form of estrogen that is used in the vagina for therapy of vaginal dryness and is effective for severe dyspareunia associated with urinary tract infections. OR a weak form of estrogen that is high during pregnancy. It is not effective for treatment of hot flushes or osteoporosis but is effective for 'vaginal dryness' or vaginal atrophy.

Estrogen: an important group of hormones essential for normal women's maturation and the healthy functioning of reproductive and other tissues. During the reproductive years in women estrogens are primarily made in the ovaries. Estrogen is also normally made in children, men and menopausal women by conversion of androgens in fat and muscle tissues. There are three kinds of estrogens. Estradiol is the ovarian hormone of the premenopausal years, estrone is the hormone of the menopausal years and estriol, a weak estrogen is present in high levels during pregnancy. High levels are associated with nausea, breast tenderness, insulin resistance and fluid retention. OR the name for a family of hormones including estradiol, estrone and estriol.

Estrogen deficiency: the wrong way of thinking about the normally low levels of estrogen after menopause.

Estrogen receptor positive: refers to cells in breast cancer that are stimulated by estrogen to grow and undergo proliferation.

Estrone: the common form of estrogen in menopausal women. It can be made from adrenal and ovarian androgens.

Etidronate: the first member of the bisphosphonate family of bone therapies for preventing or treating osteoporosis. It prevents spine fractures. The active medicine is only taken for the first two weeks of every three months. It is less expensive, has fewer side effects and is easier to take than newer bisphosphonates. It can be taken in the middle of the night. OR an early biphosphanate taken for two weeks, every three months. Prevents spine fractures in randomized placebo-controlled trials. Does not cause heartburn or esophageal injury. See bisphosphonates.

Exogenous: means coming from outside the body. It is the opposite of endogenous.

External locus of control: see Health Locus of Control.

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Fallopian tubes: flexible hollow tubes that allow an egg released from the ovary to be delivered to the uterus.

Fasting blood sugar: a blood test taken before breakfast and after no food for the previous 12 hours. It is used to assess the risk for diabetes mellitus and its control.

Fasting glucose: see fasting blood sugar.

Fasting lipids:a test taken without eating for 12-16 hours. It measures fats in the blood including total cholesterol, high density lipoprotein and low density lipoprotein cholesterol, and triglycerides.

Ferritin level: a blood test that reflects iron stores in the bone marrow and therefore the risk for iron-deficiency or blood loss anemia.

Fibrinolysis: the breakdown of fibrin, the principal component of blood clots. The fibrinolytic system is activated in parallel with the clotting system when a blood vessel is damaged. Any factor that disturbs this natural balance can produce a blood clot.

Fibroids: are benign tumors of fibrous and muscular tissue that grow in the muscle wall of the uterus. They increase in midlife women, and decrease after menopause. They are commonly without symptoms but often discovered because they are associated with heavy menstrual flow (menorrhagia).

Fibromyalgia: is a condition in which pain at trigger points is associated with sleep disturbances and decreased exercise. Helped by improved sleep, increased exercise and often by low does tricyclic anti-depressant medications.

Folate: a vitamin in the B-vitamin family that helps cells to mature and is needed before and after pregnancy to prevent birth defects.

Follicle: the nest of cells surrounding an egg in the ovary. One follicle becomes the dominant follicle each menstrual cycle and releases the egg with ovulation.

Follicle Stimulating Hormone (FSH): an important pituitary hormone, one of two called gonadotrophins, which stimulate the ovaries during the premenopausal years.

Follicular phase: the first part of the menstrual cycle before ovulation.

Fracture: a break in a bone caused by a sudden force of greater intensity than the bone can withstand. Fractures of the spinal bones in the back (vertebrae) involve compression (becoming shorter) and are often not recognized. They can be diagnosed with an X-ray. Those with front vertebral compression fractures often develop a rounded upper back (kyphosis); both front and back compressions cause height loss.

Fragility Fracture: a broken bone that occurs with a fall from a standing height or lesser amount of trauma. Anyone who has suffered a fragility fracture, by definition, has osteoporosis, even if his/her bone mineral density is normal.

FSH: see follicle stimulating hormone.

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Gabapentin: a medicine used for nerve-type pain or some kinds of seizure, that has recently been shown to help hot flushes and night sweats.

Gastritis: irritation of the lining of the stomach causing heartburn.

Glaucoma: a disease in which pressure builds inside the eyeball. Glaucoma can cause blindness if not treated.

Glucose tolerance test: a test measuring the blood sugar after a person is given a test dose of glucose (a form of sugar). It measures the effectiveness of the action of insulin—it is rarely used except during pregnancy.

GnRH: see Gonadotropin Releasing Hormone

Goiter: a swelling or enlargement of the thyroid gland.

Gold standard: the reference value for a test. Used for validation of a new test.

Gonadotrophin: the general name for two hormones that stimulate activity and hormone production in the gonads (the ovaries or testicles). These are both secreted by the pituitary gland and are called Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH).

Gonadotrophin releasing hormone (GnRH): the name for the pulsatile hypothalamic hormone that regulates the production of LH and FSH and therefore controls the function of the ovaries. OR also GnRH, is the hormone from the hypothalamus that integrates signals from stress hormones, insulin, and other signals to wisely direct actions of the pituitary and the ovary.

GP: short for physician who is a general practitioner. Now, after a family practise residency, general physicians are usually called family physicians.

Gynecologist: a surgical specialist that is an expert in pelvis, uterus, and ovary surgery and the treatment of some forms of infertility.

Gynecology: the specialty within surgery that focuses on the uterus and ovaries and treatment of pelvic problems in women. OR the surgical specialty that is expert in pelvis, uterus, and ovary surgery and the treatment of some forms of infertility.

