Female fertility: ovulation, hormones, and fertility testing

Many women only start learning about ovulation, AMH, or fertility hormones when they begin trying to conceive — but hormone imbalances can show up much earlier, through changes in your cycle, skin, energy levels, or periods.

If you’ve been dealing with irregular or painful periods, struggling to track ovulation, or feeling concerned about your fertility, you’re not alone. Fertility challenges are common, and testing can help give you a clearer picture of what’s going on — from ovulation and ovarian reserve to hormone balance and possible next steps.

In this guide, we cover:

• What are the signs of female fertility problems?
• Ovulation and fertility
• PMOS (PCOS) and hormone imbalance
• AMH and ovarian reserve
• Endometriosis and fertility
• Can lifestyle affect female fertility?
• Female fertility testing explained
• When should women consider fertility testing?
• Understanding female fertility health

What are the signs of female fertility problems?
 

The most common sign of fertility problems is difficulty becoming pregnant, but hormone or ovulation problems can also affect your menstrual cycle and overall wellbeing.

Some women notice obvious symptoms, while others may have very few signs at all.

Possible signs of fertility or hormone problems can include:

• Irregular periods 
• Absent periods 
• Very painful periods 
• Heavy bleeding 
• Pelvic pain 
• Difficulty tracking ovulation 
• Recurrent miscarriage 
• Excess facial hair or acne 
• Hot flushes or vaginal dryness 

Your menstrual cycle can often provide important clues about reproductive health. Changes in cycle length, bleeding, pain, or ovulation patterns may sometimes point to underlying hormone imbalances worth investigating.

Ovulation and fertility
 

Ovulation is when your body releases an egg, usually once during each menstrual cycle, and it’s a key part of fertility. Many people track ovulation using apps like Flo, which can help predict fertile days and identify patterns in your cycle over time.

You may notice signs of ovulation such as clearer, stretchy cervical mucus, mild cramping, bloating, breast tenderness, or a positive ovulation test. Some people also track their temperature each morning, as it can rise slightly after ovulation.

If your cycles are irregular or ovulation feels difficult to track, it may be linked to factors such as stress, thyroid health, PCOS, excessive exercise, or significant weight changes. Hormone blood tests can help give a clearer picture of whether ovulation is happening regularly, alongside checking reproductive hormones, ovarian reserve, and thyroid function.

Ovulation may be affected by:

• PCOS 
• Thyroid disorders 
• Hypothalamic dysfunction 
• Premature ovarian insufficiency 
• Hyperprolactinaemia 
• Significant weight changes 
• Excessive exercise 
• Chronic stress 

Hormone blood tests may help assess:

• Ovulation 
• Ovarian reserve 
• Reproductive hormone balance 
• Thyroid function 

If you would like to understand more about reproductive hormones, read our guides to pregnancy hormones, AMH and fertility, and thyroid health and fertility.

PMOS (PCOS) and hormone imbalance
 

Polyendocrine metabolic ovarian syndrome (PMOS), previously known as Polycystic ovary syndrome (PCOS), is one of the most common hormonal conditions linked to female infertility.⁵ It can affect ovulation, menstrual cycles, insulin sensitivity, androgen levels, and wider hormone balance.

Some women with PCOS may experience:

• Irregular periods 
• Acne 
• Excess facial or body hair 
• Weight gain 
• Difficulty conceiving 

Others may have very few symptoms at all.

Because PCOS can affect ovulation, many women only discover they have the condition when investigating fertility or irregular cycles. Hormone blood testing can help provide more clarity around reproductive hormone patterns associated with PCOS.

AMH and ovarian reserve
 

Anti-Müllerian hormone (AMH) is commonly used to assess ovarian reserve, which refers to the number of eggs remaining in the ovaries.

AMH testing can provide useful insight into egg reserve, although it cannot predict the ability to conceive naturally on its own.

Female fertility naturally changes with age as both egg quantity and egg quality decline over time. Although fertility varies from person to person, these changes generally become more noticeable after the age of 35.

If you would like to learn more, read our guide to age and fertility.

 

Endometriosis and fertility
 

Endometriosis is a condition where tissue similar to the lining of the womb grows outside the uterus. For some women, it can affect fertility by disrupting ovulation, causing inflammation, affecting implantation, or damaging the fallopian tubes.

Symptoms may include:

• Painful periods 
• Chronic pelvic pain 
• Pain during sex 
• Heavy periods 
• Fatigue 
• Difficulty conceiving 

Some women with endometriosis have no symptoms at all and only discover the condition during fertility investigations.

