Fertility Hormones: What Estrogen, Progesterone, LH, and FSH Can Tell You
Getting pregnant doesn’t happen magically. Even if you and your partner are both fertile, you still only have a 25% chance of getting pregnant each cycle. Conception is a dance between your fertility hormones and your partner’s — and if you aren’t paying attention to the data, it could take months or even years to figure out what’s not working.
Hormones control everything in our bodies from our appetites to our moods to our fertility. If we experience a drastic difference in our appetite or moods, you might recognize the signs of a hormone imbalance. Changes in fertility hormones, however, are harder to track — unless you know the physical signs you’re looking for.
There are four major fertility hormones responsible for pregnancy: estrogen, progesterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH). An imbalance of even one fertility hormone will throw off the rhythm of reproduction, making the dance unlikely to end in pregnancy.
So, what can you do, outside of sending blood work to the lab every morning? You can track your physical symptoms — here’s how.
Important Fertility Hormones
What is estrogen?
Estrogen is produced by the follicles and remnant egg sac after ovulation. Healthy estrogen levels are essential for a fertile menstrual cycle. Estrogen also plays a role in bone formation, cholesterol levels, and the development of secondary female sex characteristics like breasts and pubic hair.
What is a healthy estrogen level?
Healthy estrogen levels for women change throughout the life cycle. There are two types of estrogen — estrone and estradiol — responsible for maintaining fertility. Girls and women of different ages need different amounts of each type of estrogen:
- Prepubescent females may have undetectable amounts of estrogen in their bodies, or as much as 20 pg/mL estradiol and 29 pg/mL estrone.
- Pubescent females may have undetectable levels of estradiol, or up to 350 pg/mL estradiol. They may also have anywhere from 10 – 200 pg/mL estrone.
- Premenopausal adult females may have anywhere from 17 – 200 pg/mL estrone and 15 – 350 pg/mL estradiol.
- Postmenopausal adult females may have anywhere from 7 – 40 pg/mL estrone, and will generally have less than 10 pg/mL estradiol.
Any change in your estrogen level can affect your ovulation, fertility, and overall health. For example, lower estrogen as we age results in the changes associated with menopause, like discontinued menstrual cycles and night sweats.
What does low estrogen mean (and what are the symptoms)?
Low estrogen may impact your ability to get pregnant. A lack of estrogen in the body can cause infrequent or irregular ovulation, which can make it more challenging to track your menstrual cycle and determine when to have sex for the best odds of conception.
In some cases, low estrogen may be a sign of an eating disorder. Excessive exercise and/or extreme underweight can cause amenorrhea or the lack of a normal menstrual period. This, too, can impact your fertility. If you suspect you or someone you love may be suffering from an eating disorder, contact a mental health professional for guidance.
Symptoms of low estrogen include:
- Painful sex because of little or no vaginal lubrication
- Increase in the number of UTIs
- Mood swings
- Irregular or absent periods
- Hot flashes
What does high estrogen mean (and what are the symptoms)?
A high level of estrogen is associated with menstrual health conditions like endometriosis and polycystic ovarian syndrome (PCOS). Both these conditions can impact your ability to conceive, by causing adhesions (a.k.a. scar tissue) on the reproductive organs (in the case of endometriosis) or irregular ovulation (in the case of PCOS).
High estrogen can also result from obesity because adipose tissue (fat) produces estrogen; obesity is more common in women with PCOS, which makes it even more difficult for these women to conceive. High estrogen may also be caused by medications like antibiotics or birth control pills. The effects of oral contraceptives on fertility may last for several months after stopping the pill, which may impact how quickly you are able to conceive.
Symptoms of high estrogen include:
- Weight gain in the hips and thighs
- Heavier or lighter periods than usual
- Worsening of premenstrual syndrome
- Uterine fibroids and/or fibrocystic breasts
- Fatigue, loss of sex drive and/or changes in mood
What is progesterone?
The fertility hormone progesterone is produced by the adrenal glands and the remnant egg sac in the ovaries after ovulation. Progesterone is essential for fully-functioning fallopian tubes, a healthy period, and ensures you are able to get and stay pregnant, carrying until full term.
On top of that, all other female fertility hormones are made from progesterone. That makes it a pretty important hormone to track for your fertility and overall health!
