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You’re born with all the eggs you’ll ever have and you can’t increase the number of eggs you have, so there’s no proven way to increase your AMH levels in a way that improves your fertility. But some things can lower your AMH reading, such as hormonal contraception and smoking, and addressing them may help. And a low AMH result doesn’t mean you can’t get pregnant. If your AMH result came back lower than you expected, it’s natural to want to do something about it. Search online and you’ll find supplements, foods and programmes promising to “boost” your AMH, sometimes quickly. Here’s what the evidence actually says: what can affect your AMH, what you can realistically do to protect your fertility, and what your result really means. Quick facts What is AMH and what does it tell you? AMH (anti-Müllerian hormone) is made by the small, developing follicles in your ovaries, each of which contains an immature egg. The more of these follicles you have, the higher your AMH tends to be. That’s why your AMH level gives an indication of your ovarian reserve: roughly, how many eggs you have left compared with others your age. AMH is most useful if you’re planning ahead, considering egg freezing or preparing for IVF, where it helps predict how your ovaries will respond to fertility medication. But it reflects egg quantity, not egg quality, and it can’t tell you whether you’ll get pregnant naturally. Read our full guide to what AMH is and how it’s tested. Can you increase your AMH levels? Not in a way that improves your fertility. You’re born with all the eggs you’ll ever have, and your supply declines naturally with age. No diet, supplement or treatment has been proven to create new eggs or reverse that decline. It helps to separate your AMH number from your ovarian reserve. Your AMH result can change for reasons that have nothing to do with how many eggs you have. For example, it can be lower while you’re using hormonal contraception and rise again after you stop.  What can lower your AMH levels? Some factors lower your AMH reading temporarily. Others affect your ovarian reserve itself. Age. This is the biggest factor. AMH declines gradually through your 20s and 30s, and more quickly from your mid-30s, as your egg supply naturally falls. Hormonal contraception. The pill and other hormonal methods can lower your AMH by 20-30%, but the effect is temporary. If you test while using hormonal contraception, your result may underestimate your ovarian reserve, so some people choose to retest around three months after stopping. Read more about testing your hormones on hormonal contraception. Smoking and vaping. Current smoking is linked with lower AMH, and smokers reach menopause more than a year earlier than non-smokers on average. Research has found lower AMH in people who currently smoke but not in people who used to, which suggests stopping may help. Long-term exposure to second-hand smoke has also been linked with lower AMH. Hertility’s own research has also linked vaping to lower AMH. Ovarian surgery. Surgery on your ovaries can reduce your ovarian reserve, because some healthy tissue may be removed along with the problem. This is particularly true of surgery to remove endometriomas (cysts caused by endometriosis). Cancer treatment. Chemotherapy and radiotherapy to the pelvis can damage your ovaries and lower your ovarian reserve. If you’re about to start cancer treatment, ask about fertility preservation, such as egg freezing, before it begins. Health conditions. Endometriosis and some genetic and autoimmune conditions can affect your ovarian reserve. Premature ovarian insufficiency (POI), where your ovaries stop working normally before the age of 40, causes very low AMH. Can low AMH levels be reversed? It depends on what’s causing it. If your AMH is low because your egg supply has naturally declined with age, it can’t be reversed. Nothing can restore eggs that have already been used up. But a low AMH result doesn’t always reflect your true ovarian reserve. Your reading may be higher when you retest if: After chemotherapy, some women’s ovarian function recovers partly over time, although this varies widely. And in POI, the ovaries sometimes work on and off, so some women with POI still occasionally ovulate and conceive. If your result is lower than you expected, a Hertility specialist can help you work out whether anything might be affecting it. Are there supplements to increase AMH levels? No supplement has been proven to increase your ovarian reserve. Here’s what the evidence says about the most commonly recommended ones. Vitamin D. Research on vitamin D and AMH is mixed. A review of studies found vitamin D supplements raised AMH in women without PMOS but lowered it in women with PMOS. The researchers concluded that larger trials are needed. Vitamin D may change how much AMH your follicles make rather than how many follicles you have. Correcting a deficiency is good for your health, but it isn’t a proven way to improve your fertility. Folic acid. Folic acid hasn’t been shown to raise AMH. But if you’re trying to conceive, you should be taking 400 micrograms of folic acid a day anyway, to help prevent neural tube defects such as spina bifida. Selenium and vitamin E. Small, early studies have suggested these antioxidants may help some markers of ovarian function in women with premature ovarian insufficiency. They haven’t been shown to increase AMH in other women, and high doses of selenium can be harmful, so don’t take them without advice. DHEA. DHEA is a hormone supplement sometimes used by fertility clinics for women expected to respond poorly to IVF. The evidence is low quality, and European fertility guidelines don’t recommend it for this purpose. It can also cause side effects such as acne and excess hair growth, so it should only be taken under specialist supervision. CoQ10. CoQ10 is popular in fertility supplements because it’s involved in producing energy in eggs. Small studies suggest it may help egg quality in some […]

Perimenopause is the time leading up to menopause, when your hormone levels start to change and your periods become less regular. It usually starts in your 40s and lasts several years, ending once you’ve gone 12 months without a period. During this time, many people notice symptoms such as hot flushes, sleep problems and mood changes. Perimenopause can creep up on you. Your periods might change, you might start waking at 3am, or you might feel more anxious than usual, without realising your hormones could be behind it. This guide explains what perimenopause is, when it starts, how long it lasts, how to tell if you’re in it and what can help. Quick facts: What is perimenopause? Perimenopause is the stage before menopause, when your ovaries gradually stop working as they used to. Your hormone levels start to change, your periods become less predictable, and you may notice new physical and emotional symptoms. What is the difference between perimenopause and menopause? Perimenopause, menopause and postmenopause are often used interchangeably, but they mean different things: Many people say “menopause” when they mean perimenopause. That’s understandable, but the difference matters. Perimenopause is usually when symptoms are most noticeable, and when you can still get pregnant. What age does perimenopause start? Perimenopause most often starts in your mid-40s, but everyone is different. Some people notice changes in their late 30s or early 40s, and others not until their late 40s. Menopause usually happens between 45 and 55. Under 45. If your periods stop before you’re 45, this is known as early menopause. Under 40. If your periods stop before you’re 40, it’s called premature menopause or premature ovarian insufficiency (POI). It affects around 1 in 100 women under 40. If you’re under 40 and your periods have become