Thyroid hormones are made in the thyroid gland and play a crucial role in regulating many different body functions. But what happens when these hormones get out of balance and what is a thyroid disorder? Read on to find out.  Quick facts: What are thyroid hormones? Thyroid hormones are incredibly important hormones for overall health. They play a crucial role in influencing many, many different bodily processes.   There are three thyroid hormones—TSH, T4 and T3. Each has a different function in the body which we’ll explain in a second.  TSH is made in the pituitary gland in the brain. TSH then stimulates the thyroid gland—a butterfly-shaped gland in your throat to produce T4 and T3. What are the different types of thyroid hormones? There are three main thyroid hormones: What do thyroid hormones do in the body? Thyroid hormones play an essential role in many different functions of the body, including: The thyroid hormone feedback loop Just like lots of hormones, our thyroid hormones are all linked—involved in what’s known as a feedback loop. Essentially they all depend on each other to work optimally.  Here’s how the thyroid feedback loop works: Can thyroid hormones become imbalanced? Yes. Thyroid imbalances, known as thyroid disorders, are really common and can disrupt many aspects of your health—bringing on a whole range of unwanted symptoms.  1 in 8 women are estimated to develop thyroid problems during their lifetime. Thyroid disorders are caused by either an underactive thyroid (known as hypothyroidism) or an overactive thyroid (hyperthyroidism). Let’s take a look at each in turn. Hypothyroidism: an underactive thyroid Hypothyroidism is when your thyroid isn’t producing enough T4 (and sometimes T3). This means you have an abnormally high level of TSH, compared to your T4 and/or T3 levels. Because of the thyroid hormone feedback loop, when T3 and T4 are low our brains will overcompensate. This means you’ll produce more TSH to try and boost your T3 and T4 levels. This results in the classic low T3 and T4 levels paired with high TSH reading seen in hypothyroidism. Symptoms of an underactive thyroid  Hypothyroid symptoms include: Having an underactive thyroid can also increase the risk of developing long-term health problems such as cardiovascular conditions, insulin resistance, nerve damage and a swollen enlarged thyroid (goitre).  Causes of an underactive thyroid Hypothyroidism can be caused by a range of factors including age, poorly balanced diets and pre-existing medical conditions like Polycystic Ovary Syndrome (PCOS). Additionally, taking certain medications such as oestrogen-containing hormonal contraception and high doses of steroids can interfere with thyroid function.  Treatments for an underactive thyroid Hypothyroidism is typically treated with a medication called Levothyroxine that replaces T4. Cytomel, a T3 replacement, may also be required in specific cases. Lifestyle changes can also improve your thyroid function. Eating iodine-rich foods like milk and dairy products and adding more white fish, eggs, beans, pulses or red meat into your diet can help. Stress is a big factor in many hormone imbalances and conditions. So, like always, try to find a stress management method that works for you. If you smoke, consider quitting. Cutting down on your alcohol intake can help too. Hyperthyroidism: An overactive thyroid An overactive thyroid means you’re making too much T4 and T3. This triggers your brain to make less TSH—giving the characteristic low TSH paired with high T3 and T4. Symptoms of hyperthyroidism: Causes of an overactive thyroid Much like an underactive thyroid, lifestyle factors like poor diet, smoking, alcohol and stress can cause an overactive thyroid.  Genetics, autoimmune disorders like diabetes or Grave’s disease in addition to long-term problems with cardiovascular health and weight loss are associated with an overactive thyroid. Excess iodine consumption has also been linked to an overactive thyroid. Be mindful of rich sources of iodine like kelp and seaweed and take extra care to check any supplements. Treatments for an overactive thyroid Prescription medications like carbimazole can be prescribed to decrease the function of your thyroid. Beta-blockers can also provide symptom relief from a racing heart or heart palpitations. If needed, surgical intervention to partially remove your thyroid gland can also be an option. Can a thyroid imbalance affect fertility? Thyroid disorders can affect your fertility indirectly, because of the various issues they can cause to your metabolism and other hormones. One study demonstrated that 76% of women who fixed their thyroid were able to conceive between 6 weeks to 1 year afterwards.  Thyroid disorders can indirectly cause: Why should I test my thyroid hormones? If you suspect you have an issue with your thyroid or are experiencing any hormonal symptoms, testing your thyroid levels is the best place to start to help you understand whether you may be suffering from a thyroid disorder.  Most thyroid function tests will not measure T3 unless you are known to have problems with your thyroid. This is because you are unlikely to have abnormal levels of T3 without having abnormal levels of TSH and/or T4. Resources:

Hormone replacement therapy (HRT) is a common treatment for easing menopause symptoms, like hot flashes, brain fog, joint pain, low mood and low libido. But how does it work and what are the signs you need hormone replacement therapy? Read on to find out. Quick facts: HRT explained Hormone Replacement Therapy for menopause is a treatment that uses hormones to relieve the symptoms of menopause and to prevent health problems that can occur after menopause.  The hormones commonly used in HRT are oestrogen, progesterone and sometimes testosterone. It does what it says on the tin—replaces the hormones that are declining in your body during this natural part of ageing, with synthetic or bioidentical hormones. These hormones mimic your natural hormones, relieving symptoms.  HRT can be taken in a variety of ways, including pills, patches, gels, sprays, vaginal cream and pessaries. The best method to take HRT will depend on your individual needs, preferences and medical history. Do you need HRT? You can take HRT to relieve menopause symptoms if you’re in perimenopause (the years leading up to menopause before your periods stop) or postmenopause.  Challenging symptoms like brain fog, night sweats, vaginal dryness, reduced sex drive, insomnia and concentration issues can interrupt your daily life. Hormone replacement therapy helps to restore hormonal balance to provide relief. Whether or not you’ll need HRT will depend on your symptoms and physiology and is always a personal choice. For personalised advice, you can book an appointment with one of our Menopause Specialists.  They can prescribe HRT based on your individual needs and preferences and can offer expert guidance on navigating symptoms and treatment options. Different types of HRT There are different types of HRT to choose from. Which type is right for you will depend on: HRT options can contain different hormones, including oestrogen, progestogen, a combination of both, and sometimes testosterone. HRT can be taken in different ways tablets, including patches, gels, sprays, implants, coils, or creams. It can also be taken using different regimens, including cyclical or sequential treatments, or continuous treatments.  