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  • Kassandra Vaughn

TTC Over 40: What Hormones Matter and Why

There's this blanket assumption about women TTCing over 40 that is made by many reproductive endocrinologists and it goes something like this:


"Oh... you're 41 (42, 43, 44, 45)... Clearly, you're in perimenopause.... and, oh by the way, you probably don't ovulate every month and, if by some miracle you do, your eggs are too old to crate a healthy baby which probably won't happen because, at your old age, your progesterone levels are probably shot which means your body won't allow an embryo to implant anyway... so... what do you think about using donor eggs?"





Now... doctors won't say this all in one go and they probably have a more tactful conversation using gentler words but boiling down to stating all of the above... AS IF they were facts... and when you say this to a 40-something year old woman who doesn't really understand what hormones she needs, at what levels and why, it doesn't take much to see why this news will freak her out... which makes educating yourself about your own hormones CRITICAL to any TTC journey, especially after the age of 40.



There's a beautiful dance that a woman's reproductive hormones participate in throughout the entire menstrual cycle. Each hormone has got to take the lead at a different part of the cycle while the other hormones continue participating in the dance in order for ovulation and conception to occur well. The key hormones involved are estrogen, progesterone and LH.


However, before we even dive in to this hormones, let me put a disclaimer out there:

I am NOT a medical doctor or practitioner nor is this post (or anything I write on this topic) medical advice. I strongly recommend that you surround yourself with a fabulous team of licensed, amazing medical professionals so all of your questions can be answered by the right expert.


I am a woman who's done countless hours of research and who wishes that I'd had a post like this to read (rather than having to spend hours and hours piecing this info together myself); hence, why this blog post exists.


Okay... Before we dive into the reproductive hormones, here's one thing I've learned:

There are a hierarchy of hormones (both reproductive and non-reproductive in nature) and if the foundational, powerhouse hormones (cortisol, insulin, and oxytocin) are running amuck, then the Tier 2 (DHEA, Pregnenolone) and Tier 3 (Thyroid hormones, melatonin, progesterone, estrogens, and testosterone) will also run amuck. In other words, the first three hormones (oxytocin, insulin, and cortisol) need to be well managed in order for the other ones to run smoothly... which is why you can see that if you (like me) have insulin/blood sugar issues, the reproductive hormones that you need to dance well with each other (estrogen, progesterone, LH and even testosterone) will not be doing so... which then will cause problems with your ability to conceive.


To better understand the hormonal hierarchy, check out Dr. Mindy Pelz's podcast episode where she interviews Dr. Anna Cabeca (Ob/Gyn) about the hormonal hierarchy >>HERE<<.


Once you understand the hormonal hierarchy, it's time to understand your reproductive hormones. I'm going to focus on progesterone, estrogen, and LH because they work very closely together to achieve successful ovulation and conception. Let's take a look at each...


Progesterone

What is it?

Progesterone is a type of steroid hormone that is secreted by the adrenal glands and the corpus luteum (located in the ovaries). The purpose of progesterone is to regulate your menstrual cycle and prepare your body to accept a fertilized egg. If there's not enough progesterone, a fertilized egg will not be able to successfully implant into the lining of your uterus.


What should it be?

According to a Mira article (found >>HERE<<), during menstruation and the follicular phase, progesterone tends to stay below .89 ng/mL. During ovulation and the luteal phase, it rises to 1.8-24 ng/mL. That's a HUGE variation. When a woman is in menopause, progesterone typically falls below .20 ng/mL.


How to Check it

It's important to track your hormones DAILY using a tool like Mira so you can see, over two or three months, what YOUR progesterone pattern looks like. For any doctor to take your progesterone ONE TIME and then jump to a conclusion that you have low progesterone is ridiculous. Give yourself time to look for patterns and not guess based on one test result on one day in a 28-33 day cycle.


Estrogen

What is it?

Estrogen is a primary sex hormone that regulates the menstrual cycle. While estrogen lives mainly in the ovaries, small amounts can also be found in the adrenal glands and fat tissue. There are 3 types of estrogen that you can learn more about by reading a Mira article (found >>HERE<<): estradiol, estrone, and estriol. When it comes to fertility, we're most concerned with estradiol.


What should it be?

A normal level of estradiol is less than 50 pg/mL during the menstrual period. During the follicular phase (the time between menstruation and ovulation), estradiol should be between 19 pg/mL and 140 pg/mL. Estrogen reaches its highest peak just before ovulation. At that peak, estradiol should be between 110 and 410b pg/mL with a more favorable outcome of reaching about 400 pg/mL prior to ovulation. For example, using my Mira app this cycle, my highest peak of estradiol was at 287.5 pg/mL. During the luteal phase, a normal level of estradiol is as high as 160 pg/mL at the early and middle parts of the luteal phase and then dropping as low as 19 pg/mL right before your menstrual period is set to start.


How to Check it

Again, using something like the Mira app is extremely helpful in tracking your estrogen levels on a daily basis. By knowing the info on what your hormone level should be at each part of your cycle, you can start to (over a few months of tracking) figure out at which part of your cycle there could be a problem and then work with your medical experts to determine solutions.


LH

What is it?

LH, also known as Luteinizing Hormone, is what controls ovulation and helps with the early stages of pregnancy. LH triggers ovulation. It also stimulates the corpus luteum to produce progesterone (supports early pregnancy).


What should it be?

In a Mira article (found >>HERE<<), normal LH levels are indicated as 5-25 IU/L. More specifically, in the follicular phase, it should be 1.9 to 14.6 IU/L. During the ovulation phase, it should rise to 12.2-118 IU/L and, during the luteal phase, it should be between .7 and 12.9. During pregnancy, LH should be less than 1.5 IU/L and during menopause, it should be 5.3 to 65.4. High LH levels could indicate that you may not be ovulation or may have PCOS. Low LH levels could indicate that you may have problems with your pituitary gland or are currently malnourished (either because you're not eating the right things or perhaps you aren't digesting the nutrients).


How to Check it

There are a number of tools, such as the Mira app, that can help you track your LH levels on a daily basis.


This is a lot to learn and it's critical that you learn it. Doctors will tell you all kinds of things and, unless you educate yourself on your own body and can advocate for your own care, it will be challenging to question or oppose what a physician is telling you is wrong.


Remember: You know your body best. Be sure that you understand the language of your hormones well enough to discuss your concerns and your thoughts on solutions with the medical care providers who are there to support you...




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