Glossary

AAE: or anovulatory androgen excess [25].

Abdominal visceral fat: a layer of fat surrounding abdominal organs that increases with obesity [26], especially in those with insulin resistance [27]. It is the major contribution to increased waist circumference [28].

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 [29] for both young women and men but normally goes away after that. It is also a common androgenic [30] sign of anovulatory androgen excess [25].

Adenomyosis: when endometrial glands are present in the wall of the uterus [31] 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 [31] 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 [32]. The trapped blood is slowly released causing extended spotting throughout the rest of the cycle. Perimenopausal [33] 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 [34]: cortisol [35], aldosterone [36], androgens [30], and catecholamines [37].

Adrenalin: a kind of hormone [34] called a catecholamine [37] that is made by nerves and in the centre of the adrenal gland [38]. 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 [39] vessels in arms and legs to constrict. It is also called epinephrine [40].

Aldosterone: a hormone [34] made in the adrenal glands [38] that causes the kidneys to retain sodium and water and get rid of potassium [41]. High levels can cause high blood pressure [42] or hypertension. A medication that can block the effects of aldosterone is called spironolactone [43].

Alendronate: a powerful form of bisphosphonate [44] treatment for osteoporosis [45] that prevents spine and hip fracture [46]. 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 [47]) 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 [48] that occurs with damage to the brain with aging and with many strokes [49].

Amenorrhea: the absence of menstrual bleeding for six months or longer. This is normal before menarche [50], during pregnancy, and for the first year or two of lactation. Amenorrhea is also normal in late perimenopause [33] and after menopause [51].

Androgen: a name for a 'male sex hormone [34]', the most important of which is testosterone [52]. Androgens are also a normal part of women’s reproduction. Besides testosterone, other important androgens are DHEA [53] and androstenedione [54]. 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 [25]. 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 [30] levels.

Androgenic Progestins: synthetic forms of progesterone [55] that are made from testosterone [52] and act a little like androgens [30] as well as like progesterone [55].

Androgen Receptor blocker: a medicine, like spironolactone [43], that blocks the action of male-type hormones [34] in cells in the body.

Androstenedione: an androgen [30] normally made in the ovary [56] and which, like testosterone [52] and DHEA [53], is converted into estrogen [57] 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 [58] B 12 may occur in vegetarians who are not taking B 12 supplements.

Anemic: describes a person with anemia [59].

Anorexia: a condition in which a person doesn’t eat normally. This severe eating disorder [60] is associated with a need for control and severe weight loss, amenorrhea [61], high cortisol [35] levels, bone loss and the metabolic effects of undernutrition.

Anorexic: describes a person with anorexia [62].

Anovulation: a menstrual cycle [63] in which an egg is not prepared and released. Because a corpus luteum [64] is not formed, the levels of progesterone [55] will remain low in the second half of the cycle and the cycle will have no luteal phase [65].

Anovulatory Androgen Excess (AAE): a more accurate term for what is often called “Polycystic Ovary Syndrome [66]” (PCOS). AAE is diagnosed when a woman has clinical evidence of androgen excess (usually hirsutism [67] or acne [68]) and evidence past or present ovulation disturbances [69] (anovulatory [70] or short luteal phase [71] cycles). AAE is associated with both infertility [72] and risk for insulin resistance [27] and Diabetes Mellitus Type 2 [73].

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 [34] called prostaglandin [74]s. They are used to treat menstrual cramps [32]. To be effective they must be taken before symptoms become severe and repeated as soon as the cramps [75] start to return. Ibuprofen [76] 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 [34] into estrogen [57].

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 [49].

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 [77]. See molimina [78].

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 [77] as evidence of the action of progesterone [55] in the hypothalamus [80].

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 [42], hyperthyroidism [81], heart disease, fast heart rates, migraine [82] prophylaxis, and performance anxiety that prevents the action of catecholamines [37] like adrenalin [83] and noradrenalin [84]. People with asthma should not take beta-blocker medicines. Propranolol [85] is a kind of beta-blocker.

