Dr. Amy Nett: It probably was information uploaded from a DUTCH profile. Yeah, I don’t remember exactly either.
As you know, normally estrogen is the dominant hormone for the first two weeks leading up to ovulation. The first two weeks is the follicular phase, and we expect to see estrogen high. But then estrogen is balanced by progesterone, and progesterone becomes the dominant hormone during the last two weeks, or the luteal phase. We’re not really going to go into hormone testing during this initial ADAPT course, but you do the DUTCH Complete Hormone Profile a certain number of days after ovulation so that it’s clearly done in the luteal phase, and we use the reference ranges. Preferably, if patients can time it appropriately, we’re using the reference ranges a certain number of days after ovulation when progesterone should be the dominant hormone. Estrogen dominance is going to be characterized by relatively more estrogen than progesterone during that luteal phase, so that’s what the profile is. So when you’re looking at that DUTCH hormone test, you’re going to see much more estrogen than progesterone, and you don’t even need to have high estrogen levels to have an estrogen-dominant situation. Estrogen dominance can also just be if you have very low progesterone, similarly, so it’s all about the ratio, the relative estrogen-to-progesterone ratio.
Then you asked if I always test for that or if I ever make assumptions. No, I don’t make assumptions because the symptoms for estrogen dominance can be anything from PMS, bloating, breast swelling, breast tenderness, decreased libido, insomnia, headaches. Some people even think low thyroid function with cold hands, cold feet, hair loss, those can also potentially sometimes be reported as symptoms of estrogen dominance. So I’ve sort of stopped trying to use symptoms to determine what the test results are going to show me. We almost always do a complete hormone profile on any new patients who come into the clinic so that we can get a good sense of what the hormone profiles look like, so I would never try to just guess, like, “Oh, I think your symptoms are due to estrogen dominance.” You can, if you have a pretty clear picture, but I prefer to look to get a sense of what’s going on, especially if I’m going to recommend a therapeutic intervention like doing vitex … or, sorry, that would raise progesterone even further, but if I’m going to do DIM to lower estrogens.
Laura is asking, “So what about blood testing for progesterone and estrogen on day 21?” Yeah, you could do that. That would be the same thing, right? You’re looking for higher progesterone to estrogen. I think you can calculate a ratio for that. I almost always do the DUTCH testing, so I don’t know that ratio off the top of my head, but I think you can calculate the ratio based on … for a normal cycle, I think it would be days 20 to 21, and it would be roughly, I think, six days after ovulation. If it’s an irregular cycle, you might have to adjust the day that it’s done relative to ovulation, but that’s the same idea. That’s exactly what we’re looking for, around day 20 to 21. You can either do blood testing, or we happen to do the dried urine test because you get more information. But if you’re just following up on that, then you can just do the blood testing. That’s a perfectly good way to assess whether or not there’s estrogen dominance.