DUTCH Cycle Mapping + Sex Hormone Metabolites (Dried Urine)

What is the DUTCH Cycle Mapping + Sex Hormone Metabolites (Dried Urine) Test?

This bundle combines the DUTCH Cycle Mapping™ and the DUTCH Sex Hormone Metabolites tests. It analyzes progesterone and estrogen patterns throughout the menstrual cycle, as well as various sex hormone metabolites.

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

The addition of the Sex Hormone Metabolites (Dried Urine) profile allows for additional insight into a person’s hormone balance and metabolism.  This test enables healthcare providers to identify hormonal imbalances, estrogen metabolism issues, and other factors that may underlie mood swings, weight gain, infertility, menstrual cycle disorders, and reproductive health issues. 

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 as estrone and estradiol and the progesterone metabolites b-Pregnanediol and a-Pregnanediol nine times throughout one complete cycle by Gas Chromatography and Mass-Spectrometry in tandem. 

What Does the DUTCH Sex Hormone Metabolites (Dried Urine) By Precision Analytical Measure?

The following biomarkers are assessed in urine based on the cycle mapping value with the highest progesterone: 

Progesterone Metabolites

b-Pregnanediol

a-Pregnanediol

Estrogens and Metabolites

Estrone(E1)

Estradiol(E2)

Estriol(E3) 

2-OH-E1 

4-OH-E1 

16-OH-E1

2-Methoxy-E1 

2-OH-E2 

Total Estrogen 

Androgens and Metabolites

DHEA-S

Androsterone

Etiocholanolone

Testosterone

5a-DHT

5a-Androstanediol

5b-Androstanediol

Epi-Testosterone

Liquid Chromatography followed by Mass Spectrometry in tandem (LC-MS/MS) is the methodology used in this test. These highly sensitive methods show increased accuracy over immunoassays typically used in other hormone tests.

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 + Sex Hormone Metabolites (Dried Urine) Clinically Relevant?

The graphs provided as part of an individual’s Cycle Mapping 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, 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.  [6.]  

The addition of sex hormone metabolites may provide additional insight into complex cases, especially those where an androgen excess or estrogen/progesterone imbalance is suspected.  Additionally, if cycle mapping values are normal but metabolites are low, a hormone processing issue may be a causative factor.  

Which Patients is the DUTCH Cycle Mapping + Sex Hormone Metabolites Test 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 suspected of having hormone processing or detoxification issues

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.  Please Click Here for Full Collection and Shipping Instructions.

Additional Resources for Practitioners

Video: Understanding Cycle Mapping and FAQs

Video: DUTCH Cycle Testing: Interpreting Common Results 

Class: Mastering the Menstrual Cycle: a Truly Comprehensive Lab Assessment of Female Reproductive Hormones

An accurate understanding of the menstrual cycle is a critical foundation for helping your female clients.  Whether your patient is dealing with irregularity, abnormal bleeding, PCOS, infertility, or other hormonal disorders, a clear view of hormonal patterns through the menstrual cycle is the first step in developing a successful treatment plan.  In this presentation, Dr. Smeaton, a top women’s health and fertility expert, will review how she uses conventional and functional lab testing to evaluate female reproductive hormones throughout the cycle.  Attendees will:

Review the “normal” hormonal cycle and understand how various hormones will shift throughout the cycle

Obtain an understanding of how and when to measure the various female reproductive hormones

Understand the pros and cons of serum, urine, and salivary assessment of hormones

Leave with a clear clinical approach to evaluate menstrual hormones in cycling and postmenopausal females

Learn what tests Dr. Smeaton prefers to use in her own practice and how she interprets them to extract the most clinical value for her patients

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.] Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.

[6.] 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. 

[7.] Zeng LH, Rana S, Hussain L, Asif M, Mehmood MH, Imran I, Younas A, Mahdy A, Al-Joufi FA, Abed SN. Polycystic Ovary Syndrome: A Disorder of Reproductive Age, Its Pathogenesis, and a Discussion on the Emerging Role of Herbal Remedies. Front Pharmacol. 2022 Jul 18;13:874914. doi: 10.3389/fphar.2022.874914. PMID: 35924049; PMCID: PMC9340349.