Biomarkers

Progesterone Metabolites (Urine) – DUTCH — Interpretation of DUTCH test (Dried Urine Test) from Precision Analytics (PART 1)

If you are having trouble trying to understand your DUTCH test results, here are some helpful information on how to read the test and how to understand it.

DUTCH test interpretation progesterone a-pregnanediol b-pregnanediol

Progesterone Metabolites (Urine) – DUTCH

Progesterone is a very important hormone marker for overall cycle health.

Progesterone is only secreted in abundance after ovulation.

Progesterone helps balance the effects of estrogens.

Knowing whether a woman reaches healthy progesterone levels in the luteal phase is key to understanding her physical and emotional well-being, as well as her fertility.

Why measure metabolites?

Since very little parent progesterone hormone is present in urine, measurement of its metabolites is used to estimate progesterone present in circulation.

With urinary progesterone metabolites, the result reflects an average of her hormone production since her last urination. A serum or saliva sample only shows a progesterone level for a specific moment in time. A single urine result is an improvement on a single serum result, because it covers a longer span of time.

Progesterone gets metabolized primarily down two pathways, creating a 5a-pregnanediol and 5b-pregnanediol metabolite. Both metabolites have been shown to correlate to serum values.

Each pathway (alpha and beta) represents about half of the progesterone being produced. One woman may heavily prefer the alpha pathway while another may push more heavily down the beta pathway.

Women with PCOS, for example, tend to push testosterone down the alpha pathway towards the more potent DHT. These women will also tend to push progesterone down its alpha pathway.

Patients with hypothyroidism, on the other hand, tend to push much more heavily down the beta pathway. Reporting both major progesterone pathways provides the most accurate hormonal representation.

a-Pregnanediol (luteal range)

A healthy result should fall into the range 200 – 740 ng/mg.

This test measures pregnanediol, a metabolite of progesterone. It is used in the evaluation and decision making in women who are having difficulty becoming pregnant or maintaining a pregnancy. It is also used to monitor “high-risk” pregnancies.

Urinary pregnanediol is measured to evaluate progesterone production by the ovaries and placenta. The main effect of progesterone is on the endometrium. It initiates the secretory phase of the endometrium in anticipation of implantation of a fertilized ovum.

Usually, progesterone is secreted by the ovarian corpus luteum after ovulation. Both serum progesterone levels and urine concentration of progesterone metabolites (pregnanediol and others) are significantly increased during the second half of an ovulatory cycle.

Pregnanediol is the most easily measured metabolite of progesterone. Because pregnanediol levels rise rapidly after ovulation, this study is useful in checking whether ovulation has occurred and, if so, exactly when. During pregnancy, pregnanediol levels normally rise because of placental production of progesterone. Repeated testing can be used to monitor the status of the placenta in women who have difficulty becoming pregnant or maintaining a pregnancy. Repeated testing can also be used to monitor the status of the placenta in high-risk pregnancy. Hormone testing for urinary pregnanediol are primarily used to monitor progesterone supplementation in patients with an inadequate luteal phase to maintain an early pregnancy. Urinary assays may be supplemented by plasma testing, which are quicker and more accurate.

Various normal ranges*:

  • Luteal (premenopausal) Range: 200 – 740 ng/mg
  • Postmenopausal Range: 15-50 ng/mg
  • Follicular Range: 25-100 ng/mg
  • Ovulatory Range: 25-100 ng/mg
  • Oral Progesterone (100mg) – Range: 580 – 3000 ng/mg
  • Male Range: 20 – 130 ng/mg

*the Luteal Range is the premenopausal range. When patients are taking oral progesterone this range for progesterone metabolites is not luteal and reflects the higher levels expected when patients take oral progesterone. This test is intended to be taken in the luteal phase of the menstrual cycle (days 19-22 of a 28 day cycle) for premenopausal women.

References:

– Lobo RA. Reproductive endocrinology: neuroendocrinology, gonadotropins, sex steroids, prostaglandins, ovulation, menstruation, hormone assay. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 4.

– Lehmann HP, Henry JB. SI units. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia, Pa: Saunders Elsevier; 2006:appendix 5.

What does it mean if your a-Pregnanediol (luteal range) result is too low?

Low or low-normal levels of pregnanediol signal less than optimal progesterone. This commonly results in an increase in symptoms occurring in the luteal phase. In the perimenopausal years, progesterone levels tend to fall faster than estrogens, resulting in a relative estrogen dominance. Botanicals or supplemental progesterone can be useful for managing symptoms. Low levels are commonly associated with sleep disturbances, anxiety, stress, and edema.

