The 6 Key Pregnancy Hormones

There are 6 key pregnancy hormones, which contribute to the emotional and physiological changes women tend to experience when pregnant. In this article, Consultant Gynaecologist Pradnya Pisal provides information on each of these hormones:

HCG

• Pregnancy stage: HCG appears on the 8th day after ovulation, one of the earliest secreted hormones from the conceptus, and can be detected usually by 5-6 days after ovulation but definitely by 10 days after ovulation.
• Peak time: it generally doubles every 48 hours, reaching its maximum level at 8-10 weeks.
• Function: its only function is supporting the corpus luteum. 
• Side effects: headache, irritability, restlessness, fatigue, insomnia, nausea, vomiting (can be excessive and abnormal) and fluid retention. 

Oestrogen

• Pregnancy stage: oestrogen is produced from pre-pregnancy until about 10-12 weeks from the follicle area in the ovary, where the egg is released from. After this, the placenta and fetal adrenal gland produce it until term.
• Peak time: late third trimester.
• Function: preparing uterine lining for the implantation of the embryo. It is helpful in preventing miscarriage, and acts as a catalyst for chemical changes for growth, development and energy in the baby. It steps up blood circulation and regulates the production of other key hormones, as well as promoting breast engorgement in early pregnancy and regulating bone density. 
• Side effects: increased blood flow to mucous membranes leading to headache, postnasal drip and nasal congestion; sensitive skin and some areas showing hyper-pigmentation (especially nipple areola and along midline on abdominal wall); melasma.

Progesterone

• Pregnancy stage: progesterone is produced from pre-pregnancy until about 10-12 weeks from the follicle area in the ovary where the egg is released from. The placenta then produces it until term. There is a second gradual increase after 32 weeks.
• Peak time: late third trimester
• Function: preparing uterine lining for the implantation of the embryo, suppressing maternal response to fatal antigens and prevents the rejection of trophoblast. It maintains quiescence of the uterine muscle and is helpful in preventing miscarriage and pre-term labour. It also encourages breast tissue growth.
• Side effects: GI discomfort, including indigestion, heartburn, constipation and bloating.  Aching hips (pubic bone and back), bleeding from teeth and gums and increased sweat gland secretion. 

Relaxin

• Pregnancy stage: produced by the corpus luteum and the placenta from early pregnancy to late pregnancy.
• Peak time: at 14 weeks and around the time of delivery.
• Function: preparing uterine lining for the implantation of the embryo, uterine growth and accommodation, the control of myometrial activity to prevent preterm labour, and cervical ripening and the facilitation of labour. It is also important in reducing insulin resistance.
• Side effects: joint and ligament pains and backache. It can also cause heartburn as it relaxes the smooth muscle and sphincter of the stomach, so acid comes up into the food pipe.

Oxytocin

• Pregnancy stage: produced by the hypothalamus and released from the pituitary gland in the mother’s brain throughout pregnancy.
• Peak time: oxytocin levels rise from the first to the third trimester and fall during the postpartum period.
• Function: stimulates the ripening of the cervix, leading to successive dilation during labour. Along with other hormones, it causes the release of prostaglandins, which play an important role in the ripening of the cervix. It also aids bonding with the baby. 
• Side effects: can cause irritability and awareness of normal uterine contractions, Braxton-Hicks.  Can lead to excessive hair growth. 

Prolactin

• Pregnancy stage: secreted by the decidua, endometrial lining and also by maternal pituitary gland, starting in early pregnancy. 
• Peak time: starts in early pregnancy and there is a sustained rise until the third trimester and postnatally.
• Function: enlargement of the mammary glands and preparation for milk production, which normally starts when levels of progesterone fall by the end of pregnancy and a suckling stimulus is present.
• Side effects: n/a

What Happens to your Period as you get Older?

Our periods change over time. They are affected by many factors, from age and body mass index to contraception, pregnancies, breastfeeding and menopause. Below, Consultant Gynaecologist Narendra Pisal explains how these things can have an impact on hormone balance, and in turn cause period issues as we move through different stages of our lives.