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Health Care Providers: a general term used for physicians, nurses, emergency medical technicians, ambulance personnel and others in health delivery fields.

Head CT scan: a computed tomography form of X-ray that examines structures within the brain including the pituitary gland.

Health Locus of Control: means attitude toward one's health. "External" believes doctors are responsible for health; "Chance" says it is fate or luck; "Internal" says what an individual does determines their health.

Heart palpitations: a feeling of fluttering or pounding in the chest that usually means a rapid or irregular heartbeat.

HgA1C: see hemoglobin A1C.

Hemoglobin: the chemical compound that requires iron and becomes part of red blood cells to carry oxygen in the blood stream.

Hemoglobin A1C: a test used to monitor those with diabetes mellitus. It tells the percentage of time in the past three months that the blood sugar level has been abnormally high. A normal Hemoglobin A1C is usually four to six percent. Also called HbA1C.

Hepatitis: an infection of the liver usually caused by one of several viruses.

Hepatitis tests: blood tests that measure liver enzyme levels.

High blood pressure: when the average pressure is more than 140/90 in young people and more than 145/95 in those over 60. Also called hypertension.

High bone resorption: means increased bone loss because osteoclasts are removing bone too quickly.

Hirsutism: the presence of coarse hair occurring in a male-type pattern in women. Hair can grow on the chin and upper lip, as well as the sideburn areas of the face or the inner thigh, up from the pubic hair line toward the navel, and around the nipples. It is normal for hair to be present in these areas but it is usually very fine. This is a sign of high androgen levels or actions like acne and head hair thinning.

Homophobia: the negative attitude toward women or men who choose partners of the same sex.

"Hormone Replacement Therapy" (HRT): an innaccurate term for estrogen or estrogen plus progesterone/progestin therapy for menopausal women. See OHT or Ovarian Hormone Therapy for a more appropriate term.

Hormones: naturally occurring substances produced by endocrine glands that have effects throughout the body. They travel in the blood stream and act through receptors in multiple tissues.

Hot flush: sometimes called hot flash-a sudden feeling of heat often associated with sweating and accompanied by warm hands, a slightly faster heart rate and higher blood pressure. The intensity of hot flushes varies from a mild warm feeling without sweating to "a tropical rain storm." Hot flushes originate in the hypothalamus that is exposed to estrogen withdrawal after first becoming habituated to high estrogen. It involves a fundamental change in temperature regulation. Hot flushes may begin in perimenopause (especially in women who have experienced high estrogen signs such as increased premenstrual symptoms). Hot flushes are maximal during the year following the final menstrual period. Men having anti-androgen treatment for prostate cancer may also experience them. These are sometimes called hot flashes and along with night sweats are part of a general uncomfortable experience called vasomotor symptoms.

Hyperplasia: an increase of cell growth and turnover that is a risk factor for cancer. See also endometrial hyperplasia.

Hyperthyroidism: the term used for an over-active thyroid gland or caused by taking too much thyroid hormone. The person feels too hot, loses weight despite eating well, develops muscle weakness, trembling hands and a fast heart rate. TSH is usually low.

Hypothalamus: a small and important organ in the centre of the brain that interprets signals from the environment and controls body temperature, breathing, heart rate and reproduction. Emotional signals are translated into hormonal and other changes and brain signals.

Hypothalamic suppression: is a protective response to weight loss, emotional stress, illness (pain and sleep disturbances) and over-exercise in which reproduction is temporarily and reversibly suppressed. It is associated with higher levels of cortisol.

Hypothyroidism: means when the thyroid gland isn't making enough thyroid hormone. Often there is a feeling of coldness, need to sleep more, and sometimes dry skin and hair. Usually the TSH level is increased.

Hysterectomy: surgery to remove the uterus. This is performed primarily for benign conditions and in perimenopausal women whose average age is 45-47. Although fibroids are commonly present, the surgery is most often performed because of inadequately treated menorrhagia or heavy menstrual flow. Hysterectomy is indicated for endometrial cancer and invasive cervical cancer. The ovaries may or may not be removed (ovariectomy), but evidence suggests that even if they remain, ovarian function decreases. Women who have had hysterectomy appear to be at lower risk for breast cancer perhaps because of lower ovarian testosterone production.

Hysterosalpingogram: a test in which a substance visible on an X-ray is pushed into the uterus and fallopian tubes to determine whether eggs can travel to the uterus or not. It is an expensive test that is often painful.

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Ibuprofen: an over-the-counter kind of anti-prostaglandin medicine that is very effective for menstrual cramps and menorrhagia to decrease heavy flow.

Immitrex®: a powerful medicine used to treat an acute migraine attack.

Incontinence: involuntary passing of urine. There are many causes but changes in the tissues of the bladder and urethra with aging and traumatic vaginal deliveries can be contributory factors. Exercise of the pelvic muscles with the Kegel exercises is helpful in preventing and treating incontinence. It may be transient in early perimenopause.

Infertility: the inability to become pregnant or bear a child after one or more years of trying.

Inhibin: the name for several protein hormones made by the ovaries. Inhibins regulate within the ovary and control the production of FSH. Inhibin B decreases early in perimenopause and is thought to be responsible for the endogenous perimenopausal ovarian hyperstimulation that may occur. OR a family of hormones made by the ovarian follicle and part of the control system for FSH levels and hence the menstrual cycle. Inhibin B decreases in the follicular phase early in perimenopause.

Insomnia: difficulty obtaining sufficient, restorative sleep. Insomnia is not a disease itself but a symptom of an underlying condition. Night sweats are a common cause of sleep disturbances in menopausal women.

