If you’re already on body-identical hormone replacement therapy (HRT) or thinking about starting, you might be wondering: “Can I even do a DUTCH hormone test while I’m on estrogen or progesterone?”
The short answer is: Yes, you can.
The DUTCH test can be used while you’re on body-identical estrogen and progesterone, and it’s an excellent tool for understanding how your body is responding — not just in terms of levels, but also how you’re metabolising and clearing those hormones.
Monitoring HRT with the DUTCH hormone Test
I can’t prescribe hormones myself — that’s your GP or specialist’s role — but I can help you understand your results, see how your body is processing hormones, and guide you in asking the right questions so you can make informed decisions with your doctor.
HRT is more openly discussed now than it was a decade ago. Many doctors are far more open to prescribing it, and women are more informed. But there’s still a lot of confusion — especially in perimenopause — about whether it’s needed, how it should be monitored, and the differences between body-identical and synthetic forms.
Hormone Replacement Therapy (HRT) can be life-changing for the right person, but it’s not a “one-size-fits-all” solution. I see women thrive on it — and I see women struggle. One of the most important lessons from my clinic is this: it’s not just about being on HRT, it’s about being on the right HRT, at the right dose, and for the right reasons.
This is where the DUTCH hormone test becomes invaluable. Unlike standard blood tests, the DUTCH test provides a detailed look at hormone levels and how your body is metabolising them. This matters not only for symptom relief but also for long-term health and safety.
Why testing matters before and during HRT
Menopause and perimenopause can bring a mix of symptoms: hot flushes, sleep disturbance, mood changes, low libido, brain fog, joint pain, weight changes, and more. It’s tempting to assume low estrogen or progesterone is always to blame — but it’s not that simple.
In perimenopause especially, estrogen can fluctuate wildly. You might have low-estrogen days, but you can also have surges that make symptoms worse. Giving estrogen without understanding your baseline can tip you into estrogen dominance — which can fuel heavy bleeding, breast tenderness, headaches, and mood swings.
The DUTCH test helps by showing:
- Estrogen and progesterone levels: (and whether your symptoms are truly from low estrogen)
- Estrogen metabolism pathways: (2-OH, 4-OH, 16-OH)
- Androgen levels and metabolism: (important for hair changes, acne, libido)
- Cortisol rhythm and clearance rate: (how well your body processes stress hormones)
- Nutritional and inflammation markers: that may influence hormone balance
Body-identical vs synthetic HRT
When I talk about HRT in my practice, I’m referring to body-identical hormones — forms of estrogen and progesterone that are chemically identical to what your body produces. They are very different from synthetic hormones such as conjugated equine estrogens or synthetic progestins, which can act differently in the body and carry different risk profiles.
That said, even body-identical hormones need monitoring. For example:
- If estrogen metabolism favours the 4-OH pathway, there may be a higher risk of DNA damage and certain hormone-related cancers if left unaddressed.
- If clearance is slow, estrogen may accumulate in tissues and worsen symptoms.
Knowing this before starting HRT means we can support detoxification pathways (liver, gut, antioxidant status) before and during therapy.
The role of adrenal and liver health in HRT success
From what I see in clinic, HRT works best when the whole hormone environment is supported — not just the hormones you’re taking. Your adrenals and liver are two big players here.
The adrenals are your built-in stress-response system. If they’re under strain from chronic stress, poor sleep, or illness, you may not respond to HRT as well as expected. In some cases, cortisol issues can mimic low-estrogen symptoms, so supporting adrenal resilience first — with nutrition, lifestyle, and targeted supplements — can make a huge difference.
The liver is where much of your hormone metabolism happens. Once you take estrogen or progesterone, your liver processes it into metabolites, which are then excreted through the gut and urine. If liver function is sluggish — whether from nutrient deficiencies, inflammation, alcohol, certain medications, or poor detox capacity — you might not clear hormones efficiently. This can leave you with higher-than-needed circulating levels or an unfavourable balance of estrogen metabolites (such as the more damaging 4-OH form).
And here’s where genetics comes into play. Some women have variations in detox enzymes (like COMT, CYP1B1, CYP1A1) that influence how quickly or slowly they metabolise hormones. This is why two women on the same HRT dose can feel completely different — one might metabolise estrogen too quickly and feel underdosed, while another might process it too slowly and develop estrogen-dominant symptoms.
Lifestyle factors matter too. Inflammation, insulin resistance, and gut health can all shift hormone pathways. For example, chronic inflammation can increase aromatase activity — the enzyme that converts androgens into estrogens — potentially pushing estrogen higher. Insulin resistance can influence androgen metabolism and worsen symptoms like weight gain, fatigue, and skin changes.
The beauty of the DUTCH test is that it captures this whole picture: Monitoring HRT with the DUTCH hormone test, not just hormone levels, but also how your body processes them. That means we can personalise your plan — whether it’s adjusting HRT dose, supporting detox pathways, fine-tuning nutrition, or addressing stress and inflammation.
Real-world examples from my clinic
Over the years, I’ve supported many women navigating HRT. Every case is different, but here are a few examples:
- A postmenopausal woman on estrogen: She was prescribed two pumps of body-identical estrogen, but her DUTCH test showed her levels were still borderline low. We discussed her results, supported her adrenals, and she went back to her GP feeling confident about asking whether a slightly higher dose could help her remaining low-estrogen symptoms
- A woman who felt amazing on HRT at first… until she didn’t: After COVID, she experienced fatigue, weight gain, and was prescribed estrogen for what seemed like low-estrogen symptoms. She felt better for a short time but soon started feeling worse. Her DUTCH test showed very high estrogen, and a thyroid panel confirmed Hashimoto’s with high antibodies. This changed her treatment direction completely.
- A perimenopausal client with heavy, painful periods from endometriosis and adenomyosis: Her symptoms improved with a Mirena IUD, but after illness and COVID, she developed symptoms that looked like low estrogen. Her GP prescribed three pumps of estrogen, but she started experiencing pain and worsening symptoms. When we looked at her case, it didn’t fit the “low estrogen” picture. She reduced her dose and eventually stopped HRT, and her symptoms improved.
- A woman thriving on HRT but with a hidden risk: Her symptoms were well controlled on estrogen, but her DUTCH test showed she was metabolising estrogen down the 4-OH pathway. With a family history of breast cancer, this was a red flag. We worked on supporting her detox pathways while she stayed on HRT under medical supervision.
- A client on “combined HRT” who didn’t realise it wasn’t body-identical: She was on bioidentical estrogen but a synthetic progestin. She didn’t sleep well, had anxiety, and had no idea what she was actually taking. We discussed switching to body-identical progesterone with her GP. Once she changed, her sleep improved, anxiety reduced, and she finally felt informed and empowered about her treatment.
Perimenopause: why HRT isn’t always the answer
Perimenopause is a unique hormonal landscape. Estrogen doesn’t simply “decline” — it fluctuates, sometimes going from high to low in the space of days. Adding more estrogen in this stage can actually make some symptoms worse.
When I work with perimenopausal women, I start by looking at adrenal function and the body’s ability to adapt to these hormonal shifts. The adrenals take on a bigger role in producing hormones during this stage, so if they’re under stress or fatigued, symptoms can be magnified.
My first steps are usually to:
- Support adrenal resilience with targeted nutrition and lifestyle changes
- Introduce phytoestrogen-rich foods (like flax, sesame, legumes) to gently balance estrogen activity
- Optimise diet for blood sugar stability, gut health, and liver detoxification
In many cases, symptoms improve significantly just by addressing these foundations. If there’s still no improvement after these steps—and testing confirms low estrogen—then it may be time to consider HRT alongside your doctor.
The take-home message
HRT can be life-changing for the right woman, at the right time, in the right dose—but it’s not a one-size-fits-all solution. The DUTCH test helps you and your doctor:
- See how your body metabolises hormones (especially important for breast and endometrial health)
- Check whether your current dose is working for you
- Identify other hormone imbalances that may be contributing to symptoms
- Guide supportive nutrition and lifestyle strategies alongside medical treatment
If you’re already on HRT or considering it, testing can help you take a more informed, personalised approach. You’ll feel more confident in your choices and in the conversations you have with your GP.
Disclaimer: This article is for educational purposes only and does not replace medical advice. Always discuss any changes to your medication, supplements, or HRT with your healthcare provider.
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