DUTCH Cycle Mapping (Dried Urine)

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.

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

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. [2., 3.]

How is The DUTCH Cycle Mapping Test Clinically Relevant?

The graphs provided as part of an individual’s 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.

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Estrone (E1) and estradiol (E2) rise in the follicular phase, 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. [1.]  In fact, as few as 24% of cycling women may ovulate on day 14 or 15.  [5.]  

The objective cycle data demonstrated in the DUTCH Cycle Mapping Test may provide clarity regarding the timing of a woman’s cycle.  As noted below, this test is not an appropriate diagnostic tool for women whose cycles follow the expected pattern, as anovulation may occur in up to one third of clinically normal menstrual cycles. [4.]

For women struggling with infertility or unexplained changes in cycle patterns from month to month, this test may uncover hidden patterns of hormone imbalance.

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 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

The test is not recommended in postmenopausal women, women on birth control, or women with cycles that follow the expected pattern. [4.]

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.] 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.

[2.] 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.

[3.] 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

[4.] 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. 

[5.] 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.