If you’re experiencing symptoms and challenges related to hormone changes of perimenopause or hormonal imbalances generally, a more comprehensive approach to hormone testing could help you find a clearer way forward.
Many doctors will say that testing hormone levels during perimenopause (your 40s) isn’t worth it because estrogen levels are fluctuating erratically across the month and therefore testing can be unreliable and or a waste of time.
This may well be the case when it comes to a hormone blood test, which is essentially just showing a snapshot of one hormone in the blood at any one time.
For example, if you tested low for oestrogen one day, this might be because your oestrogen was low at that exact point of the oestrogen rollercoaster. And vice versa if you tested high.
So, you couldn’t know from that test whether or not your overall oestrogen levels are low, high, or just right.
Irregular periods are a common symptom during perimenopause, indicating a shift from predictable menstrual cycles to more unpredictable ones.
A Regular Blood Test
Your doctor may run a blood test for you for FSH (Follicle Stimulating Hormone) and LH (Luteinising Hormone). And if these are elevated it can indicate lower levels of estrogen and progesterone which would suggest that you’re in perimenopause. But you’ll already know that because if you’re in your 40s you ARE in perimenopause!
However, there are other ways to test your hormones in perimenopause, which conventional doctors don’t have access to.
A Urine Test
A comprehensive urine test can show you not only how your oestrogen levels are looking, but also how your body is metabolising it (breaking it down).
THIS is the difference between blood and urine hormone testing and why urine testing can actually be so helpful. Knowing how your body (liver) is breaking down your used oestrogen is really helpful.
This insightful information to then be able to form a clear plan of how best to naturally support your body and hormones.
Testing can also help manage menopausal symptoms by providing detailed insights into hormonal imbalances and guiding appropriate treatments.
Enter The DUTCH Test
The specific test I use in my practice with clients is called the dried urine test for comprehensive hormones (DUTCH) by a laboratory called Precision Analytical.
The DUTCH Complete is a great test but I tend to use the Dutch Complete PLUS Cortisol Awakening Response (CAR) as this provides a little more information about the stress response (adrenal health) and circadian rhythm regulation. Both of which significantly impact hormone health and perimenopause.
The DUTCH Plus is a home/self administered urine and saliva test and once samples are sent to the lab, results usually take around 2-3 weeks, but it’s well worth the wait.
I absolutely love this test for the invaluable information it provides and the positive outcomes that can be achieved once a person implements the recommendations based on their results.
You would ideally collect your samples between day 19 and day 22 of an average 28 day cycle (earlier or later if your cycle length is shorter or longer than 28 days), however if your cycles are irregular you can test anytime.
Why is this perimenopause hormone test so helpful?
Not only does it look at sex hormone production, it also looks at the metabolism (breakdown) and clearance of these hormones in the body.
The DUTCH test provides a snapshot of oestradiol, progesterone and testosterone but also the metabolites (breakdown process) of those hormones over the course of a whole day, not just a snapshot.
This gives us a much better picture of how hormones are actually behaving as well as how they are being broken down and detoxified (by your liver), which is really helpful, and even crucial, information to know.
Also, hormone therapy can be informed by these results, especially in managing symptoms like hot flashes and vaginal dryness during perimenopause.
Snapshot of total oestradiol, progesterone and testosterone results from DUTCH test
A Powerful Set of Test Results
The diagram below is a screen shot from a sample set of test results showing how the person is breaking down and detoxing their used oestrogens.
The breakdown (metabolism) and safe inactivation of your oestrogen occurs inside phase 1 of liver detoxification (see the red arrow on the diagram).
Here, your used oestrogen goes through a chemical process that converts it into 3 oestrogen metabolites; 2-Hydroxy-Oestrogen (2OH), 4-Hydroxy-Oestrogen (4OH), and 16-Hydroxy-Oestrogen (16OH), which can be seen in the diagram.
You can think of 2OH as the well behaved, safe and preferred metabolite as 4OH as the unruly, not so safe or preferred metabolite and 16OH as somewhere in-between.
When too much oestrogen is being processed down the 4-OH pathway it can be harmful for health and increase the risk of oestrogen-driven cancers.
If too much is processed down the 16-OH pathway it can increase symptoms such as breast pain, heavy periods and fibroids.
This is what makes this test so special and such a great tool to guide and inform a client’s next steps and main focus.
I go into more detail about this in this blog post, where I explain how you break down and detoxify used oestrogen in the liver and the various foods, nutrients and botanicals that can support the different detox pathways and phases shown here.
Sex hormone metabolism results report page from the DUTCH test
Adrenal Health: A Crucial Factor in Sex Hormone Levels
The DUTCH (PLUS with CAR) test looks at your adrenal health, including your cortisol awakening response (CAR), which can provide information about your body’s (nervous system) ability to handle stress and how healthy your circadian rhythm.
These two factors play a HUGE role in the health of your sex hormones plus other things such as blood sugar regulation, energy regulation, mood and overall health and sense of wellbeing.
Adrenal stress testing can also help in understanding and managing hot flashes, a common symptom during perimenopause.
Adrenal Test Results from DUTCH test
Brain chemicals and key organic acids: Another Crucial Factor
The screenshot below shows a lovely bonus aspect of the results report which is information on levels of brain neurotransmitters such as dopamine (the focus and motivation hormone) and melatonin (the sleep hormone) as well as the person’s need for two key B vitamins; B12 and B6 and antioxidant support.
Vaginal dryness, another symptom of perimenopause, can also be managed with insights from the DUTCH test.
Organic acids results from DUTCH test report
In summary: understanding perimenopausal symptoms
The DUTCH test can be a useful tool, not just for assessing hormone levels but also for taking a deeper dive into HOW someone is processing their used oestrogen. Which is such a key factor in any and all hormone-related problems, conditions and symptoms, including risk for oestrogen-driven cancers. Understanding hormone metabolism is crucial in reducing the risk of breast cancer.
The information from the report, on oestrogen detoxification, adrenal health and circadian rhythm and the organic acids can help inform the best way forward and a completely personalised support plan.
The current cost of the test, at the time of me writing this blog, is £270 and must be ordered through a qualified and registered Nutritional Therapist (e.g. me) or Functional Medicine Practitioner so that the results can be interpreted properly for you with professional support and comprehensive plan of action.
IF you would like to explore using this test and would like me to be your practitioner, you can email me on francesca@francescaliparoti.com and we can go from there or you can explore ways to work with me here.
