PCOS is one of the most common reproductive health conditions. Some of the most common symptoms people struggle with are physical symptoms such as issues with weight; skin and hair related issues such as acne or excessive hair growth and irregular periods. These are mainly driven through disrupted hormones. Androgens are a group of hormones, including testosterone,  that are made in the ovaries and are often found at much higher levels in women with PCOS, called “hyperandrogenism”. Insulin is also found to be at much higher levels, due to insulin resistance. Normally, Insulin helps manage blood sugar levels, helping cells absorb glucose. Insulin resistance is when the body no longer responds to normal levels of insulin. This can result in excess amounts of insulin being produced, misregulated blood sugar levels and metabolism issues like weight gain and type 2 diabetes. Women are also 3 times more likely to experience mental health related symptoms like anxiety, depression or body image issues. Unfortunately there is currently no cure for PCOS, however, there are  treatment options  aimed to manage symptoms.  Think you might have PCOS? Check your hormones Benefits of regular exercise Regular exercise can be an extremely effective way to help manage PCOS symptoms. Some experts suggest exercise as a first port of call for PCOS management but can also work alongside medications like metformin for increased effects, particularly for improving cycle related issues (1). Exercise can have positive effects on physical, hormonal and mental health related issues including: How much exercise is recommended? For a healthy lifestyle, preventing weight gain and maintaining health: Adults should do a minimum of 150 minutes a week of moderate-intensity physical activity or 75 minutes per week of vigorous activity or a combination of both and include muscle-strengthening activities Young women should do 60 minutes or more of moderate to vigorous activity per day including those that strengthen muscle at least three times a week Activity can be done in 10-minute bursts or around 1000 steps, aiming to do at least 30 minutes on most days. For those who have a goal to lose weight, prevent weight regain or achieve greater health benefits more exercise is needed: A minimum of 250 minutes a week of moderate-intensity activity or 150 minutes a week of vigorous activity or a combination of both Muscle-strengthening activity on 2 non-consecutive days of the week. Overall, aim for around 30 minutes per day. Of this, 90 minutes per week should be more active or aerobic activities (running, biking, fast pace walking etc.) at a moderate to high intensity to optimise clinical outcomes (see table below for suggested activities). Remember physical activity includes walking, activity at work, household chores, sports and planned exercise. Choose an exercise you like and if possible exercise with friends or others to increase your motivation. Mixing up exercise will also help with motivation. Benefits for your body What are the benefits of exercise on PCOS? PCOS can affect the body’s metabolism making it harder to lose weight and also affect where fat is stored. Visceral fat (fat in the abdomen and around your organs) tends to be increased in those with PCOS. Alongside this, there is an increased risk of long-term health issues including obesity, cardiovascular disease and high blood pressure. Regular physical activity can help improve body composition and is extremely beneficial for reducing these risks.  In general aerobic exercise (or cardio), like running, swimming or cycling, is great for reducing blood pressure and improving heart health. Increasing your daily energy expenditure (the amount of energy you burn in a day) can help with losing weight by creating a calorie deficit (burning more calories than you consume). Women with PCOS who had greater vigorous activity levels were found to have less visceral fat (2). A 6 month study introducing an exercise regime of 30 mins aerobic exercise 3 times a week saw a reduction in waist circumference (as a measure of visceral fat), and improvements in menstrual cycle patterns (3).  What type of exercise is best? There is a lack of evidence supporting any one type and intensity of exercise being better than another for metabolic, hormonal, reproductive or psychological outcomes. The International guidelines and majority of studies have focused on aerobic exercise routines, however, resistance training (exercise designed to improve muscle strength or endurance) such as weight lifting, has big benefits too. Resistance training has a positive effect on body composition by increasing muscle mass, which can contribute to increasing your energy expenditure. In studies focusing on resistance training for women with PCOS, a reduction in visceral fat and an increase in lean muscle mass was seen (4). It is also important to know that exercise without weight loss or only moderate weight loss can still lead to a reduction in visceral fat and improve insulin sensitivity. Think of being active as often as you can through the day, for example take stairs instead of lifts, park further away from shops etc. Can exercise improve chances of conceiving? Improvements in reproduction have been seen in women with minimal weight loss – so the scales are not the be all and end all! The NHS states as little as 5% reduction bodyweight can help improve symptoms (5). Other important lifestyle factors to consider, particularly for managing weight, are issues with appetite regulation – if this is something you are struggling with you can speak to one of our Fertility Nutrition Consultation. Benefits for your hormones  Insulin resistance is common among those with PCOS and can contribute to many of the symptoms like dark skin patches, fatigue and weight issues. This goes hand in hand with visceral fat and general inflammation throughout the body.  