DUTCH Cycle Mapping + Adrenal (Dried Urine)

This bundle combines the DUTCH Cycle Mapping™ and the DUTCH Adrenal tests. It analyzes daily free cortisol and cortisone patterns as well as the patterns of progesterone and estrogen throughout the menstrual cycle. 

This bundle cannot be ordered for patients under 12 years of age.

What is the DUTCH Cycle Mapping Test?

The DUTCH Cycle Mapping™ test maps the patterns of progesterone and estrogen throughout the menstrual cycle.

By requesting this test, the physician will get a complete picture of a woman’s cycle, which may be relevant for patients with month-long symptoms, infertility, and Polycystic ovary syndrome.

Nine targeted estrogen and progesterone measurements are taken throughout the cycle to characterize the follicular, ovulatory, and luteal phases.

It is expected to find a pattern of hormones with relatively low estrogen levels early in the cycle, an increase around ovulation, and modest levels in the luteal phase.

Progesterone levels stay relatively low until after ovulation, but after ovulation levels ideally increase (10-fold) and then drop back down at the end of the cycle.

Critically, a disruption in this cycle can lead to infertility or hormonal imbalance.

What Does DUTCH Cycle Mapping Test Measure?

The DUTCH Cycle Mapping tests estrogen and progesterone metabolites nine times throughout one complete cycle by Gas Chromatography and Mass-Spectrometry in tandem (MS/MS). 

This is the most accurate method for testing urinary reproductive hormones and their metabolites; research shows that urine hormones correlate well with serum hormones throughout a woman’s menstrual cycle, and can demonstrate ovulation with accuracy. [6., 7.]

What Does DUTCH Adrenal (Dried Urine) Test Measure?

The DUTCH Adrenal (Dried Urine) test measures the daily free cortisol pattern, daily free cortisone pattern, cortisol metabolites (a-THF, b-THF), cortisone metabolites (b-THE), and DHEAS.

This test requires 4 urine samples across 24 hours to assess diurnal cortisol and cortisone patterns.

How is This Combination of the DUTCH Cycle Mapping Test + Adrenal (Dried Urine) Panel Clinically Relevant?

The graphs provided as part of an individual’s cycle mapping test results illustrate estrogen (E) and progesterone (Pg) production over the menstrual cycle, with reference ranges and patient results. 

Cycles typically range from 21-35 days, and the 9 most relevant measurements have been selected from multiple samples. Single-day measurements are utilized for cycles <34 days, representing ovulatory and luteal peaks.  In the case of longer cycles, samples are taken from 2-day averages to ensure that any peaks in estrogen or progesterone metabolites are not missed.

Estrone (E1) and estradiol (E2) rise in the follicular phase, and estrogen stimulates luteinizing hormone (LH) surge before ovulation.  This leads to Pg production in the second half of the cycle. Pg peaks 5-7 days post-ovulation, declining before menses.  An absent or weak rise in Pg suggests anovulation or luteal phase defect, associated with infertility. 

This test helps uncover ovulation and fertile days; many women do not ovulate on day 14, which can cause confusion regarding a woman’s fertile window and slow the process of conception. [2.]  In fact, as few as 24% of cycling women may ovulate on day 14 or 15.  [10.]  

The addition of the Adrenal (Dried Urine) test to the DUTCH Cycle Mapping Test provides additional insight into the effects of stress on a woman’s hormone cycle.  Stress can have various effects on a woman’s menstrual cycle, including:

Infertility [4.]

PMS symptoms [3.]

Irregular or absent periods [12.]

Heavy bleeding and/or spotting between periods [11.] 

Painful periods [9.]

PCOS [1.]

This Panel is ideal for any woman struggling with menstrual or fertility issues who also reports high stress.

Patient results, including creatinine for hydration correction, are presented in a table below the graphs, with low or high creatinine levels potentially affecting hormone measurement reliability.

Which Patients is the DUTCH Cycle Mapping + Adrenal (Dried Urine) Panel Best Used For?

Women struggling with infertility

Women with cycling hormones and no menses

Partial hysterectomy (ovaries intact but no uterus)

Ablations

Women with irregular cycles

PCOS

If the luteal phase shifts from month-to-month

Not sure when to test due to long or short cycles

Women whose hormonal symptoms tend to fluctuate throughout the cycle

Women struggling with PMS, mid-cycle spotting, migraines, etc.

Women who cannot or want to avoid repeated blood draws for serum hormone testing throughout the month

Women with any of the above concerns who also report subjective or objective levels of high stress

The test is not recommended in postmenopausal women, women on birth control, or women with cycles that follow the expected pattern. [8.]

This is a long and detailed test.  Click here to access Collection and Shipping Instructions.

Additional Resources for Practitioners

Video: Understanding Cycle Mapping and FAQs

Video: DUTCH Cycle Testing: Interpreting Common Results 

References

[1.] Benjamin JJ, MaheshKumar K, Radha V, et al. Stress and polycystic ovarian syndrome-a case control study among Indian women. Clinical Epidemiology and Global Health. 2023;22:101326. doi:https://doi.org/10.1016/j.cegh.2023.101326

[2.] Bull JR, Rowland SP, Scherwitzl EB, Scherwitzl R, Danielsson KG, Harper J. Real-world menstrual cycle characteristics of more than 600,000 menstrual cycles. NPJ Digit Med. 2019 Aug 27;2:83. doi: 10.1038/s41746-019-0152-7. PMID: 31482137; PMCID: PMC6710244.

[3.] Gollenberg AL, Hediger ML, Mumford SL, Whitcomb BW, Hovey KM, Wactawski-Wende J, Schisterman EF. Perceived stress and severity of perimenstrual symptoms: the BioCycle Study. J Womens Health (Larchmt). 2010 May;19(5):959-67. doi: 10.1089/jwh.2009.1717. PMID: 20384452; PMCID: PMC2875955.

[4.] Lewinski A.,Brzozowska M., Female infertility as a result of stress-related hormonal changes, GREM Gynecological and Reproductive Endocrinology & Metabolism (2023); 02-03/2022:094-098 doi: 10.53260/grem.22302035 

[5.] Tufail A, Mustafa R, Munaver SA, Nawaz B. Frequency of psychological stress among women with new onset menstrual disorders amid corona pandemic lockdown. Pak J Med Sci. 2022 May-Jun;38(5):1159-1164. doi: 10.12669/pjms.38.5.4606. PMID: 35799741; PMCID: PMC9247749. 

[6.] Newman M, Pratt SM, Curran DA, Stanczyk FZ. Evaluating urinary estrogen and progesterone metabolites using dried filter paper samples and gas chromatography with tandem mass spectrometry (GC-MS/MS). BMC Chem. 2019 Feb 4;13(1):20. doi: 10.1186/s13065-019-0539-1. PMID: 31384769; PMCID: PMC6661742.

[7.] Pattnaik, S., Das, D. & Venkatesan, V.A. Validation of urinary reproductive hormone measurements using a novel smartphone connected reader. Sci Rep 13, 9227 (2023). https://doi.org/10.1038/s41598-023-36539-w

[8.] Prior JC, Naess M, Langhammer A, Forsmo S. Ovulation Prevalence in Women with Spontaneous Normal-Length Menstrual Cycles - A Population-Based Cohort from HUNT3, Norway. PLoS One. 2015 Aug 20;10(8):e0134473. doi: 10.1371/journal.pone.0134473. PMID: 26291617; PMCID: PMC4546331. 

[9.] Rafique N, Al-Sheikh MH. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Med J. 2018 Jan;39(1):67-73. doi: 10.15537/smj.2018.1.21438. PMID: 29332111; PMCID: PMC5885123.

[10.] Symul L, Wac K, Hillard P, Salathé M. Assessment of menstrual health status and evolution through mobile apps for fertility awareness. NPJ Digit Med. 2019 Jul 16;2:64. doi: 10.1038/s41746-019-0139-4. PMID: 31341953; PMCID: PMC6635432. 

[11.] Tufail A, Mustafa R, Munaver SA, Nawaz B. Frequency of psychological stress among women with new onset menstrual disorders amid corona pandemic lockdown. Pak J Med Sci. 2022 May-Jun;38(5):1159-1164. doi: 10.12669/pjms.38.5.4606. PMID: 35799741; PMCID: PMC9247749.

[12.] Vigil P, Meléndez J, Soto H, Petkovic G, Bernal YA, Molina S. Chronic Stress and Ovulatory Dysfunction: Implications in Times of COVID-19. Front Glob Womens Health. 2022 May 23;3:866104. doi: 10.3389/fgwh.2022.866104. PMID: 35677754; PMCID: PMC9168655.