Bio-identical: a hormone that is exactly like the one made by the human body. For example, progesterone [55] is bio-identical but medroxyprogesterone [86], a progestin [87] is not (Also spelled bioidentical). For more information on bioidentical hormones, see Ask Jerilynn: What Are Bioidentical Hormones? [88]

Bipolar affective disease: a mental or emotional illness characterized by extreme mood changes from severe depression to inappropriate hyperactivity and elation. Also called manic [89]-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 [90], decrease bone resorption [91] and slow bone loss as well as decreasing risks for fracture [46]. All bisphosphonates must be taken at least an hour away from food and two hours away from calcium [92], vitamins [58] and iron. Members of the bisphosphonate family include etidronate [93], clodronat [94]e [94], alendronate [95] and risedronate [96]. Currently available medicines in the biphosphanates family include etidronate [93], clodronate [94], alendronate [95], risedronate [96], zoledronate, pamidronate and ibandronate.

Black cohosh: an herb that seems to help with hot flushes [97] and night sweats [98]. 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 [99] because they can travel to the lungs or block off a blood [39] vessel.

Blood pressure: the pressure created by the heart's pumping power and the resisting of blood [39] vessels. When the heart contracts it creates the systolic [100] 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 [100]/diastolic [101] 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 [39] without oxygen back to the heart.

Blood sugar: the natural energy, also called glucose, which is carried in the blood stream [99]and provides energy for the cells of the body. Usually it is measured as fasting glucose. [102]

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 [103].

BMI: abbreviation for body mass index [104].

Bone formation: the process that uses osteoblasts [105] to build new bone protein matrix [106]. Bone formation is slow and any one spot takes about three months. Progesterone [55] and PTH [107] stimulate bone formation and cortisol [35] inhibits it.

Bone Mineral Density (BMD): a measure of the amount of bone and its mineral. There are several kinds but one called DXA [108] uses very low doses of X-rays [109] 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 [110]. A T Score lower than –2.5 is considered osteoporosis [45], and lower than –1.0 to -2.4 is called osteopenia [111].

Bone marrow: the collection of cells in the middle of many cortical bone [112]s in which new blood [39] 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 [90] and replaced with new bone by osteoblasts [105].

Bone resorption: the process by which old bone tissue is broken down and removed by special cells called osteoclasts [90]. 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 [92] intakes) and colas (because the body uses calcium [92] to help excrete the phosphoric acid colas contain). Bone resorption is normally in balance with bone formation [113]. Increased calcium [92] and vitamin D [114] control resorption rates.

BP pill: a common way of describing medicines used for high blood pressure [42].

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

Breast density: a characteristic on the mammogram [115] 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 [116]women, is maximal in perimenopause [33] and decreases with menopause [51]. Estrogen [57] therapy increases breast density.

Breast hormone receptor status: describes which of the ovarian hormones [117], estrogen [57] or progesterone [55], makes breast cancer [118] cells grow.

Bulimia: a kind of eating disorder [60] with binge eating followed by guilt and often by self-induced vomiting or diarrhea. OR an eating disorder [60] in which people tend to over-eat (binge) and then vomit (purge) or cause diarrhea to control weight.

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 [92] supplement in which elemental calcium [119] is combined with citrate. This is the only kind of calcium [92] 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 [45], fracture [46] and bone mineral density [120]. 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 [117] and cortisol [35] than to exercise.

Candidiasis: infection with yeast named "Candida"—may be in the vagina [121] 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 [34] that act on blood [39] vessels and the heart. Catecholamines include adrenaline [83] (epinephrine [40]) and noradrenalin ( [84]norepinephrine [122]).

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/ [123]). An international advisory council includes women and men from many disciplines and seven countries.

Cervix: the neck of the uterus [31] (womb), which projects onto the upper part of the vagina [121]. 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. [124]

Chest X-rays: a test using X-rays [109] of the chest to see heart, lung, or blood [39] 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 [39] attached to proteins. LDL cholesterol is the bad form as it forms the basis for atherosclerosis [125]. 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 [33].

Clodronate: an early form of bisphosphonate [44] that can be given intravenously. It decreases bone resorption [91] but hasn’t been shown to prevent fractures [46]. It may decrease bone and other metastases [126] in breast cancer [118].

Cognitive dietary restraint: worry that certain foods will cause weight gain. It is also called "eating restraint." It is associated with higher cortisol [35] production and short luteal phase [71] cycles. It is the mildest kind of "eating disorders [60]," of which anorexia [62] 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 [57] created from the urine of pregnant horses with the brand name Premarin®. [127] Contains a mixture of unique horse estrogen [57]s and predominantly estrone [128], a common type of estrogen [57].

