DUTCH Cycle Mapping+ Plus maps the progesterone and estrogen pattern throughout the menstrual cycle. It also includes a comprehensive assessment of 35 different sex and adrenal hormones, including oestrogen, progesterone, testosterone, DHEA and cortisol along with their metabolites.
This test also looks at the overall diurnal pattern of free cortisol and cortisone along with a more in-depth assessment of the Cortisol Awakening Response (CAR). The oxidative stress marker 8-OHdG, melatonin and nine organic acids including markers for vitamin B12 (methylmalonate), vitamin B6 (kynurenate and xanthurenate), biotin (β-hydroxyisovalerate), glutathione (pyroglutamate), dopamine (homovanillate), norepinephrine/epinephrine (vanilmandelate), neuroinflammation (quinolinate) and tryptophan putrefaction (indican) are also included.
The Cortisol Awakening Response
When we wake in the morning and open our eyes, cortisol levels naturally begin to rise by an average of between 50-160% in the first 30 minutes after waking. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise of cortisol levels at waking, known as the Cortisol Awakening Response, can be used as a “mini stress test”. Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range.
DUTCH Cycle Mapping+ Plus provides the full picture of a woman’s cycle to answer important questions for patients with month-specific symptoms, infertility and hormone imbalances and is particularly useful when HPA axis dysregulation is suspected.
Nine targeted estrogen and progesterone measurements are taken throughout the cycle to characterise the follicular, ovulatory and luteal phases. The sample with the highest progesterone measurement will be used to assess the estrogen and progesterone metabolism. An additional 4 urine samples and 5 saliva samples are taken at the start of the next cycle for the assessment of the androgens and metabolites, adrenal hormone metabolites, free cortisol and cortisone daily patterns, cortisol awakening response and OATs.
For some women, testing reproductive hormones (progesterone, estrogen, etc.) on a single day is sufficient. In other scenarios, the clinical picture cannot be properly captured without “mapping” out the hormonal pattern throughout their menstrual cycle. The expected pattern of hormones shows relatively low estrogen levels early in the cycle, a surge around ovulation and modest levels in the latter third of the cycle (the luteal phase). Progesterone levels, on the other hand, stay relatively low until after ovulation. After ovulation, levels ideally increase (>10-fold) and then drop back down at the end of the cycle. A disruption in this cycle can lead to infertility or hormonal imbalance.
Estrogen and progesterone metabolites (a-pregnanediol and b-pregnanediol) for this profile are all tested (9x) by GC-MS/MS. Cortisol, cortisone, 8-OHdG, melatonin (6-OHMS), organic acid tests and metabolites related to cortisol are tested by LC-MS/MS.
When should I use
DUTCH Cycle Mapping+ Plus can help identify the root causes of sex hormone and adrenal imbalances in women is recommended when a closer assessment of the clinical picture is required of both the HPA Axis AND across the menstrual cycle, for example:
• Women struggling with infertility
• Women with cycling hormones and no menses
• Partial hysterectomy (ovaries intact but no uterus)
• Women with irregular cycles
• 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
• PMS, mid-cycle spotting, migraines, etc.
• Especially where HPA axis dysregulation is suspected
This test is not suitable for:
• Postmenopausal women
• Women on birth control
For postmenopausal women, women with cycles that follow the expected pattern or without cycle specific symptoms DUTCH Complete or Plus is sufficient.
Please note, DUTCH Cycle Mapping (code HOR33) is available as a standalone test or can be combined with DUTCH Complete (code HOR34) if the hormone metabolism and OATS are needed but the in-depth assessment of the cortisol awakening response is not.
DUTCH Cycle Mapping is also available with Adrenal (code HOR36) but this does not include the hormone metabolism or CAR.