Checking your hormones before, during and after menopause can be an invaluable and insightful way of finding out what’s going on inside your body. Editor-in-Chief Katy Sunnassee does just that with a month-long hormone test and expert insight from functional hormone nutritionist Pippa Campbell.
For many women, the years leading up to menopause can feel bewildering. Periods become unpredictable, sleep starts to suffer, anxiety creeps in, energy dips, weight shifts, moods fluctuate – yet blood tests often come back “normal”.
You’re told everything looks fine, even when you don’t feel fine at all. This is where hormone testing, done well and interpreted properly, can be genuinely transformative. Rather than relying on symptoms alone or on single, static blood tests, hormone testing can offer a far more accurate picture of what your body is actually doing – and why you might be feeling the way you are.
‘In midlife especially, hormones don’t decline in a neat, linear fashion. They fluctuate. They spike. They crash. They surge at unexpected times of the cycle,’ says Pippa Campbell, functional nutritionist and weight loss specialist (pippacampbellhealth.com).
‘A snapshot blood test taken on one random day can easily miss the bigger picture. Functional hormone testing aims to solve that problem by looking at patterns, trends and metabolism – not just raw hormone levels.’ One of the best tests around, and one that Pippa uses with many of her clients, is the DUTCH test (it stands for Dried Urine Test for Comprehensive Hormones).
Rather than measuring hormones directly in your blood, the DUTCH test assesses hormones and their metabolites through urine, collected on specially treated filter paper that’s then analysed in a laboratory. The reason urine is used rather than blood, is because urine testing doesn’t just show how much of a hormone you’re producing – it shows how your body is processing and clearing those hormones.
‘That distinction is crucial, particularly in perimenopause, when symptoms are often driven as much by hormone metabolism as by hormone levels themselves,’ says Pippa.
The DUTCH test looks at sex hormones including oestrogen, progesterone and testosterone; how those hormones are broken down and detoxified by the liver; stress hormones such as cortisol and cortisone; key metabolites that influence mood, sleep, inflammation and energy; and organic acids that offer insight into your nutrient status, neurotransmitters and oxidative stress.
All in all, it can give a really detailed picture of your health. But there isn’t just one version of the DUTCH test – there are several, designed for different stages of life and different clinical questions. Some versions involve collecting 4-5 urine samples over a single day to assess daily cortisol rhythm alongside sex hormones.
I did one of these many years ago and it showed I had stage 2 adrenal fatigue, based on the fact my cortisol in the morning was very low – it’s meant to be at its peak at that time to give you that “get up and go” feeling – and was rising through the day and staying high later on, leading to that classic “tired and wired” feeling and wanting to stay up late to get work done as you feel switched on, even though you know you’ll be drained the next day. Cortisol is meant to decline into the evening, so you can wind down.
Getting the full picture
But back to sex hormones. Other DUTCH tests are designed for postmenopausal women or those on HRT and focus on how these externally supplied (also called exogenous) hormones are being metabolised, i.e. processed in the body for use/excretion. For women still menstruating, especially those in late perimenopause, the most revealing option is often the DUTCH Test Cycle Mapping, as one of the defining features of perimenopause is unpredictability.
Ovulation may or may not happen each cycle. Also, cycles may shorten, lengthen or alternate between the two, which is what’s been happening to me over the past few years – I’ve recently had two periods within weeks of each other, but also had a gap of around three months at one point! Oestrogen can also surge to very high levels before dropping suddenly, which I’ve also experienced and which showed up on the test I did.
On the other hand, progesterone often declines earlier and more consistently – another thing I’ve had happen as this and previous tests I’ve done all showed extremely low levels of the “kind and compassionate” hormone – no wonder my husband and son find me irritable a lot of the time!
The problem with a lot of tests for progesterone is that they must be done on a specific day: day 21 of what needs to be an average 28-day cycle. But in the run up to menopause, regularity is rare, and so even if you count forward the right number of days from your period to get to day 21, it’s assuming you ovulated on around day 10, which you may or may not have.
If you didn’t ovulate, or ovulated really early on, then the level of progesterone on day 21 won’t be elevated, as would be expected from a “normal” 28-day cycle.
And so, the DUTCH Cycle Mapping test was designed specifically to address this issue as rather than testing on a single day, it involves collecting urine samples every other day across an entire cycle, from the first day of your period up until the next one begins. To collect the samples, you either wee directly onto the paper, or you can pee into a pot and dip the paper in.
You then let them dry out entirely, before folding the papers and writing your details on (note: it’s worth doing this in advance and preparing your test strip the night before so it’s right there ready to go when you get up in the morning). At the end of the cycle, all samples are sent to the lab together for analysis.