Conjugated estrogens: a kind of estrogen [57] that is joined to other chemicals to improve its stability. Conjugated estrogen [57] sulfate (CES) is “vegetarian premarin.” Conjugated equine estrogen [57] (Premarin® [127]) is the historically important mixture of estrogens [57] derived from pregnant mare’s urine used for so called “HRT [129].” These oral forms of estrogen [57] have been repeatedly shown to cause over a 200% increased risk for thrombosis [130] and should be avoided in favor of transdermal estrogen [131].

Corpus luteum: a temporary structure in the ovary [56] that arises after an egg is released from the follicle (ovulation [77]). It secretes estrogen [57] and progesterone [55]. If the egg is not fertilized, the corpus luteum stops secreting progesterone [55] and decays - this triggers the shedding of the endometrium [132] (menstruation [133]). 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 [34] made by the adrenal glands [38] in response to stress, including dieting, cognitive dietary restraint [134], situational stress, illness, and intense exercise. High estrogen [57] levels amplify the stress-related production of cortisol. OR a stress hormone made by the adrenal glands [38]. An essential hormone, it functions to maintain blood pressure [135], 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 [91] and decreased bone formation [113]. Progesterone [55] competes for the cortisol receptor on the osteoblast, [105] possibly preventing cortisol from stopping bone growth.

Cramps: see Menstrual Cramps [32]

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 [91] for the person's kidney function.

Cycle day: the days of the menstrual cycle [63] counted from the first day of flow, called Day One, to the day before the next flow starts.

Cyclic Etidronate: (Didrocal®, Didronal®) see Etidronate [93].

Cyclic progesterone therapy: progesterone [55] or medroxyprogesterone [86] given during cycle days 14 through 27 to mimic the normal timing and action of progesterone [55] in ovulatory [77] menstrual cycles [63]. This treatment is used for absent, irregular or heavy menstrual bleeding or severe menstrual cramps [32]. Along with spironolactone [43] it is very helpful therapy in anovulatory androgen excess [25]. Cyclic progestin [87] therapy with medroxyprogesterone [86] caused a significant increase in spinal bone density in premenopausal [116] women with menstrual cycle [63] and ovulation disturbances [69].

Cyst: a round, fluid-filled structure that is common in ovaries [56], thyroid glands [136], and breast tissue. Only rarely is a cyst caused by cancer.

Dementia: a decreased ability to remember, to reason or speak, associated with diseases, some medicines and aging. (See Alzheimer's [137]).

Deoxypyridiniline: a test for bone resorption [91] that measures the excretion of this protein from bone in morning urine. It is abbreviated D-pyr [138].

DHEA: an androgen [30] made in both the ovaries [56] (about 15%) and the adrenal glands [38] (about 85%). DHEA is attached to a sulfate and is measured in the blood [39] as DHEAS. DHEAS is often elevated when women have acne [68]. DHEAS levels are increased when a woman is under stress. DHEA is converted into estrogen [57] by fat and muscle tissues, especially in menopause [51].

Diabetes mellitus: an often-hereditary disease in which the blood sugar [139] becomes abnormally high because the body either doesn't make enough insulin [140] (Type 1) or the insulin [140] that is made is not effective (Type 2). Type 2 diabetes mellitus [141] is associated with anovulatory androgen excess [25]. Insulin resistance [27], being overweight or obese [26], having anovulatory androgen excess [25] and being inactive all predispose one to diabetes.

Diagnostic mammogram: a more detailed mammogram [115] done to rule out breast cancer [118]—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 [142] 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 [135] 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 [143] and spine fractures [46].

Dihydrotestosterone: an androgenic [30] hormone made from testosterone [52] 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 [144].

Dimenhydrinate: a kind of over-the-counter antihistamine [145] 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 [146], and for high blood pressure [42].

Dominant follicle: the large cyst [147] in the ovary [56] during each menstrual cycle [63]. An egg is released from the dominant follicle [148] with ovulation [77]—it supplies the majority of estrogen [57] and all of the progesterone [55] for that particular menstrual cycle [63].

Dong quai: a Chinese herb used to improve energy and help with menopausal [149] 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 [150].

D-pyr: see Deoxypyridinoline [151].

DXA: a kind of bone mineral density [120] 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 [32].

