81. Pregnancy Hormone Monitoring: What You Must Know

In this episode of Cycle Wisdom, Dr. Monica Minjeur dives into the critical role of progesterone and estradiol in pregnancy and miscarriage prevention. She shares Sarah’s journey—after two heartbreaking losses, hormone monitoring and bioidentical supplementation helped her carry a healthy baby to term. Dr. Minjeur explains how proactive hormone testing, personalized care, and holistic pregnancy support can reduce miscarriage risks and improve outcomes. Tune in to learn how to advocate for better reproductive care!

Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles to improve health and promote fertility. I'm your host, Dr. Monica Minger, and I'm so glad you're listening today. Imagine this. You finally see the 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 was 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, this episode is for you. So let's start off as always with a patient story about a past client of mine who we'll call Sarah. 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 a 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 just 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 in order to ensure that her levels stayed stable. While her obstetrician was skeptical at first, the numbers didn't lie, and Sarah's pregnancy progressed smoothly. She was successfully able to carry her baby to term, and nine months later, Sarah held her beautiful baby girl in her arms. 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. So why does 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 hormone levels are crucial for maintaining a healthy pregnancy. When someone has hormonal imbalances, this can increase your risk of miscarriage or complications. It's important to make sure that we provide a personalized and proactive support prior to conception, during pregnancy, as well as postpartum. During pregnancy, progesterone is specifically important for helping with placental development early on, as well as maintaining placental support throughout an entire pregnancy. In cases of placental insufficiency, meaning the baby is not getting enough nutrients to them, we oftentimes will identify there is a progesterone defect or a deficiency causing that. Estradiol also plays a crucial role in early pregnancy. In fact, estradiol levels can more accurately predict if a miscarriage is going to happen, even than just looking at the progesterone levels. 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 even prior to that next pregnancy. In many cases, this actually leads to lower requirements for progesterone and estradiol support during the upcoming pregnancy and can prevent miscarriage by helping to ensure a more healthy and robust ovulation with better supporting hormone levels. After conceiving within the first trimester, we establish a baseline and try to create stability with both the progesterone and estradiol levels. Early on, we closely follow these hormone levels as well as HCG to make sure if supplementation is needed and to ensure that we are on the right track. Most importantly, we're looking to make sure that HCG levels are increasing appropriately to ensure that baby is doing well, as well as making sure that all of those early markers are met. 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 appropriate location, making sure that that pregnancy is in the uterus. We want to check 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 know an exact ovulation date, and we're able to adjust the due date accordingly to that ovulation date. 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. As for hormone monitoring and how we track what's normal, we follow treatment recommendations and guidelines for normal levels during pregnancy that have been set out by two separate authorities in the field of restorative reproductive medicine. The first was created by Dr. Tom Hilgers, who is the founder of Creighton Model and Napro Technology. He established a normal progesterone curve during pregnancy and lined that up throughout an entire gestation in order to determine at each gestational age what an appropriate level should be, 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, and typically if you're low on estradiol, we are supplementing with DHEA. Now, DHEA is a precursor that produces estradiol. Now, it's important to note that we're only giving 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. We often times see that your body will use up DHEA, which can then decrease the estradiol levels. So it's important to make sure that we replete what you are deficient in, in order to get back up to normal levels. If you're interested in more information about DHEA, check out our website, radiantclinic. com. Go to the section about patients, and down towards the bottom you'll see a whole section that will refer you on to additional information as well as published research on DHEA. Now, we continue to follow these levels throughout your first trimester, and generally we follow them weekly up until 8 weeks, and then every 2 3 weeks thereafter, depending upon how things are going. When it gets into second trimester, we continue to evaluate and making adjustments as needed. We want to ensure that the placenta has now taken over as the primary source of progesterone production. Because 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 also address other symptoms of hormone deficiency like fatigue, bleeding, contractions, and then we continue to adjust what we need from a hormone standpoint for ongoing pregnancy support. If you're someone who is on thyroid medications, We also oftentimes find 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 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 that those levels continue to stay nice and elevated in order to prevent preterm labor in order to help continue to support the placenta, which then will help to decrease your chances of intrauterine growth restriction or problems with the baby. We also discuss appropriate tapering dosages as far as the progesterone and DHEA if that applies, as well as give guidance for what happens in the postpartum time frame. Another benefit of following with our office throughout pregnancy is that we're able to provide second opinion support for challenges that 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 that her OB doctor was in and out of her room during a regular OB checkup in less than 60 seconds. After she heard from the nurse that the baby's heartbeat was okay and that my client didn't have any new concerns. This is not the kind of care that women deserve to have 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 also discuss evidence based care in relationship to common pregnancy concerns. We have oftentimes helped to navigate unexplained bleeding, preterm labor prevention strategies, working through birth plans and informed decision making, as well as discussing what's going to happen during labor and delivery processes. We do work together collaboratively with OB doctors, midwives, and maternal fetal medicine specialists as needed and when appropriate. Unfortunately, we do often get a lot of pushback from OB doctors, stating that tracking hormones is unnecessary or doesn't make a difference in outcomes. I would beg to differ that 50 plus years of management with these techniques that were developed by Dr. Boyle and Dr. Hilgers Beg to differ. One of the big reasons that we see this is unfortunately, there was a medication called Mekina that was removed from the market in April of 2023. Now this medication was an injectable form of artificial progesterone called hydroxyprogesterone. And it was initially created in a way to try and prevent preterm labor. Now it's different than the progesterone support we provide, and a couple things are notable with this. The first being is that Makina was only approved for moms who had already had a history of preterm birth and it was not started until 16 weeks gestation. Over time, additional studies showed that Makina 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 said, Oh, progesterone is not effective during pregnancy and doesn't prevent preterm birth. However, Many people did not take into account that this artificial progesterone is not the same as bio identical progesterone. Additionally, if we're not starting it early enough, the placenta does not have the benefit of having that improved progesterone levels early in pregnancy. And this is a theory that has stuck for a lot of doctors and a lot of times is the reason that the OB doctors give some pushback, stating that progesterone is unnecessary. We also always are going to be discussing the risks versus benefits of progesterone and even if there was 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 in order to try and help improve those progesterone and estradiol levels. I just want to reiterate here the importance of not treating blindly. And so the big difference here is that we're continuing to monitor these levels. If your levels are appropriate and things are coming up nicely, we're going to back off the medication. This is not saying we just go on these medications long term. 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 as 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 with giving the hormones that are necessary is the most important thing in order to make sure that Hormone levels hit their target before delivery. We discuss what's going to happen with you during that postpartum timeframe. One of the big things is that you experience a significant hormone drop of progesterone right after delivery of baby and the placenta. Now 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, and now all of a sudden the placenta is gone. And your progesterone levels drop down to near zero, literally overnight. This is oftentimes 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. However, in this point in time, we have already prepared you and your partner 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 need to wait until you get to 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 help support them during this postpartum time frame. We also discuss what appropriate treatment options for postpartum depression can look like as well as how to get the help that you need. We also discuss what it looks like to start your charting again. When you're breastfeeding or nursing, 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 even have a return of their period again. And 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 that you know how to utilize that time appropriately. I have personally followed these guidelines for management of pregnancy and miscarriage prevention over the last 13 years and have seen significant reduction of miscarriage rates and full term pregnancies after people have had even up to two, 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 help to 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, go to our website radiantclinic. com to schedule a free discovery call with me and learn more about our package based pricing for comprehensive care. We are currently able to see people for in person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in the states of Iowa, Illinois, Minnesota, Wisconsin. Michigan, Connecticut, Florida, Texas, and more coming soon. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.