Resolve Hormone Imbalances With Functional Lab Testing & BHRT
How Advanced Hormone, Nutrient, Toxin, and Gut Testing Personalizes Care for PCOS, Endometriosis, PMS, and Menopause
Hormonal imbalances are often at the root of persistent symptoms that disrupt daily life—but they are frequently misunderstood, oversimplified, or treated without identifying the underlying cause.
Irregular menstrual cycles, acne, weight changes, excess hair growth, and fertility challenges are commonly associated with conditions such as PCOS. Severe cramping, heavy bleeding, bloating, and pelvic pain may point toward endometriosis. PMS can present as mood swings, fatigue, headaches, and irritability. During perimenopause and menopause, many women experience hot flashes, night sweats, sleep disruption, memory changes, and shifts in mood or libido.
While these symptoms are often grouped together under the umbrella of “hormonal imbalance,” they rarely stem from a single hormone being too high or too low.
At Denver Sports & Holistic Medicine, we approach hormone concerns through a systems-based lens. Hormones are regulated through complex feedback loops involving the brain, adrenal system, liver, gut, nutrient status, detoxification capacity, and metabolic signaling. When one or more of these systems becomes dysregulated, hormone communication can break down—even when standard blood work appears “normal.”
This is why effective hormone care requires more than symptom-based treatment or basic lab testing. A personalized approach begins with advanced functional diagnostics that evaluate hormone production, metabolism, clearance, and regulation alongside key contributors such as nutrient deficiencies, toxic burden, and gut health.
This article explains how advanced functional lab testing—including hormone, nutrient, toxin, and gut assessments—helps identify the root causes of hormonal imbalance and guides personalized care for PCOS, endometriosis, PMS, perimenopause, and menopause.
→ Women’s Hormone & Fertility Support
Identifying Hormone Imbalances Beyond Symptoms with Lab Testing
When it comes to hormone health, symptoms alone rarely tell the full story.
Relying solely on symptoms to guide treatment can lead to incomplete assessments, trial-and-error interventions, or therapies that fail to address the true drivers of hormonal dysregulation. Symptoms such as painful or irregular periods, fatigue, brain fog, mood changes, weight gain, and hot flashes may signal a hormone imbalance—but they represent downstream effects, not the root cause.
Hormones function within an interconnected regulatory network involving the brain, adrenal system, liver, gut, metabolic pathways, and detoxification systems. Disruption anywhere along this network can alter hormone signaling, metabolism, or clearance—even when individual hormone levels appear “normal” on basic blood tests.
For a truly personalized and comprehensive approach to hormone care—especially when considering Bioidentical Hormone Replacement Therapy (BHRT)—it is essential to move beyond symptom-based decision-making and utilize advanced functional lab testing. These diagnostics allow us to evaluate not only hormone levels, but also how hormones are produced, metabolized, and eliminated, and how other physiological systems influence hormone balance.
By leveraging tools such as comprehensive hormone testing, micronutrient analysis, toxin assessments, and gut health testing, we gain critical insight into the internal patterns contributing to hormonal imbalance. This information forms the foundation for targeted, data-driven treatment plans designed to restore balance, improve resilience, and support long-term outcomes rather than temporary symptom relief.
The sections below outline the key functional medicine tests—beyond basic blood work—that are essential for accurately assessing hormone health and guiding personalized care prior to initiating BHRT.
→ Advanced Functional Lab Testing
DUTCH Test (Dried Urine Test for Comprehensive Hormones)
The DUTCH test is one of the most clinically comprehensive tools available for evaluating hormone production, metabolism, and clearance. Unlike standard blood tests—which provide a single-point snapshot—the DUTCH test assesses hormone patterns over time, offering a more physiologically accurate view of hormonal regulation.
By measuring hormones through dried urine samples, the DUTCH test reflects integrated hormone output across a full 24-hour period in postmenopausal women and across the full menstrual cycle in perimenopausal women. This allows for assessment of not only absolute hormone levels, but also daily rhythm, balance between hormones, and downstream metabolic pathways.
