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As the chemical messengers of the body, hormones rule all. Constant stress added to decreasing sex hormones from aging cause the body to shift out of balance and send adrenal glands into overdrive. 

The majority of perimenopausal (pre-menopause) women I see are exhausted and burned out from juggling family, work, and life challenges. My patients experience symptoms of PMS, irritability, decreased sex drive, fatigue, anxiety, brain fog, depression, weight gain, and bloating. To get to the root cause of the symptoms, I use a variety of tests. The Salivary Cortisol Awakening Test is a mini stress test for insomnia concerns, the Serum Hormone Blood Test measures endogenous hormones, and the Thyroid Hormone Serum Test checks thyroid functions, since it is our master thermostat control. 

My go-to test is the DUTCH (Dried Urine Test for Comprehensive Hormones), which give the most in-depth look at sex hormone metabolism (estrone, estriol, testosterone, progesterone), cortisol rhythm fluctuation (cortisol, cortisone), and adrenal stress concerns (Vitamin B markers, melatonin, oxidative stress markers).

The DUTCH test is easy; simply (1) Dip strips of filtered paper into your urine (four to five times throughout the day), (2) Let strips dry, and (3) Mail them off. 

This simple home test has been a great tool to assess sex hormone imbalance in patients at all stages of their reproductive life. Based on the results, we practice precision medicine and targeted treatments to effectively help reduce symptoms and rebalance hormones. Here’s a breakdown of what it all means.


Age: 50-year-old 
Last menstrual cycle: 18 months ago
Symptoms: fatigue, brain fog, difficulty losing weight, bloating, low libido, poor sleep 


Hormones are chemicals that “make things happen”.  Hormone fluctuations cause mood changes and overall body composition. SUPERMOM’s results show that she is below the Postmenopausal Range for Estradiol (1) and Progesterone (2). Her numbers are lower than I would expect from a woman who entered menopause recently. SUPERMOM’s rapid Estrogen decline may account for her mood swings, decreased libido, sparse hair growth, painful intercourse, dryness of skin, a decrease in bone mineral density, and weight gain. While Progesterone normally has a calming effect on the brain, the fluctuations may be responsible for her difficulty sleeping and mood changes. SUPERMOM’s Testosterone (3) while not significantly low is starting to decrease. Testosterone helps her with sleep, sense of wellbeing, vitality, increasing muscle mass and libido.

After measuring five points throughout the day (waking, 30 minutes after waking, 60 minutes after waking, afternoon, and night), SUPERMOM’s Saliva Free Cortisol Pattern (4) values are significantly above the “High Range Limit.” Typically, numbers fall somewhere between the “Low Range Limit” and “High Range Limit.” SUPERMOM’s values are in pink and significantly above the high range. With a  Cortisol Awakening Response  320% higher than expected, SUPERMOM is what I call “wired and tired.” She is anxious from the moment she wakes up and unable to sleep at night.


To improve sleep quality we chose to supplement with sustained-release melatonin and L-theanine/magnesium.

Based on nutrition testing deficiencies, we initiated fish oil, Vitamin D, and an adrenal support complex daily to improve the adrenal stress response.

With a normal mammogram and PAP study, we felt comfortable trialing a low dose of DHEA. We began estrogen cream replacement therapy, balancing with a low dosage of oral progesterone for improved sleep quality.

In addition to supplements, we focused on self-love and nurturing. SUPERMOM took a 2-week break from “exercise”, and instead focused on “movement”. We made changes to SUPERMOM’s nutrition, focusing on healthy fats, proteins, and veggies and limiting her sugar, alcohol, wheat, and dairy. Instead of hitting snooze, she listens to daily calm meditation for 10 minutes. SUPERMOM is feeling a bit more SUPER these days.

Do SUPERMOM’s symptoms sound like you? It’s time to start feeling better! Complete your free 15-minute strategy call with Dr. Del Negro and start your journey to REDISCOVER WELLNESS.

Robyn C. Del Negro, MD, a board-certified physician, has been practicing conventional-based western medicine since 1993. She completed a post-MD multi-year fellowship at the Andrew Weil Center for Integrative Medicine and received specialty training with the Institute of Functional Medicine. Dr. Del Negro loves empowering her community to embrace healthy behaviors and optimize wellness.