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If you’re planning for the future, thinking about egg freezing, preparing for IVF or trying to understand your fertility, you may have come across the term antral follicle count, often shortened to AFC. It sounds technical, but an AFC scan is simply an ultrasound scan that counts the small follicles visible in your ovaries. These follicles can help clinicians estimate your ovarian reserve, which means the approximate number of eggs remaining in your ovaries. In this guide, we’ll explain when is the best time to book an AFC scan and why timing can affect the results. Quick facts: What is an antral follicle count (AFC) scan? An antral follicle count, or AFC scan, is a specialist internal ultrasound that counts the number of small follicles visible in the ovaries. Think of it as a snapshot of ovarian activity at a specific point in your cycle. An AFC scan is usually carried out using a transvaginal ultrasound. This involves gently inserting a slim ultrasound probe into the vagina to get a clear view of the ovaries. During the scan, a doctor or sonographer counts the visible antral follicles in each ovary and also assesses the overall appearance of the ovaries and uterus. Antral follicles are small, fluid-filled sacs, usually measuring around 2-10 mm in diameter. Each follicle contains an immature egg, although the scan does not count the eggs themselves. Instead, the number of visible antral follicles gives an indirect indication of your ovarian reserve, the remaining pool of eggs in the ovaries. In general, seeing fewer antral follicles may suggest a lower ovarian reserve, while seeing more may suggest a higher ovarian reserve. However, AFC is not a direct measure of egg quality, and it cannot predict your exact chances of getting pregnant naturally. Your fertility is influenced by many factors, including age, ovulation, egg quality, sperm health, Fallopian tube health, uterine health, hormone levels and medical history. This is why AFC should be interpreted as one part of a wider reproductive health picture, not as a standalone fertility diagnosis. Why do I need an antral follicle count (AFC) scan? An AFC scan may be recommended if you are trying to understand your fertility, preparing for fertility treatment or considering fertility preservation, such as egg freezing. Doctors commonly use AFC to help assess: AFC is particularly useful during fertility treatment because it can help fertility specialists plan medication doses and counsel you about likely responses to ovarian stimulation. However, AFC is just one piece of the fertility puzzle. It should not be used in isolation to make big decisions about your reproductive future. AFC scan vs AMH blood test: what’s the difference? If you have come across both AFC and AMH while researching fertility testing, you might be wondering whether you need one, both, or whether they tell you the same thing. The short answer is that they both help estimate ovarian reserve, but they do it in different ways. AMH, or anti-Müllerian hormone, is a blood test that measures a hormone produced by small follicles (eggs)  in the ovaries. AFC is an ultrasound scan that counts the small follicles (eggs) developing in the ovaries during that cycle.  Both tests can help estimate how your ovaries may respond to fertility medication during IVF or egg freezing. ASRM guidance notes that AMH and AFC have been shown in multiple studies to be broadly equivalent, although each has strengths and limitations.  In practice, many clinicians use AFC and AMH together because they provide different but complementary information. AMH gives a hormone-based estimate of ovarian reserve, while AFC gives a visual assessment of the ovaries and pelvic anatomy. At Hertility, we offer both. AMH is included in our Advanced Hormone & Fertility Test, and our clinical team can arrange a Pelvic Ultrasound Scan that includes an AFC scan as well as assessing the uterus, ovaries and endometrium and interpret both results together, giving you a full, personalised picture of your ovarian reserve rather than a number in isolation. How is an antral follicle count (AFC) scan done? An AFC scan is usually performed as a transvaginal ultrasound, which gives a clearer view of the ovaries than an abdominal scan. A narrow ultrasound probe is covered with a protective sheath and lubricating gel, then gently inserted into the vagina. Most people describe the scan as mildly uncomfortable rather than painful, often similar to the sensation of a smear test. The sonographer slowly scans each ovary from one side to the other, counting the small follicles visible on screen. These often appear as small, dark, round shapes within the ovary. You may be able to see the ultrasound screen during the appointment, and your sonographer can talk you through what they are seeing. The scan typically takes 10 – 20 minutes. As well as counting your follicles, at Hertility, our sonographer will also assess: This means an AFC scan can give more information than follicle count alone. When is the best time to do an AFC scan? The best time to have an AFC scan is usually during the early follicular phase of your menstrual cycle. For most people with regular periods, this means around day 2 to day 7 of the cycle, with cycle day 1 being the first day of proper menstrual flow, not spotting. This early-cycle timing is preferred because the ovaries are usually in a more “baseline” state. At the beginning of the cycle, several small follicles may be visible in the ovaries. As the cycle progresses, one follicle usually becomes dominant and prepares for ovulation. Once a dominant follicle develops, it can become harder to assess the smaller antral follicles clearly. Can you have an AFC scan at any time in your cycle? Yes, in many cases, an AFC scan can still be performed outside the early follicular phase. Your doctor or clinic may recommend scanning at another point in your cycle if: However, if the main reason for the scan is to get the most accurate baseline AFC, the early follicular […]

