This bundle combines the DUTCH Cycle Mapping™ and the DUTCH Complete™ tests. It analyzes progesterone and estrogen patterns throughout the menstrual cycle, levels of various sex and adrenal hormones and their metabolites, as well as levels of several organic acids.
This bundle cannot be ordered for patients under 12 years of age.
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.
The DUTCH (Dried Urine Test for Comprehensive Hormones) Complete test offers insights into hormone levels and their metabolism to complement information in the DUTCH Cycle Mapping Test.
Key features of the DUTCH Complete include a thorough assessment of hormones such as cortisol, cortisone, estrogen, progesterone, and testosterone and their metabolites, offering insight into hormonal dynamics beyond what conventional blood tests can offer.
Moreover, the test incorporates a diurnal rhythm analysis of adrenal hormones, shedding light on natural daily patterns of cortisol and cortisone to assess adrenal function and circadian rhythm disturbances.
The DUTCH Complete also includes an organic acids assessment to dive deeper into an individual’s metabolic, nutritional, and hormonal health.
By analyzing urine samples for neurotransmitter metabolites, organic acids, oxidative stress markers, and melatonin levels, this test aids healthcare providers in identifying nutritional deficiencies, hormone and neurotransmitter imbalances, and oxidative stress, facilitating tailored treatment strategies for patients.
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.]
The DUTCH Complete measures a variety of urinary hormones and their metabolites, and includes a diurnal cortisol and cortisone curve, as well as various organic acids and relevant markers.
Specific hormones and their metabolites include;
Progesterone Metabolites
Estrogens and Metabolites
Androgens and Metabolites
Cortisol, Cortisone and Creatinine
Cortisol Metabolites and DHEA-S
Nutritional Organic Acids
Neuro-related Markers
Additional Markers
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 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 should be considered.
This bundle includes diurnal cortisol and cortisone rhythms to enhance a clinician’s understanding of the impact 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.]
Combining this knowledge with organic acids may further uncover hormone processing issues or nutritional deficiencies that can contribute to a woman’s hormonal health.
This Panel is ideal for any woman struggling with menstrual or fertility issues, including complex or chronic conditions that have not responded as expected to traditional therapies, especially in the setting of 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.
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 have not responded as expected to prior therapies for hormone imbalance
Women with complex presentations, especially in the setting of subjective or objective high stress levels
Presentations that include sleep problems
Individuals with a Suspected Hormonal Contribution to Chronic Conditions, including chronic fatigue syndrome, fibromyalgia, and certain autoimmune diseases, where hormone imbalances may play a role
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. [8.]
This is a long and detailed test. Click here to access Collection and Shipping Instructions.
Video: Understanding Cycle Mapping and FAQs
Video: DUTCH Cycle Testing: Interpreting Common Results
Video: Benefits of the DUTCH Complete
[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.
This bundle combines the DUTCH Cycle Mapping™ and the DUTCH Complete™ tests. It offers a comprehensive hormonal analysis throughout the entire menstrual cycle. This bundle cannot be ordered for patients under 12 years of age. NOTE: If you order for a patient in MD, NY, or RI, you must provide them with a written prescription or lab order on a document with a letterhead from your facility that they will send back to the lab with their samples.
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