This level of analysis is particularly valuable for women with PCOS, endometriosis, PMS, or menopausal symptoms. In PCOS, for example, elevated androgen activity—especially dihydrotestosterone (DHT)—and disrupted estrogen metabolism are common contributors to symptoms such as acne, hair changes, cycle irregularity, and insulin resistance (1). In endometriosis, altered estrogen metabolism and estrogen dominance play a central role in disease progression and symptom severity (2).
Beyond measuring estrogen, progesterone, and testosterone, the DUTCH test evaluates how these hormones are metabolized and detoxified—information that is essential for identifying why imbalances persist and for reducing long-term risks associated with improper estrogen clearance.
The test also includes key markers such as cortisol, all three estrogen pathways, progesterone, testosterone, and hormone metabolites. Together, these markers provide a detailed picture of hormone synthesis, breakdown, and elimination, as well as insight into adrenal function and stress physiology. Because chronic stress can significantly alter both sex hormone balance and hormone metabolism, this adrenal data is critical for accurate interpretation and effective treatment planning.
This depth of information allows hormone care to be guided by patterns and physiology rather than isolated lab values, supporting precise, individualized decision-making—particularly when Bioidentical Hormone Replacement Therapy (BHRT) is being considered.
Hormone Testing with Mira: A Convenient and Accurate Approach to Hormonal Health
Mira provides a convenient way to track day-to-day hormone patterns at home, offering insight into cycle dynamics that cannot be captured by single-point laboratory testing alone.
Using urine-based testing, Mira monitors key reproductive hormones—including luteinizing hormone (LH), estrone-3-glucuronide (E3G), pregnanediol glucuronide (PdG), and follicle-stimulating hormone (FSH). This allows for identification of the fertile window, prediction and confirmation of ovulation, and observation of cycle variability over time.
When used alongside comprehensive laboratory testing such as the DUTCH test, Mira serves as a complementary tool rather than a diagnostic replacement. While functional lab testing provides in-depth information about hormone production, metabolism, and clearance, Mira adds longitudinal context by capturing daily fluctuations across multiple cycles.
This ongoing data can be particularly helpful for individuals navigating fertility planning, cycle irregularity, PMS, PCOS, endometriosis, or perimenopause. Tracking real-time hormone trends also allows practitioners to correlate symptoms with hormonal patterns and to assess how factors such as stress, sleep, nutrition, and lifestyle influence cycle physiology.
Used appropriately, Mira supports a more informed, data-driven understanding of menstrual and hormonal patterns between formal lab assessments, enhancing personalization without replacing comprehensive clinical evaluation.
Micronutrient Testing: The Foundation of Hormonal Health
Micronutrient deficiencies are a frequently overlooked contributor to hormonal imbalance. Vitamins and minerals are required at multiple levels of hormone physiology, including hormone synthesis, receptor signaling, enzymatic conversion, and metabolic clearance.
Clinical research shows that women with PMS commonly exhibit deficiencies in magnesium and B vitamins, nutrients that play a direct role in neurotransmitter balance, stress regulation, and progesterone support (3,4). In PCOS, deficiencies in zinc and chromium are more prevalent and can impair insulin sensitivity, androgen regulation, and ovarian signaling (5).
Medication use is another major driver of micronutrient depletion. Nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics can disrupt gut integrity and microbial balance, reducing nutrient absorption and increasing loss over time (6,7). Hormonal birth control is also well documented to deplete key nutrients, including folate, vitamins B2, B6, B12, vitamins C and E, and minerals such as magnesium, selenium, and zinc—nutrients essential for hormone metabolism and detoxification (8).
Because micronutrient insufficiency does not always produce obvious symptoms, deficiencies can persist unnoticed while contributing to cycle irregularity, fatigue, mood changes, impaired stress tolerance, and suboptimal response to hormone therapy.
Micronutrient testing allows for objective identification of these deficiencies and supports targeted repletion strategies tailored to individual needs. Correcting nutrient imbalances improves hormone regulation, supports metabolic and detoxification pathways, and enhances the effectiveness and safety of Bioidentical Hormone Replacement Therapy (BHRT) when it is clinically appropriate.
By ensuring that the body has the foundational nutrients required for proper hormone signaling and metabolism, micronutrient repletion helps address hormonal imbalance at its physiological roots rather than masking symptoms alone.
Toxins: The Hidden Disruptor
Environmental toxins are a major—and often underrecognized—driver of hormonal imbalance. Many chemicals encountered in daily life interfere with hormone signaling by mimicking natural hormones, blocking receptor activity, or altering hormone synthesis, metabolism, and clearance (9).
Because of this, evaluating toxic burden is a critical component of restoring hormone balance and safely personalizing Bioidentical Hormone Replacement Therapy (BHRT). Without addressing toxic interference, hormone therapy alone may be less effective or produce unpredictable results.
Endocrine-disrupting chemicals (EDCs) are widely present in plastics, pesticides, food packaging, cosmetics, and household products. These compounds can accumulate in tissues over time and disrupt estrogen, progesterone, androgen, and thyroid signaling. EDC exposure has been associated with increased risk of infertility, PCOS, endometriosis, and hormone-dependent cancers through mechanisms involving receptor disruption and altered estrogen metabolism (10,11).
Heavy metals—including lead, mercury, arsenic, cadmium, and aluminum—represent another significant source of endocrine disruption. Exposure can occur through contaminated water, food sources (particularly large fish), environmental pollution, dental materials, and certain medical products. These metals promote oxidative stress and inflammation while interfering with estrogen and progesterone balance, impairing the body’s ability to regulate hormones effectively (12).
Proper estrogen metabolism depends on well-functioning detoxification pathways in the liver, gut, and lymphatic system. Hormonal imbalance can arise when these pathways are overwhelmed or impaired due to genetic and epigenetic factors, nutrient deficiencies, toxic overload, gut dysfunction, oxidative stress, or chronic inflammation (13).
Targeted toxin testing allows for identification of specific exposures and informs individualized detoxification strategies. When implemented thoughtfully, detoxification protocols—combined with dietary adjustments, environmental modifications, and appropriate lifestyle support—can reduce toxic burden, improve estrogen clearance, and enhance hormonal resilience.
Because mobilizing toxins without adequate elimination support can worsen symptoms, detoxification should be guided by a qualified practitioner. Under clinical supervision, detox strategies can be implemented safely and progressively, minimizing the risk of adverse reactions while supporting hormone regulation and improving long-term outcomes of BHRT.
→ Detoxification & Environmental Medicine
Gut Health and Estrogen Metabolism
Gut health plays a central role in hormone regulation, particularly in the metabolism and elimination of estrogen. While estrogen is processed in the liver, it is ultimately excreted through the gastrointestinal tract. When gut function is impaired, this elimination process can be disrupted, contributing to estrogen recirculation and estrogen dominance (14).
This imbalance is especially relevant in conditions such as endometriosis and PMS, where excess or poorly cleared estrogen is a known driver of symptom severity and disease progression (15).
Disruptions within the gut—such as dysbiosis (imbalanced gut microbiota), increased intestinal permeability, chronic inflammation, or fungal overgrowth—can interfere with normal estrogen metabolism. An altered gut microbiome may increase beta-glucuronidase activity, an enzyme that promotes reabsorption of estrogen rather than elimination, further exacerbating hormonal imbalance (16).
Comprehensive gut testing allows for identification of these underlying disturbances, providing insight into microbial balance, inflammatory markers, digestive capacity, and detoxification support. Addressing gut health through targeted dietary strategies, microbiome-supportive interventions, and individualized supplementation can improve estrogen clearance, reduce inflammatory burden, and support more stable hormone regulation.
Optimizing gut function is therefore not a standalone goal, but a foundational component of restoring hormonal balance—particularly when addressing estrogen-driven conditions or supporting the effectiveness and safety of hormone-based therapies.
Choosing the Right Partner for Precision Hormone Care
When hormone imbalances are complex, long-standing, or involve multiple systems, outcomes depend not only on what therapies are used, but on how accurately the underlying drivers are identified, interpreted, and monitored over time. This is especially critical when considering Bioidentical Hormone Replacement Therapy (BHRT), where precision and context matter.
Effective hormone care requires more than matching symptoms to hormones. It demands clinical expertise in hormone physiology, metabolism, detoxification, nutrient status, stress regulation, and gut–liver signaling, along with the ability to interpret patterns across multiple data points rather than relying on isolated lab values.
A hormone-literate, integrative practitioner works from a data-driven, individualized framework—using comprehensive testing, clinical correlation, and ongoing reassessment to guide decisions. This approach prioritizes understanding why hormones are dysregulated, how different systems interact, and when hormone therapy is appropriate, rather than defaulting to standardized protocols or symptom suppression.
When hormone care is guided by this level of clinical insight, treatment can be adapted as physiology changes over time—supporting both short-term symptom relief and long-term hormonal stability.
What Matters Most in Advanced Hormone Care
When selecting a provider to guide Bioidentical Hormone Replacement Therapy (BHRT) and long-term hormone restoration, outcomes depend on more than credentials or treatment availability. The quality of care is defined by how hormones are evaluated, interpreted, and monitored over time.
When selecting a provider to guide BHRT and hormone restoration, look for the following:
Diagnostic Depth
Hormone health cannot be accurately assessed with basic blood work alone. A qualified provider should utilize advanced functional testing—such as comprehensive hormone analysis, micronutrient assessment, toxin screening, and gut health evaluation—to understand hormone production, metabolism, clearance, and receptor signaling. Without this depth, treatment decisions are often incomplete or misdirected.
Clinical Precision
Hormone therapy should be guided by physiological patterns, ratios, and downstream effects rather than standardized dosing protocols. Precision in interpretation helps reduce side effects, improves symptom resolution, and supports long-term safety—particularly when hormone therapy is introduced into an already complex system.
Ongoing Monitoring and Adaptation
Hormonal needs change with stress exposure, aging, metabolic shifts, and life transitions. Effective care includes regular reassessment, thoughtful interpretation of follow-up testing, and adjustments over time. Static treatment plans fail to account for the dynamic nature of hormone regulation and often limit long-term success.
Restoring Hormone Balance Through Personalized, Root-Cause Care
Hormonal imbalances affect far more than reproductive function. They influence energy, mood, cognition, metabolic health, immune regulation, and long-term disease risk—often in ways that extend well beyond what conventional testing captures.
Whether navigating PCOS, endometriosis, PMS, perimenopause, or menopause, sustainable improvement depends on identifying why hormones are dysregulated and addressing the contributing factors at their source rather than treating symptoms in isolation.
By combining advanced functional lab testing with individualized treatment strategies—including Bioidentical Hormone Replacement Therapy (BHRT) when appropriate, targeted nutrient repletion, detoxification support, gut restoration, and lifestyle optimization—it is possible to restore balance and resilience across the entire hormonal system.
Dr. Martina Sturm works closely with each patient to develop a comprehensive, data-driven plan designed to support both short-term symptom relief and long-term hormonal stability within a root-cause, systems-based framework.
You may request a free 15-minute consultation with Dr. Martina Sturm to review your health concerns and outline appropriate next steps within a root-cause, systems-based framework.
Frequently Asked Questions About Hormone Imbalance Testing, BHRT, and Personalized Care
Why don’t basic blood tests show the full picture of hormone imbalance?
Basic blood tests measure hormone levels at a single moment in time and typically assess only a narrow set of hormones. They do not account for daily fluctuations, hormone rhythms, or how hormones are being metabolized and cleared from the body. Many people have “normal” blood results while still experiencing significant symptoms because the issue lies in hormone processing, balance between hormones, or downstream effects rather than absolute levels alone.
What is the DUTCH test and why is it important for hormone health?
The DUTCH test (Dried Urine Test for Comprehensive Hormones) provides a more complete assessment of hormone health by measuring sex hormones, cortisol, and hormone metabolites over a full cycle or a 24-hour period. This allows insight into how hormones are produced, converted, and eliminated. It is especially valuable for identifying patterns such as estrogen dominance, impaired estrogen detoxification, androgen excess, or stress-related hormone disruption that are often missed with standard testing.
How does the Mira system support hormone tracking between lab tests?
Mira allows for at-home, daily monitoring of key reproductive hormones such as LH, E3G, PdG, and FSH. This continuous data helps reveal cycle patterns, ovulation timing, and hormone variability over time. When used alongside comprehensive lab testing, Mira adds real-world context by showing how hormones fluctuate day to day and how lifestyle factors like stress, sleep, or nutrition may influence cycle physiology.
Why is micronutrient testing important for balancing hormones?
Hormone production, signaling, and metabolism depend on adequate levels of specific vitamins and minerals. Deficiencies in nutrients such as magnesium, B vitamins, zinc, or chromium can impair hormone synthesis, insulin regulation, stress response, and detoxification pathways. Micronutrient testing identifies deficiencies that may not be apparent through symptoms alone, allowing for targeted correction that supports more stable hormone regulation and improves overall treatment outcomes.
How do environmental toxins interfere with hormone balance?
Many environmental chemicals act as endocrine disruptors, meaning they can mimic, block, or alter natural hormone signaling. These exposures—commonly found in plastics, pesticides, cosmetics, and contaminated food or water—can interfere with estrogen, progesterone, androgen, and thyroid pathways. Heavy metals can further contribute to oxidative stress and inflammation, making it harder for the body to regulate and clear hormones effectively.
What does gut health have to do with estrogen metabolism?
Estrogen is metabolized by the liver and eliminated through the digestive tract. When gut health is compromised—due to dysbiosis, inflammation, increased intestinal permeability, or fungal overgrowth—estrogen can be reabsorbed rather than eliminated. This process can contribute to estrogen dominance, which is commonly associated with symptoms such as heavy periods, PMS, breast tenderness, and endometriosis. Supporting gut function is therefore an important component of hormone balance.
What is BHRT and how is it different from conventional hormone therapy?
Bioidentical Hormone Replacement Therapy (BHRT) uses hormones that are chemically identical to those produced by the human body. Unlike conventional hormone therapies that often use synthetic or structurally altered hormones, BHRT is designed to more closely match natural physiology. When guided by advanced testing and careful monitoring, BHRT can be used to restore balance while minimizing unwanted effects.
Why does working with a hormone-literate practitioner matter?
Hormones do not function in isolation. A hormone-literate practitioner evaluates symptoms alongside advanced testing, metabolic patterns, detoxification capacity, nutrient status, and stress physiology. This systems-based approach allows care to be adjusted over time as the body changes, rather than relying on static treatment plans. Ongoing interpretation and reassessment are key to achieving safe, effective, and sustainable hormone balance.
Resources
PMC – Androgen Excess and Polycystic Ovary Syndrome
PMC – Estrogen Receptors and Endometriosis
PMC – Dietary B Vitamin Intake and Incident Premenstrual Syndrome
PMC – Evaluating the Effect of Magnesium and Magnesium Plus Vitamin B6 Supplement on the Severity of Premenstrual Syndrome
PMC – The Impact of Mineral Supplementation on Polycystic Ovary Syndrome
PMC – NSAID–Gut Microbiota Interactions
PMC – Antibiotics as Major Disruptors of Gut Microbiota
PubMed – Oral Contraceptives and Changes in Nutritional Requirements
PMC – Endocrine-Disrupting Chemicals and Human Health
PMC – Endocrine Disruptors and Female Reproductive Health
PMC – Environmental Exposure to Endocrine Disrupting Chemicals and Risk of Gynecological Disorders
PMC – Heavy Metals and Female Reproductive Toxicity
PMC – Estrogen Metabolism and Detoxification Pathways
PMC – Gut Microbiota and Estrogen Metabolism
PMC – The Estrobolome and Its Impact on Estrogen Regulation
PMC – Gut Dysbiosis, Estrogen Dominance, and Hormone-Related Disease