Whether you’ve just come off the pill, had your implant removed, stopped the contraceptive injection or had your IUD taken out, one of the most common questions is: when should I test my hormones after stopping contraception? You might call it birth control or contraception, either way, the timing of hormone testing depends on the method you used and whether your natural cycle has returned. Some forms of hormonal contraception suppress ovulation and temporarily affect the hormones involved in your menstrual cycle. Test too soon, and your results may not reflect your natural baseline. Test at the right time, and your hormone results can give you a much clearer picture of your reproductive health, ovarian reserve and cycle function. Here’s exactly when to test your hormones after stopping contraception, broken down by type. Quick facts: Why timing matters when testing hormones after contraception Hormonal contraception introduces synthetic hormones into your body. Depending on the type, it may suppress ovulation, change cervical mucus, thin the womb lining or affect the signals between your brain and ovaries. Your cycle needs time to restart This signalling system is called the hypothalamic-pituitary-ovarian axis, or HPO axis. It controls the hormones involved in ovulation and menstrual cycles, including FSH, LH and oestradiol. When you stop hormonal contraception, your body needs time to clear the synthetic hormones. Your natural hormonal rhythm also needs time to restart. Some people get their period back within a few weeks. Others need several months before their cycles become regular again. Testing too soon can affect your results If you test cycling hormones too soon, your results may not show your natural baseline. FSH, LH and oestradiol may still look suppressed. Your cycle may also be too unpredictable to time the test correctly. This can make results harder to interpret. You may see results that look abnormal, even though your body is simply adjusting after contraception. You may also get results that seem reassuring but do not show the full picture. Getting the timing right makes your hormone test more accurate and more useful. How does hormonal contraception affect hormone test results? Different hormones respond to contraception in different ways. You can test some markers while you still use contraception. Others need a natural cycle to return first. Cycling hormones (FSH, LH, oestradiol) FSH, LH and oestradiol are cycling hormones. They rise and fall across the menstrual cycle and are closely linked to ovulation. Hormonal contraception can suppress the brain-ovary signals that control these hormones. This happens most clearly with combined hormonal contraception, such as the combined pill, patch and ring. If you test FSH, LH and oestradiol while using hormonal contraception, the results usually show the effect of contraception. They do not show your natural cycle. This is why Hertility recommends waiting until you have had 3 full cycles before testing these markers. AMH or anti-Müllerian hormone, gives information about ovarian reserve. It is not a cycling hormone. This means you can test AMH at any point in your cycle, including while you use hormonal contraception. However, research suggests hormonal contraception may lower AMH in people currently on it, with the effect more pronounced in long-term users. Importantly, AMH levels appear to rebound to true baseline within a few months of stopping. This means an AMH result on contraception can still be useful, but testing or retesting after 3 full cycles off hormonal contraception can give a more accurate baseline. Androgens (testosterone and DHEAS) Hertility can test androgens, including testosterone and DHEAS, while you use hormonal contraception. However, your results need careful interpretation. The combined pill can increase SHBG, or sex hormone-binding globulin. SHBG binds to testosterone in the bloodstream. This can reduce the amount of free, active testosterone available to the body. Hertility always interprets androgen results in context, rather than looking at one hormone on its own. SHBG (sex hormone-binding globulin) The combined pill substantially raises SHBG, which affects the interpretation of any androgen and oestrogen results. SHBG can remain elevated for months after stopping the pill in some people, which is another reason retesting after a full 3 cycles gives a clearer picture. Thyroid hormones (TSH, Free T4) Hormonal contraception does not usually suppress thyroid hormones. You can usually test TSH and Free T4 whether you are on or off contraception. Prolactin Most forms of hormonal contraception do not meaningfully affect prolactin. You can test prolactin at any point. When to test your hormones after stopping the combined pill Recommended wait before testing hormones: 3 cycles after stopping The combined pill contains synthetic oestrogen and progestogen. It works mainly by stopping ovulation, which means it suppresses the natural rise and fall of cycling hormones such as FSH, LH and oestradiol. For most people, natural hormone production begins to resume within a few weeks of stopping, but cycles can take up to 3 months to fully re-establish their rhythm. For the most accurate results, we recommend waiting 3 months after your last pill before testing cycling hormones (FSH, LH, oestradiol). Can AMH be tested after stopping the pill? AMH can be tested at any point, including while you are still on the pill. However, because AMH may be mildly suppressed during hormonal contraception use, testing after 3 full cycles off the pill may give the clearest baseline. If you test AMH while on the pill, the result can still provide useful information about ovarian reserve, but it should be interpreted in context. When to test your hormones after stopping the progestogen-only pill (mini pill) Recommended wait before testing hormones:  3 cycles after stopping The progestogen-only pill, often called the mini pill, contains progestogen rather than oestrogen. It mainly works by thickening cervical mucus, making it harder for sperm to reach an egg. Some types can also suppress ovulation. Because the mini pill may still affect ovulation and cycle regularity, At Hertility, we recommend waiting until you have had 3 full cycles before testing your hormones. This helps ensure your hormone results reflect your natural baseline rather than a cycle that […]

