Hormonal Assessment For Women
Everything You Need To Know About The DUTCH Hormone Test
Understanding the Dutch Test: A Comprehensive Hormonal Health Assessment
What Is The DUTCH Test?
The DUTCH test is a comprehensive hormone test that measures urine for hormonal metabolites. This level of testing can give us a more detailed and nuanced look at a woman’s hormonal load and balance, and also how she is processing/eliminating her hormones. Although it can be a more expensive test ($350-450), doing it just once in a woman’s life can help us better understand areas where she may need added support. Our naturopathic doctors have a focus in women’s health and the data provided by the Dutch hormone test is very valuable in guiding a proper treatment plan.
What Is The DUTCH Test?
DUTCH stands for Dried Urine Test for Comprehensive Hormones. It measures all relevant female sex hormones:
- Estrone
- Estradiol
- Estriol
- Estrogen metabolites (2-OH-E1, 4-OH-E1, 16-OH-E1, 2-methoxy-E1, 2-OH-E2, 4-OH-E2)
- Progesterone (via progesterone metabolites – a- & b-pregnanediol)
- Testosterone and other androgens (androsterone, etiocolanolone, 5a-DHT, 5a-androstanediol, 5b-androstanediol)
- DHEAS
There is also the option to add on the adrenal profile which includes:
- Diurnal cortisol and cortisone curve
- Melatonin
The urine sample is collected at home 1 week prior to a woman’s menstrual period (if she is having regular periods, otherwise see below). At-home urine testing collection is convenient and ideal when the day of testing is crucial (and may fall on a day when the lab is not open).
Why Is Hormone Testing Important for Women's Health?
Hormonal imbalances can affect various aspects of a woman’s health, including mood, energy levels, menstrual cycles, and much more. Although a lot of information about hormonal activity can be acquired by doing a thorough symptom review, getting a good look under the hood with hormone testing not only allows us to rule out any non-hormonal causes of symptoms but also helps us determine WHY the hormones are in the balance that they are.
Even at hormonally fluctuant times like perimenopause, hormone testing can be valuable to determine where on the hormonal spectrum a woman rests. For instance, even though there is a daily, even hourly, hormonal fluctuation in perimenopause, a woman with an under functioning CYP1A1 liver enzyme will tend to build up more estradiol and her daily/hourly fluctuations will be higher than a woman who can more easily clear the total estrogen levels.
Who Should Consider the Dutch Test?
We believe that any person should have access to medical information about their health if they are interested. If there are no symptoms and the woman is healthy, it is absolutely fine to avoid hormone testing. If, however, there are symptoms that may indicate a hormonal concern, or if the woman is at a phase in their life where hormonal insights would better prep her for an upcoming event (pregnancy or perimenopause for instance), then testing is warranted even in asymptomatic patients.
Symptoms for hormonal concerns:
- Irregular menstrual cycles
- Heavy and/or painful period
- Low libido
- Fatigue
- Mood swings
- Weight gain or difficulty losing weight
- Infertility
- Insomnia
- Hair loss
- Acne
- Thyroid disorders
- Cyclical headaches
- Any symptom that cycles monthly
The Dutch Test Compared to Blood Testing
Blood testing, urine testing, or saliva testing for hormones at the right point in the cycle are all valuable. It all comes down to a cost-benefit analysis to determine which test is most appropriate for the patient at the given time.
Benefits of Blood Testing for Female Hormones
The biggest benefit of blood testing for estradiol and progesterone is that it is cost-effective and that it is what is most commonly tested; therefore, other providers on the patient’s care team will also be comfortable reviewing the results. We will all be speaking the same language. The blood test tells us generally WHAT is going on in the blood, but not WHY it’s happening.
Benefits of the Dutch Test for Female Hormones
Progesterone, whether tested in the blood or urine, is basically the same. The estrogens, on the other hand, are much more illuminating when tested via urine metabolites. Not only do we see the 3 types of estrogen (estrone, estradiol, and estriol), we also see their metabolites, which helps us better understand how these estrogens are being eliminated from the system.
Estrogens require a two-phase elimination via the liver. Step 1, estrone, estradiol, and estriol are converted by 3 liver enzymes (CYP1A1, CYP1B1, and CYP3A4) to intermediate estrogen metabolites (2-OH-E1, 4-OH-E1, and 16-OH-E1), and then another enzyme COMT methylates these intermediates and they are then eliminated from the body. The Dutch test allows us to see which steps along this pathway are functioning well or identify the ones that are not. That way we can do a more targeted (and usually simpler) treatment plan to balance the woman’s hormone levels.
The Dutch Test also measures androgens which can either be an inflow excess point for estrogens, or can directly cause hormonal symptoms on their own.
How to Prepare for the Dutch Test
Timing of hormonal testing is very important. We must aim to test at the peak of progesterone levels, which is usually midway through the luteal phase. For a woman with a regular 28-day cycle, this testing day would be on day 21, 1 week prior to her period. If a woman has a regular cycle but is consistently longer or shorter than 28 days, then the testing day can be adjusted accordingly (meaning a 35-day cycle is 7 days longer than 28, so we must also add 7 days to 21 and test on day 28).
Progesterone is only secreted by the ovary once ovulation has occurred. In a 28-day cycle, it is likely that ovulation was on day 14 approximately. Giving 1 week for the progesterone levels to rise, we test on day 21. If the cycle is shortened, and ovulation occurred on day 10, then we would want to move up the testing day by 4 as well, and test on day 17.
If a woman has a more irregular cycle, it may be worth using Ovulation Predictor Urine Strips to confirm ovulation and therefore be more precise with the day of the Dutch test.
How To Use Ovulation Predictor Test Strips To Prep For Hormone Testing
If you have a 28-day cycle or longer, start using OPK strips (found at your local pharmacy) on day 10 of your cycle. Once you get a positive test, make in your calendar to take your Dutch Test 1 week later. If your cycle is usually shorter than 28 days, you may want to start using the OPK strips on day 5 of your cycle to make sure you don’t miss the LH spike.
How To Prepare For The Dutch Test – The Day Before And Day Of Testing
48 hours prior to testing:
- Avoid avocado, banana, and fava beans (as these may alter the OATs results)
- Discontinue quercetin if you are taking it.
The day of the test:
- Limit total fluid intake to 40 oz (1.2L)
- No fluids for 2 hours before samples #1 and #2
- No more than 1 cup of fluids between samples #3 and #4
- No caffeine
- No alcohol
When To Take The Dutch Test Samples:
- Sample #1: DINNERTIME (~5pm)
- Sample #2: BEDTIME (~10pm)
- Bonus sample: OVERNIGHT – collect only if you wake to pee during the night.
- Sample #3: WAKE/RISING (within 10 minutes of waking up)
- Sample #4: 2-HRS AFTER WAKING
Once the samples have been collected (which is simply peeing on the test paper), let the samples dry in open air for 24 hours, and package them up as instructed for shipping. All shipping materials are included in the test kit, and your requisition has been uploaded to your Sequence Wellness Jane patient portal. Please print that off and include it with the test before sending it off.
The Dutch Test results are usually within 2 weeks, and we automatically upload them to your Sequence Wellness Jane patient portal so that you can download a copy for your records. We also then prompt you to book a follow-up with your naturopathic doctor in order to thoroughly review the results.
Hormone Assessment Professionals
Understanding your hormonal health through tools like the Dutch Test can empower you to take control of your well-being. Whether you’re experiencing symptoms or simply want to optimize your health, hormone testing can provide valuable insights. If you’re interested in learning more about the Dutch Test and how it can benefit you, don’t hesitate to reach out to us. Take the first step towards a healthier, balanced life today!
