What Is A DUTCH Test? The Hormone Panel Explained

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Imagine walking into your OB-GYN’s office with a detailed symptom log. You’ve been tracking all your weird sleep, mood swings, irregular periods, and all the other weird sh*t that happens when you turn a certain age as a woman. You’re begging for help, asking for a full hormone panel, but you’re met with what feels like a lack of concern and just a nod to the ever-trending term: perimenopause. They don’t offer any tests or bloodwork, but say they want to treat the symptoms. If you start Googling your options or scrolling social media, you might come across something called a DUTCH test, an at-home hormone panel that could provide you some answers. Scary Mommy spoke with two OB-GYNs about why hormone testing is the way it is, and what you need to know about alternative testing.

Perimenopause and menopause are frustrating — it seems like the potential list of symptoms is endless, and with between 1 and 2 million women entering menopause each year, the demand for doctors who specialize in it is extremely high. When you just want answers about what your hormones are doing in your body, it can feel extremely frustrating to visit your OB-GYN and be told they aren’t ordering you bloodwork to check on your hormones.

What To Expect When You Bring Hormone-Related Concerns To Your Doctor

For starters, you should know your OB-GYN is not trying to shrug you off or withhold information by not calling in a full hormone panel of bloodwork. Sometimes, hormone testing is a great way to diagnose a specific condition. But perimenopause and menopause are clinical diagnoses, meaning there is no reliable test to diagnose them; you have to be diagnosed based on your symptoms and your health history, which your doctor will ask you about in clinic.

“Once you’ve gone 12 months without a menstrual cycle, that’s when you become menopausal. But prior to that, you’re considered perimenopausal just based on your symptoms alone: hot flashes, night sweats, insomnia, irritability, those types of things,” says Dr. Natasha Spencer, an OB-GYN at Orlando Health Physician Associates.

Hormone levels are determined by where you are in your cycle, she explains, so women in perimenopause having irregular periods are naturally going to have ever-changing, unreliable hormone levels in their bloodwork. “I can check your lab work one week, and it looks like you’re menopausal. And then I can check it a week later, and all of your parameters are completely normal. That’s why most people only go on the clinical signs and they may not get labs on you.”

“The issue with hormone testing is that, even prior to perimenopause, hormone levels fluctuate throughout the month. In perimenopause, there’s even more fluctuation. So testing done in one day may be different to test to the results done on another day. It’s not reliable, and maybe even more important is that many times the test results are in a normal range,” says Dr. Candice Fraser, board-certified OB-GYN and Menopause Society-certified practitioner at the Carolyn Rowan Center for Women's Health and Wellness at Mount Sinai.

If you are struggling to sleep at night, having irregular cycles, or are concerned about your hormone levels, your provider will likely ask you a number of questions to help narrow down whether you may be in perimenopause or menopause. These conditions are not diagnosed this way to make life harder for women, though it may feel like it when you’re struggling with debilitating symptoms. The purpose is to help, Fraser says. If diagnoses were based on hormone panels alone and your results came back normal, as they often do, what then?

“Let’s say you’re 46 years old, your periods are irregular, you’re having all these symptoms, but we did your test and everything’s in normal range,” Fraser says. “We don’t have a reliable test that we can say, ‘These test numbers at these values mean perimenopause.’ That doesn’t exist. It always comes back to treating the person.”

To treat perimenopause symptoms, doctors have to see what works without relying on labs too. “I change the methods that I’m using solely based on whether it’s resolving their symptoms or not. It’s not based off lab work because once I start them on something, I can’t use the lab work. We're giving them hormones. We're giving them medications that can alter those results,” says Spencer.

In online discussions about this frustration of treating the symptoms without testing the hormones, the DUTCH test (Dried Urine Test for Comprehensive Hormones) comes up in the comments as a do-it-yourself option for those who want to know more about their hormones. So what is it, and can it really help?

What does a DUTCH test tell you?

A DUTCH test is an at-home kit that gathers urine samples four times within a 24-hour period. Once you mail them back, those samples will be analyzed for 35 different hormone metabolites (the waste products left over in urine after hormones are used by the body). Those readings include analysis of estrogen, progesterone, and testosterone levels, as well as adrenal hormones like cortisol and DHEA-S, according to DUTCH, the manufacturer of the test kit.

So, why don’t most OB-GYNs offer this test or refer their patients to it? There isn’t enough independently verified data to support its efficacy at detecting certain conditions. It may be a helpful product for those who love data about their bodies, but if you’re looking to figure out a specific health concern like perimenopause, the results aren’t actionable — your provider is still going to have to take a thorough patient history from you and treat you based on your symptoms.

“Is the test accurate in what it’s measuring? Likely. But it doesn’t give us more insight into a disease or a clinical process. There’s nothing correlating it to a better diagnosis of conditions, treatment, or outcomes. Most of the studies we have are from the actual developers of the test. We don’t have any independent testing of the DUTCH test or larger-scale tests that are by people who are not the manufacturers,” Fraser says. “It would be malpractice for someone to try to use tests that they’ve never been trained to [that] they don’t know anything about how to interpret.”

How much does a DUTCH test cost?

Because there is insufficient data to support the use of the DUTCH test, it is usually not covered by insurance. The baseline DUTCH Complete test costs $500, and the prices go up from there. Because of that price tag, you should consider whether your doctor will be able to use the results meaningfully before adding to cart, Fraser says.

“There are groups of clinicians who rely more heavily on things like the DUTCH test. If that is a type of care that you’re looking for, there are functional medicine physicians or clinicians who may be able to support you in getting testing and may give you a little bit more guidance. But as a physician who follows major national clinical guidelines, I can’t advise someone on something that I don’t have the data to support or I haven’t been trained to interpret.”

What You Should Ask Yourself Before Purchasing Alternative Tests & Supplements

When we’re frustrated with our health care, of course we turn to Google and social media to find answers and read about others’ experiences. But before you buy products recommended in the comments, consider the following, Fraser says:

• Where did this information come from? Is the person talking about the test a clinician with verifiable credentials? What’s the evidence? Why are they saying this works? Who studied it, and how many people were in that study? What were the side effects? Or, is this an individual sharing their experience?
• Does this other person’s experience apply to me? OB-GYNs may order hormone testing to diagnose specific conditions or rule out others. One person saying they received a hormone panel doesn’t mean it’s appropriate or helpful for your needs. “We don’t always know the context with which people are telling us their stories. We don’t know their medical histories, we don’t know anything else about what they’re telling us. We all have different medical conditions. We take different medications. There are things that will and won’t apply to us.”
• If I take this test and get the results, what happens next? Ask your doctor if they can take any action based on a screening before you buy it. If the manufacturer or provider offering it will use the results to sell you something, be wary. “A lot of times, what a clinician who orders this may do is then utilize it to then sell the patient other treatments, whether it be supplements or other things that are not FDA-approved, well-accepted, or that have a lot of data,” Fraser says.

If you went in to your OB-GYN hoping to get bloodwork to check your hormones, don’t hesitate to ask them why they don’t want to order it, Fraser and Spencer agree. You can say, “I was hoping to leave with lab orders for a hormone panel to better understand what’s going on. Is that an option, and would it help me find the answers I’m wanting?” Or, “I saw this other test online. Does this apply to me? Is this something I should be thinking about?”

“Medical care is a negotiation,” Spencer adds, saying she often orders bloodwork for patients who still want it. It may just be that your doctor is trying to save you the trouble and the copay by making it clear the test results aren’t reliable enough to inform your perimenopause treatment plan one way or the other. But if a blood test will give you peace of mind, they will likely still order it.

“I think it’s great to have the conversation, but there’s definitely information overload that I think people really need the assistance of a trusted clinician to help them sort through it,” Fraser says.

source https://www.scarymommy.com/lifestyle/what-is-a-dutch-test