Whether you’re trying to conceive, living with PMOS ( formerly known as PCOS), considering egg freezing, navigating perimenopause, or simply trying to understand what your hormones are doing, you are not alone. Reproductive health can feel confusing, especially when symptoms are dismissed, cycles become unpredictable, or you’re told to “just wait and see” without clear answers. But your questions deserve more than vague reassurance. They deserve clinical context, personalised support and practical next steps. Welcome to Your Questions Answered with Hertility,  our expert-led series answering the reproductive health, hormone and fertility questions you really want answered. I’m Zoya Ali, Hertility’s Senior Scientific Research Associate, and in this series I’ll be helping to break down complex fertility and hormone topics in a way that feels clear, clinically grounded and easy to understand. From irregular periods and PMOS to egg freezing, perimenopause and trying to conceive, my goal is to give you evidence-based information without shame, confusion or medical jargon. In this edition, we’re answering some of the most common questions we hear from the Hertility community, including what to do if you feel dismissed by your GP, whether egg freezing in your early thirties is worth it, why a PMOS diagnosis matters, and whether pregnancy is still possible during perimenopause. Have a question you’d like answered in a future edition of Your Questions Answered with Hertility? Submit your question here. Q: We’ve been trying to conceive for over a year. My GP told me to lose weight and said ovulation can happen at any time. I only get a period once every three months. I feel pushed aside. What can I do? First, I’m really sorry you’ve been made to feel like this, your concerns are completely valid. After 12 months of trying to conceive, you are entitled to a comprehensive fertility assessment. Being told to lose weight and come back later, with no investigations or plan is not adequate care and you deserve more than that. Now, let’s talk about what’s actually going on with your body, because irregular periods every three months are telling us something important. That pattern is known as oligomenorrhoea and it is a sign that your body may not be ovulating regularly. Ovulation is the event that makes conception possible, and if it’s only happening sporadically, or not at all, trying to conceive can become significantly harder. Weight can be one piece of this picture, and it’s worth being honest about that. Weight can affect how the body manages insulin and inflammation, both of which influence reproductive hormones and ovulation. But weight is one factor in a much larger story, and it should never be used as a reason to withhold investigations. The most common cause of irregular, infrequent periods is PMOS ( previously known as PCOS ) which is a hormonal and metabolic condition affecting how the ovaries function. But thyroid imbalance, raised prolactin, insulin resistance and stress can all produce a very similar picture. You cannot know which of these is driving your symptoms without testing. If you feel your GP is still not listening, you are entitled to ask for a referral to a gynaecologist or fertility specialist, or to seek a second opinion. At Hertility, our Advanced At-home Hormone and Fertility Test can give you clinical-grade results, insight into your egg count and screening for up to 18 reproductive health conditions, alongside a doctor-written report, personalised Care Plan and a Clinical Result Review Call. We also offer Fertility Nutrition Consultations that can support ovulation, hormone and metabolic health without shame, blame or crash dieting. You don’t have to wait to be taken seriously. Q: What is the success rate for egg freezing if you freeze your eggs in your early thirties? This is one of the most common questions I hear from people considering egg freezing, and I understand why, you want a number, something reassuring and concrete. The honest answer is that there isn’t one single success rate, let me explain why, and what the picture actually looks like. Age is genuinely one of the most important factors in egg freezing. Freezing in your late twenties to early thirties is the most recommended, because egg quality and quantity are typically the best. But age alone doesn’t determine your outcome, two women who are both 31 can have very different responses to fertility treatment depending on factors like their AMH levels and antral follicle count. When we talk about success rates, we’re really talking about a chain of events, and at each link in that chain, some eggs are naturally lost. First, your frozen eggs need to survive the thawing process, thaw survival rates are typically around 80 to 90%. Then, not every thawed egg will fertilise successfully. Not every fertilised egg will develop into a good-quality embryo. And not every embryo will implant and lead to a pregnancy. Sperm quality and uterine health both play a role at that final stage too. Most clinics recommend aiming for around 15 mature eggs to give yourself a reasonable chance of a future live birth, with some recommending closer to 20 if you’re hoping for more than one child. Depending on how your ovaries respond to stimulation, some people collect enough eggs in one cycle; others need two or more. This is why egg freezing planning really is personal, it’s not a one-size approach. An AMH blood test and pelvic ultrasound to check our Antral Follicle Count (AFC) are the best starting points for understanding your ovarian reserve. They can’t tell us about egg quality directly, that remains something we can only assess once eggs are fertilised, but they give us a meaningful picture of quantity and potential response to fertility medications. At Hertility, our Advanced At-home Hormone and Fertility Test includes insight into your egg count alongside a full hormone profile. We can also arrange a Pelvic Ultrasound Scan to assess your antral follicle count and pelvic structures, and we work with HFEA-accredited partner clinics to support a smooth referral process […]