Dyspareunia: the medical term for painful sexual intercourse. Women usually call it vaginal dryness [152].

Early menopause: menopause [51] before age 40. It needs treatment with ovulatory [77] cycle-matching doses of transdermal estrogen [131] and cyclic progesterone [153] until approximately age 50 when the estrogen [57] 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 [134], eating restraint [154]) and extends to serious diseases such as anorexia [62] or bulimia [155].

Eating restraint see cognitive dietary restraint [134].

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 [42]. It is treated with a low salt diet or diuretics [156].

EEG: a test that measures brain waves.

Elemental calcium: means the weight of the calcium [92] is itself in mg, without the weight of the carbonate or citrate [157] that calcium [92] 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 [34].

Endogenous: means coming from within the body. It is the opposite of exogenous [158], for example in perimenopause [33] a woman can be on the Pill [159] and still have high endogenous estrogen [57]levels.

Epinephrine: see adrenaline [83].

“Endogenous Perimenopausal Ovarian Hyperstimulation”: a phrase used to describe the disturbance of normal feedback control resulting in higher estrogen [57] levels in perimenopause [33]. Lower levels of inhibin B [160] that are unable to control production of FSH [161] 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 [31] (endometrium [132]). It is used to treat heavy flow (menorrhagia [162]), especially in perimenopause. [33]

Endometrial biopsy: an office procedure in which the cervix [142] is made larger and a tool is used to cut out a small piece of the endometrium [132]. Is a test used to see whether endometrial cancer [163] is present.

Endometrial Cancer: cancer of the endometrium [132]. Endometrial cancer is caused by estrogen [57] without sufficient progesterone [55]. Being overweight, having anovulatory androgen excess [25] and diabetes mellitus [73] are risk factors. Estrogen [57] treatment without progesterone therapy [153] as well is a major cause. It is usually preceded by persistent endometrial proliferation [164] and endometrial hyperplasia [165] (both of which are reversible with progesterone [55] therapy).

Endometrial thickness: the thickness or depth of the endometrium [132] seen in pelvic [166] or vaginal ultrasound [167].

Endometriosis: An abnormal state in which bits of the endometrium [132] grow outside the uterus [31]. This tissue is normally stimulated by estrogen [57] and inhibited by progesterone [55]—this is similar to the endometrium [132]. Before and during menstruation [133], these bits of tissue bleed causing abdominal pain and increased dysmenorrhea [168] or menstrual cramps [32]. It is treated by suppression of estrogen [57], high levels of progesterone [55] or both.

Endometrium: a specialized tissue that lines the uterus [31] and undergoes changes during the menstrual cycle [63]. It builds up (proliferates) under the influence of estrogen [57] during the follicular phase [169] before ovulation [77]. Following ovulation [77], under the influence of progesterone [55] as well as estrogen [57], it becomes more mature (secretory [170]) and ready for egg implantation. Endometrial shedding occurs normally with a decrease in estrogen [57] and progesterone [55] levels but occurs with decreases in estrogen [57] levels in anovulatory cycles [70] and also despite continued high levels of estrogen [57]. Estrogen [57] stimulates and progesterone [55] inhibits the endometrium. OR the inner lining of the uterus [31] that is stimulated by estrogen [57] to become thicker, and is caused by progesterone [55] 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 [171] estrogen [57]. Estradiol is made in the ovaries [56], the placenta and by conversion in fat and muscle cells from androgen [30]s into estrogen [57]s. It causes growth or proliferation [164] of most cells in the body, especially in the breasts, uterus [31], and vagina [121].

Estradot®: a form of bio-identical [171] estradiol [172] that is transdermal [131] and delivered as a small patch that has a lower risk for blood clots [173] than oral estrogen [57].

Estragel®: a form of bio-identical [171] estradiol [172] as an alcohol-based gel for rubbing on the skin. This transdermal [131] form of estrogen [57] has decreased risks for blood clots [173] than oral estrogen [57].

Estriol: a weak form of estrogen [57] that is used in the vagina [121] for therapy of vaginal dryness [152] and is effective for severe dyspareunia [174] associated with urinary tract infections [175]. OR a weak form of estrogen [57] that is high during pregnancy. It is not effective for treatment of hot flushes [97] or osteoporosis [45] but is effective for 'vaginal dryness [152]' or vaginal atrophy [176].

Estrogen: an important group of hormones [34] essential for normal women's maturation [177] and the healthy functioning of reproductive and other tissues. During the reproductive years in women estrogens are primarily made in the ovaries [56]. Estrogen is also normally made in children, men and menopausal [149] women by conversion of androgens [30] in fat and muscle tissues. There are three kinds of estrogens. Estradiol is the ovarian hormone of the premenopausal [116] years, estrone [128] is the hormone of the menopausal [149] years and estriol [178], a weak estrogen is present in high levels during pregnancy. High levels are associated with nausea, breast tenderness, insulin resistance [27] and fluid retention. OR the name for a family of hormones [34] including estradiol [172], estrone [128] and estriol [178].

Estrogen deficiency: the wrong way of thinking about the normally low levels of estrogen [57] after menopause [51].

Estrogen receptor positive: refers to cells in breast cancer [118] that are stimulated by estrogen [57] to grow and undergo proliferation [164].

Estrone: the common form of estrogen [57] in menopausal women. It can be made from adrenal and ovarian androgens [30].

Etidronate: the first member of the bisphosphonate [44] family of bone therapies for preventing or treating osteoporosis [45]. It prevents spine fractures [46]. 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 bisphosphonate [44]s. It can be taken in the middle of the night. OR an early biphosphanate [44] taken for two weeks, every three months. Prevents spine fractures [46] in randomized placebo-controlled trials [150]. Does not cause heartburn or esophageal injury. See bisphosphonates [44].

Exogenous: means coming from outside the body. It is the opposite of endogenous [179].

External locus of control: see Health Locus of Control [124].

Fallopian tubes: flexible hollow tubes that allow an egg released from the ovary [56] to be delivered to the uterus [31].

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 [73] and its control.

Fasting glucose: see fasting blood sugar [180].

Fasting lipids:a test taken without eating for 12-16 hours. It measures fats in the blood [39] including total cholesterol [181], high density lipoprotein [182] and low density lipoprotein cholesterol [181], and triglycerides [183].

Ferritin level: a blood [39] test that reflects iron stores in the bone marrow [184] and therefore the risk for iron-deficiency or blood loss anemia [59].

Fibrinolysis: the breakdown of fibrin, the principal component of blood clots [173]. The fibrinolytic system is activated in parallel with the clotting system when a blood [39] vessel is damaged. Any factor that disturbs this natural balance can produce a blood clot [173].

Fibroids: are benign [185] tumors of fibrous and muscular tissue that grow in the muscle wall of the uterus [31]. They increase in midlife women, and decrease after menopause [51]. They are commonly without symptoms but often discovered because they are associated with heavy menstrual flow (menorrhagia [162]).

Fibromyalgia: is a condition in which pain at trigger points [186] is associated with sleep disturbances and decreased exercise. Helped by improved sleep, increased exercise and often by low does tricyclic anti-depressant [187]medications.

Folate: a vitamin [58] in the B-vitamin [58] 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 [56]. One follicle becomes the dominant follicle [188] each menstrual cycle [63] and releases the egg with ovulation [77].

Follicle Stimulating Hormone (FSH): an important pituitary [189] hormone [34], one of two called gonadotrophins [190], which stimulate the ovaries [56] during the premenopausal [116] years.

Follicular phase: the first part of the menstrual cycle [63] before ovulation [77].

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 [109]. 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 [45], even if his/her bone mineral density [120] is normal.

FSH: see follicle stimulating hormone [161].

Gabapentin: a medicine used for nerve-type pain or some kinds of seizure, that has recently been shown to help hot flushes [97] and night sweats [98].

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 [139] after a person is given a test dose of glucose (a form of sugar). It measures the effectiveness of the action of insulin [140]—it is rarely used except during pregnancy.

GnRH: see Gonadotropin Releasing Hormone [191]

Goiter: a swelling or enlargement of the thyroid gland [136].

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

Gonadotrophin: the general name for two hormones [34] that stimulate activity and hormone production in the gonads (the ovaries [56] or testicles). These are both secreted by the pituitary [189] gland and are called Follicle Stimulating Hormone (FSH) [161] and Luteinising Hormone (LH) [192].

