Knowledge Centre

Managing Polyendocrine Metabolic Ovarian Syndrome (PMOS) (formerly Polycystic Ovary Syndrome, PCOS) starts with a simple question: which symptoms matter most to you right now? There’s no single treatment, because the condition affects everyone differently. The right approach depends on your symptoms, your wider health, whether you need contraception and whether you’re trying to conceive. Living with PMOS can mean juggling several symptoms at once: irregular periods, acne, unwanted facial hair, thinning hair, fatigue, or changes to your weight and metabolism. Or it might be just one or two that really bother you. Either way, PMOS rarely needs to be tackled all at once. Here, Dr Yewande, a Women’s Health GP at Hertility, shares practical, evidence-based ways to manage some of the most common PMOS symptoms, and the treatments and support that can help. For a full overview of the condition, read our guide to everything you need to know about PMOS (PCOS). Quick facts 1. Keep track of your periods, even if they have always been irregular If your periods have always been unpredictable, it’s tempting to accept long gaps as normal for you. But with PMOS (PCOS), how often you bleed matters as much as how predictable your cycle is. A typical cycle lasts 21 to 35 days. With PMOS (PCOS), periods often come less frequently, stop altogether (amenorrhoea) or arrive erratically, because PMOS can disrupt ovulation. Why frequency matters. After you ovulate, your body makes progesterone. If you rarely ovulate, your womb lining is exposed to oestrogen without that regular progesterone. Over time, this can make the lining thicken too much, a condition called endometrial hyperplasia. The relative risk of endometrial cancer is also higher with PMOS, although the absolute risk stays low meaning that even though the chance of developing endometrial cancer with PMOS is higher than if you didn’t have PMOS the actual risk of it occurring is low. That’s why long gaps in periods are still worth acting on rather than ignoring. What can help? If you regularly go several months without a period, speak to your GP. Depending on your history and whether you need contraception, options may include hormonal contraception like the pill, a hormonal coil such as the Mirena, or intermittent courses of a progestogen to bring on a withdrawal bleed. If you’re trying to conceive, your options will be different, because the focus shifts to understanding and supporting ovulation. Don’t wait for your cycles to settle before mentioning them. Keep a record for 2-3 months before your appointment of your cycle length (first day of one period to first day of the next), how long bleeding lasts, how painful it is, and flow (light, medium, heavy), so you can tell your doctor exactly how often you’re bleeding.  Want to understand what’s happening with your hormones? Hertility’s Advanced Hormone and Fertility Test helps you build a clearer picture of your hormones and cycle, with results reviewed alongside your symptoms and health history. 2. Stop searching for the perfect “PCOS diet” There’s no single diet proven to be best for PMOS (PCOS). Low-carb diets, keto, intermittent fasting and other eating plans are often promoted for PMOS (PCOS)., but the international guidelines doesn’t recommend one diet over another. Rather than following strict rules, focus on an eating pattern that supports your health and that you can realistically keep up. For many people, that means: If insulin resistance is a concern, eating carbohydrates alongside protein, fibre and healthy fats can make meals more filling and help keep your blood sugar steady. But eating well with PMOS (PCOS), shouldn’t mean constant dieting or feeling guilty about food. The best approach fits your health, culture, budget, preferences and relationship with food. Read our guide on There a Best Diet for PMOS (PCOS)?. If nutrition feels confusing, a Hertility Nutrition Consultation can help you build a plan around you, rather than another generic PMOS (PCOS)  meal plan. 3. Exercise for your health, not just the number on the scales Exercise is one of the most useful tools for managing PMOS (PCOS)., even if your weight doesn’t change. Regular activity supports insulin sensitivity, heart health, sleep, mood and metabolic health. There’s no single “best exercise for PCOS”: current recommendations suggest around 150-300 minutes of moderate activity a week (or 75-150 minutes of more vigorous activity). Either way, add muscle-strengthening activity on at least two days a week. This is in line with UK physical activity guidelines. That doesn’t have to mean intense workouts. Walking, cycling, swimming, Pilates, resistance training or a combination of these are all good options, and the best type is the one you’ll actually keep doing. If you’re currently doing very little, jumping straight to 10,000 steps and five gym sessions a week can make exercise feel impossible. Start smaller. A 15 to 20 minute walk most days is better than an ambitious plan you give up on after a fortnight. 4. If you’re constantly exhausted, don’t automatically blame PCOS Fatigue is common with PMOS (PCOS), but it has many possible causes. Depending on your symptoms, your doctor may check for: PMOS (PCOS) is also linked with a higher rate of obstructive sleep apnoea, regardless of your weight. So if you snore heavily, wake up unrefreshed, get morning headaches or feel unusually sleepy during the day, mention it to your doctor. Sleep apnoea is treatable, and it’s often missed. 5. Your skin symptoms might be hormonal, and topical treatment may not be enough Persistent acne or oily skin can be a visible sign of the hormonal changes linked to PMOS (PCOS). Higher androgen activity (including testosterone) can increase oil production and contribute to acne. This is particularly likely when it appears alongside irregular periods, excess facial or body hair, or scalp thinning. Topical treatments. These can still be very effective. Depending on severity, options include benzoyl peroxide, azelaic acid, topical retinoids or other prescription treatments. When acne keeps coming back. If your acne keeps returning or isn’t improving despite the right treatment, that’s a clue […]

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 […]

It isn’t usually hard to get pregnant at 30. According to NICE, around 86% of women aged 30 to 34 get pregnant within a year of trying, and 94% within two years. Fertility declines gradually through your 30s and more quickly after 35. So preparing your body, understanding your cycle and knowing when to get help can all make a real difference. If you’re in your 30s and thinking about starting a family, you’re far from alone. The average age of mothers in England and Wales is now over 30. But it’s natural to wonder whether you’ve left it too late and what you can do to improve your chances. Here’s what the evidence says, and how to give yourself the best start. Quick facts Is it hard to get pregnant at 30? For most people, no. Your fertility changes gradually with age rather than suddenly. It can take a little longer to get pregnant in your 30s than in your 20s, but most women in this age group still conceive naturally.NICE figures show that: Even in your 20s, getting pregnant isn’t guaranteed in any single cycle, and taking several months is completely normal, over 80% of heterosexual couples in the general population will conceive within 1 year of trying. Your age is only part of the picture. Your cycle, your general health, any underlying conditions and your partner’s fertility all matter too. How does fertility change in your 30s? You’re born with all the eggs you’ll ever have, and both the number and quality of your eggs decline over time. Research on ovarian reserve estimates that by 30, most women have around 12% of the eggs they were born with. By 40, it’s around 3%. In your early 30s, the decline is gradual, and most women still have a good chance of conceiving each month. According to the American College of Obstetricians and Gynecologists, the chance of a woman getting pregnant in a single cycle is about 25% to 30% if she’s in her 20s or early 30s. But by age 40, a woman’s chance of getting pregnant drops to less than 10% per menstrual cycle. Egg quality also changes with age. Eggs rely on the mitochondria, which provide the energy needed for fertilization and embryo development. Over time, mitochondrial function can decline, and oxidative stress can increase, both of which can affect egg quality. From around 35, it speeds up. More eggs have chromosomal abnormalities, which is why the risk of miscarriage rises with age. NHS figures put the risk at around 1 in 10 pregnancies for women under 30, and around 2 in 10 for women aged 35 to 39. Everyone is different, though. Some women have a lower ovarian reserve than average for their age, and some a higher one, so understanding your own fertility can tell you more than your age alone. Read more about how ageing affects fertility and what AMH is and how it’s tested. Your partner’s age matters too. Sperm quality also declines gradually with age, particularly after 40. How to prepare for pregnancy after 30 It’s worth starting to prepare a few months before you start trying. Eggs and sperm both take around three months to fully develop, so the changes you make now may support the ones released when you’re trying. Start taking folic acid. Take 400 micrograms of folic acid every day from before you start trying until you’re 12 weeks pregnant. Some people need a higher 5mg dose, for example if they have a BMI of 30 or more or diabetes. Your GP can prescribe this. The NHS also recommends a daily 10 microgram vitamin D supplement, particularly in autumn and winter. Most people don’t need other supplements, such as iron or calcium, before pregnancy unless a blood test shows they’re low, and you can usually get enough from a balanced diet. If you take a multivitamin, choose one designed for pregnancy, and avoid supplements containing vitamin A (retinol), as too much can harm a developing baby. Book a preconception check with your GP. It’s worth seeing your GP before you start trying if you: Your GP can also talk you through any pregnancy risks linked to your age or health. Plan when to stop contraception. Most contraception doesn’t affect your long-term fertility, and your cycle usually returns quickly after you stop. With some methods, such as the contraceptive injection, it can take longer. Find out how long it takes for your period to return after stopping the pill. Stop smoking and drinking. Stopping smoking and vaping, and cutting out alcohol, are some of the most important steps you can take. Find out when to stop drinking before trying to conceive. Involve your partner. Their health matters just as much. Stopping smoking, cutting down on alcohol and eating well can all support sperm quality. Understand your fertility. Knowing your ovarian reserve and how your hormones are working can help you plan and pick up anything worth addressing early. The Advanced Hormone and Fertility Test gives you that baseline before you start trying. Tips for getting pregnant in your 30s Have regular sex. NICE advises having sex every two to three days throughout your cycle. This covers your fertile window without needing to time sex exactly, and it takes some of the pressure off. For more detail, read our guide on [when to have sex when trying to conceive] (add link). Understand your cycle. You’re most fertile in the five days before ovulation and on the day itself. This is known as your fertile window. It lasts this long because sperm can survive inside your body for up to five days, while an egg only survives for around 12 to 24 hours after it’s released. Having sex in the days before ovulation means sperm are already waiting when the egg is released. Your body gives signs that you’re approaching ovulation, such as changes to your cervical mucus. Read our guide on everything you need to know about ovulation […]

The safest approach is to stop drinking before you start trying to conceive. If you have a partner, it helps if they cut down around three months before you start trying, because that’s roughly how long sperm takes to develop. Knowing when to stop is one thing. Actually doing it can be harder. This guide gives you a clear timeline, practical ways to cut down, and help with one of the trickiest parts: what to say when people ask why you’re not drinking. Quick facts When should you and your partner stop drinking when trying to conceive ? If you’re the one trying to get pregnant, stop drinking from the point you start trying. The NHS advises that the safest approach when planning a pregnancy is not to drink at all. That’s because you could be pregnant for several weeks before you know it, and there’s no known safe amount of alcohol in pregnancy. If you drink regularly, start cutting down a few months before you begin trying. Going from drinking most days to to suddenly stopping overnight can be hard. A gradual approach makes it more likely to stick, and gives your body and cycle time to settle. If you’re trying with a male partner, they should cut down around three months before you start trying. Sperm take roughly three months to develop, so the changes they make now affect the sperm they’ll produce when you’re trying. They don’t need to stop completely, but staying well within the UK low-risk guidelines (14 units a week) and avoiding heavy drinking helps. Research has found sperm quality starts to decline with regular drinking. For the full evidence on how alcohol affects your chances of conceiving, ovulation and sperm, read our guide to alcohol and fertility. A timeline for going alcohol-free Three months before you start trying One month before you start trying When you start trying Once you’re pregnant Can you drink alcohol when trying to conceive ? Most people don’t find out they’re pregnant until they’ve missed a period, around four weeks into pregnancy, and often later. Alcohol passes through the placenta into the baby’s bloodstream, and there’s no known safe amount during pregnancy. That’s why UK guidance recommends not drinking at all while you’re trying. The risk of harm depends on how much you drink, how often, and the stage of pregnancy. It’s highest with regular heavy drinking or binge drinking. Drinking alcohol in pregnancy has been found to increase the risk of pregnancy complications like risk of miscarriage, preterm birth and your baby having a low birth weight. It can also cause your baby to have a serious life-long health condition, fetal alcohol spectrum disorder, which causes a range of lifelong conditions that affect a child’s learning, behaviour and physical development. Not every baby exposed to alcohol will be affected. The risk is likely to be low if you had small amounts before you knew you were pregnant. But experts can’t say how much alcohol is safe, so the safest choice is to avoid it completely. Alcohol may also affect conception itself. Getting pregnant involves several steps happening at the right time: releasing an egg, fertilisation and implantation. One study found that moderate-to-heavy drinking in the second half of the cycle, after ovulation, was linked with a lower chance of conceiving. This is the stage when implantation would normally take place)  The evidence on light drinking is less clear, but there’s no known safe amount while you’re trying. For the full evidence, read our guide to alcohol and fertility. What if you drink regularly or heavily while trying to get pregnant? If you drink most days, or more than the UK recommended guideline of 14 units a week, give yourself more time. Starting to cut down three to six months before trying makes the change more manageable. The NHS explains how many units are in different drinks. If you drink heavily or feel you depend on alcohol, don’t stop suddenly. If you get symptoms such as shaking, sweating, anxiety or feeling sick when you haven’t had a drink, stopping abruptly can be dangerous. Speak to your GP first. They can help you cut down safely and put you in touch with free, confidential support. GPs are there to support you, not judge you, so try to be open about how much you drink. You’ll also find a list of organisations that can help at the bottom of this page. It’s also worth being honest with yourself about why you drink. If alcohol is how you unwind or cope with stress, including the stress of trying to conceive, having another way to manage those feelings will make stopping much easier. Tips to stop drinking when trying to get pregnant If drinking is how you usually relax, socialise or celebrate, cutting it out can feel like a big change. It’s easier if a partner or friend does it with you. And remember, it doesn’t have to be forever. Start gradually if you need to. You don’t have to go from your usual amount to zero overnight. Try having more alcohol-free days each week, switching to smaller measures or alternating alcoholic drinks with soft drinks. Clear alcohol out of your home. Replace it with alcohol-free drinks you genuinely enjoy, such as kombucha, sparkling water with fresh fruit, or lightly flavoured soda water. Lowersugar options are best for your health. Find alcohol-free versions of your usual drink. There’s now a huge range of alcohol-free beers, wines and spirits in supermarkets, and they can give you a similar taste. In bars and restaurants, try a mocktail such as a virgin mojito or a virgin Mary. Know your triggers. Notice the feelings and situations that make you want a drink. If you drink when you’re stressed, try another way to unwind, such as going for a walk, having a bath or calling a friend. Do it together. It’s much easier if your partner, a friend or a family member cuts down with you. […]

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

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

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

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

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