How Mira Hormone Tracking Works With HRT

Hormone replacement therapy (HRT) can be life-changing—but it often raises questions.

“Is it working?”

“What are my hormones doing?”

“Are my symptoms lining up with my hormones?”

💚 77% of women find Mira helpful in their HRT journeys¹

Mira hormone tracking doesn’t replace clinical care or blood tests, but it gives you visibility into your hormone patterns.

Here’s how Mira works alongside HRT, what it can help you understand, and what it can’t do.

1. Does Mira help me know if HRT is working for me?

With Mira, you can track patterns in hormone levels over time and visualize changes alongside menstrual cycle trends and self-reported symptoms.

If undergoing hormone replacement therapy, you may choose to share these hormone patterns with your healthcare provider. It does NOT measure exact hormone doses.

Mira shows trends in your own hormones, like FSH, LH, E3G, and PdG.
It can show if your cycles are more coordinated, if ovulation is occurring, and whether hormone patterns are stabilizing.
Mira tracks FSH suppression or stabilization, which is an important signal that estrogen therapy is being absorbed.
PdG and E3G trends provide context for progesterone and estrogen activity, but Mira cannot tell you whether your dose is too high or too low.
Mira helps you and your clinician correlate symptoms with hormone changes.

ℹ️ Remember: Mira shows hormone patterns, not dosage. It’s a tool to monitor your hormonal trends.*

2. How does Mira work with HRT?

What Mira does

Tracks hormone trends: E3G, PdG, LH, FSH
Shows your hormone activity even while on HRT (applies to specific HRT forms, see section 3)
Helps visualize cycle coordination and ovulation
Helps correlate symptom changes with hormone trends
Shows FSH suppression or stabilization over time

What Mira does not do

Does not measure therapeutic hormone levels
Does not determine if your dose is correct
Cannot replace blood tests
Cannot confirm whether local estrogen therapy achieves its target

*How this helps you**

Observe FSH trends to indicate estrogen effect
Monitor endogenous hormone patterns for ovary activity
Track changes in cycle and luteal phase
Support timing of cyclic progesterone therapy

*Note—When taking bioidentical oral estrogen/estradiol or bioidentical oral progesterone, E3G and PdG levels may be maxed out and will not fully reflect the therapeutic effect.

Mira’s upper limit for each hormone are: E3G: up to 640ng/ml; FSH: up to 200mIU/ml; LH: up to 240mIU/ml; PdG up to 30µg/ml.

3. What about specific types of HRT?

Different types of HRT interact with your body in different ways.

Mira does not identify, measure, or distinguish hormonal changes caused by medical treatments, medications, or therapies.

ℹ️ The Mira Hormone Monitor is intended for hormone tracking and personal cycle awareness. It is not intended to monitor, assess, or evaluate response to hormone replacement therapy (HRT) or any other medical treatment.

Find out more about your specific type of HRT below.

HRT Type	How Mira hormone results are affected	What Mira does	What Mira does not do	How this helps you
Oral bioidentical estrogen Such as: - Estrace® - Estradiol® - Gynodiol® - Progynova® - Estrofem® - Zumenon® - Elleste Solo®	• With oral estradiol, Mira E3G may be maxed out due to first-pass metabolism in the liver. • Higher estrogen activity due to oral estrogen supplementation can also cause lower FSH and LH results.	• Tracks E3G trends • Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol • Cannot confirm if dose is correct • Serum estradiol is not represented separately from oral biodentical estrogen in urine	• See how E3G levels are changing day by day • Connect these changes to improvements or fluctuations in symptoms
Oral conjugated equine estrogen Such as: - Premarin®	• Conjugated equine estrogens typically do not raise urinary E3G, as they have other ways of metabolizing in the body and excrete in urine in other forms rather than E3G, but they interact with estrogen receptors and mimic the effects of estrogen, which is how they improve symptoms of estrogenic deficit. • This is not a reliable indicator of estrogenic effect, unlike with bioidentical estradiol therapy. • LH and FSH levels may appear lower.	• Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol • Cannot confirm if dose is correct	• Tracks changes in hormone levels • Helps link patterns to day-to-day symptoms • Gives insight into how HRT is affecting your patterns.
Estradiol patch Such as: - Climara® - Vivelle‑Dot® - Alora® - Minivelle® - Lyllana® - Estradot® - Evorel® - FemSeven® - Systen® - Dermestril®	• With an estradiol patch, E3G levels may be slightly elevated in your results • FSH and LH may be lower due to the effect of estrogen therapy.	• Tracks overall E3G trends • Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol • Cannot confirm if dose is correct • Serum estradiol is not represented separately from patches’ biodentical estrogen in urine	• See how E3G levels are changing day by day • Connect these changes to improvements or fluctuations in symptoms
Estradiol gel Such as: - Divigel® - EstroGel® - Elestrin® - Estrogel® - Oestrogel® - Sandrena® - Gelis®	• With estradiol gel, E3G levels may be slightly elevated • FSH and LH may be lower due to the effect of estrogen therapy.	• Tracks E3G trends • Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol • Cannot confirm if dose is correct • Cannot fully track local estrogen effect • Serum estradiol is not represented separately from gel’s biodentical estrogen in urine	• See how E3G levels are changing day by day • Connect these changes to improvements or fluctuations in symptoms
Estradiol cream Such as: - Estrace® - Ovestin® - Gynest®	• With estradiol cream, E3G levels may be slightly elevated • FSH and LH may be lower due to the effect of estrogen therapy.	• Tracks E3G trends • Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol • Cannot confirm if dose is correct • Cannot fully track local estrogen effect • Serum estradiol is not represented separately from cream’s biodentical estrogen in urine	• See how E3G levels are changing day by day • Connect these changes to improvements or fluctuations in symptoms
Estradiol spray Such as: - Lenzetto® - Evamist®	• When using estradiol spray, E3G levels may read higher in your results • FSH and LH levels may appear suppressed.	• Tracks E3G trends • Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol • Cannot confirm if dose is correct • Cannot fully track local estrogen effect • Serum estradiol is not represented separately from spray’s biodentical estrogen in urine	• See how E3G levels are changing day by day • Connect these changes to improvements or fluctuations in symptoms
Vaginal estrogen (ring, tablets, capsules) Such as: - Femring® - Estring® - Vagifem® - Yuvafem® - Imvexxy®	• Topical vaginal estrogen doesn’t usually affect Mira results • Contact with your urine sample could affect estrogen readings.	• Shows endogenous hormone patterns and correlates them with symptoms • Because vaginal estrogen is not systemic, Mira accurately reflects your body’s own estrogen production	• Cannot determine if local estrogen is effective • Urine may be contaminated by vaginal use	• Track natural estrogen activity via E3G while using vaginal estrogen • See how your body’s hormone patterns are behaving over time.
Oral bioidentical progesterone Such as: - Oral Micronized Progesterone (OMP) - P4 - Prometrium® - Utrogestan® - Progeffik®	• Oral progesterone can cause Mira PdG levels to be consistently high due to first-pass metabolism in the liver. • May also make FSH and LH lower.	• Monitors endogenous progesterone patterns before supplementation • Supports timing of cyclic progesterone to match luteal phase • Tracks indirect effects like symptom changes, luteal phase length, and estrogen balance	• Cannot measure exact therapeutic dose • PdG may be maxed out, often reaching Mira’s upper limit, limiting direct assessment of therapeutic effect	• Track your body’s natural progesterone patterns • Helps you time your cycles to match your luteal phase for better hormonal rhythm. • See patterns for symptoms, luteal phase length, and hormone balance.
Sublingual Progesterone (Lozenge or Troche)	• Sublingual progesterone can cause PdG levels on Mira to rise, sometimes in a variable pattern • It may also make FSH and LH slightly lower.	• Monitors endogenous progesterone patterns before supplementation • Supports timing of cyclic progesterone to match luteal phase • Tracks indirect effects like symptom changes, luteal phase length, and estrogen balance	• Cannot measure exact therapeutic dose • PdG may be maxed out, often reaching Mira’s upper limit, limiting direct assessment of therapeutic effect	• Track your body’s natural progesterone patterns • Helps you time your cycles to match your luteal phase for better hormonal rhythm. • See patterns for symptoms, luteal phase length, and hormone balance.
Injectable bioidentical progesterone	• Injectable progesterone can cause PdG levels on Mira to rise in line with blood progesterone • It may also make FSH and LH slightly lower.	• Monitors endogenous progesterone patterns before supplementation • Supports timing of cyclic progesterone to match luteal phase • Tracks indirect effects like symptom changes, luteal phase length, and estrogen balance	• Cannot measure exact therapeutic dose • PdG may be maxed out, often reaching Mira’s upper limit, limiting direct assessment of therapeutic effect	• Track your body’s natural progesterone patterns • Helps you time your cycles to match your luteal phase for better hormonal rhythm. • See patterns for symptoms, luteal phase length, and hormone balance.
Topical/Local progesterone creams and gels	• Topical progesterone may not consistently raise blood progesterone or PdG levels • Mira PdG results often stay the same or show only small, irregular increases.	• Monitors endogenous progesterone patterns before supplementation • Supports timing of cyclic progesterone to match luteal phase • Tracks indirect effects like symptom changes, luteal phase length, and estrogen balance	• Cannot measure exact therapeutic dose • PdG may be maxed out, often reaching Mira’s upper limit, limiting direct assessment of therapeutic effect	• Track your body’s natural progesterone patterns • Helps you time your cycles to match your luteal phase for better hormonal rhythm. • See patterns for symptoms, luteal phase length, and hormone balance.
Vaginal progesterone Such as: - Crinone® - Cyclogest®	• With vaginal progesterone, PdG results may increase, but usually less consistently and at lower levels than with oral or injectable progesterone. • FSH and LH may be lower.	• Monitors endogenous progesterone patterns before supplementation • Supports timing of cyclic progesterone to match luteal phase • Tracks indirect effects like symptom changes, luteal phase length, and estrogen balance	• Cannot measure exact therapeutic dose • PdG may be maxed out, often reaching Mira’s upper limit, limiting direct assessment of therapeutic effect	• Track your body’s natural progesterone patterns • Helps you time your cycles to match your luteal phase for better hormonal rhythm. • See patterns for symptoms, luteal phase length, and hormone balance.
Combined patch (bioidentical estradiol + progestin) Such as: - CombiPatch® - Evorel Conti® - Climara Pro® - FemSeven Conti®	• May raise Mira E3G levels over time • It can lower FSH and LH. • PdG is not affected.	• Tracks E3G trends • Monitors FSH and LH changes • Due to the way bioidentical estradiol is metabolized, Mira E3G may reach the upper limit of the chart • Correlates hormone patterns with symptoms	• Cannot measure exact therapeutic hormone levels • Cannot determine dose effectiveness	• Shows how estrogen and progesterone work together • Tracks changes in hormone levels • Helps link patterns to day-to-day symptoms • Gives insight into how combined HRT is affecting your patterns.
Conjugated equine estrogen + bazedoxifene Such as: - Duavee® - Duavive®	• Does not affect Mira E3G or PdG levels. • FSH and LH may appear lower.	• Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Cannot measure exact therapeutic hormone levels • Cannot determine dose effectiveness	• Helps link patterns to day-to-day symptoms • Gives insight into how combined HRT is affecting your patterns.
Bioidentical estradiol + progesterone Such as: - Bijuvia®	• With oral estradiol and oral progesterone, Mira E3G and PdG may be maxed out due to first-pass metabolism in the liver. • May also cause FSH and LH to lower.	• Tracks E3G and PdG trends • Monitors FSH and LH changes • Due to the way bioidentical estradiol and progestrone is metabolized, Mira E3G and PdG may reach the upper limit of the chart • Correlates hormone patterns with symptoms	• Cannot measure exact therapeutic hormone levels • Cannot determine dose effectiveness	• Helps link patterns to day-to-day symptoms • Gives insight into how combined HRT is affecting your patterns.
Testosterone cream Such as: - AndroGel® - Testim® - Testogel® - AndroFeme®	• Testosterone cream may raise Mira E3G levels if estradiol levels are increased • Can cause FSH and LH to lower.	• Tracks E3G trends • Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol and testosterone levels • Cannot confirm if dose is correct	• Track daily changes in your FSH,LH, E3G, PdG • Correlate hormone patterns with symptoms
Testosterone pellets/injections Such as: - Testopel® - Testosterone cypionate - Testosterone enanthate - Sustanon® - Nebido®	• Testosterone pellets and injections may raise Mira E3G levels • Can cause FSH and LH to lower.	• Tracks E3G trends • Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol and testosterone levels • Cannot confirm if dose is correct	• Track daily changes in your FSH,LH, E3G, PdG • Correlate hormone patterns with symptoms
Combined pills (conjugated estrogen + medroxyprogesterone acetate Such as: - Premique®	• Conjugated equine estrogens typically do not raise urinary E3G or PdG levels • Can lower LH and FSH.	• Monitors FSH and LH changes • Correlates hormone patterns with symptoms	• Does not measure therapeutic serum estradiol • Cannot confirm if dose is correct	• Track daily changes in your FSH,LH, E3G,PdG • Correlate hormone patterns with symptoms
Combined pills (bioidentical estrogen +progestin) Such as: - Femoston® - Kliofem® - Kliovance® - Elleste® - Indivina® - Novofem® - Clinorette® - Activella® - Mimvey® - Kliogest®	• Combined pills with bioidentical estrogen may raise Mira E3G levels • It may lower FSH and LH, while Mira PdG remains unaffected.	• Tracks E3G trends • Monitors FSH and LH changes • Due to the way bioidentical estradiol is metabolized, Mira E3G may reach the upper limit of the chart • Correlates hormone patterns with symptoms	• Serum estradiol is not represented separately from pills’ biodentical estrogen in urine • Does not provide PdG changes	• Track daily changes in your FSH,LH, E3G,PdG • Correlate hormone patterns with symptoms
Hormonal IUD or intrauterine system Such as: - Mirena®	• Can monitor endogenous hormones patterns. • Hormonal IUDs containing Levonorgestrel typically do not affect Mira PdG levels.	• Helps to identify if ovulation is occurring or suppressed in perimenopause and hormonal patterns in respect are changed • Correlates hormone patterns with symptoms	• Not intended to determine whether a hormonal IUD is achieving its intended effect	• See how your hormone levels and ovulation patterns behave while using a hormonal IUD. • Understand if changes in symptoms are linked to hormone activity • Track how treatment is affecting your patterns over time.

Conclusion

Mira doesn’t replace medical care while on HRT—but it does give you something powerful: visibility.

By tracking your own hormone trends over time, you can notice meaningful hormone patterns during HRT, and have more informed conversations with your clinician.

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¹Based on survey responses from 166 participants using the Mira Monitor for hormonal tracking.