Tag: hormones

Oestrogen is a group of hormones that controls your menstrual cycle and supports your fertility, bones, heart, skin, mood and vaginal health. The main type before menopause is oestradiol. Your oestrogen levels rise and fall across your cycle and gradually fall with age, and levels that are too high or too low can cause symptoms. You might have come across oestrogen because your periods have changed, you’re trying to conceive, or you’ve noticed symptoms that could be hormonal. This guide explains what oestrogen does, how it changes through your cycle and life, the signs of high and low oestrogen, and how to get your levels tested. Quick facts: Not sure whether your oestrogen is behind your symptoms? Hertility’s Advanced Hormone and Fertility Test checks your oestradiol alongside other key hormones from home, timed to your cycle. You’ll get a doctor-written report explaining what your results mean for you. What is oestrogen? Oestrogen is a reproductive hormone that everyone makes, whatever their sex. Levels are much higher in women. It’s often called the “female” sex hormone because it drives the development of the female reproductive system and controls the menstrual cycle. Before menopause, most oestrogen is made in your ovaries by follicles, the small sacs that contain your developing eggs. Its production depends on other hormones: Smaller amounts of oestrogen are also made in fat tissue. What are the different types of oestrogen? Your body naturally makes three main types of oestrogen, plus a fourth specialised type found during pregnancy: Weak forms of oestrogens can attach to oestrogen receptors, but their effect on the body is less compared to more active oestrogens.  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: How does oestrogen change during your menstrual cycle? Like all of our menstrual cycle hormones, our oestrogen levels during the menstrual cycle fluctuate.  1. At the start of your period, oestrogen is low. 2. In the first half of your cycle (the follicular phase), eggs mature inside follicles in your ovaries. As the follicles grow, they release more oestrogen, so levels rise steadily. 3. Just before ovulation, oestrogen peaks. This triggers a surge of LH, which causes a follicle to release a mature egg.  During this phase of your cycle i.e. from the start of your period to ovulation, oestrogen levels are high. You may notice your skin is feeling clearer and you have increasing energy levels and improved mood. Your cervical fluid also changes throughout the follicular phase, during the early to mid follicular it is dry or sticky, around the mid to late follicular phase it can become thicker, sticky or creamy and as you move towards ovulation, it becomes wet and slippery, like egg white. Additionally, some people notice an increase in their libido around ovulation. 4. In the second half of your cycle (the luteal phase). After the egg is released, the follicle’s walls form a new structure called the corpus luteum. The main function of the corpus luteum is to produce high levels of progesterone and some oestrogen. Progesterone rises to prepare your womb lining for a possible pregnancy. 5. If the egg isn’t fertilised, oestrogen and progesterone fall back to baseline, and this triggers your period. When oestrogen levels are lower before your period, you may start noticing Premenstrual symptoms (PMS). Why this matters for getting pregnant. Oestrogen helps trigger ovulation, so low or disrupted oestrogen can affect whether you ovulate. If you don’t ovulate, you can’t get pregnant. That’s why checking your hormones is useful if you’re trying to conceive. Read more about ovulation. 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: How does oestrogen affect your fertility? Oestrogen is involved in almost every step of getting pregnant. It triggers ovulation. As follicles grow in the first half of your cycle, they release more and more oestrogen. When levels peak, they trigger the surge of LH that releases an egg. It helps sperm reach the egg. Rising oestrogen changes your cervical mucus, making it clear, slippery and stretchy around ovulation. This type of mucus helps sperm swim through your cervix towards the egg. It prepares your womb. Oestrogen thickens your womb lining so that a fertilised egg has somewhere to implant. Progesterone then takes over after ovulation to keep the lining ready. If your oestrogen is low, you may not ovulate regularly, and your womb lining may stay thin. If your oestrogen is high compared with progesterone, it’s often a sign that you’re not ovulating every cycle. Either way, it can make it harder to conceive. That’s why oestradiol is one of the hormones usually checked when you’re trying to get pregnant. It’s also closely monitored during IVF and egg freezing, to track how your follicles are growing. If you’re trying to conceive and your cycles are irregular, Hertility’s Advanced Hormone and Fertility Test can help you understand what’s going on. Does oestrogen decline with age? Yes. As you get older, your ovaries contain fewer eggs and follicles, so they gradually make less oestradiol. During perimenopause, the years leading up to menopause, oestrogen doesn’t fall steadily. It goes up and down unpredictably, which can cause irregular periods, hot flushes and mood changes. Read our guide to what perimenopause is. After menopause, once you’ve gone 12 months without a period, oestradiol falls to low levels and oestrone becomes the main type. Lower oestrogen causes many common menopause symptoms, such as hot flushes, vaginal dryness, dry skin and mood changes. It also raises your long-term risk of osteoporosis and heart disease. Hormone replacement therapy (HRT) can relieve symptoms of low oestrogen for many people during perimenopause and after menopause. Find out more about […]

