QUESTION: Detail the role of major hormones in pregnancy (e.

g HCG, progesterone, estrogen,

prolactin and oxytocin)

Introduction

The correct balance of hormones is essential for a successful pregnancy. Hormones act as the
body’s chemical messengers sending information and feeding back responses between different
tissues and organs. Hormones travel around the body, usually via the blood, and attach to
proteins on the cells called receptors – much like a key fits a lock or a hand fits a glove. In
response to this, the target tissue or organ functions in a way that ensures pregnancy is
maintained. Initially, the ovaries, and then later, the placenta, are the main producers of
pregnancy-related hormones that are essential in creating and maintaining the correct
conditions required for a successful pregnancy.

The early stages of pregnancy

Following conception,a new embryo must signal its presence to the mother, allowing her body to
identify the start of pregnancy. When an egg is fertilised, it travels though the female
reproductive tract and implants into the womb around 9 days after it was fertilised, releasing a
hormone called human chorionic gonadotrophin in the process. This hormone enters the
maternal circulation and allows the mother to recognise the embryo and begin to change her
body to support a pregnancy. This hormone continues to be produced in large quantities during
pregnancy.

Human chorionic gonadotrophin can be detected in the urine as early as 7-9 days after
fertilization and is used as an indicator of pregnancy in most over-the-counter pregnancy tests.
It is partly responsible for the frequent urination often experienced by pregnant women during
the first trimester. This is because rising levels of human chorionic gonadotrophin causes more
blood to flow to the pelvic area and kidneys, which causes the kidneys to eliminate waste
quicker than before pregnancy. Human chorionic gonadotrophin passes through the mother’s
blood to the ovaries to regulate the levels of the pro-pregnancy hormones, oestrogen and
progesterone.

The role of progesterone and oestrogen during pregnancy

High levels of progesterone are required throughout pregnancy with levels steadily rising until
the birth of the baby. During the first few weeks of pregnancy, progesterone produced from the
corpus luteum (a temporary endocrine gland of the ovaries) is sufficient to maintain pregnancy.
At this early stage, progesterone has many different functions which are vital to the
establishment of pregnancy, including:

Increasing blood flow to the womb by stimulating the growth of existing blood vessels.
Stimulating glands in the lining of the womb (the endometrium) to produce nutrients that sustain
the early embryo.

Stimulating the endometrium to grow and become thickened, producing the decidua (a unique
organ that supports the attachment of the placenta) and allowing implantation of the embryo.

Helping to establish the placenta.

As the placenta forms and grows, it develops the ability to produce hormones. The cells that
make up the placenta, known as trophoblasts, are able to convert cholesterol from the mother’s
bloodstream into progesterone. Between weeks 6-9 of pregnancy, the placenta takes over from
the ovaries as the main producer of progesterone. As well as being vital to the establishment of
pregnancy, progesterone also has many functions during mid- to late pregnancy, including:

Being important for correct foetal development.

Preventing the muscles of the womb contracting until labour starts.

Preventing lactation(breastfeeding) until after pregnancy.

Strengthening the muscles of the pelvic wall in preparation for labour.

Although progesterone dominates throughout pregnancy, oestrogen is also very important.

Many of the functions of progesterone require oestrogen and in fact, progesterone production
from the placenta is stimulated by oestrogen. Initially, oestrogen is made and released by the
corpus luteum of the ovaries. As the pregnancy develops, the foetal adrenal glands produce
androgen that are then passed to the placenta and converted to the hormone oestriol (an
oestrogen often used to determine foetal wellbeing in pregnancy) and other oestrogen Levels of
oestriol increase steadily until birth and have a wide range of effects, including:

Maintaining, controlling and stimulating the production of other pregnancy hormones.

Ensuring the correct development of many foetal organs including the lungs, liver and kidneys.

Stimulating the growth and correct function of the placenta.