Insulin: a hormone made in the beta cells of the pancreas that allows sugar (glucose) to move into cells. Lack of insulin causes Type 1 Diabetes Mellitus.

Insulin resistance: occurs when abdominal fat and inactivity plus an inherited risk make insulin less effective. It is diagnosed by a waist circumference over 88 cm in women and over 100 cm in men.

In situ: means that the cells that contain cancer are still in one spot and not spreading through the blood vessels or to nearby tissues.

Internal Health Locus of Control: see Health Locus of Control.

Internal Medicine: the name for a physician specialist who is not a surgeon. This specialty includes endocrinologists, cardiologists, dermatologists, gastroenterologists, neurologists, rheumatologists, and those who run intensive care units and often emergency rooms.

Invasive: a kind of test that involves pain, high cost and/or potential risks.

In vitro: a biological process that happens in the laboratory rather than in the body. It literally means 'in glass'. Tests successfully carried out in vitro do not always show the same effects in vivo (in the body).

In vitro fertilization (IVF): a treatment for infertility when the fallopian tubes are blocked but the ovaries are functioning. A woman’s ovaries are hormonally caused to make several eggs. The eggs are surgically removed, fertilized with sperm in the laboratory and then implanted into the woman’s prepared uterus.

In vivo: a biological process that goes on within a person.

IUD: an intrauterine device created for birth control. Women wear a small piece of plastic or metal inside their uterus. It may or may not have a medicine in it (such as the progestin-releasing IUD, Mirena®). It is inserted through the cervix and has a string for its eventual removal. An IUD slightly increases menstrual flow (except for the progestin-releasing one) plus it may cause increased cramps.

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Kegel exercises: involve tightening and holding the muscles used during urination to strengthen them and treat incontinence. May also enhance sexual pleasure.

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Lactose: a milk sugar that some people with lactose intolerance can't breakdown normally.

Least squares analysis method: a quantitative way of figuring out whether or not basal temperature is increased after ovulation.

LH: see luteinizing hormone.

LH peak: the high level of luteinizing hormone that occurs in response to the estrogen peak in the middle of the menstrual cycle and which triggers ovulation.

Littermate rats: a kind of laboratory animal in which all are very closely related, like identical twins.

Libido: the medical term for sexual desire. Libido is affected by many factors, including emotional, social and psychological factors. Hormonally, androgens are believed to play a role in women’s libido.

Lipoproteins: particles consisting of a fatty core and a protein surround to allow transport of fat in the blood stream. Lipoprotein A is a cholesterol-rich lipoprotein, which resembles LDL cholesterol and is an independent risk factor for cardiovascular disease. It has proven resistant to drug treatment and does not appear to be decreased by estrogen-containing ovarian hormone therapy (OHT).

Low-trauma fracture: also called a "fragility fracture". It is defined as a broken bone with a fall with less or equal force as a fall from a standing height. A low trauma fracture is one way of defining osteoporosis.

Lubricants: over-the-counter preparations to help vaginal dryness.

Luteal phase: the portion of the normal menstrual cycle from ovulation until the day before the next flow. A normal luteal phase is 10 days or longer (assessed by quantitative basal temperature methods) or 12 days or longer from the LH peak at midcycle. The length of the luteal phase is roughly proportional to the amount of progesterone in the cycle.

Luteal phase length: the portion of the normal menstrual cycle from ovulation until the day before the next flow. A normal luteal phase is 10 days or longer (assessed by quantitative basal temperature methods) or 12 days or longer from the LH peak at midcycle. The length of the luteal phase is roughly proportional to the amount of progesterone in the cycle.

Luteinizing hormone: a pituitary hormone controlled by gonadotrophin releasing hormone, (GnRH) from the hypothalamus. It stimulates the ovary's outer cells to make androgens that are then converted into estrone or estrogen.

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Magnesium: an element found abundantly in human food that is often inadequate in the diet of mice and rats. For this reason these animals, but not humans, need supplements for normal bone remodeling.

Mammography or mammogram: an X-ray procedure using a special low irradiation technique to detect abnormal change in breast tissue. Its main use is to detect breast lumps that are too small to be found during breast self examination or physical examination. The higher the level of estrogen (and possibly progestin) the more dense breast tissue is and the less likely that a mammogram will see abnormal tissue. It has many false positive readings meaning that there is no cancer yet the test was abnormal.

Manic: a state of high excitement and activity found in bipolar affective disease and occasionally with other mental illness.

Mastalgia: the medical term for breast pain or tenderness typically in the front of the breast and under the nipple. Breast tenderness typically occurs with estrogen levels equal to or higher than the mid-cycle estrogen peak during the menstrual cycle.

Maternity vitamin: a multivitamin that includes enough folate for the mother and the fetus's good health.

Matrix: the protein produced by osteoblasts that become full of calcium and other minerals and forms the basic structure for bones.

Maturation: the process of becoming more mature or grown up.

Maximal exercise performance: sometimes called "VO2 max". It means the heart, lungs and muscle are working so hard that no more oxygen can be used or the body is working without oxygen.

Medical menopause: an artificial kind of menopause in which the ovary stops producing estrogen and progesterone because of therapy with GnRH or other hormones. This is used sometimes for severe endometriosis or migraine headaches.

Medroxyprogesterone: a manufactured kind of progestin that resembles natural progesterone.

Menarche: the first menstrual bleeding (period). The usual age range is from 10-15 with the average about 12.5 years. The age of menarche has dropped (called the “secular trend”) during the past century but the age of menarche now appears to be stabilizing in developed countries in the 21st century.

Menopausal: the situation of being in menopause (one year since the final menstrual flow). This term is preferred over 'postmenopausal' which is a duplication of ideas.

