Why hormone monitoring during pregnancy is crucial

Imagine this: You finally see two lines on a pregnancy test, and your heart fills with joy.  But deep down there's also fear. What if this pregnancy ends in a miscarriage? What if something is wrong, and no one is looking closely enough? What if I've already had a miscarriage? Is this one going to end the same way?For so many women, this isn't just a fear. It's their reality. But what if there were a proactive way to support your pregnancy from the very beginning? 

Today, we're diving into the powerful role of progesterone and estradiol monitoring throughout pregnancy, how proper monitoring can make all the difference, and why so many women are being overlooked when it comes to hormone support. If you've ever wondered whether a hormone imbalance could be impacting your pregnancy, or if you just want to be empowered with the right knowledge, then keep reading! 

Sarah’s Story

Sarah had always dreamed of being a mother, but after experiencing two heartbreaking miscarriages within eight months, she started to fear that something was wrong. Both pregnancy losses happened early in the first trimester, and her OB told her that it was just bad luck. 

But Sarah couldn't shake the feeling that there must be a deeper reason. When she became pregnant for the third time, she decided to take a different approach. She came to our clinic to take a deeper look at her hormone levels. We immediately tested her progesterone, estradiol, and HCG levels, and the results were eye-opening. 

Sarah's progesterone was far below the optimal range, putting her at risk for another miscarriage. Instead of taking a watch-and-wait approach like she had experienced in the past, we took action immediately. I started Sarah on bioidentical progesterone supplementation, and within days, she noticed a difference. Her early pregnancy symptoms became stronger, and for the first time, she felt hopeful. Regular hormone monitoring of both estradiol and progesterone levels throughout her pregnancy were just what she needed, and we continued to adjust her dosage of medications to ensure her levels stayed stable. 

While her obstetrician was skeptical at first, the numbers didn't lie, and Sarah's pregnancy progressed smoothly. She was able to successfully carry her baby to term, giving birth to a beautiful baby girl. 

Now, Sarah is a strong advocate for hormone testing in early pregnancy and encourages other women in our community to trust their instincts and seek answers when something doesn't feel right. Sarah's story is proof that proactive hormone monitoring and support can make all the difference in pregnancy outcomes. 

Hormone Monitoring During Pregnancy

So why do hormone monitoring and holistic pregnancy support even matter? How do I know if I need hormone therapy, and does everybody need it? Why isn't my OB doctor talking about this?  

Progesterone, estradiol, and multiple other hormones are crucial for maintaining a healthy pregnancy. When someone has hormonal imbalances, this can increase your risk of miscarriage or complications. 

During pregnancy, progesterone specifically is important for helping with early placental development, as well as maintaining placental support throughout the entire pregnancy. In cases of placental insufficiency, meaning the baby is not getting enough nutrients, we will often identify a progesterone defect or deficiency. 

Estradiol also plays a crucial role in early pregnancy. In fact, estradiol levels can more accurately predict if a miscarriage is going to happen than just looking at progesterone. 

Within the first trimester, we establish a baseline and try to create stability with both the progesterone and estradiol levels. We also closely follow HCG and supplement if needed. Appropriately increasing HCG levels indicate that the baby is doing well.

Here at Radiant Clinic, we follow treatment recommendations and guidelines for healthy hormone levels during pregnancy that have been set by two separate authorities in the field of Restorative Reproductive Medicine. The first was created by Dr. Thomas Hilgers, who is the founder of the Creighton Model and NaPro Technology. He established a normal progesterone curve during pregnancy and lined that up throughout an entire gestation to determine what an appropriate level should be at each gestational age, as well as how we adjust the progesterone dosing.  

More recently, Dr. Phil Boyle of NeoFertility has established a similar curve in regards to estradiol. Typically if you're low on estradiol, we supplement with DHEA, a precursor to estradiol. It's important to note that we only give you DHEA if your body needs it. 

If you are deficient now, some of the reasons you can be deficient include excessive stress, whether that's emotional stress or physical stress caused by excessive exercise, an illness, or increased strain on your body. Your body will use up DHEA, which can then decrease your estradiol levels. So it's important to replete what you are deficient in to get back up to normal levels. You can read more about DHEA use for estradiol support here.

Now, we generally follow your hormone levels weekly until eight weeks gestation, and then every two to three weeks thereafter, depending upon how things are going. 

When you get into the second trimester, we continue to evaluate your progesterone and estradiol and make adjustments as needed. We want to ensure the placenta has taken over as the primary source of progesterone production. Sometimes that's why we need to supplement early on, as there wasn't enough progesterone initially, but now that that placenta is around, we should have a good source of progesterone. We also continue to monitor estradiol levels because this is especially crucial for the baby to continue to grow, as well as to allow the uterus to be a welcoming environment. If needed, we address other symptoms of hormone deficiency like fatigue, bleeding, and contractions, and we continue to adjust what we need from a hormone standpoint for ongoing pregnancy support. 

If you're on thyroid medications, we often see that your thyroid requirements change drastically throughout pregnancy. So we continue to monitor these levels and adjust your thyroid medications appropriately. 

When you get into the third trimester, we're still monitoring levels because we have seen that, with decreasing progesterone levels in the third trimester, you can be at increased risk for preterm labor. So we want to make sure those levels continue to stay elevated to support the placenta, which then decreases your chances of intrauterine growth restriction, problems with the baby, and preterm labor. We also discuss appropriate tapering of dosages of progesterone and DHEA if that applies, as well as give guidance for what happens in the postpartum time frame. 

Why Aren’t All Doctors Offering Hormone Support During Pregnancy?

Another benefit of working with our office throughout pregnancy is that we're able to provide second opinion support for challenges you may face seeing a conventional OB doctor. One of our main roles is to help educate and advocate for our patients, especially those who may feel unheard in conventional OB care. 

I recently saw a patient who told me her OB doctor was in and out of her room during a regular OB checkup in less than 60 seconds. She heard from the nurse that the baby's heartbeat was okay and my client didn't have any new concerns, so the appointment was over. This is not the kind of care that women deserve when they are getting ready to enter into motherhood. 

Pregnancy should be a sacred space where you're able to get all your questions answered in a way that helps empower you to enter into this next phase of life. During our consultations, we discuss evidence-based care for common pregnancy concerns. We have helped navigate unexplained bleeding, implemented preterm labor prevention strategies, worked through birth plans and informed decision making, and discussed what will happen during labor and delivery. 

We do work collaboratively with OB doctors, midwives, and maternal fetal medicine specialists as needed and when appropriate. Unfortunately, we often get a lot of pushback from OB doctors, who state that tracking hormones is unnecessary or doesn't make a difference in outcomes. I would argue that 50 plus years of management with the techniques developed by Dr. Boyle and Dr. Hilgers point to the contrary!  

One of the big reasons why many OB doctors think hormone monitoring isn’t important is due to the medication Makena, which was removed from the market in April 2023. Makena was an injectable form of artificial progesterone called hydroxyprogesterone. It was initially created to try to prevent preterm labor. Makena was only approved for moms who had already had a history of preterm birth, and it was not started until 16 weeks gestation. One issue with this is, if the supplementation isn’t started early enough, then the placenta does not have the benefit of having improved progesterone levels early in development. The other is that this artificial progesterone is not the same as the bioidentical progesterone we utilize. 

Over time, additional studies showed Makena was ineffective and did not decrease the preterm birth risk. And unfortunately, when this medication was removed from the market, many physicians saw this and thought, Oh, progesterone is not effective during pregnancy and doesn't prevent preterm birth. This is why many doctors think progesterone support during pregnancy is unnecessary.

I want to emphasize here the importance of not treating blindly. We monitor your hormone levels, and if your levels are appropriate naturally, then we do not need to supplement. If your levels are less than optimal, we will supplement and monitor how your body responds. If your levels begin to correct, then we're going to back off the medication. 

We also always discuss the risks versus benefits of progesterone. Even if there were no significant benefit from progesterone (which certainly there is if it's bioidentical), the risk is very, very low. There is no increased risk of blood clotting, no increased risk of complications, and I always discuss with my patients that I am happy to share with their consultant the numbers, the target ranges, and what we're doing to improve those progesterone and estradiol levels. 

Hormone Support Postpartum

Postpartum is a time of significant hormonal changes. You will experience a significant hormone drop in progesterone right after delivery of the baby and the placenta. Remember, the placenta acts as a main source of progesterone, and blood levels typically go pretty high towards the end of pregnancy, generally ranging from 170 to 200 nanograms per milliliter. Now, all of a sudden, the placenta is gone. Your progesterone levels drop down to near zero, literally overnight. This is a big reason why women will see such a huge shift in what's going on with their mood, whether that's anxiety, mood swings, or fatigue. 

At our clinic, we prepare pregnant couples to screen for postpartum depression and anxiety. It's not enough to just get a couple of questions asked at the baby's two week checkup or have to wait until your own six week postpartum checkup before someone asks how you are doing. So we teach women and their partners and support staff how to support them during this postpartum time frame. We discuss what appropriate treatment options for postpartum depression can look like, as well as how to get the help you need.  

We also discuss what it looks like to start charting again. When you're breastfeeding, or even if you're just postpartum and not breastfeeding, your cycle return can be really erratic. Approximately 50 percent of women will ovulate before they have a return of their period. So if your intention is to avoid a pregnancy for a time or to space out your pregnancies, it's really important to be able to identify when that ovulation event has occurred so you know how to utilize that time appropriately. 

These Methods Work

I have personally followed these guidelines for management of pregnancy and miscarriage prevention over the last 13 years and have seen full term pregnancies and a significant reduction of miscarriage rates, even in women who have had up to seven miscarriages. We have an incredibly low percentage of preterm deliveries, less than half the national average.

And most importantly, I am honored to walk with women through this most beautiful time of their journey and address any fears or concerns that may come along. We work together to navigate pregnancy in a way that honors you by seeking holistic, evidence-based care for your reproductive health. 

Imagine if you were able to take a proactive approach to management of your pregnancy in order to decrease your risk of miscarriage and support a healthy pregnancy. We can help you to monitor hormone levels, to feel heard throughout your pregnancy, and provide individualized care to lead you through your entire reproductive journey. 

If you're ready to work with our elite team of healthcare professionals, schedule a free discovery call with me.

It's important to provide personalized and proactive support prior to conception and during pregnancy, as well as postpartum. 

Generally in our office, we are checking an early ultrasound around 7 to 8 weeks, which is earlier than many other OB offices. Part of the reason we do this is we want to check for an appropriate location, making sure the pregnancy is in the uterus. We want to check the baby's heartbeat, and we also want to assess fetal growth to make sure that our dates are aligning with what we expect to see. 

Because most of our clients are charting their cycles, we often know an exact ovulation date, and we're able to adjust the due date according to that ovulation date. This allows us to give the most accurate measurement with the early ultrasound, as well as give the appropriate due date based on your ovulation, not just on your menstrual cycle, which can be really variable. 

We're treating to a target level to help make up for hormonal deficiencies that may have been present even prior to conceiving. When that ovulation event is a poor ovulation event or it’s a smaller follicle, your hormone levels are going to be lower initially and we can't go back and correct that ovulation event that has occurred if you're already pregnant. So helping to support by giving the hormones that are necessary is the most important thing in order to make sure that hormone levels hit their target before delivery. 

Now, ideally, we're looking with all of these levels to get a good balance even prior to trying to conceive again in the future, especially if you've already experienced a pregnancy loss. We are oftentimes able to identify hormone abnormalities and work to restore balance prior to that next pregnancy. 

In many cases, this actually leads to lower requirements for progesterone and estradiol support during the subsequent pregnancy and can prevent miscarriage by helping to ensure a healthier and more robust ovulation with better supporting hormone levels.