It is true that female hormones fluctuate from day to day, from month to month, but that does not mean that their evaluation is not useful or even important in determining the state of health of wife. Although a hormone test gives us a snapshot of a monthly cycle, we will see that if the right period is chosen, we can obtain crucial information in order to improve the hormonal balance, this being especially true when we are faced with hormonal problems such as premenstrual syndrome, fibroids, ovarian cysts, infertility or during a difficult premenopause or menopause.
Doctors often make these evaluations in the blood but this is often the least relevant because in the blood we evaluate the hormones linked to the transporter proteins whereas it is more judicious to evaluate the free or bioavailable hormones that we can evaluate in saliva and in urine. In this article we will see that various symptoms or diseases are due to a hormonal imbalance favored by different factors such as, for example, stress, xenoestrogens from our environment, poor hepatic detoxification or an unbalanced microbiota. To regain hormonal health thanks to a global and interconnected care, it is necessary to have a complete and intelligent evaluation of hormones and we will see that this is possible by the DUTCH test.
Timing and options for hormone testing
Generally, it is best to test for sex hormones between 19th and the 22th day of the cycle because the body produces progesterone only following ovulation which occurs around the 14th day. The progesterone peak often occurs between the 19th and the 22th day, which gives us an idea of the maximum production of progesterone. During this time window, estrogen should be reduced from its pre-ovulatory level, if estrogen is abnormally high, an imbalance called “estrogen dominance” can be suspected.
To assess a woman’s hormones, there are several options, either through a blood test, saliva test, or urine assays.
Blood tests
Blood tests are often the option most frequently used by doctors due to the speed and ease of a simple blood test. In addition to the estrogen and progesterone assay, the doctor can complete the assessment by assaying the pituitary hormones (LH and FSH), SBHG (sex binding hormone globulin) and prolactin. On the other hand, the sex hormones tested in the blood are in bound form and not in the free or bioavailable form which acts on the tissues. This means that in some cases the hormones in the blood may be within the norm while the bioavailable and active part of the hormone is low. In addition, blood assays do not allow to assess the metabolized forms of sex hormones which give valuable indications as we will see later.
Saliva tests
Samples are usually taken at home. Saliva assays correspond to the free and active form of sex hormones and can give a clear picture of estrogen and progesterone levels. This often involves taking several samples during the day and adds the profile of stress hormones (cortisol) which has an impact on sex hormones.
Saliva can also be used to measure FSH, LH as well as testosterone, DHEA and cortisol. On the other hand, saliva assays do not make it possible to evaluate hormone metabolites and saliva assay is not an accurate method for evaluating hormone replacement therapy.
Urine examinations
The urinary assays make it possible to evaluate the three main estrogens (E1, E2 and E3), progesterone, testosterone, DHEA, metabolites of sex hormones as well as a profile of cortisol during the day. These urinary assays not only show the bio-available forms of the hormones but allow to evaluate the hormonal secretions over 24 hours instead of a time T of a blood assay.
In addition, knowing how estrogens are metabolized gives us information regarding the detoxification pathways of the liver (phase I and phase II) and we will see why this information is important for health. On the other hand, urinary assays do not make it possible to evaluate the pituitary hormones (LH and FSH) and the evaluation of the level of progesterone is calculated from the measurement of the metabolites of progesterone.
Why the DUTCH test offers a plethora of information regarding a woman’s hormonal health
From dry urine samples, the DUTCH test makes it possible to evaluate:
- Cortisol and cortisone on a 24-hour profile
- The three main estrogens: estradiol, estrone and estriol with these metabolites
- Progesterone and its metabolites
- The DHEA and DHEA sulfate
- Testosterone and androgens with these metabolites
- Melatonin
On the other hand, in the complete DUTCH test, we added the dosage of 2 important B vitamins for hormonal health (B6 and B9), a marker of oxidative stress which assesses the risk of damage to cells, mitochondria and the DNA. We also have a dosage of certain neurotransmitters such as dopamine as well as an assessment of glutathione needs, which is the most powerful antioxidant we produce. Proper detoxification is difficult without sufficient levels of glutathione.
One might ask the question of the usefulness of measuring all these hormones but we will see that there are many reasons which justify these measures.