Menorrhagia: very heavy menstrual bleeding often with clots and flooding. It is usually caused by high estrogen levels and associated with endometrial hyperplasia from too little progesterone. It commonly occurs in perimenopause and may also happen in the teen years.

Menstrual cramps: these are a discomfort or pain caused by the uterus muscle contracting. They often occur just before and during the first days of menstruation. The muscle contractions are caused by high levels of prostaglandins that relates to both hormone levels and to the tightness of the cervix. OR the discomfort caused by contraction of the uterus before and during menstrual flow because of prostaglandins. It is also called dysmenorrhea. It is treated by anti-prostaglandin agents such as ibuprofen.

Menstrual cycle: the time from the start of menstrual flow until the day before the next flow.

Menopausal Transition: the period of a midlife woman’s life cycle between the onset of irregular periods and the “final menstrual flow.” A broader and more accurate term is perimenopause.

Menopause: defined when a year has passed since the final menstrual period. This marks the beginning of women’s mature life following approximately 30-45 years of reproductive life. The average age of menopause in western countries is approximately 51. The average age of menopause is younger in smokers and those who have never had children (nulliparous). Low levels of both estrogen and progesterone are normal after menopause.

Menstruation: vaginal bleeding resulting from the process of periodic shedding of the endometrium. The first day of menstrual flow marks the beginning of a new menstrual cycle.

Metabolite: a substance that is the product of breakdown reactions in the body. Drugs are broken down in the body to one or more metabolites. A drug may act primarily through its metabolites.

Metastases: small bits of cancer spreading through blood vessels and lymph system and growing in bones, liver, brain and other parts of the body.

Metoprolol: a medicine used for high blood pressureit is from the 'beta-blocker family' of medicines that work against catecholamines. It slows the heart rate, decreases the force of the heart's contraction and decreases blood pressure.

Micronize: means to make into very small or microscopic bits. For oral micronized progesterone, each tiny amount of hormone is surrounded by fat. This process allows progesterone to be taken by mouth.

Midcycle estrogen peak: the highest level of estrogen that occurs in the middle of the menstrual cycle. This triggers the luteinizing hormone peak that leads to ovulation.

Migraine headache: a severe kind of headache involving blood vessels in the brain. It is usually associated with nausea and is often preceded by an aura that may involve a change in how nerves work. Prevention of migraines involves avoiding triggers (like some wines and cheeses), reduction of emotional stress and not taking estrogen-containing medicines such as the Pill, and not starting and stopping hormones suddenly.

Milk of magnesia: an over-the-counter medicine containing magnesium that helps with constipation and causes diarrhea.

MinEstrin®: a lower dose form of oral contraceptive agent containing 20 micrograms of ethinyl estradiol and an androgenic progestin in the same amount for three weeks with one week off. In a 6-cycle randomized controlled trial of perimenopausal women with heavy flow, it was shown to decrease flow slightly, but it did not significantly improve hot flushes or quality of life.

Mirena®: the brand name of a powerful androgenic progestin-releasing IUD used to treat menorrhagia in perimenopause.

Miscarriage: means that a woman was pregnant but that the pregnancy ended early. Usually this occurs before three months of pregnancy because the fetus had an abnormality.

Molimina: the set of normal experiences that tells a woman that her period is coming and that she has ovulated. Most specific of these is the development of breast tenderness under the armpit when the rest of the breast is not sore. Other experiences include some increase in fluid retention, perhaps an increase in appetite and possibly an increased sensitivity to the emotion in everyday experiences. It is different from premenstrual symptoms because it is less intense and indicates ovulation.

Multinodular: a term commonly used for the breast and thyroid glands that contain many cysts.

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Naproxen: the brand name of a kind of anti-prostaglandin prescription medicine.

Natural progesterone: means bio-identical progesterone. This term is often used to refer to progesterone creams that, in low doses, are sold without a prescription in the USA.

Needle biopsy: a test in which a needle is used to gather cells to decide whether a lump is a cancer or benign. Often used for diagnosis in breast and thyroid lumps.

Neural tube defect: means a birth or congenital problem often related to inadequate folate intake by the mother before and early in pregnancy. The baby's spinal canal doesn't close properly so that the muscles and nerves in the feet and legs can't develop normally.

Neurology specialist: an internal medicine physician who is an expert in problems involving the diagnosis and treatment of brain and nerves.

Neuropathy: a problem of nerves causing pain or lack of normal functions. This occurs in those with diabetes that is not well controlled.

Night Sweats: a term for hot flushes occurring during the time of sleep. Night sweats may begin in regularly menstruating women in early perimenopause. In these women they are most intense before flow. They may persist and cause insomnia in women in late perimenopause and early menopause.

Noradrenalin: a name for a hormone made in sympathetic nerves and the adrenal gland that makes the heart beat faster and harder, and blood vessels constrict in the hands and feel. Also called norepinephrine.

Norepinephrine: see Noradrenalin.

Normal luteal phase range: describes the pattern of expected progesterone levels after ovulation in the normal menstrual cycle. This provides the guide for the amount of progesterone used for treatment of heavy flow, hot flushes and breast tenderness.

Non-steroidal anti-inflammatory drugs (NSAIDs): these are medications that block prostaglandin production and therefore treat menstrual cramps.

NSAID: see Non-steroidal Anti-inflammatory drug.

Nucleus: the special centre part of all cells containing genetic material and receptors that allow hormones to direct the cell.

Nulliparous: never having been pregnant and delivered a baby.

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Obesity: being heavier than normal for height—a BMI more than 30.

OHT: see Ovarian Hormone Therapy.

Oil of evening primrose: a kind of oil that is used for premenstrual sypmtoms and other of women's symptoms. It has not been shown to be effective.

