This ratio is helpful when both E2 and Pg are within range, yet the patient continues to have symptoms. It is not expected to be normal or used clinically when either E2 and/or Pg are outside of their expected ranges or if the patient does not have clinical symptoms.
Is the ratio relevant in women using hormone therapy?
With some types of hormone therapy such as topical progesterone, Pg levels in saliva are much higher than endogenous luteal phase levels, ranging from 200-3000 pg/mL at 12-24 hours after dosing, and so the ratio can appear high. However, because symptoms of both estrogen dominance and progesterone dominance can look the same, testing and assessing the ratio along with clinical symptoms can help determine the next step for treatment.
A low ratio occurs when Pg is low relative to E2. This describes the classic situation of estrogen dominance. In general, either decreasing estrogen and/or increasing progesterone are appropriate. Women who are postmenopausal are generally in this group.
A high ratio occurs when Pg is high relative to E2. This is most common with supplementation and describes progesterone dominance. When this occurs, a patient may complain of symptoms of estrogen deficiency resuming after previous successful treatment as estrogen receptors are down-regulated by excessive progesterone. In general, either increasing estradiol and/or decreasing progesterone are appropriate. This commonly occurs in menopause after a woman has been using progesterone successfully in perimenopause and her estrogen levels finally start to decrease as menopause is reached.
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