In postmenopausal women the level of pregnanediol is expected to be much lower than in premenopausal women with optimal luteal ovarian function.

Possible causes of low levels:

– Progesterone is made by the placenta during pregnancy. Pregnanediol is a metabolite of progesterone, which is decreased when placental viability is threatened.

– Ovarian neoplasm: Ovarian epithelial cancers can destroy functional ovarian tissue. Progesterone levels may decrease.

– Amenorrhea, Ovarian hypofunction: Without ovulation, a corpus luteum will not develop. Progesterone will not be secreted, and progesterone and pregnanediol levels will be lower than expected.

What does it mean if your a-Pregnanediol (luteal range) result is too high?

 

– Ovulation: Ovulation occurs with development of a corpus luteum, which makes progesterone. Pregnanediol is a metabolite of progesterone.

– Pregnancy: A healthy placenta produces progesterone. Pregnanediol is a metabolite of progesterone.

– Molar pregnancy: Hydatidiform mole can produce progesterone, although at lower levels than during pregnancy.

– Luteal cysts of ovary: The corpus luteum produces progesterone in the nonpregnant woman and in the early stages of pregnancy. Cysts can also produce progesterone for prolonged periods of time. Pregnanediol is a metabolite of progesterone.

– Arrhenoblastoma of ovary: This tumor can secrete sex hormones or their metabolites (usually testosterone). 17-Hydroxyprogesterone is a precursor of sex hormones. Pregnanediol is a metabolite of progesterone.

– Hyperadrenocorticism, Adrenocortical hyperplasia: Adrenal cortical hormones are secreted at increased rates. 17-Hydroxyprogesterone is a precursor of these cortical hormones. Pregnanediol is a metabolite of progesterone.

– Choriocarcinoma of ovary: This tumor produces progesterone.

b-Pregnanediol (luteal range)

A healthy result should fall into the range 600 – 2000 ng/mg.

Pregnanediol is a metabolite of the molecule of progesterone, which is important for fertility and for menstruation. Pregnanediol levels increase after ovulation and when the placenta releases the hormone.

When pregnanediol levels fall during a menstrual cycle, it means that progesterone levels are less than ideal. It results in symptoms during the luteal phase.

During the adaptation of the body to menopause, progesterone levels fall and estrogen dominance begins. That’s when progesterone supplements may be offered to manage the symptoms. Some of the symptoms include hot flashes, vaginal dryness, mood instability, low sex drive, sleep problems, brain fog, hair loss, loss of muscle mass and strength, weight gain and anxiety.

Various normal ranges*:

  • Luteal (premenopausal) Range: 600 – 2000 ng/mg
  • Postmenopausal Range: 60-200 ng/mg
  • Follicular Range: 100-300 ng/mg
  • Ovulatory Range: 100-300 ng/mg
  • Oral Progesterone (100mg) – Range: 2000-9000 ng/mg

*the Luteal Range is the premenopausal range. When patients are taking oral progesterone this range for progesterone metabolites is not luteal and reflects the higher levels expected when patients take oral progesterone. This test is intended to be taken in the luteal phase of the menstrual cycle (days 19-22 of a 28 day cycle) for premenopausal women.

Sources:

  1. http://www.labtesthelp.com/test/Pregnanediol
  2. http://meridianvalleylab.com/wp-content/uploads/2016/06/Urine-Hormone-Interp-Guide.pdf
  3. https://www.gdx.net/product/complete-hormones-test-urine

What does it mean if your b-Pregnanediol (luteal range) result is too low?

You can have low levels of pregnanediol as well as high levels.

Low levels of pregnanediol are associated with any of the following:

– Breast or ovarian cancer

– Pre-eclampsia (high blood pressure during pregnancy)

– When a mother is carrying a baby that is dead

– When the placenta fails

– When menstruation stops

– Sleep disturbances

– Anxiety and stress

– Edema or swelling in the body

What does it mean if your b-Pregnanediol (luteal range) result is too high?

 

High levels of pregnanediol are associated with the following:

– Breast or ovarian cancer

– Adrenal gland dysfunction

– High levels of oral progesterone

 

For more information on the DUTCH test, please visit our website at HealthMatters.io

 

Disclaimer:

Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you.

The information on healthmatters.io is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

 

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