irregular or stopped, see your GP. POI needs proper assessment and treatment. Your genes, lifestyle habits like smoking, some medical treatments and surgery on your ovaries can all affect when perimenopause starts. Find out more in our guide to whether you can predict when menopause will happen. How long does perimenopause last? Perimenopause usually lasts several years, and the length varies a lot from person to person. For most, perimenopause will last about 4 to 8 years, but it can be longer (or shorter!). It ends once you’ve gone 12 months without a period. Symptoms don’t always stop when your periods do. Hot flushes and night sweats often carry on into postmenopause. In one large study, hot flushes and night sweats lasted more than seven years overall for around half of the women. What causes perimenopause? Perimenopause happens because your ovaries gradually run out of eggs and stop responding to the hormones that control your cycle. This is why symptoms can come and go, and why they can be so unpredictable. It’s also why a single blood test often can’t confirm perimenopause: your hormones can look normal one day and very different the next. What are the first signs of perimenopause? For many people, the first sign is a change to their periods. Your cycle might get shorter or longer, your periods might become heavier or lighter, or you might skip periods altogether. Other common early signs include: Period and cycle changes Often the earliest and most recognisable sign of perimenopause is a change in your menstrual cycle. This can include shorter cycles (less than 21 days), longer cycles or skipped periods, heavier or lighter periods than before, spotting between periods or more intense PMS symptoms. Hot flushes and night sweats Hot flushes are sudden feelings of heat, usually in your face, neck and chest, which can make your skin red and flushed. They can happen at any time, often with no obvious trigger. Falling oestrogen affects the part of your brain that controls body temperature, making it more sensitive to small changes. Night sweats are hot flushes that happen while you sleep. They can be heavy enough to soak your nightwear and bedding, and wake you up. Sleep disturbance Poor sleep is one of the most common and most underestimated symptoms. Night sweats can wake you, but falling progesterone and changing oestrogen levels can also affect your sleep directly. Many people find they wake in the early hours and can’t get back to sleep. Mood changes – anxiety, low mood and irritability Changing oestrogen levels can affect the brain chemicals involved in mood, such as serotonin. You might notice: These are some of the most often missed perimenopause symptoms, because they’re so easily put down to stress, relationship problems or a mental health condition. Brain fog and cognitive changes Many people notice difficulty concentrating, forgetfulness or a feeling of mental “fuzziness”, often called brain fog. Oestrogen plays a role in memory, attention and processing speed, so changing levels can affect how sharp you feel. Brain fog can be worrying, but it’s a common, recognised symptom of perimenopause, not a sign of something more serious. Vaginal and bladder changes Falling oestrogen can make the tissues of your vagina, vulva and urethra drier, thinner and less elastic. This is known as genitourinary syndrome of menopause (GSM), and it can cause vaginal dryness or discomfort, pain during sex, increased susceptibility to thrush or bacterial vaginosis, urinary urgency or frequency and recurrent urinary tract infections Low libido Changes in libido during perimenopause are driven by a combination of declining testosterone, vaginal discomfort, disrupted sleep and mood changes.  Skin, hair and body changes Decreased oestrogen reduces collagen production, causing skin to feel drier, thinner, and less elastic. Some people also notice increased sensitivity or new adult acne. Falling oestrogen alongside declining progesterone and testosterone changes the hair growth cycle, and many perimenopausal people notice hair thinning at the temples or crown. Hormone changes can affect where your body stores fat, with more weight gathering around your middle, even if your diet hasn’t changed. Joint pain and muscle aches Aching joints and muscles, especially stiffness in the morning, are a recognised symptom of perimenopause. Heart palpitations Some people notice […]

Yes. Many women with PCOS (polycystic ovary syndrome), now called Polyendocrine metabolic ovarian syndrome (PMOS) conceive naturally. Others need medical support. Either way, a diagnosis is not a barrier to pregnancy. Around 1 in 10 women in the UK have PCOS. If you’ve just been diagnosed, you’ve probably heard frightening things.  That PCOS means infertility. That pregnancy will be impossible without IVF.  None of that is true. PCOS affects how your ovaries release an egg, but ovulation remains possible, and with the right approach, so does pregnancy. For the full step-by-step pathway, read our comprehensive guide on trying to conceive with PCOS. For tracking methods when cycles are unpredictable, read how to track ovulation with PCOS. How does PCOS affect getting pregnant? PCOS affects how and how often your ovaries release an egg. Normally, follicle-stimulating hormone (FSH) prompts your ovaries to mature and release one egg each cycle. In PCOS, higher-than-usual androgens (like testosterone) can disrupt that signal, so several small follicles develop without one consistently maturing and releasing. Your body may not get the cue to ovulate, so the cycle stretches out or ovulation doesn’t happen that month. The result is variability, some people with PCOS ovulate regularly, some sporadically, and some not at all for a time. That’s what makes PCOS a fertility challenge rather than a barrier,  the difficulty is usually in the timing, not in whether pregnancy is possible. (Our PCOS explainer covers the wider condition in full.) So how hard is it to get pregnant if I have PCOS? Honestly, it can be harder, but it’s usually not impossible, and most people with PCOS do conceive, naturally or with help. The key thing is that “how hard” isn’t one answer: it depends entirely on how PCOS affects you. So the honest answer is: harder than average for many people, but the degree varies enormously, and for most it’s very much still possible. What makes the difference is knowing which situation you’re in, which comes down to one question: are you ovulating, and when? That single piece of information shapes everything about your next steps.  Hertility research found more than 41% of people trying to conceive couldn’t accurately identify their fertile window, and PCOS widens that gap,  you can’t assume day-14 ovulation after a 50-day cycle. If your cycles are unpredictable, our guide to tracking ovulation with PCOS covers the methods that actually work. If your cycles are irregular, you’re struggling to identify when you ovulate, or you simply want a clearer picture of what your hormones are doing, Hertility’s Advanced At-Home Hormone and Fertility Test can help you investigate what may be going on. Start with an Online Health Assessment, which personalises your hormone panel and screens for up to 18 conditions, including PCOS. You’ll get clinical-grade results alongside a doctor-written report, personalised Care Plan and Clinical Result Review Call, so you know what your results mean and what to do next. How to get pregnant with PCOS quickly There’s no shortcut to pregnancy itself, but there are ways to move things forward efficiently rather than spending months on approaches that aren’t working. The key is starting the investigation early, so you can escalate to medical support if required quickly. The single biggest lever is finding out whether you’re ovulating: if your cycles are irregular, you don’t necessarily need to wait the full 12 months advised for regular cycles. A hormone test can help confirm your PCOS and, crucially, establish if you are ovulating or not. If ovulation is happening, understanding your pattern helps you time things well; if it’s infrequent or absent, lifestyle changes are usually the first step, and where they aren’t enough, ovulation-induction medication can help, these are effective at getting many people with PCOS to ovulate, which is step one.  