Category: Hormones

You’ve just received your hormone test results. There are numbers, units, and a column of figures labelled ” hormone reference range” and it’s not immediately obvious what any of it means, or whether you should be worried. You’re not alone. Hormone reference ranges are one of the most misunderstood parts of any blood test result. At Hertility, we interpret your hormone results in clinical context, not just against a number. This guide explains what reference ranges actually are, why they vary, and how to read your results properly. Quick summary What is a hormone reference range? When you receive hormone test results, each value is accompanied by a reference range, a set of numbers that tells you where your result sits relative to a defined population.  The first step in understanding where a reference range comes from is to remember that we expect different things from different groups of people. This can be age-related or gender-related, but can also be lifestyle-related. In actual fact, the ideal ranges are usually pretty broad and rarely take important factors such as ethnicity into account. They are usually defined by the population to which the range will apply (in this case women), but also their age. A large number of individuals from a group who are thought to represent a “normal” population, will be tested for a particular laboratory test. The reference range is then derived mathematically by taking the average value for the group and allowing for natural variation around that value (plus or minus 2 standard deviations from the average). In this way, ranges quoted by labs will represent the values found in 95% of individuals in the chosen ‘reference’ group. In other words, even in a “normal” population, a test result will lie outside the reference range in 5% of cases (1 in 20).  This is precisely why the term “reference range” is preferred over “normal range” in clinical medicine. A result outside the range is not automatically abnormal. A result inside the range is not automatically healthy. The range is a reference point, a tool to aid interpretation, not a binary verdict on your health. Why do hormone reference ranges vary between labs? One of the most confusing aspects of hormone testing is that you can test at two different labs and receive two different results, and both can be correct. This happens for several reasons. Lab environment and equipment. Every laboratory uses precisely calibrated equipment and specific reagents (the chemical substances used to detect hormone levels in a blood sample). Minor differences between labs like temperature, supplier of testing materials, calibration protocols, mean that the same sample can produce slightly different numerical results when analysed in different settings. Neither lab is producing an incorrect result. They are simply measuring with different tools, against different benchmarks. Different reference populations. Each lab establishes its reference range by testing its own reference population. If Lab A and Lab B each test a group of healthy women but recruit from different populations, ages, or regions, their resulting ranges may differ, even if the underlying biology is identical. What this means in practice. If you test at one lab and retest a month later at a different lab, a change in your result may reflect the different reference populations of each lab rather than a genuine change in your hormone levels. This is why, whenever possible, it is best to retest at the same lab  and why any result should always be interpreted against the reference range of the specific lab that analysed your sample, not a generic “normal” value found online. Type of sample: Reference ranges are also different depending on the type of sample used to measure a hormone. Take oestrogen as an example. Oestrogen can be measured in blood, saliva, or urine, but the concentration of oestrogen differs significantly between each of these, and so the reference ranges are different too. This is relevant if you ever compare results from different types of tests. A blood oestrogen result and a urine oestrogen result cannot be directly compared, even if they are measuring the same hormone. The numbers will look different, the reference ranges will be different, and the clinical interpretation will differ accordingly. How hormone reference ranges are categorised by age, sex, and cycle phase Because different groups of people have different hormone levels for entirely normal physiological reasons, reference ranges are not one-size-fits-all. They are adjusted for the characteristics of the population being assessed. By sex Testosterone is a clear example. Men have significantly higher testosterone levels than women, so separate reference ranges exist for each sex. Applying a male testosterone reference range to a female result or vice versa  would make most healthy women appear deficient. By age Many reproductive hormones change significantly across a woman’s lifespan. AMH (anti-Müllerian hormone), which reflects ovarian reserve, naturally declines with age. It would be clinically meaningless to compare a 22-year-old’s AMH to a 42-year-old’s using the same reference range, the 22-year-old would almost always appear to have “better” results simply because of age, not because of any meaningful difference in health status. At Hertility, we use age-stratified reference ranges for AMH and other hormones that change across the reproductive lifespan. This means your result is compared to the expected range for people your age, giving you a more accurate and clinically meaningful interpretation. By cycle phase Cycling hormones like FSH, LH, oestradiol, and progesterone fluctuate significantly throughout the menstrual cycle. Their reference ranges are therefore tied to a specific phase of the cycle. FSH, LH and oestradiol, for example, are typically measured on day 2 or 3 of the menstrual cycle, because the reference ranges for these hormones are calculated on day 3 of a healthy population’s cycle. Testing FSH on day 14 (mid-cycle, around ovulation) and comparing it against a day 3 reference range would produce a meaningless result because LH surges dramatically at ovulation, and FSH also rises. The timing of the test and the timing of the reference […]

Anti-Mullerian Hormone (AMH) is one of the most talked-about markers in reproductive health, providing an insight into your hormonal health and ovarian reserve. But receiving a “low” AMH result can feel alarming, especially when you’re not sure what it actually means. The good news is that a low AMH is not a confirmation that you cannot conceive naturally. In this article, we explore what it means to have a low or out-of-range AMH result, what causes it, and what your options are; whether you’re trying to conceive now, or simply planning for the future. If you haven’t yet tested your AMH, our Advanced At-Home Hormone & Fertility Test can measure AMH alongside up to nine other key hormones, giving you a personalised, clinically meaningful picture of your reproductive health. Quick Facts: A low AMH result indicates a lower-than-expected ovarian reserve for your age, but does not mean you cannot conceive naturally AMH measures egg quantity only, it tells you nothing about egg quality, which is one of the most important factors in conception AMH naturally declines throughout life; a low result does not mean you have done anything to cause it. Certain factors, including hormonal contraception and some medical conditions can temporarily affect AMH levels. Low AMH may have implications for IVF planning and NHS eligibility, but a low result does not close the door on treatment Your AMH result should never be interpreted in isolation, it only makes sense alongside your age, other hormones, and clinical history What is AMH and what does it measure? Anti-Müllerian hormone (AMH)  is a hormone made by small fluid-filled sacs in the ovaries called follicles, each of which contains an immature egg. Because AMH is made by these follicles, your AMH level gives an indication of how many eggs you have remaining at a given time. This is known as your ovarian reserve. Unlike hormones such as FSH, oestradiol, and LH, which fluctuate significantly across the menstrual cycle, AMH remains relatively stable. This stability is one of the key reasons it became widely adopted in reproductive medicine: it can be measured on any day of your cycle and still give a meaningful result. It is worth noting, however, that more recent studies have shown that there may be some slight variation in AMH levels across the menstrual cycle, but this variation remains considerably smaller than that seen in other reproductive hormones. As a result AMH is still considered one of the most stable and reliable markers of ovarian reserve. AMH is now routinely used when someone is considering undergoing a fertility treatment to estimate how the ovaries are likely to respond to stimulation, guide medication dosage, and determine eligibility for treatment. For a deeper dive into everything AMH testing can and can’t tell you, including its role in identifying PCOS and guiding fertility treatment, read our full guide: What Does AMH Testing Tell You? 5 Key Insights About Your Fertility What Does “Low AMH” Actually Mean? When we refer to “low AMH,” we mean a result that falls below the expected range for your age group. Because AMH naturally declines as you get older, what counts as “low” is always interpreted relative to age-specific reference ranges, not a single universal cutoff. A low AMH result can suggest that your ovarian reserve may be lower than expected for someone your age. This is sometimes referred to as having a Diminished Ovarian Reserve (DOR). However, it is important to emphasise that a lower ovarian reserve does not automatically mean reduced fertility or an inability to conceive naturally. The most important thing to understand: AMH measures quantity, not quality This distinction is worth repeating, because it is the most common source of confusion and unnecessary distress after receiving a low AMH result. AMH tells you about egg