Tag: hormone

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

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

Ovulation is the release of a mature egg from one of your ovaries, triggered by a surge in luteinising hormone (LH). It happens once per menstrual cycle and marks the point when pregnancy is biologically possible, but it is also an indicator that your hormones are working as they should, whether or not you are trying to conceive. This guide covers everything you need to know: how ovulation happens, when it happens, what it means for your health, the myths that routinely mislead people, what the physical signs look like, and what can disrupt the process. Quick facts How does ovulation work? Ovulation is the result of a hormonal sequence that begins the moment your period starts, not something that happens in isolation mid-cycle. At the start of each menstrual cycle, the hypothalamus, a small region at the base of your brain releases gonadotropin-releasing hormone (GnRH), which signals the pituitary gland (also in the brain), to make follicle-stimulating hormone (FSH). FSH stimulates a group of follicles in the ovaries to begin developing, each one containing an immature egg.  Several follicles begin growing simultaneously, but over the following one to two weeks, one becomes dominant – larger and more developed than the rest (which are gradually reabsorbed by the body). As the dominant follicle grows, it produces rising levels of oestrogen. This oestrogen has two simultaneous effects: it thickens the lining of the uterus in preparation for a potential pregnancy, and it sends a hormonal signal back to the pituitary gland. When oestrogen reaches a peak, it triggers dramatic release of luteinising hormone – the LH surge. This surge is the direct trigger for ovulation. Within 24 to 36 hours, the dominant follicle ruptures and releases its mature egg into the fallopian tube to be fertilised. What happens next matters as much as the egg release itself. After the egg is released, the empty follicle transforms into a structure called the corpus luteum, which makes progesterone for the remainder of the cycle. Progesterone stabilises the uterine lining and supports implantation. If fertilisation does not occur, the corpus luteum breaks down, progesterone falls, and your period begins, resetting the cycle. When does ovulation start after period and how long does it last? So, does ovulation always happen on day 14? Only in the context of a textbook 28-day cycle, and even then, it’s an approximation. In reality, ovulation occurs around 12 to 16 days before your next period, not 14 days after your last one. That distinction matters, because it means ovulation timing shifts depending on your cycle length. For example, in a shorter 24-day cycle, it may occur as early as days 8 to 12. In a longer 35-day cycle, it may not happen until days 19 to 23. While day 14 is often quoted as the “average”, applying it as a universal rule is misleading. Cycle lengths vary widely between individuals and even from month to month in the same person. If you are taking birth control or hormonal contraception, you may not ovulate. These methods work primarily by suppressing ovulation and also thickening cervical mucus, making it harder for sperm to reach and fertilise an egg. It’s also important to understand where cycle variability comes from. The second half of the cycle, from ovulation to your next period (the luteal phase) tends to be relatively consistent, typically lasting around 14 days. The variation in total cycle length mostly comes from the first half (the follicular phase), which is why ovulation timing can shift. Even if you have regular cycles, ovulation isn’t perfectly predictable. Factors like stress, illness, travel, weight fluctuation, and disrupted sleep can delay ovulation by interfering with the hormonal signals that trigger it. When a period arrives later than expected, it’s usually because ovulation happened later,  not because the period itself was delayed. As for how long ovulation lasts, the process itself only takes about 12 to 24 hours. You can expect to ovulate about 8-20 hours after your LH peaks or 24-36 hours after the LH surge begins rising. What is the fertile window? Your fertile window is a six-day window during each menstrual cycle, the five days leading up to ovulation and the day of ovulation itself when you are most likely to get pregnant. An egg can only survive for 12–24 hours after ovulation, but sperm can survive for up to five days in the female reproductive tract, so if you have unprotected sex in the days before ovulation, pregnancy is still possible. Recent research has shown that the two to three days immediately before ovulation carry the highest probability of conception. In 2025, Hertility’s research team published a study that has become the largest of its kind on fertility awareness in women actively trying to conceive. Analysing responses from 97,414 women, the study found that more than 41% could not accurately identify their fertile window.  What are the signs of ovulation? Your body produces a recognisable set of physical signs and symptoms  around ovulation. Not everyone experiences all of them, but knowing what to look for is the first step in understanding your cycle. The most consistent physical sign is a change in cervical mucus. In the days before ovulation, discharge becomes increasingly clear, slippery, and stretchy, a consistency often compared to raw egg white. This mucus coincides with peak fertility and is driven by rising oestrogen. After ovulation, progesterone causes mucus to thicken and reduce. Other signs include a mild one-sided ache or twinge in the lower abdomen (mittelschmerz), a slight rise in basal body temperature (BBT) after ovulation has occurred, light mid-cycle spotting, increased libido, and breast tenderness. To know read our blog here. How can you track ovulation signs and symptoms? There are several methods you can use to track ovulation, including hormone testing kits, monitoring cervical mucus changes, tracking basal body temperature, and using a period tracking app. Each has different strengths and limitations. Ovulation predictor kits (OPKs) Ovulation predictor kits detect the LH surge in your urine […]