Tablets Tablets are one of the most common ways of taking HRT. You usually take them once a day. Tablets are available in both oestrogen-only and as combined HRT.  Although it’s small, the risk of developing blood clots is higher with tablets compared to other HRT methods like patches, gels and sprays. Skin patches HRT patches are available in both oestrogen-only and combined. They are stuck to the skin, usually on the lower half of your body, and gradually release small amounts of hormones through the skin. You’ll usually change your skin patch every few days. Patches could be a preferred option if you have difficulty swallowing tablets, get indigestion or are likely to forget to take tablets. Some patches can leave marks and cause redness or irritation. Oestrogen skin gels and sprays You apply oestrogen-only skin gels by smoothing them onto your skin. Apply sprays by spraying them on the inside of your arm or thigh once a day. Your body absorbs the oestrogen gradually. Vaginal oestrogen Low-dose vaginal oestrogen is also available in tablets, pessaries, creams or vaginal rings that you insert into your vagina. This can help to provide relief for particular menopause symptoms like vaginal dryness and pain during sex (dyspareunia). Testosterone Like oestrogen and progesterone, menopause also causes your testosterone to decline. This can make you feel tired, unmotivated and low in libido. While testosterone isn’t currently licensed to treat menopause symptoms in the UK, specialists may prescribe it. It’s given in the form of a gel that you can rub over the skin where it’s gradually absorbed. Although uncommon, possible side effects of taking testosterone include acne, unwanted hair growth and weight gain. Intrauterine system (IUS) or Mirena coil If you have a womb and are using oestrogen-only HRT, you’ll need to also take a form of progesterone HRT to protect against endometrial cancer. You can do this with the Mirena coil, an intrauterine system (IUS). Inserted into your womb, the Mirena coil gradually releases progestogen (levonorgestrel) into your body. Once inserted, the Mirena coil can stay in place for up to five years and double up as contraception to prevent pregnancy. Benefits and risks of HRT Like other medications, there are benefits and risks associated with HRT. Benefits of HRT Most of the symptoms of menopause are associated with declining oestrogen levels. People have found that HRT is useful to manage symptoms including:  There are several long-term effects associated with low oestrogen. Taking HRT can help to reduce the risk of: Risks of HRT The risks of any serious side effects are usually very low, and depend on: HRT can slightly increase the risk of breast cancer. If you’ve had breast cancer or have a family history of it you’ll usually be advised not to take HRT.  Currently, the risk of breast cancer when using HRT has been found to be an extra 5 in every 1000 women who take combined HRT for 5 years. The risk increases the longer you take it, and the older you are. It falls again after you stop taking it.  Oral HRT can increase the risk of blood clots and in rare cases, stroke. If your medical history would indicate that you are at an increased risk of blood clots or strokes you should be recommended HRT patches, spray or gel rather than tablets, which have been found to not carry this risk. Weighing up the risks and benefits of taking HRT needs to be considered on an individual basis. It has been found in more recent studies that usually the benefits outweigh the risks and why HRT is now so commonly used. If you haven’t had a hysterectomy, you’ll need to take oestrogen and progesterone combined to protect against cancer. Oestrogen thickens the womb lining which can increase the risk of developing endometrial cancer. Progesterone helps to protect against it by ensuring the lining is shed regularly. The HRT timeline: How long before results? Once […]

Stress is bad news, period. It can affect the menstrual cycle, and just about every other bodily process. In this article we’ll cover exactly what stress is, the science behind it, how it can impact our periods, and some top tips for managing it. Quick facts: What is stress? Stress is defined as a state of worry caused by a difficult situation. It’s always been a part of human life and is a fundamental element for our survival.  Stress is a natural part of life and impacts us almost daily. Whilst a small amount of stress can actually be good for us (believe it or not), chronic stress and burnout can end up negatively impacting almost all of our body’s processes—including our menstrual cycles. The bodily changes you feel when you’re stressed are akin to what your ancestors felt when they were running away from life-threatening predators. Except, nowadays, predators take on the shapes of boardrooms, bosses and bills. Stress is classed as a state of ‘disharmony’, disrupting the carefully coordinated balance that your body is consistently fine-tuning. Usually, your body’s reaction to stress is temporary and it’s able to revert to its previous state.   However, it’s increasingly common to be exposed to prolonged periods of stress or several different, unresolved stressors, which cannot be adapted to—resulting in chronic stress. This can feel never-ending and all-encompassing, impacting both our mental and physical health.  This is the type of stress linked to depression, fertility issues and other health problems. The science behind stress The body’s reaction to stress is coordinated by something called the hypothalamic-pituitary-adrenal axis (HPA axis). The hypothalamus, in the brain, helps encourage the production of hormones like cortisol aka stress hormone (1). These kickstart the body’s stress response and divert the brain’s attention away from other processes, like coordinating your reproductive system. When we are chronically stressed, our cortisol remains constantly high. This can put us in a constant state of ‘fight or flight’, leading to the body being unable to adequately support other bodily functions. What is a ‘normal’ period? To understand how stress may affect your menstrual cycle, it’s important to understand what a ‘normal’ or average cycle looks like. A ‘normal cycle’ can last anywhere from 21 to 35 days, depending on the individual.   A one-off longer or shorter cycle is still considered normal, but if yours are consistently irregular, it’s worth getting checked out as they could be caused by an underlying health condition, such as PCOS. Can stress affect your period? Stress can affect your period in many different ways. This is because your menstrual cycle and your body’s response to stress are both coordinated by the same part of the brain—the hypothalamus. If you have high cortisol it can disrupt the hypothalamus, disrupting the production of gonadotropin-releasing hormone (GnRH).  GnRH controls the production and regulation of follicle-stimulating hormone (FSH) and luteinising hormone (LH), two hormones incredibly important for the regulation of the menstrual cycle.  