quantity. It does not tell you anything about egg quality. Egg quality i.e. how healthy eggs are, how likely they are to be fertilised, and how likely they are to develop into a viable embryo is influenced primarily by age and genetics. Currently there is no reliable way to measure it directly outside of accessing embryos created during IVF. This matters enormously in practice. Research consistently shows that AMH levels alone are not strongly predictive of natural pregnancy rates. People with low AMH conceive naturally every day. Conversely, a normal or high AMH result does not guarantee fertility. Fertility is shaped by many factors: ovulation, sperm health, Fallopian tube function, uterine health, and overall wellbeing. In short: a low AMH result is not a diagnosis of infertility. Hertility’s own research found no significant association between low AMH and risk of miscarriage or recurrent pregnancy loss, an important finding that further underscores the limitations of AMH as a standalone predictor of pregnancy outcomes. What Causes Low AMH? In most cases, there is no single identifiable “cause” of a low AMH level in the way we typically think about causes of illness. It is important to know that if you have received a low AMH result, nothing you’ve done has caused this. AMH levels follow a natural trajectory across the reproductive lifespan; it peaks in the early-to-mid twenties, and then gradually declines toward menopause. This decline is a normal part of reproductive ageing, and the rate at which it happens varies between individuals, largely due to genetics. Some factors that may be associated with lower AMH levels include: Age – the most significant driver of declining AMH Genetics – family history can influence the rate of ovarian ageing Previous ovarian surgery – procedures to remove ovarian cysts or tissue (for example endometriosis) may reduce ovarian reserve Certain autoimmune conditions – which can affect ovarian function, for example Hashimoto’s disease, rheumatoid arthritis, and Addison’s disease. Cancer treatment – some types of chemotherapy and radiotherapy are referred to as gonadotoxic (i.e. toxic to the gonads such as the ovary) which can impact the ovaries Hormonal contraception – can cause a temporary, reversible reduction in AMH levels, typically by 15% to 30% and […]

If you’ve ever been told to get bloods done on day 3 and wondered why that specific day matters, or felt frustrated trying to time a test around an unpredictable cycle, this guide is for you. We’re going to explain not just when to test, but why the timing matters at a biological level, what each hormone is actually measuring, and what to do when life doesn’t cooperate with your cycle. First: What does “day 3 of your cycle” mean? Day 1 of your cycle is the first day of your period, this means full menstrual flow, not spotting. If you see light spotting on Monday and Tuesday but don’t experience a proper flow until Wednesday, Wednesday is your day 1. Count forward from there: day 3 is the third day of your period (in this scenario that would be Friday). If your period is less than 3 days, day 3 is the third day after your period starts.  This matters because starting the count from spotting rather than full flow is one of the most common reasons people test at the wrong time. How does the menstrual cycle affect hormone levels? To understand why day 3 matters, it helps to have a basic picture of what’s happening in your body across the menstrual cycle. Your menstrual cycle is divided into two main phases separated by ovulation. The follicular phase always begins on day 1 of the menstrual cycle and ends with ovulation. In a 28-day cycle, the follicular phase extends from day 1 to approximately day 14. The luteal phase then follows ovulation and typically lasts 14 days, ending when your next period begins. The follicular phase is a period of rapid hormonal change, making it significant for hormone testing. When the previous menstrual cycle completes, levels of oestrogen and progesterone decrease. This triggers the release of follicle-stimulating hormone (FSH) into circulation.  Therefore, the days right around day 3 are when your body’s hormone system essentially resets and returns to its baseline. This is precisely why it’s the ideal time to take a snapshot of your reproductive hormones. Which hormones can be tested on day 3, and what does each one tell us? At Hertility, we test a broader panel than many providers. Here’s a detailed breakdown of each hormone in our Advanced At-Home Hormone and Fertility Test and why its timing matters. The Cycling Hormones These are tested on day 3 as mentioned earlier because they are at their ‘baseline’ around the first few days of your cycle. FSH (follicle-stimulating hormone) FSH is made by the pituitary gland in the brain and is the primary driver of egg development. FSH stimulates the production of oestradiol and eggs (oocytes) during the first half of the menstrual cycle.  Your FSH on day 3 might tell us whether the body is working as we would expect, or a little bit harder to induce follicular growth which may indicate reduced ovarian reserve, suggesting the egg supply could be beginning to decline.  Oestradiol (E2) Oestradiol is the primary form of oestrogen produced by the ovaries, and it plays a complex, interconnected role with FSH. Oestradiol serves as the brakes for the brain’s production of FSH. It travels from the ovaries to the brain and signals it to dial down FSH levels.  This is why FSH and oestradiol are always measured together. Not only their results, but their interpretation relative to each other is important for our clinicians to determine whether there is anything going on.  LH (luteinising hormone) LH is best known as the hormone that surges dramatically at mid-cycle to trigger ovulation. But measuring it at baseline on day 3 also tells us something important. If LH is too high on day 3, it may signal a condition like polycystic ovary syndrome (PCOS). An elevated LH:FSH ratio in the early follicular phase is one of the hormonal patterns clinicians look for when investigating PCOS and irregular ovulation. AMH (anti-Müllerian hormone) AMH is one of the most valuable markers for assessing ovarian reserve, and it works quite differently from the cycling hormones.  Historically, it has been thought that AMH doesn’t fluctuate dramatically across the cycle in the same way, so could be measured at any point during the menstrual cycle. However, research does suggest there may be some variation, which is why at Hertility, we standardise AMH testing to the days 2-5 window. This allows us to negate any potential fluctuation and ensure our results are consistent and comparable over time. AMH tells us about egg quantity (how many follicles are available) but it’s important to note it doesn’t directly measure egg quality. It should always be interpreted alongside your other results and your clinical history. Thyroid hormones (TSH and free T4) Thyroid hormones don’t fluctuate with the menstrual cycle, so strictly speaking they don’t need to be tested on day 3. We include them in the same panel because thyroid dysfunction, both overactive and underactive thyroid can significantly disrupt ovulation, cycle regularity, and fertility outcomes. Testing them alongside your reproductive hormones gives a more complete picture of your overall hormonal health in a single sample. Androgens (including testosterone) Androgens like testosterone are relatively stable across the menstrual cycle, making cycle timing less critical for these markers. That said, testing during the early follicular phase, when oestrogen is at its lowest means androgens aren’t being masked or influenced by rising oestrogen levels. For women investigating conditions such as PCOS, elevated androgens are an important part of the diagnostic picture. Prolactin Prolactin can technically be tested on any day. What does affect prolactin is the time of day and lifestyle factors. Prolactin naturally rises during sleep and can remain elevated for some hours after waking. Stress, physical activity, and even eating can temporarily raise levels. This is why Hertility asks you to take your sample first thing in the morning, before eating or exercise, to capture the most stable reading. The science behind day 3 testing: what does the research actually say? Day […]

Experiencing persistent fatigue or low energy that just won’t shift, no matter how much you sleep or how many coffees you have? You’re not alone. Many women and people with cycles dismiss chronic tiredness as a normal part of a busy life, yet it can be a sign that something is going on. When fatigue becomes persistent, heavy, and impacts your daily life, it’s time to look beyond just needing more rest. Fatigue is a feeling of constant tiredness or weakness, and it can be physical, mental, or both. Low energy describes a lack of vigour or motivation. Whilst lifestyle factors – like a poor night’s sleep, stress, or a less-than-ideal diet – can certainly cause temporary dips, when these symptoms become chronic, it’s often a signal from your body that your delicate hormonal balance might be disrupted. This article will explore the common, and often overlooked, hormonal drivers behind feeling tired all the time and outline how taking our Advanced At-Home Hormone and Fertility Test can uncover the root causes of your symptoms. TAKE THE TEST → What Causes Fatigue and Low Energy? The causes of fatigue are diverse, ranging from simple lifestyle factors to underlying medical conditions. However, many of the most persistent and hard-to-diagnose cases in women often circle back to hormone health. Common Lifestyle and Medical Causes Before diving into the hormonal links, it’s important to rule out the most common causes of low energy: Sleep Deprivation: Lack of quantity or quality sleep. Sleep disorders like sleep apnoea are common culprits. Nutrient Deficiencies: Low levels of iron (leading to anaemia), Vitamin B12, and Vitamin D are strongly associated with fatigue. Stress and Mental Health: Chronic stress, anxiety, or depression can deplete both physical and mental reserves. Other Medical Conditions: Fatigue is a key symptom of conditions such as coeliac disease, chronic fatigue syndrome (ME/CFS), and heart disease. The Hormonal Connection: A Deeper Dive For many, general medical checks come back clear, yet the profound tiredness persists. This is where hormones often step in as the missing piece of the puzzle. Hormones act as chemical messengers throughout the body, regulating metabolism, sleep cycles, stress response, and reproductive health – all of which are intrinsically linked to your energy levels. How Hormones Affect Fatigue and Low Energy Several key hormones play critical roles in regulating your energy, and imbalances in any of them can lead to that heavy, constant feeling of being drained. 1. Cycling Hormones (Oestrogen, Progesterone, LH & FSH) The menstrual cycle is an intricately regulated process driven by the hypothalamic-pituitary-ovarian (HPO) axis. The fluctuation of key hormones – oestrogen (specifically estradiol), progesterone, luteinising hormone (LH) and follicle-stimulating hormone (FSH) – has a significant influence on central nervous system function, affecting energy metabolism, sleep architecture, and neuropsychiatric stability (Li et al., 2020). Oestrogen’s Role: Oestrogen generally acts as a boost; it can be linked to improved muscle function, mood, and sleep quality. When oestrogen peaks in the late follicular phase (leading up to ovulation), many women report feeling their most energetic. A notable dip in oestrogen – such as during the early follicular phase (the start of the cycle/period) or during perimenopause – is often associated with low mood and brain fog. Progesterone’s Role: Often called the calming hormone, progesterone rises sharply after ovulation (in the luteal phase). Progesterone has a sedative effect, primarily by enhancing the activity of GABA, the brain’s main inhibitory neurotransmitter. While this is great for promoting sleep, high progesterone during the pre-menstrual (PMS) week can be a key driver of that characteristic fatigue or sluggishness. Poor sleep quality due to a fall in progesterone just before a period can also lead to day-time exhaustion (Ennour-Idrisi et al., 2015). LH & FSH: These hormones, released by the pituitary gland, regulate the production of oestrogen and progesterone. While they don’t directly cause fatigue, measuring their levels is crucial for diagnosing reproductive health conditions (like PCOS) or age-related shifts (like perimenopause/menopause), which have fatigue as a key symptom. 2. Androgens (Testosterone, DHEAS & SHBG) Androgens are essential for vitality in women and people with menstrual cycles. Testosterone and its precursor, DHEAS, are powerful hormones linked to motivation, muscle mass, bone density, and energy metabolism. Testosterone’s Impact: A drop in testosterone can lead to decreased muscle mass, lower bone density, reduced libido, and a general sense of low energy (Bolour & Braunstein, 2005). Low testosterone levels often naturally occur with age or can be caused by certain hormonal contraceptives. Sex Hormone-Binding Globulin (SHBG): This protein acts as a transport mechanism, binding to sex hormones like testosterone and making them biologically inactive. If your SHBG levels are too high (often seen in high-oestrogen states or with certain medications), it can ‘hoover up’ your biologically active testosterone, leading to low energy and other symptoms, even if your total testosterone level is within the normal range (Szybiak-Skora et al., 2025). 💡 Find out what your hormones are telling you Take our Advanced At-Home Hormone and Fertility Test to uncover the root causes of your symptoms, including persistent fatigue and low energy. TAKE THE TEST → 3. Cortisol (The Stress Hormone) Cortisol is released by the adrenal glands and is part of the body’s natural “fight or flight” stress response. While essential in short bursts, chronic stress leads to chronically elevated cortisol, which eventually impacts energy regulation (Kumari et al., 2009). Chronic Stress and Adrenal Fatigue (Exhaustion): While “adrenal fatigue” isn’t a recognised medical diagnosis, prolonged high stress can lead to dysregulation of the HPA (Hypothalamic-Pituitary-Adrenal) axis, which manages cortisol. This dysregulation is linked to the symptoms of tired all the time and low energy women. Initial high cortisol can disrupt sleep, and later dysregulation can leave you feeling depleted and unable to manage stress. 4. Insulin Insulin regulates blood sugar, which is your body’s primary fuel source. When insulin is dysregulated (known as insulin resistance), your cells struggle to absorb glucose, leaving your body and brain starved of the energy they need. This common issue is a […]

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 advanced 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 […]

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 advanced hormone and 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 advanced 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 advanced hormone and fertility 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 advanced hormone and fertility test 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 one of the most talked-about fertility hormones, but also one of the most misunderstood. Because AMH is closely linked to your eggs, testing it can offer valuable insight into your ovarian reserve (the number of eggs you have left). But it’s not a fertility “yes or no” test. In this guide, we break down exactly what AMH testing can and can’t tell you about your reproductive health.  Quick facts: What is AMH and why is it so important? Anti-müllerian hormone (AMH) is made by small fluid-filled sacs in the ovaries called follicles, each of which houses an immature egg. Because AMH is made by these follicles, your AMH level gives an indication of how many eggs you may have remaining at a given time. However, this is only one piece of the fertility puzzle. There are a few myths out there about what exactly AMH testing can tell us. 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 or egg reserve is what is expected with other healthy people in your age group. It helps you understand whether your egg reserve is higher, average, or lower than expected for your age. 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 more complete 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 be used as an indicator of 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, acne, hair thinning or loss and high testosterone levels. According to updated guidelines, AMH can now be used as an indicator for polycystic ovaries in place of doing an ultrasound scan for the diagnosis of PCOS. However, at Hertility, we would always recommend getting a pelvic ultrasound scan to further assess your ovarian reserve. During this scan, your ovaries are assessed to determine your antral follicle count (the number of eggs sacs seen within your ovaries) and to confirm the diagnosis. Whether IVF or egg freezing could be right for you In fertility treatment settings, AMH plays an important role in guiding decisions around interventions such as IVF and egg freezing . It is commonly used to estimate how the ovaries may respond to stimulation and to guide medication dosing.  Lower AMH levels are generally associated with retrieving fewer eggs during IVF, while higher levels may indicate a stronger response but also carry a risk of developing a rare but potentially life threatening condition called OHSS (ovarian hyperstimulation syndrome). This makes AMH a valuable tool for planning treatment safely and effectively. 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 marks the point at which your periods stop permanently, typically between the ages of 45 and 55, with the average age for menopause in the UK being 51. After menopause, natural conception is no longer possible. It is associated with a very low, or completely depleted, ovarian reserve. Clinically, menopause is usually diagnosed retrospectively, after 12 consecutive months without a period in someone not using hormonal contraception. In individuals under the age of 45, follicle-stimulating hormone (FSH) is more commonly used as a diagnostic marker, as levels tend to rise when ovarian function declines. While AMH is not currently recommended as a standalone test to diagnose menopause, it is well established that AMH levels fall to very low levels as ovarian reserve diminishes. This makes AMH a useful indicator of overall ovarian activity. Declining or very low AMH levels can suggest that you are approaching menopause, although it cannot predict the exact timing. In younger individuals, particularly those under 40, significantly low AMH levels may raise suspicion of premature ovarian insufficiency (POI), a condition in which the ovaries stop functioning earlier than expected. What can’t AMH testing tell me? While AMH testing is a useful tool for understanding your ovarian reserve, it only represents one part of your overall fertility picture. There are several important limitations to be aware of, and understanding these can help you interpret your results more accurately and avoid common misconceptions. It can’t determine your egg quality One of the biggest limitations is that AMH cannot tell you anything about your egg quality. Although AMH reflects the number of eggs you may have remaining, it does not provide any insight into how healthy those eggs are. Egg quality is one of the most important factors influencing fertility and pregnancy outcomes, and it is largely driven by age and genetics. At present, there is no reliable test to measure egg quality directly, except through assessing embryos during IVF treatment. It can’t determine your exact egg quantity AMH also cannot determine your exact number of eggs. While it gives an indication of the size of your ovarian reserve, it is not a precise measurement. This is because AMH is made by ovarian follicles, and each follicle can release different amounts of the hormone depending on its size and […]

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 […]