Oligomenorrhea: means menstrual cycles farther apart than 36 days but shorter than 180 days. This may normally occur during early adolescence and in perimenopause. It is commonly a protective form of hypothalamic suppression in association with weight loss, inappropriately intense exercise training, emotional stress or under-nutrition. It appears to precede the development of anovulatory androgen excess. When oligomenorrhea is related to hypo-thalamic suppression, estrogen levels are low; but when related to anovulatory androgen excess, estrogen levels are high or normal.

Oncologist: an internal medicine specialist in cancer.

Open biopsy: a small surgery to remove a breast lump that might be cancer.

Opthalmologist: a doctor that specializes in diseases and surgery of the eye.

Oral contraceptive therapy: a kind of contraceptive agent that involves taking a pill containing a high dose of estrogen with progestin to suppress normal ovulation and egg implantation. OR commonly called the Pill. Contains high doses of a synthetic estrogen and moderate doses of a progestin, typically an androgenic progestin. "Low dose" (20-30 micrograms) estrogen-containing kinds still have four to five times more estrogen effect than is normal for the menstrual cycle. The Pill prevents ovarian cancer but increases the risks for migraine headaches, blood clots and strokes. The new ring and patch forms of contraception are less likely to cause blood clots.

Oral micronized progesterone: refers to natural progesterone treated to remain active when taken by mouth. It improves deep sleep, and is a useful therapy in perimenopause.

Orthotics: special inner soles for shoes crafted to correct foot problems.

Osteoblasts: are cells that lay down the protein matrix that becomes bone after mineralization (adding calcium and other minerals) under the influence of Vitamin D. Osteoblast cells form new bone (“bone formation”) in the normal process of bone renewal called “remodeling.” Formation occurs rapidly during growth in adolescence. It also occurs more rapidly than usual under the influence of progesterone during the luteal phase of the menstrual cycle or from therapy with progesterone, most progestins or parathyroid hormone (which is experimental).

Osteoclasts: cells that remove old bone during bone remodeling (a process called “resorption”). Osteo-clastic bone resorption is fast and occurs over about three weeks in any spot in bone. Any weight loss causes increased bone loss as does excess stress, excess caffeine (in women with low calcium intakes) and colas (because the body uses calcium to help excrete the phosphoric acid they contain).

Osteopenia: a lower than normal Bone Mineral Density with a T-score between –1 and –2.5.

Osteoporosis: a weakness of bone sufficient to cause a fragility fracture or very low Bone Mineral Density (lower than a T-Score of –2.5) by Bone Mineral Density. Men and women are both at risk with increasing age—almost 25% of adults over age 50 have had one or more vertebral compression fractures.

Ovarian Cyst: a fluid-filled sack in the ovary that enlarges before ovulation or that remains because no egg was released that cycle. Ovarian cysts may rarely represent a serious condition or cancer. Usually they simply indicate that ovulation has not occurred. Ovarian cysts are normal before menarche and in adolescence, occur during pregnancy and in perimenopause and when a woman is using oral contraceptives.

Ovarian Hormone Therapy (OHT): therapy with estrogen and progesterone for specific problems that menopausal women may experience. Historically, OHT was called “hormone replacement therapy”. The three appropriate reasons for OHT since the Women’s Health Initiative and other randomized controlled trial results are: early menopause, chronically disturbing hot flushes/night sweats or osteoporosis in a menopausal woman who also has hot flushes.

Ovarian hormones: includes estradiol or estrogen and progesterone that are necessary for women's reproduction and general health.

Ovarian hyperstimulation: a serious complication of hormonal therapy in preparation for in vitro fertilization. It involves very high estrogen levels, the abnormal accumulation of fluid in the abdomen and liver and kidney as well as clotting problems. "Endogenous ovarian hyperstimulation" is used to describe the perimenopausal high estrogen levels.

Ovariectomy (Oophorectomy): surgical removal of one or both ovaries. It is usually associated with hysterectomy. Removal of both ovaries in a menstruating woman is called surgical menopause.

Ovaries: twinned organs found on either side of the uterus. The ovaries produce important estrogen and progesterone hormones cyclically during about 35-40 years of women's lives. OR the two glands in the abdomen of women that contain millions of follicles, each of which includes an egg and cells that can make ovarian hormones.

Overactive thyroid: see hyperthyroidism.

Over-pronation: a tendency of the foot to tilt toward the middle of the body. Can cause foot and knee pain. Commonly corrected by orthotics.

Ovulated: means the action of ovulation.

Ovulation disturbances: cycles in which either no egg is released (anovulation) or an egg is released but the luteal phase is too short. OR also called ovulation disturbance. Includes short luteal phase and anovulatory cycles. Ovulatory disturbance occurs in regular cycles and oligomenorrhea.

Ovulation: the time when the ovary has prepared and released an egg. Ovulatory cycles are ones in which progesterone production is present in the second half of the menstrual cycle.

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Pap test: short for Papnicolaou test for cervical cancer. This is performed during an internal examination, or pelvic examination.

Parathyroid hormone: A hormone produced by the thyroid gland that acts to increase the concentration of calcium in the blood.

PCOS: see anovulatory androgen excess.

Peak bone density: the highest bone mineral density achieved sometime between the teens and about ages 20-30.

Pedometer: a small instrument worn to measure the number of steps or how many kilometers a person has walked.

Pelvic: relating to the circle of bones sheltering the uterus, bladder and nerves, muscles, and tendons connecting the trunk to the legs.

Pelvic examination: this means examination of the vagina and cervix using a special tool called a speculum. Also includes feeling the size and shape of the uterus and ovaries with one hand in the vagina and one on the lower abdomen. Commonly called an internal examination.

