HORMONES

BENEATH
THE MENSTRUAL
CYCLE
Introduction
Fertility hormones play a crucial role in a woman’s menstrual cycle
and overall health, as long as they are balanced. Whether you are
trying to conceive, or simply maintain good health, these chemical
messengers are working behind the scenes every month
to prepare for a potential pregnancy.

As your body goes through a series of predictable changes each

month, different hormones come into play and their levels can
change dramatically. These levels don’t just affect menstruation,
but can have serious implications for the state of your health as
well. Often overlooked, menstruation is a vital sign of your health
and understanding what’s going on behind the scenes can help
you not only on your fertility journey, but address any issues with
your mental and physical fitness as well.

This e-book takes a look at the hormones beneath the menstrual

cycle and how they interact to orchestrate menstruation. For each
hormone we’ll discuss what it does, how it impacts your health,
and what a healthy level should look like during the different
phases of your menstrual cycle.

Here you will find everything you need to understand how

the hormones of your menstrual cycle work together to play
an essential role in your monthly cycle and health.

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Contents
Fertility Hormones Abbreviations
that You Need to Know 5
Hormone abbreviations
Fertility and pregnancy status abbreviations
Medical Conditions and Symptoms
Various TTC Abbreviations

Luteinizing Hormone (LH) 9

What is LH and what is an LH surge?
How long does the LH surge last?
How long after your LH surge do you ovulate?
The best ways to test LH levels to predict ovulation
What is a healthy LH level?
What does low and high LH mean?
And what are the symptoms

Estrogen (E3G) 15
What is estrogen?
Types of estrogen
What does estrogen do?
How to test?
What is a healthy estrogen level?
What does low and high estrogen mean?

3
Progesterone 20
What is progesterone?
What does progesterone do?
How to test?
What is a healthy progesterone level?
What does low and high progesterone mean
And what are the symptoms?

Follicle Stimulating Hormone (FSH) 25

What is follicle stimulating hormone (FSH)?
What does FSH do?
How to test?
What is a healthy FSH level?
What does low and high FSH mean?
And what are the symptoms?

Human Chorionic Gonadotrophin (hCG) 29

What does hCG do?
The role of hCG in pregnancy
How to test?
What is a normal hCG levels?
What does low and high hCG mean?
And what are the symptoms?

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Fertility Hormones
Abbreviations that You
Need to Know

Hormone abbreviations
LH – Luteinizing Hormone

E3G – Estrogen (Estradiol)

PdG – Progesterone

FSH – Follicle Stimulating Hormone

hCG – Human Chorionic Gonadotrophin

Fertility and pregnancy status

abbreviations
TTC – Trying to Conceive

TTA – Trying to Avoid (Pregnancy)

NFP – Natural Family Planning

PG – Pregnant

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Important Terms
of Menstrual Cycle
CD# – Cycle Day

O / Ov – Ovulation

#DPO – Days past Ovulation

CY# – Cycle Number

FP - Follicular Phase

LP – Luteal Phase

CM – Cervical Mucus

CF – Cervical Fluid (same as mucus)

EGCM – Egg White Cervical Mucus

2WW / TWW – Two-Week Wait

(the time between ovulation and either
your next period or a
positive pregnancy test)

LMP – Last Menstrual Period

(the first day of your last period)

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Medical Conditions and
Symptoms
PCOS – Polycystic Ovary Syndrome

Endo – Endometriosis

OHSS – Ovarian Hyperstimulation Syndrome

PID – Pelvic Inflammatory Disease

MC or M/C – Miscarriage

CP – Chemical Pregnancy

M/S – Morning Sickness

B/W – Blood Work (diagnostic testing of blood)

U/S – Ultrasound

BP – Blood Pressure

HCG – Hysterosalpingogram (an X-ray of the womb and fallopian tubes)

IB – Implantation bleeding (slight bleeding or spotting that may happen

around the time an
embryo implants in your womb)

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Various TTC
Abbreviations
OPK / OPT – Ovulation Predictor Kit / Test

HPT – Home Pregnancy Test

BFN – Big Fat Negative (the result of pregnancy test)

BFP – Big Fat Positive

BBT – Basal Body Temperature

BBTC – Basal Body Temperature Charting

BC / BCP – Birth Control / Birth Control Pills

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Luteinizing Hormone
Luteinizing hormone, or LH, plays an important role in regulating your
menstrual cycle and predicting ovulation. When trying to understand
when your fertile and infertile days are in your cycle, it’s important to
understand how long after your LH surge you ovulate.