Yes, stress can affect your period. It can delay ovulation, which makes your period late. It can also make your cycles shorter or more irregular, change how heavy your bleeding is, and in some cases stop your periods altogether. This happens because stress hormones can disrupt the signals from your brain that control your cycle. Most of us have noticed our period arriving late during a stressful month, or acting differently when life feels overwhelming. That’s not your imagination. This guide explains how stress affects your menstrual cycle, the different changes it can cause, how to tell if stress is behind them, and when to get checked. Quick facts: Want to know what’s really behind your cycle changes? Hertility’s Advanced Hormone and Fertility Test checks the key hormones that control your periods from home. It comes with a doctor-written report, so you’re not left guessing. How does stress affect your period? Stress affects your period through your brain. Two systems are involved, and they both start in the same place: a part of your brain called the hypothalamus. Your stress response. When you’re stressed, your hypothalamus releases corticotropin-releasing hormone (CRH). This leads your adrenal glands to make cortisol, often called the stress hormone. This system is known as the hypothalamic-pituitary-adrenal (HPA) axis. Your menstrual cycle. Your hypothalamus also makes gonadotropin-releasing hormone (GnRH). GnRH tells your pituitary gland (another part of the brain) to make follicle-stimulating hormone (FSH) and luteinising hormone (LH), which control how your eggs develop and when you ovulate. This system is known as the hypothalamic-pituitary-ovarian (HPO) axis. Because both systems are controlled from the same place, one can affect the other. When your stress response is working hard, CRH and cortisol can interfere with the release of GnRH. That disrupts FSH and LH, which can delay or prevent ovulation. And because the timing of ovulation largely decides when your next period arrives, disrupted ovulation can change your whole cycle. In the short term, this is your body putting survival ahead of reproduction. A one-off stressful week is unlikely to cause lasting changes, but ongoing, chronic stress can keep disrupting these signals over many months. What counts as stress. Stress isn’t only emotional. Your body responds in a similar way to physical stress, such as not sleeping or eating enough, being unwell, or exercising very hard. Worry, feeling overwhelmed, and big life events such as exams, job pressure, money problems or relationship difficulties can all play a part.  Everyone reacts differently. Some people notice changes to their cycle straight away. For others, changes take longer to appear, and some people never notice a physical effect at all. That’s why it’s hard to predict which kinds of stress will affect your period.The science behind stress Can stress delay your period? Yes. Stress is one of the most common reasons for a late period. Your cycle has two halves. The first half, before ovulation, is known as the follicular phase, and it can vary in length. The second half, known as the luteal phase, usually lasts about 12 to 14 days. When stress hormones block the LH surge that triggers ovulation, ovulation happens later, so your period arrives later too. How late depends on how long ovulation is delayed. It might be a few days, or a week or more. If you don’t ovulate at all that cycle, you may skip a period entirely. If your period is late, take a pregnancy test first if there’s any chance you could be pregnant. Pregnancy is the most common reason for a missed period. Can stress cause early periods? Yes, it can. Research has linked high stress with shorter cycles as well as longer ones. A cycle that arrives a few days early once in a while is usually nothing to worry about. The average menstrual cycle is about 28 days, but anywhere from 21 to 35 days is considered within a normal range. Cycles can naturally vary by a few days from month to month, especially during times of higher stress, travel, or schedule changes. If your period is a little early but your flow, length, and symptoms feel like your usual cycle, it is likely your body responding to a temporary change. Things often settle back into rhythm on their own once the stressor passes. Stress can also cause spotting or light bleeding between periods, which is easy to mistake for an early period. If you often bleed between periods, see your GP to rule out other causes. Can stress stop your period? Yes. Severe or ongoing stress can stop ovulation for months at a time, which stops your periods altogether. This is known as functional hypothalamic amenorrhoea (FHA). FHA is most likely when psychological stress, such as a major life event, work or study pressure, money worries or relationship difficulties, happens alongside physical strain on your body. That strain could be: When your body senses it doesn’t have the energy or safety to support a pregnancy, it switches off the signals that control your cycle. FHA isn’t just about missed periods. Without regular periods, your oestrogen levels fall. Over time, that can affect your bone health and make it harder to get pregnant. The NHS advises seeing your GP if your periods have stopped for three months or more, or if you’ve missed periods and are worried. With the right support, which can include reducing stress, eating enough and adjusting your exercise, periods often return. Have your periods stopped or become unpredictable? Missed periods can be caused by stress, but they can also be a sign of PMOS, a thyroid problem or raised prolactin. Hertility’s Advanced Hormone and Fertility Test checks your FSH, LH, oestradiol and other key hormones from home, to help find out why your periods have changed. Can stress cause longer or heavier periods? It can. When stress delays or stops ovulation, your body doesn’t make the progesterone that normally follows. Without progesterone to balance it, oestrogen can keep thickening your womb lining for longer […]

From PMDD symptoms and AMH levels to managing PMOS without contraception, Hertility’s clinical team answers your most pressing cycle and hormone questions.

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 […]

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

Whether you’ve just come off the pill, had your implant removed, stopped the contraceptive injection or had your IUD taken out, one of the most common questions is: when should I test my hormones after stopping contraception? You might call it birth control or contraception, either way, the timing of hormone testing depends on the method you used and whether your natural cycle has returned. Some forms of hormonal contraception suppress ovulation and temporarily affect the hormones involved in your menstrual cycle. Test too soon, and your results may not reflect your natural baseline. Test at the right time, and your hormone results can give you a much clearer picture of your reproductive health, ovarian reserve and cycle function. Here’s exactly when to test your hormones after stopping contraception, broken down by type. Quick facts: Why timing matters when testing hormones after contraception Hormonal contraception introduces synthetic hormones into your body. Depending on the type, it may suppress ovulation, change cervical mucus, thin the womb lining or affect the signals between your brain and ovaries. Your cycle needs time to restart This signalling system is called the hypothalamic-pituitary-ovarian axis, or HPO axis. It controls the hormones involved in ovulation and menstrual cycles, including FSH, LH and oestradiol. When you stop hormonal contraception, your body needs time to clear the synthetic hormones. Your natural hormonal rhythm also needs time to restart. Some people get their period back within a few weeks. Others need several months before their cycles become regular again. Testing too soon can affect your results If you test cycling hormones too soon, your results may not show your natural baseline. FSH, LH and oestradiol may still look suppressed. Your cycle may also be too unpredictable to time the test correctly. This can make results harder to interpret. You may see results that look abnormal, even though your body is simply adjusting after contraception. You may also get results that seem reassuring but do not show the full picture. Getting the timing right makes your hormone test more accurate and more useful. How does hormonal contraception affect hormone test results? Different hormones respond to contraception in different ways. You can test some markers while you still use contraception. Others need a natural cycle to return first. Cycling hormones (FSH, LH, oestradiol) FSH, LH and oestradiol are cycling hormones. They rise and fall across the menstrual cycle and are closely linked to ovulation. Hormonal contraception can suppress the brain-ovary signals that control these hormones. This happens most clearly with combined hormonal contraception, such as the combined pill, patch and ring. If you test FSH, LH and oestradiol while using hormonal contraception, the results usually show the effect of contraception. They do not show your natural cycle. This is why Hertility recommends waiting until you have had 3 full cycles before testing these markers. AMH or anti-Müllerian hormone, gives information about ovarian reserve. It is not a cycling hormone. This means you can test AMH at any point in your cycle, including while you use hormonal contraception. However, research suggests hormonal contraception may lower AMH in people currently on it, with the effect more pronounced in long-term users. Importantly, AMH levels appear to rebound to true baseline within a few months of stopping. This means an AMH result on contraception can still be useful, but testing or retesting after 3 full cycles off hormonal contraception can give a more accurate baseline. Androgens (testosterone and DHEAS) Hertility can test androgens, including testosterone and DHEAS, while you use hormonal contraception. However, your results need careful interpretation. The combined pill can increase SHBG, or sex hormone-binding globulin. SHBG binds to testosterone in the bloodstream. This can reduce the amount of free, active testosterone available to the body. Hertility always interprets androgen results in context, rather than looking at one hormone on its own. SHBG (sex hormone-binding globulin) The combined pill substantially raises SHBG, which affects the interpretation of any androgen and oestrogen results. SHBG can remain elevated for months after stopping the pill in some people, which is another reason retesting after a full 3 cycles gives a clearer picture. Thyroid hormones (TSH, Free T4) Hormonal contraception does not usually suppress thyroid hormones. You can usually test TSH and Free T4 whether you are on or off contraception. Prolactin Most forms of hormonal contraception do not meaningfully affect prolactin. You can test prolactin at any point. When to test your hormones after stopping the combined pill Recommended wait before testing hormones: 3 cycles after stopping The combined pill contains synthetic oestrogen and progestogen. It works mainly by stopping ovulation, which means it suppresses the natural rise and fall of cycling hormones such as FSH, LH and oestradiol. For most people, natural hormone production begins to resume within a few weeks of stopping, but cycles can take up to 3 months to fully re-establish their rhythm. For the most accurate results, we recommend waiting 3 months after your last pill before testing cycling hormones (FSH, LH, oestradiol). Can AMH be tested after stopping the pill? AMH can be tested at any point, including while you are still on the pill. However, because AMH may be mildly suppressed during hormonal contraception use, testing after 3 full cycles off the pill may give the clearest baseline. If you test AMH while on the pill, the result can still provide useful information about ovarian reserve, but it should be interpreted in context. When to test your hormones after stopping the progestogen-only pill (mini pill) Recommended wait before testing hormones:  3 cycles after stopping The progestogen-only pill, often called the mini pill, contains progestogen rather than oestrogen. It mainly works by thickening cervical mucus, making it harder for sperm to reach an egg. Some types can also suppress ovulation. Because the mini pill may still affect ovulation and cycle regularity, At Hertility, we recommend waiting until you have had 3 full cycles before testing your hormones. This helps ensure your hormone results reflect your natural baseline rather than a cycle that […]

Menopause support at work is an increasingly important part of employee wellbeing, inclusion, and retention. For UK employers, effective support can help reduce avoidable barriers to performance, improve employee experience, and create a more inclusive workplace for people at different life stages. This focus has been further sharpened by the government’s rollout of The Renewed Women’s Health Strategy for England. Aligned with the Employment Rights Act, the updated strategy brings a heavy focus on keeping women in the workforce by tackling health-related economic inactivity. Crucially, from Spring 2026, large employers (250+ employees) are being actively encouraged to publish voluntary “Menopause Action Plans” outlining how they support staff, a framework expected to become mandatory by 2027. To champion these changes, the government also expanded the national remit by appointing a new Women’s Employment Ambassador to ensure businesses actively dismantle workplace health barriers. The most effective menopause support combines clear policies, flexible working, practical workplace adjustments, manager training, and access to specialist health support. Together, these measures can help employees manage symptoms such as poor sleep, anxiety, hot flushes, heavy periods, fatigue, and difficulty concentrating. Why menopause support matters for UK employers Menopause can affect employees in different ways and to different degrees. For some, symptoms are manageable. For others, they can have a substantial impact on confidence, attendance, comfort, and work performance. In the UK, employers should also be aware that menopause symptoms may overlap with legal obligations under equality and health and safety frameworks. Guidance from the Equality and Human Rights Commission has made clear that if menopause symptoms have a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities, employers may have a duty to make reasonable adjustments. There is also growing public and employer focus on the role menopause can play in retention, progression, and the gender pay gap. Without the right support, organisations risk losing experienced employees at a point in their careers when they often hold significant knowledge, leadership capability, and commercial value. What menopause workplace benefits should UK employers offer? The most effective menopause workplace benefits are practical, consistent, and easy to access. In most organisations, support falls into five areas: Flexible working arrangements Menopause-friendly workplace adjustments Clear absence and leave guidance Manager training and internal support Access to specialist health benefits 1. Flexible working and leave policies Flexible working is one of the most important tools employers can use to support employees experiencing menopause symptoms. Symptoms can fluctuate from day to day, and rigid schedules may make work more difficult to manage. UK employers can support employees by offering: flexible start and finish times hybrid or remote working where appropriate temporary adjustments to working hours additional short breaks during the day flexibility during periods of more severe symptoms Clear menopause-related absence guidance is also important. Acas recommends that when someone is off sick because of menopause, employers should consider recording this separately from other types of sickness absence. This can help reduce the risk of employees being unfairly penalised under standard absence trigger processes. A supportive policy should make it easier for employees to ask for help without feeling that their symptoms will be treated as a performance or conduct issue. 2. Workplace adjustments that improve comfort Small adjustments to the physical working environment can make a meaningful difference to how manageable symptoms feel during the working day. In many cases, these are low-cost changes that are simple to put in place. Examples of workplace adjustments for menopause include: desk fans or improved ventilation seating near windows or cooler areas access to drinking water easy access to washrooms provision of emergency sanitary products quiet rooms or rest areas for short breaks flexibility around uniforms or dress codes to allow breathable fabrics These measures can help employees manage symptoms such as hot flushes, dizziness, fatigue, anxiety, and, for those in peri-menopause, heavy or irregular periods with greater comfort and dignity. 3. Health benefits that support menopause care In addition to practical workplace adjustments, many UK employers are strengthening their health benefits to include menopause-specific support. This can help employees access timely information, specialist guidance, and appropriate clinical care. Menopause-related employee health benefits include: occupational health referrals menopause specialist consultations counselling or mental health support nutrition support hormone health education guidance on treatment options, including HRT where appropriate Some employers also provide educational workshops or lunch-and-learn sessions to improve awareness across the wider organisation. These sessions can help colleagues and managers better understand menopause symptoms, treatment pathways, and the impact symptoms can have at work. 4. Manager training and internal support A menopause policy is only effective if managers know how to apply it. Manager confidence plays a major role in whether support is experienced as meaningful in practice. Training should help managers: have sensitive and confidential conversations respond appropriately to disclosures about symptoms understand that symptoms such as brain fog, poor sleep, or difficulty concentrating may be health-related avoid treating menopause-related challenges as misconduct or underperformance signpost employees to internal and external support Some employers also create internal support structures such as menopause champions, peer support groups, or wellbeing leads. These can help make support more visible and reduce stigma across the organisation. 5. What should a menopause policy include? A clear menopause policy helps create consistency across teams and gives employees confidence that support is available. For UK employers, a menopause policy may include: a statement of organisational commitment guidance for managers examples of workplace adjustments flexible working options how menopause-related absence should be handled confidentiality expectations information about employee benefits and support pathways signposting to occupational health, EAP support, or specialist providers The purpose of the policy should be to make support clear, practical, and fair, rather than dependent on individual manager discretion. Menopause workplace benefits: quick reference table Support area Example Why it helps Flexible working Later start times, hybrid work, adjusted hours Helps employees manage poor sleep, fatigue, and fluctuating symptoms Physical adjustments Fans, ventilation, rest spaces, washroom access Improves comfort and reduces disruption […]

Anti-Mullerian Hormone (AMH) is one of the most talked-about markers in reproductive health, providing an insight into your hormonal health and ovarian reserve. But receiving a “low” AMH result can feel alarming, especially when you’re not sure what it actually means. The good news is that a low AMH is not a confirmation that you cannot conceive naturally. In this article, we explore what it means to have a low or out-of-range AMH result, what causes it, and what your options are; whether you’re trying to conceive now, or simply planning for the future. If you haven’t yet tested your AMH, our Advanced At-Home Hormone & Fertility Test can measure AMH alongside up to nine other key hormones, giving you a personalised, clinically meaningful picture of your reproductive health. Quick Facts: A low AMH result indicates a lower-than-expected ovarian reserve for your age, but does not mean you cannot conceive naturally AMH measures egg quantity only, it tells you nothing about egg quality, which is one of the most important factors in conception AMH naturally declines throughout life; a low result does not mean you have done anything to cause it. Certain factors, including hormonal contraception and some medical conditions can temporarily affect AMH levels. Low AMH may have implications for IVF planning and NHS eligibility, but a low result does not close the door on treatment Your AMH result should never be interpreted in isolation, it only makes sense alongside your age, other hormones, and clinical history What is AMH and what does it measure? Anti-Müllerian hormone (AMH)  is a hormone made by small fluid-filled sacs in the ovaries called follicles, each of which contains an immature egg. Because AMH is made by these follicles, your AMH level gives an indication of how many eggs you have remaining at a given time. This is known as your ovarian reserve. Unlike hormones such as FSH, oestradiol, and LH, which fluctuate significantly across the menstrual cycle, AMH remains relatively stable. This stability is one of the key reasons it became widely adopted in reproductive medicine: it can be measured on any day of your cycle and still give a meaningful result. It is worth noting, however, that more recent studies have shown that there may be some slight variation in AMH levels across the menstrual cycle, but this variation remains considerably smaller than that seen in other reproductive hormones. As a result AMH is still considered one of the most stable and reliable markers of ovarian reserve. AMH is now routinely used when someone is considering undergoing a fertility treatment to estimate how the ovaries are likely to respond to stimulation, guide medication dosage, and determine eligibility for treatment. For a deeper dive into everything AMH testing can and can’t tell you, including its role in identifying PCOS and guiding fertility treatment, read our full guide: What Does AMH Testing Tell You? 5 Key Insights About Your Fertility What Does “Low AMH” Actually Mean? When we refer to “low AMH,” we mean a result that falls below the expected range for your age group. Because AMH naturally declines as you get older, what counts as “low” is always interpreted relative to age-specific reference ranges, not a single universal cutoff. A low AMH result can suggest that your ovarian reserve may be lower than expected for someone your age. This is sometimes referred to as having a Diminished Ovarian Reserve (DOR). However, it is important to emphasise that a lower ovarian reserve does not automatically mean reduced fertility or an inability to conceive naturally. The most important thing to understand: AMH measures quantity, not quality This distinction is worth repeating, because it is the most common source of confusion and unnecessary distress after receiving a low AMH result. AMH tells you about egg quantity. It does not tell you anything about egg quality. Egg quality i.e. how healthy eggs are, how likely they are to be fertilised, and how likely they are to develop into a viable embryo is influenced primarily by age and genetics. Currently there is no reliable way to measure it directly outside of accessing embryos created during IVF. This matters enormously in practice. Research consistently shows that AMH levels alone are not strongly predictive of natural pregnancy rates. People with low AMH conceive naturally every day. Conversely, a normal or high AMH result does not guarantee fertility. Fertility is shaped by many factors: ovulation, sperm health, Fallopian tube function, uterine health, and overall wellbeing. In short: a low AMH result is not a diagnosis of infertility. Hertility’s own research found no significant association between low AMH and risk of miscarriage or recurrent pregnancy loss, an important finding that further underscores the limitations of AMH as a standalone predictor of pregnancy outcomes. What Causes Low AMH? In most cases, there is no single identifiable “cause” of a low AMH level in the way we typically think about causes of illness. It is important to know that if you have received a low AMH result, nothing you’ve done has caused this. AMH levels follow a natural trajectory across the reproductive lifespan; it peaks in the early-to-mid twenties, and then gradually declines toward menopause. This decline is a normal part of reproductive ageing, and the rate at which it happens varies between individuals, largely due to genetics. Some factors that may be associated with lower AMH levels include: Age – the most significant driver of declining AMH Genetics – family history can influence the rate of ovarian ageing Previous ovarian surgery – procedures to remove ovarian cysts or tissue (for example endometriosis) may reduce ovarian reserve Certain autoimmune conditions – which can affect ovarian function, for example Hashimoto’s disease, rheumatoid arthritis, and Addison’s disease. Cancer treatment – some types of chemotherapy and radiotherapy are referred to as gonadotoxic (i.e. toxic to the gonads such as the ovary) which can impact the ovaries Hormonal contraception – can cause a temporary, reversible reduction in AMH levels, typically by 15% to 30% and […]

Research shows that on average, it takes two years and visits to three different doctors for someone to get a diagnosis of polycystic ovary syndrome (PCOS), even though it’s one of the most common hormonal conditions in the UK, affecting around 1 in 10 women. Part of the problem is that PCOS presents differently in different people. There’s no single symptom that confirms it, no single test that catches every case, and whilst the  diagnostic criteria is  clinically sound, it requires ruling out other conditions before it can be applied. Add  that to the reality that many GPs have limited time and variable knowledge of reproductive hormones,  it’s not difficult to understand why so many people spend years being told their symptoms are normal, or being tested for the wrong things. This guide walks through exactly how PCOS is diagnosed: the criteria clinicians use, the tests involved, what the process typically looks like, and what you can do if you’re struggling to get answers. Quick Facts How is PCOS diagnosed? PCOS is most commonly diagnosed using what’s known as the Rotterdam criteria, established by an international consensus in 2003 and last updated in 2023. To receive a PCOS diagnosis, a person must meet at least two of the following three criteria: 1. Irregular or absent menstrual cycles. This means cycles that are consistently shorter than 21 days, longer than 35 days, or absent altogether. Irregular cycles indicate that ovulation is not occurring regularly, a key feature of PCOS. According to the 2023 International Evidence-Based PCOS Guidelines, irregular cycles are defined as fewer than eight cycles per year, or cycle intervals outside the 21–35 day range, in women who are at least three years post-menarche (which is your first period). 2. Clinical or biochemical signs of high androgens (hyperandrogenism). This means either physical symptoms associated with elevated androgens such as excess facial or body hair (hirsutism), acne, or scalp hair thinning or elevated androgen levels on a blood test – typically testosterone. Importantly, you don’t need both signs of hyperangrogenism – physical signs alone, or blood results alone, can satisfy this criterion. 3. Polycystic ovarian morphology (PCOM). This refers to the appearance of the ovaries on an ultrasound scan, specifically a high number of small antral follicles (the immature follicles that house eggs) in one or both ovaries, or an increased ovarian volume. Alternatively, a high AMH (anti-Müllerian hormone) level on a blood test can be used as a marker of PCOM when an ultrasound isn’t available or appropriate. Two out of three. That’s the threshold. Which means you can have PCOS without polycystic-looking ovaries on a scan. You can have PCOS without acne or excess hair growth. You can have PCOS with a relatively regular period. This variability is one reason why the diagnosis of PCOS is frequently missed or delayed – there’s no single presentation that fits everyone. What tests might I need to do to get a PCOS diagnosis? A PCOS diagnosis is built from a combination of clinical assessments, blood tests, and often an ultrasound. Here’s what each one involves. Blood tests for PCOS diagnosis Blood tests are central to PCOS diagnosis, both for assessing hormone levels and for ruling out other conditions that can mimic PCOS. The following are typically included in a diagnostic workup: LH and FSH Luteinising hormone (LH) and follicle-stimulating hormone (FSH) are both made by the pituitary gland and work together to regulate the menstrual cycle. In PCOS, LH is often elevated relative to FSH, producing a raised LH:FSH ratio (typically greater than 2:1). This is one of the hormonal patterns clinicians look for in the early follicular phase, ideally tested around day 2–5 of the cycle. Oestradiol Oestradiol (the primary form of oestrogen) is tested alongside FSH to interpret the hormonal picture correctly. High oestradiol can suppress FSH artificially, which is why these two should always be read together. Testosterone and other androgens Testosterone and DHEAS (dehydroepiandrosterone sulphate) are tested to assess androgen levels. Elevated androgens support the hyperandrogenism criterion and help explain symptoms like excess body or facial hair and acne.  SHBG blood test measures the level of a protein called sex hormone binding globulin (SHBG) in your blood. SHBG attaches to sex hormones such as testosterone and estrogen and helps control how much of these hormones are active  in the tissues of your body and to understand how testosterone and oestrogen are working in the body. AMH (anti-Müllerian hormone) AMH is made by the antral follicles in the ovaries (early stage follicles that haven’t been selected for ovulation yet) and reflects the size of your egg reserve. In PCOS, AMH is often significantly elevated becausethere is a high number of small follicles stuck at different stages of development. A high AMH can serve as a marker of polycystic ovarian morphology in clinical settings, particularly when an ultrasound is unavailable. AMH doesn’t fluctuate dramatically across the cycle but is ideally tested on day 3 of the cycle for consistency. Thyroid function tests (TSH and free T4) Both an underactive and overactive thyroid can cause irregular cycles, weight changes, and fatigue that closely resemble PCOS symptoms. Ruling out thyroid issues is a standard part of the diagnostic process. Prolactin Elevated prolactin (hyperprolactinaemia) can also disrupt the menstrual cycle and cause irregular or absent periods. Testing prolactin helps exclude this as an alternative explanation for cycle irregularity. Glucose and insulin / HbA1c Because insulin resistance affects a lot of people with PCOS and significantly impacts its management, assessing metabolic markers such as fasting glucose or HbA1c is an important part of a thorough diagnostic workup. These tests are ideally taken in the early follicular phase, between days 2–5 of the menstrual cycle, when cycling hormones like LH, FSH, and oestradiol are at their baseline. If your cycles are very irregular, your doctor may advise testing at a specific point or to simply proceed whenever possible. Hertility’s Advanced At-home Hormone & Fertility Test checks for these markers including LH, FSH, oestradiol, testosterone, […]

In our recent webinar, we unpacked the science behind fertility, explaining how hormones regulate ovulation, why timing matters, and how ovarian reserve naturally changes with age. We explored evidence-based ways to optimise egg and sperm health through nutrition, sleep, stress management, and reducing exposure to endocrine disruptors. But as always, the most important part of the session was your questions. Many of them couldn’t be answered fully in the time we had live. So we’re starting something new. Welcome to the Hertility Expert Q&A series,  a new post-webinar blog series where our clinical and research team answer your most pressing women’s health questions in depth. This edition covers the questions submitted during our fertility science webinar, including: What’s the difference between folic acid and methylfolate? What are the best nutrition and supplement strategies for managing PCOS? How soon can you try again after a miscarriage? Should men stop alcohol and nicotine when trying to conceive? Can diet improve AMH levels? Watch the webinar here This edition’s questions were answered by Emily Moreton, Clinical Services Manager at Hertility, fertility nurse, and registered nutritionist specialising in reproductive health. Emily holds a Master’s degree in Clinical Nutrition and Public Health from UCL and is a trained nutrition counsellor. Her work focuses on health-promoting behaviours, empowering individuals to improve their relationship with food, movement, and their body without restrictive dieting. ​​Her clinical expertise supports individuals in optimising fertility, managing PCOS and hormonal symptoms, maintaining a healthy pregnancy, and navigating menopause with confidence. We’ve rounded up every answer here so nothing gets lost in your inbox. Folic acid vs methylfolate: what’s the difference and which should you take? If you’re trying to conceive, you’ve likely been told that folic acid is non-negotiable. But then you see supplements advertising “methylfolate” or “5-MTHF” and suddenly the choice feels far less straightforward. Here’s what you actually need to know. The basics first. Folate is the natural form of vitamin B9 found in food. Folic acid is the synthetic version used in most prenatal supplements and fortified foods. Methylfolate, also known as 5-methyltetrahydrofolate (5-MTHF)  is the biologically active form your body ultimately uses. When you take folic acid, your body converts it into methylfolate through a series of enzymatic steps. For most people, this happens efficiently. The official recommendation is . 400mcg of folic acid for all women from three months before conception through the first 12 weeks of pregnancy to reduce the risk of neural tube defects (NTDs) like spinal bifida. This recommendation is backed by major health bodies including the NHS and CDC, and is supported by decades of large-scale clinical trial data. Folic acid is currently the only form of folate clinically proven in human trials to significantly reduce NTD risk. So why does methylfolate exist as an alternative? Some people carry variations in a gene called MTHFR, which can reduce how effectively the body converts folic acid into its active form. For those individuals, methylfolate may raise blood folate levels more efficiently because it bypasses this conversion step entirely. The catch is that methylfolate has not been put through the same rigorous, large-scale trials as folic acid for NTD prevention and at this point, it would be unethical to design such a trial, because it would require withholding a known protective intervention from pregnant women. Which is better absorbed: Folic Acid or Methylfolate? Folic acid is actually very well absorbed, and crucially it is the form used in the large clinical trials that proved it prevents neural tube defects like spina bifida. That is why public health bodies, including the NHS, recommend 400 micrograms of folic acid daily before conception and during the first trimester. However, this dose needs to be increased to 5 milligrams daily (prescription-only in the UK) in certain higher-risk situations. When is a higher 5mg dose of Folic Acid recommended? A higher 5mg dose (prescription-only in the UK) may be recommended if you: Have previously had a pregnancy affected by a neural tube defect Have diabetes Have epilepsy and take anti-epileptic medication Carry certain genetic variants affecting folate metabolism Have a haematological condition such as Sickle Cell Disease or Thalassaemia Are taking medications that interfere with folate metabolism When might methylfolate be worth considering? It may be appropriate in cases of known MTHFR variants, recurrent pregnancy loss, recurrent implantation failure, or where a previous pregnancy was affected by a neural tube defect despite folic acid supplementation. Hertility’s in-house clinical team or registered nutritionists and dieticians if you’d like some advice but ultimately it should be up to the individual to make an informed decision. A large number of fertility supplements now use methylfolate rather than folic acid and that shift isn’t without reason. The reality is that experts are divided. Folic acid remains the gold standard in public health guidelines because it’s backed by decades of clinical trial data. Methylfolate is a promising and increasingly popular alternative, but it doesn’t yet carry the same evidence base for preventing neural tube defects in large-scale trials. Which foods are richest in folate? Supplementation is important, but dietary sources matter too. Good sources include spinach, kale, Brussels sprouts, broccoli, beans and lentils, eggs, oranges, fortified breakfast cereals, nuts and seeds, and wholegrains. Because folate is water-soluble and lost during cooking, steaming or microwaving vegetables rather than boiling helps preserve it. The bottom line: for most women, folic acid remains the evidence-backed standard. If you have reason to believe methylfolate may be more appropriate for you, whether due to a genetic variant or a history of pregnancy complications, speak with your GP or Hertility’s clinical team before switching. Book A nutrition consultation What is the best nutrition approach for PCOS and improving ovulation? PCOS is one of the most common hormonal conditions affecting women of reproductive age and one of the most common causes of irregular ovulation. Search online for the “best diet for PCOS fertility”  or “how to improve ovulation naturally with PCOS,”  and you’ll be met with extremes: cut carbs, go keto, […]