Perceived exertion: the feeling an exercising person has of how hard she/he is working.

Percussing: a technique of tapping on the outside of the body as a way of learning the position and characteristics of internal organs. Percussing is regularly used for the lungs and to determine the position and size of the liver and spleen.

Perimenopause: the period of time before and for a year after the final menstrual period during which ovarian hormonal patterns, experiences and sociocultural roles change. The average age at which irregular cycles develop is approximately age 47. Perimenopause probably begins several years before that in women with regular cycles whose ovaries are making higher amounts of estrogen and tending to make lower amounts of progesterone. Like menopause, this is a normal part of a woman’s life cycle.

Physiology: the science of the normal process of changes in cells and organs.

Phytoestrogens: plant-based molecules that act like estrogens at the same time as they act against estrogens in tissues. Soy foods are high in phytoestrogens.

Pituitary gland: a small gland in the base the brain behind the bridge of the nose that produces a number of hormones including LH

Pituitary hormones: for the front or anterior part of the pituitary gland these include thyroid stimulating hormone (TSH), prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH), growth hormone and adrenocortical stimulating hormone (ACTH). The back or posterior part of the pituitary gland releases anti-diuretic hormone and oxytocin that are made in the hypothalamus.

Placebo: an inactive medicine that is used for double blind, randomized controlled trials.

PMI: point of maximum impulse of the heartbeat that can be seen or felt on the chest wall.

PMS: the abbreviation for premenstrual syndrome that some experts believe is a mental illness. Also used for premenstrual symptoms, a set of physical and emotional changes before menstrual flow that occur when estrogen is too high and progesterone too low.

Polycystic Ovary Syndrome: see Anovulatory Androgen Excess

Population-based studies: an accurate kind of epidemiology study that asks a random (by chance) set of people to participate. Ideally over 50% of those invited will join the study.

Postmenopausal: see "Menopause" This term arose from the peculiar idea that the final menstrual period is menopause and everything after is postmenopause. That is peculiar because a perimenopausal woman doesn't know until one year has passed without another period that that particular flow was her final one! With this year she becomes menopausal.

Postmenopause: an old-fashioned, inaccurate and repetitive way of describing menopause.

Potassium level: the amount of the small electrically charged molecule in the blood stream. Low potassium levels interfere with the work of the heart and blood vessels and are often caused by diuretics.

Pre-eclampsia: a serious health problem in pregnancy that results in high blood pressure, edema, abnormal kidney function and carries risks for the health of the mother and baby.

Premarin®: brand name for conjugated equine estrogen.

Premature menopause: a medical term for early menopause. It means menopause that occurs before the age of 40 or 45 and is appropriately treated with ovulatory cycle-matching doses of transdermal estrogen and cyclic progesterone.

Premenopausal: women who are in premenopause.

Premenopause: refers to women from menarche until perimenopause. Before perimenopause was understood, this term described any menstruating woman.

Premenstrual symptoms: a collection of physical and emotional changes that are bothersome and occur in the days immediately prior to flow. These symptoms are greater the higher the estrogen levels and the lower the progesterone levels. Although “Premenstrual Syndrome” (PMS or PMT) is popular, it is extremely rare in the population. Premenstrual symptoms are increased by situational stresses and by a dependent socioeconomic situation. Unlike molimina premenstrual symptoms do not indicate normal ovulation.

Progesterone: an important ovarian hormone produced by the ovaries following ovulation during the menstrual cycle. Progesterone rises 1400 percent over a week from the midcycle to its peak during the luteal phase. It acts on specific receptors in every tissue in the body in which estrogen acts. Its primary job is to cause differentiation (maturation) and to stop the proliferation (growth) caused by estrogen. Progesterone causes the endometrium to become secretory and able to accept and nurture a fertilized egg. If fertilization does not occur estrogen and progesterone levels decrease and a period results.

Progestin: a group of synthetic drugs created to resemble progesterone. Androgenic forms have been in use in oral contraceptives for many years. The most common form in North America is medroxyprogesterone. This is not androgenic.

Prolactin: a pituitary hormone that, when its levels are very high, can cause amenorrhea, oligomenorrhea and ovulation disturbances.

Proliferating: describes cells that are growing rapidly. In general the more rapidly proliferating cells carry a higher cancer risk.

Proliferation: a process in which cells grow rapidly, dividing frequently and increasing in number. If proliferation gets out of control, it leads to cancer.

Prometrium®: the brand name for oral micronized progesterone.

Prophylactic: a descriptive word for things that are meant for prevention.

Prophylaxis: the process or set of treatments used for prevention of a disease or problem.

Propranolol: a kind of medicine that blocks the actions of adrenalin and noradrenalin, thus slowing the heart rate and decreasing the contraction force of the heart. Used in hyperthyroidism, high blood pressure and for migraine prophylaxis.

prostaglandin: a fatty acid kind of hormone made in the uterus that causes menstrual cramps also known as dysmenorrhea, pain and often headaches or diarrhea. These hormones are blocked by anti-prostaglandin medications such as ibuprofen. OR hormones made in many tissues that cause pain, increased or decreased blood flow and menstrual cramps.

Provera®: the most common brand name for the progestin, medroxyprogesterone acetate.

Psychiatrist: an internal medicine specialist who deals with emotional problems and mental diseases.

PTH: see parathyroid hormone.

Pulse: the heart beat including whether or not it has a regular rhythm and its rate.

Puberty: the normal process of change from a child into a reproductive adult. For women it involves development of breasts and pubic hair as well as enlargement of the uterus, widening of the hips and an increase in body fat.