Some examples of situations that can justify this type of assessment
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During a state of exhaustion or poorly managed stress
The dosage of the production of stress hormones as well as the fluctuations over 24 hours of stress hormones will make it possible to evaluate the impact of stress on the organism as well as the influence of these hormones on sex hormones.
The DUTCH test thus makes it possible to evaluate the fatigue of the adrenal glands and to give in part an explanation for a drop in the level of energy of a person.
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In a state of estrogen dominance
Estrogen dominance is when estrogen levels are high compared to progesterone levels. This can lead to various symptoms such as weight gain, swollen breasts, irregular menstrual cycles such as heavy or painful periods, mood swings, sleep problems, menstrual migraines etc.
Estrogen dominance can be an important factor in endometriosis, premenstrual syndrome, cystic fibrosis breasts, uterine fibroids, mood disorders, etc. This test gives the full picture and allows us to understand how these hormonal imbalances contribute to these health issues.
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During an infertility problem or polycystic ovary syndrome
The DUTCH test is useful because it provides a complete picture of the balance of androgen and estrogen hormones. We know, for example, that polycystic ovary syndrome is often due to an increase in the production of androgens by the ovaries and/or the adrenals. Often this syndrome is associated with an increase in androgens, we can see high levels of LH, high blood sugar or insulin in the context of insulin resistance.
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During menopause or symptomatic perimenopause
We will explore in the next article how the DUTCH test can be a winning strategy during a difficult menopause.
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In premenstrual dysphoric disorder
About 3-10% of menstruating people have premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS). With, in the foreground, psychological symptoms during the luteal phase, between ovulation and menstruation. Panic attacks, anger, aggression, deep sadness, social anxiety, difficulty concentrating, apathy and suicidal thoughts are some of the elements that can emerge during each cycle.
We might still give multiple examples or the DUTCH test might provide valuable information to optimize support. We will now give some examples of women who have been able to change their lives thanks to the information provided by the DUTCH test.
Some examples of women who have changed their lives thanks to the DUTCH test
Laura feels exhausted
Take the example of 52-year-old Laura who has been feeling exhausted for months in relation to her increased workload. Laura has suffered from chronic stress for a long time, she tends to gain weight despite a low-calorie diet and regular intensive cycling (spinning). Although she applies an estrogen patch, she continues to suffer from hot flashes.
His Dutch test shows high levels of cortisol, correct levels of estrogen and progesterone indicating that his hormone replacement is correct. Thanks to the DUTCH test, we were able to target treatment on lifestyle corrections by introducing a stress management technique, adding calories to their diet (a diet low in carbohydrates can aggravate stress hormones), reducing the excessive practice of sport (promotes a depletion of stress hormones) and supporting with food supplements and herbal medicine its axis of stress. Thanks to targeted care, Laura was able to regain more energy, lose weight even by eating more.
Sylvie, with a history of breast cancer, complains of sleep disturbances and anxiety
Take the example of Sylvie aged 44 who survived breast cancer and who will present symptoms of early menopause due to the hormone therapy she received for her cancer. She particularly complains of sleep disturbances and a state of anxiety. The DUTCH test shows low levels of estrogen with a problem of detoxification of hormonal metabolites, this associated with an increase in stress hormones and an increased need for glutathione.
Other examinations will highlight nutritional deficiencies, liver overload and immune dysregulation. Management consisted of dietary corrections, appropriate supplements focused on hepatic detoxification, and herbal medicine to support his immune system and detoxification functions. Over the next year, she was able to wean herself off her anti-anxiety medication, regain restful sleep, and greatly reduce her hot flashes and anxiety.
Valérie has polycystic ovary syndrome and infertility
We will take the case of Valerie, 31, who is known to have polycystic ovary syndrome and who was not improved by taking a contraceptive pill. It was impossible to know if or when she was going to ovulate and she longed for children. The DUTCH test showed high testosterone levels, low progesterone, high estrogen levels and high cortisol levels.
We know Valerie has insulin resistance. Treatment consisted of the prescription of food supplements, appropriate herbal medicine, dietary advice and stress management to allow hormonal rebalancing and promote ovulation and more regular cycles.
The next article on female hormones will be devoted to menopause and how the DUTCH test can be a particularly powerful tool for targeted and effective management of this sometimes difficult period.
Dr Antonello D’oro
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