Why should you test your hormones?

First, let’s get back to basics… What even are hormones?

Put simply, hormones are small chemical messengers that travel through the blood to different parts of your body. They help control many different functions from growth and development to metabolism (how your body gets energy from the food you eat), menstrual cycles,  fertility and mood, just to name a few! 

Hormones are made by special cells in a network of glands and organs called the endocrine system. If you cast your mind back to  biology lessons at school, you’ll probably remember that some of the major endocrine glands are:

• The pituitary gland, pineal gland and hypothalamus (these can all be found in the brain)
• The thyroid and parathyroid gland (the butterfly-looking gland at the front of your neck)
• The adrenal glands (these sit right on top of the kidneys and pancreas) 
• Sex organs (also known as the testes and ovaries)

Why do you need to test your hormones?

As well as maintaining your reproductive health, hormones play a role in influencing our general health and well-being. 

Our hormones are carefully balanced all the way from puberty to menstruation, pregnancy to menopause and beyond. However, when this system becomes disrupted or doesn’t function properly, it can affect your whole body. So, a change in your hormone levels could be the reason why  you’re feeling sluggish, slightly emotional, your period has gone out of whack or you’re struggling to get pregnant

So much of modern medicine focuses on treating one health issue at a time, resulting in a long and arduous journey to pinpoint a cause for various combinations of symptoms., However, our hormone test aims to revolutionise the diagnostic process to shorten the diagnosis time for a range of reproductive health conditions.

In short, it is no longer acceptable for an endometriosis diagnosis to take an average of 8 years or for a  PCOS diagnosis to take longer than 2 years.  Nor is it acceptable to be made to feel like your symptoms are all in your head. 

Hormones 101

Let’s look at the hormones that control your menstrual cycles:

We are all born with all the eggs we will ever have. This is called the ovarian reserve. During the first half of each menstrual cycle, a small number of eggs from this reserve will begin to grow and mature under the influence of our hormones. To learn more about the basics of the menstrual cycle, check out this article but for now, let’s take a look at each of the menstrual cycle hormones

Follicle-Stimulating Hormone: One of the main hormones that regulate your menstrual cycle is Follicle-Stimulating Hormone (FSH). It’s produced by the pituitary gland in the brain and plays a big role in your fertility as it stimulates a chosen set of eggs from the ovarian reserve to grow and develop during the first half of every cycle called the follicular phase. However, not all the eggs which get matured under FSH will make it to the final stages of development. Eventually, only one egg will be selected as the chosen one, called the dominant follicle, and will continue to grow. 

The smaller your ovarian reserve, the more FSH your brain produces to try and encourage eggs to grow, which is why monitoring it can help you understand the health of your ovaries. FSH levels will therefore slowly increase with age as your ovarian reserve declines. When your ovarian reserve is finally depleted (and menopause occurs), FSH levels become substantially elevated, which is why it is a good indicator of menopause. Persistently high FSH levels in someone younger than 40 is an indication of premature ovarian insufficiency (POI) which is when someone experiences menopause before the age of 40.

Oestradiol: During the follicular phase of the menstrual cycle, the follicles start to make another important hormone, called Oestrogen, as they grow. Oestrogen levels rise throughout the follicular phase, which also encourages the growth and thickening of the lining of the uterus, creating a comfy place for a fertilised egg to implant. So, monitoring oestrogen levels gives a good indication of how well your ovaries and menstrual cycle are working.

Although this is not Oestrogen’s only job, it really knows how to multitask. Not only does it help to control our menstrual cycles, but it also regulates many other aspects of our well-being, including our bone health, heart health, skin, hair, and mood. Oestrogen levels will fluctuate and eventually significantly drop when your ovarian reserve becomes depleted and menopause (or POI) occurs. Low oestrogen levels are therefore linked with many symptoms of menopause, such as dry skin and hair, vaginal dryness, painful sex, hot flushes, night sweats, difficulty falling asleep and fatigue. Oestrogen levels before menopause could be affected by lifestyle factors such as smoking and exercise.  

Towards the end of the follicular phase, oestrogen levels reach their peak. This stimulates the pituitary gland in the brain to produce a surge of a hormone called  Luteinising hormone (LH). LH then triggers ovulation, which is the release of the mature egg from its ovarian home so it can have a shot at fertilisation. 

If you have ever used ovulation predictor kits to track ovulation, then you’ll be familiar with LH as they are designed to detect the LH levels in your urine. Checking your LH levels at the beginning of your cycle with a blood test can help you understand if you’ll ovulate later in the cycle, which is particularly important if you’re looking to conceive.

If your LH levels are too low or too high, it can interfere with ovulation. High LH levels are often seen in those with polycystic ovary syndrome (PCOS), which can cause irregular ovulation and issues with periods and fertility. Consistently low LH levels are often associated with issues with the pituitary gland, which can be caused by anorexia or malnutrition.

Did you know? 

You can have your period even if you didn’t ovulate during that menstrual cycle. It’s called an anovulatory cycle and is actually fairly common, even in those that haven’t been diagnosed with a health condition.

Remember how we said you were born with all your eggs and how you will lose some each month during your period? Well, have you ever wondered how you can keep track of how many you have left?

Here’s where the Anti-Müllerian hormone (AMH) comes in. AMH is produced by special cells in the follicles (the little sacs that house the immature eggs in the ovaries) which is why it’s used to measure ovarian reserve and as an indicator of your ability to reproduce. 

AMH levels change as you age, reaching their peak during puberty and decreasing throughout your reproductive years, reaching almost undetectable levels at menopause. Therefore, high AMH levels are seen as a positive thing ie: a proxy indicator of lots of eggs in the bank! However, high levels of AMH can also be an indicator of PCOS. This is because people with PCOS have multiple “cysts” in their ovaries which also secrete AMH, which leads to high AMH levels in the blood. Low levels of AMH signal a low ovarian reserve, which is normal if you are nearing menopause (which usually occurs between the ages of 45 and 55.) However, having AMH levels that are lower than expected for your age could be a sign of POI or premature menopause. 

AMH is often used to predict someone’s chances of success during fertility treatment, such as egg freezing and IVF (In vitro fertilisation). However, it’s important to remember that AMH can only tell you about the quantity, and not the quality, of your eggs.  Unfortunately, the only way to find out about your egg quality is to go through IVF treatment and perform specialist tests once your eggs have been fertilised in the lab.

Testosterone is typically associated with male fertility and sexual function but doesn’t let the name fool you, it’s equally as important for us! Testosterone can be converted to produce the wonder hormone oestrogen and is also associated with libido, maintaining muscle mass, vaginal health, breast health and bone health. High levels of testosterone can cause symptoms such as excess body and facial hair, hormonal acne, and irregular or absent periods. These symptoms are often seen in women with PCOS which can cause high testosterone. Low levels of testosterone may also affect your mood and libido.

Prolactin is another hormone that originates from the pituitary gland. It is most commonly associated with stimulating breast milk production after childbirth and naturally, levels are low in someone who is not lactating. However, when prolactin levels are too high (also known as hyperprolactinemia), due to stress, for example, it can stop the production of FSH and LH, affecting ovulation and leading to irregular or absent periods. One of the most common symptoms to look out for is milky white discharge from the nipples, but it can also result in double vision and persistent vomiting.

The next set of hormones we’ll focus on are those that control your thyroid (the butterfly-shaped gland at the front of your throat.)

Thyroid-stimulating hormone (TSH) is produced by the pituitary gland in the brain. It controls your thyroid health by telling your thyroid gland to produce the hormone Thyroxine (T4)which is eventually converted to Triiodothyronine (T3). These thyroid hormones play a role in many important functions in your body such as your fertility, metabolism, heart function, nervous system and mood. If you want to know more, we’ve written an article explaining the ins and outs of thyroid function and fertility here.  

If your TSH levels are too low or too high, it suggests too much or too little thyroid hormone is being produced. This can prevent ovulation, making your periods irregular or stopping them together. Low TSH and high T4 levels are a sign that your thyroid is overactive, a condition called hyperthyroidism. Common symptoms can include feeling irritable and anxious, feeling tired and being sensitive to warm temperatures.  On the other hand, high TSH and low T4 levels indicate that your thyroid is underactive, a condition called hypothyroidism. Some commonly experienced symptoms are feeling very cold, struggling with weight gain and excessive fatigue. 

What can hormone testing tell me? 

Hormone testing is a good way to give you insight into your overall health and wellbeing. You can measure your hormone levels using your blood, urine and even saliva. However, the current gold standard for testing most hormones is with a blood test. 

It might be that you’re experiencing symptoms or are just curious about your health. You might be checking in to make sure everything will be ok for future babies or you could be actively trying to conceive. Wherever you’re at, it’s a good idea to keep tabs on your hormones to see what’s going on with your reproductive health and make your hormones work with you, not against you when you need them the most. 

Once you’ve had your hormones tested, you’ll receive a report which will tell you if your levels are in range compared to other people your age (we call this the reference range). The reference range is calculated by the manufacturers of the device used to test your hormones and might vary slightly from lab to lab depending on which device is used. 

Menstrual cycle hormones will fluctuate during your cycle, which is why it’s recommended to test on day 3 of your period (day 1 is the first day of bleeding).  This allows us to measure your baseline hormones at the beginning of your cycle and compare your results to what is normal for other people your age at baseline. Since your reproductive hormones affect one another, your test results for all the different hormones will be interpreted together rather than in isolation. With Hertility, one of our private gynaecologists will review your hormone test results along with your online health assessment answers in a comprehensive report to give you the whole picture of what’s going on with your hormonal health. 

Hormonal contraception, such as the combined oral contraceptive pill, contains synthetic (not naturally occurring) versions of the hormone progesterone (with or without oestrogen). They work by affecting your natural menstrual cycle hormones (oestrogen, FSH and LH) to stop ovulation and fertilisation from taking place. This means these hormones cannot be tested in people who are taking hormonal contraception. You can usually test the whole range of hormones within 3 months of stopping hormonal contraception, with the exception of the contraceptive injection such as Depo Provera, where you might have to wait up to 12 months.

If you would like to understand what hormones you should be tested for, take our Online Health Assessment. In just 5 minutes, we’ll take all your personal information, symptoms and medical history into account to create a personalised hormone test, just for you to get the answers you’re looking for. 

However, it’s important to note that although hormone testing can give us a lot of valuable information, it cannot tell you how fertile you are. There is no test that can actually measure this, the only way to know for sure is when you are actively trying to have a baby. A successful pregnancy is dependent on many aspects, the quality of the egg and sperm, whether there are any issues with anatomy such as blocked fallopian tubes (where fertilisation happens) or with the uterus as well as lifestyle factors such as weight, smoking, and drinking.

A reproductive health assessment, however, can help flag up whether a potential underlying health condition could affect your chances of having a baby. 

How often should I test my hormones? 

Regularly testing is a good way to see how your hormone levels change over time, this is why we recommend retesting once every 12 months, and once every 6 months if you’re older than 35 or have an underlying condition which may affect your fertility. It could also help you understand how your lifestyle changes or medications might be affecting your symptoms so you can manage them more effectively.

How can I test my hormones? 

Proactively keeping tabs on your hormones in the traditional healthcare system is expensive, convoluted and confusing. That’s why we started Hertility – to make checking in on hormones and fertility accessible to as many people as possible. With at-home testing, digital screening tools and access to our vetted network of female health experts, we’ve got everyone covered from menstruation to menopause.

• 3 appointments in 1: Instead of multiple appointments with GPs, specialists and nurses, a Hertility test gives you a health assessment, hormone blood test and a comprehensive report all in one (you don’t even need to leave the house!)
• Diagnosis in days: Female health conditions such as PCOS and endometriosis take an average of 2-8 years to diagnose. Hertility can flag whether you have 9 of the most common gynaecological pathologies in just 10 days.
• Affordable price: Private fertility clinics will charge up to £1,200 for hormone blood tests. But we’re making it as accessible as possible with our £149 test.
• No more waiting: Enough with the waiting rooms, the waiting lists and waiting for the bus to get to appointments. Now with Hertility you can receive a blood test to your door within 72 hours and get results in 10 days.
• More than just a test: Get everything from testing to treatment all under 1 roof. Whatever the results, one of our private gynaecologists will be on hand to discuss your results and get you fast-tracked to the care you need. 

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3. Thiyagarajan, DK, Basit, H and Jeanmonod, R. Physiology, Menstrual Cycle.  StatPearls. Treasure Island (FL)2021.
4. Shebl, O, Ebner, T, Sir, A, Schreier-Lechner, E, Mayer, RB, Tews, G and Sommergruber, M. Age-related distribution of basal serum AMH level in women of reproductive age and a presumably healthy cohort. Fertility and Sterility. 2011;95(2):832-4.
5. Tyagi, V, Scordo, M, Yoon, RS, Liporace, FA and Greene, LW. Revisiting the role of testosterone: Are we missing something? Rev Urol. 2017;19(1):16-24.
6. Al-Chalabi, M, Bass, AN and Alsalman, I. Physiology, Prolactin.  StatPearls. Treasure Island (FL)2021.
7. Shahid, MA, Ashraf, MA and Sharma, S. Physiology, Thyroid Hormone.  StatPearls. Treasure Island (FL)2021.
8. Hyperprolactinaemia
9. Siriwardhane, T, Krishna, K, Ranganathan, V, Jayaraman, V, Wang, T, Bei, K, Ashman, S, Rajasekaran, K, Rajasekaran, JJ and Krishnamurthy, H. Significance of Anti-TPO as an Early Predictive Marker in Thyroid Disease. Autoimmune Dis. 2019;2019:1684074-.