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Quantitative basal temperature (QBT): a scientific way of determining from a series of first morning temperature readings across one menstrual cycle whether or not the cycle is ovulatory and the luteal phase length.

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Receptors: tiny structures on or within cells that allow hormones, germs and chemicals to bind and trigger changes within the cell.

Risedronate: a powerful form of bisphosphonate treatment for osteoporosis that prevents spine and hip fractures but is expensive and may have some negative effects on the esophagus and stomach. It may be taken once a week.

Raloxifene®: a selective estrogen receptor modulator or SERM that prevents spine but not hip fractures. It causes side effects of hot flushes, muscle cramps and blood clots.

Randomized placebo controlled study: a scientifically important way of testing that involves assignment to a group by chance, like a roll of dice. One group gets an inactive intervention or placebo therapy. These are usually double blind also.

Rebound increase in flushes: the increase in hot flushes that occurs when women with past hot flush suddenly stop estrogen treatment.

Remifemin®: a commercial preparation of the herb, black cohosh.

Remodeling: a term used for the renovation process, including bone resorption and bone formation that maintains the strength of bone.

Retina: the blood vessel-rich tissue in the back of the eyeball that allows sight.

Rheumatic fever: an illness caused by a reaction to the germ causing strep throat. It usually involves a fever and sore joints, and often a skin rash and problems with heart valves.

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Sage tea: a tea made out of the spice, sage---it is believed to help hot flushes. This treatment has not been scientifically studied.

Secretory: a tissue that makes special secretions. For example, under the influence of progesterone, the endometrium in the luteal phase becomes glandular and secretes fluids so that a fertilized egg can implant.

Selective estrogen receptor modulator: a kind of created non-hormonal medicine that sometimes acts like, and sometimes acts against, estrogen in the body.

Selective serotonin re-uptake inhibitor (SSRIs): a newer kind of antidepressant that does not cause drowsiness. Some of these kinds of anti-depressants are difficult to stop, cause decreased sexual interest and sleep problems, but also improve hot flushes. Abbreviated SSRI.

SERM: see selective estrogen receptor modulator.

Serum creatinine: the blood concentration of a chemical that reflects kidney function.

Shin splints: a pain in the foot in the front of the lower leg that is caused by not enough blood to the working muscles beside the shinbone. May be confused with a stress fracture of the tibia.

Short luteal phase: a type of ovulatory disturbance in which the luteal phase is shorter than normal and progesterone production is less than optimal. Shortening of the luteal phase is a common hypothalamic protective response to weight loss, stress, exercise training that is too intense or cognitive dietary restraint, the worry that what you eat will make you gain weight. Short luteal phase cycles are associated with infertility, bone loss and osteopenia.

Spironolactone: an anti-androgen medication that also is used for high blood pressure. It is very helpful when used with cyclic progesterone therapy for the treatment of anovulatory androgen excess.

Soy-based foods: food made from soy, a member of the legume or bean family of vegetables. These contain high levels of phytoestrogens.

Sperm count: is an important infertility test for men. The number, movement, shape and health of sperm seen after a man ejaculates.

SSRI:see selective serotonin re-uptake inhibitor antidepressant.

Statistical power: a way using math and the variability of what you are studying, to determine whether, in a scientific study, you could detect a difference if there is one.

Stress fracture: a kind of broken bone or fracture in which there is disruption of cortical bone and pain but no crack going through a bone. Often occurs with excess exercise of the same kind, a problem of how the foot and leg line up with exercise (like over-pronation), or with compulsive exercise.

Stroke: a major brain injury in which a blood clot or bleeding in the blood vessels of the brain interfere with the brain's function. Stroke risk is increased by high blood pressure and OHT, estrogen treatment or use of the Pill.

Subclinical: indicating a condition cannot be observed or detected without doing specific tests. For example, “Anovulation may be subclinical and occur in regular menstrual cycles.”

Surgical menopause: means menopause induced by the surgical removal of both ovaries.

Systolic: the top reading. See blood pressure.

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Tamoxifen: a medicine that was the first SERM. It decreases breast cancer recurrence but has side effects of blood clots, hot flushes and endometrial cancer.

Tanner Stage: a way of describing the maturation of breasts and pubic hair during women's adolescent reproductive development. It includes five stages from a child's characteristics to those of a mature woman.

TB: or tuberculosis is a bacterial disease that attacks the lungs and can spread to the adrenal glands, kidneys and bone. It is worse with overcrowding, poor nutrition and AIDS.

Testosterone: the major androgen or make hormone made by the adrenal glands and the ovaries in women, and primarily by the testicles in men.

The Pill: common name for oral contraceptives.

Thrombosis: the formation of a blood clot (thrombus) in arteries or veins. In the specific case of venous thrombosis, the clot occurs within deep lying veins usually in the legs. It is generally caused by sluggish blood flow through one part of the body. In some instances, part of the clot can break fee and be carried up to the heart and lungs where it may block an artery; this is known as embolism. A clot in the lung is called pulmonary embolism and is a serious condition.

Thyroid: a small butterfly shaped gland in the front of the neck that produces thyroid hormone and through its action is important for energy, temperature and heart rate control.

Thyroid hormone (T4): hormone produced by the thyroid gland that acts on energy metabolism (heart rate, body temperature, and burning of food). Hypothyroidism is common in women and can easily be treated with a small daily pill containing T4. OR T4 or L-thyroxine is the major hormone released by the thyroid gland under the influence of TSH. T4 is made, within body cells, into the active hormone, T3, that is tightly controlled and protectively decreases when a person is undernourished or ill or very stressed.

Thyroid-stimulating hormone: a hormones released from the pituitary gland that acts on the thyroid gland. It directs the levels of thyroid hormone (T4) that is released by the thyroid. Often abbreviated as TSH.