The teenage years 

The average woman starts her periods at around 11-14 years. It is normal to have irregular periods during the teenage years as the ovulation is still sporadic and unpredictable. It can take a few years (until the early 20s) for regular ovulation to establish and for periods to develop a particular pattern.

Twenties and thirties

This is a more stable period for the menstrual cycle and the periods are often regular and predictable.

If you’re on birth control, this can affect your periods. Read our blog for more information on periods and contraception here. 

A missed period or late period can occur because of several reasons or sometimes for no reason at all. The common causes are:

• Pregnancy: If there is any chance of pregnancy at all, please do a pregnancy test. You should do this even if you are using contraception.
• Polycystic ovaries: Polycystic ovaries are common and occur in around 22% of women. Some women with polycystic ovaries can also have anovulation (lack of ovulation) and this can lead to a late or missed period. A scan and blood tests may be necessary to make this diagnosis.
• Hormonal imbalance: Thyroid hormone problems or pituitary (a gland in the brain) hormone issues can cause delayed or absent periods. Your doctor will be able to check for this.
• Eating disorder: Anorexia can cause reduced body fat and can affect ovarian function leading to late or even absent periods.
• Extreme exercise: The same can happen with a lot exercise. Many of the Olympic athletes often miss their periods due to reduced body fat.
• Perimenopause or menopause: Cycles can often be delayed around the time of menopause. This is because of unpredictable ovulation and ovarian function.
• No cause: Sometimes, periods can be late due to no obvious reason. Stress or long distance travel or some medications can affect the cycle too. If pregnancy is ruled out, it is OK to wait for a few more weeks before seeing a doctor. Keep a record of your period dates and any other symptoms you may have.

Thirties and forties

If you’ve had a baby, your periods will change afterwards.

• Breastfeeding stops the periods for up to twelve months. One can still get pregnant while breastfeeding, so it is best to use some form of contraception.
• Periods often improve after delivery. The cervix is more open and hence the periods are less painful.
• It is not uncommon for conditions such as fibroids or polyps to develop and cause period problems. So heavy, prolonged or irregular periods should always prompt a doctor’s visit.

As you approach peri-menopause in the mid-forties, periods can become heavier and more frequent (or sometimes even more spaced out). Whilst cycle length can vary, bleeding between periods and prolonged or heavy periods should act as red flag symptoms.

Fifties and beyond

Menopause is the period in a woman’s life when menstruation ceases. In normal circumstances this usually occurs after the age of 45.

During this time ovarian function declines and periods become irregular, unpredictable and eventually stop. This decline in ovarian function means the decreased release of hormones oestrogen and progesterone and this change in hormone level causes menopause symptoms such as hot flushes, night sweats, mood swings, lack of libido and vaginal dryness.

Menopause is a retrospective diagnosis and is made 12 months after the last period. The symptoms above can point towards onset of menopause and can sometimes affect your life in a major way. It’s best to see your doctor to see if hormone replacement therapy may be a solution for you.

If you are concerned about any changes in your period it is best to seek medical advice with either your GP or gynaecologist.

Changes in the Second Trimester of Pregnancy

Meghan Markle’s pregnancy took a toll on her during her Australian tour, and the Duchess had to skip a few days of engagements. However, she is expected to attend more events in the next few weeks as she enters a new transition in her pregnancy. Consultant Gynaecologist Pradnya Pisal speaks to Express.co.uk about the improvement in symptoms that tends to come with the second trimester of pregnancy. Read the article here.

Organic Tampons

Over the past year or so, organic menstruation products have been steadily rising in widespread popularity, spurred on by ambitions to things better by the environment and by women. Consultant Gynaecologist Meg Wilson contributes to an article on organic menstrual products. Read it here.

4 Things a Gynaecologist Really Wants you to Know

A woman’s vagina changes over the course of her life, often in response to hormone changes through puberty, pregnancy, breastfeeding and the menopause, as well as to issues such as prolapse and infections like thrush and bacterial vaginosis. Consultant Gynaecologist Meg Wilson talks through these changes with NetDoctor. Read the article here.