Promoting growth of maternal breast tissue (along with progesterone) and preparing the mother
for lactation (breastfeeding).
Other hormones produced by the placenta

The placenta also produces several other hormones including human placental lactogen and
corticotrophin-releasing hormone. The function of human placental lactogen is not completely
understood, although it is thought to promote the growth of the mammary glands in preparation
for lactation. It is also believed to help regulate the mother’s metabolism by increasing maternal
blood levels of nutrients for use by the foetus. Corticotrophin-releasing hormone is thought to
regulate the duration of pregnancy and foetal maturation. For example, when pregnant women
experience stress, particularly in the first trimester of pregnancy, the placenta increases the
production of corticotrophin-releasing hormone. There is a good reason for this. In the first days
of pregnancy, corticotrophin-releasing hormone suppresses the mother’s immune system,
preventing the mother’s body from attacking the foetus. Later in pregnancy, it improves the
blood flow between the placenta and foetus. In the last weeks of pregnancy
corticotrophin-releasing hormone levels climb even higher – a rise which coincides with a major
spike in cortisol levels. The rise in corticotrophin-releasing hormone and cortisol may help the
foetal organs mature just before labour begins, and influence the timing of birth, through
production of a ‘late-term cortisol surge’. This prenatal cortisol surge has also been linked to
more attentive mothering in both animals and women. It is thought to be an adaptive response
that induces an increased liking for their infant’s body odours, strengthening the bond between
mother and baby.

Side-effects of pregnancy hormones

High levels of progesterone and oestrogen are important for a healthy pregnancy but are often
the cause of some common unwanted side-effects in the mother, especially as they act on the
brain. Until the mother’s body has adapted to the higher levels of these hormones, mood swings
can be very common. The majority of women will experience morning sickness – a feeling of
nausea, any time of day, which may lead to vomiting. The exact cause of morning sickness is
unknown but it is likely to be because of the rapid increase in oestrogen, progesterone and
human chorionic gonadotrophin, or a decrease in thyroid stimulating hormone (which has a
similar structure to human chorionic gonadotrophin). Although it is probably caused by a
combination of all these hormonal changes. Morning sickness usually starts around week 5-6 of
pregnancy and often subsides by week 12-16, although some women suffer throughout
pregnancy and/or have very severe forms of morning sickness.

Many women experience pain and discomfort in the pelvis and lower back during the first
trimester. This is mostly due to a hormone called relaxin. Relaxin becomes detectable by week
7-10 and is produced throughout pregnancy. This hormone relaxes the mother’s muscles, joints
and ligaments to make room for the growing baby. The effects of relaxin are mostly
concentrated around the pelvic region, and softening the joints of the pelvis can often lead to
pain in the area. Softer pelvic joints can also decrease stability and some women may notice it
is harder to balance.

Although uncomfortable and frustrating at times, all these side-effects will usually lessen or even
subside by the end of the first trimester.
Hormones and labour

The exact events leading up to the onset of labour are still not fully understood. For the baby to
arrive, two things must happen: the muscles in the womb and abdominal wall have to contract
and the cervix needs to soften, or ripen, allowing passage of the baby from the womb to the
outside world.

The hormone oxytocin plays a key role in labour. Often called the ‘love hormone’, oxytocin is
associated with feelings of bonding and motherhood. This is also true of another hormone
released during labour called prolactin. If labour needs to be induced (brought on artificially),
oxytocin or a synthetic oxytocin equivalent is often administered to ‘kick-start’ the process.
Oxytocin levels rise at the onset of labour, causing regular contractions of the womb and
abdominal muscles.

The cervix must dilate (open) to around 10cm for the baby to pass through. Oxytocin, along with
other hormones, stimulates softening of the cervix leading to successive dilation during labour.
Oxytocin, with the help of the high levels of oestrogen, causes the release of a group of
hormones, known as prostaglandins, which may play a role in softening of the cervix. Levels of
relaxin also increase rapidly during labour. This aids the lengthening and softening of the cervix
and the softening and expansion of the mother’s lower pelvic region, thereby further aiding the
baby’s arrival.

As labour contractions become more intense, natural pain relief hormones are released. Known
as beta-endorphins, they are similar to drugs like morphine and act on the same receptors in the
brain. As well as pain relief, they can also induce feelings of elation and happiness in the
mother. As birth becomes imminent, the mother’s body releases large amounts of adrenaline
and noradrenaline - so-called ‘fight or flight’ hormones. A sudden rush of these hormones just
before birth causes a surge of energy in the mother and several very strong contractions, which
help to deliver the baby.

Hormones after labour

When the baby is born, oxytocin continues to contract the womb in order to limit blood flow to
the womb and reduce the risk of bleeding, and to help detach the placenta (which is delivered
shortly afterwards). Blood levels of oxytocin and prolactin are very high, which supports bonding
between the mother and baby. Skin-to-skin and eye contact between the mother and baby also
stimulate the release of oxytocin and prolactin, further encouraging bonding. Many mothers
describe being in a euphoric state just after labour; this is due to the effects of oxytocin, prolactin
and beta-endorphins.

