Hormone Testing for Women: What to Test, When, and Why It Matters
Hormone testing is one of the most useful diagnostic tools in clinical nutrition, and one of the most misunderstood. A single blood test on the wrong day of the cycle can completely miss a hormonal imbalance. Understanding what to test, when to test it, and what the results actually mean transforms the clinical picture.
Why Standard GP Testing Often Misses the Problem
Standard GP hormone testing typically includes FSH, LH, oestradiol, and sometimes progesterone, ordered at a single time point. This approach has significant limitations:
• Hormones fluctuate dramatically across the menstrual cycle. A single result captures one moment, not a pattern.
• Blood testing measures total hormone levels, not free (bioavailable) hormone or downstream metabolites.
• Progesterone is often tested at day 21, but in irregular cycles this may not be the correct timing.
• Oestrogen metabolites, which are important for understanding oestrogen dominance and cancer risk, are not typically included.
• Cortisol dysfunction and adrenal status are rarely included in standard hormonal workups.
The DUTCH Test
The DUTCH (Dried Urine Test for Comprehensive Hormones) is the gold standard for comprehensive hormonal assessment in clinical nutrition practice [1]. It measures:
• Oestrone, oestradiol, and oestriol (the three oestrogen forms)
• Oestrogen metabolites (2-OH, 4-OH, 16-OH oestrogens) showing how oestrogen is being metabolised and cleared
• Progesterone metabolites
• Androgens (DHEA, testosterone, cortisone)
• Diurnal cortisol pattern (4 samples across the day)
• Cortisol metabolites (showing total cortisol production, not just secretion)
• Melatonin
• Organic acids including markers of B12, B6, and neurotransmitter metabolism
This level of detail is clinically invaluable for women with PMDD, perimenopause, oestrogen dominance, endometriosis, or unexplained hormonal symptoms.
Blood Testing: What to Ask For
For comprehensive blood hormone testing, relevant markers include:
• Oestradiol (day 3 for baseline; day 19-22 for luteal phase assessment in a 28-day cycle)
• Progesterone (7 days post-ovulation, ideally confirmed with LH tracking)
• FSH and LH (day 2-3 for ovarian reserve and menopausal status)
• SHBG (sex hormone binding globulin, affects free hormone availability)
• DHEA-S (adrenal androgen precursor)
• Free androgen index or free testosterone
• Thyroid panel: TSH, free T3, free T4, thyroid antibodies (TPO-Ab, TG-Ab)
• Prolactin (can disrupt reproductive hormones if elevated)
• Fasting insulin and glucose (insulin resistance drives androgen excess and PCOS)
Thyroid Testing
Thyroid dysfunction is the most commonly missed hormonal issue in women. TSH alone is insufficient. A full thyroid panel includes TSH, free T3, free T4, and antibody testing (to identify autoimmune Hashimoto's thyroiditis, which accounts for the majority of hypothyroidism in women). See the full article on thyroid health.
Timing Your Tests
Cycle day matters enormously for hormonal testing accuracy:
• Day 2-3: FSH, LH, oestradiol, anti-Mullerian hormone (ovarian reserve)
• Day 7: Post-menstrual baseline oestradiol
• Around ovulation (day 12-14 in a 28-day cycle): LH surge tracking, peak oestradiol
• 7 days post-ovulation: Progesterone (most important for luteal phase adequacy)
• Day 19-22: Second luteal phase oestradiol
For functional testing via DUTCH, the sample is typically collected in the mid-luteal phase (days 19-22 of a 28-day cycle).
Want clarity on what your hormones are actually doing?
Book a Clinical Case Assessment with Kirstie to talk through which tests are appropriate for your situation and how to interpret what you already have.
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References
• Stanczyk FZ, Clarke NJ. Measurement of estradiol challenges ahead. Journal of Clinical Endocrinology and Metabolism. 2014;99(1):56-58. PubMed