Sugar and the Menstrual Cycle

To mark Sugar Awareness Week, Nutritional Therapist Laura Southern clarifies the links between sugar and the menstrual cycle. She explains why so many women crave sugar at certain times of the month, and tells us what we should eat instead to combat these cravings and improve our health. 

For most women sugar cravings occur about a week before their period starts, but everyone is different so there’s no exact time. Often the cravings end once the period has started, or a few days in. 

The sugar cravings are usually down to changes in our hormones. Before our periods begin there is a drop in the hormone progesterone and a rise in oestrogen, which can cause blood sugar levels to drop. When blood sugar levels drop the brain sends signals to replenish sugar, and therefore cravings occur. There can also be a change in serotonin – ‘the happy hormone’. Women who suffer from PMS often have lower serotonin than is optimal. These low levels can cause sugar and carbohydrate cravings because insulin is needed to ‘shunt’ serotonin from the gut (where it’s made) to the brain. 

If you suffer from PMS, it can be positive to eat carbohydrates before your periods so that your body makes enough insulin to transport serotonin. Blood sugar regulation is key for managing all the hormones in the body – your body treats blood sugar balance as a priority, its life or death. For this reason all the body’s focus is on managing insulin and cortisol to regulate blood sugar, and this will be at the expense of all other hormones, especially the reproductive/ female hormones. Women that eat lots of high sugar foods, or find it difficult to stabilise their blood sugar (due to diet or illness), will often suffer badly with PMS.

It is key to try and manage blood sugar. To do this, protein rich foods (meat, fish, eggs, nuts, seeds, beans, legumes) are key; try and include these at every meal (although you don’t need animal protein at every meal).

The good fats are also essential. The fats are needed to synthesise our hormones and keep our cells and hormones able to communicate with each other. Good fat also helps make us feel ‘satiated’, so that sugar cravings can decline. Again, nuts and seeds are great, as well as olive oil, avocados and coconut. Certain nutrients can also be helpful: magnesium can help (try an epsom salt bath), and a good B vitamin complex can help manage blood sugar and keep cravings at bay. 

Exercise and Pregnancy

There are a few unique things to consider when it comes to exercising while pregnant. Our fitness ambassador, Ellie Baker, outlines the beneficial impact of keeping fit during pregnancy, and explains the changes you should think about making to your fitness regime.

Running, swimming, cycling – which is best during pregnancy?

When it comes to which sport is best during pregnancy, I believe it is a very individual thing, provided your pregnancy is low-risk. If you’re in any doubt regarding the status of your pregnancy you should speak to your GP or obstetrician, who will be able to advise you further.

Otherwise, it varies according to your individual lifestyle choices. If you ran regularly before pregnancy, you should be able to continue to run while you’re pregnant, with zero effects for you or your baby. If you didn’t run regularly before, pregnancy is probably not the best time to start. However, there are many fantastic effects you and your baby will get from sports like swimming during pregnancy. For example: exercising in water supports your bump and is great for your circulation as the pressure of the water on your blood vessels stimulates blood flow and helps reduce any swelling. It’s also an excellent way to maintain your abdominal tone.

How should you change your exercise regime throughout pregnancy (1st trimester, 2nd trimester, 3rd trimester)?

In each trimester most exercises are ok, as long as you don’t overdo it. You will need to listen to your body. Low impact sports like prenatal yoga, swimming and biking are good to do if you feel worried or didn’t exercise much before getting pregnant. Many people get worried about exercise in the first trimester due to risk of miscarriage, but it is said that as long as you listen to your body there should not be a problem as there are no direct links between exercise and miscarriage.

What are the benefits of exercise during pregnancy?

There are major benefits to exercising whilst being pregnant. Exercise improves posture and massively helps to reduce backaches, constipation, bloating and swelling. This will make your pregnancy feel a lot more comfortable. It can also help to reduce fatigue and leaves you feeling more energised.