Getting diagnosed with PMOS (PCOS), should not take years. Yet many people are dismissed, told their symptoms are normal, or given the pill without being told what is driving their irregular periods, acne, excess hair growth or fertility concerns. PMOS is diagnosed using the Rotterdam criteria. This means you need to meet at least 2 out of 3 criteria: irregular or absent periods, signs of high androgens, and/or polycystic ovarian morphology on ultrasound or AMH testing. Other conditions, such as thyroid disorders and raised prolactin, should also be ruled out. This guide explains the tests used to diagnose PMOS, what the criteria mean, whether you need an ultrasound, and what to do if you are not getting clear answers. Quick facts: What tests are used to diagnose PMOS (PCOS)? There is no single test that can diagnose polyendocrine metabolic ovarian syndrome, or PMOS. Instead, diagnosis is usually based on a combination of your symptoms, menstrual cycle pattern, hormone levels, metabolic health markers and, in some cases, an ultrasound scan. Your doctor may recommend a combination of the following assessments. Medical history and symptom assessment The first step is usually a detailed conversation about your symptoms and health history. This may include questions about: This helps build a clearer picture of whether your symptoms fit with PMOS and whether other conditions need to be ruled out. Physical examination A clinician may also look for physical signs that can be associated with PMOS. These may include acne, excess facial or body hair, scalp hair thinning, skin tags or darker velvety patches of skin, which can sometimes be linked to insulin resistance. This helps identify patterns that may guide further testing. Blood tests for PMOS (PCOS) Blood tests are often used to check hormone levels, assess metabolic health and rule out other conditions that can cause similar symptoms. These may include: These tests help identify whether PMOS is likely, how it may be affecting your body, and what kind of support may be most appropriate. Pelvic ultrasound scan for PMOS (PCOS) A pelvic ultrasound may be recommended to look at the ovaries and uterus. This can help assess whether the ovaries have a polycystic appearance, meaning they contain a higher number of small follicles. A transvaginal ultrasound is often used because it provides a clearer view of the ovaries. This involves placing a slim ultrasound probe into the vagina, which uses sound waves to create images on a screen. However, having polycystic-looking ovaries alone is not enough to diagnose PMOS. Some people have polycystic ovaries without symptoms, and some people with PMOS may not have obvious changes on ultrasound. Pelvic examination In some cases, a pelvic examination may be offered to check for abnormalities or signs of other reproductive health conditions. This is not always needed for a PMOS diagnosis, but it may be useful if you have symptoms such as pelvic pain, abnormal bleeding or pain during sex. Testing does more than confirm a diagnosis. It can help rule out other causes of irregular periods, acne, excess hair growth or difficulty conceiving, and it can identify whether PMOS is affecting ovulation, hormone balance or metabolic health. That means your care can be tailored to what is actually happening in your body, whether that involves cycle support, fertility planning, skin and hair treatment, metabolic health support or longer-term monitoring. How is PMOS/PCOS diagnosed? PMOS is diagnosed using the Rotterdam criteria, the internationally recognised diagnostic framework, most recently updated in the 2023 International Evidence-Based PCOS Guidelines. To receive a diagnosis, you must meet at least 2 of the following 3 criteria. You do not need all three. Criterion 1: Irregular or absent menstrual cycles This criterion reflects the disruption to ovulation that is central to PMOS. When elevated androgens interfere with follicle development, ovulation doesn’t happen reliably, and without ovulation, the regular hormonal cycle that produces a period is disrupted. What counts as irregular?  A single late or missing period doesn’t meet this criterion, it needs to be a consistent pattern, not an occasional variation. Criterion 2: Clinical or biochemical hyperandrogenism (elevated androgens) This criterion reflects the androgen excess that is the hormonal driver of many PMOS symptoms. It can be met in two ways, through physical symptoms, or through blood test results, either is sufficient. Clinical hyperandrogenism means physical signs of elevated androgen activity: Biochemical hyperandrogenism means elevated androgens on a blood test including high testosterone and DHEAS. SHBG is a protein that binds to testosterone and reduces its biological activity. In PMOS, SHBG is often low, meaning more testosterone is free and active. This is why a PMOS-focused blood panel should always include SHBG alongside testosterone, not testosterone in isolation. Hormonal contraception can raise SHBG significantly, which suppresses testosterone and can mask androgen excess entirely. If you’re on or have recently stopped the pill, your androgen levels may not reflect your true baseline for several months. Ideally, androgens should be tested at least 3 full cycles after stopping hormonal contraception for the most accurate picture. Criterion 3: Polycystic ovarian morphology (PCOM) This criterion refers to evidence of the characteristic ovarian appearance associated with PMOS, a high number of follicles that haven’t been able to progress to ovulation. It can now be assessed in two ways: Transvaginal ultrasound (TVUS) A pelvic ultrasound scan counts the number of follicles visible in each ovary. The scan should ideally be performed in the early follicular phase, days 1-7 of the menstrual cycle, when follicles are at their most clearly countable.  AMH blood test This is the significant change introduced in the updated 2023 guidelines. AMH (anti-Müllerian hormone) is a hormone made by the follicles themselves. In PMOS, AMH is typically elevated, reflecting the high number of small arrested follicles. AMH is now formally accepted as an alternative to ultrasound for assessing polycystic ovarian morphology. This means that for many people, a blood test alone can support this third criterion, without the need for an internal transvaginal scan. Can AMH diagnose PMOS (PCOS)? AMH can help […]

