Wherever you may be on your own reproductive journey, there are likely times where it feels much is unknown or out of your control. However, one simple step in supporting your reproductive health is understanding the role hormones play in fertility, paying attention to how you’re feeling, and finding out if your own hormone levels need adjustment or are a sign of an underlying health issue.

Hormones 101

While we use the word “hormones” a lot as a way of explaining away moods or symptoms, let’s first understand their specific job in maintaining body functions. Hormones are like the body’s messenger system, sending the prompts that regulate things like breathing, hunger, blood pressure … and yes, reproduction. These molecules are highly specialized, and each hormone fits with its own receptor site on cells, much like a lock and key.

Lower levels of these hormones can present with a set of symptoms that let you know something is off, and higher levels can be a signal of an underlying health issue that may interfere with conception. The best path forward is to speak to your doctor about testing, and make a plan for any treatment, lifestyle changes or supplements that can correct these imbalances.

There are four key hormones that play a big role in fertility: Progesterone, Dehydroepiandrosterone, Anti-Müllerian hormone, and Follicle-Stimulating Hormone and Luteinizing Hormone. 

Progesterone

Progesterone has two jobs – first, to regulate the menstrual cycle and second, to prepare and nurture the uterus during pregnancy. 

After ovulation, progesterone helps stimulate the growth and thickening of the endometrium (uterine lining), getting it ready to accept a fertilized egg. Progesterone also prevents uterine muscle contractions, which could prevent an egg from implantation. If implantation is successful, the hormone keeps stimulating blood vessel growth, supporting the growing fetus.

If an egg is not implanted, progesterone levels decrease and menstruation begins.

Low progesterone levels may be a factor in fertility challenges and frequent miscarriages. Some other common symptoms include:

• Headaches or migraines
• Mood changes, anxiety and depression
• Abnormal uterine bleeding
• Irregular or missed periods
• A high level of the hormone estrogen, which can lower you sex drive, make you gain weight, or cause gallbladder problems

On the other end of the spectrum, high progesterone levels can be the result of congenital adrenal hyperplasia – a group of genetic conditions that limit the production of hormones in the adrenal glands. Higher levels of progesterone are also linked to an increased risk of breast cancer.

Dehydroepiandrosterone (DHEA)

DHEA is required for testosterone production, which helps develop the follicles, or the egg sacs that hold and then release eggs during ovulation. 

Women only need small levels of testosterone for reproductive health, but levels naturally decrease with age. This is why prenatal vitamins often include DHEA as an ingredient, to help boost egg quality, especially in women who are trying to conceive at later ages.  

Low DHEA levels can present with these symptoms: 

• Low libido
• Fatigue
• Depression
• Mood swings
• A weak immune system
• Weight gain
• Painful joints
• Low bone density

Higher DHEA levels are often connected to Polycystic Ovarian Syndrome, or PCOS, which is a hormonal disorder that results in cysts on the outer edges of the ovaries, can interfere with ovulation,  and is a leading cause of infertility. Symptoms of high DHEA include:

• Hirsutism, or excessive hair growth
• Female pattern baldness
• Acne and/or oily skin
• Missed periods
• Irritability

Anti-Müllerian Hormone (AMH)

AMH helps develop the follicles in the ovary, and is a key indicator of your ovarian reserve, or how many eggs you have available. Low AMH levels suggest lower ovarian reserve, and therefore increased challenges in conception.

There are no specific symptoms of low AMH levels, but there are several causes, including:

• Age and possible menopause
• Hormonal imbalance
• Genetics
• Endometriosis
• Autoimmune attack on the ovaries
• Cancer treatments

Like with DHEA, higher AMH levels can also indicate PCOS. Consult your doctor if you have the following symptoms:

• Difficulty conceiving
• Irregular periods, or none at all
• Hirsutism
• Weight gain
• Thinning hair or hair loss
• Acne or oily skin

If your doctor suspects you might have PCOS or other medical conditions related to AMH, blood tests, a pelvic exam or an ultrasound will help in diagnosis. 

Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH)

FSH and LH work together to stimulate ovarian follicle which helps eggs grow. FSH has the specific job to start the development of the oocytes (immature eggs in your ovaries), and triggering estrogen production. When estrogen levels go up, the pituitary gland knows to stop FSH production and produce LH, which releases the egg, ready for fertilization.

Lower FSH and LH levels can signal a variety of underlying issues that can impact your reproductive health.

Lower FSH levels might indicate that:

• You are not producing eggs
• Your hypothalamus or your pituitary gland are not functioning properly
• You have a tumor that might be interfering with your brain’s ability to control FSH production
• You are malnourished 

Low LH levels might suggest that:

• You have a pituitary disorder
• You have anorexia or malnutrition
• You are under stress

Higher FSH and LH levels can indicate serious conditions or obstacles to conception.

If you have high FSH levels, this might suggest the following:

• Primary Ovarian Insufficiency (POI), which is the loss of ovarian function before the age of 40
• Menopause
• Chromosomal abnormalities such as Turner syndrome, a disorder that affects women only and which involves the partial or full deletion of an X chromosome

If you have high LH then this might indicate:

• PCOS
• Menopause
• A pituitary disorder

You should get FSH and LH tests done for the following reasons:

• Assessing irregular or absent menstrual periods
• Assessing problems with infertility  

The takeaway on reproductive hormones

Hormone imbalance can present minor fertility problems with straightforward corrections, or in some cases may be a sign that something more serious is happening. Understanding which hormones play a role in reproductive health, their specific jobs, and common symptoms of imbalance will help you start a conversation with your OBGYN or a fertility specialist about blood tests and any exams that may be required. Be sure to track any ongoing and unusual signs that your hormone levels may be off, to give your physician a full picture of your symptoms so you can make a plan, together.