If FSH and LH become disrupted, you’re likely to experience disruptions to ovulation and menstrual cycle regularity. This can also disrupt sexual desire and arousal. One study found that women experiencing high levels of stress showed lower levels of sexual desire, linked to elevated cortisol levels. Can stress delay your period? Elevated cortisol levels as a result of stress can effectively delay ovulation by blocking the release of LH. Without a surge in LH, you won’t ovulate. This can make your cycles longer and potentially heavier. On the flip side, high levels of stress are also associated with shorter cycles. Can stress stop your period? In situations of chronic stress, ovulation can be prevented for long periods of time (known as chronic anovulation), stopping your period altogether. This can be due to psychological stress but also periods of intense exercise or eating disorders. Missing periods due to stress is called functional hypothalamic amenorrhoea. How do I know if stress is the cause of my menstrual cycle changes? Without the analysis of a medical professional or hormone test, it’s not possible to know for certain that stress is the cause of your menstrual cycle changes.  Lifestyle factors often work in tandem. Changes to your cycle may be because of a handful of interacting factors. That being said, there are steps you can take to get a better idea of whether stress could be behind your period irregularities.  Tracking your periods and symptoms, either with a period tracking app or just using a calendar or diary can help you understand if stress is linked to your cycle. Make a note of how irregular or regular your periods are and any symptoms like pain, acne and how you’re feeling emotionally, including stress.  You can also take our Online Health Assessment. Our assessment analyses your biometrics, medical history, periods and lifestyle factors, to calculate your risk profile and help determine the cause of your symptoms. By looking at the pattern between your menstrual cycle and stress levels, you should be able to spot if there’s any obvious link. Even if they aren’t linked, just being able to rule out stress as the cause of your period troubles is helpful—you’ll then at least know to direct your attention elsewhere. If you are under stress consistently, it may be difficult to pinpoint that this is what’s causing your irregular cycles. The best way to establish what is going on with your cycles is to look at your hormone health – you can do this using our tailored at-home Hormone and Fertility Test. By looking at hormones such as testosterone and thyroid-stimulating hormone, we can eliminate other things which can affect your cycle, such as PCOS or abnormal thyroid function. How can we manage stress? Although experiencing stress might not feel great in the moment, it does serve an important purpose and actually, in small doses, it’s a powerful motivator, helping us to work harder and achieve our goals.  Although our modern-day stressors might not be as dangerous as the threats facing our ancestors, they do still present […]

You can test some of your hormones with Hertility regardless of the type of birth control you’re using. In this article, we run through the differences between hormonal and non-hormonal birth control and which hormones you can test with us depending on the type you’re using.  Quick facts: Different types of birth control Despite most of us only being able to reel off a handful, there are actually many different types of birth control, or contraception. These include both hormonal and non-hormonal options, plus, long-term and short-term methods. Whatever method of contraception works best for you is personal and will depend on your goals, your body and if you choose to use hormonal contraception, your hormones too.  So, from condoms to coils, let’s take a look at the different types of birth control, how they work, and how each will affect a hormone and fertility test. What is hormonal contraception? Hormonal contraception uses synthetic hormones, which are basically (wo)man-made versions of our natural hormones, to either prevent us from ovulating and/or to bring about bodily changes that prevent pregnancy. Types of hormonal contraception include: How does hormonal contraception work? To understand how hormonal contraceptives work (and how this might affect your test), it’s important to first understand exactly how your hormones control your menstrual cycle and overall fertility. Your menstrual cycle hormones, including oestrogen, progesterone, follicle-stimulating hormone (FSH), luteinising hormone (LH) and testosterone, all work together to ensure that each month you ovulate a healthy, mature egg from one of your ovaries.  If any of these hormone levels are altered, disrupted or suppressed, your overall menstrual cycle and ovulation can be affected—impacting your fertility and ability to conceive.  Hormonal contraceptives use either a combination of synthetic oestrogen and synthetic progesterone (called progestin), or simply just progestin (depending on the type) to alter the balance of your menstrual hormones.  This brings about a series of bodily changes that prevent pregnancy, including: Hormonal contraception can also be used to help relieve hormonal symptoms, like acne, and those related to your menstrual cycle, like heavy menstrual bleeding. Can I test my hormones if I’m on hormonal contraception? Technically, yes you can—but because your natural hormone levels will be altered due to the synthetic hormones in your system, you won’t be able to get an accurate result of your natural menstrual cycle hormone levels, including your FSH, LH, or oestradiol (E2). The good news is, with Hertility, even if you’re on hormonal contraception, we can still test you for Anti-Müllerian Hormone (AMH) and your thyroid hormones—Thyroid Stimulating Hormone (TSH) and Free Thyroxine (FT4).  Taking a Hertility Hormone & Fertility Test to test your AMH will give you insight into how many eggs you’ve got left (your ovarian reserve), giving you a good idea of your current fertility. Hormonal contraception can temporarily impact AMH levels, to determine your ovarian reserve more accurately. We would recommend retesting your AMH with your cycling hormones (FSH, oestradiol and LH) at least 3 months after coming off your form of contraception. Your thyroid hormone levels are a good indicator of your general hormone health and remain unaffected by taking any hormonal contraception.  If you’re using a long-term form of hormone contraception, such as the contraceptive injection (known as Depo Provera), you might have to wait up to 12 months for your menstrual cycle hormones to regulate and get back to their natural levels, so we can get an accurate result. What is non-hormonal contraception? These are your contraceptive types that don’t contain any synthetic hormones, and won’t alter your natural hormone levels if you use them.  Types of non-hormonal contraception include: How does non-hormonal contraception work? Non-hormonal contraceptives prevent pregnancy through several different methods, the difference being they tend to use just one method, rather than a combination, like in hormonal contraception. These include:  These include: Can I test my hormones if I’m on non-hormonal contraception? Yes, you’re good to go! Non-hormonal contraception does not alter any of your natural hormone levels, so with our Hormone and Fertility Test you can test all of your menstrual cycle hormones, AMH and thyroid hormones when you’re using non-hormonal contraception. Do I need a hormone test? Testing your hormones and fertility can give you important insights into both your overall and reproductive health.  Whether you’re experiencing possible hormonal symptoms, or planning ahead for your future family forming options—testing can help give you clarity into what’s going on inside your body.  Our At-home Hormone & Fertility Test is personalised to you and based on your unique biometrics, medical history, cycle and symptoms. Our test will screen you for up to 18 reproductive health conditions and give you insights into your ovarian reserve. This can help you to identify any potential underlying health conditions or hormonal imbalances that could affect your chances of conceiving. We recommend regular testing—once a year, or every six months if you’re above 35 or have an underlying condition that might affect fertility. Because our hormones are constantly changing, regular testing helps to ensure you’re tracking any changes over time. This can help you to better manage any symptoms and measure the success of any lifestyle changes or medication if you need to. So, whether you’re curious about your health, planning for future children or trying to conceive, regular hormone testing with our At-Home Hormone & Fertility Tests could be an essential step toward understanding your reproductive health. If you’re on contraception, hormonal or non-hormonal, and want to test your hormones and fertility, you can get started today by taking our online health assessment today. References:

Anti-Müllerian Hormone (AMH) is a really important hormone for your fertility because of how closely it is linked to your eggs, AMH testing can help you understand your fertility and give you insights into your overall reproductive health. Here’s what testing can and can’t tell you. Quick facts: What is AMH and why is it so important? Anti-müllerian hormone (AMH) is a super important hormone for fertility. AMH is made by the small sacs, called follicles, in your ovaries. These follicles house your eggs.  Because of its close relationship to your eggs, testing your AMH levels can help indicate how many eggs you have left at the time of testing.  There are a few myths out there about what exactly AMH testing can tell us. So in this article, we cover the main things an AMH test can and can’t tell you. Let’s get into it… What can AMH testing tell me? Whether your ovarian reserve is a normal for your age AMH testing will give you insights into whether your ovarian reserve is in line with other healthy people in your age group. If you are not using any hormonal contraception, testing other hormones, like follicle-stimulating hormone (FSH) and oestradiol alongside AMH can also help to build a full picture of egg reserve. Generally, people with low egg reserves are known to have higher levels of FSH and lower levels of oestradiol. Whether you have polycystic ovaries or polycystic ovary syndrome AMH testing can also indicate whether you could have polycystic ovaries (PCO). PCO is a common reproductive health condition affecting around 30% of reproductive-aged people assigned female-at-birth. PCO is benign and does not affect fertility, but it can cause other unwanted symptoms.  People with PCO have a higher-than-expected number of immature follicles in their ovaries. More follicles mean a higher level of AMH in the blood.  Some people with PCO also have the syndrome that can be associated with it—polycystic ovary syndrome (PCOS), which often presents as symptoms like irregular periods and high testosterone levels.  According to updated guidelines, AMH testing can be used as a marker for polycystic ovaries, which is one of the criteria for a  PCOS diagnosis. However, we would always recommend getting a scan of your ovaries) to confirm the diagnosis. Whether IVF or egg freezing could be right for you AMH testing and understanding your ovarian reserve can also help to determine if certain fertility treatments like IVF or egg freezing could be suitable for you. During these fertility treatments, AMH levels are often tested to help determine the doses of medication needed and used to predict the outcomes of the egg collection process. People with lower AMH levels are known to have less successful IVF treatment cycles, whereas someone with high AMH might be at increased risk of developing a rare but potentially life threatening condition called OHSS (ovarian hyperstimulation syndrome).  Many NHS-funded and private IVF clinics therefore require a minimum AMH level for you to be eligible for a free IVF treatment cycle. The minimum level on the NHS will depend on where in the UK you are currently residing. Whether you may be perimenopausal or menopausal or have POI Menopause refers to the period of your life, usually post 45-50, where you no longer have menstrual cycles and are therefore no longer able to conceive naturally. Menopause is associated with having an extremely low, or completely diminished, ovarian reserve.  It is usually diagnosed retrospectively—when women are over 45 years old and have not had a period in 12 months (and are not using hormonal contraception).  For people who are younger, FSH levels are useful for diagnosing menopause, as FSH levels are known to increase for people with low egg reserves. Although AMH levels are not recommended to help diagnose menopause, it is known that AMH levels reduce to very low levels at the time of menopause. There is also evidence that people with very low AMH levels (who are not going through menopause) will undergo menopause much sooner than those with AMH levels that are within range. When the ovaries stop working before the age of 40, this is known as premature ovarian insufficiency (POI), which AMH levels have also been shown to provide a good indicator of. If you have a higher risk of miscarriage or recurrent pregnancy loss It is estimated that approximately 1 in 5 pregnancies end in miscarriage. Miscarriages occur most frequently in the first 12 weeks of pregnancy and can be associated with lots of different risk factors. Some of the most common are your and your partner or sperm donors’ age, pre-existing conditions and ethnicity. Recent evidence has shown that people with diminished ovarian reserve, and therefore very low AMH levels, are more likely to have a miscarriage or recurrent miscarriage (two or three consecutive pregnancy losses).  However, more research needs to be done to understand the links between AMH levels and miscarriage, including its risk factors. What can’t AMH testing tell me? Unfortunately, AMH testing and ovarian reserve forms only one part of the fertility picture and there are some things that AMH testing may not be able to tell you. Let’s take a look… It can’t determine your egg quality Although AMH levels can give insight into your egg quantity, it does not provide any insight into the quality of those eggs. Despite poor egg quality being one of the most common causes of female infertility, there is currently no test that can definitely determine egg quality (unless testing embryos in IVF treatment). It can’t determine your exact egg quantity Your AMH result can give an indication of the size of your ovarian reserve.  This is because it is released by the follicles which contain our eggs, meaning that the more follicles we have, the higher the AMH that will be produced. However, it can’t tell you your exact number of eggs because each follicle may produce a different amount of AMH depending on its size.  In order to estimate the number […]

Can smoking cause hormonal imbalances? Just like the negative consequences to heart and lung health, smoking can also negatively impact our reproductive health. Read on to find out.  Quick facts: How smoking affects the body It’s a well-known fact that smoking can have a negative impact on health, with both active and passive smoking being associated with multiple forms of cancer, diabetes and heart disease. Despite this, in the UK, as of 2019, 28% of men and 22% of women aged between 25 and 34 years are current smokers, according to published health data in England (1)—and a whopping 175 million people assigned-female-at-birth (AFAB) smoke worldwide. But whilst smoking’s effects on the heart and lungs are fairly common knowledge, fewer people are aware that it can also influence the body’s hormones. But how exactly are hormones and smoking linked? In this article we’ll look at: Does smoking affect hormones? Despite the lack of public awareness, there is plenty of research that shows how smoking can impact and even wreak havoc on our hormonal health. The chemical components of cigarette and cigar smoke can disrupt the normal functioning of our bodily systems, including the endocrine system. The endocrine system is a network of glands which influence the production, secretion and regulation of hormones throughout the body, such as the hypothalamus, thyroid, adrenal gland, and even the ovaries.  This disruption might lead to lasting effects on all kinds of hormonally regulated processes, including sexual function and reproductive potential, our metabolism and even our sleep.  As mentioned, both active and passive smoking (also known as second-hand smoking) can cause these nasty effects, with some research even indicating that prolonged exposure and inhalation of cigarette smoke can even affect the onset of menopause (3). There are over 4,000 substances in cigarettes that display reproductive toxicity. How does smoking affect different hormones? Smoking has been linked to abnormal changes and fluctuations in various hormone levels, including: Let’s take a look at each of these in detail. Smoking and testosterone Studies have consistently shown that smoking increases testosterone in AFAB individuals. Those who smoke have been found to have higher serum testosterone levels in their blood than those who don’t (4).  This is because smoking is inherently pro-androgenic, meaning it has a positive effect on androgen hormones like testosterone. Increased testosterone levels can bring on side effects such as excess body hair growth (hirsutism), acne, greasy hair and skin, irregular periods and low libido. The main reason for smoking’s pro-androgenic effects lies with nicotine. As tobacco is metabolised, the nicotine within it produces a compound known as cotinine, which inhibits testosterone breakdown (17). However, it’s interesting to note that similar studies performed on ageing men have indicated that, over a long enough timespan, smoking can reduce testosterone levels in those assigned-male-at-birth (AMAB) (16). Smoking and oestrogen As well as being pro-androgenic, smoking is also anti-oestrogenic, which means it has a negative effect on oestrogen levels. Studies have shown that women who smoke have  lower progesterone and oestrogen levels in both their blood and follicular fluid (the fluid which surrounds the developing egg, important for egg growth) (2,5).  Smoking even affects the conversion of androstenedione to oestradiol by cells within the eggs (2). This switch is mainly driven by the effects smoking has on the production of these hormones.  As well as negatively affecting oestrogen production and metabolism by your liver, smoking increases the levels of a hormone called sex hormone-binding globulin (SHBG) which binds to oestrogen—preventing it from performing its essential functions around the body. Symptoms of low oestrogen can include low libido, fatigue, and negative mood changes. Smoking and gonadotropins Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are both gonadotropin hormones. These are hormones released from the hypothalamus (a part of the brain) to regulate the menstrual cycle and induce ovulation.  Unsurprisingly, smoking has been found to affect gonadotropin levels as well. Studies have shown that habitual smokers tend to have higher levels of FSH and LH in the first half of their cycle and during their periods, than non-smokers (6,7).  Disrupted FSH and LH levels can lead to problems with both fertility and menopause. Smoking and Anti-müllerian hormone Anti-müllerian hormone (AMH) is produced by granulosa cells within the ovarian follicles. It’s used as an indicator of ovarian reserve, sometimes referred to as egg count. Research has shown that smokers generally have lower AMH levels. One study in particular found that current smokers have  44% lower AMH levels than non-smokers (8), indicating that smoking can be directly toxic to the eggs within the ovaries. Another study showed that, in smokers, the fluid produced by the granulosa cells (known as follicular fluid) also contains increased levels of harmful nicotine toxins (9). Chemicals derived from cigarettes and smoking have even been detected in the cervical mucus (10). Smoking and thyroid hormones Cigarette smoke has been found to have both inhibitory and stimulatory effects on thyroid hormones. Both active and passive smoking have been linked to decreased levels of thyroid-stimulating hormone (TSH) and increased levels of free thyroxine (T4) and triiodothyronine (T3) (11,12).  Because the thyroid gland plays an important role in the regulation of many different bodily functions such as growth and development, disruption in thyroid level can have huge knock on effects all around the body. The thyroid can also affect fertility.Smoking is consequently a known risk factor for thyroid-related disorders, especially Grave’s disease and Goitres (13,14). Smoking and prolactin Prolactin is produced by the pituitary gland in the brain and is most commonly associated with milk production and altering breast physiology, but it also has a number of different roles throughout the body.  Chronic long-term smoking has been found to be associated with decreased prolactin levels (14), which can cause irregular menstrual cycles, difficulty breastfeeding and negative mood changes. Smoking and cortisol Smoking has also been linked to increased cortisol levels in the blood. It also affects hormones involved in the production of cortisol (2), which can disrupt the regulation of its levels. Cortisol […]

Oestrogen—the matriarch of female sex hormones. But what exactly does it do in the body, what’s its role in the menstrual cycle and what are the symptoms to look for if your oestrogen has become imbalanced? Read on to find out.  Quick facts: What is oestrogen? Oestrogen is an important reproductive hormone in people of all sexes. It’s generally known as the ‘female’ sex hormone, because of its role in the development of the female reproductive system and regulation of the menstrual cycle.  Oestrogen works to enable ovulation and produce female sex characteristics. When we have healthy levels of oestrogen, it can help us to feel feisty, frisky and fabulous. Whilst it’s true that oestrogen plays a bigger role in those assigned-female-at-birth, everybody produces oestrogen, regardless of sex. In those assigned-female-at-birth, oestrogen is produced mainly in ovaries and depends on other reproductive hormones including follicle stimulating hormone (FSH), luteinising hormone (LH) and testosterone for both its production and regulation. Like all of our hormones, our oestrogen levels can sometimes become off-balanced—with many different lifestyle and genetic factors impacting its production and regulation throughout the body. Types of oestrogen? There are three different types of oestrogen, also sometimes spelt estrogen (the American spelling). What does oestrogen do? Oestrogen wears many hats—it helps to regulate our menstrual cycles, triggers the development of secondary sex characteristics like breasts and pubic hair and helps to maintain things like our skin’s moisture, our mood and even our bone and heart health. Let’s take a look at these in more detail: What is oestrogen’s role in the menstrual cycle? Like all of our menstrual cycle hormones, our oestrogen levels during the menstrual cycle fluctuate.  During the first part of our menstrual cycles, the follicular phase, which lasts from day 1 of our periods until ovulation (when we release a mature egg), our oestrogen levels start off low but steadily increase. In this phase, our eggs are maturing in preparation for ovulation.  Our eggs mature in our ovaries, in little sacs called follicles. These follicles make oestrogen, so whilst your eggs are maturing, your follicles steadily release this oestrogen—and it rises until it reaches a peak, just before we ovulate. Because of oestrogen’s feel-good factors, just before and during ovulation is the time of the month when we’ll be killing it, feeling our most fierce and fabulous. This is the time to book that big presentation at work, go on that first date or really push it in your gym session. This peak in oestrogen causes a surge in LH, which triggers the release of a mature egg from one of our ovaries during ovulation. After ovulation, oestrogen levels gradually drop and despite a small second wind around a week later, they continue to level off throughout the second stage of our menstrual cycles—the luteal phase. At the end of our cycles, if the ovulated egg has not met a sperm and been fertilised, all of our menstrual cycle hormones, including oestrogen, drop off to their baseline levels—triggering our periods. If our oestrogen levels get off balance, it can disrupt the balance of our other menstrual cycle hormones—potentially impacting ovulation. No ovulation = no pregnancy. So if you’re trying to get pregnant, testing your hormone levels is really important for understanding your ovulation and general menstrual cycle health. What affects oestrogen levels? As well as fluctuating naturally month to month, lots of other lifestyle, genetic and medical conditions can affect our oestrogen levels, including: Does oestrogen decline with age? Thanks to our wonderful ‘biological clocks’, as we age, our oestrogen levels gradually decline. This is because our number of egg cells decreases as we age and as a result, our follicles stop growing and producing as much oestradiol (E2). After menopause (when our periods stop completely), our E2 levels completely drop off, which is what causes the common low oestrogen menopausal symptoms like hot flushes, dry skin and mood swings. During perimenopause (the lead up to menopause), E2 levels fluctuate up and down which can also cause menopausal symptoms. Declining oestrogen levels has whole-body knock-on effects, but luckily these days hormone replacement therapy (HRT) can be a great option to relieve symptoms for many people during perimenopause and postmenopause. How do I know if my oestrogen levels are normal? Because our oestrogen levels fluctuate during our cycles, as we age, and are dependent on whether we’re taking hormonal birth control or not, our ‘normal’ level is constantly changing.  Like all of our hormones, our oestrogen is super sensitive and can easily get off balance. Oestrogen imbalances can cause a whole host of symptoms and can be caused by both lifestyle and genetic factors. Symptoms of high oestrogen levels Oestrogen dominance is a phrase that has been used to describe a phenomenon when oestrogen levels are too high in relation to the other sex hormones in your body.  Although it’s not a clinically recognised term, being more sensitive or having excess oestrogen is known to cause symptoms like irregular periods, abnormal vaginal bleeding, bloating, swollen or tender breasts and weight gain. Some causes of high oestrogen levels include underlying health conditions, genetic factors, dietary and lifestyle factors and environmental pollutants. Symptoms of low oestrogen levels On the flip side, when oestrogen levels are too low we can experience irregular periods, fertility difficulties, reduced bone density, vaginal dryness, hot flashes and dry skin—to name a few. Having very low oestrogen levels can be caused by your ovaries not working properly, which occurs in menopause or primary ovarian insufficiency (POI). However, underlying health conditions like pituitary gland disorders, as well as having very low levels of body fat, a high caffeine intake, smoking and excessive exercise can also result in lower oestrogen levels. Luckily, testing our E2 levels with a hormone test can help us to decipher if our oestrogen levels are within the normal range for us. Oestrogen FAQs Where can I get an oestrogen blood test? You’ve landed in the right place. With a Hertility Hormone and Fertility test […]

Prolactin has several important functions in the body. But what exactly does prolactin do and how do we know if our levels have become imbalanced? In this article, we’ll dive into exactly what prolactin is, what its functions are in the body, discuss imbalances in its levels and the importance of testing prolactin levels for reproductive and overall health. Quick facts: What is prolactin? Prolactin is a hormone that encourages breast growth and milk production during and after pregnancy, as well as maintaining our metabolism, regulating our stress response, maintaining a functioning immune system and in the development of our reproductive organs.  Similarly to follicle-stimulating hormone (FSH) and luteinising hormone (LH) it is secreted by the anterior pituitary gland, located at the base of the brain. From there, it’s released into the bloodstream where it travels around the body to carry out its functions.  Prolactin interacts with FSH and LH, and other cycle hormones, in a complex negative feedback loop. After ovulation prolactin production increases to prepare the body for a potential pregnancy. Prolactin’s role in breastfeeding In pregnant women, prolactin stimulates milk production in the mammary glands of the breasts—allowing for the secretion of breast milk. After birth, there is a postnatal rise in prolactin, which gets things started—but this isn’t enough to maintain breast milk development. When a baby suckles, prolactin levels in the blood increase in response, which stimulates the production of more milk. Prolactin levels spike around 30 minutes after the start of the feed, so this positive feedback effect is important for ensuring there is enough milk for the next feed.  This can also be stimulated by breast pumping, if you choose not to, or are unable to breastfeed. Prolactin levels Just like all of our hormones, from time to time, our prolactin levels can get off balance. This can cause a whole range of different symptoms and effects throughout the body, including affecting our thyroid hormones, stress hormones, menstrual cycles and ovulation. What are normal prolactin levels? Reference ranges for what is a normal prolactin level will be specific to the lab that is testing your sample.  Higher prolactin levels are usually present in those assigned-female-at-birth than those assigned-male-at-birth. In general, prolactin levels are expected to be less than 25 μg/L in those assigned-female-at-birth, who are not pregnant or breastfeeding. High prolactin levels Too much prolactin can stop our brains from producing FSH and LH—two key hormones involved in regulating our menstrual cycles and bringing about ovulation.  If FSH and LH are affected, ovulation can stop leading to the loss of periods, which is called amenorrhoea. No ovulation means no chance of a pregnancy, and therefore big issues for our fertility. Disruption to our menstrual cycle can also cause knock-on effects on our oestrogen levels, causing oestrogen deficiency. Some of the most common symptoms of high prolactin levels to look out for are milky white discharge from the nipples when not breastfeeding (galactorrhea), disturbances to the menstrual cycle, visual disturbances, headaches and symptoms of oestrogen deficiency. High prolactin levels can be caused by a variety of reasons, including imbalances in our thyroid and stress hormones. Additionally, a growth or tumour present in our pituitary glands, called a prolactinoma, can also cause persistent or increasing prolactin levels. Symptoms of high prolactin levels can include: Note: If you are experiencing any form of nipple discharge when not breastfeeding, get this checked by a physician or GP as it can be a symptom of breast cancer. Symptoms of high prolactin levels after menopause Although high prolactin levels are not common in those postmenopausal, it can occur. Excess prolactin after menopause often causes hyperthyroidism, when the body doesn’t make enough thyroid hormone. Symptoms can include: How to lower prolactin levels If you’re wondering how to reduce prolactin levels, this is very much dependent on the cause of your excess prolactin levels.  Your doctor may prescribe you medications like bromocriptine or cabergoline to lower your prolactin secretion. Surgery may also be recommended as the best treatment option for you.  Persistently high prolactin that has been caused by chronic stress, over-exercising or poor sleep may be lowered by lifestyle modifications. Low prolactin levels On the flip side, low prolactin levels is called hypoprolactinemia. Sometimes there aren’t any obvious symptoms of low prolactin levels, other than not being able to produce or release much breast milk after giving birth. Breastfeeding can increase our prolactin levels naturally—as the more we stimulate the nipples, more prolactin is produced.  Most people with low prolactin levels don’t have any specific medical issues, although there is preliminary evidence that suggests they might have reduced immune response to some infections and it could indicate that the pituitary gland isn’t functioning properly. Why should we test our prolactin levels? Like all of our reproductive hormones, it’s good to check in with prolactin regularly, especially if we’re trying to conceive or having any problems with our menstrual cycles or experiencing hormonal symptoms.  Testing our prolactin levels with a prolactin blood test can help us to determine if there are any hormonal issues affecting our fertility or menstrual cycle, or investigate any symptoms of prolactinoma. With a Hertility Hormone and Fertility test, we can test your prolactin levels alongside your Anti müllerian hormone (AMH), thyroid hormones and cycling hormones (FSH, LH and oestrogen) to help you gain a full insight into your hormonal health and fertility. If you’ve already done a test and received an abnormal prolactin result, you can book an appointment with one of our Private Gynaecologists specialising in hormone and fertility concerns to discuss your results and get a personalised care plan. Appointments are available daily, with no GP referral required. Prolactin FAQs Can I get an FSH, LH, Prolactin test all in one? Luckily, you’re in exactly the right place. With our Hormone and Fertility test we will test you for up to 10 reproductive hormones, including your FSH, LH, prolactin and more.  Do prolactin levels change with age? Unlike hormones like Anti Müllerian Hormone […]

Luteinising hormone is an important cycling hormone, involved in the regulation of the menstrual cycle and ovulation. But what happens when our levels get a little off balance? In this article, we’ll explain exactly what luteinising hormone is, how it works, and take a deep dive into its importance for female fertility. We’ll also take a look at LH levels and why they’re important, as well as how to recognise the symptoms of low or high LH. Quick facts: What is Luteinising Hormone (LH)?  Luteinising hormone (LH) plays a huge role when it comes to fertility and ovulation, despite it being one of the lesser-known cycling hormones. Luteinising hormone (LH) is what’s known as a gonadotropin hormone. There are only two types of this hormone, LH and its partner in crime, follicle-stimulating hormone (FSH). Gonadotropins are hormones that are released from the pituitary gland in the brain, into the bloodstream where they are transported to the gonads—or ovaries in those assigned female-at-birth and the testes in those assigned male-at-birth. LH has 3 main functions in those assigned-female-at-birth:  Oestrogen production LH works in tandem with FSH to stimulate the ovaries and surrounding cells to produce oestrogen. First, LH stimulates what’s known as theca cells in the ovaries, which then produce testosterone. Once testosterone is abundant, nearby granulosa cells are then stimulated by FSH to produce an enzyme called aromatase, which converts the testosterone into a type of oestrogen, oestradiol, or E2. Without the correct functioning of LH or FSH, testosterone and oestrogen production can become impacted. Ovulation LH is also crucial for successful ovulation. First, FSH stimulates the growth of follicles (small sacs that contain your eggs) in your ovaries. A number of eggs mature during the first half of your cycle, but only one gets released during ovulation—usually the ‘most mature’ follicle. In the days leading up to ovulation, this follicle increases its sensitivity to LH. It gradually produces more and more E2 and when this reaches a certain level, the pituitary gland releases a surge of LH. This LH surge is what causes the follicle to rupture and release the mature egg into the fallopian tube—triggering ovulation. Progesterone production After ovulation has occurred, LH stimulates the now empty follicle to start producing progesterone throughout the second half of the menstrual cycle—also known as the luteal phase. Both progesterone and E2 released by the empty follicle are intended to support conception, implantation and the early stages of pregnancy. However, if the egg is not fertilised and no embryo implants into the uterus, the empty follicle stops producing these hormones and eventually wastes away at the end of the menstrual cycle. What are normal LH levels in women? LH levels in women, or those assigned-female-at-birth, fluctuate during the menstrual cycle—so their levels will vary depending on where you are in your monthly cycle. LH levels can also vary depending on