Many women come into my naturopathic clinic wondering whether their symptoms are related to hormonal imbalances.
Our hormonal systems are very complex and there are many factors that come in to play, which need to be explored before we can make recommendations, or come to conclusions.
For example we need to look at the menstrual cycle in detail: from when menstruation first started, the length of the cycle, the flow, the impact of any hormonal contraception, related moods, pregnancies and more. With many clients I will start with a detailed questionnaire to assess whether there are hormonal issues. There are many Apps available which are also a helpful way to begin to record your cycle, and to develop awareness of what is going on in your body.
Some women have already had the basic blood hormone testing done from the doctor, however there are more complex testing options available. Two of them are the DUTCH test and the saliva test.
Why have the DUTCH hormone test?
The DUTCH test stands for: Dried Urine Test for Comprehensive Hormones.
This very thorough test covers your reproductive and adrenal hormones as well as melatonin, some neurotransmitters and other hormones.
Why would I use a urine test? Rather than saliva or blood?
Simple answer is that the DUTCH test is far more comprehensive in what it collects that you can possibly collect in blood or saliva.
What will it test? And why is that beneficial over saliva or blood?
When testing for adrenal issues using saliva you are able to get what’s called a “diurnal” pattern of cortisol (blood will not give this measurement). Diurnal meaning an every day pattern. So we can see the production of cortisol upon waking, in the middle of the day, in the evening and before bed. This is great – it’s what’s needed when analyzing HPA axis dysfunction.
However, where saliva falls short when it comes to assessing the health of our adrenals is that it doesn’t give us the metabolites of cortisol.
The DUTCH test allows us to measure this same diurnal pattern of free cortisol but it also allows us to measure cortisol metabolites, and this gives us a much more accurate picture of how much cortisol your adrenal glands are actually producing.
Metabolized cortisol (only measured in the DUTCH test, not in saliva or blood) accounts for about 80% of total cortisol output from your adrenal glands. The free cortisol – the only cortisol saliva and blood test for – only accounts for about 1 – 3% of total cortisol production
So to recap:
Blood only gives you the free cortisol but no metabolites or diurnal pattern
Saliva gives you the free cortisol and diurnal pattern but no metabolites
The DUTCH test gives you everything: free cortisol, diurnal pattern and metabolites
About 40% of people who have low free cortisol (the only kind tested in saliva and blood) actually present with elevated levels of cortisol metabolites (as tested only in the DUTCH test). This means they are potentially being put on protocols for low cortisol when they really have high cortisol production. For example, people who are obese typically make less free cortisol and more cortisol metabolites. So if they do a saliva test they’re going to likely be under the impression they are not making enough cortisol and their practitioner may put them on a protocol aimed to increase cortisol when really it’s high and the opposite protocol might be required
Sex Hormones: androgens, oestrogens and progesterone
The DUTCH test shows the metabolites of sex hormones as well, which again we are unable to do with a saliva or blood test. This is important for understanding how we’re clearing oestrogens from the body (to avoid such states as oestrogen dominance) and in terms of the various types of oestrogen we are making. The types of oestrogen you are making will tell us how at risk you are for certain oestrogen-dependant cancers such as breast, ovarian and uterine. We can also see the methylation pathway of oestrogen when doing the DUTCH test, which can tell you if there are nutrient deficiencies or an MTHFR gene mutation, (which is relatively common) which would then need to be addressed in order to maximize health.
Additionally, another downfall of saliva is that it struggles to accurately measure and decipher between low, normal and elevated levels of oestrogen – sometimes they even co-mingle together. It’s simply not sensitive enough to see the various different levels of oestrogen therefore lacking in accuracy, which is an issue for women when it comes to trying to figure out their oestrogen state, which can impact overall health.
If you would like to know more about either the DUTCH test, or how I can work with you to support your hormones, book in a 15 minute discovery call. We can discuss what options I can offer you.