“I am experiencing many signs of perimenopause. I can’t sleep, I’m tired all the time, I’m anxious about everything and OMG, the flooding periods. I went to my doctor and asked to have my hormones tested. He refused and told me that it wouldn’t be useful because I was too young (42) and hormone levels change constantly. He did an FSH and it was in “normal” range. I was offered birth control pills and an antidepressant, but I don’t want that! I know there’s something hormonal going on and I want to get to the bottom of it. Help!”
The scenario above is so common in my practice! Hormone testing is controversial in the medical community. Traditional practitioners suggest that testing is not useful because “hormone levels change all the time.” This is true, but any lab test is a snapshot in time. In my practice, I find testing useful to look at the magnitude of the imbalances that may be present and the metabolic pathways the woman’s body prefers. The test I most often use is the DUTCH test.
DUTCH is an easy at-home test to do that helps me create a plan of action for my clients. You collect 4 or 5 urine samples over the course of a day, let it dry on filter paper, then pack it up and send it to the lab. Easy peasy!
Here are 7 reasons why it is my go-to tool for uncovering hormone imbalances:
- The DUTCH test can tell you if you are estrogen dominant. Estrogen dominance is one of the most problematic hormone imbalances that modern women face today. This occurs when you don’t have enough progesterone to balance out your estrogen and is VERY common in perimenopause. Symptoms of estrogen dominance include PMS, migraines, heavy periods, moodiness, weight gain, and breast tenderness (among others).
- It gives you a comprehensive look at cortisol production by your adrenal glands. Saliva adrenal testing only measures the free fraction of cortisol, which is around 1% of your production. The DUTCH measures free and total (metabolized) cortisol for a better look at overall production. Metabolized cortisol comprises 80% of your total production and is a better marker of overall adrenal health. A saliva panel doesn’t offer this deep dive and many a woman has been told she has “adrenal fatigue” when her overall production of cortisol is fine.
- The DUTCH test can point to possible thyroid or insulin resistance problems. The DUTCH test doesn’t measure thyroid hormones or insulin specifically (that requires blood), but the relationship of free to metabolized cortisol may suggest that a workup for thyroid or blood sugar problems is in order. Low metabolized cortisol along with high free levels suggests poor cortisol clearance and the thyroid governs this process. High metabolized cortisol compared to free cortisol can indicate insulin resistance.
- The DUTCH test gives you a total picture of DHEA production. DHEA is made in the adrenal glands and promotes an overall feeling of well-being. It also is the precursor to estrogen and testosterone. The DUTCH test measures DHEA and DHEA-S. DHEA-S is a sulfated form of DHEA. If DHEA-S is lower than DHEA, this may indicate inflammation in the body.
- Insight into the breakdown of estrogen. This is one of the biggest advantages of the DUTCH test. Elimination of estrogen in the body is very important. Your body uses 3 pathways to do this.
- In Phase 1, the estrogen is broken down into 2, 4, and 16-hydroxy estrone (2-OH, 4-OH, 16-OH). Most of your estrogen should break down into the 2-OH metabolite because this is the more protective pathway. The 4-OH pathway is associated with DNA damage and increased cancer risk. The good news is that the 4-OH metabolite can be pushed to the 2-OH pathway by the use of certain supplements like DIM and rosemary.
- In Phase 2, estrogen is methylated, sulfated, or glucuronidated for further breakdown. Issues in this pathway can result in the recirculation of spent estrogen, leading to more problems with estrogen dominance.
- In Phase 3, estrogen is eliminated from the GI tract.
- The DUTCH test tells you how well you are methylating your estrogen via the COMT enzyme. Methylation of estrogen is part of the second phase of the estrogen detoxification process and is a protective step that neutralizes the hormone. COMT activity is in part genetically mediated
- The DUTCH test tells you what type of testosterone metabolites your body favors. Testosterone can break down into 5a-DHT or 5b-DHT. 5a-DHT is a more potent metabolite of testosterone and is responsible for things like acne, oily skin, thinning head hair, excess body hair, and feelings of irritability or aggression. Knowing which pathway your body prefers helps in the event DHEA or testosterone supplementation is used (and in some cases, progesterone). If you have a 5-alpha preference, there are ways to block the pathway so you’re less likely to experience adverse effects.
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at www.perimenopausebook.com.
Dr. Anna is available for 1-1 consultations. Find out more at www.drannagarrett.com/lets-