If you’re over 35, or you’ve already been trying for six months with irregular cycles, it’s reasonable to move towards medical support rather than waiting longer. The theme isn’t rushing, it’s getting clarity early and acting on it, rather than guessing. Our TTC guide walks through each treatment option in full. When should you seek help when trying to get pregnant with PCOS? Standard NHS advice is to seek support after 12 months of trying if you’re under 35, or after 6 months if you’re over 35. With PCOS it’s worth adjusting that, if your cycles are irregular or you go months without a period, waiting a full year can mean spending much of it not actually ovulating. It’s worth speaking to a GP or fertility specialist sooner if: Seeking advice early doesn’t commit you to treatment, it gives you clarity. The reassuring part is that PCOS is one of the more treatable causes of fertility difficulty, where ovulation needs support, there are well-established options, which our trying to conceive with PCOS guide explains in detail. And remember fertility involves both partners, if you’re trying with a male partner, a semen analysis early on means you’re seeing the whole picture, not just your health. How to get pregnant with PCOS and no period Absent periods usually mean you’re not ovulating, so natural conception is unlikely until that’s addressed, but it’s very treatable.  Start with proper investigation. Schedule a GP appointment and ask for hormone testing and a pelvic ultrasound. These confirm PCOS diagnosis but also rule out other causes of amenorrhea (thyroid disorders, prolactin issues, structural problems). Once you know what’s causing the absent periods, you know how to treat it. If PCOS is confirmed, there are several effective pathways to restore ovulation. This can involve a course of tablets or injections to stimulate the ovaries to release an egg that can be fertilised, either during intercourse or through intra-uterine insemination (IUI). If this doesn’t work, there may be other reasons why pregnancy can’t be achieved and more invasive treatments such as IVF may be needed. IVF involves a course of injections to stimulate the ovaries to produce multiple eggs. When they’re mature the eggs are retrieved in an ultrasound-guided procedure under […]

There’s no single best diet for PMOS (polyendocrine metabolic ovarian syndrome, formerly known as PCOS). The 2023 international guideline finds no evidence that any one type of diet works better than another. What matters most is the overall quality of what you eat. That means meals built around fibre-rich carbohydrates, protein and healthy fats that keep your blood sugar steady, in a way you can stick with. Search “best diet for PCOS” and you’ll be met with a wall of extremes, cut carbs, go keto, ditch gluten, try fasting. It’s loud, it’s contradictory, and most of it isn’t backed by evidence. The good news is that having PMOS doesn’t mean you need an extreme or restrictive eating plan. Here’s what the evidence actually says about eating well with PMOS, and how to put it into practice. Quick facts: Why does what you eat matter so much with PMOS (PCOS)? PMOS is a hormonal and metabolic condition, not just an ovary problem. That’s why nutrition has such an effect on how you feel. For many people, PMOS is closely linked to insulin resistance. Insulin is the hormone that helps your body use glucose (sugar) from food for energy. With insulin resistance, your cells respond less well to insulin, so your body produces more of it to compensate. Higher insulin levels can stimulate your ovaries to produce more androgens, such as testosterone. That can contribute to irregular periods and ovulation, acne and excess hair growth. Insulin resistance can also make weight harder to manage. Because what you eat directly affects your blood sugar and insulin, food is one of the most useful tools you have for managing PMOS. And because insulin resistance can happen at any body size, eating well with PMOS isn’t simply about weight loss. If you are wondering whether your symptoms could be linked to PCOS, Hertility’s Advanced Hormone & Fertility Test can help build a clearer picture of your hormones, cycle and symptoms to help you understand what’s going on. What is the best diet for PMOS (PCOS)? No. There is no single diet that has been shown to be best for everyone with PMOS. The 2023 international guideline recommends general healthy eating principles and a way of eating that suits your preferences, rather than one particular diet. What matters most is the overall quality of your diet over time. A Mediterranean-style diet is a useful framework because it naturally includes the foods that support metabolic and heart health: plenty of vegetables, fruit, wholegrains, beans and pulses, nuts, seeds, olive oil and oily fish. That matters in PMOS, which carries a higher long-term risk of type 2 diabetes and heart disease. Lower-glycaemic eating may also help. The glycaemic index (GI) ranks carbohydrate foods by how quickly they raise your blood sugar. Lower-GI foods raise it more slowly and steadily. Some studies suggest lower-GI, higher-fibre diets can improve insulin resistance in people with PMOS, and some have linked them to more regular periods. Think of these as helpful patterns rather than strict rules. You don’t need to follow a rigid meal plan. The common thread is choosing better-quality carbohydrates and keeping your blood sugar steadier. How to make a PCOS-friendly meal? Instead of focusing on what to cut out, start with what to add. A useful rule of thumb is to build each meal around three things: a fibre-rich carbohydrate, a source of protein and some healthy fat, with plenty of vegetables or fruit alongside. For example: Choose fibre-rich carbohydrates more often Less-refined, higher-fibre carbohydrates are digested more slowly, so they raise your blood sugar more gradually and keep you fuller for longer. Good options include oats, quinoa, wholegrain or seeded bread, wholewheat pasta, brown rice, beans, lentils, chickpeas and potatoes with their skins on. Fibre also supports your gut health. Glycaemic Index (GI)  is a ranking system, showing how quickly your blood sugar rises after eating different carbohydrates. Choosing mostly low or moderate GI foods which cause your blood sugar levels to rise slowly, can be useful to manage symptoms of PMOS. Very-low-carbohydrate and ketogenic diets have been studied in PMOS, but current guidelines don’t recommend one specific dietary pattern for everyone with the condition. The rest of your meal matters too. Pairing carbohydrates with protein, fat and vegetables slows down how quickly your blood sugar rises. So you can still enjoy white bread, pasta or rice. Choose higher-fibre versions more often, and think about the whole plate rather than whether one food is good or bad. Include protein throughout the day Protein makes meals more satisfying, helps manage your appetite and helps steady your blood sugar when you eat it with carbohydrates. Mix up your sources across eggs, fish, chicken, yoghurt, cottage cheese, tofu, tempeh, beans, lentils, nuts and seeds. Plant proteins such as beans, lentils and tofu are a particularly good choice because they provide fibre at the same time. Protein is essential for making hormones and it may help lower androgens and raise SHBG (sex hormone-binding globulin), the protein that mops up excess testosterone and is often low in PMOS.  Don’t be afraid of healthy fats Unsaturated fats from extra-virgin olive oil, avocado, nuts like walnuts and almonds.and seeds support heart health and make meals more filling. Omega-3 fats from oily fish such as salmon, trout, mackerel and sardines may help improve insulin resistance and reduce inflammation in PMOS. NHS guidance is to eat at least two portions of fish a week, one of which should be oily. Want help turning these principles into meals that fit your life? A Nutrition Consultation with a Registered Nutritionist or Dietitian can build a plan around your symptoms, tastes and routine. What foods should you avoid with PMOS (PCOS)? No foods need to be completely off-limits with PMOS. But it helps to cut back on foods and drinks that are high in added sugar or refined carbohydrates and low in fibre. These can raise your blood sugar quickly without keeping you full. Sugary drinks are one of […]

