As a consultant dermatologist, I’ve seen many women come through my clinic doors frustrated by stubborn acne that doesn’t seem to respond to any treatment. If this sounds familiar, you’re not alone. Acne can be a visible and sometimes painful marker of an underlying condition called polycystic ovary syndrome (PCOS). Understanding the connection between acne and PCOS is crucial, not just for the health of your skin but for your overall well being Why Should You Consider PCOS if You Have Acne? Acne is often thought of as a teenage problem, something that magically disappears with age. But for many people, particularly those with PCOS, acne can persist into adulthood and become a significant concern. PCOS is a hormonal condition that affects up to 10% of women and people assigned female at birth and is often characterised by elevated levels of androgens like testosterone– hormones that can lead to increased oil production in the skin, causing clogged pores and, subsequently, acne. But it’s not just any acne we’re talking about. Women with PCOS often experience more persistent and inflammatory acne that tends to appear along the lower third of the face, jawline, and upper neck. This is because of the hormonal imbalance that’s driving excess oil production. So, if you find yourself struggling with acne in these areas and have tried countless treatments without success, it might be time to think beyond the skincare aisle and look a little deeper. What Are the Signs That PCOS Could Be Affecting Your Skin? When we talk about PCOS and acne, it’s essential to consider the bigger picture. PCOS is not just about your skin; it can impact various aspects of your health. So, when should you start thinking about getting screened for PCOS? Here are a few signs that might suggest PCOS could be contributing to your acne: If you’re noticing any of these symptoms alongside your acne, it’s worth discussing them with your doctor. Why Early Diagnosis and Treatment is Key If you’ve been diagnosed with PCOS, it can feel like a lot to take in. But remember, getting an early diagnosis is a positive step. Why? Because it allows you to take control of your health and manage the condition effectively. PCOS doesn’t just affect your skin; it’s a systemic condition that can have long-term health implications, including an increased risk of developing type 2 diabetes, high blood pressure, mental health issues and other metabolic issues. It can also impact fertility and increase the risk of complications during pregnancy. By diagnosing PCOS early, you can work with your healthcare provider to develop a management plan tailored to your needs. This might include lifestyle changes, like a balanced diet and regular exercise, which are crucial in managing weight and improving insulin sensitivity – both key factors in PCOS. Medications may also be prescribed to help regulate your menstrual cycle, manage acne, or reduce excess hair growth. Treating Acne in PCOS: What Works? When it comes to managing acne in the context of PCOS, it’s not just about what you put on your skin – it’s also about addressing the hormonal imbalance driving it. Here are some treatment options that might be recommended: Lifestyle Changes: Small Steps, Big Impact Don’t underestimate the power of lifestyle changes when managing PCOS and its symptoms. Maintaining a healthy weight through a balanced diet and regular physical activity can significantly impact hormone levels and insulin sensitivity, improving both your skin and overall health. Focus on whole foods, such as fruits, vegetables, lean proteins, and whole grains, and try to reduce your intake of sugar and processed foods. Staying hydrated and getting plenty of sleep can also make a difference. In addition to lifestyle changes, a consistent and gentle skincare routine can help manage acne. Opt for non-comedogenic (non-pore-clogging) products and avoid harsh scrubs or overly drying treatments that can irritate the skin further. Take Charge of Your Health Remember, PCOS is a manageable condition. With the right care and support, you can control its impact on your life. Getting screened is the first step towards understanding your body better and finding a treatment plan that works for you.PCOS and acne don’t have to define you. With early screening and proper management, you can take control of your skin and health and feel more confident in your body. The journey might seem daunting, but with the right information and a proactive approach, you can find a way forward that brings clarity and comfort to both your skin and your overall well being Inspiring skin confidence with Hertility and Self London Hertility and Self London are collaborating to give you absolute clarity into what’s going on inside your body and inspire skin confidence. We’re working with patients to uncover how hormones impact not only our reproductive health but also our skin’s natural glow.Discover the partnership

If you’re trying to conceive, understanding when you’re ovulating can greatly improve your chance of getting pregnant. Read to find out what ovulation is and how to track it.  Quick facts: What is ovulation? Ovulation refers to the phase around halfway through your menstrual cycle when your body releases an egg (ovum). It travels through the fallopian tube where sperm can fertilise it and you can become pregnant. The fertile window Pinpointing the day you ovulate can improve your chance of conception since you can ensure you have sex within your fertile window. Your fertile window is a six-day window during each menstrual cycle, it includes the five days leading up to the day of ovulation, and the day after ovulation. If the sperm fertilises the egg and implantation (the attachment of the fertilised egg to the wall of the uterus) occurs, it can develop into a pregnancy. But if it doesn’t implant, around 14 days later, you’ll have a period. Your period (or menstruation) bleed is the uterus wall lining (endometrium) shedding. An egg can only survive for 12–24 hours, which might seem like a brief window of opportunity for the egg and sperm to meet and fertilise, but sperm’s lifespan is much longer. Sperm can survive for up to five days in the female reproductive tract, so if you have sex five days before ovulation, it’s still possible to become pregnant. When does ovulation occur? Ovulation will usually happen during the middle of your cycle (anytime from 11-16 days after your period starts) if you have a regular period.  The day of ovulation is dependent on the length of your cycle and can also sometimes vary from cycle to cycle, particularly if you don’t have regular periods. You may hear that ovulation happens on day 14—but this assumes everyone has a 28-day cycle which isn’t always the case.  