What is a healthy progesterone level?
Progesterone levels change throughout the menstrual cycle and throughout pregnancy. Depending on where you are in your menstrual cycle or pregnancy, a healthy progesterone level could be anywhere from zero to 214 ng/mL.
Here’s what healthy progesterone levels can look like at different stages of the menstrual cycle and different trimesters of pregnancy:
- Pre-ovulation: <0.89 ng/mL
- Ovulation: up to 12 ng/mL
- Post-ovulation: 1.8 – 24 ng/mL
- First trimester of pregnancy: 11 – 44 ng/mL
- Second trimester of pregnancy: 25 – 83 ng/mL
- Third trimester of pregnancy: 58 – 214 ng/mL
Currently, you cannot track progesterone levels without the help of a physician, so if you suspect your progesterone levels may be too low or too high, make an appointment with your OB/GYN for further testing. In the future, Mira plans to release a progesterone test wand for easier testing at home — stay tuned!
What does low progesterone mean (and what are the symptoms)?
Low progesterone levels can create a hormone imbalance that results in negative effects on a woman’s health. When progesterone levels are too low, estrogen levels are too high in comparison, resulting in a condition called estrogen dominance that can make it harder for you to get pregnant. Like high estrogen, low progesterone can also result from PCOS.
Symptoms of low progesterone, besides estrogen dominance, include:
- Changes in your luteinizing hormone (LH) level
- No spike in basal body temperature
- Irregular or heavy menstrual bleeding
- Decreased sex drive
- Hot flashes
- Development of new anxiety and/or depression
- Miscarriage or early labor
What does high progesterone mean (and what are the symptoms)?
High progesterone is associated with a birth defect called congenital adrenal hyperplasia, in which children produce too many male sex hormones and too little cortisol — but this is a symptom rather than a cause of the condition.
High progesterone may also result from taking hormone therapy for the prevention of pregnancy, symptoms of menopause, or suppressing the menstrual cycle in conditions like endometriosis.
The most serious risk associated with high progesterone is an increased chance of developing breast cancer. However, high progesterone levels may also have a protective effect against ovarian cancer.
High progesterone may also impact fertility by causing low estrogen levels in comparison, resulting in a hormone imbalance called functional estrogen deficiency that may affect your ability to conceive.
Symptoms of high progesterone, besides functional estrogen deficiency, include:
- Yeast infections
Luteinizing Hormone (LH)
What is luteinizing hormone (LH)?
LH is produced in the anterior pituitary gland and is responsible for triggering ovulation and the development of the remnant egg sac in the ovary. LH is extremely important in understanding exactly when you are ovulating, making it an essential hormone to track if you are trying to conceive (TTC).
During ovulation, LH surges, which sends a signal to the ovary that it’s time to release an egg. A tracking device like Mira Fertility can help you understand your personal LH surge and fertility hormone patterns for a more precise measurement of your fertility window.
What is a healthy LH level?
Healthy LH levels fluctuate throughout the life cycle and throughout the menstrual cycle. Before puberty, levels of LH are generally very low. These levels begin to rise as a child approaches puberty.
In premenopausal women who are menstruating, LH normally measures between 5 – 25 IU/L — and even higher during ovulation. After menopause, levels of LH become even higher than that, measuring around 14.2 – 52.3 IU/L.
What does low LH mean? + symptoms
Low LH signals a problem with the pituitary gland or hypothalamus. The hypothalamus is the part of the brain that produces pituitary hormones — like LH.
Hypopituitarism is the name for a condition in which the pituitary gland produces too little of one or more pituitary hormones. The result is a loss of function in the organ(s) controlled by the low hormone(s). In the case of hypopituitarism marked by low LH, this could indicate secondary ovarian failure, which results in infertility.
Malnutrition and eating disorders can also cause low LH. A nutrition professional and/or mental healthcare provider can help you determine if this may be the case for you or someone you care about.
Symptoms of low LH include:
- Amenorrhea (no period)
- Unexplained weight loss
- Muscle weakness
- Decreased appetite
What does high LH mean (and what are the symptoms)?
High levels of LH can indicate primary ovarian failure, another possible cause of infertility. In the case of high LH, the problem is with the ovaries themselves, rather than the pituitary gland.
People with PCOS may have high LH levels, resulting in comparatively high levels of testosterone. Genetic conditions like Turner syndrome and Klinefelter syndrome can also cause high LH, as can exposure to radiation or chemotherapy for cancer and other health conditions.
Symptoms of high LH include:
- Anovulation (failing to ovulate)
- Amenorrhea (no period)
- Early puberty
- Premature menopause
Follicle Stimulating Hormone (FSH)
What is follicle stimulating hormone (FSH)?
Like LH, FSH is produced by the anterior pituitary gland. They work together to tell follicles in the ovaries to begin maturing. It’s important for your ovaries to release a mature egg when you ovulate because only mature eggs can be fertilized.
FSH also affects your cervical mucus, one of the telltale signs you’re within your fertile window. Most of the time, your cervical mucus will be thick, white or off-white, and creamy. When you are ovulating, however, your cervical mucus becomes stretchy and clear, like the consistency of an egg white, to help sperm survive and reach an egg. FSH is responsible for this important change.
What is a healthy FSH level?
Healthy FSH levels change throughout the life cycle. Before puberty, it is normal to have anywhere from zero to 4.0 mIU/mL of FSH. During puberty, that level rises to between 0.3 and 10,0 mIU/mL.
Adult women who are premenopausal and still menstruating should have anywhere from 4.7 to 21.5 mIU/mL of FSH, depending on where they are in their menstrual cycle. After menopause, FSH levels rise much higher, measuring between 25.8 and 134.8 mIU/mL.
What does low FSH mean (and what are the symptoms)?
Low FSH can make it more difficult to conceive, as it may mean your ovaries are not producing enough eggs. It can also signify a problem with the pituitary gland or hypothalamus, much like low LH.
You may also have low levels of FSH if you are extremely underweight. This can occur due to an eating disorder. People with eating disorders sometimes stop getting their periods in a condition known as hypothalamic amenorrhea. If you or someone you love is underweight due to an eating disorder, it’s important to talk to your doctor in order to protect your future fertility.
Symptoms of low FSH include:
- No changes in your cervical mucus throughout the menstrual cycle
- Hot flashes
- Sleep disturbances
- Mood swings
- Vaginal dryness
- Increase in the number of UTIs
What does high FSH mean (and what are the symptoms)?
High FSH has many potential causes. One possible cause of high FSH that may impact your fertility is premature ovarian failure or primary ovarian insufficiency (POI), a condition in which the ovaries stop working before the age of 40.
Women with POI may still get a monthly period, but their ovaries do not work properly, leading to irregular ovulation or anovulation. POI is a common cause of infertility.
Another cause of high FSH is PCOS. PCOS is one of the leading causes of female infertility and affects all of the female sex hormones mentioned in this article. Turner syndrome, a genetic condition caused by a missing or incomplete X chromosome, may also cause high FSH.
If you are older than the age of 40, high FSH may be a normal sign that you have entered menopause, especially if you are experiencing symptoms like vaginal dryness or hot flashes. If you are under the age of 40, high FSH can sometimes indicate you are entering premature menopause, which is different than POI.
Sometimes high FSH is a sign of ovarian cancer. 1 in 78 women develops ovarian cancer in their lifetime. This is more likely if you have a BRCA1 or BRCA2 genetic mutation. The median age of diagnosis for ovarian cancer is 63. If you are younger than this, it is unlikely you have ovarian cancer, though a rare type of ovarian cancer called a germ cell tumor is most common in adolescents.
Ovarian cancer has a low survival rate because it is often caught in the late stages. If you notice high levels of FSH while tracking your fertility hormones, it is important to visit your doctor ASAP for further testing to rule out ovarian cancer.
Symptoms of high FSH include:
- Irregular periods
- Hot flashes
- Fewer eggs or follicles in the ovaries
Unhealthy levels of any of these hormones may put your fertility at risk. It’s important to track your urine hormone concentrations throughout the month to keep an eye on your fertility levels.
Doctors usually tell their patients to “try” for at least a year (six months if you’re over 35) before you take any diagnostic tests. However, if you track your data using a device like Mira Fertility, you’ll be able to help understand your hormone patterns (and see actual data), which can help you realize that something might be wrong before your opportunity to conceive is up.