The result is a hormone map – a visual representation of how oestrogen and progesterone rise and fall across your actual cycle, not a theoretical one. Despite sounding complex, the process itself is surprisingly straightforward. You start collecting samples on day one of your period.
Every other day, you take a urine sample (usually first-morning urine). The test kit provides clear instructions and everything you need. You don’t need to change your routine dramatically, though you’re usually advised not to introduce new supplements or hormones during the testing window as this can skew the results of what your body is doing on its own.
The goal is to capture your hormones as they are, not as you’d like them to be. If your cycle is short, the test may last just a few weeks. If it’s long, which is common in perimenopause, it may run for 40 or even 50 days. That extended duration is precisely what makes it so valuable.
What cycle mapping can reveal
For many women, the results are eye-opening. Cycle mapping can show whether ovulation is even occurring and, if not, how often cycles are anovulatory (when an egg is not released). It can reveal high oestrogen states, even in women who’ve been told they’re “low in oestrogen”. It often shows consistently low progesterone, particularly in the second half of the cycle.
This was the case with my test, as I had super-low progesterone throughout alongside heightened oestrogen as apparently my pituitary gland, in the brain, is screaming at my ovaries to release an egg but they’re not listening!
Crucially, it can also highlight when symptoms make sense hormonally. Anxiety before a period may coincide with a late oestrogen spike and absent progesterone rise. Poor sleep may line up with low progesterone metabolites or disrupted cortisol rhythm.
Why this matters for midlife women
Rather than guessing, you’re working with evidence. The years leading up to menopause can be messy. Many women are prescribed treatments based on assumptions that don’t reflect their actual physiology.
‘Having detailed hormone data allows for more personalised, targeted decisions. That might mean supporting progesterone rather than adding oestrogen. It might mean focusing on liver detoxification rather than hormone replacement.
‘It might mean addressing stress hormones or thyroid function alongside reproductive hormones,’ says Pippa, who has developed targeted supplements to help in these scenarios, such as Pippa Campbell Health Detox (£56.99) which contains the right balance of vitamins and minerals needed to optimise the detoxification process, and help combat tiredness, low mood, poor skin, brain fog, stomach upsets and headaches.
It also supports hormonal detoxing – from cortisol, oestrogen, progesterone and testosterone – as they need to be detoxified after your body has used them.
Detox support for your body is especially important if you’re on HRT, as it can put an extra burden on the liver. Also, if you drink alcohol, Pippa recommends taking four tablets within 30 minutes of the drink, another four after dinner and four the next morning with breakfast. Hormone testing isn’t about chasing perfect numbers or medicalising every symptom.
Used well, it’s a tool for understanding – one that can guide conversations with practitioners, inform lifestyle changes, and help women make decisions that feel grounded rather than reactive.
Katy’s experience…
‘I’m not always very good at being consistent when it comes to taking supplements or doing those small healthy habits on a daily basis, but I found I easily got into a routine of remembering to write on my little test strip each evening with the date, my details and the day of my cycle. I always wake up busting for a wee, and so would need to use the test ASAP and not faff around writing on it – and I didn’t want to do it and then forget to write on it later.
So this became my little ritual of preparing the paper every other night before bed. Then it’s so easy just to wee directly onto it, place it on the side of the sink to let it dry (not letting the paper touch anything of course, but they bend in a way that means they won’t) and then collecting them all up. I was advised to freeze a batch half way through to preserve them better and so did that.
I thought I would run out as my period hadn’t arrived by the time I was close to the end, and I’d requested some more strips to be sent out, but as luck would have it, my period arrived the day after I did my final one.
‘Finding out that my progesterone was super low was no surprise as it has been in the past. But it was interesting to see that I hadn’t ovulated in that cycle – this is indeed what happens in perimenopause when the ovaries don’t always release an egg each month. So, I know for sure I am in early perimenopause.
Pippa sent me some of her supplements, including Magnesium Complex (£42.99, pippacampbellhealth.com) to help with relaxation, as well as Chill (£51.99), also with magnesium but also L-Theanine and saffron to further aid relaxation and mood. I also took her Ener-Boost (£48.99) containing adaptogenic plant extracts with CoQ10 to promote energy, stamina and resilience, which are all needed in perimenopause.
Pippa also suggested I take DIM, short for diindolylmethane, which is found in cruciferous vegetables and which helps your body detox and modulate excess oestrogen, as mine was running high in the second half of my cycle.
‘It was such an in-depth report plus a follow up chat, and I’d recommend this to any woman wondering where she’s at in the menopause process, or struggling with symptoms she can’t quite get a handle on. Having a detailed look at what’s going on inside your body can really help steer you towards the best lifestyle support.’
Find out more about Dutch Test Cycle Mapping and supplements at pippacampbellhealth.com.
