Who Should Consider Urine Hormone Testing

Urine hormone testing can offer clarity when standard labs fall short. It’s especially valuable for women in midlife who are experiencing symptoms like:

• Persistent weight gain, particularly around the abdomen, hips, or thighs
• Sleep disruptions, night sweats, or chronic fatigue
• Mood changes, irritability, or anxiety
• Breast tenderness or bloating
• Menstrual changes or irregular cycles
• Poor results from BHRT, even after dosage adjustments

If your bloodwork is “normal” but your body tells a different story, this deeper level of testing may reveal the missing piece. It’s not about chasing more data — it’s about finding the right insight.

What Are Urinary Metabolites — and Why Do They Matter?

Unlike traditional blood tests, which offer a snapshot of hormone levels in the bloodstream, urine hormone testing looks at hormone metabolites — the compounds your body creates as it processes and breaks down hormones. These urinary metabolites reveal how your body is using, detoxifying, and clearing hormones like estrogen, progesterone, testosterone, cortisol, and DHEA.

This matters because many hormone-related symptoms aren’t due to how much hormone is present — but to how well your body is metabolizing it.

“When a patient’s bloodwork looks ‘normal’ but they still feel unwell, we often find the missing piece through urinary metabolites. This testing allows us to see not just hormone levels, but how the body is processing them — and whether something’s getting stuck in the detox or clearance pathways.”
— Dr. Delilah Renegar, DC, Medical Director of Functional Medicine and Hormone Health at Aligned Modern Health

How Advanced Urine Hormone Testing Works

Dried urine hormone testing is one of the most comprehensive ways to assess hormone balance, metabolism, and stress response. Unlike traditional blood tests—which capture only a single moment in time—this method collects urine samples throughout the day to reflect hormonal activity over a full 24-hour cycle.

This type of testing is completed at home using a convenient kit. Here’s what to expect:

• You’ll receive a test kit with simple, step-by-step instructions

• You’ll collect 4–5 dried urine samples at specific times over the course of one day

• The samples are mailed to a certified lab for analysis

• Your provider receives a detailed report showing hormone levels and their metabolites, including estrogen, progesterone, testosterone, cortisol, DHEA, and more

The result: a more complete and nuanced view of how your body produces, uses, and clears hormones—something that single blood draws often miss.

It Shows What Your Body Does With Hormones — Not Just the Levels

Blood tests measure total hormone levels at a single point in time. That can be useful — but it doesn’t capture the whole picture, especially during times of hormonal fluctuation like perimenopause.

Urine hormone testing provides insight into:

• How your body metabolizes estrogen — into protective or potentially harmful forms
• Whether your detox and methylation pathways are working efficiently
• How hormone levels shift over a full day — not just in one moment

This is especially valuable for women in midlife, whose hormone levels may still fall “within range” on bloodwork while their metabolism of those hormones is clearly dysfunctional.

It Detects Estrogen Dominance — Even If Estrogen Is Low

During perimenopause, progesterone often drops years before estrogen does, creating a relative estrogen dominance — even if estrogen levels are technically declining.

Urine testing helps uncover:

• Whether estrogen is being recycled and reabsorbed (a sign of poor clearance)
• If estrogen metabolites are accumulating in fat tissue
• If there’s a mismatch between estrogen and progesterone activity

These patterns often drive symptoms like bloating, breast tenderness, mood swings, and stubborn weight gain — even in women whose blood hormone levels look unremarkable.

It Explains Weight Gain That Doesn’t Respond to Diet or Exercise

Many women in perimenopause or menopause notice fat accumulating around the abdomen, hips, or thighs — even when they’re eating well and exercising consistently. Urine hormone testing helps explain why, by identifying:

• Estrogen metabolites that promote fat storage
• Elevated cortisol (especially at night), which increases menopause belly fat and disrupts sleep
• Low DHEA or testosterone, which reduces lean muscle and metabolic rate
• Sluggish detoxification pathways that prevent hormone clearance

With this information, we can stop guessing — and start creating a plan that’s tailored to your biology.

It Offers Direction — Not Just Data

The DUTCH hormone test isn’t just diagnostic — it’s strategic. It helps your care team determine where to intervene and how to support your body more effectively.

This might include:

• Supporting liver function (Phase I and II hormone metabolism)

• Reducing harmful estrogen metabolites while promoting protective ones

• Restoring progesterone or balancing androgens

• Adjusting BHRT (bioidentical hormone replacement therapy) if you’re already using it

• Addressing adrenal health and thyroid interplay

At Aligned Modern Health, we go beyond symptom management. We combine this testing with a whole-body approach — supporting your nutrition, sleep, stress response, and movement so you’re not just surviving midlife, but thriving in it.

Frequently Asked Questions

Is urine hormone testing more accurate than blood testing?
Not necessarily more accurate — but more informative. Urine tests provide insight into hormone metabolism and detoxification that blood tests don’t capture.

Can I take the DUTCH test on my own?
No. It’s a clinical tool meant to be interpreted by a licensed provider. This ensures your results are used to build a targeted, safe treatment plan.

Does insurance cover the DUTCH test?
Coverage varies. While many insurance plans don’t cover it, patients often find the investment worthwhile for the depth of insight it provides.

How long does it take to get results?
Most results are available within 10–14 business days after the lab receives your samples.

The Next Step to Feeling Like Yourself Again

If your lab results say everything is fine — but your body says otherwise — you deserve answers that go deeper. For many women in perimenopause or menopause, advanced testing like the DUTCH hormone test marks a turning point.

At Aligned Modern Health, we don’t settle for “normal” when you still feel off. We use urine hormone testing to uncover the why behind menopause weight gain, sleep problems, and stress overload — and help you create a care plan that works with your biology, not against it.

You don’t have to push through discomfort or accept symptoms as the price of aging. You can understand what’s happening — and take control of it.

Your Labs May Be “Normal.” But That Doesn’t Mean You’re Fine.

If you’ve been told everything looks normal, but you still don’t feel right — you’re not alone, and you’re not out of options.

Advanced testing like the DUTCH hormone test (a leading method of urine hormone testing) can bring clarity to what’s been missing. For many women, this is where everything starts to make sense — and where real, lasting solutions begin.

Whether you’re navigating perimenopause weight gain, frustrated by menopause belly fat, or looking for the best hormone test for women, this kind of in-depth testing can uncover what standard blood tests miss.

Read more about advanced hormone testing and who should consider it before starting — or reconsidering — hormone therapy.