In this section, we will look at the role LH plays in ovulation, the best ways
to track it, and what the measurements mean.

What is LH and what is an LH surge?

LH is a reproductive hormone that triggers ovulation. Normally, LH levels
remain fairly steady throughout the menstrual cycle. The exception is just
before ovulation when LH levels surge dramatically.

60

50
LH conc (mlU/ml)

40

30

20

10

0
5 10 15 20 25 30

Day of menstrual cycle

The time from the first day of your period until ovulation is known as the
follicular phase. During the follicular phase, follicles in the ovaries are
maturing, getting ready to release an egg. Eventually, one follicle emerges as
the dominant follicle that will release its egg during this menstrual cycle. The
surge in LH triggers the release of the egg from the follicle, enabling ovulation.

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When you ovulate, the egg released by the dominant follicle travels down
the fallopian tubes. If it is fertilized within 24 hours, it will travel further down
and implant in the uterus to begin growing into a baby. If not, the egg dies
and is shed, along with the uterine lining, during your menstrual period.

A woman's egg can survive for only 24 hours once it is released, but
a man's sperm can live for up to five days in the female reproductive tract.
Therefore, the five days before ovulation and the day of ovulation itself
are known as your fertile window. This is the best time to have sex if you
are trying to conceive (TTC).

How long does the LH surge last?

Commonly, LH surges 24-36 hours before ovulation. If you are TTC,
it's important to pay attention to the length of your LH surge in relation
to your ovulation day.

Before ovulation, the estrogen surge indicates the start of your fertile window,
while the LH surge indicates your peak fertile days. After ovulation, the egg
can live up to 24 hours and beyond that the chance of conceiving is zero.
Thus, your fertile window ends 24 hours after ovulation.

Some people advise using the basal body temperature (BBT) method over
tracking your LH surge for pinpointing ovulation. However, BBT does not
rise until 12 to 24 hours after ovulation, so you may miss your fertile
window if you are using the BBT method alone to track ovulation.

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How long after your
LH surge do you ovulate?
In a healthy woman, ovulation usually takes place 24 to 36 hours after
the LH surge. After ovulation, LH then usually decreases sharply, but
this doesn’t always happen and every woman is different.

Ovulation time varies as well and women can ovulate as early as day 8
of their cycle, or as late as day 21. Many women believe they ovulate
on day 14, but this is considered the average, not necessarily what
happens every month.

Late ovulation Early ovulation

Real Mira customers' charts

Finding the timing of your ovulation by simply logging your period

on an app may not be enough to accurately determine your fertile
window. Assuming you have a regular cycle, it could take more than one
year of continuous logging to ensure the calendar method becomes
accurate for ovulation prediction.

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The best ways to test LH levels to
predict ovulation
There are multiple ways to test your LH levels:

Blood test from a doctor's office. This is the most accurate method.
However, it requires you to visit the lab for every test. For people
trying to conceive (TTC) or trying to avoid (TTA) pregnancy, it usually
requires 10-15 tests per month, which could be inconvenient and
expensive. You can reduce the number of tests slightly, but it
increases the chance of missing ovulation as you may not ovulate
on the exact same day every cycle.

Testing at home with an OPK. A positive result when using an OPK

means you are above the hormone threshold set by the OPK
manufacturer, which is usually based on the population average.
A negative result means you are below the population average.
However, a positive or negative result may not necessarily mean
you are ovulating or not, due to huge inter-woman hormone level
variabilities. You also need to log down the daily OPK results
manually, which can be troublesome and stressful.

Using a smart hormone tracker. Mira is a palm-sized hormone

tracker that tracks and shows you your actual hormone
concentrations with the accuracy of hospital-grade lab equipment.
It is intended for home use. Mira measures your LH, estrogen, and
other female hormone concentrations in your urine, the same way
an at-home pregnancy test works. The data is automatically synced
with the Mira App, which optimizes the ovulation prediction based
on your personal health. It is accurate, easy to use, and adapts to
your individual hormone patterns.

