A young mom called recently for nutrition suggestions after a miscarriage. She was hoping to be pregnant again before long and wanted to know how she could build up her resources before then. It was an early miscarriage, which does not diminish the sadness, and fortunately there were no complications. While I’m not a doctor, and we had no reference numbers from blood tests, there are many signs about hormones to be gleaned from her cycle and overall physical picture.
Naturally we talked about iron and blood loss, and I asked about her energy level overall, since I know she’s chasing a toddler all day. Does she nap? Would she like to nap? She said she would like to nap but rarely found time to do so, because like many moms she wants to get things done during her toddler’s naps. When someone tells me they would like to nap and can’t, I tend to assume they need more nutrients in addition to more sleep, and the next step is to figure out what can easily be added to improve this mom’s energy.
She likes protein and iron-rich foods but doesn’t always have time to eat them, and since she mostly eats whole foods we talked about the challenge of getting sufficient calories while nursing and running after an active child, particularly without dense calories like nuts or creamy smoothies.
Then we discussed her cycle, and it turned out she appeared to have just a 7 or 8-day luteal phase in the months preceding conception and the miscarriage. Since this mom had one healthy baby and had not needed progesterone for that pregnancy, I asked if she weighed less now than she had a few years prior, because being underweight or under-fat can contribute to low progesterone. She said she wasn’t sure how much because she doesn’t use a scale regularly, but she was thinner. She had possibly maintained her muscle mass but lost body fat, and we discussed how this, and not being able to rest easily, might be contributing to her short luteal phase.
So her cycle was telling us that her brain didn’t consider there to be enough resources to keep progesterone up after ovulation, because it should stay up for at least 10 days, ideally 12-14 for the luteal phase. While we have no way of knowing if this was a factor in the miscarriage, because there are also genetic, immune, and other factors, it makes sense to use the luteal phase as a gauge of her body’s resources available for a future pregnancy. Also, regardless of whether she is hoping to be pregnant, she will likely feel better with a longer luteal phase and the appropriate amount of progesterone.
There are several possible ways to address a short luteal phase with a nursing toddler, such as:
1) nurse less
2) eat more, particularly foods rich in nutrients and calories
3) rest more, to reduce energy use and the brains’ perception of stress - this could mean sitting, laying down, napping, or changing the night time sleeping arrangements so the toddler sleeps longer, in a separate bed or room, etc,…
4) get bloodwork done and possibly get a prescription for progesterone to lengthen her luteal phase
She wasn’t planning to wean her toddler, and she wasn’t sure how their insurance would cover blood work and if it was worth the hassle of getting a prescription, so we discussed how she could get more calories in both her and the toddler, and rest more, so her body would have the resources to make more progesterone.
With some discussion and thinking through various scenarios, this mom now has several options she can pursue to shift her cycles toward the norm and improve her hormone balance before future pregnancies. While she may ultimately need supplemental progesterone, I’ve heard from other moms that it’s more effective when combined with rest and good nutrition. If she pursues further treatment, she can be more confident that she’s done what she could to balance her hormones and she’s getting the appropriate dose.
I hope this example helps other moms who may be in a similar situation, or supporting a friend in a similar situation. Please take the time to get the nutrition and rest if you can.