If you have PMOS (polyendocrine metabolic ovarian syndrome, formerly PCOS), figuring out when or whether you’re ovulating can feel a little like trying to hit a moving target. While you can track ovulation with PMOS, the usual methods can be less reliable. The good news is that with the right combination of methods, and the right timing, you can build a clear picture of whether and when you’re ovulating. Quick facts Can you ovulate if you have PMOS (PCOS)? Yes, having PMOS doesn’t mean you never ovulate. What it commonly causes is ovulatory dysfunction. This means ovulation may happen less often, less predictably or not at all during some cycles, which is why periods can be irregular or absent and why you can sometimes have a bleed without having released an egg. But there’s a lot of variation.You might ovulate most months but on different cycle days. Or you may have some cycles where ovulation doesn’t happen, known as an anovulatory cycle. Not sure whether PMOS (or something else) is behind your irregular cycles? Hertility’s Advanced Hormone & Fertility Test looks at the hormones involved including LH, FSH, AMH, testosterone, prolactin and thyroid to help explain what’s driving your pattern. Why is ovulation harder to track with PMOS (PCOS) ? Two things make it trickier. First, cycles are often long or irregular and less predictable.  Most tracking methods and apps assume ovulation lands mid-cycle, roughly two weeks before your period, but with PMOS the follicular phase (the first half, before ovulation) can stretch out or vary a lot month to month, so ovulation can happen late, early, or not at all. It’s also why the textbook idea that everyone ovulates on day 14 really doesn’t work. Second, and most importantly for tracking, your baseline hormones may already be raised. Many people with PMOS have persistently high LH, which is exactly the hormone home ovulation kits measure and exactly why those kits so often mislead. More on that next. How do I know if I’m ovulating with PMOS (PCOS) ? There isn’t one perfect at-home test. Instead, it can help to combine information that suggests ovulation might be approaching with information that tells you it probably already happened. 1. Watch your cervical mucus. In the days before ovulation, cervical mucus usually becomes wetter, clearer and more stretchy (like raw egg white) as oestrogen rises. These changes create an environment that helps sperm survive and travel through the reproductive tract, so they can be a useful sign that your fertile window may be approaching. With PMOS, fluctuating hormones can sometimes mean you notice fertile-looking mucus more than once during a long cycle. So think of cervical mucus as another piece of information rather than confirmation that ovulation definitely happened. 2. Track your basal body temperature (BBT). Progesterone causes a small rise in your resting temperature after ovulation, so charting BBT over a few cycles can confirm, in hindsight, that ovulation likely happened and reveal whether you’re ovulating at all. What it can’t do is give you any warning, by the time your temperature rises, ovulation has already been and gone. It’s also easily thrown off by poor sleep, waking at different times, illness, alcohol, travel and shift work, and long cycles can make the pattern harder to read. ASRM describes BBT as inexpensive but often unreliable, and doesn’t recommend it routinely for evaluating ovulation. So if you enjoy charting it and your pattern is clear, it’s a good piece of the picture, just don’t feel you have to wake up to a thermometer every morning to understand your fertility. 3. Track your cycles. Period tracking apps are useful for recording, less so for predicting. Most basic cycle apps estimate your fertile window from your previous period dates and average cycle length. If your cycles are fairly consistent, that gives a rough idea of when ovulation might happen, but if you have PMOS and your cycles vary a lot, the app is essentially trying to predict an unpredictable event from past averages, and calendar-based prediction is known to do this poorly. Research has found that calendar-based apps can perform poorly at identifying the actual day of ovulation because fertile-window timing naturally varies between cycles. That doesn’t make your app useless. It’s genuinely helpful for logging things like the first day of your period, period and cycle length, flow, cervical mucus changes, ovulation-test results and symptoms. Think of it as a record of what your body has done, rather than a crystal ball for what it’ll do next. Do ovulation predictor kits work with PMOS (PCOS) ? Often, no, or at least not reliably. OPKs measure Luteinizing Hormone (LH) in your urine. They’re designed to detect the LH surge that typically happens 24-36 hours before ovulation. But with PMOS that baseline is frequently already elevated, and some people have several small LH rises across a cycle rather than one clean peak. That leads to two problems. The kit can read your already-high LH as a surge and show repeated positives even when no egg is released or several apparent surges during one cycle. Or a genuine surge can be too small to stand out against a high baseline, so you miss it entirely. The issue is that most OPKs work on fixed thresholds rather than measuring your actual hormone level, fine if your levels sit in the average range, less so if PMOS keeps yours unusually high. Different brands can even have different thresholds and give you different results and either way, no OPK confirms ovulation actually happened, it only flags a likely fertile window. None of this means throwing the kits away. If you use them, fertility specialists suggest choosing a kit with a threshold set well above your baseline, or better a quantitative test or monitor that shows your actual LH level rather than a simple positive/negative. They’re most useful paired with a method that confirms ovulation after the fact. And if you repeatedly get positives without any sign of ovulation, […]