If you’ve recently heard the term PMOS and wondered what it means, or if you’ve had a PCOS diagnosis for years and want to understand what’s changed, this is your complete guide. PMOS stands for polyendocrine metabolic ovarian syndrome. It’s the new name for what was previously called polycystic ovary syndrome (PCOS). The name has changed, but the condition hasn’t, and understanding it properly has never mattered more. PMOS affects an estimated 1 in 8 women and people with ovaries worldwide, more than 3.1 million in the UK alone. Despite being one of the most common hormonal conditions, it remains widely misdiagnosed, misunderstood, and undertreated. On average, it takes two years and multiple doctor visits to get a diagnosis. You deserve better than that. This guide covers everything: what PMOS actually is, what causes it, what it feels like, how it’s diagnosed, and what you can do about it. Quick facts: What is PMOS? P – PolyendocrineM – MetabolicO – OvarianS – Syndrome Let’s break that down: Polyendocrine means more than one hormone system may be involved. PMOS can affect reproductive hormones such as testosterone, LH and FSH, but it may also affect insulin, thyroid hormones, cortisol and other metabolic pathways. Metabolic refers to the way your body processes energy, sugar and insulin. Many people with PCOS/PMOS have some degree of insulin resistance, where the body has to produce more insulin to keep blood sugar stable. Ovarian reflects the fact that the ovaries may be affected, particularly ovulation. However, despite the old name “polycystic ovary syndrome”, you do not need to have cysts on your ovaries to have the condition. Syndrome means it is a collection of features that can look different from person to person. PMOS is the most common cause of irregular periods and ovulatory infertility in people with ovaries. It is also linked to an increased risk of developing insulin resistance and longer-term health risks including type 2 diabetes, cardiovascular disease, endometrial cancer, anxiety and depression. Is PMOS the same as PCOS? PMOS is just the newer name being used for PCOS. For years, the condition was called polycystic ovary syndrome (PCOS), but that name has always been a bit misleading. Not everyone with PCOS has polycystic-looking ovaries, and not everyone with polycystic-looking ovaries has PCOS. The condition also affects far more than the ovaries. The shift towards PMOS aims to better reflect the full-body nature of the condition, including its links with insulin resistance, androgen excess, metabolic health, cardiovascular risk, mental health and fertility. That said, PCOS is still the most widely recognised search term, and most NHS, NICE and clinical guidance currently still uses PCOS. So, for now, you may see both terms used: PCOS = the older, widely used namePMOS = the newer, more accurate name You can read more about why PCOS was renamed PMOS here. What causes PMOS? The exact cause of PMOS isn’t fully understood, but research points to a combination of genetic, hormonal and metabolic factors. It tends to run in families, and if your mother, sister or aunt has PMOS, you might be at a higher risk. At its core, PMOS involves a dysfunction in the way the body produces and responds to hormones, particularly androgens and insulin. Androgen excess – the ovaries (and in some cases the adrenal glands) produce higher levels of androgens than normal. Androgens are often called “male hormones,” but they play important roles in everyone’s body. In PMOS, elevated androgens disrupt the normal development of follicles in the ovaries, preventing regular ovulation. Insulin resistance – the majority of people with PMOS have some degree of insulin resistance, meaning their cells don’t respond efficiently to insulin. This causes the pancreas to produce more insulin to compensate, and elevated insulin in turn stimulates the ovaries to produce more androgens, creating a self-reinforcing cycle. Disrupted pituitary signalling – the hormonal signals from the brain to the ovaries are altered in PMOS. LH (luteinising hormone) is often disproportionately elevated relative to FSH (follicle-stimulating hormone), which further disrupts follicle development and ovulation. Genetic factors – PMOS can run in families, suggesting genes play an important role. Researchers are trying to identify which genes are involved, but because it’s a complex condition, it’s not surprising that it’s not a single gene, but that many genes are involved. What are the symptoms of PMOS? PMOS presents differently  from person to person. Some people have many symptoms; others have very few. Some symptoms are visible; others are internal. This variability is one of the reasons it takes so long to diagnose. Irregular or absent periods Irregular menstrual cycles are one of the hallmark features of PMOS. Because elevated androgens interfere with regular ovulation, periods can arrive unpredictably, sometimes weeks late, sometimes skipped altogether. Some people experience very long cycles (35 days or more); others may go several months without a period. What counts as irregular? Cycles shorter than 21 days or longer than 35 days, fewer than 8 periods per year, or periods that have no predictable pattern. If your periods have always been irregular  or if they became irregular after stopping the pill, PMOS is one of the first things worth looking into. Hormonal acne Hormonal acne is one of the most common and most distressing symptoms of PMOS. PMOS-related acne typically appears along the jawline, chin and lower cheeks. It may flare around the time of a period, or it may be persistent and seemingly random. It tends to involve deeper, more inflamed spots rather than surface-level break out, and it often doesn’t respond well to standard skincare. If you’ve tried everything on your skin and still can’t get it under control, your hormones are worth investigating. Unwanted hair growth (hirsutism) Elevated testosterone stimulates hair growth in areas where most women don’t typically grow coarse hair, the upper lip, chin, jaw, chest, stomach and inner thighs. This is called hirsutism, and it affects a significant proportion of people with PMOS. It can range from fine, barely noticeable hair to […]

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 […]