an individual’s age and whether they’re pregnant. Normal LH levels for women before menopause are around 5-25 IU/L, depending on the stage of the menstrual cycle. After menopause, normal LH levels range from around 14-52 IU/L. LH levels during the menstrual cycle Let’s take a closer look at how LH fluctuates during the menstrual cycle. As we mentioned earlier, a dramatic surge in LH around the middle of the cycle triggers ovulation. But after ovulation, LH production is dulled by rising levels of progesterone. If no pregnancy occurs and progesterone levels fall, LH production will start again anew at the beginning of the next cycle. LH levels during pregnancy During early pregnancy, LH levels remain low—blocked by continued progesterone production. High levels of human chorionic gonadotropin (hCG) released throughout pregnancy also ensure that they stay low throughout pregnancy, so no further ovulation is triggered. LH levels in menopause During menopause, LH levels become elevated, although this can vary from person to person. This increase in LH levels happen as a result of the general decline in hormone production by the ovaries. When the ovaries stop producing as much oestrogen and progesterone, the pituitary responds by increasing the production of FSH and LH, in an attempt to stimulate the ovaries. However, the ovaries become less responsive and, instead, LH levels rise. This rise in LH levels is associated with a lot of the typical symptoms of menopause, including hot flashes and night sweats. After menopause, LH levels can decline by around 30-40%. High LH levels High LH levels in females outside of normal menstrual cycle fluctuations can cause fertility problems, irregular periods and early puberty. High LH levels are often seen in people with primary ovarian insufficiency and in those with polycystic ovary syndrome (PCOS) often have elevated LH compared to their FSH. This unusual imbalance can lead to irregular periods and the overproduction of testosterone, both key symptoms of PCOS. Sometimes LH levels can become elevated due to dietary and lifestyle factors, including: Symptoms of high LH levels Symptoms of high LH levels in females are more related to the underlying cause than the LH itself. However, some of the most common symptoms associated with the causes of high LH levels include: How to lower LH levels If your LH levels are elevated and you are a regular smoker or drinker, consider taking steps to reduce these habits. If you’re trying to conceive, consider cutting alcohol and cigarettes completely as this will improve your chances of conception and prevent harmful effects to the baby during pregnancy. Low LH levels There are also a number of reasons why low LH levels might occur. Meningitis infections that have occurred in the last 12 months have been linked to low LH levels and so have eating disorders. Sometimes, LH levels can be decreased due to dietary and lifestyle factors as well as certain medications including: Low LH levels in females can lead to problems with ovulation. This includes anovulation, which is not ovulating at all. This can also lead to problems with menstruation, such as irregular, missing, or complete cessation of periods. Symptoms […]

Sex hormone-binding globulin (SHBG) is an important protein involved in the regulation of our sex hormones and in turn our ability to conceive. So what is a good, or ‘normal’ range for our SHBG levels? And how do we know when ours might be too high or too low? We’ve broken down all you need to know about SHBG levels, including what they mean, why they matter and what to do if you suspect yours might be out of range. Quick facts: What is SHBG? SHBG is an important protein that regulates the amount of testosterone and oestrogen available in the body by ‘binding’ to these hormones—which makes them inactive. This is because to bring about an effect in the body, hormones need to be unbound or free so they can enter cells and bring about their effect. The vast majority of testosterone and oestrogen in our bodies is bound to SHBG and other proteins. SHBG also controls the balance between testosterone and oestrogen, which is also important for the healthy functioning of our menstrual cycles. Why do SHBG levels matter? Because SHBG levels regulate the amount of testosterone and oestrogen available to be used by the body, if our SHBG levels are too high or low, this will have a knock on effect on our levels of both of these sex hormones.  If our SHBG levels are higher, we’ll have less free testosterone or oestrogen available. If our SHBG levels are lower, we’ll have more testosterone and oestrogen available.  Both of these sex hormones have important roles in the regulation of the menstrual cycle, ovulation, libido, energy levels and our mental health. Low SHBG When our SHBG levels are low, our levels of free unbound testosterone and oestrogen can become high. Let’s take a look at some of the symptoms, causes and what can be done to help. Symptoms of low SHBG These symptoms can often mirror those of excess testosterone including: Or excess oestrogen: Causes of low SHBG There is no single cause for abnormal SHBG levels, although increases in insulin, prolactin and androgens have been found to block SHBG production which could be a factor for those with low SHBG levels.  Low SHBG can also be caused by a number of lifestyle factors, certain medical conditions and genetics. Here are several conditions, as well as other factors, that low SHBG has been found to be associated with: How to raise low SHBG If you have low SHBG there are a number of lifestyle changes that may help to increase your levels. These include: High SHBG  On the flip side, when our SHBG levels are too high, our unbound testosterone and oestrogen can become abnormally low. Here are some symptoms, causes and what can be done to reduce high levels of SHBG. Symptoms of high SHBG These symptoms can often mirror those of low testosterone including:  Or low oestrogen: Causes of high SHBG Again, there is no single cause for abnormal SHBG levels, although as we mentioned previously, increases in oestrogen and thyroxine (T4) have been found to increase SHBG production, which could be a factor for those with high SHBG levels. There are also a number of conditions associated with high SHBG which include: How to lower SHBG Dietary changes are the most effective way to lower SHBG levels. Decreasing alcohol consumption, gaining weight if you have a low BHM and following a high-fat, low fibre diet may help decrease levels of SHBG. One study involving 48 premenopausal women showed that maintaining a high-fat, low diet decreased SHBG. However, more clinical studies are required to confirm this association. If the levels are elevated due to contraception use, this will usually return to normal levels once you stop using that contraception. Other possible causes such as type 1 diabetes and an overactive thyroid will need further investigation and will require medication specific to these conditions. SHBG tests Ultimately, if you suspect you may have abnormal levels of SHBG, the only way to definitively get a diagnosis is via a blood test. Because symptoms of abnormal SHBG levels can mimic those of high or low oestrogen and testosterone, your SHBG levels should be tested in tandem these hormones. You can test all of these hormones and more, with a Hertility at-home Hormone and Fertility Test. Resources: