The DUTCH Test and Perimenopause: What It Measures, What It Misses, and When It's Worth It

What Is the DUTCH Test?

DUTCH stands for Dried Urine Test for Comprehensive Hormones. It is a urine-based hormone test developed by Precision Analytical, a lab based in Oregon. You collect urine samples at specific times throughout the day, dry them on filter paper strips, and mail them to the lab.

The DUTCH test is not a standard medical test ordered through your doctor's office. It is a specialty test used primarily by functional medicine practitioners, naturopaths, and integrative gynecologists. You can order it through a qualified practitioner, and in some cases directly as a consumer.

The report you receive is detailed and runs many pages. It looks different from a standard blood panel and requires someone trained in interpreting it to be genuinely useful.

What the DUTCH Test Measures That Blood Tests Do Not

Standard blood hormone panels measure circulating hormone levels at a single moment in time. They tell you how much estradiol, FSH, or testosterone is in your bloodstream right now. That is useful, but it is a limited picture.

The DUTCH test measures hormone metabolites, the downstream products your body creates after processing hormones. For estrogen, this includes 2-hydroxyestrone, 16-alpha-hydroxyestrone, and 2-methoxyestrone, among others. These metabolites reveal how your liver is processing and excreting estrogen, not just how much is circulating.

The DUTCH test also measures a full cortisol pattern across the day. You collect samples in the morning, afternoon, evening, and before bed. This shows whether your cortisol is appropriately high in the morning and drops off through the day, or whether the pattern is disrupted, which is common when sleep, stress, or HPA axis function is compromised.

Additionally, the DUTCH test measures melatonin (specifically a urinary metabolite called 6-OHMS), some B vitamin markers, and oxidative stress markers depending on which version of the test you order.

What the DUTCH Test Is Good For

The strongest use case for the DUTCH test in perimenopause is evaluating estrogen metabolism pathways. If you have symptoms that suggest estrogen dominance, or if your provider wants to understand how your liver is processing estrogen, the metabolite data can guide decisions about liver support, DIM supplementation, or other interventions.

The daily cortisol curve is valuable when fatigue, sleep disruption, and stress are major concerns. If your cortisol is crashing mid-morning, or not coming down enough in the evening, that has direct implications for your sleep quality and energy levels. Blood cortisol at a single time point gives you much less of that picture.

The DUTCH test is also useful for monitoring women who are on bioidentical hormone therapy, particularly progesterone and DHEA. Some practitioners use it to check whether applied hormones are being absorbed and metabolized appropriately.

Its Limitations

The DUTCH test has real limitations that are worth knowing before you spend money on it.

It is expensive. Out of pocket costs typically run from $300 to $500 depending on which version you order and which practitioner you work with. Health insurance almost never covers it.

It does not measure everything your blood panel does. It does not replace FSH, LH, thyroid function tests, or blood glucose testing. If you need a comprehensive perimenopause workup, the DUTCH test is an addition to standard labs, not a replacement for them.

Interpretation is genuinely complex. The report uses a lot of terminology that sounds scientific but can be misapplied without proper training. Some practitioners who offer DUTCH testing have limited expertise in how to use the results. A detailed report used by someone who does not fully understand it can lead to over-treatment or misguided interventions.

Urinary hormone metabolites also reflect what your body has already processed, not necessarily what is biologically active right now. This is useful for some questions and less useful for others.

DUTCH vs. Standard Blood Hormone Panel

Think of the blood panel and the DUTCH test as answering different questions. A blood panel tells you the levels of active hormones circulating in your body at a moment in time. The DUTCH test tells you how your body is processing those hormones over the course of a day.

For most women starting a perimenopause hormone workup, a standard blood panel is the right first step. It is covered by insurance, ordered by any general practitioner or gynecologist, and provides the foundational numbers your provider needs.

The DUTCH test makes more sense as a second-level investigation. If your standard labs look unremarkable but you have significant symptoms, if you want deeper insight into cortisol patterns, or if you are exploring specific questions about estrogen metabolism, the DUTCH test adds meaningful information.

Doing the DUTCH test first without a basic blood panel is like skipping the foundation and going straight to the interior design.

When Is the DUTCH Test Worth Doing?

There are specific situations where the DUTCH test is more likely to provide actionable information.

If your standard labs are normal but your symptoms are significant, the estrogen metabolite and cortisol data from the DUTCH test may explain why. Some women metabolize estrogen in ways that create more symptomatic metabolites even when circulating estradiol looks fine.

If you are already on hormone therapy and want to know if it is being absorbed and metabolized well, the DUTCH test can help your practitioner adjust dosing. This is particularly relevant for topical progesterone and DHEA, which do not always show up reliably in blood tests.

If fatigue and sleep disruption are your primary concerns and you suspect a cortisol or adrenal rhythm issue, the four-point cortisol curve is a genuinely useful piece of data that standard labs do not provide.

If your practitioner is focused specifically on optimizing estrogen metabolism pathways for cancer risk reduction, the metabolite data is directly relevant to that goal.

How to Find a Qualified Practitioner to Interpret It

This step is not optional. A DUTCH test interpreted by someone without sufficient training is a significant risk of over-supplementation, unnecessary interventions, or missing what the results actually mean.

Look for practitioners who hold credentials in functional or integrative medicine and have specific experience with female hormone health. Relevant credentials include MD or DO with fellowship training in integrative medicine, ND (naturopathic doctor) licensed in a state that regulates naturopathic practice, IFMCP (certified through the Institute for Functional Medicine), or a registered dietitian or nurse practitioner with demonstrated specialization in hormonal health.

When interviewing a practitioner, ask directly how many DUTCH tests they interpret per month, what advanced training they have done in hormone interpretation, and whether they will coordinate with your primary care provider or gynecologist.

The Precision Analytical website (the maker of the DUTCH test) maintains a practitioner directory that is a reasonable starting point, though not a guarantee of quality.

Ordering the DUTCH Test

Most people access the DUTCH test through a practitioner who orders it on their behalf. The practitioner typically charges a separate interpretation fee on top of the lab cost. Ask in advance what the total cost will be.

There are also direct-to-consumer pathways through telehealth companies that offer the DUTCH test online. Some are excellent. Others are essentially supplement sales channels that use the test as a marketing tool. Be critical of any service that leads with a test and ends with a personalized supplement package.

The most common version for perimenopausal women is the DUTCH Complete or the DUTCH Cycle (which involves collecting samples at multiple points across a full cycle for a more detailed hormone pattern).

Once your results are in, reading articles on PeriPlan about what each hormone marker means can help you prepare better questions for your interpretation appointment.

The Bottom Line

The DUTCH test is a legitimate and detailed hormone assessment tool with real advantages over a single blood draw. It is most valuable when used by a trained practitioner for a specific clinical question, not as a first step or a standalone test.

For most perimenopausal women, the right path is a standard blood hormone panel first, then a DUTCH test if there are unanswered questions, and always with a practitioner who genuinely knows how to interpret what it shows.

If the cost feels significant, prioritize the standard panel first. If symptoms persist despite normal standard labs, that is the moment to consider whether the DUTCH test might help fill in the picture.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.