Cycles can vary in length from person to person and even from one cycle to another. Anything from a 21-day cycle to a 35-day cycle is considered regular. If you’re taking birth control or hormonal contraception exactly as prescribed, you shouldn’t ovulate. The hormones in hormonal contraception work by stopping ovulation and thickening cervical mucus, which makes it harder for sperm to reach and fertilise an egg. Tracking ovulation: signs and symptoms There are a few different methods you can use to track ovulation, such as using a predictive period tracker app, monitoring signs like basal body temperature and discharge changes, or using an ovulation test kit. Let’s take a look at each.  Ovulation test kits Ovulation test kits can determine whether you’re ovulating. They work similarly to a pregnancy test. They test your urine to detect the levels of luteinising hormone (LH) – the hormone released by the pituitary gland in the brain to trigger ovulation. Although LH is always present at low levels, it surges 24-36 hours before you ovulate. Ovulation prediction kits may not be suitable for someone with PCOS, because they often have high LH levels which can cause falsely positive results. Our at-home hormone and fertility test can help you get clarity on what’s going on inside your body including your egg count and highlight any red flags to do with fertility. It’s personalised to include a comprehensive Online Health Assessment, personalised hormone panel, at-home blood collection kit, and a gynaecologist to analyse your results and help you create an actionable plan for the future. Calendar method Tracking your menstrual cycle is an effective way to determine when you’re ovulating. You can use a traditional pen and paper, digital calendar or even period tracking apps that you mark when you’re bleeding. You can also track different symptoms throughout the month to notice patterns that can indicate which menstrual cycle phase you’re in. Mobile application-based fertile window predictions may not always take into account current cycle variations or factors that might impact your cycle. They are also reliant on the accuracy of the information you input, which is why you should be careful with relying on them for predicted fertile windows because it could put you at risk of an unintended pregnancy.  Cervical mucus changes Cervical mucus changes throughout your menstrual cycle and plays a key role in conception. Before ovulation, it’s often pasty and creamy. During ovulation, it becomes clear, slippery and stretchy resembling raw egg whites. This consistency makes it easier for sperm to swim up the vagina and into the uterus to meet and fertilise an egg. Cervical mucus can be affected by many other factors, such as infections, sex and medications, and may naturally alter within each cycle, which is why relying only on this method alone might not be accurate. Basal body temperature changes You may be able to detect ovulation by checking your basal body temperature with a digital basal body thermometer. Your body temperature increases slightly during ovulation by 0.5 to 1 degree. This method works more effectively if you track your basal body temperature for several months first thing in the morning before you eat, drink and go to the toilet to get an idea of your baseline temperature. That way, you’ll notice when it increases. Although, it is important to remember that basal body temperature can be affected by many things such as alcohol consumption, a change in sleep schedule or if you are feeling unwell.  Physical ovulation symptoms Some people who menstruate often feel physical symptoms when ovulating too. It’s common to have tender breasts, an increased sex drive, minor pelvic or abdominal pain (ovulation pain or mittelschmerz), light bleeding or spotting, bloating, a heightened sense of smell, taste or sight, mood changes and appetite changes. However, these symptoms aren’t an effective way to predict ovulation. Whether you’ve just started trying to get pregnant or are considering your future family options, knowing when you’re ovulating and understanding your body puts you in the driver’s seat of your reproductive journey to give you peace of mind and improve the chance of conceiving. Problems with ovulation If […]

Anti-Müllerian Hormone (AMH) is a really important hormone for your fertility because of how closely it is linked to your eggs, AMH testing can help you understand your fertility and give you insights into your overall reproductive health. Here’s what testing can and can’t tell you. Quick facts: What is AMH and why is it so important? Anti-müllerian hormone (AMH) is a super important hormone for fertility. AMH is made by the small sacs, called follicles, in your ovaries. These follicles house your eggs.  Because of its close relationship to your eggs, testing your AMH levels can help indicate how many eggs you have left at the time of testing.  There are a few myths out there about what exactly AMH testing can tell us. So 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 reserve is in line with other healthy people in your age group. 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 full 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 indicate 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 and high testosterone levels.  According to updated guidelines, AMH testing can be used as a marker for polycystic ovaries, which is one of the criteria for a  PCOS diagnosis. However, we would always recommend getting a scan of your ovaries) to confirm the diagnosis. Whether IVF or egg freezing could be right for you AMH testing and understanding your ovarian reserve can also help to determine if certain fertility treatments like IVF or egg freezing could be suitable for you. During these fertility treatments, AMH levels are often tested to help determine the doses of medication needed and used to predict the outcomes of the egg collection process. People with lower AMH levels are known to have less successful IVF treatment cycles, whereas someone with high AMH might be at increased risk of developing a rare but potentially life threatening condition called OHSS (ovarian hyperstimulation syndrome).  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 refers to the period of your life, usually post 45-50, where you no longer have menstrual cycles and are therefore no longer able to conceive naturally. Menopause is associated with having an extremely low, or completely diminished, ovarian reserve.  It is usually diagnosed retrospectively—when women are over 45 years old and have not had a period in 12 months (and are not using hormonal contraception).  For people who are younger, FSH levels are useful for diagnosing menopause, as FSH levels are known to increase for people with low egg reserves. Although AMH levels are not recommended to help diagnose menopause, it is known that AMH levels reduce to very low levels at the time of menopause. There is also evidence that people with very low AMH levels (who are not going through menopause) will undergo menopause much sooner than those with AMH levels that are within range. When the ovaries stop working before the age of 40, this is known as premature ovarian insufficiency (POI), which AMH levels have also been shown to provide a good indicator of. If you have a higher risk of miscarriage or recurrent pregnancy loss It is estimated that approximately 1 in 5 pregnancies end in miscarriage. Miscarriages occur most frequently in the first 12 weeks of pregnancy and can be associated with lots of different risk factors. Some of the most common are your and your partner or sperm donors’ age, pre-existing conditions and ethnicity. Recent evidence has shown that people with diminished ovarian reserve, and therefore very low AMH levels, are more likely to have a miscarriage or recurrent miscarriage (two or three consecutive pregnancy losses).  However, more research needs to be done to understand the links between AMH levels and miscarriage, including its risk factors. What can’t AMH testing tell me? Unfortunately, AMH testing and ovarian reserve forms only one part of the fertility picture and there are some things that AMH testing may not be able to tell you. Let’s take a look… It can’t determine your egg quality Although AMH levels can give insight into your egg quantity, it does not provide any insight into the quality of those eggs. Despite poor egg quality being one of the most common causes of female infertility, there is currently no test that can definitely determine egg quality (unless testing embryos in IVF treatment). It can’t determine your exact egg quantity Your AMH result can give an indication of the size of your ovarian reserve.  This is because it is released by the follicles which contain our eggs, meaning that the more follicles we have, the higher the AMH that will be produced. However, it can’t tell you your exact number of eggs because each follicle may produce a different amount of AMH depending on its size.  In order to estimate the number […]

Can smoking cause hormonal imbalances? Just like the negative consequences to heart and lung health, smoking can also negatively impact our reproductive health. Read on to find out.  Quick facts: How smoking affects the body It’s a well-known fact that smoking can have a negative impact on health, with both active and passive smoking being associated with multiple forms of cancer, diabetes and heart disease. Despite this, in the UK, as of 2019, 28% of men and 22% of women aged between 25 and 34 years are current smokers, according to published health data in England (1)—and a whopping 175 million people assigned-female-at-birth (AFAB) smoke worldwide. But whilst smoking’s effects on the heart and lungs are fairly common knowledge, fewer people are aware that it can also influence the body’s hormones. But how exactly are hormones and smoking linked? In this article we’ll look at: Does smoking affect hormones? Despite the lack of public awareness, there is plenty of research that shows how smoking can impact and even wreak havoc on our hormonal health. The chemical components of cigarette and cigar smoke can disrupt the normal functioning of our bodily systems, including the endocrine system. The endocrine system is a network of glands which influence the production, secretion and regulation of hormones throughout the body, such as the hypothalamus, thyroid, adrenal gland, and even the ovaries.  This disruption might lead to lasting effects on all kinds of hormonally regulated processes, including sexual function and reproductive potential, our metabolism and even our sleep.  As mentioned, both active and passive smoking (also known as second-hand smoking) can cause these nasty effects, with some research even indicating that prolonged exposure and inhalation of cigarette smoke can even affect the onset of menopause (3). There are over 4,000 substances in cigarettes that display reproductive toxicity. How does smoking affect different hormones? Smoking has been linked to abnormal changes and fluctuations in various hormone levels, including: Let’s take a look at each of these in detail. Smoking and testosterone Studies have consistently shown that smoking increases testosterone in AFAB individuals. Those who smoke have been found to have higher serum testosterone levels in their blood than those who don’t (4).  This is because smoking is inherently pro-androgenic, meaning it has a positive effect on androgen hormones like testosterone. Increased testosterone levels can bring on side effects such as excess body hair growth (hirsutism), acne, greasy hair and skin, irregular periods and low libido. The main reason for smoking’s pro-androgenic effects lies with nicotine. As tobacco is metabolised, the nicotine within it produces a compound known as cotinine, which inhibits testosterone breakdown (17). However, it’s interesting to note that similar studies performed on ageing men have indicated that, over a long enough timespan, smoking can reduce testosterone levels in those assigned-male-at-birth (AMAB) (16). Smoking and oestrogen As well as being pro-androgenic, smoking is also anti-oestrogenic, which means it has a negative effect on oestrogen levels. Studies have shown that women who smoke have  lower progesterone and oestrogen levels in both their blood and follicular fluid (the fluid which surrounds the developing egg, important for egg growth) (2,5).  Smoking even affects the conversion of androstenedione to oestradiol by cells within the eggs (2). This switch is mainly driven by the effects smoking has on the production of these hormones.  As well as negatively affecting oestrogen production and metabolism by your liver, smoking increases the levels of a hormone called sex hormone-binding globulin (SHBG) which binds to oestrogen—preventing it from performing its essential functions around the body. Symptoms of low oestrogen can include low libido, fatigue, and negative mood changes. Smoking and gonadotropins Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are both gonadotropin hormones. These are hormones released from the hypothalamus (a part of the brain) to regulate the menstrual cycle and induce ovulation.  Unsurprisingly, smoking has been found to affect gonadotropin levels as well. Studies have shown that habitual smokers tend to have higher levels of FSH and LH in the first half of their cycle and during their periods, than non-smokers (6,7).  Disrupted FSH and LH levels can lead to problems with both fertility and menopause. Smoking and Anti-müllerian hormone Anti-müllerian hormone (AMH) is produced by granulosa cells within the ovarian follicles. It’s used as an indicator of ovarian reserve, sometimes referred to as egg count. Research has shown that smokers generally have lower AMH levels. One study in particular found that current smokers have  44% lower AMH levels than non-smokers (8), indicating that smoking can be directly toxic to the eggs within the ovaries. Another study showed that, in smokers, the fluid produced by the granulosa cells (known as follicular fluid) also contains increased levels of harmful nicotine toxins (9). Chemicals derived from cigarettes and smoking have even been detected in the cervical mucus (10). Smoking and thyroid hormones Cigarette smoke has been found to have both inhibitory and stimulatory effects on thyroid hormones. Both active and passive smoking have been linked to decreased levels of thyroid-stimulating hormone (TSH) and increased levels of free thyroxine (T4) and triiodothyronine (T3) (11,12).  Because the thyroid gland plays an important role in the regulation of many different bodily functions such as growth and development, disruption in thyroid level can have huge knock on effects all around the body. The thyroid can also affect fertility.Smoking is consequently a known risk factor for thyroid-related disorders, especially Grave’s disease and Goitres (13,14). Smoking and prolactin Prolactin is produced by the pituitary gland in the brain and is most commonly associated with milk production and altering breast physiology, but it also has a number of different roles throughout the body.  Chronic long-term smoking has been found to be associated with decreased prolactin levels (14), which can cause irregular menstrual cycles, difficulty breastfeeding and negative mood changes. Smoking and cortisol Smoking has also been linked to increased cortisol levels in the blood. It also affects hormones involved in the production of cortisol (2), which can disrupt the regulation of its levels. Cortisol […]

Oestrogen—the matriarch of female sex hormones. But what exactly does it do in the body, what’s its role in the menstrual cycle and what are the symptoms to look for if your oestrogen has become imbalanced? Read on to find out.  Quick facts: What is oestrogen? Oestrogen is an important reproductive hormone in people of all sexes. It’s generally known as the ‘female’ sex hormone, because of its role in the development of the female reproductive system and regulation of the menstrual cycle.  Oestrogen works to enable ovulation and produce female sex characteristics. When we have healthy levels of oestrogen, it can help us to feel feisty, frisky and fabulous. Whilst it’s true that oestrogen plays a bigger role in those assigned-female-at-birth, everybody produces oestrogen, regardless of sex. In those assigned-female-at-birth, oestrogen is produced mainly in ovaries and depends on other reproductive hormones including follicle stimulating hormone (FSH), luteinising hormone (LH) and testosterone for both its production and regulation. Like all of our hormones, our oestrogen levels can sometimes become off-balanced—with many different lifestyle and genetic factors impacting its production and regulation throughout the body. Types of oestrogen? There are three different types of oestrogen, also sometimes spelt estrogen (the American spelling). What does oestrogen do? Oestrogen wears many hats—it helps to regulate our menstrual cycles, triggers the development of secondary sex characteristics like breasts and pubic hair and helps to maintain things like our skin’s moisture, our mood and even our bone and heart health. Let’s take a look at these in more detail: What is oestrogen’s role in the menstrual cycle? Like all of our menstrual cycle hormones, our oestrogen levels during the menstrual cycle fluctuate.  During the first part of our menstrual cycles, the follicular phase, which lasts from day 1 of our periods until ovulation (when we release a mature egg), our oestrogen levels start off low but steadily increase. In this phase, our eggs are maturing in preparation for ovulation.  Our eggs mature in our ovaries, in little sacs called follicles. These follicles make oestrogen, so whilst your eggs are maturing, your follicles steadily release this oestrogen—and it rises until it reaches a peak, just before we ovulate. Because of oestrogen’s feel-good factors, just before and during ovulation is the time of the month when we’ll be killing it, feeling our most fierce and fabulous. This is the time to book that big presentation at work, go on that first date or really push it in your gym session. This peak in oestrogen causes a surge in LH, which triggers the release of a mature egg from one of our ovaries during ovulation. After ovulation, oestrogen levels gradually drop and despite a small second wind around a week later, they continue to level off throughout the second stage of our menstrual cycles—the luteal phase. At the end of our cycles, if the ovulated egg has not met a sperm and been fertilised, all of our menstrual cycle hormones, including oestrogen, drop off to their baseline levels—triggering our periods. If our oestrogen levels get off balance, it can disrupt the balance of our other menstrual cycle hormones—potentially impacting ovulation. No ovulation = no pregnancy. So if you’re trying to get pregnant, testing your hormone levels is really important for understanding your ovulation and general menstrual cycle health. What affects oestrogen levels? As well as fluctuating naturally month to month, lots of other lifestyle, genetic and medical conditions can affect our oestrogen levels, including: Does oestrogen decline with age? Thanks to our wonderful ‘biological clocks’, as we age, our oestrogen levels gradually decline. This is because our number of egg cells decreases as we age and as a result, our follicles stop growing and producing as much oestradiol (E2). After menopause (when our periods stop completely), our E2 levels completely drop off, which is what causes the common low oestrogen menopausal symptoms like hot flushes, dry skin and mood swings. During perimenopause (the lead up to menopause), E2 levels fluctuate up and down which can also cause menopausal symptoms. Declining oestrogen levels has whole-body knock-on effects, but luckily these days hormone replacement therapy (HRT) can be a great option to relieve symptoms for many people during perimenopause and postmenopause. How do I know if my oestrogen levels are normal? Because our oestrogen levels fluctuate during our cycles, as we age, and are dependent on whether we’re taking hormonal birth control or not, our ‘normal’ level is constantly changing.  Like all of our hormones, our oestrogen is super sensitive and can easily get off balance. Oestrogen imbalances can cause a whole host of symptoms and can be caused by both lifestyle and genetic factors. Symptoms of high oestrogen levels Oestrogen dominance is a phrase that has been used to describe a phenomenon when oestrogen levels are too high in relation to the other sex hormones in your body.  Although it’s not a clinically recognised term, being more sensitive or having excess oestrogen is known to cause symptoms like irregular periods, abnormal vaginal bleeding, bloating, swollen or tender breasts and weight gain. Some causes of high oestrogen levels include underlying health conditions, genetic factors, dietary and lifestyle factors and environmental pollutants. Symptoms of low oestrogen levels On the flip side, when oestrogen levels are too low we can experience irregular periods, fertility difficulties, reduced bone density, vaginal dryness, hot flashes and dry skin—to name a few. Having very low oestrogen levels can be caused by your ovaries not working properly, which occurs in menopause or primary ovarian insufficiency (POI). However, underlying health conditions like pituitary gland disorders, as well as having very low levels of body fat, a high caffeine intake, smoking and excessive exercise can also result in lower oestrogen levels. Luckily, testing our E2 levels with a hormone test can help us to decipher if our oestrogen levels are within the normal range for us. Oestrogen FAQs Where can I get an oestrogen blood test? You’ve landed in the right place. With a Hertility Hormone and Fertility test […]

Luteinising hormone is an important cycling hormone, involved in the regulation of the menstrual cycle and ovulation. But what happens when our levels get a little off balance? In this article, we’ll explain exactly what luteinising hormone is, how it works, and take a deep dive into its importance for female fertility. We’ll also take a look at LH levels and why they’re important, as well as how to recognise the symptoms of low or high LH. Quick facts: What is Luteinising Hormone (LH)?  Luteinising hormone (LH) plays a huge role when it comes to fertility and ovulation, despite it being one of the lesser-known cycling hormones. Luteinising hormone (LH) is what’s known as a gonadotropin hormone. There are only two types of this hormone, LH and its partner in crime, follicle-stimulating hormone (FSH). Gonadotropins are hormones that are released from the pituitary gland in the brain, into the bloodstream where they are transported to the gonads—or ovaries in those assigned female-at-birth and the testes in those assigned male-at-birth. LH has 3 main functions in those assigned-female-at-birth:  Oestrogen production LH works in tandem with FSH to stimulate the ovaries and surrounding cells to produce oestrogen. First, LH stimulates what’s known as theca cells in the ovaries, which then produce testosterone. Once testosterone is abundant, nearby granulosa cells are then stimulated by FSH to produce an enzyme called aromatase, which converts the testosterone into a type of oestrogen, oestradiol, or E2. Without the correct functioning of LH or FSH, testosterone and oestrogen production can become impacted. Ovulation LH is also crucial for successful ovulation. First, FSH stimulates the growth of follicles (small sacs that contain your eggs) in your ovaries. A number of eggs mature during the first half of your cycle, but only one gets released during ovulation—usually the ‘most mature’ follicle. In the days leading up to ovulation, this follicle increases its sensitivity to LH. It gradually produces more and more E2 and when this reaches a certain level, the pituitary gland releases a surge of LH. This LH surge is what causes the follicle to rupture and release the mature egg into the fallopian tube—triggering ovulation. Progesterone production After ovulation has occurred, LH stimulates the now empty follicle to start producing progesterone throughout the second half of the menstrual cycle—also known as the luteal phase. Both progesterone and E2 released by the empty follicle are intended to support conception, implantation and the early stages of pregnancy. However, if the egg is not fertilised and no embryo implants into the uterus, the empty follicle stops producing these hormones and eventually wastes away at the end of the menstrual cycle. What are normal LH levels in women? LH levels in women, or those assigned-female-at-birth, fluctuate during the menstrual cycle—so their levels will vary depending on where you are in your monthly cycle. LH levels can also vary depending on an individual’s age and whether they’re pregnant. Normal LH levels for women before menopause are around 5-25 IU/L, depending on the stage of the menstrual cycle. After menopause, normal LH levels range from around 14-52 IU/L. LH levels during the menstrual cycle Let’s take a closer look at how LH fluctuates during the menstrual cycle. As we mentioned earlier, a dramatic surge in LH around the middle of the cycle triggers ovulation. But after ovulation, LH production is dulled by rising levels of progesterone. If no pregnancy occurs and progesterone levels fall, LH production will start again anew at the beginning of the next cycle. LH levels during pregnancy During early pregnancy, LH levels remain low—blocked by continued progesterone production. High levels of human chorionic gonadotropin (hCG) released throughout pregnancy also ensure that they stay low throughout pregnancy, so no further ovulation is triggered. LH levels in menopause During menopause, LH levels become elevated, although this can vary from person to person. This increase in LH levels happen as a result of the general decline in hormone production by the ovaries. When the ovaries stop producing as much oestrogen and progesterone, the pituitary responds by increasing the production of FSH and LH, in an attempt to stimulate the ovaries. However, the ovaries become less responsive and, instead, LH levels rise. This rise in LH levels is associated with a lot of the typical symptoms of menopause, including hot flashes and night sweats. After menopause, LH levels can decline by around 30-40%. High LH levels High LH levels in females outside of normal menstrual cycle fluctuations can cause fertility problems, irregular periods and early puberty. High LH levels are often seen in people with primary ovarian insufficiency and in those with polycystic ovary syndrome (PCOS) often have elevated LH compared to their FSH. This unusual imbalance can lead to irregular periods and the overproduction of testosterone, both key symptoms of PCOS. Sometimes LH levels can become elevated due to dietary and lifestyle factors, including: Symptoms of high LH levels Symptoms of high LH levels in females are more related to the underlying cause than the LH itself. However, some of the most common symptoms associated with the causes of high LH levels include: How to lower LH levels If your LH levels are elevated and you are a regular smoker or drinker, consider taking steps to reduce these habits. If you’re trying to conceive, consider cutting alcohol and cigarettes completely as this will improve your chances of conception and prevent harmful effects to the baby during pregnancy. Low LH levels There are also a number of reasons why low LH levels might occur. Meningitis infections that have occurred in the last 12 months have been linked to low LH levels and so have eating disorders. Sometimes, LH levels can be decreased due to dietary and lifestyle factors as well as certain medications including: Low LH levels in females can lead to problems with ovulation. This includes anovulation, which is not ovulating at all. This can also lead to problems with menstruation, such as irregular, missing, or complete cessation of periods. Symptoms […]

Sex hormone-binding globulin (SHBG) is an important protein involved in the regulation of our sex hormones and in turn our ability to conceive. So what is a good, or ‘normal’ range for our SHBG levels? And how do we know when ours might be too high or too low? We’ve broken down all you need to know about SHBG levels, including what they mean, why they matter and what to do if you suspect yours might be out of range. Quick facts: What is SHBG? SHBG is an important protein that regulates the amount of testosterone and oestrogen available in the body by ‘binding’ to these hormones—which makes them inactive. This is because to bring about an effect in the body, hormones need to be unbound or free so they can enter cells and bring about their effect. The vast majority of testosterone and oestrogen in our bodies is bound to SHBG and other proteins. SHBG also controls the balance between testosterone and oestrogen, which is also important for the healthy functioning of our menstrual cycles. Why do SHBG levels matter? Because SHBG levels regulate the amount of testosterone and oestrogen available to be used by the body, if our SHBG levels are too high or low, this will have a knock on effect on our levels of both of these sex hormones.  If our SHBG levels are higher, we’ll have less free testosterone or oestrogen available. If our SHBG levels are lower, we’ll have more testosterone and oestrogen available.  Both of these sex hormones have important roles in the regulation of the menstrual cycle, ovulation, libido, energy levels and our mental health. Low SHBG When our SHBG levels are low, our levels of free unbound testosterone and oestrogen can become high. Let’s take a look at some of the symptoms, causes and what can be done to help. Symptoms of low SHBG These symptoms can often mirror those of excess testosterone including: Or excess oestrogen: Causes of low SHBG There is no single cause for abnormal SHBG levels, although increases in insulin, prolactin and androgens have been found to block SHBG production which could be a factor for those with low SHBG levels.  Low SHBG can also be caused by a number of lifestyle factors, certain medical conditions and genetics. Here are several conditions, as well as other factors, that low SHBG has been found to be associated with: How to raise low SHBG If you have low SHBG there are a number of lifestyle changes that may help to increase your levels. These include: High SHBG  On the flip side, when our SHBG levels are too high, our unbound testosterone and oestrogen can become abnormally low. Here are some symptoms, causes and what can be done to reduce high levels of SHBG. Symptoms of high SHBG These symptoms can often mirror those of low testosterone including:  Or low oestrogen: Causes of high SHBG Again, there is no single cause for abnormal SHBG levels, although as we mentioned previously, increases in oestrogen and thyroxine (T4) have been found to increase SHBG production, which could be a factor for those with high SHBG levels. There are also a number of conditions associated with high SHBG which include: How to lower SHBG Dietary changes are the most effective way to lower SHBG levels. Decreasing alcohol consumption, gaining weight if you have a low BHM and following a high-fat, low fibre diet may help decrease levels of SHBG. One study involving 48 premenopausal women showed that maintaining a high-fat, low diet decreased SHBG. However, more clinical studies are required to confirm this association. If the levels are elevated due to contraception use, this will usually return to normal levels once you stop using that contraception. Other possible causes such as type 1 diabetes and an overactive thyroid will need further investigation and will require medication specific to these conditions. SHBG tests Ultimately, if you suspect you may have abnormal levels of SHBG, the only way to definitively get a diagnosis is via a blood test. Because symptoms of abnormal SHBG levels can mimic those of high or low oestrogen and testosterone, your SHBG levels should be tested in tandem these hormones. You can test all of these hormones and more, with a Hertility at-home Hormone and Fertility Test. Resources:

Hertility partners with Pearl & Dean for the launch of #MeToo film, ‘She Said’, to rally women in the UK for the next women’s rights movement, the Reproductive Revolution.   Women’s health company Hertility’s award-winning film, ‘Ooh Someone’s Hormonal,’ spotlighted the lack of research on women’s bodies and called out society for using women’s hormones against them. Now, they’re teaming up with Pearl & Dean, the UK’s best-known cinema advertising contractor, to take the “Mother of all movements” to the next level in a bid to urge millions of women across the UK to get to know their bodies. For 5 weeks from November 25th, ‘Ooh Someone’s Hormonal,’ created by female-founded creative content agency Be The Fox, will be shown before every screening of ‘She Said’ in Pearl and Dean cinemas nationwide, the film starring Carey Mulligan and directed by Maria Schrader telling the story of the #MeToo movement.  Founded by women and powered by an (all female) research team, Hertility is setting a new standard of scientific rigour in female health by empowering women with information about exactly what’s going on under their skin using at-home diagnostic testing, telemedicine and treatment. By joining forces with cinema ad sales firm Pearl & Dean, the partnership aims to fuse science and art in the fight for equality. ‘The #MeToo movement was such a huge step forwards in women’s rights but from a reproductive perspective, women are still second-class citizens. We want to inspire women watching ‘She Said’ to join us in our fight in the next revolution – the Reproductive Revolution – by getting to know their bodies and taking control of their life choices. For themselves and for all women worldwide.’ – Dr Helen O’Neill, CEO and Founder of Hertility Carey Mulligan, has spoken openly about the lack of support for women in the film industry but as a middle finger to the male-dominated Harvey Weinstein era, ‘Ooh Someone’s Hormonal’, produced by female-led production company, Be The Fox, shows Hollywood how it’s done. Echoing the equality seen in the production of ‘She Said’, the female-powered cast and crew of ‘Ooh Someone’s Hormonal’ worked to the soundtrack of female artist Rebecca Taylor of Self-Esteem, complete with childcare on set, changing the outdated landscape and showing what’s possible when women, fully supported, come together. Diana Ellis Hill, Co-Founder, Be The Fox comments: “Empowering women and having true representation is an important cause that’s close to our hearts. We gathered an 80% female team to make the film from DOP and Director to Editor and Colourist as we wanted it to be real and authentic. We are immensely proud of what’s been produced and to see our film on screens at cinemas nationwide ahead of She Said.” Kathryn Jacob OBE, CEO at Pearl & Dean, said: “Cinema is a unique advertising medium in the sense that it is both a personal and shared experience. Cinema has the power to truly reach an individual, and to speak to them one on one, as well as spark a conversation. We are honoured to be working with Hertility to launch its first ever cinema campaign and to be a part of helping to better articulate an important issue that is often hidden or ignored by wider society.” Watch the cinema advert ‘Ooh Someone’s Hormonal’ More information on ‘She Said’

Anti-Müllerian Hormone (AMH) is a really important hormone for fertility. It can give insight into your ovarian reserve and how many eggs you have left. But what is a good AMH level for your age? Here’s everything you need to know about AMH levels.  Quick facts: What is AMH? Anti-Müllerian Hormone (AMH) is an incredibly important hormone when it comes to fertility and overall reproductive health.  AMH is made by the small sacs, called follicles, in your ovaries. These follicles house your eggs. Because of this close relationship with your eggs, testing your AMH levels can therefore give you an insight into your ovarian reserve, or how many eggs you have at the time of testing.  We are all born with all of the eggs we’ll ever have. As we age, both our egg quality and quantity declines. This is due to both the natural ageing process and eggs being lost with each menstrual cycle. This happens right up until menopause when all your eggs are gone. As our egg count diminishes, generally so do our AMH levels, unless we have an underlying condition or lifestyle factor which is affecting our AMH levels (like PCOS).  What is a normal AMH level for my age? AMH levels will steadily decrease year after year from your mid-20s onwards. This occurs in tandem with your ovarian reserve declining.  After your mid-30s, AMH decline becomes much more rapid. It completely drops off as you near menopause (usually between 45 and 55 years old).  Although the overall levels of AMH by age is a general downward trend, each person has an individual rate of decline depending on genetics, lifestyle, medication and underlying conditions. What is a good AMH level? The higher your AMH the better, right? Well… not exactly. Like all of our hormones, too much or too little can indicate problems.  High AMH levels In general, higher AMH levels indicate a larger number of ovarian follicles and therefore a larger ovarian reserve.  However, some underlying reproductive health conditions like polycystic ovarian syndrome PCOS are associated with high AMH levels too. PCOS can cause hormonal imbalances which can negatively impact your fertility. Symptoms of high AMH levels Generally, high AMH levels don’t have any specific symptoms. But if you’re experiencing any symptoms that indicate a possible problem with your cycle you should test your hormones including AMH levels to investigate the possibility of PCOS. These symptoms could be things like irregular or no periods, or any other PCOS symptoms like acne, excessive body or facial hair, hair thinning or loss.  Low AMH levels On the flip side, low AMH levels can indicate lower numbers of remaining follicles and therefore, a smaller ovarian reserve.  Very low AMH levels are often seen in premature ovarian insufficiency (POI), which is a condition where menopause occurs before the age of 40 or even when you are going to experience menopause. Ovarian surgery can also carry a risk of low AMH levels afterwards. Some lifestyle factors have also been linked to low AMH levels – smoking, obesity, and poor diet and nutrition—specifically insufficient Vitamin D levels.  How to increase AMH levels? Unfortunately, you can’t stop your AMH from declining with age. That being said, there are some lifestyle and diet changes that can improve your fertility.  Monitoring your AMH levels with an at-home blood test if you have low AMH levels and are actively trying to conceive, or wanting to do so soon is a good idea to understand your rate of decline. Additionally, if you’re worried about your future fertility but not ready to have kids yet, you may want to consider egg freezing. Or, if you have low AMH levels and are struggling with conceiving, IVF treatment could be a good option for you.  If you’re concerned about your AMH levels, you can speak to our Private Gynaecologists at any time. Our Doctors can help you with a care plan that’s right for you and your body.  Do AMH levels fluctuate? Unlike your menstrual hormones which are cyclical, meaning their levels fluctuate throughout the month, your AMH levels stay relatively stable throughout your menstrual cycle. How do I know if I have normal AMH levels?  Testing your hormones is the only way to definitively know if your AMH levels are within the normal range for your age.  Doing an AMH blood test can give you an accurate insight into your current AMH levels, and give you an insight into your reproductive health because it is reflective of your ovarian reserve (egg count). Your AMH levels can also be used as an indication of whether you have polycystic ovaries, however, it can not currently be used to diagnose PCOS based on current guidelines. Understanding your AMH levels and ovarian reserve can also help to determine if you would be suitable for certain fertility treatments like IVF or egg freezing.  During fertility treatment, AMH levels are often tested to help determine the doses of medication and to predict the outcomes of the egg collection process.  Investigation of AMH levels is often done in combination with an Antral follicle count (AFC), which is an internal ultrasound scan where the number of small follicles seen on the ovary is counted. What is a good AMH level to get pregnant or to have IVF? Successfully getting pregnant is not entirely dependent on your AMH levels and ovarian reserve. Other factors can affect fertility such as: There is, therefore, no evidence of a good AMH level to increase the likelihood of pregnancy.  The success of IVF treatment is also dependent on many different factors. However, there is evidence that an AMH level lower than 5.4 pmol/L may have a poorer response to fertility medications. This is why some NHS IVF clinics will not accept patients who have an AMH level lower than this threshold.   Resources:

Testosterone is an important androgen hormone in people of all sexes. In this article, we’ll cover exactly what it does in the body, what the symptoms and causes of high or low testosterone are and how you can ensure your levels are balanced and healthy.  Quick facts: What is testosterone? Testosterone is an important hormone for regulating sex drive (libido), bone and muscle mass and fat distribution. It’s part of a group of hormones called androgens.  There are a lot of misconceptions about testosterone being just a “male” hormone. Whilst testosterone plays an important role in the development of the male sex organs and male secondary sex characteristics, people of all sexes have testosterone.  Everyone produces and requires a certain amount of androgen hormones for reproductive development. The difference is just how much testosterone we have based on our sex-at-birth. How is testosterone made? In women and people assigned female-at-birth, testosterone is produced by the ovaries and adrenal glands. It’s then converted to hormone–oestrogen. Testosterone production is age-dependent and it gradually declines with age. Most of the testosterone in the body is inactive. It remains bound to a protein called, sex hormone-binding globulin (SHBG). The small amount of testosterone that’s unbound and therefore active, is called freely circulating testosterone (free T).  Free T can enter cells to bring about its effects. Our free T levels are affected by the levels of SHBG. Low levels of SHBG result in higher free testosterone, whereas high levels of SHBG result in lower free testosterone. What does testosterone do in the body? Some of the functions of testosterone are: What are the symptoms of high testosterone? Excess levels of testosterone in the body is called hyperandrogenism. This can bring about symptoms like:  Some studies suggest that high testosterone levels may increase the risk of developing high cholesterol, heart disease and type 2 diabetes. What causes high testosterone levels? The most common causes of high testosterone levels are underlying health conditions. It can also be caused by certain medications and lifestyle factors. Let’s look at the main ones… PCOS Polycystic ovary syndrome (PCOS) is a hormonal and metabolic condition affecting 1 in 10. The exact cause is still being researched, however, the proposed causes include an excess of androgens and insulin, genetic and environmental factors. If you suspect you might have PCOS, our at-home tests can give you a better insight into your hormones.  Congenital andreal hyperplasia Congenital adrenal hyperplasia (CAH) is an inherited condition that affects the adrenal glands. These are small glands located on top of the kidney. They produce hormones like cortisol (stress hormone), dehydroepiandrosterone (DHEA) and testosterone. People with CAH are unable to produce an enzyme necessary to regulate the production of these hormones, which can result in an overproduction of testosterone. It’s been found to be more common in some ethnic groups such as people of Hispanic, Mediterranean, Yugoslavian and Ashkenazi Jewish descent. Cushing’s syndrome is another hormonal condition impacting the adrenal glands. It results in excessive cortisol and androgen production. Medications Testosterone levels can rise due to certain medications, such as: Alcohol Excessive alcohol consumption may increase levels of testosterone in premenopausal women, however, research is conflicting.  How to lower my testosterone levels? Treatment for high testosterone depends on the cause, but generally, it is a combination of lifestyle changes and medications. Achieving a healthy weight by including a healthy balanced diet and exercise routine may help with the symptoms of a hormonal balance.  Medications used to treat high testosterone, and associated symptoms include: What are the symptoms of low testosterone? If you’re experiencing low testosterone, you may experience some of the following symptoms:  Low testosterone over a long period may also contribute to long-term health conditions such as heart disease, memory issues and loss of bone density. Often, the symptoms of low testosterone in women are undiagnosed or misdiagnosed. Some of the conditions that low testosterone may be mistaken for include stress, depression and the side effects of menopausal changes in women. What could cause low testosterone levels? The most common causes of low testosterone levels are often age, underlying conditions and problems with certain glands. Age Testosterone levels naturally decrease as we age. As it’s produced in the ovaries, the natural decrease in ovarian function with age means that some may experience low testosterone levels as they transition from the perimenopausal phase into menopause.  Underlying health conditions Premature ovarian insufficiency (POI) can increase your risk of low testosterone. Additionally, surgery, such as the removal of the ovaries, can cause lowered testosterone levels.  Problems with the hypothalamus or pituitary gland Underlying health conditions impacting the pituitary, hypothalamus, or adrenal glands can also cause lowered testosterone levels. This is because these parts of the brain are responsible for the secretion of hormones which control the proper functioning of the ovaries.  A disruption in the pituitary gland can also impact the adrenal gland. Addison’s disease or adrenal insufficiency is a hormonal condition that occurs due to underactive adrenal glands and can cause a low level of its hormones. What can I do to increase my testosterone levels? Low testosterone levels effects and treatments in women are still being researched and treatment is usually recommended only if symptoms are significantly impacting health and quality of life.  Testosterone replacement therapy is a form of hormone replacement therapy (HRT) based on the replacement of testosterone. It may be prescribed orally, as injections, gels or skin patches. DHEA is a precursor to testosterone, and it is believed that taking DHEA supplements could increase the amount of testosterone. It is always recommended to speak with a doctor before starting any medication or supplements. How to test testosterone levels? If you’re experiencing any of the symptoms mentioned above, our at-home hormone tests can determine your testosterone levels. Hormone testing is the only way to know what your testosterone levels are for definite.  Our Doctors can recommend a care plan for you, based on your symptoms, hormone levels and specific health goals. Resources: