Women deserve to have better answers as to what is happening in their bodies, and clarity about what they can do to resolve health issues, especially in regards to their menstrual cycle, fertility, perimenopause, and after menopause. 

Unfortunately, standard blood work does not show what can be found in a urine test, and yet urine testing for hormones, like estrogen and progesterone, is not available through a gynecologist or endocrinologist (at this time). 

That is exactly why I am proud to offer women access to a urine hormone test women can do from home, from most places around the world, and to information that can transform their health, including to help women clear HPV and prevent an abnormal Pap report. 

In this episode of How Humans Heal, I talk with Dr. Jaclyn Smeaton, Chief Medical Officer for Precision Analytical, the lab that offers the urine hormone test I recommend. Dr. Jaclyn is a naturopathic physician specializing in fertility, reproductive health, and genitourinary health. She has practiced for over 20 years.

Why Urine Hormone Testing Matters

When Dr. Jaclyn and I first trained as naturopathic doctors (over 20 years ago), urine hormone testing wasn’t available. Now a woman can do a test at home and get much more information than blood work gives us about estrogen, progesterone, testosterone, and DHEA. I want all women to know this testing exists and how it can help at every stage of life.

Jaclyn explained that DUTCH stands for dried urine test for comprehensive hormones, and it is comprehensive in two ways. 

First, it looks at several hormone systems: estrogen and progesterone, androgens, and cortisol and the HPA axis. 

Second, it measures metabolites. Sometimes the problem is at the tissue, where the body uses the hormone, and metabolites show us that.

Blood Testing Versus the DUTCH Test

Many women ask why they can’t just do blood work. You can do blood work for estradiol and progesterone, however, as Dr. Jaclyn explains, often blood results fall within the “normal” range while the patient clearly doesn’t feel normal. Blood tells you how much hormone is made, not how the body uses, metabolizes, or excretes it.

A blood test is also a single snapshot. The DUTCH test collects four samples in one day, capturing the highs and lows. Progesterone, for example, varies 20 to 30% over a day. We it is much more useful to look at urine levels that are collected over a 24 hour period.

How to Collect the Urine Samples

The test kit includes cards with a strip of paper on each. You pee on the strip of paper, or dip it in urine collected in a cup, let it dry for 24 hours, and mail it. In the lab, the urine is reconstituted from the paper. The lab accounts for changing urine concentration and has published peer-reviewed research on the accuracy of measuring from dried paper.

Why isn’t this standard in gynecology? Practice guidelines focus on very few hormones, and the main gynecology tool is the birth control pill, which overrides natural physiology, so they don’t need to know how your ovaries are functioning. 

With a functional or naturopathic approach, we want to identify the root cause of your symptoms, so we do want to know how your hormones are being metabolized and what may be affecting them.

Urine Cortisol Levels and the Hormone Pyramid

The complete DUTCH test includes diurnal cortisol levels, plus metabolites and conversion to cortisone. This information is important because the treatment differs depending on whether cortisol is too high or too low.

As someone who researches stress, I find cortisol testings, at four different times of day, to be instrumental in helping patients with a myriad of health issues, including high risk HPV.

Dr. Jaclyn described hormones as a pyramid: insulin, metabolic health, and cortisol at the base, then thyroid, with estrogen, progesterone, and testosterone at the top. If stress is a factor, lasting change is difficult. Stress is the most recognized cause of hypothalamic amenorrhea. The menstrual cycle is like a vital sign.

Understanding Your Estrogen Metabolites Makes a Difference

I use metabolites when helping women with fibroids, cramps, breast cysts, breast cancer risk, HPV, and abnormal pap smears. Estrogen and progesterone might look optimal, but metabolites show how well the liver is detoxifying estrogen.

Dr. Jaclyn described “estrogen dominance,” when women may experience breast tenderness, bloating, and heavy periods. Levels may look normal, but 16-hydroxy estrogen still binds the estrogen receptor and adds to the total estrogen load, which we can see with the DUTCH test.

Some women also don’t clear estrogen well. With estrogen detoxification there are 3 phases: phase 1, phase 2 (methylation), and phase 3 (elimination in the gut). If you treat phase 1 while methylation is poor, you create a backup at phase 2. 

It’s important to work with a practitioner who can help you to understand your results, your body, and to choose supplements, in a dose and sequence, that will help you most.

Testing Androgens and Help for PMOS

It may be surprising to learn that women have more testosterone than estrogen. The DUTCH test measures testosterone, the metabolites, and DHEA, which comes from the adrenals and is related to cortisol. 

Dr. Jaclyn highlighted 5-alpha-androstenediol, the best marker distinguishing women with or without PMOS or PCOS. Testosterone converts in the cell to DHT, three times stronger, which becomes 5-alpha-andro in urine. Women with acne, hirsutism, and hair loss often have normal blood testosterone, but their metabolites are high. Two women with PMOS can have completely different levels.

In perimenopause, symptoms can be vague, and the cause may be estrogen, progesterone, androgens, and/or cortisol. I recommend a DUTCH panel even in your 40s and yearly after to understand what is behind your symptoms and to how to address them. Women with a balanced HPA axis have fewer symptoms of menopause.

How the DUTCH Test Can Help with Hormone Therapy 

The researchers who linked estrogen to breast cancer (over 20 years ago), recently explained that they were incorrect. Actually, the slight increase in risk was due to synthetic progestins. 

Now we are in a resurgence of hormone therapy for women in peri and post menopause, using natural, bio-identical estradiol and progesterone instead of the synthetic forms. Beyond symptom relief, there are known benefits to bones, emerging evidence about protection from cardiovascular issues, and early data indicating protection for the brain.

Dose and delivery matters. Dr. Jaclyn shared that In Jarvinen’s 2001 study of 24 women, 30% didn’t absorb enough estrogen from a patch, gel, or both, unpredictably. A 2025 UK study of about 1,500 women found the same. Testing for estrogen levels can tell us whether the hormones are being absorbed.

Hot flashes resolve at 5 to 25 pg/mL in serum, bone protection starts around 60, osteoporosis may require a level of 250 to 300, and cardiovascular benefit is around 60 to 120. That means that resolving hot flashes alone may not be enough to protect from other health issues. You can’t just go by feeling better. 

Serum levels of estrogen are difficult to interpret when using daily gels or creams; patches can be tested at the patch midpoint. The DUTCH test looks at four collection times and gives an average, and they’ve published equivalency data in the Menopause Journal, so practitioners can use the DUTCH test to identify whether you have adequate estrogen doses (except if you use oral estrogen).

It is not possible to assess adequate progesterone doses based on a test (blood or urine). At this time, the recommendation is to use 100 or 200 mg (depending on your estrogen dose) of oral micronized progesterone daily for endometrial protection. 

Dr. Jaclyn recommends doing the DUTCH test before starting hormone therapy, retest 6 to 8 weeks later with the sex hormone panel, and then yearly to monitor your doses. Finding the right fit takes flexibility, so stick with it.

The DUTCH Panel Can Help with Fertility and HPV

The “complete” DUTCH panel includes organic acids, the “sprinkles on the sundae”: markers for B12, B6, glutathione, biotin, dopamine, melatonin, and 8-OHdG for oxidative stress. Rising 8-OHdG has led me to find mold, glyphosate, or methylation issues. It’s key for egg, sperm, and ovarian health.

This panel has helped many women clear HPV and abnormal cells to negative. Ovarian hormone imbalance, and estrogen detoxification issues, is one of the common susceptibilities to HPV I help women to identify and address. Your health is worth the investment.

The DUTCH test is available worldwide. Every sample returns to the LC-MS lab in McMinnville, Oregon. 

If you want to learn more about Dr. Jaclyn you can find her on Instagram @dr.jaclynsmeaton and @dutchtest. You can also learn more about the tests she offers here.

A Note from Dr. Doni

I want to add that I offer Precision Analytical testing through my office for patients and program participants. If you’d like to access the urine hormone test we’ve been discussing, please reach out. You can go to DoctorDoni.com to contact my team and to set up an initial one-on-one appointment with me. 

As a women’s health expert for over 26 years, I can help you with menstrual cycle related health issues, fertility, perimenopausal symptoms and menopausal symptoms, and hormone therapy. I work with patients in person and virtually, and since this is a test you do from home, we can help you to get access to it wherever you’re located.

I completely agree with Dr. Jaclyn that hormone testing needs to be comprehensive, and that we can’t just single out one hormone. To get the complete story, we need to look at estrogen, progesterone, testosterone, DHEA, and cortisol, along with the metabolites, so we can understand not just your hormone levels, but how well your body is metabolizing them.

I observe the most significant healing in my patients when they have this information, because it gives us clarity and takes away the guessing. Instead of giving everyone the same supplements, we can see exactly what your body needs, whether that’s support for cortisol, estrogen metabolism, methylation, and/or testosterone metabolism, or finding the right dose of hormone therapy for you. 

This approach can help with so many health issues, including PMS, painful menstrual cramps, fibroids, breast cysts, PMOS, hair loss, fertility, perimenopausal symptoms, postmenopausal symptoms, as well as HPV and abnormal Pap smear results.

When we do the DUTCH test, we might uncover methylation issues, estrogen metabolism issues, or oxidative stress that we weren’t aware of. And by addressing them, I’ve seen so many women clear HPV and abnormal cells to negative.

It turns out that stress affects all our hormones. Stress is the most recognized cause of hypothalamic amenorrhea, and women who are under less stress tend to experience fewer symptoms of perimenopause and menopause. Stress recovery helps with all of it.

That is exactly what inspired my book: Master Your Stress Reset Your Health. In the book, I explain how stress, toxins, and a lack of recovery can cause us to become stuck in “stress mode” and turn on our genetic susceptibilities, including how our bodies metabolize hormones.

I describe my research and identification of the 5 Stress Types®, which exemplify the most common responses to stress, and the Stress Recovery Protocol I developed that is unique to each Stress Type. Because if your cortisol is too high, we use a different approach than if it’s too low, and the Stress Recovery Protocol helps you optimize your cortisol and help your body recover from the stress it’s exposed to.

You can find out your Stress Type by taking the Stress Type® Quiz. It will help you understand how the stress you’ve been exposed to is impacting your health today, and how to use the Stress Recovery Protocol and C.A.R.E. Method to support your body and nervous system to heal using diet changes and natural approaches, including time in nature.

No matter what stage of life you are in – whether you’re having menstrual issues, working on fertility, dealing with high-risk HPV, going through perimenopause or post menopause, or using hormone therapy – this approach can help you improve your day-to-day health and feel better.

I offer the Precision Analytical DUTCH test through my office, both for one-on-one patients and for participants in my online Say Goodbye to HPV Program. If you would like to learn more about how I guide patients from around the world, please don’t hesitate to reach out to my office. Click here to set up a call with my team. 

Thank you, everyone, for listening in to How Humans Heal® and learning all about urine hormone testing with Dr. Jaclyn Smeaton. If you are new here, I welcome you to subscribe so you don’t miss the next episode.

I’m so glad to have you as part of this healing community.

Dr. Doni

Disclaimer: This specific article and all other Content, Products, and Services of this Website are NOT intended as, and must not be understood or construed as, medical care or advice, naturopathic medical care or advice, the practice of medicine, or the practice of counseling care, nor can it be understood or construed as providing any form of medical diagnosis, treatment,  natural HPV cure, or prevention of any disease.