Knowledge Centre

PMS and PMDD can both occur during the luteal phase of the menstrual cycle. But what is the difference between PMS and PMDD and what are the treatments available? Read on to find out.  Quick facts: What is Premenstrual Syndrome (PMS)? Premenstrual Syndrome (PMS) refers to a group of physical, emotional, and behavioural symptoms that occur in the days or weeks leading up to your period. For many people, PMS is a familiar but manageable part of the menstrual cycle, with up to 90% of women and people who menstruate experiencing it at some point.  PMS can vary from person to person, with some people just experiencing mild symptoms, with others suffering from more extreme symptoms that can affect their daily lives. What are the most common symptoms of PMS? There are a combination of physical and mental symptoms that can be associated with PMS. Some of the most common symptoms include: What is PMDD? Premenstrual Dysphoric Disorder (PMDD) is a cyclical hormone-based mood disorder. that affects mood, behaviour, and physical wellbeing in the days leading up to your period. While PMS exists on a spectrum, PMDD sits at the most severe end. What makes PMDD distinct is not just the symptoms themselves, but how disruptive they can be. People often describe feeling like a completely different version of themselves in the second half of their cycle, with changes that affect their ability to work, maintain relationships, or carry out daily routines.  These symptoms follow a clear cyclical pattern, typically emerging after ovulation, intensifying in the week before a period, and easing shortly after menstruation begins. This predictable timing is one of the most important clinical clues and one of the reasons PMDD is often misunderstood or missed altogether. PMDD is estimated to affect up to 5.5% of the population in the UK who menstruate, which adds up to over a million. That is 1 in 20  people. What Are the Main Symptoms of PMDD? PMDD can present a wide range of emotional, physical, and cognitive symptoms.  The main symptoms of PMDD include severe mood swings, irritability or anger, anxiety, depression, and difficulty concentrating. Many people also experience physical symptoms such as fatigue, bloating, sleep disturbances, and appetite changes. Symptoms occur in the luteal phase  or premenstrual phase of the menstrual cycle and subside within a few days of menstruation due to the brain’s sensitivity to the natural rise and fall of progesterone and oestrogen. Recognising these patterns is key to understanding whether what you’re experiencing could be PMDD. 🌪 Emotional & Mood Changes  🧠 Cognitive & Psychological 🛌 Physical & Sensory Symptoms In the most severe cases of PMDD, some people may experience suicidal ideation or suicidal thoughts. If you need urgent help for your mental health you can contact the Samaritans 24/7 helpline, or Mind’s crisis resources. What Does PMDD Actually Feel Like? PMDD is often characterised by a shift in emotional and psychological state that can feel difficult to control or explain. Unlike PMS, where symptoms may feel uncomfortable but manageable, PMDD can feel overwhelming and, at times, debilitating. Many people report intense mood changes, including persistent low mood, anxiety, irritability, or a sense of being emotionally overwhelmed. There can be a loss of interest in things that would usually bring enjoyment, alongside difficulty concentrating or making decisions. For some, these changes are accompanied by intrusive or distressing thoughts, and in more severe cases, feelings of hopelessness or suicidal ideation, which is why PMDD is recognised as a serious medical condition. Importantly, these symptoms are cyclical. They tend to resolve once the period starts, sometimes quite suddenly, which can make the contrast between phases of the cycle feel even more pronounced. It’s also important to note that PMDD can occur even in people who do not bleed regularly. For example, individuals using a hormonal coil or those who have had a hysterectomy but still have functioning ovaries may still experience PMDD symptoms, as hormonal cycling continues. What Causes PMDD?  PMDD is often misunderstood as a hormonal imbalance, but current research suggests something more nuanced. Most people with PMDD have hormone levels that fall within the typical range. Instead, the condition appears to be driven by an increased sensitivity in the brain to the normal hormonal changes especially linked to oestrogen and progesterone that occur across the menstrual cycle, particularly after ovulation.  There is also evidence to suggest a genetic component. Individuals with PMDD are more likely to have a family history of the condition, as well as mood disorders such as depression or anxiety.Variations in genes involved in hormone regulation and serotonin signalling may increase susceptibility, helping to explain why some people experience more severe reactions to hormonal shifts than others. Emerging research and lived experience also point towards a potential link between PMDD and neurodiversity. Some neurodivergent individuals, including those who are autistic, report more intense or difficult-to-manage symptoms. This may be related to differences in how the nervous system processes stress, sensory input, and emotional change. It is important to note that neurodiversity does not cause PMDD, but it may influence how symptoms are experienced and perceived. Stress is another key factor. Chronic stress can disrupt the body’s hormonal and neurological balance, particularly through its effects on cortisol, the primary stress hormone. This may amplify sensitivity to normal hormonal fluctuations and worsen the emotional and physical symptoms associated with PMDD.  Mental health history also plays an important role. Individuals with a history of trauma, anxiety, or depression may be more vulnerable to PMDD, and symptoms can often overlap or intensify during certain phases of the cycle. This does not mean PMDD is purely psychological, but rather that it sits at the intersection of hormonal and mental health processes. Beyond the brain and hormones, there is growing interest in the role of inflammation. Some studies have found elevated inflammatory markers in people with PMDD, suggesting that inflammation may interact with hormonal sensitivity and contribute to symptoms such as fatigue, low mood, and brain fog. Nutritional […]

Annie Coleridge, CEO of Alva Health, shares her story of getting a PMOS (formerly PCOS) and dermoid cyst diagnosis. Erratic periods I’ve always had a feeling something wasn’t quite right with my hormones. Nothing major, but something a little skew-whiff.  Since I was a teenager I’ve had erratic periods. They’re on the light side, making me one of the lucky ones, but sometimes they won’t come for months.  Once, just after my final exams at university, my period didn’t come for about 9 months. I’ve always been a normal weight and was eating ok (albeit a bit stressed about exams) but 9 months seemed excessive…  So did the endless doctor’s appointments checking that I wasn’t pregnant or having a flare of an autoimmune condition I had previously. That was my early 20s. My mid-twenties passed with little change to that pattern, to be honest. Months and months without a period, then they’d just restart again.  I tried to track my periods, but I didn’t have the monthly reminders to help me remember. So I just put up with a mild, low-level, background kind of anxiety about my reproductive health.  Weirdly, although I understand contraception pretty well, it made me reluctant to go on any hormonal birth control. I just didn’t want to mess with these hormones which seemed in such fine balance. And anyway, it didn’t bother me that much. Testing my hormones Then I started working at a health tech company, which really highlighted to me that knowledge is power when it comes to your body. Finally, it clicked – I really should check if my hormones are balanced.  I knew that wouldn’t hold all the answers to my period woes… but it seemed like a very interesting place to start.  When I got my first test back I had high testosterone and low oestrogen – which was not what I expected… I knew that raised testosterone suggested PMOS but I also knew I didn’t have the typical symptoms. Beyond the messed up periods and the raised testosterone, I just didn’t have much else that was typical for PMOS. Or at least I thought I didn’t.  What I knew about PMOS was that it usually causes heavy periods, excessive hair growth, insulin sensitivity and weight gain. I didn’t struggle with those. I had light, irregular periods and bad mood swings. But that was it.  So… I ignored my first few sets of results, for about a year. I’d had abnormally high cortisol results at the same time, so as ever I just sort of put it all down to stress. Maybe my periods were just super super super sensitive to stress. A sudden change Then my periods suddenly got incredibly heavy. I thought it might be a sign of something really serious so I went to a doctor. I don’t hate the doctors at all, but I do find the process often quite inconvenient. It just doesn’t fit in with my life. Despite having recent blood tests, the doctors made me take another test and told me I had PMOS. That was it. A single phone call. Just the test results and a simple conclusion. Nothing else on the matter,  no follow-up information.  Doctor Google and my mum (an actual doctor) helped me learn that there are loads of different types of PMOS. Turns out whilst some people get the more ‘classic’ PMOS symptoms it’s actually a hugely varied condition. PMOS diagnosis – what else? But this new diagnosis didn’t explain the sudden changes in my periods. Or at least I didn’t think it did. I was pretty confused to be honest. So I went back to my GP and they said I could have an ultrasound.  The process of finding out I had a dermoid cyst involved an initially inconclusive scan – where the sonographer simply told me that I had ‘some sort of mass.  Four weeks later, another scan followed. This time they told me that the mass was probably a ‘ benign cyst’. The probably in that sentence didn’t fill me with confidence. So I went to my GP to ask what next? What next was a very long wait to see an NHS gynaecologist.  Now, let me say that although I felt pretty horrific after my various appointments I am staunchly pro the NHS. They gave me a certain first diagnosis – PMOS – and a probable second one – a benign cyst.  I did feel a little lost though. Suddenly my fertility (not something I’d thought about being 28 years old at the time and in a very new relationship) felt uncertain. I’m not even sure I want kids but that feeling was very unsettling. Knowledge is power To get a quicker second diagnosis I went and got a private scan. I’m very lucky they could confirm it was a dermoid cyst that was not cancer.  They could also see the characteristic ‘string of pearls’ appearance around my ovaries that suggested PMOS. It was a relief to be able to see what was going on in my ovaries, although they didn’t look in the best shape I must say.  I feel so fortunate to have been able to quickly access answers but it took me years to take control of my reproductive health. Even though it’s not perfect – nothing ever is and it’s much better to know Written by Annie Coleridge, CEO Alva Health If like Annie, you’re experiencing irregular and erratic periods, it could be a sign of a hormonal imbalance. Our at-home hormone tests can help you get to the root of your period problems. Our team of experts include PMOS (formerly PCOS) specialists that can help you to manage your PMOS (formerly PCOS) symptoms.

For LGBTQIA+ individuals and couples, family forming is never straight forward. Luckily there are lots of fertility treatments and options out there. We’ve put together a list of the different options available, whether you’re looking to embark on family forming now or in the future.  Quick facts: Sourcing sperm for fertility treatment There are three options for sourcing sperm in the UK:  If you source your sperm through a HFEA-licensed UK fertility clinic or sperm bank, your donor will have been vetted and their medical history checked. This includes infections such as HIV and hepatitis or a history of any genetic disorders.  The clinics will also be able to offer support and legal advice and each donor is only allowed to donate sperm to make up to 10 families.  If you’re planning on bypassing a licensed clinic or sperm bank and using donated sperm either from a known donor or another source, it’s recommended to ask the individual to carry out their own medical checks before donation. With using sperm from someone you know personally, there are legalities around who is the legal father of the child. It’s important to research this option thoroughly if this is a route you’re choosing to go down.  If you would like to use a known donor but would still like all the legal protections around parenthood, you will still be protected if you carry out the insemination at a clinic. Intra-uterine insemination (IUI)  Intra-uterine insemination (IUI), also known as artificial insemination, is a type of fertility treatment that involves injecting sperm into the uterus (womb) using a special syringe-like device called a catheter.  IUI is a commonly used fertility treatment for same-sex female couples, where one (or both) partners want to carry a child. For IUI, you’ll need to source some sperm—either through a licenced sperm bank or fertility clinic, or some couples opt to use a sperm donor that they know personally.  As long as you are ovulating regularly and have no issues with your Fallopian tubes you should be eligible for IUI.  However, IUI may not be recommended for you (or your partner) if you: Couples have the choice for the insemination process to take place in a licensed clinic, or they may opt to do this in the comfort of their own home to save them money and time. But, there are some legal risks if you choose this second option. IUI is thought to be a less invasive and more natural process than IVF because it doesn’t involve as many medications. In vitro Fertilisation (IVF)  IVF is a fertility treatment where eggs are removed from the ovaries and fertilised with sperm in a lab. If an egg is successfully fertilised, the resulting embryo is transferred into the uterus.  IVF is another popular fertility treatment for same sex-female or gender-diverse couples and is one of the most common in the UK. Again, it requires a sperm donor which can be sourced from a licenced sperm bank, fertility clinic or someone you know personally.  IVF also forms part of the shared motherhood and surrogacy process. Shared Motherhood Otherwise known as Reciprocal IVF, shared motherhood is where eggs are collected from one partner, fertilised in a lab with donor sperm, and the resulting embryo is transferred to the other partner’s uterus for them to carry the baby.  Shared motherhood can be a great option for couples where both individuals have working female reproductive anatomy, allowing for both partners to be physically involved in the family-forming journey. Not all fertility clinics offer this treatment and eligibility depends on various factors such as your age, weight, lifestyle and medical history. Surrogacy Surrogacy is where an individual agrees to carry a child on behalf of another person or couple.  Traditional or partial surrogacy involves the surrogate’s eggs being fertilised using the sperm from someone within the couple, to create the biological link to one of them. This is often used by male same-sex couples looking to form a family.  Full or gestational surrogacy is when the eggs of the intended mother or a donor are used, and therefore, there is no genetic connection between the surrogate and the baby.  Whilst surrogacy is legal in the UK, it is an altruistic process. Essentially this means it is illegal for a surrogate to receive any monetary gain from helping you on your journey to parenthood, and it is even illegal to advertise seeking a surrogate. A surrogate can receive expenses.  There are a lot of other complicated legal issues to note about surrogacy. The most important is that the surrogate is the legal mother of the child when it’s born. This is even if the eggs and sperm used in the process are yours or were donated, and the carrier is not genetically related to the child.  The surrogate has rights over the child until you receive a parental order from the court – so of course, it is vital to choose someone you trust. For these reasons, it is common for a close friend or family member to carry a child on behalf of the couple. If you are looking for more information, please visit the Human Fertilisation and Embryology Authority (the regulatory body for fertility treatment in the UK) website or Surrogacy UK. Coparenting Co-parenting is a pathway some LGBTQIA+ couples are now choosing to go down. It usually involves two or more people who are not in a romantic relationship deciding to raise a child together. For example, a lesbian couple chooses to have a biological child with a gay male and agrees to raise the child collectively.  They can choose to opt for fertility treatment such as IUI or IVF for this depending on age, medical history and sperm quality. Although this is something that has been going on for years, the rise of the internet has caused a shift in the way prospective co-parents may look for partners. If you are choosing to go down this path, it’s important to understand […]

Hypothalamic amenorrhea (HA) is when your menstrual cycle and ovulation are interrupted due to the influence of the hypothalamus gland, located in the brain.  In this article we run through common symptoms, the causes and treatment options available. Quick facts: What causes hypothalamic amenorrhea? The hypothalamus is a small region of the brain that plays a crucial role in lots of important bodily functions. It controls the release of certain hormone and helps to regulate body temperature, sleep patterns, hunger and the menstrual cycle.  It is a commonly occurring condition in women with eating disorders, athletes or dancers or those with a low body mass index (BMI) Hypothalamic amenorrhea is caused specifically by issues in the functioning of the hypothalamus. The function of the hypothalamus can be disrupted by lots of different things, usually lifestyle factors.  Common disruptors include: Symptoms of hypothalamic amenorrhea Common symptoms include: What causes menstrual cycle disruption When you eat too little or exercise too much, the body perceives this as stress. This can lead to severe fluctuations in a hormone called gonadotropin-releasing hormone (GnRH). This is the main hormone regulated by the hypothalamus.  GnRH influences the production of other hormones, including those involved in the regulation of the menstrual cycle.  Follicle-stimulating hormone (FSH), needed to mature an egg each cycle and luteinising hormone (LH), needed for the release of the mature egg each cycle, can become disrupted as they both rely on GnRH.  FSH and LH, in turn, regulate oestrogen and progesterone production by the ovaries. Oestrogen helps the eggs to mature and progesterone prepares the uterus lining for a fertilised egg. Typically, a rise and fall in FSH, LH, oestrogen and progesterone is what controls the menstrual cycle. If a disruption happens at the hypothalamic level, the hormonal cascade is affected, resulting in low FSH, LH and oestrogen. Essentially, this is just your body trying to protect you. It’s putting your basic energy needs ahead of your reproductive health, which is why your periods become irregular. How can hypothalamic amenorrhea be diagnosed? It is usually a “diagnosis of exclusion,” which requires healthcare providers to rule out other conditions that could be interrupting the menstrual cycle. Your doctor may consider the following blood hormone tests to base their diagnosis on:  GnRH levels are tested to analyse the function of the hypothalamus, with a low GnRH result being indicative of a dysfunctional hypothalamus. Low levels of FSH, LH and E2, may also indicate hypothalamic amenorrhea.  High levels of prolactin can also lead to irregular or absent periods. Testosterone levels are analysed to eliminate the possibility of hyperandrogenism (high androgen levels) and Polyendocrine Metabolic Ovary Syndrome (PMOS, formerly known as PCOS). Thyroid-stimulating hormone is analysed to rule out the influence of thyroid gland disorders. Human chorionic gonadotropin is purely tested to confirm or eliminate the possibility of pregnancy influencing your periods. Hypothalamic amenorrhea treatments If you’ve received a diagnosis of hypothalamic amenorrhea, your pathway to care and treatment options will usually be tailored according to the cause. Healthy lifestyle habits, diet and exercise routine modifications can help improve your symptoms, and make them more manageable. If you think you may be experiencing any of the symptoms above, reach out to us.  Hertility can help you with your initial hormone testing, along with a comprehensive Doctor-written report analysing your results. We can also support you with any onward care or treatments you may need, including tele-consultations with specialists.  Resources:

Folic acid is a vital preconception supplement. But what makes folic acid so important? How and when should you be taking it? We’ve broken down everything you need to know about folic acid for preconception care. Read on to get clued up. Quick facts: What is folic acid?  Folic acid is the man-made version of the vitamin folate, a form of vitamin B9. It is used by our bodies to make new cells and is needed to support the rapid growth of foetal tissues and organs in early pregnancy.  Unfortunately, our bodies do not store folic acid, which is why we must get our supply from certain foods and supplements. Why is folic acid important for pre-conception and pregnancy? Folic acid is important in helping your unborn child’s brain, skull and spinal cord to develop properly. It reduces the risk of potential neural tube defects, such as spina bifida, by 70%.  Whilst spina bifida is not that common, it can create significant problems for its sufferers that affect everyday life. These include problems with mobility and movement, bladder and bowel problems and learning difficulties.  Folic acid is also used to: When should you start taking folic acid? The advised amount of folic acid to take daily is 400mcg. However, some people may need a higher dose if they have a higher risk of having a pregnancy affected by neural tube defects.  You may have a higher risk if:  In these cases, your doctor will be able to advise the correct dosage you should be consuming to keep your child protected. Which foods contain natural forms of folic acid? You can also find the natural form of folic acid or folate, in certain foods. Introducing these to your diet will increase your folate levels: However, the amount of folic acid in these foods is often not enough to provide your baby with the best protection, so it is important to add the tablet form to your daily routine too. Understanding preconception nutrition If you’re looking for some help understanding your preconception or pregnancy nutrition, you can book a call with one of our Fertility Nutritionists.  Our nutritionists will work with you and recommend a personalised nutrition plan for your specific fertility goals, taking into consideration your medical history and lifestyle. Get in touch today if we can help.   

In this article, we’ll explore how fertility treatments can affect your mental health. We’ll discuss the ups and downs and tips for taking care of your emotional wellbeing. Quick facts: Understanding the emotional side of fertility treatment  Sometimes, the road to parenthood is not as straightforward as we may initially think. If you’ve struggled to conceive naturally, don’t want to, or can’t, fertility treatments can be a great option.  But they can come with a huge range of emotional challenges, that are often lost in the conversation centring around all of the physical aspects of the procedures.  According to recent studies, up to 30% of people seeking fertility assistance report symptoms of anxiety and depression, while nearly 40% grapple with elevated stress levels. Fertility treatments like egg freezing and IVF are often described as ‘emotional rollercoasters’, with moments of joy and love, and moments of sadness, uncertainty and fear.  The anticipation of each treatment cycle, uncertainty of outcome and the financial burdens can all take a toll on mental health. Many individuals and couples going through fertility treatments may feel isolated or like they’re carrying the burden alone, which can exacerbate feelings of loneliness. Some individuals may also feel pressure to conceive within a certain timeframe, adding to the stress. This pressure can come from societal expectations, family, or personal goals. Here we lay out some tips for looking after your mental health during treatment as well as some proactive ways to deal with the prospect of failed treatment. Tips for looking after your mental health during fertility treatment Everyone deals with stress differently and it’s important to find a method that works for you, as well as understanding your triggers. Some of these methods may work for you.  Get as much information as possible about your treatment  Understanding the fertility treatment process can significantly reduce anxiety. Research the steps involved and make sure you know exactly what will happen at each stage. Prepare a list of questions for consultations with your doctor or specialist to clarify any doubts or worries. Knowing what to expect can make the process feel less daunting, allowing you to feel more in control of your journey. Don’t make it the only topic of conversation  While sharing your feelings and concerns with your partner is crucial, it’s essential not to let fertility worries or discussions about your treatment dominate every conversation. Taking breaks to discuss non-fertility-related topics, especially if you’re going through this process with a partner can provide relief and maintain emotional connections with your loved ones.  Lean into your family and friends Your support network is invaluable during fertility treatment. Lean on family and friends who are empathetic and understanding. Share your experiences, but also make time for enjoyable activities together that can take your mind off things. These connections can offer emotional support and a sense of normalcy. Consider fertility counselling Fertility counselling can offer a safe space to explore your emotions and concerns with a mental health professional. These experts can guide you through the emotional challenges of fertility treatment, providing valuable coping strategies and emotional support. You can book an online appointment with one of our fertility counsellors at any time.  Identify your triggers Take time to understand how stress affects you personally. Recognise your personal triggers and signs of stress, such as irritability, sleep disturbances, or physical tension. Once identified, develop a toolbox of coping strategies that work for you. This may include relaxation techniques, journaling, exercise or talking to a friend. Practice mindfulness Mindfulness techniques, like deep breathing, meditation, or progressive muscle relaxation, can help you stay grounded during the emotional turbulence of fertility treatment. Regular practice can reduce anxiety and increase your overall sense of well-being. Keep active and don’t isolate  Maintaining physical activity and staying engaged in enjoyable activities can positively impact your mood. Exercise releases endorphins, which can help alleviate stress. Additionally, avoid isolating yourself during treatment. Maintain social connections to provide emotional support and prevent feelings of loneliness. Avoid any other big life changes The fertility treatment journey itself is a significant life event that can be emotionally taxing. Avoid introducing additional stressors, like moving to a new home or starting a new job, during this period if possible. Staying in a familiar environment and maintaining your established routine can provide stability and reduce anxiety. Join a support group Support from friends and family can also be vital, but it’s important to remember that not everyone will understand the emotional complexity of fertility struggles. Joining a support group can allow you to connect with other people going through the same struggles. There are lots of online groups available or in-person group counselling-based sessions. Waiting for your pregnancy test result The two-week wait, that agonising period between embryo transfer and the pregnancy test, is often one of the most emotionally challenging phases of fertility treatment. It’s a time marked by heightened uncertainty and anxiety, as the long-anticipated results of your efforts hang in the balance.  Try to plan ahead for activities and distractions that can help take your mind off the uncertainty. Having a plan in place can provide a sense of control over your time and emotions during this period. Keep a schedule of daily activities, work commitments, or outings with friends and family. Consider engaging in hobbies you enjoy, reading a good book, or taking up mindfulness and relaxation techniques. It can be beneficial to focus on tasks and experiences that bring you joy and fulfilment. Remember that a busy mind has less space for worries. Lean on your support network during this challenging time. Share your feelings and concerns with loved ones, as they can provide invaluable emotional support. Whether it’s a shoulder to lean on, a listening ear, or a comforting presence, friends and family can help alleviate some of the anxiety and loneliness you may be feeling. Don’t hesitate to communicate your needs to them. Facing the prospect of a failed fertility treatment Experiencing a failed fertility treatment can be emotionally devastating. It’s a moment […]

Fertility preservation methods can be a great way for people to put having kids on hold, or preserve their fertility if they need to for medical reasons. Here we go through the main procedures available to women and those assigned female-at-birth. Quick facts: What is fertility preservation? Fertility preservation involves freezing your eggs, embryos, reproductive tissues or sperm, so they can be used in the future and you can hopefully have a biological family. For women or those assigned female-at-birth, there are a few different fertility preservation methods available. Which one is right for you will depend on your age, medical history and personal fertility goals.  Each method involves removing either eggs or tissues, freezing and storing them in liquid nitrogen—a process called cryopreservation. When you are ready to use them, they can be thawed and used to help you conceive.  These processes are all designed to help those at risk of potential infertility or to assist those who can’t conceive naturally. Who might use fertility preservation? There are lots of different reasons why someone may undergo fertility preservation. Generally, the reasons can be categorised as either medical or social preservation.  In the UK as of July 2022, you can store your eggs for 55 years for both medical and social reasons, as long as you renew your consent every 10 years. Medical fertility preservation Medical fertility preservation is for anyone undergoing fertility preservation for medical reasons. This could include possibly losing their ability to conceive naturally because of impending medical treatment. Reproductive health conditions Some reproductive health conditions such as Premature Ovarian Insufficiency (POI) and early menopause can affect fertility. Additionally, conditions such as endometriosis or fibroids might require surgery around the pelvic organs to manage it, your doctor may suggest fertility preservation before this in case there is a risk of damage to the ovary. Cancer Certain cancers and cancer treatment, including chemotherapy and radiotherapy (especially targeting the pelvic organs), or surgeries impacting the ovaries, can impact our fertility. Egg freezing may be suggested on a case-by-case basis for those who are looking to have children post-cancer treatment. Gender-affirming care If you’re undergoing gender-affirming care, you might want to preserve your fertility before starting hormone therapy or having reconstructive surgery. Although anyone with or undergoing the above may still be able to get pregnant naturally, there might be a risk of impacting their ovarian reserve, which may make it difficult to conceive. This is why considering fertility preservation is recommended before starting therapy.  Social fertility preservation Social fertility preservation is when you freeze your eggs or embryos for ‘social’ reasons. This can include if we are worried about our natural fertility decline with age, but we aren’t quite ready to have children yet. Or if we aren’t sure if we want children at all, but would like to keep our options open for the future.  As we age, our egg quantity and quality decline. This can make getting (and sometimes, staying) pregnant more difficult. Age, also increases the risk of pregnancy-related complications, like miscarriage, genetic disorders in the baby and gestational diabetes, especially after our mid to late 30s. In our early to mid-20s, we are at our most fertile—but there’s still only a 25–30% chance of us getting pregnant each cycle. This gradually reduces during our 30s to around 5% by age 40.  What are the different types of fertility preservation? Fertility-preservation options for women and AFAB people include egg freezing, embryo freezing, ovarian tissue cryopreservation, ovarian transposition and gonadal shielding. Egg freezing (Oocyte cryopreservation):  Egg freezing is a medical procedure which can help us to plan for our future fertility. It’s what’s known as a ‘fertility preservation method’, or scientifically speaking, ‘oocyte cryopreservation’. Egg freezing involves taking medicine to encourage the growth of the eggs in our ovaries, which will then be collected during a short surgical procedure. Viable eggs will be frozen and stored in liquid nitrogen (-196°C). They do not decline in quality—like they would do if they remained in your ovaries as you age.  These eggs can be thawed at a later date whenever you are ready to start a family through fertility treatment. This whole process is what’s called an ‘egg freezing cycle’.  Technically, you can freeze your eggs at any age before menopause, but eggs retrieved in your 20s and early 30s usually result in better outcomes than those in your late 30s and 40s. This is largely to do with the quality of the eggs at the time they are retrieved, as generally, our eggs begin to decline more rapidly from 35 onwards. Embryo cryopreservation (embryo freezing) This is a procedure that involves removing eggs from the ovaries, fertilising them with either a partner or donor sperm to create embryos and then freezing the resulting embryos for future use. Embryo cryopreservation would usually require an in-vitro fertilisation (IVF) cycle.  The egg retrieval process is similar to the one used in egg freezing. Once retrieved the eggs will be analysed in the lab by an embryologist and then fertilised with sperm from your partner or donor once. They are then placed into an incubator to allow the resulting fertilised egg (embryo) to develop.  The embryos are then frozen and stored in liquid nitrogen. Once you are ready to conceive, the embryo will be thawed, cultured and will be transferred to the uterus.  The number of embryos transferred is dependent on your age, the quality of the embryo(s) and if you have had failed IVF cycles in the past. It’s generally preferred to transfer just one embryo because this reduces the chances of complications associated with multiple pregnancies.  If you have good-quality embryos left over at this stage, you can opt to freeze them for future cycles, discard them or donate them to someone else. Sometimes, if a sufficient number of embryos are not collected in one cycle, your doctor will recommend another cycle. Ovarian tissue cryopreservation Ovarian tissue cryopreservation is the only fertility preservation option to help younger people who have not gone […]

Endometriosis is a common reproductive health condition that affects 1 in 10 in the UK. It’s characterised by painful, heavy periods as well as other, often debilitating symptoms. Here we go through each of the main symptoms in detail, so you know what to look out for and when to get checked.  Quick facts: Endometriosis in the UK In the UK, endometriosis affects around 1.5 million women and people assigned female-at-birth (AFAB). That’s 1 in 10 who are currently living with the condition, regardless of race or ethnicity (1). People with endometriosis often experience very painful periods as well as a host of other symptoms. Many people live with endometriosis for a long time before getting diagnosed. Sometimes up to 7 years or more.  This is often the result of a general lack of awareness about the condition, dismissal of women’s pain and symptoms having a lot of crossover with other conditions. So what are the main symptoms of endometriosis? Here’s what to look out for if you suspect you, or someone close to you, may have the condition. What is endometriosis? Endometriosis is a chronic reproductive health condition where cells similar to those lining the uterus grow in other parts of the body. Endometrial tissues and lesions are found in the ovaries and Fallopian tubes.  They can sometimes also grow in the vagina, cervix, vulva, bowel, bladder and rectum. Rarely, do they appear in other parts of the body, like the lungs, brain, and skin (2). Just like the lining of the uterus, these cells build up and eventually shed. But unlike your period which drains through the vagina, this blood and tissue has nowhere to go. This can cause inflammation, crippling pain and a long list of other symptoms. Endometriosis can affect women of any age, including teenagers. What are the main symptoms of endometriosis? Here are the most common symptoms of endometriosis (3):  Severe period pain  Severe period and pelvic pain are often reported to be the most debilitating symptoms of endometriosis. This pain is often described as ‘a razor blade pain’.  During your menstrual cycle, the lining of your uterus (endometrium) is built up to support a potential pregnancy. If its baby-making dreams are not fulfilled, your body releases chemicals called prostaglandins.  Prostaglandins cause the uterus to contract and your endometrium sheds. Cue, your period. These contractions are what cause period pain. With endometriosis, the endometrial-like cells that have grown outside of the uterus also build up and shed. This internal bleeding leads to inflammation, intense pain and a buildup of scar tissue and adhesions (a type of tissue that can bind your organs together).  Usually, the first or second day of your period is the most painful. But in cases of endometriosis, the crippling pain usually kicks in a few days before your period’s arrival. It can also make an unwelcome return during ovulation or even throughout the month.  People can also experience chronic pain, increased lower back and pain around their legs which increases around their periods. “Endo belly” is a common term used to refer to the uncomfortable abdominal symptoms associated with endometriosis. Heavy periods Another common endometriosis symptom is heavy periods. Heavy periods are defined as: If your periods are painful or heavy it’s important to seek medical advice. Monthly heavy bleeding can increase the risk of anaemia (iron deficiency) which can result in symptoms of fatigue, feeling cold often and hair thinning. Pain during or after sex Another common symptom of endometriosis is pain during or after vaginal penetration. This can be caused by endometrial lesions growing in the pelvic region and becoming inflamed during or after sex. This pain is called dyspareunia. It has been reported to feel like a stabbing shooting pain, usually felt deep inside the pelvis. Any unwanted pain during sex is not normal. If you experience any pain during or after sex or any bleeding, get it checked out. There is also mental health support available if you feel your intimacy is being affected by pain during sex. Bowel and urination pain Endometrial lesions can sometimes find their way to the surface of the bowel or even penetrate its wall. This can cause uncomfortable symptoms such as pain when urinating or passing bowel movements or noticing blood in your urine or poo. Pain during urination can sometimes be misdiagnosed as a UTI. If you’re in pain when passing urine or poo or if you notice any blood in either, get it checked out to understand what might be the cause. Bloating and gastrointestinal issues People with endometriosis can also experience bloating and gastrointestinal issues. These symptoms are similar to those of irritable bowel syndrome (IBS). Including diarrhoea, constipation and bloating. These symptoms are often affected by your cycle and can worsen in the days before your period. Fertility problems Unfortunately, endometriosis can affect your fertility. Infertility affects about 30-50% of those with endometriosis, but there are no definitive answers (yet) as to why—only theories.   However, this does not mean that if you have endometriosis you can’t conceive. Even in cases of severe endometriosis, natural conception is possible.  Mental health impacts Living with a chronic condition can be tough and often isolating. Endometriosis can affect various aspects of life from personal to professional relationships, which can impact your mental health.  If you feel like endometriosis is impacting your mental health, there are online support communities like Endometriosis UK. You can also talk to our Fertility Counsellors for any mental health concerns relating to your fertility.  Getting to the bottom of symptoms Just like any reproductive health condition, endometriosis varies from person to person. Not everyone with endometriosis will experience all of these symptoms to the same severity. Some people may not experience any of these symptoms at all.  Having severe pain or very heavy periods is not necessarily a sign of more severe endometriosis. It’s also important to remember that each of these symptoms can also be caused by other conditions.  If you’re experiencing any of the […]

Have you been diagnosed with endometriosis? Discover our top tips for managing endometriosis pain and the treatment options available to you. From painkillers to surgery.  Quick facts: Living with endometriosis If you live with endometriosis, you probably know that one of the biggest symptoms of endometriosis is pain… a lot of it. Experiencing chronic pain amongst other, often equally debilitating symptoms, can have big physical and emotional consequences.  Sadly, there is currently no cure for endometriosis. And with limited research and understanding of the condition, it can be difficult for both doctors and endo warriors to get a handle on managing endometriosis symptoms.   But you don’t have to put up with pain. There are several treatments available to manage symptoms and help improve your quality of life. Lots of people report huge improvements with these treatments—it’s just about finding what works for you. Medication for managing symptoms The first step in managing pain is usually exploring the use of painkillers. Your doctor may recommend taking nonsteroidal anti-inflammatory drugs (NSAIDs) (aspirin, ibuprofen) or paracetamol as a first line of treatment to manage any pain.  However, there are lots of different types of painkillers and your doctor can help you to find ones that work for you and your pain level.  Depending on the severity of your endometriosis pain, you may try a course of painkillers for a few months until you assess whether or not they are working for you.  But if you’re finding that these aren’t making the cut and you’re unable to go to work, uni, school, work or other plans, don’t suffer in silence! This is just the first option for managing endometriosis, so push your doctor for alternatives. Tips for endometriosis pain management Endometriosis UK suggests some extra tips for pain management: Heat and comfort Hot water bottles, heated wheat bags or special heat pads can really help to soothe pain, cramping and inflammation.  Remember to never put them directly onto the skin and always have a layer in between. Partnered with your comfies, hopefully, this can help you to feel more comfortable. Physiotherapy Physiotherapists can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. TENS machines Transcutaneous Electrical Nerve Stimulator (TENS) machines are small devices with electrodes that send electrical pulses into the body. This can block the pain messages as they travel through your nerves. Pain clinics Your doctor can refer you to your nearest pain clinic to see chronic pain specialists. Push for your doctor to get you the expert advice you deserve to manage your endometriosis pain. Hormone treatment for endometriosis When you’re diagnosed with endometriosis, hormone treatment is another common avenue to explore. You should discuss hormone treatment with your doctor or specialist to decide if it’s right for you. For those with endometriosis, similar cells to those lining the womb exist outside of the womb (usually in the abdomen).  These cells also respond to your sex hormones, particularly oestrogen and progesterone, in the same way as your womb lining. They thicken, break down and bleed during your period. This bleeding causes inflammation and scarring, leading to chronic pain.  Hormone treatment is commonly used to reduce the growth of this endometrial tissue.  How does hormone treatment help endometriosis? Hormone treatment aims to maintain low levels of oestrogen in the body, as oestrogen has been found to encourage the growth of endometrial tissue. Hormone therapy can help reduce heavy flow or even stop periods and therefore improve symptoms.  Whilst most endo warriors find that hormonal treatment reduces their symptoms, it is not a permanent fix to manage endometriosis. Types of hormonal treatment used to manage endometriosis? There are lots of different types of hormone treatment available. Some of the most common are also used as contraceptive methods including: Unfortunately, not everyone gets on with hormonal contraception and side effects can be common. It’s important to consider which hormone treatment is right for you. Surgery for endometriosis A last resort if the above treatments aren’t keeping your symptoms at bay, is endometriosis surgery. This aims to remove or destroy areas of endometrial tissue.  This can include laparoscopic surgery or a hysterectomy. The kind of surgery you have will depend on where the endometriosis is and how much of it there is. Laparoscopic surgery for endometriosis Initial surgery will almost always involve gynaecological laparoscopy for both diagnosis and excision. In laparoscopic surgery, also known as keyhole surgery, your surgeon inserts a small tube with a light source and a camera, through a small incision near your belly button.  They use this to be able to look inside your tummy or pelvis and then use fine tools to remove endometrial tissue (excision) or use intense heat to destroy the tissues (ablation). They can also remove any scar tissue that has built up in the area.  This form of surgery can be difficult, as many of the lesions are below the surface and not visible, so a highly skilled practitioner is required to remove them.  It might be the most long-lasting treatment, and people do notice relief in symptoms, but many who undergo surgery find their endometriosis grows back over time. This is why endo warriors may have to undergo surgeries multiple times. Hormone treatment might be used after surgery to help get better, longer-lasting results. Hysterectomy for endometriosis Sometimes healthcare professionals will also suggest undergoing a hysterectomy, a surgery where the womb is removed. This can be a very big decision as post-surgery, you will no longer be able to become pregnant or carry a pregnancy.  If you want children, you can discuss egg freezing before this procedure with your doctor. This means that you will then have the option of trying to have a baby using fertility treatments such as in vitro fertilisation (IVF) with the help of a surrogate. In some cases, someone might still experience symptoms after getting a hysterectomy done as a form of endometriosis management. If the ovaries […]

How can your thyroid be affecting your fertility? Your thyroid is a butterfly-shaped gland located at the front of your throat. It plays a crucial role in influencing metabolism, temperature, growth, and development, via the production of thyroid hormones. The main thyroid hormones are thyroid stimulating hormone (TSH) thyroxine (T4) and triiodothyronine (T3). Whilst many are aware that the imbalance of these hormones could cause changes in weight and mood, not quite so many of you know that your thyroid can also affect your fertility and menstrual cycle. If you think of your thyroid as a conductor in an orchestra, conducting many different instruments (organs) as they play their music (produce hormones), then it’s easier to understand how if one your organs is off key, it tends to mess up the whole song. If your cycles are out of sync or you’re trying to conceive, it’s probably a good idea to check your thyroid is in tune and working optimally. CHECK YOUR FERTILITY What are thyroid disorders? About 2-4% of women of reproductive age struggle with a thyroid imbalance. When your thyroid is underactive, it is known as hypothyroidism. The main symptoms of hypothyroidism are weight gain, thinning hair, severe fatigue, slowed heart rate, depression, decreased libido, and sensitivity to cold. When your thyroid is overactive, it is known as hyperthyroidism. These two issues are like yin and yang, so the main symptoms of this are pretty much the opposite of hypothyroidism. That is, rapid weight loss, increased appetite, increased sensitivity to heat, frequent bowel movements, menstrual irregularities and irritability. Also not ideal. How can thyroid dysfunctions affect your reproductive health? Thyroid disorders can mess with your metabolism, as well as disrupt your hormones in general. The hormonal issues that arise as a result can include anovulation, or the inability to ovulate, as well as luteal phase defects, hyperproalctinemia, and general sex hormone imbalance. As the thyroid plays a crucial role in growth and development, a healthy thyroid is necessary for maintaining a healthy pregnancy as well. Is there a connection with your thyroid and fertility? While thyroid issues are problematic, they are a confounding factor in your fertility, rather than a direct problem. For example, when a car blocks you in and you can’t leave, it’s not an issue with your car, but rather the other car in your way. Same goes for this –  fertility resolves once the thyroid problem resolves. One study demonstrated that 76% of women who fixed their thyroid were able to conceive between 6 weeks to 1 year afterwards. Testing your thyroid levels is the best place to start to help you understand whether you may be suffering from a thyroid disorder. In hypothyroidism, TSH would be high, while T3 and T4 would be low. With hyperthyroidism, the opposite is true, and TSH would be low, while T3 and T4 would be high. Once you have an understanding of where your thyroid stands, you can then treat this issue, which is primarily done with oral medication. Hypothyroidism is typically treated with thyroxine (T4) replacement, and Cytomel, or T3 replacement, may also be required in specific cases. Hyperthyroidism is a bit more complicated, and is treated with antithyroid medication, iodine, or surgery. Sometimes, drugs known as beta-blockers are used as well. It is important to find an endocrinologist that you trust, and possibly to even get a second opinion, if you feel like there is an issue with the treatment you’ve been prescribed. If this has got you scratching your head about your own thyroid levels or questioning your overall fertility, Hertility are here to fill in the blanks. With our at-home tests, we can give you a better insight into your health, and if this little gland isn’t in check, we’ll lead you down the path to fixing it.