If you’re experiencing symptoms and challenges related to hormone changes of perimenopause or hormonal imbalances generally, a more comprehensive approach to hormone testing might just be the thing to help you find a clear way forward.
Many doctors will say that testing hormone levels during perimenopause (your 40s) isn’t worth it because oestrogen is 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 blood testing, which is essentially only showing a snapshot of one hormone in the blood at any one time. For example, if you tested low for oestrogen, this might be because your oestrogen was low at that exact point in the oestrogen rollercoaster and vice versa if you tested high. Therefore, you couldn’t know from that test whether or not your overall oestrogen levels are low or high or just right.
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 oestrogen 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 comprehensive urine test can show you not only how your levels are looking but how your body is metabolising them (breaking them down). This is important and extremely insightful information to then be able to form a clear plan of how best to naturally support your body and hormones.
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 test so helpful?
Sex hormone production, breakdown and clearance
The 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.
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.
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.
Brain chemicals and key organic acids
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.
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. 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 cost of the test 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 email@example.com and we can go from there or you can explore ways to work with me here. The Perimenopause Roadmap and bigger coaching packages all include the cost of test results interpretation (cost of test itself is additional).