Hormone Testing vs. Saliva Hormone Testing vs. DUTCH (Dried Urine) – which option to choose?

Menopause is marked by hormonal changes that can lead to various symptoms and health implications. Several types of hormone testing are available to evaluate these changes, with serum (blood), saliva, and DUTCH testing being the most commonly considered. Each method has its own advantages and limitations, and the right choice depends on the context and goals of testing.

Serum Hormone Testing:

Serum hormone testing involves analysing hormone levels in blood samples. It is commonly used in clinical settings for diagnosing menopause and assessing hormone levels. Benefits of serum hormone testing include:

1. Widespread Clinical Use: Serum hormone testing is a widely accepted and established method employed in Australian medical practices, making it readily accessible and familiar to healthcare professionals.

2. Comprehensive Hormone Assessment: Blood samples offer a comprehensive analysis of multiple hormones, including the regulatory hormones follicle-stimulating hormone (FSH) and luteinising hormone (LH). Rising FSH levels are often one of the first indicators of approaching menopause or diminishing ovarian reserve, and thus together with oestradiol and progesterone, provide a comprehensive picture of hormonal changes associated with menopause. LH and FSH levels cannot be tested via saliva or DUTCH.

3. Established Reference Ranges: Serum hormone testing has established reference ranges, making it easier to interpret results and identify deviations from normal levels.

Saliva Hormone Testing:

Saliva hormone testing involves measuring hormone levels in saliva samples. Although less commonly used in clinical settings, saliva testing offers specific advantages:

1. Non-Invasive and Easy Sampling: Saliva collection is non-invasive and can be done at home, which increases convenience for patients. It eliminates the need for a blood draw, making it appealing to individuals uncomfortable with needles.

2. Reflects Active Hormone Levels: Saliva hormone testing measures the levels of unbound, biologically active hormones. This can have advantages as it provides insights into the hormones readily available for physiological functions and hormone-related symptoms even when total levels appear normal.

3. Hormonal Balance Evaluation: Saliva testing allows for assessment of the balance between hormones, such as the ratio of oestradiol to progesterone. For patients on bioidentical hormone therapy, especially creams or gels, saliva testing may be better suited to assess the actual absorbed (active) hormone levels. This can provide additional insights into hormonal imbalances contributing to menopausal symptoms.

DUTCH Testing (Dried Urine Test for Comprehensive Hormones):

DUTCH testing is an advanced hormone test that analyses dried urine samples over 24 hours to assess sex and adrenal hormones, including their metabolites. It combines many of the benefits of both serum and saliva testing, with added insights. Key benefits of DUTCH testing:

1. Comprehensive Hormone and Metabolite Analysis: DUTCH provides a detailed profile of oestrogen, progesterone, testosterone, DHEA, and cortisol—plus their metabolites. This reveals how hormones are processed and eliminated, not just how much is present.

2. Adrenal and Circadian Rhythm Insights: By measuring cortisol and cortisone throughout the day, DUTCH gives a clearer picture of adrenal health and stress response—something neither blood nor saliva alone can fully capture.

3. Convenient and Non-Invasive: Like saliva testing, it is done at home and requires no blood draw, making it user-friendly.

4. Best for Complex Symptom Cases: DUTCH is particularly helpful for women experiencing complex or persistent symptoms (e.g. fatigue, mood swings, sleep issues, irregular periods) when standard testing doesn’t offer clear answers.

Which method is right for me?

Serum hormone testing is best for diagnosing menopause or assessing fertility status, particularly when FSH, LH, or a broader health workup is needed. It’s the gold standard in conventional medical settings. If you are experiencing symptoms such as irregular periods, weight gain, skin changes, mood swings, hot flushes, anxiety, fatigue, or even symptoms like brain fog or low libido, it may be time to check your hormones. i-screen’s Female Hormone Check focuses on key sex hormones and is suitable if you want to assess ovulation, cycle timing, or confirm menopause.

For a more comprehensive picture—especially if you're over 35 or experiencing symptoms that could also be linked to thyroid, adrenal, or metabolic imbalances — the Hormone Imbalance Check (female) is recommended. This panel includes sex hormones as well as cortisol, DHEA-S, thyroid function, insulin, and IGF-1, offering broader insight into what may be driving hormonal symptoms. Note these tests are not appropriate if you are taking oral contraceptives.

Saliva hormone testing can be useful for symptom-based monitoring, especially in patients using topical hormone therapy or those wanting to explore bioavailable hormones. If you are experiencing mood swings, sleep disturbances, or low libido but blood tests have not indicated an imbalance, then i-screen’s Female Hormone Check (saliva) or Female Hormone 28 Day Check (saliva) may provide a more helpful view of hormone balance at either a point in time or across a 28 day period respectively.

DUTCH testing is ideal for a deeper investigation of hormonal imbalances, particularly in perimenopause or when adrenal health is also in question. It provides the most complete picture but is typically used in functional or integrative health settings. DUTCH is particularly useful when symptoms like fatigue, anxiety, brain fog, or persistent hormonal imbalance are present despite normal blood test results. i-screen's Advanced DUTCH Check

When a woman suspects she may be in perimenopause, it is important to have a comprehensive medical evaluation. Diagnosis often comes from a combination of menstrual history, symptoms, and physical changes, not hormone levels alone. Hormone testing can support the picture—but no test should be used in isolation to diagnose perimenopause.