Menopause support at work is an increasingly important part of employee wellbeing, inclusion, and retention. For UK employers, effective support can help reduce avoidable barriers to performance, improve employee experience, and create a more inclusive workplace for people at different life stages. This focus has been further sharpened by the government’s rollout of The Renewed Women’s Health Strategy for England. Aligned with the Employment Rights Act, the updated strategy brings a heavy focus on keeping women in the workforce by tackling health-related economic inactivity. Crucially, from Spring 2026, large employers (250+ employees) are being actively encouraged to publish voluntary “Menopause Action Plans” outlining how they support staff, a framework expected to become mandatory by 2027. To champion these changes, the government also expanded the national remit by appointing a new Women’s Employment Ambassador to ensure businesses actively dismantle workplace health barriers. The most effective menopause support combines clear policies, flexible working, practical workplace adjustments, manager training, and access to specialist health support. Together, these measures can help employees manage symptoms such as poor sleep, anxiety, hot flushes, heavy periods, fatigue, and difficulty concentrating. Why menopause support matters for UK employers Menopause can affect employees in different ways and to different degrees. For some, symptoms are manageable. For others, they can have a substantial impact on confidence, attendance, comfort, and work performance. In the UK, employers should also be aware that menopause symptoms may overlap with legal obligations under equality and health and safety frameworks. Guidance from the Equality and Human Rights Commission has made clear that if menopause symptoms have a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities, employers may have a duty to make reasonable adjustments. There is also growing public and employer focus on the role menopause can play in retention, progression, and the gender pay gap. Without the right support, organisations risk losing experienced employees at a point in their careers when they often hold significant knowledge, leadership capability, and commercial value. What menopause workplace benefits should UK employers offer? The most effective menopause workplace benefits are practical, consistent, and easy to access. In most organisations, support falls into five areas: Flexible working arrangements Menopause-friendly workplace adjustments Clear absence and leave guidance Manager training and internal support Access to specialist health benefits 1. Flexible working and leave policies Flexible working is one of the most important tools employers can use to support employees experiencing menopause symptoms. Symptoms can fluctuate from day to day, and rigid schedules may make work more difficult to manage. UK employers can support employees by offering: flexible start and finish times hybrid or remote working where appropriate temporary adjustments to working hours additional short breaks during the day flexibility during periods of more severe symptoms Clear menopause-related absence guidance is also important. Acas recommends that when someone is off sick because of menopause, employers should consider recording this separately from other types of sickness absence. This can help reduce the risk of employees being unfairly penalised under standard absence trigger processes. A supportive policy should make it easier for employees to ask for help without feeling that their symptoms will be treated as a performance or conduct issue. 2. Workplace adjustments that improve comfort Small adjustments to the physical working environment can make a meaningful difference to how manageable symptoms feel during the working day. In many cases, these are low-cost changes that are simple to put in place. Examples of workplace adjustments for menopause include: desk fans or improved ventilation seating near windows or cooler areas access to drinking water easy access to washrooms provision of emergency sanitary products quiet rooms or rest areas for short breaks flexibility around uniforms or dress codes to allow breathable fabrics These measures can help employees manage symptoms such as hot flushes, dizziness, fatigue, anxiety, and, for those in peri-menopause, heavy or irregular periods with greater comfort and dignity. 3. Health benefits that support menopause care In addition to practical workplace adjustments, many UK employers are strengthening their health benefits to include menopause-specific support. This can help employees access timely information, specialist guidance, and appropriate clinical care. Menopause-related employee health benefits include: occupational health referrals menopause specialist consultations counselling or mental health support nutrition support hormone health education guidance on treatment options, including HRT where appropriate Some employers also provide educational workshops or lunch-and-learn sessions to improve awareness across the wider organisation. These sessions can help colleagues and managers better understand menopause symptoms, treatment pathways, and the impact symptoms can have at work. 4. Manager training and internal support A menopause policy is only effective if managers know how to apply it. Manager confidence plays a major role in whether support is experienced as meaningful in practice. Training should help managers: have sensitive and confidential conversations respond appropriately to disclosures about symptoms understand that symptoms such as brain fog, poor sleep, or difficulty concentrating may be health-related avoid treating menopause-related challenges as misconduct or underperformance signpost employees to internal and external support Some employers also create internal support structures such as menopause champions, peer support groups, or wellbeing leads. These can help make support more visible and reduce stigma across the organisation. 5. What should a menopause policy include? A clear menopause policy helps create consistency across teams and gives employees confidence that support is available. For UK employers, a menopause policy may include: a statement of organisational commitment guidance for managers examples of workplace adjustments flexible working options how menopause-related absence should be handled confidentiality expectations information about employee benefits and support pathways signposting to occupational health, EAP support, or specialist providers The purpose of the policy should be to make support clear, practical, and fair, rather than dependent on individual manager discretion. Menopause workplace benefits: quick reference table Support area Example Why it helps Flexible working Later start times, hybrid work, adjusted hours Helps employees manage poor sleep, fatigue, and fluctuating symptoms Physical adjustments Fans, ventilation, rest spaces, washroom access Improves comfort and reduces disruption […]

