Clinical Insights on Hormonal Monitoring with Mira and Its Role in Perimenopause Management
Understanding Hormonal Chaos During Perimenopause
Perimenopause is a transitional phase marked by declining ovarian function and unpredictable hormonal shifts. It often begins in a woman’s 40s but can start earlier, bringing symptoms such as irregular periods, fatigue, brain fog, anxiety, and disrupted sleep. While these symptoms are commonly dismissed or misunderstood, hormonal dysfunction—particularly ovulatory irregularity and progesterone deficiency—is frequently the underlying cause.
The Clinical Value of Mira
Unlike traditional "spot testing" of hormone levels, which captures a single point in time and often fails to reflect true fluctuations, the Mira monitor provides a continuous, real-time analysis of urinary hormone metabolites. Clinicians using Mira gain a comprehensive view of hormone dynamics across the menstrual cycle, offering deeper insight into ovarian function and hormonal balance. This longitudinal data can support clinical decision-making in the management of perimenopause and the use of hormone replacement therapy (HRT).
Why Mira Matters: Clinical Applications
Mira monitors four key hormone markers:
E3G (estrone-3-glucuronide): a metabolite of estrogen
PdG (pregnanediol glucuronide): a metabolite of progesterone
LH (luteinizing hormone): essential for ovulation
FSH (follicle-stimulating hormone): signals ovarian reserve
Using this data, clinicians can:
Identify ovulatory vs. anovulatory cycles
Assess estrogen dominance or deficiency
Detect luteal phase defects
Track FSH variability across cycles
Correlate hormone patterns with symptoms
Personalising HRT and Treatment Strategies
Mira offers clinicians a nuanced understanding of when and how to introduce hormonal interventions. For example, by identifying a woman’s exact ovulation timing, progesterone can be administered in a way that supports natural hormonal rhythms rather than disrupting them with arbitrary schedules.
Mira also assists in monitoring the effects of lifestyle changes, supplements (like Vitex or inositol), and alternative therapies. When using systemic hormones such as oral progesterone or estrogen therapy, Mira data helps evaluate response, track cycle regularity, and anticipate symptom shifts. However, it is not a substitute for serum hormone levels when determining endometrial protection or exact therapeutic ranges.
PdG and Progesterone Monitoring
Progesterone decline is one of the first hormonal changes in perimenopause. Mira can:
Confirm whether ovulation occurred (via PdG rise after LH surge)
Identify irregular or insufficient progesterone patterns
Help time cyclic progesterone or natural hormone interventions
Clinical insight: Mira is not designed to assess the efficacy of supplemented progesterone directly but does allow for monitoring the broader response of the body to such interventions.
Estrogen Tracking (E3G)
Estrogen levels fluctuate widely in perimenopause, which can lead to both low-estrogen and high-estrogen symptoms—sometimes in the same month. Mira identifies:
Whether estrogen is rising appropriately mid-cycle
Episodes of estrogen excess (e.g. luteal out-of-phase events)
This helps avoid misattributing symptoms like mood changes or heavy bleeding solely to estrogen deficiency.
LH and FSH Insight
Mira tracks LH surges to:
Confirm ovulation events
Identify suboptimal or failed ovulatory attempts
FSH levels, which rise with ovarian decline, are also tracked, providing context about the perimenopausal transition. Because FSH fluctuates widely, ongoing tracking offers more clinical value than a one-off test.
Use Cases Beyond Traditional Cycles
Mira is also valuable for women who:
Have had a hysterectomy or uterine ablation
Are using birth control (e.g. IUDs or implants)
Are on HRT or DHEA supplementation
In these cases, Mira helps clinicians:
Detect residual ovulation
Track endogenous hormone production
Assess whether symptoms relate to hormonal fluctuations or suppression
Limitations and Responsible Use
While Mira offers rich, real-time data, it is not intended to:
Diagnose medical conditions like PCOS
Determine therapeutic hormone doses
Replace serum testing where precise hormone levels are needed (e.g. endometrial protection assessment)
Mira is most powerful when used in conjunction with clinical evaluation, patient-reported symptoms, and other diagnostic tools.
Empowering Women with Hormone Data
For perimenopausal women, Mira offers clarity in a time of hormonal uncertainty. For clinicians, it brings an additional layer of insight to guide patient care. At Sirona Health, we specialise in interpreting Mira data alongside your symptoms and history to create personalised, effective treatment plans.
Track Your Hormones with Mira—And Save 30%
Get everything you need to monitor your hormone patterns for 3 full months:
Use discount code SIRONAHEALTH at checkout to save 30%—you'll pay just £312.20 (saving £133.80 off the full price).
Book your consultation today and request a Mira Clinic invite to securely sync your hormone data with Sirona Health—so it's ready and waiting for your appointment.
About the Author
Dr Georgina Standen is a Women’s Health GP and Medical Director of Sirona Health. She specialises in menopause care, hormonal health, and holistic health assessments for women navigating midlife. Dr Standen combines evidence-based medicine with personalised, compassionate care.