Informational insert
	Sugarless gum to stimulate saliva flow
	Collection tube and an identification label to adhere to tube
	Test requisition form
	Prepaid mailer

Note: Please read all of this section before beginning saliva collection. 

Saliva collection is simple and can be performed in your home at your convenience. Hormones in saliva are stable at room temperature for several weeks so there are no special needs in shipping to Aeron. Just send your saliva specimen by regular U.S. mail to Aeron in the prepaid mailer provided. Patients outside the U.S. will need to provide postage.

1. When to Collect Your Saliva
The appropriate collection time (hour/day/month) will depend on the instructions you received from your healthcare provider. Be sure you have a clear notion of what your provider has requested.

In general, the following guidelines are recommended:

Naturally Occurring Hormone Levels
Baseline Female and Male Hormone Levels: Except for melatonin, the best time to collect saliva is in the early morning, preferably right after rising. Melatonin is best tested at 3 AM (interrupting your sleep cycle) when the hormone peaks.

Cycling Female Hormone Levels 
For premenopausal or perimenopausal women to assess ovulation and peak levels of estradiol and progesterone, the most favorable time for saliva collection is during the middle of the luteal phase (the last two weeks of your cycle). Counting from the first day of your menstrual flow, collect your saliva between days 20 and 23. If your cycles are sporadic (you have skipped several in a row), saliva collection may be done anytime as ovulation is highly unlikely. 

Hormone Replacement/Supplementation

Oral or topical: In order to assess the adequacy of hormone intervention (having been on the product for at least a week), the best time for saliva collection is in the early morning, prior to the next hormone product usage.

Sublingual: If hormones are taken by sublingual delivery (under the tongue), be sure to rinse your mouth thoroughly and wait at least 12 hours after sublingual use prior to collecting specimen. This delivery method increases the chance of saliva contamination.

Patches: For continuous pharmaceutical patches i.e. an estradiol patch, collect saliva 24-48 hours after patch application.

Multiple Collections for Monitoring Circadian (24 Hour) Rhythm of Cortisol and Melatonin 

Definition: Multiple collections of a particular hormone means that one saliva sample is collected at each of four different times throughout the day resulting in four separate saliva-containing tubes each representing a different collection time. Multiple hormone collection test results will display four different hormone levels - each representing a particular time of day.

Adrenal Function (4 X Cortisol): Collect a separate saliva sample at approximately the following four time periods: Immediately after you awake (6-8 AM), 12 PM (noon), 4 PM and 10 PM (or bedtime). Be sure the four collections are carried out in the specified order on the same day.

Note: A single cortisol collection should be taken after you awake (6-8 AM).

Melatonin Circadian Panel (4 X Melatonin): Collect your saliva at approximately the following four time periods: 9-11 PM, 3-4 AM (this is the important collection time for the expected melatonin peak),6-8 AM and 12 PM (noon). Be sure you are interrupting your sleep cycle for the 3 AM collection and that the collections are carried out in the specified order.

Note: A single melatonin collection should be taken at 3 AM.

2. How to Collect Your Saliva

Instructions:

	For all hormones except melatonin, saliva is collected generally in the early morning (AM) before brushing/flossing your teeth, eating, drinking or applying makeup. For multiple sample collections, refrain from brushing or flossing your teeth or eating within one hour of saliva collection.
	Rinse your mouth at least twice with cool water. Then chew the sugarless gum provided for 1-2 minutes, swallowing saliva as usual. You may continue to chew the gum during saliva collection but please do not spit it into the collection tube. If, for some reason, you are not able to chew the gum, saliva collection is still possible but may take longer.
	Begin the collection. Remove the cap of the saliva collection tube and spit directly into the tube. Avoid touching the mouth of the tube with your hands.

Important: Hormones left on hands from creams can potentially contaminate the saliva during collection. Therefore, if using a cream, wash your hands thoroughly with soap and water before beginning.

	Fill the tube at least 3/4 full and cap, making sure the cap is on evenly and securely. It may take you a few minutes to generate sufficient saliva.
	Neatly print your name, date and time of collection on the peel off label(s) and affix to the saliva tube(s).
	Completely fill out the requisition form either given to you by your healthcare provider or enclosed with your collection kit. Multiple saliva collections require just one requisition form. It is especially important to include the time and date of saliva collection and to list any hormonal products you are using. List each product separately and include preparation name, amount taken and time of ingestion or application.

For example:

Estradiol (Estrace®) 1 mg                    Oral              7 AM     9/9/99
Progesterone           15 mg/g (1/4 tsp) Cream       10 PM     9/9/99

3. How to Mail Your Saliva Specimen

Fold the white copy of the requisition form around the specimen tube and place both in the prepaid mailer. Cap both ends of the mailer and strike smartly on a firm surface to secure contents. It is a good idea to tape each end.

Send by U.S. mail. Patients outside the U.S. need to provide postage. Please remember to include the requisition form.

If you have any questions regarding collection or mailing of your saliva sample, please feel free to call Aeron LifeCycles Customer Services Toll Free (877) 442-3766.

Urine Collection Instructions

Collection Supplies Provided:

	Informational insert
	Paper collection cup and identification label
	30-ml transport bottle
	Requisition form
	Prepaid mailer

NOTE: Please read this section before beginning urine collection.

Deoxypyridinoline (Pyrilinks-D) is a specific marker, excreted in the urine, of bone resorption (breakdown). Increased levels of urinary Pyrilinks-D indicate accelerated loss of bone mineral density.

1. When to Collect Your Urine

Urine should be collected in the morning from the first or second voided specimen.

2. How to Collect Your Urine

Instructions: 

	Collect urine in the paper cup provided. Only a small volume is required (one to two ounces is plenty).
	Transfer the specimen to the transport container, filling the container about half full. Cap tightly. Discard remaining urine and collection cup.
	Neatly print your name, date and time of urine collection on the identification label and affix to the transport container.
	Completely fill out the requisition form, including the hormone supplement section.

3. How to Mail Your Urine Specimen

Place the transport container in the prepaid mailer. Fold the white copy of the requisition form in three and roll it to fit in the top of the mailer.

Cap both ends of the mailer and strike firmly on a hard surface to secure contents. For added security, it is advisable to tape both ends of the mailer.

Send by U.S. mail. Patients outside the U.S. need to provide postage.

If you have any questions regarding urine collection, please feel free to call Aeron LifeCycles Customer Services Toll Free (877) 442-3766.