This is believed to be associated with greater levels of visceral fat and amount of visceral fat Women who had greater levels of physical activity, had better chances of normal insulin responses (6)  and reduced chances of inflammation (7).  Excess insulin can increase the production of androgens in the ovaries, contributing to hyperandrogenism. […]

Whilst it might be tempting to want to predict the age you may experience menopause, calculators and predictions are generally not thought to be medically accurate. But there are a few things you can do to prepare for menopause. Read on to find out.  Quick facts: Can you predict menopause? It’s normal to be curious about the age at which you’ll reach menopause. We get it—you want to feel prepared and plan ahead for big life changes. Despite advances in technology and science, there’s no definitive menopause age calculator or test that can predict the age you’ll reach menopause with any certainty.  While there’s more research being carried out into predicting the age of menopause, there’s simply no one-size-fits-all approach as menopause is so dependent on your individual hormonal make-up. Since multiple factors contribute to the onset of menopause, a menopause age calculator won’t be accurate. There are, however, some factors that can affect when in life you may reach menopause—like your genetics, lifestyle choices and medical history. If you’re experiencing symptoms that may be related to menopause or perimenopause, then book an appointment to speak to one of our Menopause Specialists who can provide advice, and guidance as well as HRT prescriptions. What is menopause? You reach menopause once you have not experienced a period for more than 12 months.  It’s a natural biological process that marks the end of your reproductive years.  Biologically, your hormones are shifting, and most notably, there’s a massive dip in oestrogen —the hormone that plays a key role in regulating your menstrual cycle and supporting your reproductive health. This hormonal change can bring on physical and emotional symptoms such as hot flashes, vaginal dryness, mood changes, problems sleeping and irregular periods.  These changes can start happening years before you even reach menopause. This phase is called perimenopause. There are ways you can offset and support your perimenopause symptoms. During perimenopause, your body is adjusting to the hormonal changes and you will gradually stop producing the hormones that control and bring about your periods, causing your periods to eventually stop altogether.Once your hormones rebalance post-menopause, many report feeling like they’ve got a new lease of life. This is why menopause is often nicknamed “the second spring”—a chance for new beginnings, which is often welcome after a time of massive change in the perimenopause. The myth of menopause prediction Just like each one of us is unique, the age we reach menopause is too.  Limited research in this area means that not even the experts can determine the age you’ll reach menopause. It’s easier to want to turn to a definitive answer, but more often than not, this oversimplified prediction isn’t backed up with scientific evidence. There are too many individual variations for them to be reliable. Menopause age calculators also don’t take into consideration any external factors that are difficult to measure, for example, exposure to pollutants and other environmental factors, or exposure to stress. Ultimately, any factors that can impact your hormones can impact the onset of menopause. Average age for menopause The average age for the onset of menopause in the UK is 51, with most people reaching menopause between the ages of 45-55. A small percentage experience early menopause or premature menopause (premature ovarian insufficiency) before the age of 40. Factors that influence menopause timing Three key areas may indicate when you start menopause: your genetics, your medical history, and your lifestyle. Genetic influences Research suggests that you can roughly predict the age you’ll reach menopause according to when other females in your family like your mother or sister reached theirs.  