Gonadotrophin releasing hormone (GnRH): the name for the pulsatile hypothalamic hormone [34] that regulates the production of LH [192] and FSH [161] and therefore controls the function of the ovaries [56]. OR also GnRH [193], is the hormone from the hypothalamus [80] that integrates signals from stress hormones [34], insulin [140], and other signals to wisely direct actions of the pituitary [189] and the ovary [56].

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 [166], uterus [31], and ovary [56] surgery and the treatment of some forms of infertility [72].

Gynecology: the specialty within surgery that focuses on the uterus [31] and ovaries [56] and treatment of pelvic [166] problems in women. OR the surgical specialty that is expert in pelvis [166], uterus [31], and ovary [56] surgery and the treatment of some forms of infertility [72].

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 [109] that examines structures within the brain including the pituitary gland [189].

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 [194].

Hemoglobin: the chemical compound that requires iron and becomes part of red blood [39] cells to carry oxygen in the blood stream [99].

Hemoglobin A1C: a test used to monitor those with diabetes mellitus [73]. It tells the percentage of time in the past three months that the blood sugar [139] level has been abnormally high. A normal Hemoglobin A1C is usually four to six percent. Also called HbA1C. [195]

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

Hepatitis tests: blood [39] 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 [90] 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 [30] levels or actions like acne [68] 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 [57] or estrogen [57] plus progesterone/progestin [55] therapy for menopausal [149] women. See OHT [196] or Ovarian Hormone Therapy [196] 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 [99] and act through receptors [197] 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 [135]. The intensity of hot flushes [97] varies from a mild warm feeling without sweating to "a tropical rain storm." Hot flushes originate in the hypothalamus [80] that is exposed to estrogen [57] withdrawal after first becoming habituated to high estrogen [57]. It involves a fundamental change in temperature regulation. Hot flushes may begin in perimenopause [33] (especially in women who have experienced high estrogen [57] signs such as increased premenstrual symptoms [198]). Hot flushes are maximal during the year following the final menstrual period. Men having anti-androgen [30] treatment for prostate cancer may also experience them. These are sometimes called hot flashes and along with night sweats [98] are part of a general uncomfortable experience called vasomotor symptoms [199].

Hyperplasia: an increase of cell growth and turnover that is a risk factor for cancer. See also endometrial hyperplasia [165].

Hyperthyroidism: the term used for an over-active thyroid [136] gland or caused by taking too much thyroid [136] hormone. The person feels too hot, loses weight despite eating well, develops muscle weakness, trembling hands and a fast heart rate. TSH [200] 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 [35].

Hypothyroidism: means when the thyroid [136] gland isn't making enough thyroid [136] hormone. Often there is a feeling of coldness, need to sleep more, and sometimes dry skin and hair. Usually the TSH level [201] is increased.

Hysterectomy: surgery to remove the uterus [31]. This is performed primarily for benign [185] conditions and in perimenopausal [33] women whose average age is 45-47. Although fibroids [202] are commonly present, the surgery is most often performed because of inadequately treated menorrhagia [162] or heavy menstrual flow. Hysterectomy is indicated for endometrial cancer [163] and invasive [203] cervical cancer. The ovaries [56] may or may not be removed (ovariectomy [204]), 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 [118] perhaps because of lower ovarian testosterone [52] production.

Hysterosalpingogram: a test in which a substance visible on an X-ray [109] is pushed into the uterus [31] and fallopian tubes [205] to determine whether eggs can travel to the uterus [31] or not. It is an expensive test that is often painful.

Ibuprofen: an over-the-counter kind of anti-prostaglandin [206] medicine that is very effective for menstrual cramps [32] and menorrhagia [162] to decrease heavy flow.

Immitrex®: a powerful medicine used to treat an acute migraine [82] attack.

Incontinence: involuntary passing of urine. There are many causes but changes in the tissues of the bladder and urethra [207] with aging and traumatic vaginal deliveries can be contributory factors. Exercise of the pelvic [166] muscles with the Kegel exercises [208] is helpful in preventing and treating incontinence. It may be transient in early perimenopause [33].

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

Inhibin: the name for several protein hormones [34] made by the ovaries [56]. Inhibins regulate within the ovary [56] and control the production of FSH [161]. Inhibin B decreases early in perimenopause [33] and is thought to be responsible for the endogenous perimenopausal ovarian hyperstimulation [209] that may occur. OR a family of hormones [34] made by the ovarian follicle [148] and part of the control system for FSH [161] levels and hence the menstrual cycle [63]. Inhibin B decreases in the follicular phase [169] early in perimenopause [33].

Insomnia: difficulty obtaining sufficient, restorative sleep. Insomnia is not a disease itself but a symptom of an underlying condition. Night sweats [98] are a common cause of sleep disturbances in menopausal [149] 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 [73].

Insulin resistance: occurs when abdominal fat and inactivity plus an inherited risk make insulin less effective. It is diagnosed by a waist circumference [28] 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 [39] vessels or to nearby tissues.

Internal Health Locus of Control: see Health Locus of Control [124].

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 [210] (in the body).

In vitro fertilization (IVF): a treatment for infertility [72] when the fallopian tubes [205] are blocked but the ovaries [56] are functioning. A woman’s ovaries [56] 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 [31].

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 [31]. It may or may not have a medicine in it (such as the progestin [87]-releasing IUD, Mirena®). It is inserted through the cervix [142] and has a string for its eventual removal. An IUD slightly increases menstrual flow (except for the progestin [87]-releasing one) plus it may cause increased cramps [75].

Kegel exercises: involve tightening and holding the muscles used during urination to strengthen them and treat incontinence [211]. May also enhance sexual pleasure.

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 [212] is increased after ovulation [77].

LH: see luteinizing hormone [192].

LH peak: the high level of luteinizing hormone [192] that occurs in response to the estrogen peak [213] in the middle of the menstrual cycle [63] and which triggers ovulation [77].

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 [30] 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 [99]. Lipoprotein A is a cholesterol [181]-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 [57]-containing ovarian hormone therapy (OHT) [196].

Low-trauma fracture: also called a "fragility fracture [214]". 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 [46] is one way of defining osteoporosis [45].

Lubricants: over-the-counter preparations to help vaginal dryness [152].

Luteal phase: the portion of the normal menstrual cycle from ovulation [77] until the day before the next flow. A normal luteal phase is 10 days or longer (assessed by quantitative basal temperature [215] methods) or 12 days or longer from the LH peak [216] at midcycle. The length of the luteal phase is roughly proportional to the amount of progesterone [55] in the cycle.

Luteal phase length: the portion of the normal menstrual cycle [63] from ovulation [77] until the day before the next flow. A normal luteal phase is 10 days or longer (assessed by quantitative basal temperature [215] methods) or 12 days or longer from the LH peak [216] at midcycle. The length of the luteal phase is roughly proportional to the amount of progesterone [55] in the cycle.

Luteinizing hormone: a pituitary [189] hormone [34] controlled by gonadotrophin [190] releasing hormone, (GnRH [191]) from the hypothalamus [80]. It stimulates the ovary [56]'s outer cells to make androgens [30] that are then converted into estrone [128] or estrogen [57].

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 [217].

Mammography or mammogram: an X-ray [109] 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 [57] (and possibly progestin [87]) 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 [218] 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 [57] levels equal to or higher than the mid-cycle estrogen [57] peak during the menstrual cycle [63].

Maternity vitamin: a multivitamin [58] that includes enough folate [219] for the mother and the fetus's good health.

Matrix: the protein produced by osteoblasts [105] that become full of calcium [92] 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 [220]". 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 [51] in which the ovary [56] stops producing estrogen [57] and progesterone [55] because of therapy with GnRH [191] or other hormones [34]. This is used sometimes for severe endometriosis [221] or migraine headache [82]s.

Medroxyprogesterone: a manufactured kind of progestin [87] that resembles natural progesterone [222].

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 [51] (one year since the final menstrual flow). This term is preferred over 'postmenopausal [223]' which is a duplication of ideas.

Menorrhagia: very heavy menstrual bleeding often with clots and flooding. It is usually caused by high estrogen [57] levels and associated with endometrial hyperplasia [165] from too little progesterone [55]. It commonly occurs in perimenopause [33] and may also happen in the teen years.

Menstrual cramps: these are a discomfort or pain caused by the uterus [31] muscle contracting. They often occur just before and during the first days of menstruation [133]. The muscle contractions are caused by high levels of prostaglandins [74] that relates to both hormone [34] levels and to the tightness of the cervix [142]. OR the discomfort caused by contraction of the uterus [31] before and during menstrual flow because of prostaglandins [74]. It is also called dysmenorrhea [168]. It is treated by anti-prostaglandin agents [206] such as ibuprofen [76].

