What To Expect From Your Hormones When You're Expecting

By Dr. Brooke Kalanick

Few human experiences have as wide a range of “normal” as pregnancy and childbirth. It’s tough during this anxious time to have no certainty. Your body is changing quickly, and every little thing has you asking, “Is this normal?”

Every woman is different, and every pregnancy is different. It’s tough to have expectations of what’s “normal.” While all this uncertainly is hard to handle, it’s great practice for being a mom, where expectations might as well get tossed in the Diaper Genie.

Symptoms, mood, and fitness vary from woman to woman—and from one pregnancy to another. But there are specific hormone changes common to pregnancy in general. The question is how will they affect you personally? As you read through this pregnancy hormone cheat sheet you’ll relate to some and not to others. That, too, is totally normal.

Human Chorionic Gonadotropin

positive-pregnancy-test-450x340This is the hormone responsible for the plus sign when you pee on the stick. Just after you get pregnant, there is a surge in HCG which triggers your body to make a lot more estrogen and progesterone to support the pregnancy.

This hormone is thought to be a main culprit behind morning sickness. However, the verdict is still out on the exact cause of pregnancy nausea—which I think is a better term because I was nauseated 24/7. “Morning” sickness would’ve been a welcome alternative!

HCG is also part of the frequent urination that happens well before Baby is big enough to push down on your bladder.


Like the name implies, this is a big-time “promoter” (pro) of “gestation” (gesterone) aka, pregnancy. Low progesterone can be one factor in early miscarriages, and one your doctor may be monitoring to ensure you have enough to maintain your pregnancy.

Progesterone in initially made by the remnants of the estrogen-making follicle that released the egg from your ovary (the one that found its soulmate sperm and developed into a baby). That follicle’s remnants are now the corpus luteum, and its job is to make progesterone until it can no longer—and you get a menstural bleed—or until you get pregnant and the placenta takes over.

Progesterone, as you know from articles I’ve written before, can be one of the first dominoes to fall during stress. This means that during your first trimester, exercise as much as you feel you’re able to, but when you need that nap, take it! Eat regularly. This often helps keep the nausea at bay, but also doesn’t have your adrenals cranking out cortisol, using up valuable resources that could’ve gone towards making progesterone.

In short, pregnancy is no time for stress. One of my biggest bits of advice during pregnancy, especially the first 12-16 weeks is to rest, train as you feel able, and eat regularly and healthfully, avoiding the stress of blood sugar swings (in particularly the lows). And when it comes to emotional stress: let it go.

This is a great time to practice getting more adept at not allowing people to get under your skin, not stressing about stuff you can’t change, and adopting a healthier set of expectations for what you can reasonably accomplish in a day. Again, great practice for being a mom.

Image Source: www.acne.org

Image Source: www.acne.org

Progesterone can also be part of the breakouts that happen during pregnancy. This will be worse for a woman with insulin resistance, as progesterone can get turned into testosterone with surges in the hormone insulin (released when blood sugar is elevated).

Women with PCOS, I’m talking to you in particular. If you’ve had trouble with this before pregnancy, you will likely have first and third trimester breakouts. The best course of action is to keep your blood sugar balanced. In the blissful second trimester you will have so much estrogen that you will likely have the most clear skin you’ve ever experienced—aka “the glow.”


Prolactin makes a slow, steady climb from conception to delivery, getting the breasts ready to feed the baby. By the end of your second trimester and into the third you may very well see yellowish discharge from your breasts or wake to see wetness on your PJ shirt from overnight leaking.

woman-breastfeeding-blue-shirt-450x340High prolactin is key to being able to breastfeed your baby, but it can be troublesome for you mood. When prolactin levels are high, dopamine—a feel good, motivating, thought-organizing brain chemical—will be lower. Again, for women with PCOS, this may be a bigger issue, as you tend to have lower dopamine in general (and often high prolactin, as well).

This can look like an intermittent depression or a short fuse when it comes to stress. Ask my husband. Poor guy, those last few weeks the dude couldn’t even breathe without irritating me. During breastfeeding it can look like postpartum depression, but it’s not.

What happens for many women sensitive to low dopamine levels is something called dysphoric milk ejection reflex, or DMER. It is a temporary wave of depression or anxiety that comes with the milk let down as your baby starts to nurse—and it’s terrible. I suffered from this while breastfeeding both of my babies, and I wrote it about it here.

What can you do? There isn’t much you can take by way of medications or supplements because if you boost dopamine, you will be lowering prolactin, which you don’t want to do. But it does help to know this is just a temporary state, and you can officially blame your hormones. Knowing it’s not you, that it is your chemistry, lets you to detach from it a bit. Low dopamine feels very “gloom and doom,” but trust that it is temporary and that the world isn’t actually ending.


You owe a lot of the perks of pregnancy to estrogen. The clear, glowing skin; thick, lustrous hair that doesn’t shed for months; and maybe even leaner legs.

estrogen-graphic-450x340Normally, estrogen can pack on more padding on the hips and thighs, as certain receptors here for fat storage (alpha adrenergic receptors that respond to adrenaline) are very sensitive to estrogen. Because of this, estrogen gives us that hourglass shape. However, it also causes hips and thighs to be “trouble areas” for some women—particularly those with estrogen dominance.

Although she gets a bad rap, estrogen is also a key fat-burning and muscle-maintaining hormone. The right amount of estrogen can go a long way toward a leaner, tighter bod. If you were a low-estrogen female before (again, many women with PCOS are), you may find that during your second trimester if you are exercising and eating well you lean out a bit in the thighs and butt. (Note: you can be low-estrogen and still be estrogen dominant, getting all the bad effects of estrogen and few of the good.)

Postpartum, estrogen plummets. This drop in estrogen can give you a host of menopause-like symptoms including hot flashes, vaginal dryness, and the rapid hair shedding that starts around 5 weeks after delivery and can last until your baby is 5-6 months old. All of this will be worse if you are breastfeeding (for most women) as the prolactin to maintain the milk supply will keep estrogen low.

Your Immune Hormones: the Cytokines

Biochemical craziness is not reserved for the hormones we know and love like estrogen and progesterone, but also for the hormones of the immune system called cytokines.

Pregnancy is among the more amazing things a female body can do. It is able to make such significant shifts in its immune system that it can carry a little parasite, that is not exactly the same as her own tissue, without rejecting it. Your body does this delicate dance of some pretty significant immune system shifts in order to hold the pregnancy and let that little critter safely stay in there until it’s done baking.

Without getting into the complicated details of this (it’s truly amazing, though) understand that there are two main aspects to your immune response known as TH1 and TH2. TH1, in short, are your killer cells. The ones that go after a virus or a bacteria knowing they don’t belong in your body. TH2 cells make antibodies, which is essentially a most-wanted list that directs what the TH1 cells should kill. They say, “Ok, just kill that thing I labeled with this antibody and leave the rest of our cells out of it.”

During pregnancy there’s a lot going on with TH1 and TH2 to keep Mom healthy and not reject Baby (this is also the heart of autoimmunity, but that’s for another blog post). Because of this you may notice that your seasonal allergies or food sensitivities are much worse during pregnancy. For many women the heartburn associated with pregnancy is in part due to this, and not entirely due to Baby pressing your stomach up into your ribs. This was certainly the case for me. I don’t do great with dairy normally, but the only time I had heartburn during either pregnancy was when I gave in to those ice cream cravings.

common-food-allergens-450x299It can be a good time to experiment with eliminating certain foods if you have been unsure whether or not they bother you. But do be careful if you take out an entire food group—like dairy, gluten, or grains—that you are keeping up calories and nutrients with other foods like sweet potato, avocado, plenty of protein, and lots and lots of veggies.

These intense immune system shifts can also be triggers for autoimmunity. During pregnancy the immune system is predominantly TH2 in order to hold on to the pregnancy. After delivery there is an abrupt shift back to TH1. This postpartum TH1 dominance post can be a big trigger for Hashimoto’s in particular, but many other autoimmune diseases as well.

It is because of this that I recommend all women are screened for Hashimoto’s postpartum at 3, 6 and 12 months. It is so easy to write off fatigue, hair loss, brain fog, and trouble losing weight as just part of being a new mom—which they all can be! It’s wise to be proactive and keep an eye out for this stuff.

Who among us hasn’t said or heard, “Everything with my health went to hell after I had my baby….” I hear this every day in my practice. It’s a simple, but not routine, blood test. So I urge you to please request that you are screened for Hashimtoto’s after Baby (ask for TPO and TG antibodies)—especially if you have thyroid problems in your family history. You can see which thyroid tests I recommend here.

In summary, the changes that happen to your body during pregnancy can feel pretty unnerving, especially if you don't know what to expect. Hopefully this article has given you a glimpse into what's going on with your body during and after pregnancy, so even if some of the symptoms are a bit rough, you can recognize that they are normal, and temporary.

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About the author:  Dr. Brooke Kalanick

Dr. Brooke Kalanick earned her Doctorate in Naturopathic Medicine from Bastyr University. Known as “The Hormone Whisperer,” Brooke's balanced approach to health, using both conventional and alternative therapies, allows her to successfully treat patients with Hashimoto’s Hypothyroidism and PCOS as well as other female hormone imbalances. Learn more about Dr. Brooke on her website and connect with her on Facebook and Twitter.

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