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What is a healthy LH level?
LH levels do not look the same across all people and all cycles. Every
woman is different and research shows that there are many different LH
surge patterns.

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.

There are many different LH surge patterns and once you’ve taken several
tests, you should be able to identify a spike in your LH levels and see
a pattern developing. Patterns vary from short LH surges to showing more
than one surge. Some women even have a “plateau” pattern where LH
levels remain high after the initial surge. Keep in mind that the overall
trend is more important than the absolute value of a single test.

What does low and high LH mean?

While there is a wide range of LH values that can be considered “normal”,
if you have high or low LH you may be wondering what it means,
especially in light of your fertility. Unusually high or low LH levels may be
indicative of an underlying condition that impacts ovulation, or something
else altogether and you should consult your physician.

Low LH levels can prevent ovulation and may impact whether you even
get your period. Low LH levels are often found in women with eating
disorders, female athletes, those under a lot of stress, and women with
disorders that affect the pituitary gland or hypothalamus.

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 60

50

LH conc (mlU/ml) 40

30

20

10

0
5 10 15 20 25 30

Day of menstrual cycle

Low LH levels
High LH levels may mean that you are not ovulating, have an underlying
hormone condition like PCOS, or have an underlying genetic disorder that
affects the production of hormones. High LH levels could also mean you are
in premature menopause or perimenopause, especially if you are older.

60

50
LH conc (mlU/ml)

40

30

20

10

0
5 10 15 20 25 30

Day of menstrual cycle

High LH levels

And what are the symptoms

Symptoms of high LH levels Symptoms of low LH levels
Periods have stopped Unable to get pregnant after 12
Your periods aren’t regular months of trying
Unexplained infertility Sex drive is decreased
Irregular menstrual cycle
Fatigue, weakness, unexplained
weight loss, or decreased appetite

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Estrogen (E3G)
Whether you are trying to conceive (TTC) or simply trying to maintain good
hormone health, estrogen is one of the most crucial hormones to pay attention
to. From your cholesterol to your bones, estrogen plays dozens of distinct, yet
equally important roles in the female body.

In order for estrogen to play its proper role in the body, you need to maintain
healthy levels of this essential hormone. Estrogen levels that are either too low
or too high can result in unpleasant symptoms that can potentially become
dangerous in the long term.

In this section, we’ll learn more about estrogen, including what it does for your
body, what ideal estrogen levels look like, and how to tell if your estrogen levels
are out of balance.

What is estrogen?
Estrogen is a primary sex hormone found in women’s bodies that helps regulate the
menstrual cycle, fertility, and overall health. It is mainly produced in the ovaries,
though it can be found in small amounts in the adrenal glands and fat (or adipose)
tissue as well. Sometimes, the ovaries produce too much or too little estrogen,
which can negatively impact fertility and well-being.

Estrogen plays a key role in many functions throughout the body. It helps develop
and maintain both the reproductive system and sex characteristics like body hair
and breasts. In addition to supporting reproductive functions, estrogen also
contributes to bone development and health, cardiovascular functions, and mood
management.

Estrogen’s key role is in enabling the sexual organs to function. In the ovaries,
it helps stimulate the growth of the egg in the follicle, while in the vagina estrogen
maintains the thickness of the vaginal wall and has a role in lubrication. Estrogen is
also responsible for building up the lining of your uterus every month and helps
regulate the flow and thickness of uterine mucus secretions. It’s also responsible
for the formation of breast tissue and stopping the flow of milk after weaning.

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Types of estrogen
There are three types of estrogen found in the female body: estradiol, estrone,
and (o)estriol. Each plays a different role in reproductive health:

Estradiol is the most common type of estrogen found

in women of reproductive age and is the most active form
of estrogen
Estrone is the most common type of estrogen produced
after menopause
Estriol is the most common type of estrogen produced
during pregnancy
The fourth type of estrogen, Estretrol, is produced only during pregnancy
from the liver of the fetus. In general, when they talk about “estrogen
levels” in the body, people are talking about levels of estradiol, which
is the most active form of estrogen throughout the menstrual cycle.

