My One Year Postpartum Labs (And Why I'm Running Them)

Signs you might want to run this:

• Fatigue that doesn't respond to sleep or rest
• Hair shedding or thinning
• Ongoing high stress or a history of burnout
• Anxiety, wired-but-tired energy, or trouble handling stress the way you used to
• You're vegan, vegetarian or on a restrictive diet
• You have digestive concerns that may impact mineral absorption
• You are trying to conceive 
• You're postpartum (like me!)
• Kids with picky eating, sleep, behavioral or growth concerns (I'm running on my kids just because)
• Known or suspected heavy metal exposure

Spectracell Micronutrient Panel

The Spectracell Micronutrient Panel is hands-down my favorite panel to run on all of my clients, especially those who are trying to conceive or postpartum. 

This test looks at how your cells are actually using nutrients, not just how much of a nutrient is floating around in your serum at the moment you draw blood. I've had clients who looked fine on a standard blood panel and were still functionally deficient in several nutrients on this test, which is why I like pairing it with standard labs instead of relying on either one alone.

Two nutrients I've watched flag on my own past panels, and that I'd expect to see again in a lot of breastfeeding moms at this stage, are calcium and choline. Calcium is the more nuanced of the two, since breastfeeding triggers a hormonally driven pull of calcium from the maternal skeleton regardless of intake. Choline is also on high demand during pregnancy and breastfeeding and most people are not getting enough from their prenatal alone. The recommended intake actually goes up during lactation to 550 milligrams a day, and most prenatal and postnatal multivitamins don't come close to that number.

You might want to run this if:

• You've been pregnant and/or breastfeeding for an extended stretch
• Standard blood work looks normal but you still don't feel right
• Fatigue, brain fog, or slow recovery from illness
• You want a broader nutrient picture than a standard panel gives you
• You're vegan, vegetarian, or on a restrictive diet
• You want actionable information to ensure you are taking the right supplements and focusing on the right foods
• You're just curious if your body has what it needs

Blood Tests

CBC with Differential

This is a standard test that should be run at least annually. A CBC gives you red blood cells, white blood cells, hemoglobin, hematocrit, and platelets, so it's more than just an anemia check even though that's usually why people run it. MCV, the size of your red blood cells, is actually one of my favorite pieces of the CBC because it hints at what kind of deficiency you're dealing with before the iron panel even confirms it. Small cells point toward iron deficiency, larger cells point toward B12 or folate. White blood cells give a general read on immune status and whether there's something acute going on, and platelets matter more postpartum than people realize given how much blood volume and clotting factors shift around delivery.

You might want to run this if:

• Any of the iron panel symptoms below
• General baseline check-in
• Frequent illness or slow recovery from being sick
• Easy bruising or unusual bleeding

CMP (comprehensive metabolic panel)

This covers electrolytes, kidney function, liver enzymes, blood glucose, and protein/albumin status. It's basic, but it's the panel most people assume already got checked at their last physical when it often hasn't since delivery. Liver enzymes in particular are worth having in view given the choline piece above, since inadequate choline intake during lactation is directly tied to fatty liver risk, and this is the panel that would flag it.

You might want to run this if:

• Haven't had one since before or shortly after delivery
• General baseline check-in alongside everything else
  
• Low choline intake or a diet that's been light on eggs, meat, and organ meats through breastfeeding
• Swelling, changes in urination, or anything that could point to kidney or fluid balance issues
• Want electrolyte context alongside the HTMA sodium/potassium picture 

 Iron panel

A CBC alone can look normal while ferritin, your iron storage marker, is already low. Postpartum iron deficiency is common, driven by pregnancy demands, blood loss at delivery and the ongoing demands of breastfeeding.

Iron itself (serum iron) tells you what's circulating right now, but it fluctuates enough day to day that it's not that useful alone. TIBC, total iron binding capacity, tells you how hard your body is working to grab onto more iron, it goes up when you're actually iron deficient because your body starts making more transport protein to compensate. Transferrin saturation ties iron and TIBC together into one number and is honestly one of the more reliable pieces of the whole panel, under 20% is worth paying attention to even if ferritin looks borderline okay.

You might want to run this if:

• Fatigue, especially fatigue that feels different from normal tiredness
• Hair shedding
• Restless legs
• Ice cravings or pica
• Shortness of breath with normal activity
• Heavy blood loss at delivery
• Still breastfeeding at a year or beyond 
• Heavy menstrual cycles
• Heavy metal exposure

Thyroid, full panel

I'm running TSH, free T4, free T3, Reverse T3 and TPO/TG antibodies, not just TSH alone. Postpartum thyroiditis develops within the first year after delivery in a meaningful percentage of women. 

TSH alone can miss a lot of this. The standard non-pregnant reference range runs roughly 0.4 to 4.0 mIU/L, wide enough that someone can sit at a 3.8 and be told everything is normal while feeling nowhere close to it. TPO antibodies matter just as much as the hormone numbers, since they flag risk even when current hormone levels look fine and can be elevated for years before there is an impact on TSH.

You might want to run this if:

• Unexplained fatigue
• Hair loss beyond the normal postpartum shed
• Mood changes, depression, anxiety
• Unexplained weight changes in either direction
• Irregular or absent menstrual cycles
• Chronic constipation
• Feeling cold or intolerant of temperature changes
• Family or personal history of thyroid or autoimmune disease

Fasting insulin

You might want to run this if:

• Stubborn weight that won't budge despite consistent habits
• Strong sugar or carb cravings
• Energy crashes after meals
• Family history of diabetes or insulin resistance
• History of gestational diabetes or PCOS
• Skin changes like darkened patches at the neck or underarms
  

A1c

This captures an average of blood sugar over the past t three months, so it catches patterns a single fasting glucose draw might miss on an unusually good or bad day. It's a slower-moving marker than fasting insulin, so the two together give both the early-warning signal and the longer trend. 

You might want to run this if:

• Family history of diabetes
• History of gestational diabetes or PCOS
• Wanting a longer-term view alongside fasting insulin rather than a single point-in-time number
• General metabolic baseline check-in

Homocysteine

This one's a bit of a hidden gem. Homocysteine is an amino acid your body recycles using B12, folate, and B6 as cofactors, so when any of those are running low, homocysteine climbs. It's basically a functional cross-check, if your B vitamins look fine on paper but homocysteine is elevated, that tells me something's actually off at the level that matters. It also matters beyond just B vitamin status, elevated homocysteine is tied to cardiovascular and methylation health more broadly, so it's not just a B12 proxy, it's genuinely useful information on its own.

You might want to run this if:

• Family history of cardiovascular disease
• Known MTHFR variant or family history of one
• Fatigue, brain fog, or tingling and numbness despite "normal" B12 or folate
• Want confirmation that your B vitamin status is functionally adequate, not just  normal on paper

DUTCH (Dried Urine Test for Comprehensive Hormones)

I usually bring a DUTCH into the picture for clients once they hit nine months to a year postpartum, since by then hormones have had enough time to start settling into whatever their new normal is going to be. It's a deeper look than blood work gives you, dried urine and saliva testing that maps out sex hormone metabolism, your full daily cortisol curve, cortisol awakening response, waking melatonin, DHEA, and some organic acid markers tied to nutrient status and neurotransmitters. If you've been dealing with irregular cycles, PMS, burnout, sleep that won't cooperate, or you're just trying to understand your stress response beyond "I feel tired," this is the test that actually shows you the pattern instead of a single number.

Here's my caveat for where I am right now: I'm not running this yet, because my cycle hasn't come back. Hormone testing without a cycle to map it against doesn't give clean, interpretable data, it's more noise than signal. So instead of jumping straight to DUTCH, I'm working on the things that actually influence whether my cycle returns in the first place: regulating stress, prioritizing blood building foods, and night weaning my son, since nursing frequency and overnight feeds are a big piece of what's telling my body to stay in lactational amenorrhea.

In the meantime, I'm using the Mira Hormone Monitor to get a real-time look at what's actually happening hormonally even without a full cycle to test against. It tracks LH, PdG, E3G, and FSH from urine day to day, so I can watch for any early hormonal movement before an actual period shows up. And yes I'll be sharing more on this tool soon once I learn how to use it! 

My general rule with clients, and the one I'm following myself, is DUTCH goes on the calendar three months after weaning or three months after a cycle returns, whichever comes first. That gives hormones enough time to settle into an actual pattern instead of testing mid-transition and getting a result that doesn't mean much.

You might want to run this if:

• Irregular or painful cycles
• PMS or mood changes
• PCOS diagnosis or symptoms
• Low energy or burnout
• Sleep disturbances
• Difficulty managing stress
• Hormone-related skin issues
• Fertility concerns or preparing for another pregnancy
• Postpartum hormone shifts, once your cycle has returned or you've weaned
• Perimenopause or menopause symptoms

Need Labs? Let's Work Together!

Every lab I've mentioned here, HTMA, Spectracell, the full blood panel, and DUTCH once you're ready, is available on my labs page, and every single one comes with my personal interpretation and recommendations, not just a PDF of numbers and reference ranges left for you to google at 1am. You don't have to piece any of this together on your own the way I've laid it out here. Head to my labs page, pick what makes sense for where you're at, and I'll walk you through your actual results. 

If you need more support, you can also become a client (and clients get exclusive lab discounts!)

The Bottom Line

As a functional medicine practitioner, one of my many mottos is "test, don't guess." This applies as much to unexplained infertility as it does to postpartum depletion. I want as much information as possible to support myself in feeling my best, getting my cycle back, and staying energized and pain free so that I can be present with my family and show up for my clients. I'm one to get very excited when labs come back abnormal, so I'll definitely share my actual results once they're back along with my full postpartum repletion supplement and diet plan!