Studies suggest there may be a familial pattern and even certain genetic markers that indicate the age of menopause onset. However, while genetics play a crucial role, other factors, such as your medical history and lifestyle factors come into play too. For example, you may have a different upbringing from other female relations in terms of where you live, whether you have any underlying health conditions and what you’ve consumed in your diet and lifestyle over the years. Lifestyle and medical history  Lifestyle choices, such as whether you are overweight or underweight (or have a low or high BMI) from nutrition and exercise patterns, or whether you smoke or drink alcohol impact the age you reach menopause. This is because poor lifestyle choices can negatively affect your reproductive and overall health. They can impact your ovarian reserve and hormones and bring on menopause sooner. Biological factors can impact your menopausal age including: The wide variation of genetics, lifestyle and medical history amongst individuals makes it difficult to predict the age you’ll reach menopause. Understanding your body’s signals Becoming attuned to your body’s signals can help you predict when you’re approaching menopause. A key factor, often coined “the fifth vital sign”, is your menstrual cycle. Your menstrual cycle is considered regular if your cycle lasts roughly the same amount of days, e.g. between 21 and 35 days each cycle.  Irregular periods are one of the first signs of perimenopause you might notice, along with things like hot flashes, trouble sleeping, lowered sex drive and vaginal dryness. To find out what’s going on inside, you could take a Hertility Hormone and Fertility Test. This will give you a report indicating your hormone levels, and you can speak with a Menopause Specialist to make sense of your results and discuss your next steps. If you have questions about the age of your menopause, it’s best to speak with a healthcare professional for the most reliable information. They can advise you on your individual menopause experience with as much support as possible instead of focusing on predicting the age you’ll get there. Preparing for menopause Maintaining health and well-being is crucial for navigating menopause with ease. Adopt a healthy lifestyle with balanced nutrition and regular exercise to improve your mood, maintain a healthy weight and support your vitality. Limit alcohol and smoking, manage stress and make sure you’re getting enough sleep to balance your […]

In this article we will walk you through what happens if your Hertility at-home hormone testing kit comes back with a haemolysed blood sample, what happens during lab tests affected by hemolysis and our top tips for taking and sending off your samples to ensure your hormone blood test results don’t come back haemolysed. Quick facts: What does it mean when a blood sample is haemolysed? A haemolysed blood sample is when the red blood cells in the sample you provided have burst or broken down.  This process is called haemolysis—the red blood cells rupture and spill their contents, mainly haemoglobin (a protein that carries oxygen around your body) into their surrounding serum or plasma.  With any type of blood collection, haemolysed blood samples can happen. They are very common—in fact, they are actually the number one cause of rejected samples by labs, second only to insufficient sample size (1). Haemolysed samples are unable to be tested and labs will reject and request new samples. This is because analytes that are tested for in the sample will potentially have become diluted by haemolysis and an accurate result will not be able to be obtained. We know it can be frustrating to hear that your sample couldn’t be analysed—especially if you’re someone who doesn’t like having blood taken.  What causes a haemolysed blood sample? Haemolysis can happen with any form of blood collection, whether it’s a finger prick sample like the one used in our at-home Hormone & Fertility Test or a traditional venous blood drawn by a nurse or doctor. It can also happen regardless of where the sample was taken.  Samples can become haemolysed for a number of different reasons, but here are some common ones we’ve found with our tests. Haemolysed blood could be caused by: Can my sample be analysed if it’s haemolysed? Unfortunately, no. Because the red blood cells have broken down, the hormones within the sample can’t be analysed.  We know this can be really disappointing and frustrating. So, if your sample has come back haemolysed, we will send you a second test kit, free of charge, for you to retake your sample.  All you need to do is log in to your health hub, navigate to your tests and click on the notification we’ve sent you. We will have already credited your account with a free test, so all you need to do is check out.  Top tips for taking your sample Sometimes haemolysis can happen because of the way your blood sample was collected or packaged. We’ve put together a few tips and tricks to help you get your sample to us safe and sound. Top tips for preventing hemolysis when taking your blood sample: 1. Slow it right down Take your time when taking your sample, don’t rush through or squeeze your finger really hard. Use gentle downward strokes to encourage blood flow. 2. Make sure your hands are warm Warm hands = more blood circulation. This means it will be easier to draw your sample. Submerge your hand in warm water for a couple of minutes before collecting your sample to get that blood pumping all the way to your fingers. 