Knowledge Centre

Deciding to try for a baby is a big step, and one of the first practical questions many people ask is: when should I stop using contraception if I want to get pregnant? The answer depends on the type of contraception you’re using. For most methods, fertility can return quickly, sometimes within days or weeks. For others, particularly the contraceptive injection, it can take several months for ovulation and periods to return. The reassuring news? Contraception does not impact your long-term fertility. Most people are able to start trying as soon as they stop their method, although your cycle may take a little time to settle. This guide explains when to stop each type of contraception, how quickly fertility may return, what can affect your chances of conceiving, and when to seek support if things are not progressing as expected. Quick facts: When should you stop using contraception if you want to get pregnant? One of the most common concerns about stopping contraception is whether it can make it harder to get pregnant later. The reassuring answer is no. Reversible contraception does not permanently affect your fertility. Hormonal contraception works by temporarily changing your reproductive hormones. Depending on the method, it may stop ovulation, thicken cervical mucus, thin the womb lining or create an environment that prevents pregnancy. Once you stop using it, these effects wear off. What can vary is how long it takes for ovulation to return. For most methods, this happens quickly. For the contraceptive injection, it can take longer because the hormone is designed to stay active in the body for several months. Sometimes, stopping contraception can reveal symptoms that were previously being masked. For example, if you had irregular periods before starting contraception, they may return once you stop. Conditions such as PMOS (formerly known as PCOS), thyroid dysfunction, endometriosis or hypothalamic amenorrhoea may also become more noticeable after stopping hormonal contraception. This does not mean contraception caused the issue. It may simply have been managing or hiding the symptoms. How long does it take to get pregnant once your stop contraception? A review of 22 studies across 15,000 women found that 83.1% became pregnant within 12 months of stopping any form of contraception, which is comparable to the general conception rate. The NHS data similarly shows that 82–92% of people conceive within one year of trying, depending on age. Some people get pregnant in the first cycle after stopping contraception. For others, it can take several months, and that can still be completely normal.  When to Stop the Combined Pill Before Trying to Get Pregnant The combined contraceptive pill contains synthetic versions of oestrogen and progesterone. It prevents pregnancy mainly by stopping ovulation, meaning your ovaries do not release an egg each month. When to stop: You can stop the combined pill whenever you are ready to start trying for a baby. There is no medical need to finish your current pill pack, although some people prefer to do this because it can make bleeding easier to predict. When fertility returns: Fertility can return quickly after stopping the combined pill. Some people ovulate within the first month, although it can take one to three months for your natural menstrual cycle to become regular again. If your periods were irregular before you started the pill, they may become irregular again once you stop. When to start trying: You can start trying to conceive as soon as you stop the pill. If you get pregnant before your first natural period, it may be slightly harder to date the pregnancy, but this is not harmful and is not a reason to delay trying. When to Stop the Mini Pill Before Trying to Get Pregnant The progestogen-only pill, often called the mini pill, contains a synthetic version of progesterone. It can prevent pregnancy by thickening cervical mucus, thinning the womb lining and sometimes stopping ovulation. When to stop: You can stop the mini pill at any point. Fertility usually returns very quickly, often within days to a few weeks, because the mini pill does not always suppress ovulation in the same way as the combined pill. When fertility returns: You can start trying for a baby as soon as you stop taking the mini pill. Your period may take a little time to return, but ovulation can happen before your first bleed, which means pregnancy may be possible straight away. When to start trying: You can start trying to conceive as soon as you stop the pill. If you get pregnant before your first natural period, it may be slightly harder to date the pregnancy, but this is not harmful and is not a reason to delay trying. When to Stop the Contraceptive Patch Before Trying to Get Pregnant The contraceptive patch is worn on the skin and releases oestrogen and progestogen. It works in a similar way to the combined pill by stopping ovulation. When to stop: You can stop using the contraceptive patch by removing it when you are ready to try for pregnancy.  When fertility returns: Fertility may return quickly after stopping, although your period may take one to two months to return to its usual pattern, but even if your periods don’t come back immediately, it may still be possible to get pregnant right after stopping the patch  When to start trying: You can start trying to conceive immediately after removing the patch. As with other hormonal methods, ovulation can happen before your first period, so pregnancy may be possible straight away. When to Stop the Vaginal Ring Before Trying to Get Pregnant The vaginal ring is a small, flexible ring placed inside the vagina. It releases hormones that prevent pregnancy by stopping ovulation, thickening cervical mucus and thinning the womb lining. When to stop: You can stop using the vaginal ring by removing it when you are ready to start trying for a baby. When fertility returns: As with the combined pill and patch, the ring is a combined hormonal method and […]

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 […]

If you’re in your 40s and suddenly notice irregular periods, brain fog, broken sleep, anxiety, night sweats or hot flushes that seem to appear out of nowhere, it’s natural to wonder: could this be perimenopause? And if you are wondering that, the next question often follows quickly: how is perimenopause actually diagnosed? One of the most frustrating things about perimenopause is that many people feel dismissed whilst searching for answers. You may arrive at a GP appointment with months of poor sleep, mood changes, heavy or unpredictable periods and symptoms that are affecting your work, relationships and confidence, and  be told to just wait and see. This guide explains how perimenopause is diagnosed in the UK, what happens if you are under 45, when blood tests are useful, when they are not, and how Hertility can help you get clarity. Quick facts: What is perimenopause? Perimenopause is the transitional phase leading up to menopause. During this time, the ovaries gradually become less responsive and start producing hormones such as oestrogen and progesterone less consistently. Importantly, hormone levels do not decline in a neat, predictable line. They can fluctuate significantly from one day to the next, and sometimes even within the same day. This hormonal turbulence is what can drive many of the symptoms people associate with perimenopause, including hot flushes, night sweats, mood changes, sleep disruption and cycle changes. Perimenopause can last for a few months, but for many people symptoms may persist for 7 to 9 years, sometimes longer, and they can change over time. It most commonly begins in the mid-40s, although it can start earlier. Menopause itself is confirmed retrospectively when you have gone 12 consecutive months without a period, assuming there is no other cause, such as pregnancy, medication or hormonal contraception. The average age of menopause in the UK is around 51, with a typical range between 45 and 55. Everything before that final period, while symptoms and cycle changes are happening, is considered perimenopause. Can perimenopause happen before 45? When menopause happens before the age of 45, it is called early menopause. When ovarian function reduces significantly before the age of 40, it is called premature ovarian insufficiency, or POI. This is less common than menopause at the average age, but it is not rare. Spontaneous early menopause affects around 5% of the population before age 45, while POI is estimated to affect around 1% of women under 40 and around 0.1% under 30. This distinction matters because early menopause and POI can affect more than periods. They can have implications for fertility, bone density, cardiovascular health, sexual health, emotional wellbeing, cognition and long-term hormone support. People under 45 may also find it harder to get their symptoms recognised because perimenopause is often associated with the late 40s and early 50s. But being younger does not mean your symptoms are irrelevant. It means they should be assessed carefully, with the right investigations and support. What are the symptoms of perimenopause? Because perimenopause is mainly diagnosed through symptoms, it helps to understand what those symptoms can look like. Perimenopause affects everyone differently. Some people have mild symptoms that come and go, while others experience symptoms that significantly affect sleep, mental health, work, relationships and day-to-day life. One of the earliest signs is often a change in your menstrual cycle. Your periods may become closer together, further apart, heavier, lighter, longer, shorter or simply less predictable than before. You might also notice spotting, missed periods or a cycle pattern that feels completely new for your body. Other common perimenopause symptoms include: There can also be symptoms that feel more surprising, such as dry eyes, brittle nails, dizziness, tinnitus, gum sensitivity or changes in taste and smell. Not everyone will experience all of these symptoms. What matters most is the pattern: new or worsening symptoms in midlife, particularly when they appear alongside changes to your menstrual cycle. Perimenopause should also be considered if someone develops new mood or anxiety symptoms in midlife, especially if they have no previous history of depression or anxiety. How is perimenopause diagnosed in the UK? In the UK, perimenopause is usually diagnosed through a clinical assessment. This means a doctor will ask about your age, symptoms, menstrual cycle, medical history, contraception use and how your symptoms are affecting your quality of life. If you are under 40: possible premature ovarian insufficiency should be investigated If you are under 40 and have symptoms that suggest menopause, this should not be brushed off as stress, lifestyle, anxiety or “just hormones” without proper assessment. In this age group, doctors should consider premature ovarian insufficiency, or POI. POI happens when the ovaries stop working normally before the age of 40. It is not the same as typical menopause in the early 50s, and it needs a different level of investigation and support. FSH blood testing is usually important if POI is suspected. Because hormone levels can fluctuate, diagnosis requires two high FSH results taken 4-6 weeks apart, alongside symptoms and menstrual changes. Your doctor may also consider other tests depending on your situation, such as thyroid function, prolactin, pregnancy testing, reproductive hormone testing, autoimmune screening or genetic investigations. This depends on your symptoms, medical history and whether you are trying to conceive. A timely diagnosis matters because POI can affect fertility, bone density and cardiovascular health. Hormone replacement therapy is often recommended until at least the average age of natural menopause, unless there is a medical reason not to use it. If you are under 40 and your periods have become irregular or stopped, especially alongside hot flushes, night sweats, vaginal dryness or fertility concerns, it is reasonable to ask directly whether POI has been considered. If you are 40 to 45: early menopause may need to be assessed Early menopause means menopause before the age of 45. Like POI, it can affect fertility, bone health, cardiovascular health and long-term wellbeing, so it is important not to simply dismiss symptoms. In this age group, a […]

Anti-Mullerian Hormone (AMH) is one of the most talked-about markers in fertility and reproductive health. It is often described as a measure of ovarian reserve, which means the number of eggs remaining in the ovaries. While much of the conversation focuses on low AMH, receiving a high result can raise its own set of questions. Does high AMH mean you are more fertile? Does it mean you have polycystic ovaries? Could it be linked to PMOS ( formerly known as PCOS)? And does having high AMH mean it will be easier to get pregnant? The answer is more nuanced than a simple yes or no. High AMH levels usually suggest that your ovaries contain a higher-than-expected number of small follicles for your age. This may be linked to polycystic ovaries, PMOS or natural variation. However, AMH does not measure egg quality, does not confirm whether you are ovulating regularly, and does not predict whether you will conceive naturally. In this guide, we explain what high AMH levels mean for fertility, what causes it, how it relates to PCO and PMOS, what it can mean for IVF, and how Hertility interprets your AMH result as part of your wider hormone health. 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 What is AMH? 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, it gives an indication of how many eggs you have remaining at a given time. This is known as your ovarian reserve. Ovarian reserve refers to egg quantity, not egg quality. This distinction is important. AMH can help estimate the number of eggs remaining, but it cannot tell you whether those eggs are genetically healthy, whether they will fertilise, or whether they will develop into a viable pregnancy. Unlike hormones such as FSH, oestradiol, and LH, which fluctuate significantly across the menstrual cycle, AMH remains relatively stable. This means it can usually be measured at any point in the cycle and still provide useful information. However, 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 it is still considered one of the most stable and reliable markers of ovarian reserve. It is also routinely used when someone is considering undergoing a fertility treatment to estimate how the ovaries are likely to respond to fertility medication, guide medication dosage, and inform treatment planning. For a deeper dive into everything AMH testing can and can’t tell you, including its role in identifying  PMOS and guiding fertility treatment, read our full guide: What Does AMH Testing Tell You? 5 Key Insights About Your Fertility What Does “High AMH” Actually Mean? When we refer to “high AMH,” we mean a result that falls above the expected range for your age group. Because AMH naturally declines as you get older, what counts as “high” is always interpreted relative to age-specific reference ranges, not a single universal cutoff. A high result suggests that your ovaries contain a larger-than-expected number of small follicles for someone your age. In practical terms, this means there is more AMH being made and circulating in the bloodstream. In isolation, this is not harmful, but is a signal worth investigating further, as it is closely associated with certain hormonal and reproductive health conditions. Does High AMH Mean I Am Very Fertile? This is the most common and potentially most consequential misconception about high AMH results. A high result can feel like good news, more eggs must mean better fertility, right? In fact, this is not necessarily true. High AMH levels are not automatically good or bad for fertility. AMH tells you about egg quantity. It does not tell you anything about egg quality, that is, how healthy those eggs are, how likely they are to be fertilised, or how likely they are to develop into a viable embryo. Egg quality is influenced primarily by age and genetics, and there is currently no reliable way to measure it directly outside of assessing embryos created during IVF. Beyond egg quality, fertility depends on many factors that AMH cannot assess at all; whether you are ovulating regularly, the health of your fallopian tubes and uterus, and sperm health. A high result offers no reassurance about any of these. In short: a high AMH result does not predict your ability to conceive naturally, and should not delay seeking help if you have concerns about conceiving. What Causes High AMH Levels? A high AMH result reflects a greater number of small follicles in the ovaries than would be expected for your age. The most common reasons for this include: Unlike low AMH, a high result is not associated with previous surgery, cancer treatment, or lifestyle factors. In the vast majority of cases, the underlying explanation is PCO,  PMOS, or natural variation, and your full hormone panel and clinical history will help clarify which. What conditions can high AMH indicate? Polycystic ovaries (PCO) PCO is a common reproductive health condition affecting around 30% of people with ovaries of reproductive age. It is characterised by a higher-than-expected number of small, immature follicles in the ovaries, which is precisely why AMH levels tend to be elevated in people with PCO. More follicles indicates more AMH being produced. Importantly, PCO on its own is benign. It does not affect fertility and does not cause symptoms in most people. It is often identified incidentally, during an ultrasound, or increasingly, through a high AMH result. <p>Because AMH is so closely associated with follicle count, updated clinical guidelines now allow AMH to be used as an indicator of polycystic ovaries in place of an ultrasound scan for the […]

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 […]