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 [33].

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 [224]). Low levels of both estrogen [57] and progesterone [55] are normal after menopause.

Menstruation: vaginal bleeding resulting from the process of periodic shedding of the endometrium [132]. 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 [39] vessels and lymph system and growing in bones, liver, brain and other parts of the body.

Metoprolol: a medicine used for high blood pressure [42]it is from the 'beta-blocker [225] family' of medicines that work against catecholamines [37]. It slows the heart rate, decreases the force of the heart's contraction and decreases blood pressure [135].

Micronize: means to make into very small or microscopic bits. For oral micronized progesterone [226], each tiny amount of hormone [34] is surrounded by fat. This process allows progesterone [55] to be taken by mouth.

Midcycle estrogen peak: the highest level of estrogen [57] that occurs in the middle of the menstrual cycle [63]. This triggers the luteinizing hormone peak [216] that leads to ovulation [77].

Migraine headache: a severe kind of headache involving blood [39] vessels in the brain. It is usually associated with nausea and is often preceded by an aura [227] 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 [57]-containing medicines such as the Pill [159], and not starting and stopping hormones [34] suddenly.

Milk of magnesia: an over-the-counter medicine containing magnesium [228] that helps with constipation and causes diarrhea.

MinEstrin®: a lower dose form of oral contraceptive [229]agent containing 20 micrograms of ethinyl estradiol and an androgenic progestin [230] in the same amount for three weeks with one week off. In a 6-cycle randomized controlled trial [150] of perimenopausal [33] women with heavy flow, it was shown to decrease flow slightly, but it did not significantly improve hot flushes [97] or quality of life.

Mirena®: the brand name of a powerful androgenic progestin [230]-releasing IUD [231] used to treat menorrhagia [162] in perimenopause [33].

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 [77]. 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 [198] because it is less intense and indicates ovulation [77].

Multinodular: a term commonly used for the breast and thyroid glands [136] that contain many cysts [147].

Naproxen: the brand name of a kind of anti-prostaglandin [206] prescription medicine.

Natural progesterone: means bio-identical [171] progesterone [55]. 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 [185]. Often used for diagnosis in breast and thyroid [136] lumps.

Neural tube defect: means a birth or congenital problem often related to inadequate folate [219] 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 [232] 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 [97] occurring during the time of sleep. Night sweats may begin in regularly menstruating women in early perimenopause [33]. In these women they are most intense before flow. They may persist and cause insomnia [233] in women in late perimenopause [33] and early menopause [234].

Noradrenalin: a name for a hormone made in sympathetic nerves and the adrenal gland [38] that makes the heart beat faster and harder, and blood [39] vessels constrict in the hands and feel. Also called norepinephrine [122].

Norepinephrine: see Noradrenalin [84].

Normal luteal phase range: describes the pattern of expected progesterone [55] levels after ovulation [77] in the normal menstrual cycle [63]. This provides the guide for the amount of progesterone [55] used for treatment of heavy flow, hot flushes [97] and breast tenderness.

Non-steroidal anti-inflammatory drugs (NSAIDs): these are medications that block prostaglandin [74] production and therefore treat menstrual cramps [32].

NSAID: see Non-steroidal Anti-inflammatory drug [235].

Nucleus: the special centre part of all cells containing genetic material and receptors [197] that allow hormones [34] to direct the cell.

Nulliparous: never having been pregnant and delivered a baby.

Obesity: being heavier than normal for height—a BMI [103] more than 30.

OHT: see Ovarian Hormone Therapy [196].

Oil of evening primrose: a kind of oil that is used for premenstrual sypmtoms [198] and other of women's symptoms. It has not been shown to be effective.

Oligomenorrhea: means menstrual cycles [63] farther apart than 36 days but shorter than 180 days. This may normally occur during early adolescence and in perimenopause [33]. It is commonly a protective form of hypothalamic suppression [236] in association with weight loss, inappropriately intense exercise training, emotional stress or under-nutrition. It appears to precede the development of anovulatory androgen excess [25]. When oligomenorrhea is related to hypo-thalamic suppression, estrogen [57] levels are low; but when related to anovulatory androgen excess [25], estrogen levels are high or normal.

Oncologist: an internal medicine [232]<