Knowledge Centre

Menopause can be a challenging time, with many women experiencing a sleuth of uncomfortable symptoms. Here we get into everything you need to know about menopausal symptoms, the stages and the treatment options available.  Quick facts: What is menopause? Menopause is when your periods stop due to low hormone levels. It will happen to anyone who has periods, usually at around 45-50 years of age and is a natural part of ageing.  Menopause marks the end of your reproductive years. After you’ve experienced menopause, it’s no longer possible to become pregnant naturally without assistance. In the UK, the average age for experiencing menopause is 51. Approximately 25 million people go through menopause every year. Despite it directly affecting half of the population, knowledge and understanding of menopause remains incredibly low. For many people, menopause can be an incredibly difficult time as it is often accompanied by a series of both physical and psychological symptoms—in addition to a lack of public understanding as to what experiencing menopause can entail.  How is menopause diagnosed? Menopause is usually diagnosed when: If you are experiencing symptoms associated with menopause but don’t meet all of this criteria, it is possible you could be experiencing a different health condition, or premature menopause if you are under the age of 40. What is early menopause? Around 5% of people may experience menopause before 45 years of age, known as early menopause. This can happen naturally or due to side effects of some treatments, like cancer treatments or surgeries to remove the ovaries. What is premature menopause? If you experience menopause before 40 years of age, it is known as premature menopause, which may also be described as Premature Ovarian Insufficiency (POI), depending on your circumstances.  Again, premature menopause may occur naturally, due to genetics or lifestyle factors, or as a result of medical or surgical treatment. Some things that might increase the chances of premature menopause are: POI affects 1 in 100 people under the age of 40, one in 1,000 people under 30 and one in 10,000 people under 20. It occurs because the ovaries do not function properly and are unable to make sufficient levels of hormones like oestrogen and progesterone, which have important roles in overall health and well-being.  POI can occur because of many reasons. Unfortunately, in the majority of cases, no underlying cause can be found. What are the 3 stages of menopause? The stages of menopause include premenopause, perimenopause and post menopause. The menopause actually only references the time when it has been 12 months since your last period. Let’s take a look at these stages one by one… What is premenopause? Premenopause refers to the period of your life before the transition into menopause has started, also sometimes referred to as your reproductive years. This is when you shouldn’t be experiencing any (peri)menopausal symptoms and have a healthy and regular menstrual cycle. What is perimenopause? The transition to menopause is known as perimenopause. This is when your body starts preparing you for menopause. During the perimenopausal phase, your ovaries will begin producing less oestrogen and progesterone and your periods can become irregular or erratic. Perimenopause can be challenging because it is often accompanied by lots of physical and emotional symptoms, which can be distressing and impact your quality of life.  Perimenopause can last anywhere from a few months to several years, with the average length being four years. However, this will depend on the individual, your lifestyle and hormonal make-up. Most people start perimenopause at some point after their mid-40s, but some as early as their mid-thirties (although this is quite uncommon). Sometimes people even skip perimenopause all together and enter menopause suddenly. Although chances of pregnancy are low during perimenopause, it is still possible as ovulation may still be occurring and an increased risk of sexually transmitted infections if you aren’t using barrier contraception methods. If you are sexually active and in the perimenopausal stage, it is important to speak to your doctor about appropriate contraception for you. The menopause The menopause actually refers to the time when it has been 12 months since your last period. This is technically when you have experienced menopause.  What is post menopause? Post menopause refers to the time after you have experienced menopause—the rest of your life after menopause. During this time your sex and cycling hormones will be at different levels to where they were before menopause and you will no longer have periods.  At what stage of menopause are symptoms worse? Symptoms and their severity will depend on the individual, but for most, perimenopause is the time when you will experience the most symptoms. This is because of the huge hormonal fluctuations happening during this stage and your body adjusting to lowering hormonal levels. What are the symptoms of menopause? Most of the symptoms of menopause are associated with declining oestrogen levels. The duration and severity of these symptoms can vary depending on the individual.  Symptoms usually start a few months or years before your periods stop (in the perimenopausal stage) and can persist for some time post menopause.  On average, most symptoms will last for around four years after your last period, although some people may experience them for much longer.  Let’s take a look at some of the most common symptoms… Changes in menstrual cycle characteristics Often the first sign is a change in the normal pattern of your periods—cycles may be shorter or last longer, become erratic or increase in frequency.  You may find that you begin to experience fewer periods and go for months at a time between periods until they eventually stop altogether. Your menstrual flow may also become lighter or heavier than normal and last longer than normal. Hot flushes and night sweats Hot flushes are sudden feelings of heat, usually in the face, neck and chest, which can make your skin red and flushed. These can happen at any time and often erratically with seemingly no external trigger.  Flushes can be followed by […]

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

Polycystic Ovary Syndrome (PCOS) is a very common reproductive health condition estimated to affect 1 in 10 in the UK. In this article, we’ll cover exactly what PCOS is, its causes and symptoms, common FAQs about PCOS and some tips for those living with the condition. Quick facts: What is PCOS? Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders. PCOS is characterised by an imbalance of sex hormones which can cause a whole host of symptoms – including missed periods, acne, excessive hair growth and even fertility issues.  Despite how common it is, many people don’t get a proper diagnosis until they’re having difficulties trying to get pregnant. Research has shown that it can take on average 2 years and visiting more than 3 doctors to get a PCOS diagnosis. What are the symptoms of PCOS? We are all unique, so every person affected by PCOS will experience symptoms differently but some common symptoms include the following. Menstrual cycle-related symptoms PCOS can impact ovulation by either causing irregular ovulation or no ovulation at all (anovulation). This is because people with PCOS tend to have imbalances in hormones that regulate the menstrual cycle – particularly luteinising hormone (LH).  As these hormones are key for regulating ovulation, an imbalance can cause ovulation to happen less frequently or stop it altogether. Irregular ovulation will often result in irregular periods (oligomenorrhea). This is when your cycle is less than 21 days, or more than 35 days apart. People with PCOS tend to have very long cycles (i.e. more than 35 days) or no periods at all (amenorrhea). They have also reported experiencing heavier-than-normal periods. Skin and hair-related symptoms This can include excessive hair growth (hirsutism), especially on the upper lip, chin, neck, sideburn area, chest, upper or lower abdomen, upper arm and inner thigh. Loss of hair or thinning of the scalp hair (alopecia) can also be experienced as well as thick dark patches of skin in your armpit or around your groin or neck (acanthosis nigricans) and skin tags. Acne is also a common symptom. Skin and hair-related symptoms are caused by having too many androgens (such as testosterone) in your body, which is a common trait in people with PCOS. Weight gain or difficulty losing weight Weight gain is particularly seen around the abdomen area (known as central adiposity), which is caused by PCOS affecting your metabolism. Difficulty conceiving This is due to the hormone imbalances in PCOS causing irregular ovulation. PCOS can cause ovulation to become less frequent and unpredictable, which may make it more tricky to conceive. If ovulation doesn’t occur, there’s no egg awaiting fertilisation. Mental health-related symptoms People with PCOS are more likely to experience mental health-related symptoms including depression and anxiety as a result of the negative impact their symptoms can have on their day-to-day life. What causes PCOS? Although the exact cause of PCOS is unknown, research suggests that a combination of genetic, lifestyle and environmental factors are at play. Here are some of the main factors thought to be responsible for PCOS symptoms. High levels of Androgens Androgens are a group of hormones, the most common being testosterone. They are made mostly by the ovaries and are important for muscle growth and getting your libido going.  People with PCOS have been found to have higher than normal androgen levels, a condition called ‘“hyperandrogenism”. This can result in characteristic PCOS symptoms such as excessive body and facial hair growth, hair loss from the scalp, oily skin and acne. Don’t be fooled by its name, polycystic ovaries do not mean cysts in the ovaries. This imbalance of androgen hormones does not allow follicles (little sacs that house your eggs) in the ovaries to mature properly.  As a result, there are a large number of immature follicles which get stuck in different stages of maturation. These can appear like cysts during a pelvic ultrasound scan but are very different to cysts. High levels of insulin Some people with PCOS also experience a condition called insulin resistance. Insulin is a hormone that controls blood glucose levels (basically your blood sugar). When blood glucose levels rise (after eating for example), insulin helps the cells to absorb it so it can be used by the body for energy. Insulin resistance is when the body doesn’t respond to normal insulin levels. The body starts making excess levels of insulin to compensate for this, leading to misregulation of blood sugar levels and knock-on effects on the proper functioning of the ovaries and ovulation.  Insulin resistance can also lead to problems with metabolism, causing further symptoms such as weight gain, difficulty losing weight and higher risks of conditions like type 2 diabetes.  High insulin levels also decrease the production of sex hormone-binding-globulin (SHBG)—an important hormone that regulates testosterone levels—which therefore results in increased levels of testosterone and excess androgen-related symptoms. Genetic causes PCOS has been found to run in families, so having an immediate relative with PCOS can put you at a higher risk of developing it yourself. There have been several genes which have been identified as possible causes of PCOS, but as of yet, no conclusive links have been made. Recent research published by members of the Hertility research team shows that PCOS may be associated with genetic changes in the powerhouse of our cells called the mitochondria. Ethnicity PCOS affects people of all ethnic backgrounds, however, research has shown that those from ethnic minority communities, especially those who are Black or South Asian, are at a higher risk of developing PCOS.  Different ethnicities are also known to have different PCOS symptoms. For example, research has found that women of South Asian and Middle Eastern descent are more likely to experience excessive body and facial hair and women of East Asia are more likely to experience irregular periods. How can I be diagnosed with PCOS? Someone would need to be experiencing at least two of the following to be diagnosed with PCOS:  Is there a […]

You can test some of your hormones with Hertility regardless of the type of birth control you’re using. In this article, we run through the differences between hormonal and non-hormonal birth control and which hormones you can test with us depending on the type you’re using.  Quick facts: Different types of birth control Despite most of us only being able to reel off a handful, there are actually many different types of birth control, or contraception. These include both hormonal and non-hormonal options, plus, long-term and short-term methods. Whatever method of contraception works best for you is personal and will depend on your goals, your body and if you choose to use hormonal contraception, your hormones too.  So, from condoms to coils, let’s take a look at the different types of birth control, how they work, and how each will affect a hormone and fertility test. What is hormonal contraception? Hormonal contraception uses synthetic hormones, which are basically (wo)man-made versions of our natural hormones, to either prevent us from ovulating and/or to bring about bodily changes that prevent pregnancy. Types of hormonal contraception include: How does hormonal contraception work? To understand how hormonal contraceptives work (and how this might affect your test), it’s important to first understand exactly how your hormones control your menstrual cycle and overall fertility. Your menstrual cycle hormones, including oestrogen, progesterone, follicle-stimulating hormone (FSH), luteinising hormone (LH) and testosterone, all work together to ensure that each month you ovulate a healthy, mature egg from one of your ovaries.  If any of these hormone levels are altered, disrupted or suppressed, your overall menstrual cycle and ovulation can be affected—impacting your fertility and ability to conceive.  Hormonal contraceptives use either a combination of synthetic oestrogen and synthetic progesterone (called progestin), or simply just progestin (depending on the type) to alter the balance of your menstrual hormones.  This brings about a series of bodily changes that prevent pregnancy, including: Hormonal contraception can also be used to help relieve hormonal symptoms, like acne, and those related to your menstrual cycle, like heavy menstrual bleeding. Can I test my hormones if I’m on hormonal contraception? Technically, yes you can—but because your natural hormone levels will be altered due to the synthetic hormones in your system, you won’t be able to get an accurate result of your natural menstrual cycle hormone levels, including your FSH, LH, or oestradiol (E2). The good news is, with Hertility, even if you’re on hormonal contraception, we can still test you for Anti-Müllerian Hormone (AMH) and your thyroid hormones—Thyroid Stimulating Hormone (TSH) and Free Thyroxine (FT4).  Taking a Hertility Hormone & Fertility Test to test your AMH will give you insight into how many eggs you’ve got left (your ovarian reserve), giving you a good idea of your current fertility. Hormonal contraception can temporarily impact AMH levels, to determine your ovarian reserve more accurately. We would recommend retesting your AMH with your cycling hormones (FSH, oestradiol and LH) at least 3 months after coming off your form of contraception. Your thyroid hormone levels are a good indicator of your general hormone health and remain unaffected by taking any hormonal contraception.  If you’re using a long-term form of hormone contraception, such as the contraceptive injection (known as Depo Provera), you might have to wait up to 12 months for your menstrual cycle hormones to regulate and get back to their natural levels, so we can get an accurate result. What is non-hormonal contraception? These are your contraceptive types that don’t contain any synthetic hormones, and won’t alter your natural hormone levels if you use them.  Types of non-hormonal contraception include: How does non-hormonal contraception work? Non-hormonal contraceptives prevent pregnancy through several different methods, the difference being they tend to use just one method, rather than a combination, like in hormonal contraception. These include:  These include: Can I test my hormones if I’m on non-hormonal contraception? Yes, you’re good to go! Non-hormonal contraception does not alter any of your natural hormone levels, so with our Hormone and Fertility Test you can test all of your menstrual cycle hormones, AMH and thyroid hormones when you’re using non-hormonal contraception. Do I need a hormone test? Testing your hormones and fertility can give you important insights into both your overall and reproductive health.  Whether you’re experiencing possible hormonal symptoms, or planning ahead for your future family forming options—testing can help give you clarity into what’s going on inside your body.  Our At-home Hormone & Fertility Test is personalised to you and based on your unique biometrics, medical history, cycle and symptoms. Our test will screen you for up to 18 reproductive health conditions and give you insights into your ovarian reserve. This can help you to identify any potential underlying health conditions or hormonal imbalances that could affect your chances of conceiving. We recommend regular testing—once a year, or every six months if you’re above 35 or have an underlying condition that might affect fertility. Because our hormones are constantly changing, regular testing helps to ensure you’re tracking any changes over time. This can help you to better manage any symptoms and measure the success of any lifestyle changes or medication if you need to. So, whether you’re curious about your health, planning for future children or trying to conceive, regular hormone testing with our At-Home Hormone & Fertility Tests could be an essential step toward understanding your reproductive health. If you’re on contraception, hormonal or non-hormonal, and want to test your hormones and fertility, you can get started today by taking our online health assessment today. References:

Anti-Müllerian Hormone (AMH) is a really important hormone for your fertility because of how closely it is linked to your eggs, AMH testing can help you understand your fertility and give you insights into your overall reproductive health. Here’s what testing can and can’t tell you. Quick facts: What is AMH and why is it so important? Anti-müllerian hormone (AMH) is a super important hormone for fertility. AMH is made by the small sacs, called follicles, in your ovaries. These follicles house your eggs.  Because of its close relationship to your eggs, testing your AMH levels can help indicate how many eggs you have left at the time of testing.  There are a few myths out there about what exactly AMH testing can tell us. So in this article, we cover the main things an AMH test can and can’t tell you. Let’s get into it… What can AMH testing tell me? Whether your ovarian reserve is a normal for your age AMH testing will give you insights into whether your ovarian reserve is in line with other healthy people in your age group. If you are not using any hormonal contraception, testing other hormones, like follicle-stimulating hormone (FSH) and oestradiol alongside AMH can also help to build a full picture of egg reserve. Generally, people with low egg reserves are known to have higher levels of FSH and lower levels of oestradiol. Whether you have polycystic ovaries or polycystic ovary syndrome AMH testing can also indicate whether you could have polycystic ovaries (PCO). PCO is a common reproductive health condition affecting around 30% of reproductive-aged people assigned female-at-birth. PCO is benign and does not affect fertility, but it can cause other unwanted symptoms.  People with PCO have a higher-than-expected number of immature follicles in their ovaries. More follicles mean a higher level of AMH in the blood.  Some people with PCO also have the syndrome that can be associated with it—polycystic ovary syndrome (PCOS), which often presents as symptoms like irregular periods and high testosterone levels.  According to updated guidelines, AMH testing can be used as a marker for polycystic ovaries, which is one of the criteria for a  PCOS diagnosis. However, we would always recommend getting a scan of your ovaries) to confirm the diagnosis. Whether IVF or egg freezing could be right for you AMH testing and understanding your ovarian reserve can also help to determine if certain fertility treatments like IVF or egg freezing could be suitable for you. During these fertility treatments, AMH levels are often tested to help determine the doses of medication needed and used to predict the outcomes of the egg collection process. People with lower AMH levels are known to have less successful IVF treatment cycles, whereas someone with high AMH might be at increased risk of developing a rare but potentially life threatening condition called OHSS (ovarian hyperstimulation syndrome).  Many NHS-funded and private IVF clinics therefore require a minimum AMH level for you to be eligible for a free IVF treatment cycle. The minimum level on the NHS will depend on where in the UK you are currently residing. Whether you may be perimenopausal or menopausal or have POI Menopause refers to the period of your life, usually post 45-50, where you no longer have menstrual cycles and are therefore no longer able to conceive naturally. Menopause is associated with having an extremely low, or completely diminished, ovarian reserve.  It is usually diagnosed retrospectively—when women are over 45 years old and have not had a period in 12 months (and are not using hormonal contraception).  For people who are younger, FSH levels are useful for diagnosing menopause, as FSH levels are known to increase for people with low egg reserves. Although AMH levels are not recommended to help diagnose menopause, it is known that AMH levels reduce to very low levels at the time of menopause. There is also evidence that people with very low AMH levels (who are not going through menopause) will undergo menopause much sooner than those with AMH levels that are within range. When the ovaries stop working before the age of 40, this is known as premature ovarian insufficiency (POI), which AMH levels have also been shown to provide a good indicator of. If you have a higher risk of miscarriage or recurrent pregnancy loss It is estimated that approximately 1 in 5 pregnancies end in miscarriage. Miscarriages occur most frequently in the first 12 weeks of pregnancy and can be associated with lots of different risk factors. Some of the most common are your and your partner or sperm donors’ age, pre-existing conditions and ethnicity. Recent evidence has shown that people with diminished ovarian reserve, and therefore very low AMH levels, are more likely to have a miscarriage or recurrent miscarriage (two or three consecutive pregnancy losses).  However, more research needs to be done to understand the links between AMH levels and miscarriage, including its risk factors. What can’t AMH testing tell me? Unfortunately, AMH testing and ovarian reserve forms only one part of the fertility picture and there are some things that AMH testing may not be able to tell you. Let’s take a look… It can’t determine your egg quality Although AMH levels can give insight into your egg quantity, it does not provide any insight into the quality of those eggs. Despite poor egg quality being one of the most common causes of female infertility, there is currently no test that can definitely determine egg quality (unless testing embryos in IVF treatment). It can’t determine your exact egg quantity Your AMH result can give an indication of the size of your ovarian reserve.  This is because it is released by the follicles which contain our eggs, meaning that the more follicles we have, the higher the AMH that will be produced. However, it can’t tell you your exact number of eggs because each follicle may produce a different amount of AMH depending on its size.  In order to estimate the number […]

If you have been diagnosed with Polycystic Ovary Syndrome (PCOS) and are feeling a bit clueless or overwhelmed, we’re here to help. In this article, we explain all of the possible treatments for PCOS and how to effectively manage your symptoms. Quick facts: What is PCOS? PCOS is an extremely common reproductive health condition that affects up to 1 in 10 people assigned-female-at-birth. It can affect how the ovaries work and can cause an array of different symptoms, which can range in severity from person to person.  The good news is, that even if you are feeling overwhelmed or anxious at the outcome of your recent diagnosis, PCOS symptoms can be treated and managed with lifestyle changes. Symptoms of PCOS As with most conditions, the symptoms of PCOS vary from person to person, as does the severity of the symptoms. Not everyone with PCOS will experience all of these symptoms, but you need to have at least two of the below to have been diagnosed.   Other symptoms can include: What causes PCOS? Currently, the exact cause of PCOS is unknown but it often runs in families and can be related to abnormal hormone levels in the body, including high insulin.  Higher insulin levels also induce your ovaries to produce androgen hormones such as testosterone. An increase in androgen hormones can cause symptoms like excess hair growth (hirsutism) acne and alopecia.  High levels of insulin can also eventually cause insulin resistance. Because insulin metabolises carbohydrates in your body, those with insulin resistance are therefore unable to respond to glucose properly.  This can then lead to being overweight as your body is not able to absorb the sugars from your food into your liver and convert it into energy—so it is stored as fat instead. How to manage your PCOS symptoms The current treatment options for PCOS are symptomatic, as there is currently no cure. This means treatment is focused on treating and mitigating symptoms with lifestyle changes and certain medications.  Your treatment will follow patient-centred care, meaning you will have a say in your treatment and your doctors should respond by providing you with care that is responsive to your preference and needs. The first line of treatment they will recommend will be to make changes to your lifestyle. These include changing your diet, exercising, losing weight and taking part in activities to maintain healthy mental health.  Don’t underestimate the power of lifestyle changes. Making healthy choices and bringing positive changes to your lifestyle can create a major difference in your symptoms, allowing you to control them and improve your quality of life. With the right, tailored care plan, many people find that their PCOS symptoms can be controlled and that they don’t present any further problems for them. Let’s take a look at some of the lifestyle changes involved in PCOS symptom management. PCOS diet and nutrition Some research suggests that following a healthy balanced diet is a significant way to manage your PCOS—it can regulate your period and ovulation and reduce the presence of symptoms like acne and hirsutism. High GI carbs Vs low GI and weight loss If you are currently overweight, losing weight and maintaining a healthy weight is crucial for managing PCOS.  The more overweight you are the more complications you will face with PCOS as well as having a higher risk of developing other long term health conditions. There are many different PCOS diets that people recommend, but a healthy and sustainable option is a low glycaemic index (G.I) diet. This involves substituting high GI carbs with low GI carbs which can help PCOS sufferers lose weight efficiently. Low GI carbs increase blood glucose levels very slowly, whereas high GI foods are digested rapidly, which can cause spikes in your glucose and insulin levels.  A great book that explains the G.I diet very well is ‘ The Low GL Diet Bible’ by Patrick Holford, it contains a list of foods that you can substitute your daily carbs with. Here are some great examples of Low GI carbs that you could incorporate into your diet: Following a low GI carbs diet is generally the key piece of advice that clinicians and dieticians will advise in the case of any PCOS diagnosis and will likely form the basis of a PCOS specific nutritional care plan.  However, there are other foods and simple switches that you can incorporate into your diet which may help to further reduce your symptoms too. A PCOS friendly food list may contain: If you’d like help with anything regarding PCOS specific nutrition, you can book a consultation with one of our Fertility Nutritionists who will be able to help you with a nutritional care plan. Reducing fat and salt As well as managing and decreasing your carbohydrate intake, you should also manage your fat and salt intake and make sure you’re taking in all the necessary vitamins and minerals. Try to keep your salt intake to a maximum of 2,300 mg per day.Also, increasing the intake of whole foods aids weight loss and helps to maintain a healthy balanced diet.  Although losing weight isn’t so easy for PCOS sufferers, it is totally worth it—just a decrease in 5% of overall body weight can significantly improve symptoms. PCOS and exercise benefits Like losing weight, exercise increases metabolism and may help to improve many of your symptoms. When exercising, the main goal is to lose weight in the abdomen and reduce fat around the organs.  This will help to support your endocrine system, which secretes and regulates your hormones, including your insulin and testosterone levels.  If you’re new to regularly exercising, it’s best to start slowly, steadily increasing your workouts as well as the time spent working out. In the long run, this will be much easier to maintain.  Cardio is great for heart health, with things like swimming, hiking and running great for getting a sweat on. But there is a misconception that you will only lose weight with cardio, it’s a total myth!  […]

Can smoking cause hormonal imbalances? Just like the negative consequences to heart and lung health, smoking can also negatively impact our reproductive health. Read on to find out.  Quick facts: How smoking affects the body It’s a well-known fact that smoking can have a negative impact on health, with both active and passive smoking being associated with multiple forms of cancer, diabetes and heart disease. Despite this, in the UK, as of 2019, 28% of men and 22% of women aged between 25 and 34 years are current smokers, according to published health data in England (1)—and a whopping 175 million people assigned-female-at-birth (AFAB) smoke worldwide. But whilst smoking’s effects on the heart and lungs are fairly common knowledge, fewer people are aware that it can also influence the body’s hormones. But how exactly are hormones and smoking linked? In this article we’ll look at: Does smoking affect hormones? Despite the lack of public awareness, there is plenty of research that shows how smoking can impact and even wreak havoc on our hormonal health. The chemical components of cigarette and cigar smoke can disrupt the normal functioning of our bodily systems, including the endocrine system. The endocrine system is a network of glands which influence the production, secretion and regulation of hormones throughout the body, such as the hypothalamus, thyroid, adrenal gland, and even the ovaries.  This disruption might lead to lasting effects on all kinds of hormonally regulated processes, including sexual function and reproductive potential, our metabolism and even our sleep.  As mentioned, both active and passive smoking (also known as second-hand smoking) can cause these nasty effects, with some research even indicating that prolonged exposure and inhalation of cigarette smoke can even affect the onset of menopause (3). There are over 4,000 substances in cigarettes that display reproductive toxicity. How does smoking affect different hormones? Smoking has been linked to abnormal changes and fluctuations in various hormone levels, including: Let’s take a look at each of these in detail. Smoking and testosterone Studies have consistently shown that smoking increases testosterone in AFAB individuals. Those who smoke have been found to have higher serum testosterone levels in their blood than those who don’t (4).  This is because smoking is inherently pro-androgenic, meaning it has a positive effect on androgen hormones like testosterone. Increased testosterone levels can bring on side effects such as excess body hair growth (hirsutism), acne, greasy hair and skin, irregular periods and low libido. The main reason for smoking’s pro-androgenic effects lies with nicotine. As tobacco is metabolised, the nicotine within it produces a compound known as cotinine, which inhibits testosterone breakdown (17). However, it’s interesting to note that similar studies performed on ageing men have indicated that, over a long enough timespan, smoking can reduce testosterone levels in those assigned-male-at-birth (AMAB) (16). Smoking and oestrogen As well as being pro-androgenic, smoking is also anti-oestrogenic, which means it has a negative effect on oestrogen levels. Studies have shown that women who smoke have  lower progesterone and oestrogen levels in both their blood and follicular fluid (the fluid which surrounds the developing egg, important for egg growth) (2,5).  Smoking even affects the conversion of androstenedione to oestradiol by cells within the eggs (2). This switch is mainly driven by the effects smoking has on the production of these hormones.  As well as negatively affecting oestrogen production and metabolism by your liver, smoking increases the levels of a hormone called sex hormone-binding globulin (SHBG) which binds to oestrogen—preventing it from performing its essential functions around the body. Symptoms of low oestrogen can include low libido, fatigue, and negative mood changes. Smoking and gonadotropins Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are both gonadotropin hormones. These are hormones released from the hypothalamus (a part of the brain) to regulate the menstrual cycle and induce ovulation.  Unsurprisingly, smoking has been found to affect gonadotropin levels as well. Studies have shown that habitual smokers tend to have higher levels of FSH and LH in the first half of their cycle and during their periods, than non-smokers (6,7).  Disrupted FSH and LH levels can lead to problems with both fertility and menopause. Smoking and Anti-müllerian hormone Anti-müllerian hormone (AMH) is produced by granulosa cells within the ovarian follicles. It’s used as an indicator of ovarian reserve, sometimes referred to as egg count. Research has shown that smokers generally have lower AMH levels. One study in particular found that current smokers have  44% lower AMH levels than non-smokers (8), indicating that smoking can be directly toxic to the eggs within the ovaries. Another study showed that, in smokers, the fluid produced by the granulosa cells (known as follicular fluid) also contains increased levels of harmful nicotine toxins (9). Chemicals derived from cigarettes and smoking have even been detected in the cervical mucus (10). Smoking and thyroid hormones Cigarette smoke has been found to have both inhibitory and stimulatory effects on thyroid hormones. Both active and passive smoking have been linked to decreased levels of thyroid-stimulating hormone (TSH) and increased levels of free thyroxine (T4) and triiodothyronine (T3) (11,12).  Because the thyroid gland plays an important role in the regulation of many different bodily functions such as growth and development, disruption in thyroid level can have huge knock on effects all around the body. The thyroid can also affect fertility.Smoking is consequently a known risk factor for thyroid-related disorders, especially Grave’s disease and Goitres (13,14). Smoking and prolactin Prolactin is produced by the pituitary gland in the brain and is most commonly associated with milk production and altering breast physiology, but it also has a number of different roles throughout the body.  Chronic long-term smoking has been found to be associated with decreased prolactin levels (14), which can cause irregular menstrual cycles, difficulty breastfeeding and negative mood changes. Smoking and cortisol Smoking has also been linked to increased cortisol levels in the blood. It also affects hormones involved in the production of cortisol (2), which can disrupt the regulation of its levels. Cortisol […]

Oestrogen—the matriarch of female sex hormones. But what exactly does it do in the body, what’s its role in the menstrual cycle and what are the symptoms to look for if your oestrogen has become imbalanced? Read on to find out.  Quick facts: What is oestrogen? Oestrogen is an important reproductive hormone in people of all sexes. It’s generally known as the ‘female’ sex hormone, because of its role in the development of the female reproductive system and regulation of the menstrual cycle.  Oestrogen works to enable ovulation and produce female sex characteristics. When we have healthy levels of oestrogen, it can help us to feel feisty, frisky and fabulous. Whilst it’s true that oestrogen plays a bigger role in those assigned-female-at-birth, everybody produces oestrogen, regardless of sex. In those assigned-female-at-birth, oestrogen is produced mainly in ovaries and depends on other reproductive hormones including follicle stimulating hormone (FSH), luteinising hormone (LH) and testosterone for both its production and regulation. Like all of our hormones, our oestrogen levels can sometimes become off-balanced—with many different lifestyle and genetic factors impacting its production and regulation throughout the body. Types of oestrogen? There are three different types of oestrogen, also sometimes spelt estrogen (the American spelling). What does oestrogen do? Oestrogen wears many hats—it helps to regulate our menstrual cycles, triggers the development of secondary sex characteristics like breasts and pubic hair and helps to maintain things like our skin’s moisture, our mood and even our bone and heart health. Let’s take a look at these in more detail: What is oestrogen’s role in the menstrual cycle? Like all of our menstrual cycle hormones, our oestrogen levels during the menstrual cycle fluctuate.  During the first part of our menstrual cycles, the follicular phase, which lasts from day 1 of our periods until ovulation (when we release a mature egg), our oestrogen levels start off low but steadily increase. In this phase, our eggs are maturing in preparation for ovulation.  Our eggs mature in our ovaries, in little sacs called follicles. These follicles make oestrogen, so whilst your eggs are maturing, your follicles steadily release this oestrogen—and it rises until it reaches a peak, just before we ovulate. Because of oestrogen’s feel-good factors, just before and during ovulation is the time of the month when we’ll be killing it, feeling our most fierce and fabulous. This is the time to book that big presentation at work, go on that first date or really push it in your gym session. This peak in oestrogen causes a surge in LH, which triggers the release of a mature egg from one of our ovaries during ovulation. After ovulation, oestrogen levels gradually drop and despite a small second wind around a week later, they continue to level off throughout the second stage of our menstrual cycles—the luteal phase. At the end of our cycles, if the ovulated egg has not met a sperm and been fertilised, all of our menstrual cycle hormones, including oestrogen, drop off to their baseline levels—triggering our periods. If our oestrogen levels get off balance, it can disrupt the balance of our other menstrual cycle hormones—potentially impacting ovulation. No ovulation = no pregnancy. So if you’re trying to get pregnant, testing your hormone levels is really important for understanding your ovulation and general menstrual cycle health. What affects oestrogen levels? As well as fluctuating naturally month to month, lots of other lifestyle, genetic and medical conditions can affect our oestrogen levels, including: Does oestrogen decline with age? Thanks to our wonderful ‘biological clocks’, as we age, our oestrogen levels gradually decline. This is because our number of egg cells decreases as we age and as a result, our follicles stop growing and producing as much oestradiol (E2). After menopause (when our periods stop completely), our E2 levels completely drop off, which is what causes the common low oestrogen menopausal symptoms like hot flushes, dry skin and mood swings. During perimenopause (the lead up to menopause), E2 levels fluctuate up and down which can also cause menopausal symptoms. Declining oestrogen levels has whole-body knock-on effects, but luckily these days hormone replacement therapy (HRT) can be a great option to relieve symptoms for many people during perimenopause and postmenopause. How do I know if my oestrogen levels are normal? Because our oestrogen levels fluctuate during our cycles, as we age, and are dependent on whether we’re taking hormonal birth control or not, our ‘normal’ level is constantly changing.  Like all of our hormones, our oestrogen is super sensitive and can easily get off balance. Oestrogen imbalances can cause a whole host of symptoms and can be caused by both lifestyle and genetic factors. Symptoms of high oestrogen levels Oestrogen dominance is a phrase that has been used to describe a phenomenon when oestrogen levels are too high in relation to the other sex hormones in your body.  Although it’s not a clinically recognised term, being more sensitive or having excess oestrogen is known to cause symptoms like irregular periods, abnormal vaginal bleeding, bloating, swollen or tender breasts and weight gain. Some causes of high oestrogen levels include underlying health conditions, genetic factors, dietary and lifestyle factors and environmental pollutants. Symptoms of low oestrogen levels On the flip side, when oestrogen levels are too low we can experience irregular periods, fertility difficulties, reduced bone density, vaginal dryness, hot flashes and dry skin—to name a few. Having very low oestrogen levels can be caused by your ovaries not working properly, which occurs in menopause or primary ovarian insufficiency (POI). However, underlying health conditions like pituitary gland disorders, as well as having very low levels of body fat, a high caffeine intake, smoking and excessive exercise can also result in lower oestrogen levels. Luckily, testing our E2 levels with a hormone test can help us to decipher if our oestrogen levels are within the normal range for us. Oestrogen FAQs Where can I get an oestrogen blood test? You’ve landed in the right place. With a Hertility Hormone and Fertility test […]

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

Luteinising hormone is an important cycling hormone, involved in the regulation of the menstrual cycle and ovulation. But what happens when our levels get a little off balance? In this article, we’ll explain exactly what luteinising hormone is, how it works, and take a deep dive into its importance for female fertility. We’ll also take a look at LH levels and why they’re important, as well as how to recognise the symptoms of low or high LH. Quick facts: What is Luteinising Hormone (LH)?  Luteinising hormone (LH) plays a huge role when it comes to fertility and ovulation, despite it being one of the lesser-known cycling hormones. Luteinising hormone (LH) is what’s known as a gonadotropin hormone. There are only two types of this hormone, LH and its partner in crime, follicle-stimulating hormone (FSH). Gonadotropins are hormones that are released from the pituitary gland in the brain, into the bloodstream where they are transported to the gonads—or ovaries in those assigned female-at-birth and the testes in those assigned male-at-birth. LH has 3 main functions in those assigned-female-at-birth:  Oestrogen production LH works in tandem with FSH to stimulate the ovaries and surrounding cells to produce oestrogen. First, LH stimulates what’s known as theca cells in the ovaries, which then produce testosterone. Once testosterone is abundant, nearby granulosa cells are then stimulated by FSH to produce an enzyme called aromatase, which converts the testosterone into a type of oestrogen, oestradiol, or E2. Without the correct functioning of LH or FSH, testosterone and oestrogen production can become impacted. Ovulation LH is also crucial for successful ovulation. First, FSH stimulates the growth of follicles (small sacs that contain your eggs) in your ovaries. A number of eggs mature during the first half of your cycle, but only one gets released during ovulation—usually the ‘most mature’ follicle. In the days leading up to ovulation, this follicle increases its sensitivity to LH. It gradually produces more and more E2 and when this reaches a certain level, the pituitary gland releases a surge of LH. This LH surge is what causes the follicle to rupture and release the mature egg into the fallopian tube—triggering ovulation. Progesterone production After ovulation has occurred, LH stimulates the now empty follicle to start producing progesterone throughout the second half of the menstrual cycle—also known as the luteal phase. Both progesterone and E2 released by the empty follicle are intended to support conception, implantation and the early stages of pregnancy. However, if the egg is not fertilised and no embryo implants into the uterus, the empty follicle stops producing these hormones and eventually wastes away at the end of the menstrual cycle. What are normal LH levels in women? LH levels in women, or those assigned-female-at-birth, fluctuate during the menstrual cycle—so their levels will vary depending on where you are in your monthly cycle. LH levels can also vary depending on an individual’s age and whether they’re pregnant. Normal LH levels for women before menopause are around 5-25 IU/L, depending on the stage of the menstrual cycle. After menopause, normal LH levels range from around 14-52 IU/L. LH levels during the menstrual cycle Let’s take a closer look at how LH fluctuates during the menstrual cycle. As we mentioned earlier, a dramatic surge in LH around the middle of the cycle triggers ovulation. But after ovulation, LH production is dulled by rising levels of progesterone. If no pregnancy occurs and progesterone levels fall, LH production will start again anew at the beginning of the next cycle. LH levels during pregnancy During early pregnancy, LH levels remain low—blocked by continued progesterone production. High levels of human chorionic gonadotropin (hCG) released throughout pregnancy also ensure that they stay low throughout pregnancy, so no further ovulation is triggered. LH levels in menopause During menopause, LH levels become elevated, although this can vary from person to person. This increase in LH levels happen as a result of the general decline in hormone production by the ovaries. When the ovaries stop producing as much oestrogen and progesterone, the pituitary responds by increasing the production of FSH and LH, in an attempt to stimulate the ovaries. However, the ovaries become less responsive and, instead, LH levels rise. This rise in LH levels is associated with a lot of the typical symptoms of menopause, including hot flashes and night sweats. After menopause, LH levels can decline by around 30-40%. High LH levels High LH levels in females outside of normal menstrual cycle fluctuations can cause fertility problems, irregular periods and early puberty. High LH levels are often seen in people with primary ovarian insufficiency and in those with polycystic ovary syndrome (PCOS) often have elevated LH compared to their FSH. This unusual imbalance can lead to irregular periods and the overproduction of testosterone, both key symptoms of PCOS. Sometimes LH levels can become elevated due to dietary and lifestyle factors, including: Symptoms of high LH levels Symptoms of high LH levels in females are more related to the underlying cause than the LH itself. However, some of the most common symptoms associated with the causes of high LH levels include: How to lower LH levels If your LH levels are elevated and you are a regular smoker or drinker, consider taking steps to reduce these habits. If you’re trying to conceive, consider cutting alcohol and cigarettes completely as this will improve your chances of conception and prevent harmful effects to the baby during pregnancy. Low LH levels There are also a number of reasons why low LH levels might occur. Meningitis infections that have occurred in the last 12 months have been linked to low LH levels and so have eating disorders. Sometimes, LH levels can be decreased due to dietary and lifestyle factors as well as certain medications including: Low LH levels in females can lead to problems with ovulation. This includes anovulation, which is not ovulating at all. This can also lead to problems with menstruation, such as irregular, missing, or complete cessation of periods. Symptoms […]