Exercise and the Menopause

There are a few unique things to consider when it comes to exercising during and after the menopause. Our fitness ambassador, Ellie Baker, outlines the beneficial impact of keeping fit while going through menopause, and explains the changes you should think about making to your fitness regime.

How can exercise support menopause?

Exercise can help to alleviate the symptoms you get from menopause. Exercise is brilliant for stress relief, so will make you feel happier within yourself. Exercise is also a great way to stop you from gaining weight and keeps your muscle conditioning, which will help prevent the loss of muscle mass that occurs due to menopause.

The change in hormones during menopause can have an impact on bone strength. Which exercise would you recommend to keep bone strength up?

High impact exercise helps to build and maintain bone strength. These exercises could include: dancing, jogging, hiking, stair climbing, tennis, jump roping and weight training.

Should exercise change as you age?

Muscle mass and bone density both decline with age, so it is extremely important to exercise in order to slow down the rate at which the body is declining. Unless you have an injury, the exercise you do doesn’t need to change. High impact exercise helps build and maintain bone strength, so can slow down the rate at which you will lose bone density. Always start any new activity under supervision so that you can maintain correct form and avoid injuries. It is also a good idea to start gradually and build up to an optimal level.

Vaginal Itching: the Common Causes

Consultant Gynaecologist Mr Narendra Pisal outlines the common causes of vulval/vaginal itching and irritation:

• Vaginal candidiasis (thrush or yeast infection)

The most common cause of vaginal itching, if it is short term, is vaginal candidiasis. This is a common infection and is associated with whitish curd-like discharge and symptoms of itching. This can be easily treated by taking an oral Fluconazole, a 150mg tablet which can be obtained over the counter without a prescription. A cream called Daktacort can also be obtained over the counter which will also help relieving the symptoms.

• Other infections such as Bacterial vaginosis

Bacterial vaginosis is a common infection of the vagina that can occur when the natural balance of the bacteria in the vagina changes, this can cause intense vaginal irritation and itching. Making a diagnosis isn’t always straightforward and a visit to the GP or gynaecologist may be needed.

• Menopausal changes

Lack of oestrogen after menopause can make the vaginal mucosa and vulval skin more prone to breaking and irritation. Local oestrogen cream or pessary can help.

• Breastfeeding

Many women aren’t aware that breastfeeding can cause the vaginal mucosa to become more atrophic and prone to dryness and irritation. Using additional lube may help.

• Skin conditions

Another common cause of vulval itching is a condition called Lichen Sclerosus, particularly if your symptoms are of longer duration. This is a condition that can be sometimes difficult to control and cure. You will need to see a specialist for an expert opinion and diagnosis. They are likely to prescribe a mild steroid cream, which will control the symptoms.

• Allergic reaction

Itching can also be a result of an allergic reaction to either fabric softener, sanitary products or soap products used for washing. You can see if your symptoms are relieved by changing these products or using antihistaminic medication such as Piriton, which again can be obtained without a prescription.

• Vulval warts/condylomas

Genital warts can cause itching. These are single or multiple projections with irregular surface caused by low risk strains of human papilloma virus (HPV). Since the HPV vaccination programme started, the incidence of warts has gone down. Warts will often resolve spontaneously but can sometimes need treatment with local cream or cryocauterisation.

• Cancerous or precancerous patch

Fortunately this is not common, but it is still possible. If your symptoms are persistent, you should always see a gynaecologist so that an appropriate diagnosis can be made and treatment can be started. Treatment is usually by removing the affected area.

• Hygiene

Simple precautions should be followed, such as changing out of gym clothes as soon as possible, using simple moisturising soaps for washing and getting out of the itch-scratch-itch vicious cycle.

How long do you really need to wait between pregnancies?

A new study has said mothers should wait at least a year after giving birth before falling pregnant with another baby. Yet current guidelines from the World Health Organisation say otherwise, recommending women wait at least 18 months before falling pregnant again. Consultant Gynaecologist Mrs Pisal talks to Yahoo! Style UK about the numerous reasons women may want to wait and recover between pregnancies. Read the full article here.