A new Hertility study of more than 16,000 women has found that current vaping is associated with lower levels of anti-Müllerian hormone (AMH), a commonly used marker of ovarian reserve. Vaping is often positioned as a less harmful alternative to cigarette smoking. And when it comes to overall health, evidence suggests vaping exposes people to fewer harmful substances than smoking. But less harmful does not mean risk-free. Until now, we have known surprisingly little about how vaping could affect female reproductive health. Most previous research has come from animal studies, small fertility-clinic populations or studies looking at pregnancy rather than ovarian function. New research from Hertility, published in the peer-reviewed journal BMC Women’s Health, looked at vaping, cigarette smoking and ovarian reserve markers in 16,087 women aged 18-45. The main finding? Women who currently vaped had 5.6% lower AMH levels, on average, than women who had never vaped, even after accounting for cigarette smoking and other factors such as age, BMI and ethnicity. That does not mean vaping has been proven to reduce fertility or that someone who vapes will struggle to get pregnant. But it is an important novel signal that deserves further investigation. Does vaping affect fertility? We don’t yet know whether vaping directly reduces female fertility. However, Hertility’s new study found that current vaping was associated with lower AMH, a hormone used as a marker of ovarian reserve. The study did not measure whether women became pregnant, how long it took them to conceive, egg quality, IVF success or live birth rates. Because it was cross-sectional, it also cannot prove that vaping itself caused the difference in AMH. Instead, the findings suggest there may be an association between current vaping and one aspect of ovarian biology. This distinction matters. Fertility is influenced by many different factors, including age, egg quality, ovulation, sperm health, the fallopian tubes and uterus. AMH is one piece of that puzzle. What did the study find? Researchers analysed reproductive health and hormone data from 16,087 women aged 18-45 across the UK. The main findings were: The association between vaping and AMH was relatively small. It represented an estimated absolute difference of around 0.71 pmol/L, which the researchers emphasise should not be interpreted as a clinically meaningful reduction in ovarian reserve for an individual woman. Instead, it is better thought of as a population-level signal that now needs to be investigated in studies that follow women over time. About the research The study used anonymised data collected through Hertility’s reproductive health service between November 2022 and February 2025. Women with reproductive health conditions that could independently influence ovarian reserve or hormone levels – including PMOS, previously known as PCOS, endometriosis, primary ovarian insufficiency and hypothalamic amenorrhoea — were excluded. Women using hormonal contraception were also excluded. Participants reported whether they had never, previously, occasionally or currently vaped and smoked. AMH and follicle-stimulating hormone (FSH) were measured from at-home capillary blood samples. Where applicable, samples were collected on day three of the menstrual cycle, and the researchers accounted statistically for age, BMI, ethnicity and cigarette-smoking behaviour. Importantly, vaping and cigarette smoking were included in the same statistical model. This allowed the researchers to examine the association with vaping independently of smoking, rather than assuming everyone who vapes has never smoked cigarettes. What is AMH and what does it have to do with fertility? Anti-Müllerian hormone, or AMH, is produced by cells within developing follicles in the ovaries. It is commonly used as a marker of ovarian reserve – broadly, the pool of eggs remaining in the ovaries. In general, AMH tends to decline as ovarian reserve decreases with age. AMH testing can therefore be useful when assessing ovarian reserve and estimating how the ovaries might respond to stimulation during fertility treatment. But there is an important caveat. AMH does not measure egg quality and it cannot tell you whether you can or cannot get pregnant naturally. Someone can have low AMH and conceive naturally, while someone with a high AMH can still experience fertility difficulties for completely unrelated reasons. So, when this study reports lower AMH among current vapers, it does not mean that current vapers were 5.6% less fertile or had a 5.6% lower chance of pregnancy. Those are different outcomes. Does vaping reduce your egg count? This study cannot tell us that vaping reduces someone’s egg count. AMH is associated with the number of developing follicles in the ovaries, but it does not directly count how many eggs someone has. The researchers also did not perform antral follicle counts (AFCs) using ultrasound, which would provide another measure of ovarian reserve. For that reason, the finding should be described as an association between vaping and lower AMH, rather than evidence that vaping directly destroys eggs or causes diminished ovarian reserve. Future studies combining repeated AMH measurements with AFC, detailed vaping exposure and long-term reproductive outcomes will be needed to answer this properly. How could vaping affect the ovaries? At the moment, we don’t know. There are several biologically plausible explanations, but most of the evidence comes from cigarette smoking, laboratory studies or animal research rather than large human vaping studies. Nicotine is one possibility. Experimental research suggests nicotine can influence follicular development, cell death and the normal production of reproductive hormones. Nicotine’s major metabolite, cotinine, has also been detected in follicular fluid — the fluid surrounding a developing egg — in people who smoke and vape. But nicotine may not be the whole story. E-cigarette aerosol can contain a complex mixture of substances depending on the device and liquid used, including metals, aldehydes and flavouring chemicals. Some laboratory and animal studies have suggested that certain components may affect ovarian follicles or endocrine function. That does not mean these substances have been shown to damage human fertility at the levels produced by normal vaping. It does mean there is enough biological uncertainty to justify much better research – particularly as vaping becomes more common among younger people. Is vaping worse for fertility than smoking? […]

Stopped the contraceptive pill but your period hasn’t returned yet? For most people, fertility returns quickly after stopping the pill and periods restart within a few weeks to a few months. If you have gone 3 months without a period, and pregnancy has been ruled out, it may be worth speaking to a healthcare professional. A short delay doesn’t necessarily mean anything is wrong – sometimes your natural cycle simply needs time to re-establish itself. However, stopping the pill can also reveal an underlying hormonal or reproductive health condition that was less obvious while you were taking it. Here’s what happens after you stop the pill, how long you can expect your period to take to return, and when a missing period is worth investigating. Quick facts: What happens when you stop the contraceptive pill? When you are on the pill, whether the combined pill or the progestogen-only pill (mini pill), synthetic hormones are keeping your natural hormonal cycle suppressed. This essentially puts the signals to the ovaries to trigger ovulation on pause. When you stop taking the pill, those synthetic hormones clear your system and your body has to restart its own hormone production. The brain begins releasing hormones again, which signals the production of Follicle-Stimulating Hormone (FSH) and Luteinising Hormone (LH), which in turn tells the ovaries to get back into action. That chain of communication takes time to re-establish and until ovulation actually happens, your period will not return. Your bleeding pattern can take a little longer to become predictable, particularly if your periods were irregular before you started contraception. Is it normal to have a late or irregular period after stopping the pill? Yes. Some change to your bleeding pattern after stopping the pill is common. Your first few periods may be: You may also simply notice the return of the menstrual pattern you had before starting contraception. For example, if you originally started the pill because you had heavy, painful or irregular periods, those symptoms may return after you stop it. This isn’t the pill making things worse – it may just mean the pill had been controlling symptoms that are now visible again. What is post-pill amenorrhoea? You may have come across the term post-pill amenorrhoea when searching for why your period has not returned after stopping the contraceptive pill. Amenorrhoea means not having periods. Primary amenorrhoea is when someone has not had their first period by around age 15. Secondary amenorrhoea is when someone who has had periods stops having them for at least 3 months.  Post-pill amenorrhoea describes a type of secondary amenorrhoea whereby a period does not return after stopping the pill. It is not thought to be a separate condition caused by the pill. For many people, the body simply needs time to restart its natural hormonal cycle. Periods usually return within a few months. However, a missing period can sometimes point to an underlying condition that the pill had been masking, such as PMOS (formerly PCOS), thyroid problems, raised prolactin, hypothalamic amenorrhoea or premature ovarian insufficiency. Importantly, there is no evidence that the pill itself causes long-term amenorrhoea or permanently stops your menstrual cycle.  How long does it take for your period to return after stopping the pill? Many people’s first natural period will usually return within a few weeks to a few months after stopping the pill. One important distinction is the difference between a withdrawal bleed and a natural menstrual period. You may experience bleeding within a few days of stopping the active tablets. This happens because the level of contraceptive hormones falls. Research has found that cycles in the first few months after stopping the pill can be slightly longer than average, one study found an average cycle length of 33.3 days in recent pill stoppers, compared to 29.6 days in non-pill users. So if your cycles feel long initially, this is expected. Factors like weight, physical health, stress levels, exercise and conditions such as PMOS can all influence your natural cycle. These might affect how quickly your period returns or how regular it is.  A natural period happens after your own hormonal cycle has resumed. Ovulation generally occurs first, followed by a period around two weeks later if pregnancy has not occurred. For some people this happens quickly. For others, the first few cycles may be longer or less predictable. If you have not had a natural period after 3 months, take a pregnancy test if there is any possibility of pregnancy and get it checked out. Why has my period not returned after stopping the pill? If you’re outside the expected window and still haven’t had a period, there are several possible causes. Pregnancy This is the first thing to rule out. You can ovulate before your first period after stopping the pill, which means you can become pregnant without having seen a natural period first. If you have had sex without contraception since stopping the pill and your period hasn’t arrived, take a pregnancy test. Your natural cycle is still re-establishing itself For some people, the first ovulation after stopping hormonal contraception takes a little longer. A short delay can therefore happen without there being an underlying medical problem. But if you have missed 3 periods, it is worth investigating it. PMOS PMOS is a common cause of irregular or absent periods. The pill can create a predictable bleeding pattern and reduce symptoms such as acne or excess hair growth, meaning the underlying condition may be less apparent while you are taking it. After stopping, irregular ovulation and other symptoms may become noticeable again. If you had irregular periods before starting the pill, or you now have irregular periods alongside acne, increased facial or body hair or other signs of androgen excess, PMOS may be worth investigating. Hypothalamic amenorrhoea Hypothalamic amenorrhoea (HA) is a condition where the brain suppresses the hormonal signals needed to trigger ovulation, usually in response to chronic stress, significant under-eating, or high exercise volumes without enough fueling. The […]

A new Hertility study reveals that testosterone levels in women change continuously throughout adult life, challenging the idea that one broad reference range can accurately define what is “normal” for every woman at every age (Wainwright et al., 2026). Testosterone is often thought of as a male hormone but women produce it too. It plays an important role in sexual function, mood, muscle mass, bone health, metabolism and wider reproductive physiology (Davis and Wahlin-Jacobsen, 2015). It is also commonly tested when investigating symptoms such as excess facial or body hair, persistent acne, irregular periods, scalp hair loss and possible polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS). But interpreting the result is not always straightforward. Testosterone results are generally compared with a laboratory reference range and labelled as either inside or outside that range. However, many existing ranges are based on relatively small groups of women and use broad age categories. Published in the peer-reviewed Journal of Endocrinological Investigation, Hertility’s study suggests that age should become a much bigger part of how testosterone results are understood. What did the study find? Researchers analysed testosterone levels from 5,323 carefully screened women aged 19-59 from across England, Scotland and Wales. The main finding was clear: average testosterone levels were approximately 1.4% lower with each additional year of age. The amount of variation between women also increased with age. This means testosterone did not simply decline at one defined life stage, such as menopause. Instead, levels changed gradually throughout adult life. In practical terms, the same testosterone result may not mean exactly the same thing for a 22-year-old and a 52-year-old. The researchers therefore developed an age-continuous reference model. Rather than placing women into broad groups such as ages 20-49, which is what one of the current reference ranges does, the model shows how a result compares with the testosterone distribution expected at each individual age. About the research The study retrospectively analysed anonymised data collected through Hertility’s reproductive health service between September 2020 and August 2025. More than 30,000 records were initially available. Strict criteria were then applied to establish a reliable ‘healthy’ reference population. The final reference group included 5,323 women who had regular menstrual cycles, a normal BMI and no reported history of reproductive health conditions or hirsutism (excess hair growth). Samples were collected during the early part of the menstrual cycle, following a fast, and analysed using the same laboratory platform. This helped reduce some of the variation caused by sample timing and different testing methods. A separate group of 2,338 women who reported hirsutism was also assessed. What did the study find about excess facial or body hair? Hirsutism describes the growth of thicker, darker hair in areas such as the face, chest, abdomen or back. It can be a clinical sign of androgen excess and is commonly associated with PMOS, although not everyone with hirsutism will have raised testosterone or PMOS (Escobar-Morreale et al., 2012). The study found that women reporting hirsutism had significantly higher testosterone levels on average than women in the reference population. The difference was most noticeable at younger ages. At age 18, the most typical testosterone level in the hirsutism group was around 24% higher than in the reference group. This difference became smaller with age but remained present throughout adult life. However, there was considerable overlap between the two groups. This is important because it shows why symptoms should not be dismissed simply because a testosterone result is labelled normal. Equally, a raised testosterone result cannot diagnose the cause of someone’s symptoms on its own. Blood results and symptoms