Tibia: the shinbone in the lower leg.

Transdermal: delivery of a medication through the skin by patch, gel or cream. Transdermal estrogen is preferred over oral because of the risk for blood clots. OR means absorbed into the blood stream through the inner layer of skin that is called the dermis.

Tricyclics: an older form of medicines for depression that cause drowsiness and are used in lower does for helping sleep, decreasing pain and treating fibromyalgia and chronic fatigue syndrome.

Trigger points: spots where muscles and tendons join bone that are sore when a person does not obtain sufficient deep and refreshing sleep. People with many sore trigger points are said to have fibromyalgia.

Triglyceride: a fatty substance normally present in low levels in the blood. High levels of triglycerides are a risk factor for cardiovascular disease.

T-Score: the term used to describe standard deviations below the average in healthy premenopausal women ages 20-30 in the population as measured by bone mineral density. OR the term used to decide whether bone mineral density is normal, low (osteopenia) or suggests a strong risk for fragility fracture, called osteoporosis. Is based on the bell shaped curve distribution of bone density from a random sample of men or women ages 20-30.

TSH level: TSH is a common abbreviation for "thyroid stimulating hormone" produced from the pituitary. A high TSH level suggest hypothyroidism and a low level indicates hyperthyroidism or too high a dose of thyroid hormone therapy.

Tubal ligation: a surgery in which the fallopian tubes are cut, burned or clamped to prevent pregnancy. Is associated with an earlier perimenopause and a decreased risk for breast cancer.

Tuberculosis: also called TB.

Type 2 diabetes mellitus: see diabetes mellitus

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Ultrasound: a technique for bouncing high frequency sound waves off of tissues or structures. Used for visualizing the gallbladder, uterus, endometrium and ovaries. Also used to detect the amount or strength of bone mineral.

Urethra: the tube that carries urine from the bladder to the outside of the body. In women the urethra is short compared to men, increasing the vulnerability to urinary tract infections. This tissue is rich in estrogen and progesterone receptors.

Urinary tract infection (UTI): an infection anywhere in the urinary tract. Women are more susceptible to UTIs than men due to a shorter urethra.

Uterus: a hollow muscular organ, commonly known as the womb that is lined with endometrium. It changes during the normal menstrual cycle and is the place in which the embryo and fetus develop. The lower narrow part opens into the vagina at the cervix and the upper part into the fallopian tubes.

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Vagina: the passage extending from the uterus to the outside. The vagina is very rich in estrogen and progesterone receptors. It takes very low levels of estrogen, such as are found after the menopause in normal weight women, to maintain elasticity and moisture.

Vaginal atrophy: usually called "vaginal dryness"—it is a condition in which the surface of the vagina becomes thinned and makes less secretions so that there is discomfort with intercourse. Occurs in about thirty percent of women in menopause. Both estrogen and progesterone therapy in low doses effectively treat it. The most effective and safe therapy is 0.5 mg of estriol made by a compounding pharmacy applied to the vagina one night a week.

Vaginal dryness: when the entrance to the vagina becomes uncomfortable during penetrating sexual activity. It occurs with lack of sexual activity in women of any age and particularly in perimenopausal and menopausal women. It is usually treated by non-hormonal jellies, arousing foreplay and gentle intercourse. If estrogen therapy is needed, Estriol is the safest. Stronger estrogens if necessary should only be used in half a cm on the index finger rubbed into the vaginal opening once a week. Don’t use an applicator!

Vasomotor symptoms: a way to describe hot flushes and night sweats. They are probably not experienced by most perimenopausal and menopausal women but approximately 10% of women in the developed world report severe disturbances related to them.

Vitamin B6: a vitamin called "pyridoxine" in the Vitamin B family of water soluble vitamins. It is used in high doses as a treatment for nausea or for premenstrual symptoms.

Vitamin D: a vitamin that increases the absorption of calcium and is, therefore, necessary to prevent osteoporosis. Vitamin D can be made in the skin by direct but not indirect sunlight as is present from October through March in countries closer to the poles. Vitamin D is also a hormone made in two further forms in the liver and the kidneys and has actions in many cells in the body.

Vitamin: the name for a substance that the body cannot make and must obtain from food or other sources.

VO2 max: see Maximal Exercise Performance.

Vulva: the external or visible part of the female genitalia comprising the clitoris and two pairs of skin folds called labia.

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Waist circumference: measurement of the smallest point in the abdomen near the belly button or umbilicus. Ideal values are less than 88 cm in women and less than 100 cm in men. Larger measurements suggest insulin resistance.

Waist to hip ratio: the waist circumference divided by the hip circumference. A value of lower than 0.8 is normal for women and lower than 1.0 is normal for men.

Women’s Health Initiative (WHI): a very large series of studies on the health of menopausal women. It includes randomized double-blind placebo-controlled trials, as well as observational studies of the effect of a low fat diet on breast cancer risk and vitamin D and calcium for preventing osteoporosis. The trials involve estrogen or estrogen plus very low dose medroxyprogesterone (ovarian hormone therapy, OHT) compared with placebo therapy in healthy menopausal women. Results of the estrogen plus progestin arm that was discontinued early in July 2002 proved that “hormone replacement therapy” is not safe for healthy menopausal women and that “estrogen deficiency” is the wrong way to think about menopause. (See “Beyond ‘Estrogen Deficiency’—news from Women’s Health Initiative”, “What the Women’s Health Initiative Results Mean for Breast Cancer Survivors” and “WHI, One Year Later — WHY?”)

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X-rays: a kind of beam of radiation used commonly for diagnosis of health problems.

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Yellow Jaundice: the yellow color the skin takes on when a person has hepatitis.

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