Polycystic Ovary Syndrome (PCOS) is a very common reproductive health condition estimated to affect 1 in 10 in the UK. In this article, we’ll cover exactly what PCOS is, its causes and symptoms, common FAQs about PCOS and some tips for those living with the condition. Quick facts: What is PCOS? Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders. PCOS is characterised by an imbalance of sex hormones which can cause a whole host of symptoms – including missed periods, acne, excessive hair growth and even fertility issues.  Despite how common it is, many people don’t get a proper diagnosis until they’re having difficulties trying to get pregnant. Research has shown that it can take on average 2 years and visiting more than 3 doctors to get a PCOS diagnosis. What are the symptoms of PCOS? We are all unique, so every person affected by PCOS will experience symptoms differently but some common symptoms include the following. Menstrual cycle-related symptoms PCOS can impact ovulation by either causing irregular ovulation or no ovulation at all (anovulation). This is because people with PCOS tend to have imbalances in hormones that regulate the menstrual cycle – particularly luteinising hormone (LH).  As these hormones are key for regulating ovulation, an imbalance can cause ovulation to happen less frequently or stop it altogether. Irregular ovulation will often result in irregular periods (oligomenorrhea). This is when your cycle is less than 21 days, or more than 35 days apart. People with PCOS tend to have very long cycles (i.e. more than 35 days) or no periods at all (amenorrhea). They have also reported experiencing heavier-than-normal periods. Skin and hair-related symptoms This can include excessive hair growth (hirsutism), especially on the upper lip, chin, neck, sideburn area, chest, upper or lower abdomen, upper arm and inner thigh. Loss of hair or thinning of the scalp hair (alopecia) can also be experienced as well as thick dark patches of skin in your armpit or around your groin or neck (acanthosis nigricans) and skin tags. Acne is also a common symptom. Skin and hair-related symptoms are caused by having too many androgens (such as testosterone) in your body, which is a common trait in people with PCOS. Weight gain or difficulty losing weight Weight gain is particularly seen around the abdomen area (known as central adiposity), which is caused by PCOS affecting your metabolism. Difficulty conceiving This is due to the hormone imbalances in PCOS causing irregular ovulation. PCOS can cause ovulation to become less frequent and unpredictable, which may make it more tricky to conceive. If ovulation doesn’t occur, there’s no egg awaiting fertilisation. Mental health-related symptoms People with PCOS are more likely to experience mental health-related symptoms including depression and anxiety as a result of the negative impact their symptoms can have on their day-to-day life. What causes PCOS? Although the exact cause of PCOS is unknown, research suggests that a combination of genetic, lifestyle and environmental factors are at play. Here are some of the main factors thought to be responsible for PCOS symptoms. High levels of Androgens Androgens are a group of hormones, the most common being testosterone. They are made mostly by the ovaries and are important for muscle growth and getting your libido going.  People with PCOS have been found to have higher than normal androgen levels, a condition called ‘“hyperandrogenism”. This can result in characteristic PCOS symptoms such as excessive body and facial hair growth, hair loss from the scalp, oily skin and acne. Don’t be fooled by its name, polycystic ovaries do not mean cysts in the ovaries. This imbalance of androgen hormones does not allow follicles (little sacs that house your eggs) in the ovaries to mature properly.  As a result, there are a large number of immature follicles which get stuck in different stages of maturation. These can appear like cysts during a pelvic ultrasound scan but are very different to cysts. High levels of insulin Some people with PCOS also experience a condition called insulin resistance. Insulin is a hormone that controls blood glucose levels (basically your blood sugar). When blood glucose levels rise (after eating for example), insulin helps the cells to absorb it so it can be used by the body for energy. Insulin resistance is when the body doesn’t respond to normal insulin levels. The body starts making excess levels of insulin to compensate for this, leading to misregulation of blood sugar levels and knock-on effects on the proper functioning of the ovaries and ovulation.  Insulin resistance can also lead to problems with metabolism, causing further symptoms such as weight gain, difficulty losing weight and higher risks of conditions like type 2 diabetes.  High insulin levels also decrease the production of sex hormone-binding-globulin (SHBG)—an important hormone that regulates testosterone levels—which therefore results in increased levels of testosterone and excess androgen-related symptoms. Genetic causes PCOS has been found to run in families, so having an immediate relative with PCOS can put you at a higher risk of developing it yourself. There have been several genes which have been identified as possible causes of PCOS, but as of yet, no conclusive links have been made. Recent research published by members of the Hertility research team shows that PCOS may be associated with genetic changes in the powerhouse of our cells called the mitochondria. Ethnicity PCOS affects people of all ethnic backgrounds, however, research has shown that those from ethnic minority communities, especially those who are Black or South Asian, are at a higher risk of developing PCOS.  Different ethnicities are also known to have different PCOS symptoms. For example, research has found that women of South Asian and Middle Eastern descent are more likely to experience excessive body and facial hair and women of East Asia are more likely to experience irregular periods. How can I be diagnosed with PCOS? Someone would need to be experiencing at least two of the following to be diagnosed with PCOS:  Is there a […]

If you have been diagnosed with Polycystic Ovary Syndrome (PCOS) and are feeling a bit clueless or overwhelmed, we’re here to help. In this article, we explain all of the possible treatments for PCOS and how to effectively manage your symptoms. Quick facts: What is PCOS? PCOS is an extremely common reproductive health condition that affects up to 1 in 10 people assigned-female-at-birth. It can affect how the ovaries work and can cause an array of different symptoms, which can range in severity from person to person.  The good news is, that even if you are feeling overwhelmed or anxious at the outcome of your recent diagnosis, PCOS symptoms can be treated and managed with lifestyle changes. Symptoms of PCOS As with most conditions, the symptoms of PCOS vary from person to person, as does the severity of the symptoms. Not everyone with PCOS will experience all of these symptoms, but you need to have at least two of the below to have been diagnosed.   Other symptoms can include: What causes PCOS? Currently, the exact cause of PCOS is unknown but it often runs in families and can be related to abnormal hormone levels in the body, including high insulin.  Higher insulin levels also induce your ovaries to produce androgen hormones such as testosterone. An increase in androgen hormones can cause symptoms like excess hair growth (hirsutism) acne and alopecia.  High levels of insulin can also eventually cause insulin resistance. Because insulin metabolises carbohydrates in your body, those with insulin resistance are therefore unable to respond to glucose properly.  This can then lead to being overweight as your body is not able to absorb the sugars from your food into your liver and convert it into energy—so it is stored as fat instead. How to manage your PCOS symptoms The current treatment options for PCOS are symptomatic, as there is currently no cure. This means treatment is focused on treating and mitigating symptoms with lifestyle changes and certain medications.  Your treatment will follow patient-centred care, meaning you will have a say in your treatment and your doctors should respond by providing you with care that is responsive to your preference and needs. The first line of treatment they will recommend will be to make changes to your lifestyle. These include changing your diet, exercising, losing weight and taking part in activities to maintain healthy mental health.  Don’t underestimate the power of lifestyle changes. Making healthy choices and bringing positive changes to your lifestyle can create a major difference in your symptoms, allowing you to control them and improve your quality of life. With the right, tailored care plan, many people find that their PCOS symptoms can be controlled and that they don’t present any further problems for them. Let’s take a look at some of the lifestyle changes involved in PCOS symptom management. PCOS diet and nutrition Some research suggests that following a healthy balanced diet is a significant way to manage your PCOS—it can regulate your period and ovulation and reduce the presence of symptoms like acne and hirsutism. High GI carbs Vs low GI and weight loss If you are currently overweight, losing weight and maintaining a healthy weight is crucial for managing PCOS.  The more overweight you are the more complications you will face with PCOS as well as having a higher risk of developing other long term health conditions. There are many different PCOS diets that people recommend, but a healthy and sustainable option is a low glycaemic index (G.I) diet. This involves substituting high GI carbs with low GI carbs which can help PCOS sufferers lose weight efficiently. Low GI carbs increase blood glucose levels very slowly, whereas high GI foods are digested rapidly, which can cause spikes in your glucose and insulin levels.  A great book that explains the G.I diet very well is ‘ The Low GL Diet Bible’ by Patrick Holford, it contains a list of foods that you can substitute your daily carbs with. Here are some great examples of Low GI carbs that you could incorporate into your diet: Following a low GI carbs diet is generally the key piece of advice that clinicians and dieticians will advise in the case of any PCOS diagnosis and will likely form the basis of a PCOS specific nutritional care plan.  However, there are other foods and simple switches that you can incorporate into your diet which may help to further reduce your symptoms too. A PCOS friendly food list may contain: If you’d like help with anything regarding PCOS specific nutrition, you can book a consultation with one of our Fertility Nutritionists who will be able to help you with a nutritional care plan. Reducing fat and salt As well as managing and decreasing your carbohydrate intake, you should also manage your fat and salt intake and make sure you’re taking in all the necessary vitamins and minerals. Try to keep your salt intake to a maximum of 2,300 mg per day.Also, increasing the intake of whole foods aids weight loss and helps to maintain a healthy balanced diet.  Although losing weight isn’t so easy for PCOS sufferers, it is totally worth it—just a decrease in 5% of overall body weight can significantly improve symptoms. PCOS and exercise benefits Like losing weight, exercise increases metabolism and may help to improve many of your symptoms. When exercising, the main goal is to lose weight in the abdomen and reduce fat around the organs.  This will help to support your endocrine system, which secretes and regulates your hormones, including your insulin and testosterone levels.  If you’re new to regularly exercising, it’s best to start slowly, steadily increasing your workouts as well as the time spent working out. In the long run, this will be much easier to maintain.  Cardio is great for heart health, with things like swimming, hiking and running great for getting a sweat on. But there is a misconception that you will only lose weight with cardio, it’s a total myth!  […]

A common symptom of endometriosis is fertility issues. Up to 50% of people with endometriosis will struggle to conceive, with the causes still relatively unknown. Here take a deep dive into what you need to know about your fertility if you have diagnosed or suspected endometriosis. Quick facts: What is endometriosis? Endometriosis is a reproductive health condition where tissue similar to the lining of the womb grows in other places. This is called endometrial tissue. This tissue can grow in the ovaries and fallopian tubes and can cause painful symptoms.  It’s one of the most common reproductive health conditions. 1 in 10 women and those assigned female-at-birth (AFAB) will develop endometriosis, yet its definitive cause is still unknown.  As a long-term condition, endometriosis can significantly impact some people’s lives. One of the most common concerns is how does endometriosis affect fertility? Will endometriosis affect my fertility? In short, it might. Fertility problems are common in those with endometriosis, with 30-50% experiencing fertility problems (1). But having endometriosis does not automatically mean you will have fertility problems—every case is different. It will depend on the severity of your symptoms and any structural or hormonal issues you may have.  Is it possible to get pregnant with endometriosis? Yes, it’s possible to get pregnant with endometriosis. However, you may experience difficulty getting pregnant. Those with endometriosis have a lower chance of getting pregnant with each monthly cycle (2). This can result in it taking longer for people with endometriosis to conceive (3).  Infertility is also common in those with endometriosis, and in subfertile (failure to conceive after one year of trying) women the prevalence seems to be considerably higher, ranging from 20% to 50%, but it varies with time and age (1). How does endometriosis affect fertility? Again, not necessarily. But those with endometriosis are at an increased risk of miscarriage, ectopic pregnancy and other obstetric complications compared to those without (4). How does endometriosis affect fertility? Exactly why and how endometriosis affects fertility is still unknown. But here are the latest theories of possible links and causes.  Structural issues One of the ways endometriosis is likely to affect fertility is by distorting the position of reproductive organs. Growth of endometrial tissue and adhesions around the uterus and Fallopian tubes can cause this distortion. In turn, this may block mature eggs from reaching the uterus to be fertilised. The risk of blocked Fallopian tubes, in particular, increases in the more advanced stages of endometriosis.  Endometriomas The presence of cysts on your ovaries, called endometriomas, could also affect fertility and ovulation. Endometriomas can damage ovarian tissue and the precious ovarian follicles which house immature eggs.  Immune reaction Another theory is an immune reaction to endometrial tissue growing outside the uterus. This is because this tissue is recognised as ‘foreign’ to these parts of the body. The immune system responds by attacking it, causing inflammation. Inflammation leads to harmful toxins which may affect Fallopian tube function, sperm function and egg quality (5). Womb reciprocity There is also debate about whether endometriosis affects the receptivity of the womb to a fertilised egg. However, there is currently no conclusive evidence to prove this theory.  Painful sex Painful sex is one of the symptoms associated with endometriosis. Pain during or after intercourse can negatively impact your sex life and make the trying-to-conceive process difficult. Can treating endometriosis improve fertility? Various treatments for endometriosis that aim to improve fertility. The right ones for you will depend on the location and severity of your endometriosis and what your symptoms are.  One treatment that aims to improve fertility is laparoscopic surgery. This is surgery to remove the endometrial tissue deposits and adhesions. It aims to free the pelvic organs of any structural issues or blockages and reduce inflammation.  For people with endometrioma, laparoscopic ovarian cystectomy can remove the endometriosis-related cysts on the ovaries (6). This has been shown to lower the recurrence rate of both cysts and pain symptoms.  However, there are risks associated with any surgery. For example, ovarian cystectomy can also negatively affect ovarian reserve by the removal of healthy tissue.  It’s important to discuss the potential for surgery with a specialist. And to explore the individual risks. How can I improve my chances of conceiving with endometriosis? If you’re trying to conceive with endometriosis, there are options to improve your chances. These include expectant management and assisted reproductive techniques (ARTs).  Expectant management  This is for heterosexual people who are trying to conceive naturally and:  To improve your chances of conceiving with every menstrual cycle, it is recommended to have sex every 2-3 days so there is a good chance of catching your fertile window.   Assisted reproductive techniques (ARTs) ART options include ovarian stimulation (COS), intrauterine insemination (IUI), and in-vitro fertilisation (IVF).  Depending on your age, ART is recommended if: IUI is usually offered to couples with minimal or mild endometriosis if their partner has normal semen quality and is typically not offered to those with moderate/severe endometriosis, because of a probable effect on the Fallopian tubes. IVF can be offered to those with moderate or severe endometriosis. It can also help those with a very low egg reserve. IVF has been found to be less successful in people with endometriosis compared to those without endometriosis. However, lots of factors influence IVF success, like age, whether you’ve been pregnant before, if you’ve had treatment before body mass index, underlying health conditions, lifestyle and your partner’s sperm quality.  Resources:  

Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime. But what are fibroids, how do we look out for symptoms and what are the treatments if we’re diagnosed? Read on to find out.  Quick facts: What are fibroids? Uterine fibroids are benign or non-cancerous growths in and around the uterus, or womb. They are made up of fibrous muscle tissue and are extremely common. Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime (1). Your risk of developing a fibroid increases with age and if you: Where do fibroids grow? Fibroids can vary in size and you may have one or multiple fibroids. They can develop as singular fibroids or as clusters. There are three different types of fibroid, depending on where in the body they grow: Signs and symptoms of fibroids Not all people who develop fibroids experience symptoms. Most are actually asymptomatic and have no symptoms at all. Only approximately 1 in 3 people with fibroids will experience symptoms. The symptoms of fibroids can include: What causes fibroids?  Unfortunately, like many reproductive health conditions, the exact cause of fibroids is unknown. What we do know though, is they’re affected by oestrogen and progesterone—two hormones important for regulating the menstrual cycle. After menopause, when oestrogen and progesterone levels drop, fibroids tend to shrink (3). How are fibroids diagnosed? To diagnose fibroids you’ll need a pelvic ultrasound scan. Usually, your doctor will discuss any symptoms you’ve been experiencing with you first. Then they’ll carry out an abdominal examination to look for any areas of tenderness or masses in your abdomen, before referring you for a scan.  The ultrasound will look at your reproductive organs including your uterus, Fallopian tubes, ovaries and general pelvic area. This can be done either transvaginally (through the vagina) or transabdominally (looking at your uterus through your abdomen). A scan is the only way to definitively diagnose fibroids and to determine their size and location. You may also be offered a blood test to screen for iron deficiency anaemia, which is a condition that can occur as a result of heavy bleeding.  Because lots of people with fibroids don’t experience symptoms, often fibroids are found coincidentally. This could be during an ultrasound for a pregnancy or another suspected condition. Black women have an increased risk of developing fibroids Black women are three times more likely to develop fibroids than white women. They’re also more likely to be diagnosed with fibroids at a younger age, have a longer duration of symptoms and have larger, more rapidly growing fibroids. Although the increased risk of fibroids in Black women is known, there’s been little research conducted to understand why this is. Some research suggests genetics, such as Vitamin D deficiency in Black women (4) could be a link. Other research has suggested certain environmental factors could be linked. These include exposure to chemical relaxers, used for afro-textured hair, which have been linked to a higher risk of developing fibroids (5). Will fibroids affect my fertility? Some fibroids can cause problems with fertility (6). This largely depends on their size and where they are located.  Fibroids can affect the structure of the uterus and its surrounding organs. Meaning they can prevent sperm from fertilising an egg or prevent an embryo from implanting. However, lots of people with fibroids do not have any difficulties getting pregnant. How are fibroids treated?  Treatment for fibroids depends on:  If you have fibroids that are not causing symptoms and aren’t likely to affect your fertility, then generally no treatment is required. But if you begin to experience any new symptoms, it is really important to go back to the doctor to have a check-up.  The treatment methods for fibroids can be broken down into non-surgical and surgical methods. Non-surgical methods If you commonly experience heavy periods as a result of your fibroids, you may be given medications such as tranexamic acid. This is a medication which breaks down blood clots in the womb. You may also be given anti-inflammatory medications, like ibuprofen or an oral medication called Ryeqo. The combined oral contraceptive pill and hormonal IUD can also be prescribed to help you have lighter, less painful periods.  As well as treating heavy periods directly, you may also be given a gonadotrophin-releasing hormone (GnRH) analogue. This is to try and shrink your fibroids and is also commonly prescribed before any surgical treatment.  GnRH analogues work by reducing your levels of oestrogen. Low levels of oestrogen can lead to several other long-term complications, so this method can only be used for a short period.If you have larger fibroids, you may be offered a procedure called Uterine Artery Embolisation. This is used to block the arteries which supply blood to the fibroids. If you have smaller fibroids, you may also be offered a procedure which removes the lining of the womb called Endometrial Ablation. Surgical methods There are various surgical techniques which can be used to treat fibroids. Surgery can be explored if medical treatments don’t work for you or aren’t suitable in the long term.  You may be offered one of the following surgical treatments for fibroids:  What type of procedure is most suitable for you depends on the location, size and number of your fibroids. Each varies in terms of invasiveness, risks and its potential effect on fertility. Some people’s fibroids may grow back after surgery, known as ‘recurrence’.  Suspect you may have fibroids? As the symptoms mentioned above are commonly experienced in various types of pelvic issues, they may be linked to other causes apart from fibroids.  If you’re suffering from painful periods or any of the above symptoms, it’s important to get your hormones tested, to rule out a hormonal cause. This, alongside a pelvic ultrasound scan, can help you get to the bottom of symptoms and get a recommended care plan based on your biology.  If you’ve been diagnosed with fibroids, you can also talk to our team of […]

Recent research conducted by some of our Hertility Team, led by one of our co-founders Dr Natalie Getreu, has been published in the Fertility and Sterility Journal. Fertility can be affected by cancer and cancer treatment to such an extent that women may have reduced family planning options once they’ve completed their treatment. Although, records of the success of fertility preservation methods in cancer patients are not routinely collected by hospitals, fertility clinics or researchers. Instead, when it comes to egg and embryo freezing, clinicians routinely use success rates from patients that have undergone fertility preservation for social reasons as opposed to medical reasons. Therefore, our research team aimed to look into pregnancy outcomes in cancer survivors who had used their frozen tissues to provide more up-to-date and relevant information for these patients. Check your fertility The results revealed that between fertility preservation methods: egg, embryo or ovarian tissue freezing, there was no significant difference between these methods for women to have live births after pregnancies. At Hertility we are so proud to not only offer new and different care pathways for women but also to be home to so many amazing researchers. So we thought in this article we would take you through the research, and the findings and explain them to you. After all – knowledge is power! First up, let’s recap on fertility preservation…. We’ve already published an article that covers all the different types of fertility preservation for people with ovaries but here is a brief sum up: There are both medical and social reasons to undergo fertility preservation.  Medical fertility preservation means preserving parts of your fertility in people who might lose their ability to reproduce due to upcoming medical treatment, for example, cancer patients about to undergo chemotherapy/radiotherapy or people undergoing gender reassignment surgery, or for some who have an autoimmune condition that want to protect their fertility. Whereas, social fertility preservation is when you are opting to freeze your eggs because of social and age-related factors. There are several different fertility preservation methods, some of which include: Egg freezing – This is what it says on the tin: collecting your egg cells and putting them on ice for later use. Embryo freezing – This process involves fertilising your collected egg with IVF using either donor’s or your partner’s sperm and then the resulting embryo is frozen until you are ready to use it. Ovarian tissue cryopreservation – This method is created mostly for younger patients who have not yet gone through puberty and are therefore not able to fully mature their egg cells. Tissue containing immature eggs is cut from their ovaries and is preserved in a tissue bank until the tissue can be re-implanted and used at a later stage, however, this is not routinely used for the general population. There are more fertility preservation options but in this study, researchers only included cancer patients who had undergone oocyte, embryo or ovarian tissue cryopreservation (freezing) What did this study do? Researchers followed cancer patients that had both fertility preservation and then had fertility-damaging cancer treatment (gonadotoxic therapy) who were now looking to start a family using their cryopreserved oocyte, embryo or ovarian tissue. The main outcomes this research looked at were if there were clinical pregnancies (clinical signs of the foetus can be either seen or heard), miscarriages (pregnancy loss) and live birth (completed pregnancies that result in a live birth). What were the results? This study found that between fertility preservation methods: egg, embryo or ovarian tissue freezing, there was no significant difference between these methods for women to have live births after pregnancies. (In science it’s all about whether a difference is significant or not!).  Also high clinical pregnancy rates and live birth rates were observed in all techniques. They also found that freezing ovarian tissue results in significantly less miscarriages than embryo freezing, which is interesting and is something to further investigate! What do these results mean? Like anything in science, there are limitations in the study and this research does report some limitations since it was an early analysis. However, this is a really important and interesting starting point in this area of research and for cancer-related fertility preservation.Researchers hope that this study helps to establish better reporting of outcomes in cancer patients and will encourage clinicians to use appropriate statistics and information to counsel women who find themselves facing a cancer diagnosis on their chances of biological motherhood. If you fancy having a read of the article yourself, have a look here! At Hertility, we are dedicated to revolutionising women’s healthcare, whether that be through improving care pathways, helping women receive answers about their bodies through our at-home tests or contributing to the Women’s Health research. It’s all part of our mission for a #ReproductiveRevolution.

