Pregnancy Hormone Therapy: Exploring The Safety Debate

Pregnancy involves a lot of hormonal changes, and sometimes, hormonal supplements. The primary hormones supporting pregnancy are progesterone and estrogen. These hormones are sometimes prescribed to prevent miscarriage in people with certain conditions, such as recurrent miscarriages. Progesterone is responsible for the thickening of the uterine lining to allow for implantation of a fertilized egg, and it also softens the cervix in preparation for delivery. Estrogen helps develop the female sexual traits and triggers breast milk production. Other important pregnancy hormones include follicle-stimulating hormone (FSH), luteinizing hormone (LH), human chorionic gonadotropin (hCG), and human placental lactogen (hPL).

If you are taking any hormonal supplements or medication, it is important to consult your healthcare provider to ensure that it is safe for your pregnancy.

Progesterone and oestrogen

Progesterone

Progesterone is produced in early pregnancy to support the baby until the placenta takes over. It increases blood flow to the womb and stimulates glands in the womb lining to produce nutrients that sustain the early embryo. It also stimulates the womb lining to grow and thicken, allowing for the implantation of the embryo.

Progesterone is important for correct foetal development and prevents the womb muscles from contracting until labour starts. It also prevents lactation until after pregnancy and strengthens the muscles of the pelvic wall in preparation for labour.

Oestrogen

Oestrogen is also produced in early pregnancy to support the baby until the placenta takes over. It helps the development of the baby's organs and the correct function of the placenta.

Later in pregnancy, oestrogen helps prepare the body for breastfeeding. It also enables the uterus to respond to oxytocin during labour.

Both

High levels of both progesterone and oestrogen are important for a healthy pregnancy but can cause some unwanted side effects in the mother, such as mood swings and morning sickness.

Progesterone supplements

Progesterone is a hormone that plays a crucial role in reproduction. It is mainly produced in the ovaries, but can also be made in a lab. Progesterone levels can affect menstrual periods and menopausal symptoms.

Forms of Progesterone

Progesterone is available in many forms, including:

• Intrauterine device (IUD)
• Patch applied to the skin
• Foods that have zinc, vitamin C, vitamin B, and magnesium
• Cream

Benefits of Progesterone

Progesterone is crucial for pregnancy. It makes the lining of the uterus (called the endometrium) thicker, which helps a fertilised egg develop into a baby. During pregnancy, progesterone levels keep climbing, stopping early labour and ovulation. It also prepares the breasts to nurse a baby. If your progesterone levels are low, it might be harder to get pregnant, and you could have a higher chance of miscarriage.

Side Effects of Progesterone

Progesterone may cause side effects such as:

• Breast tenderness or pain
• Pain in your muscles, bones, or joints
• Changes in heart rate
• Difficulty breathing
• Allergic reaction

Estrogen supplements

Estrogen is a group of hormones that play a crucial role in the female body, influencing everything from reproductive function to bone density and mood regulation. Estrogen supplements are sometimes recommended by healthcare providers to prevent miscarriage and support fetal growth and development.

Forms of Estrogen Supplementation

Estrogen can be administered in several forms, including:

• Patches
• Pills
• Intramuscular injections

Pros and Cons of Estrogen Supplementation

Pros

• Support fetal growth and development
• Prevent miscarriage
• Reduce troublesome menopause symptoms
• Lower the risk of osteoporosis
• Increase energy levels
• Improve mood
• Reduce hot flashes
• Alleviate night sweats
• Enhance breast tissue
• Improve skin elasticity
• Improve vaginal dryness

Cons

• Cause painful and swollen breasts
• Cause vaginal discharge
• Cause headaches
• Cause nausea
• Increase the risk of strokes, blood clots, and other problems
• Increase the risk of breast cancer and heart attack when combined with the hormone progestin
• Cause side effects in people with liver damage
• Increase cholesterol levels
• Cause skin irritation where patches are applied
• Cause dizziness and fainting due to expanded blood vessels

Precautions

It is important to consult with a healthcare provider before taking estrogen supplements, as they can have risks and side effects. Estrogen supplements should be used under the guidance of a healthcare professional and taken at the lowest effective dose for the shortest duration required.

Thyroid medication

Pregnancy itself makes signs of hypothyroidism more likely, as the body uses more thyroid hormone to keep up with the needs of a growing baby. If you have a history of hypothyroidism and are receiving treatment before becoming pregnant, your medication dose may not be enough to meet your increased needs. Studies show that many people need a dose that is 25% to 50% higher once they become pregnant.

If you have a history of hypothyroidism and become pregnant, your healthcare provider will check your hormone levels throughout your pregnancy and make adjustments to your thyroid medication. The exact dose of medication needed will be based on your thyroid-stimulating hormone (TSH) level. The goal is a TSH of less than 4.0 mIU/L (milli-international units per liter), though many providers will try to keep your number under 2.5 during pregnancy and sometimes even before to optimise your fertility.

Levothyroxine (Synthroid) is the standard treatment for hypothyroidism. It is a synthetic form of thyroid hormone that poses no danger to your developing baby.

During pregnancy, the thyroid gland needs to produce about 40% more thyroid hormone for both you and your developing baby. Women who do not produce or receive enough thyroid hormone during pregnancy are at greater risk of complications, including miscarriage, preeclampsia, and preterm delivery. Other risks include anaemia, muscle pain, postpartum haemorrhage, and placental abnormalities. Untreated hypothyroidism in pregnancy can impact your baby, as thyroid hormone plays a critical role in a baby's brain development.

Follicle-stimulating hormone (FSH)

In women, FSH helps manage the menstrual cycle and stimulates the ovaries to produce eggs. FSH stimulates the maturation of ovarian follicles in the ovary before the release of an egg from one follicle at ovulation. It also increases oestradiol production from the ovaries. FSH levels are highest just before ovulation.

In men, FSH stimulates the production of sperm. FSH signals the testes to make sperm, and the amount of FSH in males normally stays the same after puberty. FSH stimulates Sertoli cell proliferation, which is the most significant contributor to testicular volume in children. The Sertoli cells produce an anti-mullerian hormone (AMH), which causes the involution of the Mullerian ducts, preventing the formation of female internal genitalia.

FSH levels can be measured through a blood test. Doctors can test FSH levels to assess fertility, check for medical conditions that affect how the ovaries work, and determine if a person is going through menopause.

Frequently asked questions