Women are actually able to breastfeed at around four months of pregnancy but high levels of
progesterone and oestrogen during this time prevent milk production. After the placenta is
delivered during birth, the blood levels of progesterone and oestrogen fall, allowing the mother
to produce the first meal of colostrum, a high density milk that contains more protein,minerals
and fat-soluble vitamins (A and K) than mature milk, which is produced later. When the baby
suckles, oxytocin and prolactin are released from the pituitary gland, and pass through the
mother’s blood to the breast, where prolactin stimulates milk production and oxytocin stimulates
milk delivery to the nipple. As well as stimulating bonding, these hormones also aid milk release
and further milk production. Mature milk that nourishes the baby and induces sleep starts to be
produced about four days after birth.

The effects of hormones on the reproductive organs such as Uterus, breasts and placenta.

The main reproductive hormones estrogen, testosterone, and progesterone are instrumental in
sexuality and fertility. They are responsible for pregnancy, puberty, menstruation, menopause,
sex drive, sperm production and more. These hormones are produced in the ovaries (in
females). an overview of the effects of key hormones:

1. Human Chorionic Gonadotropin (HCG):

Human chorionic gonadotrophin (hCG) is a hormone produced by the placenta during

pregnancy. It’s sometimes called the pregnancy hormone because of its unique role in
supporting a pregnancy. HCG is found in your urine or blood around 10 to 11 days after
conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of
the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy.

How is human chorionic gonadotropin produced?

After conception occurs, a fertilized egg travels through your fallopian tubes to your uterus. The
fertilized egg (called an embryo) implants (attaches) into the wall of your uterus. This triggers
the placenta to form. Your placenta begins producing and releasing hCG into your blood and
urine. HCG can be found in a person’s blood around 11 days after conception. It takes slightly
longer for hCG to register on urine tests.

HCG increases quickly (almost doubling every three days) for the first eight to 10 weeks of
pregnancy. Healthcare providers look at how quickly a person’s hCG levels rise in early
pregnancy to determine how the pregnancy and fetus are developing.

What does human chorionic gonadotropin do?

Once your placenta begins making hCG, it triggers your body to create more estrogen and
progesterone. Together with hCG, these hormones help thicken your uterine lining and tell your
body to stop menstruating (or releasing eggs). The correct balance of these three hormones
sustains and supports the pregnancy.

2.Progesterone:

Progesterone is a hormone that plays an important role in your reproductive system. Hormones
are chemical messengers that tell your body how to work. In women or people assigned female
at birth (AFAB), progesterone supports menstruation and helps maintain the early stages of a
pregnancy.
What is the main purpose of progesterone?

The main function of progesterone is to prepare the endometrium (lining of your uterus) for a
fertilized egg to implant and grow. If a pregnancy doesn’t occur, the endometrium sheds during
your menstrual period. If conception occurs, progesterone increases to support the pregnancy.

Progesterone and menstruation

Ovulation (when your ovary releases an egg) occurs around the middle of a person’s menstrual
cycle. The corpus luteum forms from the empty egg follicle and begins producing progesterone.
Your corpus luteum is a temporary gland that helps support the beginning of a pregnancy if
conception occurs during that cycle. Progesterone works by thickening your uterine lining and
creating a good environment for a fertilized egg to implant.

If an egg isn’t fertilized during that cycle (meaning you don’t get pregnant), the corpus luteum
breaks down, which decreases progesterone levels. Decreasing progesterone levels means
your uterine lining thins and breaks down, causing the beginning of your menstrual period.

Progesterone during pregnancy

If an egg is fertilized by sperm and conception occurs, the corpus luteum doesn’t break down
and continues to make more progesterone. Your uterine lining is thick and rich in blood vessels,
which provides nutrients for the fertilized egg (now an embryo). Once the placenta forms, it’ll
take over progesterone production.

During pregnancy, progesterone levels increase each trimester, reaching their highest level in
your third trimester (weeks 28 to 40 of pregnancy). Progesterone levels decline in the years
leading up to menopause, when ovulation stops.

What is the main purpose of progesterone?

The main function of progesterone is to prepare the endometrium (lining of your uterus) for a
fertilized egg to implant and grow. If a pregnancy doesn’t occur, the endometrium sheds during
your menstrual period. If conception occurs, progesterone increases to support the pregnancy.

