Beyond the Bleed: Your Questions Answered

In our recent Beyond the Bleed webinar Yasmin Ellis, Registered Nurse and Midwife, answered your most pressing questions on everything from adenomyosis to thyroid hormones and PMOS management. We couldn’t get through every question on the night, so we’re answering them all here.

This edition covers:

• What adenomyosis is and how it differs from endometriosis
• What your cycle length actually means for your hormones and egg reserve
• How to manage PMOS (formerly PCOS) without hormonal contraception
• Whether you can have PMOS and PMDD at the same time
• How thyroid dysfunction affects your cycle and what TSH levels to aim for when trying to conceive

Quick Facts

• Adenomyosis occurs when the uterine lining grows into the muscle wall of the uterus. Because it’s embedded, it can’t shed, which causes pain
• Cycle length does not affect egg reserve. AMH is the hormone that indicates ovarian reserve
• PMOS and PMDD are separate conditions and can occur together, as PMOS relates to androgen and insulin levels while PMDD relates to sensitivity to normal hormone fluctuations
• Thyroid dysfunction can delay ovulation and cause irregular cycles

1. Endometriosis and adenomyosis

What is adenomyosis?

Adenomyosis is a condition where the uterine lining grows down into the muscle of the uterus. Because it’s embedded within the muscle wall, it can’t shed in the way the normal lining does, and it’s this inability to shed that causes pain. It affects about 10% of women and those assigned female at birth. Beyond pain, other symptoms include bloating, heaviness or fullness in the abdomen or pain during sex. (2)

How is adenomyosis different from endometriosis?

According to Endometriosis UK 30-40% of people with endometriosis also have adenomyosis. The two conditions share a common thread: in both, tissue behaves like the uterine lining and wants to shed, but can’t. The key difference lies in where that tissue grows and what that means for treatment.

With endometriosis, for example, the tissue grows outside the uterus, on the ovaries, fallopian tubes, bowel, bladder, and it has even been found on the brain, in the chest cavity and in someone’s wrists. (3–5) Endometriosis can be removed surgically. By contrast, with adenomyosis, the tissue is embedded within the uterine muscle itself, which means surgical removal isn’t possible in the same way. Hormonal contraceptives like the pill or IUS, along with medications such as NSAIDs or tranexamic acid, are often used to alleviate symptoms.
However, the only curative options for the condition are surgical interventions, specifically endometrial ablation to remove the lining or a hysterectomy.(2)

Can you get pregnant with adenomyosis and hold a pregnancy?

Yes, absolutely. Having adenomyosis does not mean you cannot conceive or carry a pregnancy. However, it is worth noting that adenomyosis can occasionally complicate the path to conception and has been linked to a higher risk of miscarriage. (6,7)
To ensure you receive the most appropriate support alongside your diagnosis, we recommend consulting a specialist for personalised clinical guidance before you begin your journey to conceive.

Can contraception cause adenomyosis?

Based on our current clinical knowledge, the answer is no; there is no evidence that contraception leads to adenomyosis. (8) In fact, hormonal options are typically prescribed to help alleviate symptoms rather than being the source of the condition. While the precise cause remains a subject of ongoing research, factors like previous uterine surgery or specific physiological stressors on the tissue are believed to play a role in its development.

Can you know how long you’ve had it?

This is very difficult to determine. Adenomyosis is only being identified more frequently now because of improvements in ultrasound technology. Previously, it could only be confirmed via hysterectomy. How long someone’s symptoms have been present can give some indication of how long the condition has been active, but there’s no precise way to date it.

What should you eat to support adenomyosis?

An anti-inflammatory diet is recommended, the same approach advised for endometriosis. This means prioritising foods rich in omega-3 fatty acids, antioxidants, and fibre, and reducing ultra-processed foods, red meat, alcohol, deep fried foods and foods high in added sugar. (9)

Nutrition is a cornerstone of hormonal balance and fertility, yet finding evidence-based advice can be a challenge. Our Registered Nutritionists and Dietitians provide science-backed, 1:1 guidance tailored to your specific life stage and health goals. If you’re ready to optimise your health with a personalised nutritional care plan, book an online Nutrition Consultation.

