If you’re struggling issues such as:
- irregular periods
- heavy, painful periods
- fertility issues
- severe PMS symptoms (mood swings, irritability, tender breasts, cramping)
- fatigue or sleep issues
- low libido
…it’s likely due to hormonal issues. Hormones are used as a means of communicating throughout the body to give the body direction or tell it to do something. Insulin, for example, helps the body regulate glucose levels by letting glucose into cells. Hormones are messengers or signals and when there are hormonal issues, it’s usually a sign that your body is trying to tell you something.
Best thing to do is to test, not guess.
There are a number of lab tests you can do to collect data about your cycle and fertility health. These are the most popular ones I order and analyze for my clients.
DUTCH Complete or DUTCH Cycle Mapping
DUTCH tests are one of my favorites because they provide a deep dive into overall cycle health by measuring a variety or hormones and hormone metabolites (compounds after the body has processed the hormones). DUTCH tests are not invasive and do not require a blood draw as everything is measured via urine collection.
The DUTCH test(s) measure(s):
- estrogen (sex hormone)
- progesterone metabolites (sex hormone)
- DHEA (androgen hormone)
- testosterone (sex hormone)
- androstenedione (androgen hormone)
- cortisol (stress hormone)
- melatonin (sleep hormone)
- organic acids (measure a variety of things such as: neurotransmitter metabolites, oxidative stress, and nutrient levels)
The two most frequent DUTCH tests I order are called DUTCH Complete or DUTCH Cycle Mapping and Complete bundle. Both tests include everything listed above but the DUTCH Cycle Mapping has you collect over the course of your entire cycle so it allows you to see the where in your cycle you have estrogen peaks and how much progesterone was released and how long it was sustained. This allows us to see 1) if you ovulated, 2) when in that cycle you ovulated, and 3) the quality of that ovulation.
Everything is connected within the body – hormone systems, reproductive systems, digestive systems, etc. DUTCH results can clue us in to other things that need attention. Certain patterns of hormone levels can tell us whether the thyroid may be playing role or whether the gut needs to be looked into further.
Full thyroid panel + antibodies
Thyroid plays a major role in fertility and pregnancy so if you have symptoms such as brain fog, fatigue, sensitivity to cold or temperature changes, heavy periods, frequent and large clots during your period, or fertility issues, it’s a good idea to get a full thyroid panel.
As opposed to simply measuring TSH (thyroid-stimulating hormone), a full thyroid panel includes TSH, free and total T4, free and total T3, reverse T3, and thyroid antibodies (anti-TPO and anti-TG). A full thyroid panel gives you a complete picture of thyroid function and can clue you in to whether your thyroid is contributing to your fertility issues.
Vitamin D
Vitamin D plays a crucial role in fertility and pregnancy and is a very common nutrient deficiency. Having your vitamin D checked provides you a baseline that you can then work from. If you’re deficient, you’ll want to work with a healthcare professional to increase your levels and be re-checked after 3 months to see how they’ve improved.
Fasting insulin and glucose
Your ovaries are responsive to insulin. When there’s too much insulin present in the blood (hyperinsulinemia), it can contribute to interruptions in ovulation. Having insulin and glucose measured together allows you to determine if you’re insulin resistant. Having insulin resistance can increase your risk of developing Type II diabetes and gestational diabetes during pregnancy. Learning ways to manage insulin resistance prior to getting pregnant can help regulate cycles and help you go on to have a healthy pregnancy.
Hemoglobin A1c
Hemoglobin A1c is a 3-month average of your blood glucose levels. This value goes hand-in-hand with fasting insulin and glucose and can be used in the diagnosis of diabetes.
Anemia panel
Iron deficiency is the most common nutrient deficiency in our country. Iron is needed to transport oxygen in the blood and is crucial to the proper growth and development of a fetus. Checking your iron status can help identify an issue that can be remedied prior to getting pregnant and reduce the risk of complications developing. Anemia panels should include serum iron, ferritin, transferrin, total iron binding capacity, and sometimes folate and B12 levels.
Variety of fertility hormones (AMH, FSH, LH, estradiol, progesterone)
AMH or anti-Muellerian Hormone is a measurement of ovarian reserve. AMH should be measured along with other fertility hormones to provide an overall picture of fertility health. FSH and LH are hormones released to initiate ovulation. Estradiol is a major sex hormone also released to initiate ovulation (among many other roles). Progesterone is the hormone released after ovulation and can be used to determine if you ovulated and the quality of that ovulation.
Prolactin
Prolactin is the hormone released in the highest amounts during lactation/breastfeeding. However, certain conditions can increase levels (hyperprolactinemia) and can cause amenhorrea and ultimately lead to infertility. If your cycles are sporadic or infrequent or missing, getting prolactin levels measured is important to rule out as a cause.
hs-CRP
C-reactive protein (hs = high sensitivity) is a measure of inflammation. Research has shown that women with unexplained infertility and diminished ovarian reserve had higher levels of circulating CRP compared to women with normal ovarian reserve. Measuring CRP along with an anemia panel can help determine what role (if any) inflammation may be playing in iron status.
Gut microbiome
You’re probably wondering what your gut has to do with your fertility. But as I mentioned earlier in this post, your gut is connected to the way you metabolize and process hormones, which can contribute to cycle health or cycle interruptions. Doing an in-depth stool analysis can give you an overview of your microbiome (or a breakdown of the organisms that live in your gut such as parasites, fungi, beneficial bacteria, opportunistic bacteria, protozoa, as well as general digestive health). If you have digestive issues, this is one way to potentially determine a root cause and have a protocol developed to help relieve you of those problems.