Progesterone and menstruation

Ovulation (when your ovary releases an egg) occurs around the middle of a person’s menstrual
cycle. The corpus luteum forms from the empty egg follicle and begins producing progesterone.
Your corpus luteum is a temporary gland that helps support the beginning of a pregnancy if
conception occurs during that cycle. Progesterone works by thickening your uterine lining and
creating a good environment for a fertilized egg to implant.

If an egg isn’t fertilized during that cycle (meaning you don’t get pregnant), the corpus luteum
breaks down, which decreases progesterone levels. Decreasing progesterone levels means
your uterine lining thins and breaks down, causing the beginning of your menstrual period.
Progesterone during pregnancy

If an egg is fertilized by sperm and conception occurs, the corpus luteum doesn’t break down
and continues to make more progesterone. Your uterine lining is thick and rich in blood vessels,
which provides nutrients for the fertilized egg (now an embryo). Once the placenta forms, it’ll
take over progesterone production.

During pregnancy, progesterone levels increase each trimester, reaching their highest level in
your third trimester (weeks 28 to 40 of pregnancy). Progesterone levels decline in the years
leading up to menopause, when ovulation stops.

What does progesterone do during pregnancy?

Progesterone is critical in supporting a pregnancy because it thickens your uterine lining. A thick
uterine lining helps a fertilized egg grow into an embryo, and then to a fetus.

Progesterone levels continue to rise during pregnancy. High progesterone levels prevent your
body from ovulating while you’re pregnant. It also suppresses uterine contractions, which helps
you avoid preterm labor. Finally, progesterone helps your breasts prepare for
breastfeeding(chestfeeding).

Because progesterone is so important in maintaining the early stages of pregnancy, low

progesterone levels may make it hard for you to conceive and may put you at higher risk for
miscarriage.

3.Estrogen:

Estrogen is one of two sex hormones commonly associated with people assigned female at
birth (AFAB), including cisgender women, transgender men and nonbinary people with vaginas.
Along with progesterone, estrogen plays a key role in your reproductive health. The
development of secondary sex characteristics (breasts, hips, etc.), menstruation, pregnancy and
menopause are all possible, in part, because of estrogen.Estrogen plays an important role in
other body systems, too. For this reason, although AFAB people have the most estrogen, all
genders make this hormone.

What are the types of estrogen?

There are three major forms of estrogen:

Estrone (E1) is the primary form of estrogen that your body makes after menopause.

Estradiol (E2) is the primary form of estrogen in your body during your reproductive years. It’s
the most potent form of estrogen.

Estriol (E3) is the primary form of estrogen during pregnancy.

What role does estrogen play in reproductive health for women or DFAB?
Estrogen, like all hormones, is a chemical messenger. It tells your body when to start and stop
processes affecting your sexual and reproductive health. These processes cause important
changes in your body.

Puberty

Estrogen levels rise during puberty. The increase leads to secondary sex characteristics like
breasts and changes in overall body composition (like curves).

Menstrual cycle

Along with hormones made in your brain (FSH and LH) and progesterone, estrogen plays an
important part in your menstrual cycle. These hormones coexist in a delicate balance to keep
your periods regular. Estrogen plays a role in ovulation (when your ovaries release an egg) and
thickens the lining of your uterus (endometrium) to prepare it for pregnancy.

Pregnancy & Fertility

Estrogen peaks in the days leading up to ovulation. This is your most fertile period. At the same
time, estrogen thins your cervical mucus, a fluid sperm has to swim through to reach and
fertilize an egg. These estrogen-induced changes make it easier for you to become pregnant if
you have intercourse.

Regardless of where you are in your menstrual cycle, the presence of estrogen makes it more
comfortable to have intercourse. It keeps your vaginal walls thick, elastic and lubricated,
reducing pain associated with penetrative sex.

Menopause

Estrogen levels drop during perimenopause, the time right before menopause. Perimenopause
may last several years before menopause. Menopause officially begins when you don’t have a
period for 12 months. It usually happens around age 51. With menopause, your estrogen levels
drop and you no longer ovulate. The decrease in estrogen may lead to symptoms like vaginal
dryness, mood changes, night sweats and hot flashes.

The primary estrogen in your body changes from estradiol (E2) to estrone (E1) during
menopause.

What role does estrogen play in reproductive health for men or AMAB?

