Knowledge Centre

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, called hyperprolactinemia, is rare—and outside of pregnancy, baseline or ‘normal’ prolactin levels are usually low. 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.  […]

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 […]

If you’re trying to conceive, or thinking about trying soon, it’s a good idea to get clued up about how alcohol can impact fertility and your chances of conception. Read on to find out how drinking can impact female and male fertility. Quick facts: The relationship between alcohol and hormones If you’re trying to conceive, or beginning to think about starting a family, chances are you’ve probably recommended to stop, or at least cut down, drinking alcohol…  Not exactly the news most of us want to hear, but unfortunately alcohol consumption can affect our fertility (in both women and men) and therefore, our chances of conceiving. Although all alcohol can affect fertility, new research has indicated that in those assigned-female-at-birth, both the timing of alcohol consumption, in relation to where we are at in our menstrual cycles, and the quantity we drink can determine how bad it’s negative effects are.  But do we need to cut the vino out all together? Or is there space to find a happy medium? Let’s take a look at exactly how alcohol and fertility are linked and what the effects of drinking are at different stages of the menstrual cycle and conception. Can you drink while trying to get pregnant? Any form of alcohol consumption may impact our ability to get, and stay, pregnant.  Less is known about alcohol’s effects on fertility and chances of conception than about its harmful effect on pregnancy, but overall the NHS currently recommends that alcohol should be avoided by women who are actively trying to conceive. This is to keep any possible risks to a baby that might be conceived to a minimum, as we may not know that we’re pregnant until a few, or more, weeks into a pregnancy.  If we’re drinking and do become pregnant, we may risk unintentionally exposing the baby to alcohol. Since there is no known safe level of alcohol for a developing foetus, the safest approach is to avoid it.  Additionally, as we mentioned before, alcohol will also affect our ability to get pregnant in the first place—so if we’re trying to conceive, it’s also best to reduce our drinking to a minimum. Does alcohol affect fertility? In short yes—any form of alcohol consumption has been found to affect both female and male fertility. Some studies suggest that even low to moderate alcohol consumption, which is classed as two drinks or less per day, can be associated with reduced fertility in both men and women.  However, there have been some recent studies that suggest in women, timing of alcohol consumption can play a part in determining its negative effects on our ability to conceive. Let’s take a look at female fertility and alcohol a little more closely… Female fertility and alcohol A recently published study by the University of Louisville was the first of its kind to investigate alcohol consumption’s effects on fertility during different phases of the menstrual cycle. Whilst researchers observed a significant association between heavy drinking and a reduced likelihood of conceiving at all points during the menstrual cycle, light to moderate drinking varied significantly.  The study found that when participants drank in moderation, around 3-6 alcoholic drinks per week, during the luteal phase (the second half of the menstrual cycle, after ovulation), it resulted in a 44% reduction in the chance of conceiving compared to non-drinkers.  However, during the follicular phase (the second half of the menstrual cycle, before ovulation) and during ovulation, only heavy drinking was associated with a reduced chance of conceiving. Light and moderate drinking during these phases did not impact the participants chances of conceiving compared to non-drinkers. So what does this mean for the average person? Basically, if we’re in the first two weeks of our cycle and we’re trying to conceive—it might be safe to enjoy a glass of wine with dinner. However, everyone’s cycle is different and we will all ovulate at different times—literally no cycle is exactly the same. If we’re trying to conceive and in the last two weeks of our cycle, it’s probably best to steer clear of the booze all together. Why does alcohol affect fertility? Although the exact cause isn’t known, it’s been suggested that alcohol disrupts hormone levels, which in turn, can have knock-on-implications for our fertility.  Studies have shown that alcohol intake is associated with an increase in levels of oestrogen, Follicle Stimulating Hormone (FSH) and  Luteinising Hormone (LH), in addition to a decreasing our progesterone levels. In those assigned-female-at-birth, disrupting just one of these sex hormones can disrupt the menstrual cycle and our ability to ovulate, thus reducing our chances of conceiving.  High oestrogen levels can also lower the chance of implantation—which is when a fertilised egg or developing embryo attaches itself to the lining of the uterus. If implantation fails, no pregnancy will occur.  Aside from its effect on our hormone levels, alcohol also negatively impacts our general health—which can lead to knock-on impacts for our fertility, making it harder to get, and stay pregnant, in addition to raising the risk for foetal conditions and other birth complications. Male fertility and alcohol Despite most conversations centering on female responsibility when it comes to fertility—it’s important to remember that male fertility is also affected by alcohol consumption.  Similarly to those assigned female-at-birth, alcohol also disrupts the normal balance of hormones in men—including reducing testosterone levels, which again becomes more pronounced with heavy drinking over a longer period. Does alcohol affect sperm? A study of 1221 men in Denmark found that sperm quality decreased in men who reported drinking more than 5 units (around 3 small beers) of alcohol a week. This decrease in sperm quality became even more pronounced in men who reported drinking over 25 units of alcohol in a typical week (around 10 pints of beer). Can a man drink alcohol while trying to conceive? Although alcohol intake in men when trying to conceive will not harm any possible pregnancy that may occur, as mentioned above, it will likely affect […]

Sex hormone-binding globulin (SHBG) is an important protein involved in the regulation of our sex hormones and in turn our ability to conceive. So what is a good, or ‘normal’ range for our SHBG levels? And how do we know when ours might be too high or too low? We’ve broken down all you need to know about SHBG levels, including what they mean, why they matter and what to do if you suspect yours might be out of range. Quick facts: What is SHBG? SHBG is an important protein that regulates the amount of testosterone and oestrogen available in the body by ‘binding’ to these hormones—which makes them inactive. This is because to bring about an effect in the body, hormones need to be unbound or free so they can enter cells and bring about their effect. The vast majority of testosterone and oestrogen in our bodies is bound to SHBG and other proteins. SHBG also controls the balance between testosterone and oestrogen, which is also important for the healthy functioning of our menstrual cycles. Why do SHBG levels matter? Because SHBG levels regulate the amount of testosterone and oestrogen available to be used by the body, if our SHBG levels are too high or low, this will have a knock on effect on our levels of both of these sex hormones.  If our SHBG levels are higher, we’ll have less free testosterone or oestrogen available. If our SHBG levels are lower, we’ll have more testosterone and oestrogen available.  Both of these sex hormones have important roles in the regulation of the menstrual cycle, ovulation, libido, energy levels and our mental health. Low SHBG When our SHBG levels are low, our levels of free unbound testosterone and oestrogen can become high. Let’s take a look at some of the symptoms, causes and what can be done to help. Symptoms of low SHBG These symptoms can often mirror those of excess testosterone including: Or excess oestrogen: Causes of low SHBG There is no single cause for abnormal SHBG levels, although increases in insulin, prolactin and androgens have been found to block SHBG production which could be a factor for those with low SHBG levels.  Low SHBG can also be caused by a number of lifestyle factors, certain medical conditions and genetics. Here are several conditions, as well as other factors, that low SHBG has been found to be associated with: How to raise low SHBG If you have low SHBG there are a number of lifestyle changes that may help to increase your levels. These include: High SHBG  On the flip side, when our SHBG levels are too high, our unbound testosterone and oestrogen can become abnormally low. Here are some symptoms, causes and what can be done to reduce high levels of SHBG. Symptoms of high SHBG These symptoms can often mirror those of low testosterone including:  Or low oestrogen: Causes of high SHBG Again, there is no single cause for abnormal SHBG levels, although as we mentioned previously, increases in oestrogen and thyroxine (T4) have been found to increase SHBG production, which could be a factor for those with high SHBG levels. There are also a number of conditions associated with high SHBG which include: How to lower SHBG Dietary changes are the most effective way to lower SHBG levels. Decreasing alcohol consumption, gaining weight if you have a low BHM and following a high-fat, low fibre diet may help decrease levels of SHBG. One study involving 48 premenopausal women showed that maintaining a high-fat, low diet decreased SHBG. However, more clinical studies are required to confirm this association. If the levels are elevated due to contraception use, this will usually return to normal levels once you stop using that contraception. Other possible causes such as type 1 diabetes and an overactive thyroid will need further investigation and will require medication specific to these conditions. SHBG tests Ultimately, if you suspect you may have abnormal levels of SHBG, the only way to definitively get a diagnosis is via a blood test. Because symptoms of abnormal SHBG levels can mimic those of high or low oestrogen and testosterone, your SHBG levels should be tested in tandem these hormones. You can test all of these hormones and more, with a Hertility at-home Hormone and Fertility Test. Resources:

Follicle-stimulating hormone (FSH) is really important for our reproductive health. In this article, find out how to know what normal FSH levels look like, what the symptoms of high and low FSH levels are and how to balance your FSH levels. Quick facts: What is FSH?  FSH stands for Follicle-Stimulating Hormone and is one of the main hormones involved in the regulation of your menstrual cycle and ovulation—making it an important hormone not only for your health but your fertility too. FSH is what’s known as a gonadotropin hormone. It’s released by the pituitary gland in the brain and then acts on the ovaries.There is only one other gonadotropin hormone in the body—luteinising hormone (LH). True partners in crime, there’s no FSH without LH, and they act in tandem to bring about changes which essentially regulate ovulation. Normal FSH levels in women Because our FSH levels are intricately linked to our ovarian reserve, what’s considered a ‘normal’ FSH level changes as we age. This is because our ovarian reserve declines as we age which makes our FSH levels increase.  Gonadotropic hormones are hormones released from the pituitary gland in the brain and released into the bloodstream. Gonadotropins then go on to act on the ovaries. There are two types of gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).  The pituitary gland produces FSH which acts on the ovaries to stimulate the growth of follicles containing your eggs. As well as growing the ovarian follicles, FSH stimulates the granulosa cells that surround the follicle to produce oestrogen from testosterone, an essential hormone for regulating the menstrual cycle (1). You can read more about oestrogen here.  What does FSH do? FSH has two primary functions:  Follicular development FSH does pretty much exactly what it says on the tin—it stimulates the growth of follicles which contain your eggs.  You’re born with ‘immature’ eggs. So each month, a number of them start maturing before one is released during ovulation. Your eggs are housed in tiny follicles inside your ovaries, and it’s these follicles that FSH signals to prepare your eggs for ovulation (2). Oestrogen production FSH also stimulates the cells that surround the follicles to make an enzyme called aromatse, which converts testosterone into oestrogen, another essential hormone for regulating the menstrual cycle and reproductive health (1). The relationship between FSH and LH When your eggs are fully mature and ready to be released during ovulation, LH steps in. A surge of LH is released, again by the pituitary gland in the brain, causing the most mature follicle to rupture—releasing an egg into your Fallopian tube. This is ovulation.  Despite FSH causing numerous follicles, and therefore numerous eggs, to mature each cycle, only one follicle will release an egg each month. This is because FSH and LH are both involved in negative feedback loops, controlled by E2. But what does negative feedback loop mean? Increasing FSH levels in the early stages of your menstrual cycle leads to more oestrogen being made, but this ha, a negative feedback effect on FSH levels. In other words, when you have lots of oestrogen, it feeds back to the brain that it needs to stop making more FSH. Similarly, with LH, oestrogen levels keep increasing through the cycle and once they reach a peak around the middle of the cycle, it causes a sudden surge in LH that promotes ovulation. After ovulation, the empty follicle that once contained the egg makes another hormone, progesterone, to support conception, implantation and the early stages of pregnancy. High levels of progesterone tell the brain to stop making more FSH. Now if a pregnancy doesn’t happen, there is a drop in oestrogen and progesterone which triggers your period. It also tells the brain it needs to start making FSH to start the whole process all over again in the next menstrual cycle (5). High FSH levels Okay, but what happens when we have high FSH levels? Let’s take a look at the causes and symptoms of high FSH levels. What causes high FSH levels? The most common reason for high FSH levels is a low ovarian reserve (egg count), or ovaries that aren’t functioning properly. When we have a low ovarian reserve, this essentially means we have a smaller number of immature follicles available in our ovaries and our bodies will produce less oestrogen.  Because oestrogen controls how much FSH we produce (remember that negative feedback loop), when we have less oestrogen, our FSH levels may go up.  High FSH levels can therefore indicate that our ovaries aren’t functioning properly, be an indicator of low ovarian reserve or an indicator of the onset of menopause. Other reasons for high FSH levels can be ovarian cancer (although this is very rare) (9) and Premature Ovarian Insufficiency (POI) which is the loss of ovarian function before the age of 40 (6,7). In some cases, dietary and lifestyle factors can moderately raise FSH levels. Symptoms of high FSH levels Symptoms of high FSH levels usually mimic symptoms of menopause and are related to low oestradiol levels —which is why it’s so important to test a range of your reproductive hormones to get to the bottom of symptoms. Symptoms can include: How to lower FSH levels? It is important to understand that if high FSH levels have been caused by menopause or a low egg reserve, modifications to your diet or lifestyle will not be able to reverse this. However, there are some dietary lifestyle factors associated with a higher FSH, such as smoking and high alcohol consumption.  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 (17). For advice on how to quit smoking, see the full list of NHS quit smoking services here. Nutrition can be a really powerful tool in balancing hormones and helping to alleviate symptoms. You can book a nutritional health consultation with one of our registered nutritionists via your health hub. […]

A common symptom of endometriosis is fertility issues. Up to 50% of people with endometriosis will struggle to conceive, with the causes still relatively unknown. Here take a deep dive into what you need to know about your fertility if you have diagnosed or suspected endometriosis. Quick facts: What is endometriosis? Endometriosis is a reproductive health condition where tissue similar to the lining of the womb grows in other places. This is called endometrial tissue. This tissue can grow in the ovaries and fallopian tubes and can cause painful symptoms.  It’s one of the most common reproductive health conditions. 1 in 10 women and those assigned female-at-birth (AFAB) will develop endometriosis, yet its definitive cause is still unknown.  As a long-term condition, endometriosis can significantly impact some people’s lives. One of the most common concerns is how does endometriosis affect fertility? Will endometriosis affect my fertility? In short, it might. Fertility problems are common in those with endometriosis, with 30-50% experiencing fertility problems (1). But having endometriosis does not automatically mean you will have fertility problems—every case is different. It will depend on the severity of your symptoms and any structural or hormonal issues you may have.  Is it possible to get pregnant with endometriosis? Yes, it’s possible to get pregnant with endometriosis. However, you may experience difficulty getting pregnant. Those with endometriosis have a lower chance of getting pregnant with each monthly cycle (2). This can result in it taking longer for people with endometriosis to conceive (3).  Infertility is also common in those with endometriosis, and in subfertile (failure to conceive after one year of trying) women the prevalence seems to be considerably higher, ranging from 20% to 50%, but it varies with time and age (1). How does endometriosis affect fertility? Again, not necessarily. But those with endometriosis are at an increased risk of miscarriage, ectopic pregnancy and other obstetric complications compared to those without (4). How does endometriosis affect fertility? Exactly why and how endometriosis affects fertility is still unknown. But here are the latest theories of possible links and causes.  Structural issues One of the ways endometriosis is likely to affect fertility is by distorting the position of reproductive organs. Growth of endometrial tissue and adhesions around the uterus and Fallopian tubes can cause this distortion. In turn, this may block mature eggs from reaching the uterus to be fertilised. The risk of blocked Fallopian tubes, in particular, increases in the more advanced stages of endometriosis.  Endometriomas The presence of cysts on your ovaries, called endometriomas, could also affect fertility and ovulation. Endometriomas can damage ovarian tissue and the precious ovarian follicles which house immature eggs.  Immune reaction Another theory is an immune reaction to endometrial tissue growing outside the uterus. This is because this tissue is recognised as ‘foreign’ to these parts of the body. The immune system responds by attacking it, causing inflammation. Inflammation leads to harmful toxins which may affect Fallopian tube function, sperm function and egg quality (5). Womb reciprocity There is also debate about whether endometriosis affects the receptivity of the womb to a fertilised egg. However, there is currently no conclusive evidence to prove this theory.  Painful sex Painful sex is one of the symptoms associated with endometriosis. Pain during or after intercourse can negatively impact your sex life and make the trying-to-conceive process difficult. Can treating endometriosis improve fertility? Various treatments for endometriosis that aim to improve fertility. The right ones for you will depend on the location and severity of your endometriosis and what your symptoms are.  One treatment that aims to improve fertility is laparoscopic surgery. This is surgery to remove the endometrial tissue deposits and adhesions. It aims to free the pelvic organs of any structural issues or blockages and reduce inflammation.  For people with endometrioma, laparoscopic ovarian cystectomy can remove the endometriosis-related cysts on the ovaries (6). This has been shown to lower the recurrence rate of both cysts and pain symptoms.  However, there are risks associated with any surgery. For example, ovarian cystectomy can also negatively affect ovarian reserve by the removal of healthy tissue.  It’s important to discuss the potential for surgery with a specialist. And to explore the individual risks. How can I improve my chances of conceiving with endometriosis? If you’re trying to conceive with endometriosis, there are options to improve your chances. These include expectant management and assisted reproductive techniques (ARTs).  Expectant management  This is for heterosexual people who are trying to conceive naturally and:  To improve your chances of conceiving with every menstrual cycle, it is recommended to have sex every 2-3 days so there is a good chance of catching your fertile window.   Assisted reproductive techniques (ARTs) ART options include ovarian stimulation (COS), intrauterine insemination (IUI), and in-vitro fertilisation (IVF).  Depending on your age, ART is recommended if: IUI is usually offered to couples with minimal or mild endometriosis if their partner has normal semen quality and is typically not offered to those with moderate/severe endometriosis, because of a probable effect on the Fallopian tubes. IVF can be offered to those with moderate or severe endometriosis. It can also help those with a very low egg reserve. IVF has been found to be less successful in people with endometriosis compared to those without endometriosis. However, lots of factors influence IVF success, like age, whether you’ve been pregnant before, if you’ve had treatment before body mass index, underlying health conditions, lifestyle and your partner’s sperm quality.  Resources:  

Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime. But what are fibroids, how do we look out for symptoms and what are the treatments if we’re diagnosed? Read on to find out.  Quick facts: What are fibroids? Uterine fibroids are benign or non-cancerous growths in and around the uterus, or womb. They are made up of fibrous muscle tissue and are extremely common. Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime (1). Your risk of developing a fibroid increases with age and if you: Where do fibroids grow? Fibroids can vary in size and you may have one or multiple fibroids. They can develop as singular fibroids or as clusters. There are three different types of fibroid, depending on where in the body they grow: Signs and symptoms of fibroids Not all people who develop fibroids experience symptoms. Most are actually asymptomatic and have no symptoms at all. Only approximately 1 in 3 people with fibroids will experience symptoms. The symptoms of fibroids can include: What causes fibroids?  Unfortunately, like many reproductive health conditions, the exact cause of fibroids is unknown. What we do know though, is they’re affected by oestrogen and progesterone—two hormones important for regulating the menstrual cycle. After menopause, when oestrogen and progesterone levels drop, fibroids tend to shrink (3). How are fibroids diagnosed? To diagnose fibroids you’ll need a pelvic ultrasound scan. Usually, your doctor will discuss any symptoms you’ve been experiencing with you first. Then they’ll carry out an abdominal examination to look for any areas of tenderness or masses in your abdomen, before referring you for a scan.  The ultrasound will look at your reproductive organs including your uterus, Fallopian tubes, ovaries and general pelvic area. This can be done either transvaginally (through the vagina) or transabdominally (looking at your uterus through your abdomen). A scan is the only way to definitively diagnose fibroids and to determine their size and location. You may also be offered a blood test to screen for iron deficiency anaemia, which is a condition that can occur as a result of heavy bleeding.  Because lots of people with fibroids don’t experience symptoms, often fibroids are found coincidentally. This could be during an ultrasound for a pregnancy or another suspected condition. Black women have an increased risk of developing fibroids Black women are three times more likely to develop fibroids than white women. They’re also more likely to be diagnosed with fibroids at a younger age, have a longer duration of symptoms and have larger, more rapidly growing fibroids. Although the increased risk of fibroids in Black women is known, there’s been little research conducted to understand why this is. Some research suggests genetics, such as Vitamin D deficiency in Black women (4) could be a link. Other research has suggested certain environmental factors could be linked. These include exposure to chemical relaxers, used for afro-textured hair, which have been linked to a higher risk of developing fibroids (5). Will fibroids affect my fertility? Some fibroids can cause problems with fertility (6). This largely depends on their size and where they are located.  Fibroids can affect the structure of the uterus and its surrounding organs. Meaning they can prevent sperm from fertilising an egg or prevent an embryo from implanting. However, lots of people with fibroids do not have any difficulties getting pregnant. How are fibroids treated?  Treatment for fibroids depends on:  If you have fibroids that are not causing symptoms and aren’t likely to affect your fertility, then generally no treatment is required. But if you begin to experience any new symptoms, it is really important to go back to the doctor to have a check-up.  The treatment methods for fibroids can be broken down into non-surgical and surgical methods. Non-surgical methods If you commonly experience heavy periods as a result of your fibroids, you may be given medications such as tranexamic acid. This is a medication which breaks down blood clots in the womb. You may also be given anti-inflammatory medications, like ibuprofen or an oral medication called Ryeqo. The combined oral contraceptive pill and hormonal IUD can also be prescribed to help you have lighter, less painful periods.  As well as treating heavy periods directly, you may also be given a gonadotrophin-releasing hormone (GnRH) analogue. This is to try and shrink your fibroids and is also commonly prescribed before any surgical treatment.  GnRH analogues work by reducing your levels of oestrogen. Low levels of oestrogen can lead to several other long-term complications, so this method can only be used for a short period.If you have larger fibroids, you may be offered a procedure called Uterine Artery Embolisation. This is used to block the arteries which supply blood to the fibroids. If you have smaller fibroids, you may also be offered a procedure which removes the lining of the womb called Endometrial Ablation. Surgical methods There are various surgical techniques which can be used to treat fibroids. Surgery can be explored if medical treatments don’t work for you or aren’t suitable in the long term.  You may be offered one of the following surgical treatments for fibroids:  What type of procedure is most suitable for you depends on the location, size and number of your fibroids. Each varies in terms of invasiveness, risks and its potential effect on fertility. Some people’s fibroids may grow back after surgery, known as ‘recurrence’.  Suspect you may have fibroids? As the symptoms mentioned above are commonly experienced in various types of pelvic issues, they may be linked to other causes apart from fibroids.  If you’re suffering from painful periods or any of the above symptoms, it’s important to get your hormones tested, to rule out a hormonal cause. This, alongside a pelvic ultrasound scan, can help you get to the bottom of symptoms and get a recommended care plan based on your biology.  If you’ve been diagnosed with fibroids, you can also talk to our team of […]

On Wednesday, the 15th of February, we hosted our first community event to launch our Black Women’s Health Initiative. It was a privilege to have brought together so many people who were actively engaged in the topic.  The event provided us with such insightful information and has helped us not only hone our commitments to change but also acted as the first step in our journey as a company. We are still learning and growing as a young seed-stage start-up, but that doesn’t stop us from having big aspirations, and we hope to build on these year after year. We are so thankful to everyone who attended the event. We really appreciate the time, energy and support each person gave.  It was an incredibly proud moment to be able to share the findings from our recent research looking into the role that ethnicity played in access to fertility testing and reproductive healthcare. A roundtable discussion followed, moderated by Hertility’s CEO and founder Dr Helen O’Neill, where we heard from clinical gynaecology experts, community leaders, and patient advocates Dr Christine Ekechi, Dr Stephanie Kuku, Noni Martins and Sophia Ukor. In case you missed it, here’s a rundown of what was covered: The changes to Black women’s reproductive healthcare over the years All the panellists agreed that they are seeing a positive trend, with more conversations being had around women’s health in general, and increased awareness and advocacy from colleagues within the healthcare system and doctors for their patients. We heard about positive interactions with healthcare providers  or seeing positive changes in healthcare delivery in the last five years.  “I feel there is a change with the language, culture and even the way they listen to you. They listen and you feel understood. I felt seen, I did not feel alone. The language, the care and the attention is evident.” – Sophia Ufy Ukor, Founder & CEO of Violet Simon We heard from Dr Christine Ekechi that not only is there an increased awareness of conditions that are more prevalent in Black women, but they are more cognisant of their experiences.  We briefly touched on the current state of the healthcare system and what needs to be done to support healthcare professionals further to provide compassionate care. As the healthcare system becomes more stretched and there is continuous pressure to shorten GP appointments, there will be limitations on the capacity of doctors. It is no surprise that the average GP appointment in the UK lasts just 9.2 minutes, with an average of 2.5 health concerns being discussed (1), and there is not enough time to allow for a  comprehensive discussion about someone’s reproductive health or pregnancy history. Women whose first language is not English and/or who have had a negative experience with a healthcare practitioner are at more of a disadvantage.  “We all swear on the Hippocratic oath to do no harm, but if the system works such that the resources and the human capacity are lacking, there is a dearth of compassion. As a result, unfortunately, I think that, as with everything in life, some people are going to suffer more than others, and the human reflexes are that when you have no capacity, you are less likely to treat people the same” –  Dr Stephanie Kuku Advisor, Consultant and Health Technology Executive (MBCHB MRCOG MD) However, Dr Christine Ekechi also highlighted that the majority of UK-based doctors are willing to learn to improve the care of Black women and there is room for positive impact.  Looking to the future, we heard from both the event and post-event feedback about the importance of framing positive conversations around Black women’s reproductive health to stop the further victimisation of Black women and ethnic minority groups and to empower them so that we can help give women strength and power in healthcare situations, instead of reinforcing currently accepted narratives. The power of knowledge and tips on advocacy Throughout the discussion, a salient theme that shone through was the value and power of having the right information in a healthcare setting, especially when it comes to advocating for ourselves. Noni Martins emphasised the importance of going into GP appointments with symptom diaries and the knowledge about what is going on with your body, as no one knows your body better than you. Dr Christine Ekechi also highlighted that everyone deserves a right to a second opinion if they feel they do not understand or agree with the outcome of their appointment.   “One thing about doctors, particularly doctors now, is that we are cognisant about working in partnership with you…Of course, you’re not going to go into a consultation and understand everything about gynaecology, but you should leave with an understanding of what the concerns are and what the approach is going to be. For me the key is if you come away thinking I have no idea what they said, then you ask for a repeat explanation or ask for a second opinion” – Dr Christine Ekechi Consultant Obstetrician & Gynaecologist and Co-Chair, Race Equality Taskforce, Royal College of Obstetricians & Gynaecologists. We briefly spoke about the prevalence of myths in reproductive health, fertility and women’s health more generally. We know from the Women’s Health Strategy that many women get their information from the NHS website (2), so as Dr Christine Ekechi said, “it’s about going to the trusted sources and addressing those gaps by filling it in with the correct information”. “I think my biggest concern when we have these kinds of discussions is for people who don’t have that voice. I worry about the people who, in their homes and in their communities, cannot speak out about the fact that they have been trying to conceive and it is not working out. I’m always thinking about how we can get to those people, I don’t have the answers. I hope that by being someone who looks like them and talking about it, we can draw them out. Even if you are having a […]