There’s a lot of conflicting advice out there about trying to conceive and a surprising amount of it is wrong. People are told to try on day 14 (not always accurate), to lie down afterwards (not necessary), or that it should happen quickly if nothing’s wrong (not always the case). This guide cuts through the noise. It covers when in your cycle to time sex for the best chance of conceiving, how conception odds actually work, what might be affecting your chances, and importantly, what to do when things aren’t going as planned. Quick Facts When in the menstrual cycle are you most likely to conceive? You can only conceive during a six-day window in each menstrual cycle. This is called the fertile window, and it consists of the five days leading up to ovulation plus the day of ovulation itself. Outside of this window, the chances of pregnancy from unprotected sex is very low This window exists because of how long sperm and eggs survive in the body. Once released, an egg lives for just 12–24 hours. Sperm, on the other hand, can survive in the female reproductive tract for up to five days. That means sex in the days before ovulation can still result in conception, the sperm are already waiting when the egg arrives. When does ovulation happen? Ovulation doesn’t always happen on day 14. This is one of the most widespread and consequential misconceptions in fertility. Day 14 only applies to a textbook 28-day cycle. Latest research shows that ovulation actually occurs approximately between day 12 to 16 days for most people which means: If your cycles are irregular, ovulation timing can shift considerably from month to month. Using day 14 as your anchor when your cycle doesn’t conform to that pattern is one of the most common reasons people miss their fertile window. Hertility’s own research based on data from over 97,000 women actively trying to conceive, found that more than 41% could not accurately identify their fertile window, making this the single most common correctable barrier to natural conception. What are the chances of getting pregnant during the fertile window? The odds of conception are not equal across all six days of the fertile window, they build as you approach ovulation and peak just before the egg is released. Research shows that the two to three days immediately before ovulation carry the highest probability of conception. sex on the day of ovulation is less effective than the day before. Waiting until you’ve confirmed ovulation has occurred may mean you’ve already passed the peak window. This is why covering the full window matters, rather than pinpointing a single “best day.” How do you know when you’re ovulating? To make the most of your fertile window, you need to know when ovulation is approaching. There are several ways to identify it. The most reliable real-time indicator is a positive LH test (ovulation predictor kit), which typically detects the LH surge 24–36 hours before ovulation.  A positive test is your cue to prioritise sex in the next one to two days. They’re the most accurate day-to-day predictor available over the counter. One caveat: if you have PCOS, elevated LH throughout the cycle can produce false positives – see our PCOS and TTC guide for more on this. Egg-white cervical mucus, clear, slippery, and stretchy is another strong sign that ovulation is approaching. Basal body temperature (BBT) rises slightly after ovulation due to rising progesterone. The limitation is that this confirms ovulation has already happened, so it’s more useful for understanding your cycle pattern over time than for timing sex in the moment. Day 21 progesterone blood test A blood test measuring progesterone around day 21 of a 28-day cycle (or 7 days after suspected ovulation on other cycle lengths) can confirm whether ovulation has taken place. If your result is low or borderline, it may indicate that ovulation didn’t occur that cycle or that the timing of the test missed the progesterone peak.  Cycle tracking apps estimate your fertile window from past cycle data, a reasonable starting point for people with regular, predictable cycles, but they’re predictions, not measurements. They don’t account for cycle-to-cycle variation, stress, illness, or travel. Treat them as a guide, not a guarantee. For a full comparison of all methods, including their reliability and what works best for different cycle types, see: How to detect ovulation. Should you time sex around ovulation to increase chances of conceiving? Not necessarily, and for many couples, trying to time sex precisely creates more stress than it solves. The current clinical recommendation from NICE is sex every 2–3 days throughout the cycle. This ensures viable sperm are consistently present, without the need to nail down your ovulation date precisely. It also removes the pressure of “we have to do it tonight“, which, for many couples, is easier on the relationship and the sex itself. Something that often goes unsaid in clinical guides is that trying to conceive can make sex feel like a task. Scheduled, clinical, performance-driven. Timed sex can be hard on relationships, and the longer it goes on, the harder it gets. Something often left unsaid is that trying to conceive can make sex feel like a task. When the approach of a fertile window feels like a countdown, and sex begins to feel like a performance, that affects intimacy. It’s normal and it’s worth acknowledging. Timed sex doesn’t have to mean joyless sex, but if TTC is creating real tension around intimacy, that’s worth talking about, with your partner, and if it persists, with a professional. For some people, there are physical factors that make sex difficult or painful, including conditions like endometriosis, vaginismus, or vulvodynia. These conditions are underdiagnosed and often poorly supported, but they are treatable. If sex is painful, irregular, or difficult, this is not something to push through silently, it’s information worth sharing with a clinician, because it can be investigated and addressed. Should you only have sex on […]

If you have been diagnosed with PCOS or suspect you have PMOS, you might have seen the news this week. On 12 May 2026, a landmark paper published in The Lancet officially renamed polycystic ovary syndrome (PCOS) to polyendocrine metabolic ovarian syndrome, or PMOS. It’s one letter different in the acronym. But the reasoning behind it, and what it means for diagnosis, treatment and the millions of people living with this condition, is significant. Here’s everything you need to know. Why has PCOS been renamed? The short answer: because the old name was wrong and that had real consequences. “Polycystic ovary syndrome” implies the condition is defined by cysts on the ovaries. In reality, those are not actually pathological ovarian cysts. What is visible on ultrasound are small antral follicles – immature follicles that haven’t developed properly, not cysts in the clinical sense. Describing the condition by a feature it doesn’t actually have has caused confusion among patients and clinicians alike for decades. More importantly, the old name obscured what PCOS actually is: a complex, whole-body hormonal and metabolic condition that affects far more than the ovaries. The new name recognises that the condition is not  primarily a gynaecological disorder, but instead a complex, multisystem condition involving endocrine, metabolic, reproductive, dermatological and psychological health. The name PCOS is misleading – it focuses on ‘cysts’ and the ovaries, when the condition is much more complex than that. This has led to missed diagnoses and people not getting the right treatment. For an estimated 1 in 8 women worldwide – over 170 million people – that’s not a semantic issue, it’s a healthcare one. What does PMOS stand for and what does it mean? PMOS: Polyendocrine Metabolic Ovarian Syndrome Each word in the new name is deliberate: Polyendocrine – reflects that this is fundamentally a hormonal condition, involving multiple endocrine disruptions. People with PMOS have a disturbance in the endocrine (or chemical messenger) system of the body, which can lead to widespread impacts. This includes abnormalities in androgen production, insulin signalling, ovarian hormone regulation and neuroendocrine function. Metabolic – acknowledges the significant metabolic dimension of the condition, including insulin resistance, diabetes risk and cardiovascular risk. For many people with PMOS, the metabolic features are as impactful or more so than the reproductive ones. Ovarian – retained in the new name because the ovaries remain central to understanding the condition. Abnormalities in follicle development and ovulation are all key features of PMOS. The ovary is involved, it’s just not the only thing going on, and it’s not cysts that define it. Syndrome – correctly reflects that this is a cluster of features, not a single-cause disease. How did changing PCOS to PMOS happen? This wasn’t a quick decision. The name change followed more than a decade of vigorous debate and the most robust disease-renaming process in history. The process was led by Professor Helena Teede, Director of Monash University’s Monash Centre for Health Research & Implementation, alongside the International Androgen Excess and PCOS Society, 56 patient and professional organisations including Verity PCOS UK  and garnered more than 22,000 survey responses from patients and multidisciplinary health professionals across all world regions. The revised name was introduced in a paper published in The Lancet and presented at the European Congress of Endocrinology in Prague. “It is fantastic that the new name now leads with hormones and recognises the metabolic dimension of the condition.” – Rachel Morman, Chair of Verity PCOS UK How is PMOS diagnosed? Nothing about the diagnostic criteria has fundamentally changed. If you were diagnosed with PCOS, that diagnosis still stands. The condition is the same, the name is what’s changing. To receive a PMOS/ PCOS diagnosis, a person must meet at least two of the following three criteria: 1. Irregular or absent menstrual cycles. Irregular cycles indicate that ovulation is not occurring regularly, a key feature of PMOS/ PCOS. According to the 2023 International Evidence-Based PCOS Guidelines, irregular cycles are defined as fewer than eight cycles per year, or cycle intervals outside the 21–35 day range, in women who are at least three years post-menarche (which is your first period). 2. Clinical or biochemical signs of high androgens (hyperandrogenism). This means either physical symptoms associated with elevated androgens such as excess facial or body hair (hirsutism), acne, scalp hair thinning or elevated androgen levels on a blood test – typically testosterone.  3. Polycystic ovarian morphology (PCOM). This refers to the appearance of the ovaries on an ultrasound scan, specifically a high number of small antral follicles (the immature follicles that house eggs) in one or both ovaries, or an increased ovarian volume. Alternatively, a high AMH (anti-Müllerian hormone) level on a blood test can be used as a marker of PCOM when an ultrasound isn’t available or appropriate. Crucially, “60% of women with the condition only need those first two – they don’t need the ovaries assessed in any way,” says Professor Teede. “For the other 30–40%, they can either have a blood test or an ultrasound, and arguably, a blood test is actually cheaper and much more convenient than an internal ultrasound.” The conversation about your condition should broaden For too long, people with PCOS were told it was “just about your periods” or “just a fertility issue.” The new name makes explicit that PMOS involves the endocrine system, metabolism, skin, mental health and cardiovascular health, not just the ovaries and reproductive function. “Language matters in medicine. The previous name often led to misconceptions and stigma, particularly around fertility. This change helps shift the conversation toward overall health rather than a single aspect of the condition.” – Dr Melanie Cree What actually causes PMOS and what does it affect? The name change is an opportunity to understand PMOS more completely. It’s not a condition that starts and ends with your cycle. Hormonal disruption (the “polyendocrine” part) PMOS involves elevated androgens like testosterone which can disrupt ovulation, cause acne, trigger unwanted hair growth (hirsutism) and contribute to hair thinning. The androgen […]

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 […]