2. What does your cycle length mean?

A normal menstrual cycle lasts between 21 and 35 days with a period lasting 3-7 days. However, day-to-day variation of up to 7 days from your average cycle length is considered perfectly normal. Variations occur because your ovulation date can shift from month to month, which directly impacts when your period will begin.

What does a short cycle length mean? (24–25 days)

A shorter cycle is perfectly normal and does not indicate lower progesterone or any hormonal problem. It simply means ovulation is happening a little earlier in your cycle, typically around days 10–14 rather than the commonly cited day 14.

What does a long cycle length mean? (32+ days)

Equally normal. A longer cycle means ovulation is expected later, around days 18–22. Provided cycles are consistent and falling within the 21–35 day range, a longer cycle on its own is not a concern.

→Check out our blog on irregular cycles

Does cycle length affect egg reserve?

No. Cycle length and egg reserve are not related. The hormone that indicates ovarian reserve is AMH (anti-Müllerian hormone), not cycle length. A short cycle does not mean a smaller egg reserve, and a long cycle does not mean a larger one.

That said, large cohort studies (10-11) suggest a potential link between longer menstrual cycles and Polycystic Ovary Syndrome (PCOS/PMOS), which is often associated with higher Anti-Müllerian Hormone (AMH) levels or Antral Follicle Counts (AFC) which is used to assess your egg reserve. Additionally, unpredictable cycle lengths can also be an indicator of perimenopause.

Why do you sometimes get a randomly long or skipped cycle?

Hormones are sensitive to a wide range of external factors. Sleep deprivation, stress, travelling or alcohol can all be enough to delay ovulation and produce a longer or skipped cycle. If the following cycles return to your normal pattern, it’s likely a one-off response rather than a sign of an underlying issue.

That said, if irregular cycles persist for more than 3 months it is worth investigating.

Ready to take charge of your reproductive health? Discover our Advanced At-Home Hormone and Fertility Tests today, screening for up to 18 conditions and checking up to 10 hormone levels.

3. Managing PMOS (formerly PCOS) without hormonal contraception

What are the alternatives to the coil or hormonal contraception for managing PMOS?

There are several non-contraceptive approaches worth exploring. A Mediterranean-style diet with low-GI foods is one of the most evidence-backed interventions for PMOS, targeting the insulin resistance that underpins many of the condition’s symptoms.(12) Regular exercise can also help, though finding the right type and intensity is often a process of trial and error. The supplement inositol (particularly myo-inositol) has the strongest evidence base of any supplement for PMOS management.(13)

Should symptoms persist after 3–6 months of these lifestyle changes, a gynaecologist can prescribe non-contraceptive medication to help manage specific symptoms.

What if diet and exercise have had mixed results?

This is very common with PMOS, because the condition presents differently in different people and a generic approach doesn’t always work. Hertility’s registered nutritionists specialise in hormonal health and can offer tailored advice for people with PMOS specifically, taking into account your individual hormone results and symptoms.

More broadly, nutrition is a cornerstone of hormonal balance and fertility, yet finding evidence-based advice can be a challenge. Our Registered Nutritionists and Dietitians provide science-backed, 1:1 guidance tailored to your specific life stage and health goals. If you’re ready to optimise your health with a personalised nutritional care plan, book an online Nutrition Consultation.

How can Hertility help manage PMOS symptoms like irregular and painful periods?

Hertility offers hormone testing alongside a 30-minute consultation with a fertility advisor, which is a good starting point for understanding what’s driving your symptoms and what options are available to you.

4. PMDD — intersections with PMOS and HRT

Can you have PMOS and PMDD at the same time?

Yes. Premenstrual Dysphoric Disorder (PMDD) is a cyclical hormone-based mood disorder. that affects mood, behaviour, and physical wellbeing in the days leading up to your period. The two conditions can coexist because they involve different hormonal mechanisms. PMOS is linked to elevated androgens and often insulin resistance, while PMDD is driven by sensitivity to the normal rise and fall of hormones across the menstrual cycle, particularly oestrogen and progesterone in the luteal phase. Having one does not preclude the other.

→Check out our PMS vs PMDD blog

Can HRT relieve PMDD symptoms?

Yes. Hormonal contraception and HRT are essentially the same hormones delivered at different doses, and hormonal contraception is a recognised prescribed treatment for PMDD. (14) HRT could similarly help relieve PMDD symptoms, but the correct formulation and dose would need to be determined by a gynaecologist who can properly assess and diagnose the condition first. This is particularly relevant for perimenopausal people experiencing PMDD.

At Hertility, we believe every woman deserves access to the information, testing and care she needs to understand her hormonal health. If you’d like to take control of your reproductive health today, explore our menopause consultations.

5. Thyroid hormones and the menstrual cycle

How does thyroid dysfunction affect the menstrual cycle?

Thyroid dysfunction can delay ovulation, which in turn can cause irregular cycles. This doesn’t happen in every person with a thyroid condition, but it’s a well-established connection, and one of the reasons Hertility always includes thyroid hormones in its testing panel.

Specifically, the two main types of thyroid dysfunction affect the cycle in slightly different ways. Hypothyroidism (an underactive thyroid) is associated with heavy or irregular periods, as well as irregular ovulation because when thyroid hormones are too low, the whole hormonal feedback loop slows down, and the signals that drive a regular cycle are disrupted. Hyperthyroidism (an overactive thyroid) tends to present differently, and is associated with lighter periods, decreased menstrual flow (hypomenorrhea), and in some cases missed periods (amenorrhea) altogether. In both cases, disrupted ovulation can make it harder to conceive, and can make timing intercourse more difficult.

How does thyroid dysfunction affect day-to-day life?

When thyroid hormones are out of range, the effects on daily life can be significant. An underactive thyroid (hypothyroidism) is more common and can cause fatigue, brain fog, feeling cold, difficulty losing weight, and hair thinning. TSH tends to be elevated in hypothyroidism. Other symptoms include constipation, poor memory, low libido, joint and muscle pain, dry skin, and a slowed heart rate.

An overactive thyroid (hyperthyroidism) presents differently, with TSH typically running low. Symptoms include mood changes such as nervousness, irritability and anxiety, heat intolerance and excessive sweating, unintentional weight loss, a rapid or irregular heartbeat, palpitations, difficulty sleeping, and persistent tiredness and weakness. Many of these symptoms overlap with other hormonal conditions (including perimenopause, PMOS, and PMDD) which is why testing is so important for getting an accurate diagnosis rather than guessing at the cause.

What’s the ideal TSH level when trying to conceive?

The normal reference range for TSH goes up to around 4.2, but when trying to conceive, the target is ideally between 0.5-2.5. This tighter range reflects the additional demands pregnancy places on thyroid function in early gestation. (15) It is recommended for women with a higher TSH to get below the 2.5 threshold initially before TTC. There is insufficient evidence that the 2.5-4.2 range will lead to infertility, many in the 2.5-4.2 range still manage to fall pregnant naturally; (16) however, TSH levels >4 has been associated with miscarriage. (15)

Does Hertility test thyroid hormones?

Yes. Thyroid hormones are always included in Hertility’s hormone panel. TSH and Free T4 are tested as standard alongside reproductive hormones, giving a more complete picture of what might be affecting your cycle.

How Hertility Can Help

Whether you’re navigating adenomyosis, trying to understand your cycle, managing PMOS without contraception, or getting to the bottom of thyroid symptoms that keep being dismissed, Hertility is here to give you the clinical picture you need.

Our Advanced Hormone & Fertility Test checks up to 10 key hormones, including thyroid hormones, androgens and AMH, and screens for up to 18 conditions including PMOS and thyroid disorders. Results come with a personalised care plan and access to our clinical team for next steps.

Take the Online Health Assessment →

This content is for informational purposes only and does not constitute medical advice. Please speak with a qualified healthcare professional about your individual circumstances.

Frequently asked questions

References

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8. Zhai J, Vannuccini S, Petraglia F, Giudice LC. Adenomyosis: Mechanisms and Pathogenesis. Semin Reprod Med. 2020 May;38(2–03):129–43. doi:10.1055/s-0040-1716687 PubMed PMID: 33032339; PubMed Central PMCID: PMC7932680.
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