Period poo. What is it and why does it happen? In this article, we take a look at why our bowel movements seem to wreak havoc during our periods and some tips for managing any symptoms. Quick facts: What is period poo? Period poo is basically any changes to your bowel movements during your period. This can be loose stools, diarrhoea, more frequent bowel movements, constipation, or more wind.  Although period poo might not be the most hotly debated dinner party conversation, it’s actually really common—with one study citing that up to 73% of people who menstruate experience period poo.  What causes period poo? Throughout our menstrual cycles, our hormones cause a whole host of changes, some of which can affect our digestion and gastrointestinal tract. Here are some of the changes that occur in the lead-up to our periods specifically, which can lead to changes in bowel movements.  Prostaglandins and muscle contractions Prostaglandins are chemical messengers that your uterus (womb) produces around your period. They act on the uterine smooth muscles to help them contract and shed their lining each month. This means you have prostaglandins to thank for your period cramps.  Sometimes, excess prostaglandins can act on smooth muscles elsewhere in the body, including the bowels. This causes an increase in muscle contractions in the intestines and bowel, leading to loose stools or diarrhoea.  On the flip side, too little prostaglandins can have the opposite effect, causing things to slow down in the gastrointestinal tract. This is one theory of why some people experience constipation at the time of their period (3).  Increased progesterone levels Although the exact relationship is not well understood, your gut – as well as your uterus – also has receptors for sex hormones like progesterone and oestrogen. This means your gut is sensitive to the changes in hormones that come about at the time of your period. Just before your period, progesterone levels are high, which can cause gut sensitivity, including bloating, diarrhoea or constipation, in some people.  For people who already suffer from Irritable Bowel Syndrome, this can be exacerbated at this time of the month. If you’re experiencing flare-ups, stick to your prescribed symptom management plan and if you think you need more relief, speak to your doctor about alternative ways to manage your IBS during your period.  Diet changes and cravings An increase in progesterone levels just before our periods can cause cravings for certain foods. Changing your diet, for example eating more, consuming more carbs and processed foods, consuming less fibre and not drinking enough water can all affect digestion and lead to changes in stools.  Increased stress or anxiety A common symptom of Premenstrual Syndrome (PMS) that is often experienced just before or during our periods is increased levels of anxiety, overwhelm or stress. Each of these symptoms can lead to a change in bowel movements, as our guts are intimately linked to our stress levels (think the nervous poos).  How to manage period poo symptoms There are certain lifestyle changes you can adopt to help alleviate any gastrointestinal symptoms you notice around your menstrual cycle. Try some of the following tips to help make that time of the month a little less crappy. Eat lots of natural fibre  Fibre is like your bowel’s best friend—it helps to move things through and keep your digestion and bowel movements regular. Make sure you’re getting lots of high-fibre foods like fruit, vegetables and whole grains in the run-up to and during your period. Try not to overeat processed foods and carbs as these often have the opposite effect.  Limit caffeine If you’re experiencing loose stools and diarrhoea, try cutting down on your caffeinated drinks and foods (like dark chocolate). This is because caffeine stimulates the gut, resulting in you needing to go more frequently.  Coffee in particular (even decaf) can stimulate the gut, so best to skip the morning coffee at your time of the month and opt for another way to energise yourself, like a morning walk or some yoga. If you do experience diarrhoea, be sure to increase your water intake to prevent dehydration.  Get moving  Movement and exercise are great for the gut and bowels. They help keep things moving through your digestive tract and can reduce the instances of bloating as well as helping to alleviate period cramps. If you’re not feeling up for your usual fitness routine, some yoga or simple stretching and walking are all great options.   Stay hydrated If you’re experiencing either constipation or diarrhoea, then drinking plenty of water is essential. Being adequately hydrated is very important for a healthy functioning gut and if you have diarrhoea you are at risk of becoming dehydrated quickly if you aren’t replacing lost fluids.  Painkillers and stool softeners It’s not unusual to mistake period cramps for bowel urges and vice versa during your period. Pain and cramps associated with either gut problems or your period can be eased with exercise, heat pads, or painkillers. You can also try stool softeners if you’re experiencing bad constipation. Resources:

Premature Ovarian Insufficiency (POI) is when the ovaries stop working normally before the age of 40. Getting a diagnosis can be worrying at first, but there are options available. Let’s take a look at what you need to know about POI including symptoms and treatments.  Quick facts: What is Premature Ovarian Insufficiency? In short, Premature Ovarian Insufficiency (POI) is when the ovaries stop functioning properly before the age of 40. It can significantly reduce your fertility.  This doesn’t always mean that you don’t have any eggs left in your ovaries or that you couldn’t carry a baby. It means your body is failing to mature eggs or to ovulate each month.You may have heard of Premature Ovarian Insufficiency (POI) being referred to as premature ovarian failure. It is also referred to as Primary Ovarian Insufficiency, gonadal dysgenesis, and hypergonadotropic hypogonadism. Premature Menopause Premature Menopause is when someone before the age of 40 experiences menopause. This means they will not have any more periods and are permanently no longer able to become pregnant.  This is different to POI, where although fertility becomes significantly reduced, there is a chance of spontaneous ovulation, and hence a period might still occur. Some people are still able to conceive spontaneously after their diagnosis. However, POI and Premature Menopause do share many of the same symptoms. What are the symptoms of POI ? POI symptoms are similar to menopause and low oestrogen. You’re likely to experience: Other than menopausal symptoms, loss of skin pigmentation caused by vitiligo or hyperpigmentation can accompany POI. As can hair loss caused by alopecia.  Fatigue, anxiety, and depression can also be common symptoms as a result of other symptoms or a diagnosis (3). If you’re missing your period for three or more months, it’s important to get your hormones tested to try and decipher what’s going on.  You can miss your periods for a number of reasons, including increased stress, changes to your diet or exercise routine. Some people might even like the idea of not getting a period every month, but sudden changes should always be investigated to check the cause of the change and rule out POI or something more serious. What causes POI ? Roughly 1 in 100 people will experience POI and it can affect people up to the age of 40, with some affected as early as their teens (4). But despite its prevalence, the causes, like for many female-reproductive health conditions, are still relatively unknown (2).  POI can happen spontaneously. However, there are a few known risk factors that may increase your risk of developing POI. These include: How is POI diagnosed? To receive a POI diagnosis, you’ll need to get a hormone test. High FSH (greater than 25) and low oestrogen levels, also seen at the onset of menopause, are indicators of POI. This is accompanied by absent, unpredictable or irregular periods for at least two consecutive months.  If POI is suspected, you might also be sent for an internal ultrasound to check your antral follicle count (AFC). Antral follicles are small fluid-filled sacs in your ovaries containing immature eggs. An AFC count is an indicator of the number of eggs you have left in your ovaries, also known as your ovarian reserve. What does POI mean for my overall health? POI can increase the risk of other illnesses or health problems if left untreated. People with untreated POI have an increased risk of developing heart disease and stroke.  Also, because oestrogen plays such an important role in bone health, low oestrogen seen in POI is known to lead to lower bone density, increased risk of bone fractures, and osteoporosis.  There is also evidence that lower oestrogen levels earlier in life can increase the risk of developing Alzheimer’s disease or dementia (3,4). If you have received a POI diagnosis, your doctor will likely recommend hormone therapy to you. This could be in the form of HRT or taking some form of hormonal contraception.  Hormone therapy can help to alleviate symptoms and reduce the risk of developing the associated conditions mentioned above. Does POI affect fertility? Often, yes, POI can reduce your fertility significantly. This can mean getting a diagnosis can be stressful and upsetting, particularly if you want to start or grow your family.  Although POI means your ovaries aren’t functioning properly, as many as 25% of people with POI do spontaneously ovulate. Another 10% do conceive and deliver after their diagnosis (5). If you are looking to get pregnant, there are treatment options available if you have POI—including In Vitro Fertilisation (IVF).  Egg donation is also an option for some people. POI is a condition that affects the ovaries, not the uterus. This means egg implantation and your ability to carry a pregnancy are not greatly affected by a POI. Think you might be experiencing POI symptoms? If you suspect POI symptoms, like irregular or absent periods, it’s important to get checked. Our at-home Hormone and Fertility Test can give you a better insight into your hormones and any symptoms you might be experiencing.  Our team of experts will help you understand whether your symptoms are related to POI or other underlying health conditions. We can also support you with follow-up fertility treatments and fast-track you to specialists for tailored care plans. References:

After a 9 year battle with pain, Abbie finally got a diagnosis for endometriosis. This is Abbie’s story, detailing the ordeal she went through to finally get treatment for her pain.  Quick facts: Meet Abbie My name is Abbie (@cheerfullylive) and in May 2019 I was finally diagnosed with endometriosis after a 9-year battle with pain.  If you aren’t aware, endometriosis is a chronic and debilitating condition where cells similar to the ones in the lining of the womb are found elsewhere in the body like the ovaries and fallopian tubes.  In response to your hormones, these cells break down and bleed, similar to the lining of your womb. This can cause inflammation and symptoms like painful periods, as well as possible infertility, fatigue, bowel and bladder problems, as well as many other symptoms. This is my story with endometriosis, from pain to diagnosis and treatment. I hope it can help you if you suspect you may have endo symptoms, or just want to learn more about this condition. Living in pain I can remember distinctly the first time I had severe pain. It was about a year before I had my first period. It was absolutely terrifying and things only got worse from there. My periods started when I was 15 and month by month the pain gradually became more debilitating. It got to the point where I could no longer get out of bed or do normal activities.  I would miss school, university and even work, but my pain and symptoms were deemed ‘normal’ period pain. I was told repeatedly that ‘I just had a bad period’, ‘I had a low pain threshold and ‘it was just something I would have to endure as a woman’.  This was even when I was having fainting episodes and vomiting due to the excruciating pain I was getting between periods. Because it was doctors telling me this, I genuinely believed it was just ‘normal’ and put up for it for many years of my life. Years to diagnosis It was only when my pain became chronic in December 2018, that my health was investigated fully. After going back and forth to my GP, A&E, urology and gynaecology, I was sent for an MRI in April 2019.  After so many years of believing this pain was normal, I didn’t expect my MRI to come back with severe endometriosis adhesions all over, but it did.  