need to be interpreted together. What is a normal testosterone level in women? There is no single testosterone level that is universally normal for every woman. The reference range shown on a blood test can vary depending on the laboratory, the testing method and the population used to create it. Testosterone levels can also be influenced by menstrual-cycle timing, time of day, body mass index, stress, hormonal contraception, pregnancy and menopausal stage (Schiffer et al., 2023). Hertility’s findings add age as another essential consideration. A result may fall inside a broad laboratory range while still being relatively high or low compared with what is typically expected for someone of that specific age. It is also important to understand that a reference range is not the same as a diagnostic threshold. A reference range describes the values found in a selected population; it does not create a clear dividing line between health and disease. Why current testosterone reference ranges may be limited One widely used testosterone assay manufacturer established its female reference range using just 149 women, divided into two broad categories: ages 20-49 and ages 50 and over. By comparison, Hertility’s new model was developed using 5,323 carefully selected women and estimated expected testosterone distributions continuously across ages 19-59. Reference ranges may also differ between NHS trusts, private providers and laboratories because testing sites use different platforms or locally established ranges. This means the same testosterone level may be interpreted differently depending on where someone is tested. The study does not propose that clinical decisions should be made from age alone. Instead, it provides greater context to help clinicians understand how common or unusual an individual result is compared with other women of the same age. What does this mean for PMOS? Higher testosterone is commonly associated with PMOS, a complex hormonal and metabolic condition that can affect menstrual cycles, ovulation, skin, hair and fertility. Androgen excess may be identified through visible symptoms, such as hirsutism, or through hormone testing. International guidance recognises both clinical and biochemical signs of androgen excess when assessing someone for PMOS (Teede et al., 2023). The Hertility study does not create a new diagnostic cut-off for PMOS. Instead, it reinforces that a testosterone result within a broad laboratory range does not automatically exclude androgen excess or PMOS – particularly where someone has relevant symptoms or irregular periods. Testosterone should be considered alongside menstrual […]

As GLP-1 medications have skyrocketed in popularity over recent years, they have sparked a lot of conversation, and a fair amount of confusion. If you have been scrolling through social media lately, you have probably come across the phrase “Ozempic Babies,” leaving many wondering what these weight loss “jabs” actually do to reproductive health and fertility. Whether you are taking a GLP-1 medication for diabetes management, weight loss, or metabolic health, and you’re thinking about trying to conceive, here is everything you need to know to navigate your journey safely. Quick Facts: What Exactly Are GLP-1 Medications? Some Quick Clarification: Originally developed by pharmaceutical companies to manage type 2 diabetes and insulin resistance, their highly effective weight-management properties mean they are now widely used to manage and treat obesity [2]. Obesity is a major global health crisis, with approximately 30% UK adults living with obesity, serving as a primary risk factor for cardiovascular disease and other chronic conditions [3]. Because GLP-1 RAs have been revolutionary for metabolic health, clinicians are also exploring their benefits for managing the metabolic features of Polyendocrine Metabolic Ovarian Syndrome or PMOS, formerly Polycystic ovary syndrome (PCOS) [4]. This is because a lot of the symptoms and indications of PMOS are treated by the effects of GLP-1 RAs as they are highly effective for managing the condition’s metabolic features such as improving insulin sensitivity, suppressing appetite, and promoting weight loss [5]. If you think you might have PMOS, read our blog on How PMOS is Diagnosed for more information. Note: In the UK, GLP-1 RA medications are licensed for the treatment of type 2 diabetes and obesity management [6]. While GLP-1 RAs are commonly referred to by their brand names such as Ozempic, Mounjaro or even colloquially called “the jabs”, here’s a look at the most common GLP-1 RA medications currently available: New in 2026: The GLP-1 Pill Until recently, every GLP-1 licensed for weight loss in the UK was a weekly injection. In June 2026, the MHRA approved an oral semaglutide tablet (the “Wegovy pill”) as the first GLP-1 tablet for weight management in the UK, and the first in Europe [7]. It is currently available on private prescription, with NHS availability still under NICE review. A quick point of clarification, because the names get confusing: oral semaglutide already existed in the UK as Rybelsus, but Rybelsus is only licensed for type 2 diabetes, not weight loss. The new, higher-dose tablet is the one licensed for weight management. Unlike the injection, it has to be taken first thing on an empty stomach after fasting overnight, with only a sip of water, and you then wait around 30 minutes before eating or drinking, otherwise your body won’t absorb it properly. A second oral option, orforglipron (Foundayo), is expected to follow. It has been approved in the US and is currently under MHRA review, but it is not yet licensed or available in the UK. Does the pill form change any of the fertility advice? No. The oral tablet contains the same drug as injectable semaglutide, so exactly the same rules apply: it is not recommended in pregnancy, while trying to conceive, or when breastfeeding, and the same wash-out period stands. If anything, the arrival of these tablets is a good prompt to double-check your contraception, the documented interaction with the contraceptive pill is specific to tirzepatide (Mounjaro), not semaglutide, but any GLP-1 that causes vomiting or diarrhoea can affect how well an oral pill is absorbed. The Truth Behind “Ozempic Babies” You might have heard of the term “Ozempic Babies” in the press, which refers to women unexpectedly or spontaneously conceiving while taking GLP-1 medications. It is incredibly important to clarify GLP-1 RAs are metabolic therapies, not fertility treatments. So, why is this happening? There are two primary biological reasons behind it. Obesity and insulin resistance heavily impact the reproductive system. Excess adipose (fat) tissue produces extra oestrogen and drives insulin resistance, which can prevent regular ovulation from occurring [8]. This can cause irregular cycles, heavy, or absent periods. Because of these irregular cycles, many women might assume they cannot get pregnant and not use contraception. When someone starts a GLP-1 RA, the resulting weight loss and metabolic improvement have an indirect, positive effect on their reproductive hormones. Suddenly, cycles and ovulation become more regular, and pregnancy can occur spontaneously. GLP-1 medications slow down gastric emptying (how fast your stomach empties food), and this can affect how some oral medications are absorbed. Importantly, the evidence here is drug-specific rather than a blanket effect across the whole class. The clearest interaction is with tirzepatide (Mounjaro). Studies have shown it can reduce the amount of contraceptive hormone your body absorbs, so it is recommended to use a barrier method (such as condoms) or switch to a non-oral method for 4 weeks after starting tirzepatide, and for 4 weeks after each dose increase [9]. For semaglutide (Ozempic, Wegovy, Rybelsus), a meaningful reduction in oral contraceptive effectiveness has not been demonstrated. That said, if any GLP-1 medication causes vomiting or diarrhoea, an oral pill may not be fully absorbed, so it is always sensible to use backup contraception if you are unwell. GLP-1 Medications Are Not Recommended in Pregnancy While these medications can indirectly boost fertility by improving metabolic health, GLP-1 medications are strictly not recommended during pregnancy, while actively trying to conceive, or during breastfeeding. Because these medications are relatively new, we do not yet have enough long-term safety data to know their impact on foetal development or future outcomes. The human data available so far have not shown a clear increase in birth defects, but there simply isn’t enough of it to confirm these medications are safe in pregnancy, which is exactly why a precautionary approach is taken [10]. If you are planning a pregnancy, you must observe a strict “wash-out period” to allow the medication to completely leave your system before you start trying to conceive [6]. If pregnancy does occur while taking a GLP-1 RA, […]

If you’re an HR leader or employer in the UK or Ireland, you’ve likely felt the tension between supporting your people and navigating the realities of limited budgets, rising sickness rates, and turnover from colleagues quietly leaving because they feel unsupported.  Hertility gives UK and Ireland employers a diagnostic-first approach to fertility and hormone health benefits, combining at-home testing and virtual specialist care, to help you close support gaps before they become costly sickness, treatment or talent losses.  This guide will walk you through exactly how fertility and hormone health benefits can build genuine workplace equity – and what practical steps you can take starting today. Key Takeaways: Fertility and Hormone Health Benefits for Workplace Equity Fertility and Hormone Health benefits address a missing link in UK and Irish workplace wellbeing strategies, reducing absenteeism and boosting retention. The gender health gap costs UK and Irish businesses billions annually through lost productivity, presenteeism, and avoidable employee turnover. Supporting specific life-stages or conditions like menopause, fertility,  or PCOS and endometriosis helps close the gender pay gap. Hertility’s at-home testing and virtual specialist care pathways give employees fast answers to their health and access to care. UK employers have legal obligations to make reasonable adjustments for employees with health conditions. What Is the Gender Health Gap and Why Does It Matter for UK Employers? The gender health gap refers to the systemic difference in how women’s health concerns are diagnosed, treated, and supported compared to men’s. Women are significantly more likely to have their pain dismissed or misdiagnosed, leading to delayed diagnoses, later-stage treatment, and higher healthcare costs. According to research from REBA, women receive fewer workplace benefits than men, with 65% getting company perks compared to 75% of men. This disparity contributes to a cycle where women are less supported, more stressed, and more likely to leave. A report by Deloitte highlights that working women spend more than £1.5bn more per year on out of pocket healthcare than their male counterparts. Fuelled by gaps in public healthcare and benefit strategies.  How Does Unsupported Fertility and Hormone Health Affect UK Business Performance? Unsupported reproductive health conditions alone cost UK businesses approximately £11 billion every year through absenteeism related to heavy and painful periods, endometriosis, fibroids, and ovarian cysts. One in ten women surveyed by the Fawcett Society left work entirely due to menopause symptoms. Losing experienced employees at this career stage not only results in institutional knowledge and leadership losses – but widens your gender pay gap. But this isn’t just about lost workdays and turnover. Presenteeism – where employees show up but can’t fully function – drains productivity and is hugely damaging to businesses. A recent Hertility report using the aggregated biometric data of thousands of female employees highlights that they are living with an average of 5 career impacting symptoms each, ranging from fatigue and anxiety to pain and low-mood. Without access to screening and care, they’re forced to let them escalate and not get to the bottom of what could be a manageable condition or treatable deficiency. Typically, benefit providers and public healthcare are reactive, but many progressive organisations are bringing preventative strategies into their workforce to keep people well and working – which is exactly what Hertility does; unlike other women’s health support on the market, we support women to screen their hormone health and fertility proactively.  Giving them the fastest and most accessible way of getting a diagnosis, managing conditions and accessing treatment, making informed decisions about their fertility future, and supporting them through key life-stages.  What Is the Link Between Fertility and Hormone Health Benefits and the Gender Pay Gap? The gender pay gap in the UK has fallen over the past five years, but male health professionals still earn on average 10.2% more than their female counterparts, according to NHS Employers guidance, and the UK has recently received its lowest workplace gender equality ranking in a decade.  Fertility and hormone health play a significant, but often overlooked role in this disparity. Women disproportionately carry caring responsibilities and experience health-related career interruptions.  When menopause symptoms force someone to reduce hours or step back from promotion opportunities, the pay gap widens. When fertility challenges remain taboo and unsupported, talented employees check out or leave the workforce entirely. Proactive Fertility and Hormone health workplace benefits help you address these root causes directly.  Supporting employees through fertility journeys, conditions, perimenopause, and menopause is a measurable strategy for closing your organisation’s gender pay gap and being an employer of choice against your competitors.  What Should Fertility and Hormone Health Employee Benefits Include? Effective reproductive health benefits go beyond a single service like fertility or menopause care. They should cover the full spectrum of hormonal and reproductive health needs across all life stages, starting with menstruation through to menopause. Diagnostic Testing and Clinical Insights At-home hormone and fertility testing removes barriers to diagnosis and is accessible, reducing time off for appointments. Employees shouldn’t need to wait years for NHS gynaecology appointments when they’re experiencing symptoms now.  Hertility delivers clinical-grade results in just six days, with Doctor-Written Reports and onward Virtual Specialist Care Pathways.  Available testing should consider the individuals needs, and be completely personalised based on their symptoms, but screen for common conditions that could impact future fertility and quality of life, like PCOS, thyroid imbalances, egg reserve indicators, iron deficiency, perimenopause markers and more. The goal is to empower employees to be proactive with their health, take action and get the care they need to support their wellbeing; reducing the need for reactive care further down the line. Access to Clinical Services and Care Pathways Diagnostics are only the starting point. Benefits should include pathways to clinical care – consultations with specialists, treatment options, and ongoing support. As well as referral pathways for fertility treatment like egg freezing and IVF. When employees receive their results, they need clear next steps and a provider who is with them every step of the way.  Education and Policy Development Workshops for managers and […]