Estrogen affects the reproductive health of people who are assigned male at birth (AMAB), too.
In cisgender men, transgender women and nonbinary people with penises, estrogen impacts
sex drive and the ability to get an erection and make sperm.

Too little estrogen can lead to a low sex drive. Too much of it can cause infertility and erectile
dysfunction. Excessive estrogen can cause gynecomastia, or enlarged breasts.
If you’re assigned male at birth and concerned about your estrogen levels, speak with an
endocrinologist or a functional medicine specialist for help.

What is the non-reproductive function of estrogen?

Estrogen regulates important processes in your skeletal, cardiovascular, and central nervous
systems that impact your overall health. Estrogen affects:

Cholesterol levels.

Blood sugar levels.

Bone and muscle mass.

Circulation and blood flow.

Collagen production and moisture in your skin.

Brain function, including your ability to focus.

4.Prolactin:

Prolactin (also known as lactotropin and PRL) is a hormone that’s responsible for lactation,
certain breast tissue development and contributes to hundreds of other bodily processes.
Prolactin levels are normally low in people assigned male at birth (AMAB) and non-lactating and
non-pregnant people. They’re normally elevated in people who are pregnant or breastfeeding
(chestfeeding).

Most of your prolactin comes from your pituitary gland. It makes and releases (secretes) the
hormone.

Your pituitary gland is a small, pea-sized gland located at the base of your brain below your
hypothalamus. It’s a part of your endocrine system and is in charge of making many different
important hormones, including prolactin. Dopamine (a brain chemical) and estrogen (a
hormone) control prolactin production and release from your pituitary gland.

Your central nervous system, immune system, uterus and mammary glands are also capable of
producing prolactin. The following factors can contribute to prolactin creation in these tissues:

Nipple stimulation.

Exercise.

Stress.

Prolactin contributes to hundreds of bodily functions, but its two main functions include:
The development of mammary glands within breast tissues and milk production.

Lactation and breastfeeding (chestfeeding).

Prolactin’s role in mammary gland development and milk production

During pregnancy, the hormones prolactin, estrogen and progesterone stimulate breast tissue
development and milk production.

Prolactin promotes the growth of a certain type of breast tissue called mammary alveoli, which
are the components of the mammary gland where the production of milk occurs. Prolactin also
stimulates the breast alveolar cells to create milk components, including:

Lactose (the carbohydrate component of milk).

Casein (the protein component of milk).

Lipids (components that provide energy, essential fatty acids and cholesterol).

Prolactin’s role in lactation and breastfeeding (chestfeeding)

After delivery of your baby, progesterone levels drop, which increases the number of prolactin
receptors on the mammary alveolar cells. This allows for milk secretion through your nipple,
commonly known as lactation.

After delivery, prolactin levels don’t remain constantly elevated. Prolactin levels will only spike
during periods of nipple stimulation through suckling by your baby. As long as your baby
maintains suckling, prolactin levels stay elevated. During periods when you’re not breastfeeding,
your prolactin levels decrease, and milk production reduces. If a person doesn't breastfeed their
baby, prolactin levels fall to non-pregnant levels after one to two weeks.

5.Oxytocin:

Oxytocin is a natural hormone that manages key aspects of the female and male reproductive
systems, including labor and delivery and lactation, as well as aspects of human behavior. Your
hypothalamus makes oxytocin, but your posterior pituitary gland stores and releases it into your
bloodstream.

Hormones are chemicals that coordinate different functions in your body by carrying messages
through your blood to your organs, muscles and other tissues. These signals tell your body what
to do and when to do it.

Your hypothalamus is the part of your brain that controls functions like blood pressure, heart
rate, body temperature and digestion.

Your pituitary gland is a small, pea-sized endocrine gland located at the base of your brain
below your hypothalamus.
The two main physical functions of oxytocin are to stimulate uterine contractions in labor and
childbirth and to stimulate contractions of breast tissue to aid in lactation after childbirth.

Oxytocin also acts as a chemical messenger in your brain and has an important role in many
human behaviors and social interactions, including:

Sexual arousal.

Recognition.

Trust.

Romantic attachment.

Parent-infant bonding.

The effects of oxytocin on your brain are complex. Scientists are currently researching the role
of oxytocin in various conditions, including:

Addiction.

Anorexia.

Anxiety.

Autism spectrum disorder.

Depression.

Post-traumatic stress disorder (PTSD).