The female menstrual cycle is considered the fifth vital sign for women. Right up there with heart rate, blood pressure, body temperature, and respiratory rate. Menstrual cycle functioning is essential to women's health, as hormones produced during the cycle affect every system in the body. This article will discuss what a healthy menstrual cycle is and an in-depth look at a specific test, the DUTCH Cycle Mapping Test, that can help to assess a woman's cycle.

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What is a Healthy Menstrual Cycle?

A healthy menstrual cycle can last anywhere from 21-35 days and can be divided into three main phases: the follicular phase, ovulation, and the luteal phase. Let's explore each phase.

Follicular Phase

The follicular phase begins with menstruation, which is the shedding of the uterine lining. Levels of the two main female hormones, estrogen and progesterone, are low during this time. Follicle Stimulating Hormone (FSH), a hormone made in the brain's pituitary gland, is released during this phase. FSH stimulates ovarian follicles, containing eggs, to begin to grow. A dominant follicle will emerge between days 5-7 of the cycle, causing the other follicles to dissolve. This dominant follicle begins to produce estradiol, ending menstruation and allowing the uterine lining to begin to grow again in preparation for a fertilized egg. Estradiol levels continue to rise, eventually causing the release of another pituitary hormone, Luteniezing Hormone (LH), marking the beginning of ovulation.  

Ovulation

The ovulatory phase lasts anywhere from 16 to 32 hours. LH causes the dominant follicle to grow until it eventually ruptures, releasing the egg. This is the main event or the main purpose of the menstrual cycle. If the egg is not fertilized, the luteal phase then begins.

Luteal Phase  

The luteal phase lasts 14 days from ovulation. The remnants of the dominant follicle turn into a structure known as the corpus luteum (CL). The CL makes the other main female hormone, progesterone. Progesterone affects the function of the uterine lining, increasing blood flow and nutrients into it. In the absence of pregnancy, the CL begins to degrade ten days after ovulation, causing levels of progesterone to decline. Estradiol production also declines at this time, and the combination of the two lowering hormones triggers menstruation. The cycle then starts all over.

What is The DUTCH Cycle Mapping Test?

The DUTCH Cycle Mapping test tracks levels of estrogen, estrone, and two progesterone metabolites over one menstrual cycle via urine samples.  

Estradiol

Estradiol is the primary estrogen in cycling women. As discussed above, estradiol levels fluctuate throughout the cycle. Estradiol levels cause the growth of the uterine lining in preparation for a fertilized egg. Estradiol also helps to trigger ovulation or the release of the egg.  

Estradiol affects many body systems. For example, in the integument system (the skin), there is a marked improvement in the integrity of the skin by estradiol's ability to increase collagen, elastin, and hyaluronic acid formation. It's beneficial for bones, inhibiting bone breakdown. In relation to cardiovascular health, estradiol increases blood flow and aids in clot formation. Related to the cardiovascular system but occurring in the liver, LDL cholesterol, the "bad cholesterol" formation, is reduced by estradiol, and HDL cholesterol, "good cholesterol," is increased.  

High estradiol symptoms include irregular periods, heavy periods, breast tenderness, mood swings, headaches, fibroids, weight gain, and more. High levels of estradiol can also block progesterone production. Low estradiol symptoms include hot flashes, night sweats, low libido, vaginal dryness, weight gain, headaches, fatigue, irritability, heart palpitations, and more.

Estrone

Estrone is the primary estrogen in the postmenopausal woman, as the production of estrone is not dependent on ovaries, unlike estradiol. Estrone, in fact, is made in the peripheral tissues, especially fat tissue. Estrone can act similarly to estradiol, as they use the same receptors in the body. Caution should be taken into consideration with estrone, especially when discussing breast cancer risk. Estrone has a higher affinity for the ER alpha estrogen receptors, receptors that cause breast tissue growth, as opposed to the ER beta receptors that help to inhibit excess growth. Activation of ER alpha receptors in the breast has been implicated in breast cancer development.

Progesterone

Progesterone can aid in the functioning of the uterine lining. Progesterone increases the creation of small blood vessels, called capillaries, in the uterine lining, increasing blood flow and thus oxygen and nutrients to the tissues. It also helps to balance out estrogen, specifically lowering estrogen's ability to cause growth of the uterine lining.  

When progesterone gets broken down, one of its metabolites can increase GABA utilization in the brain, giving an anti-anxiety and anti-depressant effect in some women. It also lowers excitatory glutamate levels, again adding to a calming effect. High progesterone symptoms include breast tenderness, abdominal cramping, back pain, vaginal bleeding, dizziness due to low blood pressure, and quick clotting (hypercoagulative state). Low progesterone symptoms include irregular periods, headaches, infertility, difficulty sleeping, weight gain, mood changes including anxiety or depression, and hot flashes.

When to Consider The DUTCH Cycle Mapping Test

The DUTCH Cycle Mapping test should be considered in women with irregular menstrual cycles, including Polycystic Ovarian Syndrome (PCOS), and infertility, as it can be hard to determine if or when these women are ovulating. Also, women who have had ablations and partial hysterectomies (uterus removed but ovaries intact) do not menstruate, making it hard to track cycles and virtually impossible to know if they are still ovulating.  

It's important to note that the DUTCH Cycle Mapping metabolites correlate with the gold standard blood hormone testing. This is significant, as a urine sample is much easier for patients to complete as opposed to daily blood samples.

How to Use The DUTCH Cycle Mapping Test in Clinic?

The DUTCH Cycle Mapping test is useful as there is much variability in menstrual cycles; although we give general length ranges for the phases of the menstrual cycle, these can vary greatly from woman to woman. For example, it is said that ovulation occurs on day 14 of the cycle, but that is not the case for every single woman; some may ovulate earlier or later than day 14.  

This test is also incredibly insightful as opposed to single-day testing. Progesterone, for example, may be made in a great amount on one day of the cycle but then fall drastically after. Single-day testing may give a false appearance of an adequate hormone level.  

Treatments will vary greatly depending on the results of the individual's test. Make sure to check out these articles for more information: Estradiol, estrone, and progesterone.

Summary‍

To conclude, the DUTCH Cycle Mapping test can be incredibly insightful in gaining an understanding of an individual female's hormone production throughout an entire cycle. Providing month-long levels, and thus insight into the amount of the hormones estradiol, estrone, and progesterone, the Cycle Mapping test gives both the practitioner and patient the ability to fully understand what's happening in the patient's body, which will better allow them to treat and resolve the patient's symptoms.