Can lifestyle affect female fertility?
 

Research suggests lifestyle factors may influence hormone balance, ovulation, and reproductive health.³

Factors linked to fertility include:

• Smoking 
• Excess alcohol intake 
• Poor sleep 
• Chronic stress 
• Obesity or being underweight 
• Poor nutrition 
• Excessive exercise 
• Recreational drugs 

Lifestyle changes cannot treat every cause of infertility, but improving sleep, nutrition, exercise, recovery, and overall health may still help support reproductive wellbeing.

Female fertility testing explained
 

Fertility testing can help build a clearer picture of your reproductive and hormone health. Depending on your symptoms, medical history, and cycle patterns, investigations may look at ovulation, ovarian reserve, thyroid health, and other hormones linked to fertility.

Female fertility investigations may include:

• Hormone blood tests 
• Ovulation testing 
• AMH testing 
• Thyroid testing 
• Ultrasound scans 
• Medical history review 

Common fertility hormones tested include:

• AMH 
• FSH 
• LH 
• Oestradiol 
• Progesterone 
• Prolactin 
• Thyroid hormones 

Testing cannot always provide all the answers, but it can sometimes help identify hormone imbalances, ovulation problems, or other factors that may affect fertility.

If you are unsure where to start, our fertility test buying guide explains the different fertility blood tests available for women and men.

When should women consider fertility testing?
 

There’s no right or wrong time to look into fertility testing. Some women seek testing after struggling to conceive, whilst others simply want a better understanding of their health or ovarian reserve.

You could consider fertility testing if you:

• Have irregular or absent periods 
• Have symptoms of PCOS 
• Have painful periods or suspected endometriosis 
• Have experienced recurrent miscarriage 
• Have been trying to conceive for 12 months 
• Want insight into ovarian reserve or hormone health 
• Are considering pregnancy later in life 

If you’re feeling unsure about your symptoms, cycles, or fertility, seeking advice and exploring testing can sometimes help provide reassurance and clarity.

With hormone blood tests, please always read the instructions as some tests need to be taken at certain points in your cycle. 

Understanding female fertility health
 

Female fertility is shaped by hormones, ovulation, age, reproductive health, and overall wellbeing. While fertility can sometimes feel overwhelming or confusing, understanding your cycle and hormone health may help you feel more informed and supported.

Changes in periods, ovulation, energy levels, or symptoms such as acne, pelvic pain, or irregular cycles can sometimes reflect wider hormone imbalances worth investigating.

If you have concerns about fertility, hormone testing may help provide more clarity around ovulation, ovarian reserve, and reproductive health, helping you better understand your body and possible next steps.

References

1. World Health Organization. Infertility fact sheet. https://www.who.int/news-room/fact-sheets/detail/infertility
2. Vander Borght, M. and Wyns, C. (2018) ‘Fertility and infertility: Definition and epidemiology’, Clinical Biochemistry, 62, pp. 2–10. doi: 10.1016/j.clinbiochem.2018.03.012.
3. Sharma, R., Biedenharn, K.R., Fedor, J.M. and Agarwal, A. (2013) ‘Lifestyle factors and reproductive health: taking control of your fertility’, Reproductive Biology and Endocrinology, 11, article 66. doi: 10.1186/1477-7827-11-66.
4. Practice Committee of the American Society for Reproductive Medicine (2021) ‘Fertility evaluation of infertile women: a committee opinion’, Fertility and Sterility, 116(5), pp. 1255–1265. doi: 10.1016/j.fertnstert.2021.08.038.
5. Balen, A.H., Morley, L.C., Misso, M., Franks, S., Legro, R.S., Wijeyaratne, C.N., Stener-Victorin, E., Fauser, B.C.J.M., Norman, R.J. and Teede, H. (2016) ‘Polycystic ovary syndrome’, Nature Reviews Disease Primers, 2, article 16057. doi: 10.1038/nrdp.2016.57.
6. Crawford, N.M. and Steiner, A.Z. (2015) ‘Age-related infertility’, Obstetrics and Gynecology Clinics of North America, 42(1), pp. 15–25. doi: 10.1016/j.ogc.2014.09.005.
7. Zondervan, K.T., Becker, C.M. and Missmer, S.A. (2018) ‘Endometriosis’, Nature Reviews Disease Primers, 4, article 9. doi: 10.1038/s41572-018-0008-5
8.