Female Cortisol Awakening Response (CAR) Saliva Test
Wake Up Exhausted, Feel Tense in the Morning or Struggle to Wind Down at Night?
If your energy, alertness or stress-related symptoms change throughout the day, one morning cortisol measurement may not provide enough information.
This detailed at-home profile measures cortisol six times:
- Upon waking
- 30 minutes after waking
- 60 minutes after waking
- Before lunch
- Before dinner
- Before bed
It also measures DHEAS, providing seven results from six saliva samples.
Your ZRT Laboratory report shows how your cortisol changes during the first hour after waking and across the rest of the day. It includes numerical results, reference ranges, a visual daily graph and individualised hormone-specialist comments explaining the findings and suggesting possible next steps.
£219 — laboratory analysis and specialist laboratory comments included
- Three carefully timed measurements during the first hour after waking
- Three additional measurements across the day
- DHEAS measurement included
- Full visual cortisol curve
- Collect at home without needles or a clinic appointment
- Hormone-specialist interpretation included
- Normally reported within 3–5 working days after the laboratory receives your samples
Is This Test Right for Me?
This profile may be suitable if your main concerns include:
- Waking exhausted or unrefreshed
- Feeling tense, restless or overwhelmed immediately after waking
- Persistent tiredness or low energy
- Midday or afternoon changes in energy
- Difficulty becoming alert in the morning
- Difficulty winding down before bed
- Poor sleep or waking during the night
- Racing thoughts at bedtime
- Reduced motivation or difficulty concentrating
- Poor recovery after exercise
- Changes in wellbeing during periods of sustained pressure
- Fatigue or sleep concerns occurring alongside PMS, perimenopause or menopause
- Wanting a more detailed assessment after a simpler cortisol test
- Wanting to review DHEAS alongside your daily cortisol results
Notice when your symptoms occur. Are mornings consistently difficult? Does your energy drop at a particular time? Do you feel more alert late at night? Recording these patterns gives the laboratory and your healthcare professional useful context.
These symptoms can have several possible causes. This profile measures cortisol and DHEAS; it does not establish the definitive cause of tiredness, sleep problems, menstrual symptoms or changes in wellbeing.
What Will My Results Help Me Understand?
1. See What Happens During Your First Hour Awake
The first three samples are collected upon waking and 30 and 60 minutes later.
Benefit: Instead of receiving one isolated morning result, you can see how your measured cortisol changes during the first hour of your day.
Your specialist laboratory comments explain whether the observed change is consistent with the laboratory’s expected awakening pattern and highlight any measurements that deserve attention.
2. See How Cortisol Changes Across the Day
The remaining samples are collected before lunch, before dinner and before bed.
Benefit: You can see whether your cortisol measurements become lower as the day progresses or whether a particular result falls outside its time-specific reference range.
This may provide useful information when discussing:
- Morning tiredness
- Midday or afternoon energy changes
- Evening restlessness
- Difficulty winding down
- Night waking or disturbed sleep
3. Review Your DHEAS Result
DHEAS is produced mainly by the adrenal glands and is involved in the production of other steroid hormones.
Benefit: Measuring DHEAS adds another result for your healthcare professional to consider alongside your cortisol pattern, age, symptoms, menstrual or menopausal status, medicines and hormone treatments.
4. Understand Your Results in Context
Your report includes individualised hormone-specialist laboratory comments based on your measurements and the information recorded on your requisition form.
Benefit: You receive more than an unexplained graph. The comments may:
- Describe the observed awakening response
- Explain results that are above or below their applicable ranges
- Comment on how cortisol changes across the day
- Consider your DHEAS result alongside your age
- Refer to relevant symptoms or treatments recorded on your form
- Suggest areas to discuss with your healthcare professional
- Indicate whether further investigation may be useful
5. Create a Baseline for Future Comparison
Your report records all seven results and the exact collection times.
Benefit: If repeat testing is appropriate, you have a detailed baseline for comparing future measurements after changes to sleep, workload, lifestyle or clinical care.
What Will My Report Include?
Your ZRT Laboratory report includes:
- Six individual cortisol results
- One DHEAS result
- Time-specific laboratory reference ranges
- Clear high and low result indicators
- A visual graph showing your cortisol measurements across the day
- A separate visual presentation of your DHEAS result
- Your recorded collection dates and times
- Relevant medicines and hormone treatments reported on your form
- Your menstrual status and reported symptoms, where applicable
- Individualised hormone-specialist laboratory comments
- Suggested considerations or next steps based on the findings
The report comments can explain the shape of your measured cortisol awakening response and how your later results compare with the expected daily pattern.
The specialist interpretation is included within your ZRT Laboratory report. There is no separate Hormone Lab UK specialist report.
View a Sample Cortisol Awakening Response Report.
What Does the Test Measure?
| Result | What it helps you see |
|---|---|
| Cortisol upon waking | Your starting cortisol measurement immediately after waking |
| Cortisol 30 minutes after waking | How your cortisol changes during the early awakening period |
| Cortisol 60 minutes after waking | How the response develops during the remainder of the first hour |
| Cortisol before lunch | Your cortisol measurement around midday |
| Cortisol before dinner | Your measurement later in the day |
| Cortisol before bed | Your cortisol level as you approach sleep |
| DHEAS | An additional measure of adrenal hormone production to consider alongside cortisol |
The six cortisol measurements show both the first-hour awakening response and the wider daily pattern.
What Is the Cortisol Awakening Response?
The cortisol awakening response describes the change in cortisol that commonly occurs during the period immediately after waking.
Cortisol often rises during the early part of this period and subsequently becomes lower as the day progresses. The size and timing of this change can vary between individuals and may be influenced by collection timing, sleep schedules and other personal factors.
A single morning sample shows the cortisol concentration at one moment. Three carefully timed samples show how the measurement changes over the first hour.
This profile then adds three later measurements, allowing the morning response to be viewed within the wider daily cortisol pattern.
Test Details
Test ID: S-122
Sample type: Saliva
Markers reported: 7 — six cortisol results and one DHEAS result
Samples required: 6
Testing method: ECLIA
Laboratory: ZRT Laboratory — CLIA-certified
Hormone specialist interpretation: Included within the laboratory report
Suitable for: Adults and children able to provide the required saliva volume
Collection: At home — no clinic visit required
Laboratory reporting time: Normally 3–5 working days after the laboratory receives your samples
Kit validity: Use within 12 months of purchase
What Is Included?
Your purchase includes:
- At-home saliva collection kit
- Six saliva collection tubes
- Test Requisition Form
- Detailed timed-collection instructions
- Laboratory analysis of six cortisol measurements
- Laboratory analysis of DHEAS
- Time-specific reference-range comparisons
- High and low result indicators
- Visual daily cortisol graph
- DHEAS result graph
- Individualised hormone-specialist laboratory comments
- Suggested next steps or considerations
- Digital ZRT Laboratory report
- Laboratory analysis fee
Return postage to the laboratory is arranged and paid for separately by the customer.
How It Works
1. Choose Your Collection Day
This cortisol and DHEAS profile can be collected on any day of your menstrual cycle.
Choose a day that reflects the routine you want to assess. If you use hormone treatment or corticosteroid medication, follow the treatment-specific instructions before choosing your collection day.
2. Prepare the Night Before
Lay out and number the six collection tubes. Write your name on each tube and keep the first three beside your bed.
Stay normally hydrated, but avoid drinking excessive amounts.
3. Collect Three Morning Samples
Start the first sample immediately upon waking, ideally before getting out of bed.
Collect the second and third samples at the specified 30- and 60-minute intervals. Accurate timing is important because these samples show how your cortisol changes during the first hour.
4. Collect Three Later Samples
Collect the remaining samples:
- Immediately before lunch
- Immediately before dinner
- Immediately before bed
Record the actual collection time on every tube.
5. Send Your Samples
Complete the Test Requisition Form and return all six labelled samples using the supplied packaging and return instructions.
6. Receive Your Explained Results
Your report is normally issued by email within 3–5 working days after the laboratory receives your samples.
Kit delivery and return-postage time are separate from this laboratory reporting period.
Which Cortisol Test Should I Choose?
| What do you want to understand? | Suggested test |
|---|---|
| Is my cortisol within the expected range shortly after waking? | Female Morning Saliva Cortisol Test |
| How does my cortisol change from morning to bedtime? | Female All Day Cortisol Test |
| How does my daily cortisol pattern compare alongside DHEAS? | Female Adrenal Stress Saliva Test |
| How does cortisol change during my first hour awake and throughout the rest of the day, alongside DHEAS? | Female Cortisol Awakening Response Test |
Choose this CAR test if your main question concerns both:
- What happens to cortisol during the first hour after waking; and
- How your measured cortisol changes during the remainder of the day.
If you only need a morning result or a simpler morning-to-bedtime profile, one of the other options may be more suitable.
Preparing for Your Test
Accurate collection timing is particularly important for this profile.
Before Starting
- Choose a day that represents the routine you want to assess.
- Stay normally hydrated the night before without drinking excessive amounts.
- Number the six tubes from 1 to 6.
- Record all medicines, supplements and hormone treatments on the Test Requisition Form.
First Three Samples
- Begin tube 1 immediately upon waking, ideally before getting out of bed.
- Start tube 2 at 30 minutes from the first sample’s start time.
- Start tube 3 at 60 minutes from the first sample’s start time.
- Do not eat or brush your teeth until all three samples are complete.
- Drink only water during this period.
- Record the actual collection time on each tube.
Later Samples
Collect tubes 4, 5 and 6 immediately before lunch, dinner and bed.
For at least two hours before each later sample:
- Do not eat
- Drink only water
- Do not brush your teeth
Handling Your Samples
- Fill every tube at least halfway, excluding bubbles.
- Label each tube with your name, collection date and collection time.
- Keep the completed samples refrigerated or frozen as directed.
- Freeze the samples if they will not be posted within 24 hours.
Read the full Cortisol Awakening Response Collection Instructions.
Frequently Asked Questions
Why Are Three Morning Samples Required?
One sample shows your cortisol level at one moment. Three timed samples show how the measurement changes during the first hour after waking.
This provides more information about the awakening response than a single morning measurement.
Does This Test Show My Complete Daily Cortisol Pattern?
It provides six cortisol measurements: three during the first hour after waking and three later in the day.
This gives a detailed daily profile, although it still measures cortisol only at the specified collection times rather than continuously.
Does the Report Include Specialist Interpretation?
Yes. Your ZRT Laboratory report includes individualised comments from its hormone-specialist clinical team.
The comments explain relevant findings, describe your measured cortisol pattern and may suggest areas for further discussion or investigation.
Will This Test Explain Why I Feel Tired?
It can show whether your measured cortisol and DHEAS results fall within the applicable laboratory ranges and how cortisol changes across the collection day.
This provides useful information, but tiredness can have several possible causes. The test does not establish that cortisol is the cause of your symptoms.
When Should I Collect During My Menstrual Cycle?
This cortisol and DHEAS profile can be collected on any day of your menstrual cycle.
Record your menstrual status and relevant cycle information on the Test Requisition Form so it is available when your results are reviewed.
Can I Use This Test While Taking HRT or the Contraceptive Pill?
It may be suitable, subject to the treatment-specific collection instructions.
Continue prescribed treatment as directed and record HRT, contraception and any other medicines or treatments on your Test Requisition Form.
This profile measures cortisol and DHEAS. It does not assess whether HRT or contraception is effective or establish whether these treatments are responsible for your symptoms.
Can This Test Diagnose Adrenal Fatigue or Burnout?
No. “Adrenal fatigue” is not established by this test.
The report shows your measured cortisol pattern and DHEAS result. These findings can be discussed with your healthcare professional alongside your symptoms, medical history and any other appropriate investigations.
Does This Test Measure Oestrogen or Progesterone?
No. It measures cortisol at six time points and DHEAS.
If menstrual, perimenopausal or menopausal symptoms are your main concern, a female sex hormone profile may provide more directly relevant information.
Do I Need to Fast?
No separate fasting period is required. However, you must follow the collection restrictions:
- Do not eat or brush your teeth before completing the first three samples.
- Drink only water during the morning collection period.
- Avoid food, other drinks and toothbrushing for two hours before the midday, evening and bedtime samples.
Is the Test Suitable for Children?
Yes, provided the child can supply the required saliva volume and follow the timed collection schedule. Include their age, symptoms and reason for testing to support appropriate interpretation.
How Quickly Will I Receive My Results?
The laboratory normally reports within 3–5 working days after receiving your samples. Kit delivery and return-postage times are additional.
Does the Price Include Laboratory Analysis?
Yes. The collection kit, laboratory analysis, digital report and hormone-specialist laboratory comments are included.
You are responsible for arranging and paying for return postage to the laboratory.
How Long Can I Keep the Kit?
Use the kit within 12 months of purchase.
Not Sure Whether This Is the Right Test?
Email info@hormonelab.co.uk with your age, main symptoms, medicines and current treatments. Our team will forward your enquiry to our specialist doctors and respond with a suggested testing option within 24 hours.