I was immediately booked in for an appointment with an endometriosis specialist. He told me I had extensive endometriosis on the left side of my pelvis, my left ovary and my bowel (sigmoid colon). I was also told that it was highly likely I had endometriosis growing on my bladder, my kidneys and on the right side of my pelvis. But only this wouldn’t be known until I had surgery. Managing my endometriosis It’s been over a year since I was diagnosed and I’ve tried so many different things to help with managing endometriosis. I’ve gone from being on the combined pill to the mini pill to extra hormones on top of that.  I’ve come off those extra hormones, gone on the waiting list for excision surgery, have taken different painkillers, tried yoga, hot water bottles, a TENS machine and trialled sacral steroid injections!  It’s been a long, hard journey and there are still many difficult days, but I seem to have found a few things that have personally helped me along the road. Deciding to have an expert excision of my endometriosis I’m still waiting for a surgery date, but just being able to make this informed decision with my consultant made me feel empowered. It made me feel like I was able to have some control over my endometriosis and how much it affected my life.  Being on the mini pill This is something that has helped me, as I no longer have periods anymore, which reduces the debilitating monthly pain and anxiety that comes with it. However, I understand that hormones are a very personal choice and you have to do what’s right for YOUR body. Pain management  Investing in a decent hot water bottle and a heat pad, as well as a TENS machine has really helped me manage my everyday chronic pain. Looking ahead Despite the struggles I’ve faced and the pain I’ve had to endure whilst living with endometriosis, I’m very grateful for all the positive experiences that have come out of this journey.  I started up my own blog, enjoyed being creative on Instagram and found an incredible community of #EndoWarriors! A fellow Endo warrior and I wrote a powerful blog post on “What Endo Means To Me”. Thank you to Hertility for having me on their blog to share my journey with endometriosis! If you feel you may have endometriosis or are concerned about your symptoms, please reach out to someone and don’t suffer in silence. Whether that’s your GP, sexual health clinic, hospital or a company like Hertility who can help you get answers on your reproductive or gynaecological health. You can find me over on my blog at www.cheerfullylive.com or on Instagram at @cheerfullylive www.instagram.com/cheerfullylive. I’m always open to having a conversation around women’s/period health, pelvic pain or endometriosis! Let’s break down the stigma and have more of these conversations!

We’re all sold the ideal of perfect skin by skin care companies. But sometimes the cause of our breakouts is more than skin deep. So how do we know if our skin troubles are hormone-related? Read on to find out. Quick facts: What is hormonal acne? Hormonal acne is acne or breakouts that are related to hormonal fluctuations or imbalances.  Typically hormonal acne is found on the lower face, cheeks and jawline chest, neck, shoulders and back. Hormonal acne can affect people of all ages. Whilst it’s common during puberty when lots of hormonal changes are occurring, it can also be common as an adult, especially for women and people who menstruate, due to hormonal fluctuations throughout the menstrual cycle. What causes hormonal acne? Your skin has many small glands, called sebaceous glands, that produce an oily substance called sebum. Sebum helps keep your skin supple, smooth and healthy.  These glands also have receptors for our sex hormones, particularly androgens like testosterone, and oestrogen. Both of these hormones stimulate the production of sebum. When excess sebum is produced, this buildup causes visibly oilier skin and can clog the pores, resulting in inflammation and acne breakouts. Hormonal acne and androgens When our bodies produce excess amounts of androgens, it can cause hormonal acne and other skin problems. If androgen levels are higher than normal, there is more androgen binding to the sebaceous gland receptors, promoting more sebum production.  There can be lots of reasons for elevated androgens. A common cause is Polycystic Ovary Syndrome (PCOS). Those who experience PCOS are more likely to experience excess androgen-related symptoms like acne, excessive facial and body hair growth (hirsutism) and skin darkening.  Trans and non-binary people who begin taking testosterone as part of their transition journey may also notice acne breakouts because of raised androgen levels. Hormonal acne and oestrogen Sebum production is also influenced by the menstrual cycle, specifically by the hormone oestrogen.  Oestrogen fluctuates throughout the menstrual cycle. It’s at its lowest level during your period and gradually rises to a peak at ovulation, around the mid-point in your cycle. Although the impact of oestrogen on the sebaceous glands is not fully known, it has been shown to suppress sebum production at high levels. Therefore when your oestrogen levels are higher, generally your skin will be clearer. This is why lots of people experience hormonal acne flare-ups just before or during their periods when oestrogen levels are low.  Oestrogen is also associated with increased collagen production, skin thickness, skin hydration and wound healing—which all contribute to clear-looking, healthy skin. After menopause, your oestrogen drops. Some people find that this drop causes hormonal acne and may also leave their skin dry, itchy and saggy. For some individuals, HRT to reduce the symptoms of menopause can also cause hormonal acne. How to treat hormonal acne? If you think you suspect you’re suffering from hormonal acne, there a number of treatments you can explore.  Firstly, if you’re not already, begin tracking when you have flare-ups and your periods. You can do this with a period tracking app or just using a calendar. This will help you to understand when in your cycle you’re getting flare-ups and whether it could be due to hormonal fluctuations during your cycle.  Testing your hormones will be able to give you answers as to whether you have raised androgen levels. Our at-home hormone tests can help you identify any hormonal imbalances.  There are topical treatments available that can help with flare-ups, as well as some contraceptives like the combined pill that has anti-androgenic properties. Lifestyle changes like diet, exercise, stress and alcohol reduction can also have a significant impact.  If you’re struggling with your skin, don’t suffer in silence. Reach out to us and get on a plan to find the root cause of your skin issues. References: