DUTCH test - anyone had one done?

[Magnoliabuttons]

I'm 41 and was prescribed HRT recently, mainly for horrific mood symptoms in the second half of my cycle. Also low libido, reduced vulval health/sensation, sleep problems.

3 months in, I've got mixed results. Libido and vulval health much better (hurray!) mood during second half of the month still a massive problem (suicidal thoughts etc, awful)

I've seen the DUTCH urine test advertised, but it seems quite new so there's not masses of info about it yet - has anyone had this done, and if so did it help you figure things out?

This is the first I have heard about it but would also be interested to hear how anyone has got on!

@Magnoliabuttons If your HRT isn't working, the next step is a review.

What are you using and what dose?

If you are using micronised progesterone the first step is to consider a different progestogen. Micronised progesterone is known to give side effects of low mood.

One simple option if you're using gel is to try increasing the dose of gel during the 2nd half of each cycle.

Other options apart from micronised progesterone are tablets like Femoston, or patches, or the Mirena coil.

The Dutch tests are meaningless. It's pseudo science- for £500!
I have HRT privately from a consultant (used it for over 15 years) and have never had a blood test for hormone levels as they are not accurate.
A urine test will ( the Dutch test) not help at all.If they were helpful, they would be on offer privately, and they aren't - for good reason.

Talk to your GP about what to try next and if they cant help ask for a referral to a specialist.

Oh @JinglingSpringbells. I’ve been thinking about you. You gave me great advice a couple of years ago.

I cannot take micronised progesterone in any form. I’ve tried vaginally, I’ve tried 2 weeks out of 12. I decided to “suck it up” but I cannot. It devastates me. Doctor says there is no alternative to uterogestan. In the past mirena also caused deep depression.

I will investigate non micronised progesterone. Need to get into booking a review with GP. Next step is to go private but I doubt they can access different progesterone to my GP?

Next step is to go private but I doubt they can access different progesterone to my GP?

@RobinEllacotStrike There are no different drugs but your GP may not be aware of all the options.

There is guidance by the British Menopause Society and part of that advice is that tablet form HRT is still suitable for many women who can't tolerate micronised progesterone.

The closest to body identical is Femoston (tablet).
You could also try patches (Norethisterone is the progestogen in those.)
Or tablets like Kliofem.

They are not body-identical so it depends how you feel about that.

You can also use 3x the daily dose of the mini pill as a progestogen.

These are some options your GP needs to a) be aware of and b) offer you!

Thank you for your kind reply and for confirming the Dutch test is garbage!

I’m on 25mg estrodot patches
and prescribed 200mg urtrogestan through second half of cycle - but I’m only taking 100mg as I found the 200mg made me feel sedated and horrifically depressed, worse than before HRT!

The 100mg is ok, but I know I’m under dosing and not sure if I’m getting protective benefits at this level.

I don’t really want a mirena coil as I had awfully heavy, ten-day painful periods years ago with one, so am scared of that happening again.

@Magnoliabuttons Not surprised you feel rough on such a low dose patch.
Many women your age are often on 50/75 /100 patches.
Why are you on such a low dose???

The starting dose with gel is the equivalent of a 50mcg patch.

Ok that’s interesting, thank you

I wonder if the doctor was being cautious because I get aura migraines? She is a migraine specialist GP, alongside her menopause work. (I went private and had a 1 hour consult and we really went through everything)

I had barely had an aura migraine for a few years before HRT, then the first week I started on the estrogen I got 3 in a row - they tend to last 12-24 hours in total, so it was awful!

Things settled after that, so I continued. Then interestingly this week (3 months later) I started Estriol cream (on day 18 of cycle so guessed natural estrogen going down) for the first time and bam: severe aura migraine after 2 days.

I seem to be super sensitive to the increase in estrogen?

Thank you for your perspective, I’m hugely grateful! X

You may find it easier to use estrogen gel rather than a patch because you can control the dose more easily- ie 1.5 pumps rather than a jump from a 25 to 50mcg patch (which is the same as 2 pumps of gel.)

It's highly unlikely using vaginal estrogen gave an uplift in estrogen as it's 100th of a daily dose of HRT (0.1%0 and is not absorbed by your system.

Thank you so much @JinglingSpringbells

ive screenshot that and will hopefully get to see doc this week.

🙏🏼🙏🏼🙏🏼🙏🏼💜

OP I also started on a super low oestrogen dose for similar reasons. I have found increasing it to a 50 patch has made the ultrogestan section of the cycle much more tolerable.

Quick update, 4 months in and HRT is a massive success for me - depressive thoughts gone, much more energy, love for my family, better libido, headaches calmed down.

I feel balanced throughout the month with far less significant shifts

I’ve just progressed to 75 mg estrogen, and still on 200mg Urtrogestan for the second half of the month. This is working wonderfully for me now

I’m glad I stuck with it. thanks everyone for the advice x