Female Fertility Hormones: Everything They Didn’t Teach You in Sex Ed

Are you ready to embark on a journey through the fascinating world of female fertility hormones? We've got all the details on those tiny chemical messengers that hold the key to your reproductive prowess. Whether you're curious about boosting your chances of egg freezing success or simply want to understand the inner workings of your amazing body, this article will dive into a hormonal adventure that will leave you feeling empowered and in control. Let’s go!

Anti-Mullerian Hormone (AMH)

What it is

The most talked about hormone of them all: AMH. AMH is produced by the developing follicles in the ovaries and serves as an biomarker of ovarian reserve. It helps estimate the quantity of eggs remaining in the ovaries and is commonly used in assessing how well your body will respond to IVF or egg freezing. 

Normal AMH levels

You can take an AMH test any time in your cycle. In general, AMH levels can be interpreted by:

• Above 1.0 ng/ml (nanograms per deciliter): Normal
• Below 1.0 ng/ml: Showing weakness in the ovarian reserve
• Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report.

What AMH can tell you

As we age, our AMH levels naturally decrease until we hit menopause and our AMH reaches 0. While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than expected. AMH can give us insight into where we are on that journey.

While AMH is pretty awesome, there are two things it can’t tell us: (1) it can’t tell us the quality of the eggs remaining and (2) it can’t tell us our chances of getting pregnant unassisted.

Estrogen

What it is

Estrogen hormone is the ultimate multitasker, responsible for so many amazing things. It's the power behind that glowing, radiant skin and full, thick hair. And it also takes charge of thickening the uterine lining each month, which either sets the stage for a growing embryo, or culminates in your period.

Estrogen is actually a collective term used to describe a group of hormones that play a vital role in the female reproductive system. It includes three types of hormones: 

• Estrone (E1) which is the only type of estrogen that our bodies keeps making even after menopause
• Estradiol (E2) causes the maturation and release of the egg as well as the thickening of the uterus lining each month
• Estriol (E3) is really only present during pregnancy, and helps the uterus grow and stay healthy

Estrogen levels fluctuate throughout the menstrual cycle, with estradiol being the dominant form during the follicular phase (leading up to ovulation) and progesterone taking the lead during the luteal phase (after ovulation). Understanding the dynamics and functions of estrogen and estradiol can help shed light on the intricate mechanisms underlying female reproductive health.

Altogether, estrogen plays a key role in regulating the menstrual cycle, supporting the growth and development of the uterus and breasts, and maintaining bone health.

Normal E2 levels

Estrogen levels fluctuate throughout your life, often aligning with other hormones that regulate crucial bodily functions, such as the menstrual cycle. These dynamic changes in estrogen levels are considered a normal part of the body's hormonal rhythm. 

Estradiol (E2) is the hormone most often tested for fertility. E2 levels vary widely through the menstrual cycle, and are expected to fluctuate from test to test. A normal range is considered:

• Premenopausal: 30 to 400 pg/mL (110 to 1468.4 pmol/L)
• Postmenopausal: 0 to 30 pg/mL (0 to 110 pmol/L)

There can be variations in the normal value ranges for laboratory tests, as different laboratories may use different measurement methods (e.g. saliva, blood prick, or venipuncture) or test different samples. Your doctor will be able to provide you with accurate interpretation and insights based on your individual circumstances.

What E2 can tell you

If you consistently test on the lower range, it may indicate the onset of menopause, premature ovarian failure, or low estrogen from rapid weight loss or anorexia. If your results are higher, it may suggest a tumor of the ovary.

Follicle-Stimulating Hormone (FSH)

What it is

‍FSH is the ultimate fertility cheerleader. Like the squad captain, FSH leads the charge in the growth and development of those ovarian follicles, which contain the eggs. It's the one shouting, "Let's grow those eggs, ladies!" 

Our FSH levels change throughout the menstrual cycle, with the highest levels happening just before ovulation (when an egg is released by the ovary).

Normal FSH levels

For fertility testing, you need to have the FSH blood test on day 3 of your menstrual cycle (day 1 is the day your period begins). In general, normal FSH levels are:

• Premenopausal: 4.7 to 21.5 mIU/mL
• Postmenopausal: 25.8 to 134.8 mIU/mL

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report.  

What FSH can tell you

‍Higher-than-normal levels of FSH can be a sign of infertility due to premature ovarian failure or menopause. It could also be due to certain types of tumors in the pituitary gland, or due to Turner syndrome.

Lower levels could mean pregnancy, being very underweight or having had recent rapid weight loss, not ovulating, or that parts of the brain are not producing normal amounts of hormones. If you have abnormal results, your doctor will discuss your situation and next steps. 

Luteinizing Hormone (LH)

What it is

This hormone takes center stage and demands attention as it triggers the grand finale of the menstrual cycle: the release of a mature egg. LH sends that egg on its way, ready for its moment in the spotlight and a chance at fertilization.

While LH has a major job for our reproductive system, it’s actually secreted by a tiny structure in your brain called the pituitary gland.

Normal LH levels

LH fluctuates throughout your cycle, and the ranges are:

Premenopause: 5 to 25 IU/L

Postmenopause: 14.2 to 52.3 IU/L

Remember, lab numbers can vary. Your blood test results will show the lab’s normal range on the report.  

What LH can tell you

Abnormal LH levels can indicate ovulatory disorders, such as polycystic ovary syndrome (PCOS) or hypothalamic amenorrhea. 

LH testing (via urine test strips) can also help to predict ovulation. By detecting the LH surge each cycle, these test strips give us a glimpse into our fertile windows, or when we’re most likely to get pregnant. 

Progesterone

What it is

Progesterone swoops in after ovulation (which, remember, was ushered in by LH) to prepare the uterine lining, transforming it into a cozy, welcoming haven for a potential embryo. Progesterone is crucial for early pregnancy, helping maintain the thickened endometrium. But if an egg isn’t fertilized during that cycle, progesterone levels decrease, your uterine lining thins, and your period begins. 

Normal progesterone levels

• Pre-ovulation: less than 1 nanogram per milliliter (ng/mL) or 3.18 nanomoles per liter (nmol/L)
• Mid-cycle: 5 to 20 ng/mL or 15.90 to 63.60 nmol/L
• Postmenopausal: less than 1 ng/mL or 3.18 nmol/L
• Pregnancy 1st trimester: 11.2 to 90.0 ng/mL or 35.62 to 286.20 nmol/L
• Pregnancy 2nd trimester: 25.6 to 89.4 ng/mL or 81.41 to 284.29 nmol/L
• Pregnancy 3rd trimester: 48 to 150 to 300 or more ng/mL or 152.64 to 477 to 954 or more nmol/L

What progesterone can tell you

While LH tests can help us predict when we’re about to ovulate, progesterone tests can help confirm if we actually did ovulate. 

If you have low progesterone and aren’t pregnant, you may have symptoms like irregular periods, infertility, mood changes, trouble sleeping, or hot flashes.

If you have low progesterone and are pregnant, it could mean a higher risk of miscarriage or an ectopic pregnancy.

Prolactin

What it is

Prolactin is the hormone that orchestrates the magic of breastfeeding. It causes the breasts to grow and make milk during pregnancy and after birth. While its primary role lies in the breastfeeding realm, elevated levels of prolactin when not pregnant or postpartum can sometimes interfere with ovulation and menstrual regularity.

Normal prolactin levels

Made in the the pituitary gland, normal levels of prolactin are:

• Nonpregnant: less than 25 ng/mL (25 µg/L)
• Pregnant: 80 to 400 ng/mL (80 to 400 µg/L)

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report. Talk to your doctor about your specific results.

What prolactin can tell you

Abnormally high levels of prolactin when you are not pregnant could mean a condition called hyperprolactinemia, which is actually quite common. Believe it or not, about a third of women in their childbearing years with irregular periods (but perfectly normal ovaries) have hyperprolactinemia. Hyperprolactinemia could mean trouble getting pregnant. Not to mention, your boobs might start producing milk when you're not even expecting it (hello, galactorrhea!).

High prolactin levels can also throw a wrench in the normal hormone production, messing with the likes of estrogen and progesterone. And when that happens, it can disrupt ovulation or lead to irregular or missed periods. 

Thyroid-Stimulating Hormone (TSH)

What it is

This hormone ensures that our thyroid gland, that tiny powerhouse in our neck, is working harmoniously. Thyroid health is crucial for maintaining menstrual regularity and fertility, so when TSH steps onto the scene, you know it's time to keep that thyroid in check!

Normal TSH levels

Another hormone produced by the pituitary gland, TSH can give us insight into thyroid disorders, such as hypothyroidism or hyperthyroidism.

• Nonpregnant: 0.27 – 4.2 uIU/mL.
• First trimester (9 to 12 weeks): 0.18 – 2.99 (uIU/mL).
• Second trimester: 0.11 – 3.98 uIU/mL.
• Third trimester: 0.48 – 4.71 uIU/mL.

What TSH can tell you

Low levels of TSH typically indicate hyperthyroidism, or overactive thyroid, when your thyroid gland is making excess thyroid hormone. On the other hand, high levels of TSH may suggest an inadequate production of thyroid hormone, leading to a condition called hypothyroidism or underactive thyroid. 

Testosterone

While testosterone is often associated with male reproductive health, females also produce small amounts of testosterone from the ovaries. It helps preserve muscle mass and supports an overall sense of wellbeing. It also helps the development of those follicles and even plays a role in boosting our libido.

Testosterone does fluctuate throughout your cycle, so if you notice that your libido surges at certain times of your cycle (usually around ovulation), you can thank testosterone.

Normal testosterone levels

15 to 70 ng/dL or 0.5 to 2.4 nmol/L

What testosterone can tell you

Abnormal testosterone levels can negatively affect fertility. 

Too little testosterone could mean you are nearing menopause or have premature ovarian failure. It could also be lower due to certain medications, malnutrition, chemotherapy/radiation, 

Too much testosterone could be a sign of PCOS.

At-home fertility hormone testing

If you’re curious to test your hormones, you'll be glad to know that there are convenient at-home options available. These tests allow you to assess your hormone levels from the comfort of your own home, providing valuable insights into your reproductive health. 

Let's take a closer look at some of the top at-home fertility hormone testing options for you to consider:

• Natalist Women’s Fertility Test: Priced at $149, this comprehensive test covers a range of essential hormones. It measures five key hormones: estradiol, LH, FSH, TSH, and total testosterone. By examining these hormone levels, you can gain a better understanding of your reproductive health. And here's a bonus for our readers: use the code COFERTILITY25 to get 25% off!
• LetsGetChecked Ovarian Reserve Test: For $139, this test specifically focuses on measuring anti-Müllerian hormone (AMH), a critical marker for ovarian reserve. By understanding your ovarian reserve, you can make informed decisions about family planning and fertility preservation. And guess what? You can save 25% on this test by using code COFERTILITY25.
• Modern Fertility Hormone Test: Priced at $179, the Modern Fertility Hormone Test offers an extensive panel of seven hormones to assess your reproductive health. This test measures AMH, TSH, FSH, estradiol, prolactin, fT4, and LH. By examining these hormone levels, you can gain insights into your ovarian reserve, thyroid function, and overall hormonal balance. It's a comprehensive package that empowers you with valuable information about your fertility potential.

These at-home fertility hormone testing options give you the opportunity to better understand your reproductive health. But keep in mind that if you are planning to freeze your eggs, your doctor may want you to test again. 

Summing it up

These fertility hormones - AMH, Estrogen, FSH, LH, Progesterone, Prolactin, and Testosterone– work in harmony to regulate the menstrual cycle, facilitate ovulation, prepare the uterus for pregnancy, and support early gestation. 

Imbalances or abnormalities in these hormone levels can affect fertility and reproductive health. Unfortunately for many of us, we don’t find out there’s a problem until we start trying. 

Evaluating the levels of these hormones through diagnostic tests can provide insights into your fertility health and empower you with knowledge to make informed decisions about your reproductive journey.

By understanding your hormone levels, you can identify potential issues that may hinder reproductive health, now or in the future. 

Sources:

• Estradiol (Blood). Health Encyclopedia. University of Rochester Medical Center. URL
• Follicle-stimulating hormone (FSH) blood test. Mount Sinai. URL
• Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581. URL
• Hyperprolactinemia (High Prolactin Levels). ReproductiveFacts.org. URL
• Testosterone. Mount Sinai. URL
• Soman M, Huang LC, Cai WH, et al. Serum androgen profiles in women with premature ovarian insufficiency: a systematic review and meta-analysis. Menopause. 2019;26(1):78-93. doi:10.1097/GME.0000000000001161. URL