3. Use your ring finger This one usually works the best, giving the biggest drops. Make sure you prick the fleshy part. 4. Always wipe away the first droplet Use a tissue or sterilised wet wipe to wipe the first drop clean, before aiming the rest of your drops into your collection tube. 5. Pierce a second finger if the blood stops flowing on the first Don’t overdo it on the first finger, if the blood flow stops, start fresh on a new finger. 6. Use the cartwheel method Take your arm that is not being used for the sample (we don’t want an American psycho situation up the walls) and swing in a cartwheel motion for about a minute. Don’t ask why, but it works. 7. Get your blood pumping with some star jumps Bring back some P.E class nostalgia star jump it out for a minute or so before you take your sample. This will get your blood flowing and your fingers warm.  8. Make sure you’re hydrated Everyone is more dehydrated than usual when first waking up which can make circulation slower and collecting your sample more difficult. Stay hydrated the day before you’re due to collect your sample and drink a couple of glasses of water roughly half an hour beforehand.  Top tips for preventing hemolysis when packing your blood sample 1. Do not shake your tube after collecting your sample Place your tube carefully back into your kit box, into the space indicated. This will keep it wedged safely in place during transit. 2. Post your sample on the same day it was collected Ideally you’ll do your test first thing in the morning. Then, keep it at room temperature and post it to your nearest postbox as close to the collection time as you can. This will reduce the time it’s outside for, potentially getting hot in the sun or too cold. 3. Use a priority postbox if you can These are collected everyday, you can find your nearest one on the Royal Mail website.  4. Check our social channels for lab closures and postal service delays We regularly post or email reminders about upcoming lab closures, postal strikes and delays due to public holidays on our stories, make sure you’re following us and check our socials before doing your test. FAQs How will I know if my sample arrives haemolysed? Rest assured, we will always contact you directly if your sample arrives haemolysed. One of our customer service team will be in touch.  Will I get another test free of charge if my sample is haemolysed? Our labs will inform us, we will contact you to let you know and will offer a second kit free of charge to redo your test Do I have to wait until day 3 of my cycle before I can test again? Unless you’re on hormonal contraception, unfortunately yes, you will have to wait until […]

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 […]

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 […]

Prolactin has several important functions in the body. But what exactly does prolactin do and how do we know if our levels have become imbalanced? In this article, we’ll dive into exactly what prolactin is, what its functions are in the body, discuss imbalances in its levels and the importance of testing prolactin levels for reproductive and overall health. Quick facts: What is prolactin? Prolactin is a hormone that encourages breast growth and milk production during and after pregnancy, as well as maintaining our metabolism, regulating our stress response, maintaining a functioning immune system and in the development of our reproductive organs.  Similarly to follicle-stimulating hormone (FSH) and luteinising hormone (LH) it is secreted by the anterior pituitary gland, located at the base of the brain. From there, it’s released into the bloodstream where it travels around the body to carry out its functions.  Prolactin interacts with FSH and LH, and other cycle hormones, in a complex negative feedback loop. After ovulation prolactin production increases to prepare the body for a potential pregnancy. Prolactin’s role in breastfeeding In pregnant women, prolactin stimulates milk production in the mammary glands of the breasts—allowing for the secretion of breast milk. After birth, there is a postnatal rise in prolactin, which gets things started—but this isn’t enough to maintain breast milk development. When a baby suckles, prolactin levels in the blood increase in response, which stimulates the production of more milk. Prolactin levels spike around 30 minutes after the start of the feed, so this positive feedback effect is important for ensuring there is enough milk for the next feed.  This can also be stimulated by breast pumping, if you choose not to, or are unable to breastfeed. Prolactin levels Just like all of our hormones, from time to time, our prolactin levels can get off balance. This can cause a whole range of different symptoms and effects throughout the body, including affecting our thyroid hormones, stress hormones, menstrual cycles and ovulation. What are normal prolactin levels? Reference ranges for what is a normal prolactin level will be specific to the lab that is testing your sample.  Higher prolactin levels are usually present in those assigned-female-at-birth than those assigned-male-at-birth. In general, prolactin levels are expected to be less than 25 μg/L in those assigned-female-at-birth, who are not pregnant or breastfeeding. High prolactin levels Too much prolactin can stop our brains from producing FSH and LH—two key hormones involved in regulating our menstrual cycles and bringing about ovulation.  If FSH and LH are affected, ovulation can stop leading to the loss of periods, which is called amenorrhoea. No ovulation means no chance of a pregnancy, and therefore big issues for our fertility. Disruption to our menstrual cycle can also cause knock-on effects on our oestrogen levels, causing oestrogen deficiency. Some of the most common symptoms of high prolactin levels to look out for are milky white discharge from the nipples when not breastfeeding (galactorrhea), disturbances to the menstrual cycle, visual disturbances, headaches and symptoms of oestrogen deficiency. High prolactin levels can be caused by a variety of reasons, including imbalances in our thyroid and stress hormones. Additionally, a growth or tumour present in our pituitary glands, called a prolactinoma, can also cause persistent or increasing prolactin levels. Symptoms of high prolactin levels can include: Note: If you are experiencing any form of nipple discharge when not breastfeeding, get this checked by a physician or GP as it can be a symptom of breast cancer. Symptoms of high prolactin levels after menopause Although high prolactin levels are not common in those postmenopausal, it can occur. Excess prolactin after menopause often causes hyperthyroidism, when the body doesn’t make enough thyroid hormone. Symptoms can include: How to lower prolactin levels If you’re wondering how to reduce prolactin levels, this is very much dependent on the cause of your excess prolactin levels.  Your doctor may prescribe you medications like bromocriptine or cabergoline to lower your prolactin secretion. Surgery may also be recommended as the best treatment option for you.  Persistently high prolactin that has been caused by chronic stress, over-exercising or poor sleep may be lowered by lifestyle modifications. Low prolactin levels On the flip side, low prolactin levels is called hypoprolactinemia. Sometimes there aren’t any obvious symptoms of low prolactin levels, other than not being able to produce or release much breast milk after giving birth. Breastfeeding can increase our prolactin levels naturally—as the more we stimulate the nipples, more prolactin is produced.  Most people with low prolactin levels don’t have any specific medical issues, although there is preliminary evidence that suggests they might have reduced immune response to some infections and it could indicate that the pituitary gland isn’t functioning properly. Why should we test our prolactin levels? Like all of our reproductive hormones, it’s good to check in with prolactin regularly, especially if we’re trying to conceive or having any problems with our menstrual cycles or experiencing hormonal symptoms.  Testing our prolactin levels with a prolactin blood test can help us to determine if there are any hormonal issues affecting our fertility or menstrual cycle, or investigate any symptoms of prolactinoma. With a Hertility Hormone and Fertility test, we can test your prolactin levels alongside your Anti müllerian hormone (AMH), thyroid hormones and cycling hormones (FSH, LH and oestrogen) to help you gain a full insight into your hormonal health and fertility. If you’ve already done a test and received an abnormal prolactin result, you can book an appointment with one of our Private Gynaecologists specialising in hormone and fertility concerns to discuss your results and get a personalised care plan. Appointments are available daily, with no GP referral required. Prolactin FAQs Can I get an FSH, LH, Prolactin test all in one? Luckily, you’re in exactly the right place. With our Hormone and Fertility test we will test you for up to 10 reproductive hormones, including your FSH, LH, prolactin and more.  Do prolactin levels change with age? Unlike hormones like Anti Müllerian Hormone […]

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:

Follicle-stimulating hormone (FSH) is really important for our reproductive health. In this article, find out how to know what normal FSH levels look like, what the symptoms of high and low FSH levels are and how to balance your FSH levels. Quick facts: What is FSH?  FSH stands for Follicle-Stimulating Hormone and is one of the main hormones involved in the regulation of your menstrual cycle and ovulation—making it an important hormone not only for your health but your fertility too. FSH is what’s known as a gonadotropin hormone. It’s released by the pituitary gland in the brain and then acts on the ovaries.There is only one other gonadotropin hormone in the body—luteinising hormone (LH). True partners in crime, there’s no FSH without LH, and they act in tandem to bring about changes which essentially regulate ovulation. Normal FSH levels in women Because our FSH levels are intricately linked to our ovarian reserve, what’s considered a ‘normal’ FSH level changes as we age. This is because our ovarian reserve declines as we age which makes our FSH levels increase.  