Anti-Müllerian Hormone (AMH) is one of the most talked-about fertility hormones, but also one of the most misunderstood. Because AMH is closely linked to your eggs, testing it can offer valuable insight into your ovarian reserve (the number of eggs you have left). But it’s not a fertility “yes or no” test. In this guide, we break down exactly what AMH testing can and can’t tell you about your reproductive health.  Quick facts: What is AMH and why is it so important? Anti-müllerian hormone (AMH) is made by small fluid-filled sacs in the ovaries called follicles, each of which houses an immature egg. Because AMH is made by these follicles, your AMH level gives an indication of how many eggs you may have remaining at a given time. However, this is only one piece of the fertility puzzle. There are a few myths out there about what exactly AMH testing can tell us. In this article, we cover the main things an AMH test can and can’t tell you. Let’s get into it. What can AMH testing tell me? Whether your ovarian reserve is a normal for your age AMH testing will give you insights into whether your ovarian or egg reserve is what is expected with other healthy people in your age group. It helps you understand whether your egg reserve is higher, average, or lower than expected for your age. If you are not using any hormonal contraception, testing other hormones, like follicle-stimulating hormone (FSH) and oestradiol alongside AMH can also help to build a more complete picture of egg reserve. Generally, people with low egg reserves are known to have higher levels of FSH and lower levels of oestradiol. Whether you have polycystic ovaries or polycystic ovary syndrome AMH testing can also be used as an indicator of whether you could have polycystic ovaries (PCO). PCO is a common reproductive health condition affecting around 30% of reproductive-aged people assigned female-at-birth. PCO is benign and does not affect fertility, but it can cause other unwanted symptoms.  People with PCO have a higher-than-expected number of immature follicles in their ovaries. More follicles mean a higher level of AMH in the blood.  Some people with PCO also have the syndrome that can be associated with it polycystic ovary syndrome (PCOS), which often presents as symptoms like irregular periods, acne, hair thinning or loss and high testosterone levels. According to updated guidelines, AMH can now be used as an indicator for polycystic ovaries in place of doing an ultrasound scan for the diagnosis of PCOS. However, at Hertility, we would always recommend getting a pelvic ultrasound scan to further assess your ovarian reserve. During this scan, your ovaries are assessed to determine your antral follicle count (the number of eggs sacs seen within your ovaries) and to confirm the diagnosis. Whether IVF or egg freezing could be right for you In fertility treatment settings, AMH plays an important role in guiding decisions around interventions such as IVF and egg freezing . It is commonly used to estimate how the ovaries may respond to stimulation and to guide medication dosing.  Lower AMH levels are generally associated with retrieving fewer eggs during IVF, while higher levels may indicate a stronger response but also carry a risk of developing a rare but potentially life threatening condition called OHSS (ovarian hyperstimulation syndrome). This makes AMH a valuable tool for planning treatment safely and effectively. Many NHS-funded and private IVF clinics therefore require a minimum AMH level for you to be eligible for a free IVF treatment cycle. The minimum level on the NHS will depend on where in the UK you are currently residing. Whether you may be perimenopausal or menopausal or have POI Menopause marks the point at which your periods stop permanently, typically between the ages of 45 and 55, with the average age for menopause in the UK being 51. After menopause, natural conception is no longer possible. It is associated with a very low, or completely depleted, ovarian reserve. Clinically, menopause is usually diagnosed retrospectively, after 12 consecutive months without a period in someone not using hormonal contraception. In individuals under the age of 45, follicle-stimulating hormone (FSH) is more commonly used as a diagnostic marker, as levels tend to rise when ovarian function declines. While AMH is not currently recommended as a standalone test to diagnose menopause, it is well established that AMH levels fall to very low levels as ovarian reserve diminishes. This makes AMH a useful indicator of overall ovarian activity. Declining or very low AMH levels can suggest that you are approaching menopause, although it cannot predict the exact timing. In younger individuals, particularly those under 40, significantly low AMH levels may raise suspicion of premature ovarian insufficiency (POI), a condition in which the ovaries stop functioning earlier than expected. What can’t AMH testing tell me? While AMH testing is a useful tool for understanding your ovarian reserve, it only represents one part of your overall fertility picture. There are several important limitations to be aware of, and understanding these can help you interpret your results more accurately and avoid common misconceptions. It can’t determine your egg quality One of the biggest limitations is that AMH cannot tell you anything about your egg quality. Although AMH reflects the number of eggs you may have remaining, it does not provide any insight into how healthy those eggs are. Egg quality is one of the most important factors influencing fertility and pregnancy outcomes, and it is largely driven by age and genetics. At present, there is no reliable test to measure egg quality directly, except through assessing embryos during IVF treatment. It can’t determine your exact egg quantity AMH also cannot determine your exact number of eggs. While it gives an indication of the size of your ovarian reserve, it is not a precise measurement. This is because AMH is made by ovarian follicles, and each follicle can release different amounts of the hormone depending on its size and […]

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

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 Advanced Hormone and Fertility […]

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 advanced hormone and fertility 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: