Perimenopause Fatigue and the DUTCH Test

Fit, Healthy and Exhausted: why perimenopause isn’t always what it seems.

Being fit is not the same as feeling well. I was reminded of this recently by a patient whose story I’d like to share, with her permission, because so many women in their forties will recognise themselves in it.

The patient

She is a Fitness Instructor in her mid-forties, slender and very fit. She eats a quality, balanced omnivore diet of home-prepared meals and already takes sensible supplements such as vitamin D and magnesium. By any outward measure she was doing everything right.

She came to see me in the summer for support with perimenopause. Her periods were changing and she had signs that pointed towards oestrogen dominance: breast tenderness, irritability and broken sleep around the time of her period, and heart palpitations but fatigue was her main symptom. There was some stress in her life but nothing unusual, and no other obvious health concerns. To understand what was really going on, she chose to do a DUTCH test.

What is the DUTCH test?

The DUTCH test (Dried Urine Test for Comprehensive Hormones) is an advanced hormone profile done at home. You collect a few dried urine samples on filter paper over the course of a day and post them to the laboratory. Unlike a single blood test, it shows:

• your levels of oestrogen, progesterone and testosterone
• how your body is metabolising them, including whether oestrogen is being broken down along healthy or less favourable pathways
• your cortisol rhythm across the day, which shows how your adrenal glands and stress response are coping
• markers such as melatonin, which is relevant to sleep

That combination is what makes it so useful in perimenopause. Two women with identical symptoms can have quite different things driving them, and the treatment should tackle the precise cause rather than the symptom alone.

What we found

Her symptoms looked like oestrogen dominance, but the DUTCH test told otherwise. Her oestrogen was not excessive, and she was metabolising it in a healthy and reassuring way.

The real driver was low output from her adrenal glands. The hypothalamic-pituitary-adrenal (HPA) axis, which is the body’s stress-response system, had become down-regulated. This had a knock-on effect on the signals from the brain to the ovaries, so her ovaries were producing less oestrogen, progesterone and testosterone. Her body was adapting to sustained demand by turning down production, which is exactly what living systems do when their capacity to cope is stretched.

Without the test, the obvious approach would have been to treat oestrogen dominance. That would have missed the point entirely.

Her treatment

• A herbal adrenal tonic made up for her, built around adaptogenic herbs to support the stress-response system
• High-dose vitamin C, which the adrenal glands use in large amounts
• More protein, spread across three meals a day
• A small reduction in her weekly fitness class schedule, so her workload was more manageable

The outcome

Within one month she told me she felt “like her old self again”. Her energy and vitality had returned, she was no longer waking in the night, and the palpitations and breast tenderness had gone. She was delighted at how quickly she felt restored.

She will carry on with her herbal prescription and her higher protein intake for the next three months, so the improvement has time to properly bed in.

Why I’m sharing this

This is the heart of how I work. I look beneath the symptoms to find what is actually driving them, using testing where it adds clarity. Perimenopause is not one condition with one answer, and even very healthy, active women can find their body quietly running on empty.

If you are in your forties or fifties and feel that your energy, sleep or cycle has changed in ways you can’t explain, or you have been told that “it’s just your age”, I would be glad to help.

I offer DUTCH testing alongside a full herbal and nutritional consultation, at my clinic at The Broad Street Practice, Stamford. You can book an initial consultation using this link, or contact reception on 01780 480889 if you would like to contact me to talk through whether DUTCH testing is right for you.

Helen Shardlow MNIMH Medical Herbalist, Plant Medicine UK