What does estrogen do?

Estrogen is responsible for female sexual
development, triggering the growth of
breasts, pubic hair, and other sex
characteristics during puberty. This
hormone also plays an important role in
maintaining your reproductive health by
controlling the growth of the uterine
lining at the beginning of your menstrual
cycle and during pregnancy. However,
estrogen also plays an important role in
your overall health. Estrogen regulates
your bone and cholesterol metabolism,
as well as your body weight, glucose
metabolism, and insulin sensitivity.

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 How to test?
Estrogen can be tested in blood, urine, or saliva. Saliva and urine tests can
be done at home, but blood tests are usually done in a doctor’s office.
At-home urine testing can be done with a hormone tracking device like the
Mira Fertility Tracker. Mira tracks your numeric estrogen level with over 99%
accuracy using test wands and a handheld fertility analyzer that syncs with
the Mira app to give you real-time data and see your unique hormone curve.
The Mira Analyzer measures exact hormone concentrations and saves your
data allowing you and your doctor to see trends in the data.

Real Mira customer's chart. During this month the customer got pregnant.

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.

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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 hot flashes.

What does low and high estrogen mean?

Since estrogen plays such a vital role in your overall health, too much or too little
of this hormone can have a significant impact. In addition to the effect on your
fertility, high or low estrogen can result in a number of knock-on repercussions
that touch all areas of your life from issues with sex and sexual organs to mental
health struggles like depression or trouble concentrating.

Low estrogen may impact your ability to get pregnant (read which foods can
increase estrogen naturally). 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 (more on
tracking estrogen at home here).

In some cases, low estrogen may be a sign of an eating disorder. Excessive

exercise and/or extreme underweight may lead to decreased levels of estrogen
that result in 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 experiencing
an eating disorder, contact a mental health professional for guidance.

400

350

300
E3G conc (ng/ml)

250

200

150

100

50

0
5 10 15 20 25 30

Day of menstrual cycle

Low E3G levels

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Not often but occasionally 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 levels are also
associated with obesity, ovarian tumors, and liver disorders.
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.

600

500
E3G conc (ng/ml)

400

300

200

100

0
5 10 15 20 25 30 35

Day of menstrual cycle

High E3G levels

And what are the symptoms?

Symptoms of high estrogen levels Symptoms of low estrogen levels
Weight gain in the hips and thighs Painful sex because of little or no
Heavier or lighter periods than vaginal lubrication
usual Increase in the number of UTIs
Worsening of premenstrual Mood swings
syndrome Irregular or absent periods
Uterine fibroids and/or fibrocystic Headaches
breasts Hot flashes
Fatigue, loss of sex drive and/ Depression
or changes in mood Decreased bone density
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Progesterone
Progesterone plays an important role in regulating your monthly cycle
and preparing your body for conception. Once thought to be only found
in women, men have progesterone as well. As one of two female sex
hormones, it is essential for fully-functioning fallopian tubes, a healthy
period, and ensures you are able to get and stay pregnant, carrying until
full term. All other female fertility hormones are made from progesterone
which makes it an essential hormone to track for fertility and overall health.
Progesterone levels can give you critical information about your body
that can help you on your fertility journey.

What is progesterone?
Sometimes called the pregnancy hormone, progesterone is an all-star
female hormone that works on many fronts. From preparing your body for
pregnancy to its role in your libido, progesterone primarily supports your
body in getting pregnant and maintaining that pregnancy.

It is the major hormone in a class of hormones called progestogens

and impacts sexual development and reproduction. Made by the ovaries,
placenta (if pregnant) and adrenal glands, the rise and fall of this hormone
helps signal your body to shed the uterine lining and trigger your period.

Secreted by the corpus luteum, progesterone is mainly produced in the

ovaries. The corpus luteum, a temporary gland formed in the ovaries after
ovulation, is made from a follicle that housed a maturing egg
and forms as soon as the egg pops out.

A small amount of progesterone is produced by the adrenal glands that

sit atop the kidneys, and once pregnant, production takes place
in the placenta.

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What does progesterone do?
Progesterone has a number of jobs in the body from getting it ready
for pregnancy to maintaining that pregnancy. It does this by:
Thickening the uterine lining to welcome a fertilized egg
Concentrating mucus in your cervix to keep out harmful
bacteria and sperm
Maintaining the uterine lining throughout pregnancy
Preventing uterine contractions
Priming the glands involved in breastfeeding

Progesterone primarily supports your body in maintaining a pregnancy,

and as a result, levels change during your menstrual cycle.

Commonly used as a fertility treatment, progesterone is widely

recognized to treat a variety of issues. It can be useful to bring on
menstruation, help severe symptoms of PMS (in combination with
estrogen) and treat abnormal uterine bleeding.

When it comes to fertility treatments,

your doctor may recommend
progesterone hormone therapy to help
support your goal of getting pregnant.
Often prescribed to initiate menstruation
or because your ovaries don’t produce
enough naturally, there are other reasons
your doctor may recommend you take
progesterone. This hormone
can be unintentionally removed from
your ovaries by certain procedures, and
other medications may be suppressing
your ability to naturally produce
progesterone. Because this hormone
is the building block of pregnancy,
supplementation is often necessary.

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How to test?
Progesterone can be tested through blood, urine, or saliva. Most blood
tests involve a visit to a doctor’s office or lab, but there are a growing
number of home options as well. Blood tests give a quantitative,
or numeric value at the time of testing, but it only provides a snapshot
rather than the bigger picture. Progesterone levels can vary greatly
and have even been shown to fluctuate hour by hour.

Traditional home testing kits are qualitative rather than quantitative

and fall prey to the limitations of a one-time snapshot. Progesterone strips
test for a metabolite of progesterone called Pregnanediol Glucuronide
(PdG) that correlates to progesterone in the bloodstream. A digital fertility
analyzer, like Mira, can also quantitatively detect PdG levels and smart AI
learning and a companion app allows you to see your data over time giving
you a more complete picture of your fertility rather than a one-time
snapshot. Mira Fertility Confirm wands are now available for pre-order.
And although it’s not necessary, you can combine this information
with luteinizing hormone and estrogen level readings for a more holistic
view of your cycle’s progression.

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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

100

350
80

E3G conc (ng/ml)

LH conc (mlU/ml)

60 250

40 150

20
50

0
5 10 15 20 25 30

Day of menstrual cycle

First trimester of pregnancy: 11 – 44 ng/mL

Second trimester of pregnancy: 25 – 83 ng/mL
Third trimester of pregnancy: 58 – 214 ng/mL

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What does low and high
progesterone mean
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.

High progesterone can be caused by congenital adrenal hyperplasia, adrenal

hyperplasia, ovarian cysts, and certain ovarian tumors.

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.

And what are the symptoms?

Symptoms of high progesterone Symptoms of low progesterone
Irregular or heavy menstrual bleeding
Sleepiness
Spotting between periods
Bloating
Decreased sex drive
Dizziness
Hot flashes
Yeast infections
Development of new anxiety
Depression
and/or depression
Reduced sex drive
Miscarriage or early labor
Weight fluctuations
No spike in basal body temperature

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Follicle Stimulating
Hormone (FSH)
Follicle stimulating hormone, or FSH for short, is one of two gonadotrophic
hormones. These hormones are essential for reproduction since they stimulate
the gonads. In males this is the testes and in females, the ovaries. Released
by the pituitary gland into the bloodstream, FSH is essential to pubertal
development and healthy function of the testes and ovaries. This hormone
plays a key role not only in menstruation, but also in maintaining ovarian
follicles. An important hormone for sexual development and functioning, FSH
levels can change throughout the menstrual cycle and are highest just before
an egg is released.

What is follicle stimulating

hormone (FSH)?
As the name suggests, follicle stimulating hormone triggers the ovaries
to make eggs and estrogen by stimulating the follicles. Like LH, FSH
is produced by the anterior pituitary gland in the brain and helps control
your monthly cycle. They work together to tell follicles in the ovaries to begin
maturing. It’s important for your ovaries to release an egg when you ovulate
because only eggs can be fertilized.

FSH also affects the levels of estrogen that then has an impact on 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.

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What does FSH do?
FSH plays a crucial role in your menstrual cycle. Together with LH, it ensures
that the follicles in the ovaries mature. Several of those follicles mature each
cycle and inside the follicle, an immature egg is influenced by FSH and
is maturing. During ovulation this egg is released as the follicle bursts open
and the egg is now ready for fertilization.

During the follicular phase of your cycle, both FSH and LH peak and ovulation
occurs just after they peak. FSH is linked closely to estrogen and levels
of this hormone also rise until ovulation. There is a slight drop in FSH shortly
before ovulation, but after ovulation, levels drop precipitously before starting
the cycle again. If fertilization of the egg is successful, FSH levels begin
to drop and stay low for the duration of the pregnancy. Since your cycle
is temporarily paused while pregnant, FSH levels are naturally low.

How to test?
FSH levels can be tested in one of two ways. Your doctor can order a blood
test that will measure the level of FSH serum in your blood or you can use
an at-home testing kit that measures FSH levels in urine.

Traditionally at-home kits have been designed for women testing as a means to
confirm menopause. Devices like like the Mira Fertility Analyzer, are working
on this so you can test in the comfort of your own home.

FSH levels can help detect issues with

ovulation and whether the ovaries
are working properly. Tracking this
hormone, together with other fertility
hormones like LH, can give you even
more insight into what is going
on behind the scenes.

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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.

20

16
LH conc (mlU/ml)

12

0
5 10 15 20 25 30 35

Day of menstrual cycle

What does low and high FSH mean?

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.

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.

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Women with POI may still get an irregular 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
section. 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 sign that you have
entered premature 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 may be 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.

And what are the symptoms?

Symptoms of high FSH Symptoms of low FSH
Irregular periods Muscle weakness, excessive fatigue
Hot flashes Sleep disturbances
Headaches Mood swings
Vaginal dryness
Increase in the number of UTIs
Decreased libido

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Human Chorionic
Gonadotrophin (hCG)
If you’ve ever read the back of a home pregnancy test, you’re likely familiar
with the hormone human chorionic gonadotropin. Also known as hCG
or beta hCG and released mainly during pregnancy, this is the hormone
that home pregnancy tests detect and measure in your urine to determine
a positive result. As early pregnancy progresses, hCG levels typically follow a
predictable pattern of increasing but that may not always be the case. What
does it mean if you have slow rising hCG or your hCG levels are not rising? In
this section you’ll learn about hCG levels and what low or slow rising hCG
levels could mean for any potential pregnancy.

What does hCG do?

Although it is produced naturally in the body and
you may find trace amounts in your system at
other times, hCG is really only produced by your
placenta once an embryo implants in the uterus
and the placenta is fully developed. The real role
of hCG is to tell your body to keep producing
progesterone from the corpus luteum until the
placenta can take over. Progesterone stops an
impending menstrual cycle and protects the
uterine lining and your pregnancy. As the
embryo continues to develop, hCG levels rise
and peak around 8-11 weeks of pregnancy.
The placenta, once fully formed, takes over
progesterone production and the assistance
hCG provided is no longer needed.

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The role of hCG in pregnancy
Also known as the pregnancy hormone, hCG is produced by the cells
surrounding a developing embryo that eventually go on to form the placenta.
Production of this hormone kicks in almost immediately after implantation
and levels double every 72 hours during the early weeks of pregnancy.
After implantation happens and hCG starts to be produced, it ensures
the corpus luteum continues to produce progesterone throughout the first
trimester of pregnancy.

Without progesterone, the womb lining would shed and prevent an embryo
from implanting. hCG makes sure this doesn’t happen by ensuring the corpus
luteum continues progesterone production until the placenta is established
and can take over production.

In addition to how it triggers progesterone production and supports fetal

growth, hCG also supports other bodily functions over the course
of a pregnancy. It promotes the development of new blood vessels
in the uterus as well as smoothing the muscle cells in the uterine wall, both
critical developments for maintaining a pregnancy. The main function of hCG
though is to trigger the corpus luteum to continue progesterone production
and prevent the embryo from being rejected due to immunological reasons.

How to test?
The presence of hCG can be tested via
urine or blood. Home pregnancy tests
detect the presence of hCG but can’t
tell you the amount of hCG in your urine.

A blood test is the most accurate way to

detect and track hCG levels. And while
some pregnancy tests on the market are
geared to tell you if your hormone levels
have risen over the baseline, they are
not meant to monitor healthy pregnancies.

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Fertility tracking systems, like Mira Fertility Plus, can help you track other fertility
hormones like luteinizing hormone and estrogen. Tracking and monitoring these
hormones can help you achieve your fertility goals and provide valuable health
information about your body. In the future, you will be able to use your Mira
device to track hCG and use the information to track vital signs in early pregnancy.

What is a normal hCG levels?

Human chorionic gonadotropin naturally occurs in both males and females
throughout their lives and may be detectable due to low concentrations
produced by the pituitary gland. However, because of its key role
in pregnancy, hCG production is at its highest during the first trimester
of pregnancy, and typically follows an exponential rise.

In early pregnancy, hCG levels continue to rise until the last weeks of the first
trimester, or around the 9-12 week mark. Standard levels can vary from
woman to woman and will depend on a number of factors including how
your body reacts to pregnancy and the number of embryos you are carrying.
A woman carrying more than one embryo will usually have a higher baseline level
of hCG than one carrying a single embryo, given the hormone’s role in fetal
development and early pregnancy.

Typically, hCG levels double every 48 to 72 hours for the first four weeks
of a normal pregnancy, then slows to every 96 hours by six weeks, and peaks
around 10 weeks, before leveling off then decreasing and remaining
constant for the remainder of the pregnancy.

During the weeks that follow

implantation, these standard hCG
levels serve as a guideline for
the normal range in each week
of pregnancy. However, it should
be noted that levels vary from
woman to woman and will entirely
depend on what’s normal for you,
how your body reacts to pregnancy,
and whether or not you are carrying
multiples.

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Because a single measurement won’t provide trend information, multiple
hCG tests may be needed to confirm whether your levels are increasing at
the appropriate rate. There are reasons for slow rising hCG levels and
numbers and doubling times are not the only indicators of trouble or
concern. In a low-risk pregnancy, checking hCG doubling times is not
normally needed and is usually only reserved for cases where there are
underlying concerns such as previous miscarriages.

Typical hCG levels vary widely from woman to woman but as long
as they are in the normal range and rising steadily, there should be little
concern. Home pregnancy tests work by detecting a threshold of hCG in
urine but only exact levels can be determined with a blood test.

The table below gives the range of expected levels (measured

in milli-international units of hCG hormone per milliliter of blood (mIU/mL)).

Pregnancy Week (weeks since Standard hCG Range

last menstrual period)

Non-pregnant 0 - 5 mIU/mL

3 weeks 5 - 50 mIU/mL

4 weeks 5 - 426 mIU/mL

5 weeks 18 - 7,340 mIU/mL

6 weeks 1,080 - 56,500 mIU/mL

7-8 weeks 7,650 - 229,000 mIU/mL

9-12 weeks 25,700 - 288,000 mIU/mL

13-16 weeks 13,300 - 254,000 mIU/mL

17-24 weeks 4,060 - 165,400 mIU/mL

25-40 weeks 3,640 - 117,000mIU/mL

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 60000
hCG conc (mlU/ml)

40000

20000

0
5 10 15 20 25 30 35 40 45 50

Day of menstrual cycle

hCG levels during pregnancy

What does low and high hCG mean?

During early pregnancy, hCG monitoring is valuable for assessing the health
and status of a pregnancy. You may be wondering what low hCG levels mean
since typical values can fall in a wide range. Your doctor is more concerned
with how your levels change - are they rising or not - and the rate they change
rather than the actual number.

Low or slow rising hCG levels can mean several things and could indicate
a number of possible scenarios. A Low beta hCG result could mean that the
date of your pregnancy was miscalculated and you are not as far along as you
thought. If you have irregular periods, aren’t tracking your cycle, or are unsure
of the dates you may have miscalculated and further tests will be needed
to determine gestational age.

Slow rising hCG levels could also be a sign of some pregnancy complications
that may ultimately mean pregnancy loss. If pregnancy fails to progress, initial
levels may have appeared normal but failed to rise on subsequent tests. Falling
hCG levels can be a sign of miscarriage but will often be accompanied
by other symptoms such as cramping, bleeding, and passing tissue or clots.

In addition to miscarriage, low or slow rising hCG levels could indicate

a blighted ovum or ectopic pregnancy. Although different conditions, they
both involve the development of a fertilized egg and therefore hCG hormone.
A blighted ovum, when the fertilized egg attaches to the womb but doesn’t

33
develop, usually occurs early in pregnancy and many women may not even
know it has taken place. Symptoms may appear as normal menstruation and
you will think it’s your usual period.

An ectopic pregnancy may be a dangerous and life-threatening condition

where the fertilized egg remains in the fallopian tube but continues
to develop. As an ectopic pregnancy progresses it is usually accompanied by
a range of physical symptoms that indicate a problem with the pregnancy
such as severe abdominal pain, heavy bleeding, and dizziness or shock. Low
or slow rising hCG levels can be a sign of an ectopic pregnancy but the
doctor will order more than hCG tests alone for this type of diagnosis.

It’s important to remember that low or slow rising hCG isn’t in and of itself an
indication of pregnancy problems. A small but significant percentage of
pregnancies continue without complications, even with low hCG levels.

Although doctors aren’t usually concerned by high levels for these reasons, in
rare cases high hCG levels may indicate a serious complication known
as a molar pregnancy or chromosome abnormalities of an embryo. Molar
pregnancies are a rare abnormality where a non-viable egg implants

And what are the symptoms?

The only physical symptoms that are directly associated with hCG levels
are nausea and vomiting. Research suggests that women with severe
morning sickness (hyperemesis gravidarum) have higher levels of hCG than
other pregnant women but more research is needed for a definitive link.

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Interactions between the hormones
throughout the cycle
Your monthly menstrual cycle is just one of the physiological rhythms essential
for life. The hormones that drive the menstrual cycle have a predictable
rhythm that not only controls your menstruation but interacts with other cellular
activities through a variety of feedback mechanisms. Our sex hormones
are even related to our immune system and how it functions, on top of their
roles in sex and fertility.

An idealized menstrual cycle can be broken down into two phases: follicular
and luteal. Your period and fertile window are stages that happen within
the follicular phase.

During the first half of the cycle, estrogen levels start low and rise during
the follicular phase before a sharp drop and slight rise again. When estrogen
levels peak, it also causes LH levels to rise, kicking off ovulation. Progesterone
levels stay low with a gradual steady rise in the follicular phase before
they reach their peak in the second half of the cycle. FSH peaks in the follicular
phase as it stimulates the growth and maturation of the follicles until
a dominant follicle emerges. Maturing follicles produce estrogen
which is why these peaks are closely related.

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The last half of the cycle sees estrogen levels rising again, this time
with a progesterone peak. These two levels fall during the premenstrual
phase, which is coincidentally when most women experience a worsening
of chronic disease and premenstrual mood and physical symptoms.
In the absence of a pregnancy, progesterone and estrogen start to decrease
and along with other key hormonal changes, the inner lining of the uterus
is shed, or in other words, your period begins.

Your menstrual cycle, and the delicate interaction between hormones,

is an important window into your health. Monitoring your cycle and tracking
your hormones can give you vital information that you may otherwise miss.
Whether you are trying to conceive or not, when a menstrual cycle becomes
irregular, or just different from your normal, it can be a sign something is amiss.
By understanding the signs of your body and tracking your cycle, you can not
only plan your lifestyle and fertility but detect patterns and recurring changes
so you can stay on top of your health.

With Mira Fertility Plus, you are able to track Luteinizing Hormone (LH),
Estrogen (E3G) and Progesterone (PdG). In future years, Mira plans to expand
the system’s AI-powered analysis and testing capabilities. We expect to launch
FSH and hCG wands in 2022.

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Combine E3G + LH + PdG hormone readings to get
a complete, personalized fertility picture.

Let Mira take the guesswork out of getting pregnant,

so you know exactly when to conceive.

Order now

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