Gonadotropic hormones are hormones released from the pituitary gland in the brain and released into the bloodstream. Gonadotropins then go on to act on the ovaries. There are two types of gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).  The pituitary gland produces FSH which acts on the ovaries to stimulate the growth of follicles containing your eggs. As well as growing the ovarian follicles, FSH stimulates the granulosa cells that surround the follicle to produce oestrogen from testosterone, an essential hormone for regulating the menstrual cycle (1). You can read more about oestrogen here.  What does FSH do? FSH has two primary functions:  Follicular development FSH does pretty much exactly what it says on the tin—it stimulates the growth of follicles which contain your eggs.  You’re born with ‘immature’ eggs. So each month, a number of them start maturing before one is released during ovulation. Your eggs are housed in tiny follicles inside your ovaries, and it’s these follicles that FSH signals to prepare your eggs for ovulation (2). Oestrogen production FSH also stimulates the cells that surround the follicles to make an enzyme called aromatse, which converts testosterone into oestrogen, another essential hormone for regulating the menstrual cycle and reproductive health (1). The relationship between FSH and LH When your eggs are fully mature and ready to be released during ovulation, LH steps in. A surge of LH is released, again by the pituitary gland in the brain, causing the most mature follicle to rupture—releasing an egg into your Fallopian tube. This is ovulation.  Despite FSH causing numerous follicles, and therefore numerous eggs, to mature each cycle, only one follicle will release an egg each month. This is because FSH and LH are both involved in negative feedback loops, controlled by E2. But what does negative feedback loop mean? Increasing FSH levels in the early stages of your menstrual cycle leads to more oestrogen being made, but this ha, a negative feedback effect on FSH levels. In other words, when you have lots of oestrogen, it feeds back to the brain that it needs to stop making more FSH. Similarly, with LH, oestrogen levels keep increasing through the cycle and once they reach a peak around the middle of the cycle, it causes a sudden surge in LH that promotes ovulation. After ovulation, the empty follicle that once contained the egg makes another hormone, progesterone, to support conception, implantation and the early stages of pregnancy. High levels of progesterone tell the brain to stop making more FSH. Now if a pregnancy doesn’t happen, there is a drop in oestrogen and progesterone which triggers your period. It also tells the brain it needs to start making FSH to start the whole process all over again in the next menstrual cycle (5). High FSH levels Okay, but what happens when we have high FSH levels? Let’s take a look at the causes and symptoms of high FSH levels. What causes high FSH levels? The most common reason for high FSH levels is a low ovarian reserve (egg count), or ovaries that aren’t functioning properly. When we have a low ovarian reserve, this essentially means we have a smaller number of immature follicles available in our ovaries and our bodies will produce less oestrogen.  Because oestrogen controls how much FSH we produce (remember that negative feedback loop), when we have less oestrogen, our FSH levels may go up.  High FSH levels can therefore indicate that our ovaries aren’t functioning properly, be an indicator of low ovarian reserve or an indicator of the onset of menopause. Other reasons for high FSH levels can be ovarian cancer (although this is very rare) (9) and Premature Ovarian Insufficiency (POI) which is the loss of ovarian function before the age of 40 (6,7). In some cases, dietary and lifestyle factors can moderately raise FSH levels. Symptoms of high FSH levels Symptoms of high FSH levels usually mimic symptoms of menopause and are related to low oestradiol levels —which is why it’s so important to test a range of your reproductive hormones to get to the bottom of symptoms. Symptoms can include: How to lower FSH levels? It is important to understand that if high FSH levels have been caused by menopause or a low egg reserve, modifications to your diet or lifestyle will not be able to reverse this. However, there are some dietary lifestyle factors associated with a higher FSH, such as smoking and high alcohol consumption.  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 (17). For advice on how to quit smoking, see the full list of NHS quit smoking services here. Nutrition can be a really powerful tool in balancing hormones and helping to alleviate symptoms. You can book a nutritional health consultation with one of our registered nutritionists via your health hub. […]

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: