June 2022 Newsletter

“How old is too old to have a baby?”

This a really common question I frequently get asked in clinic and by friends and colleagues alike. There has been a lot written on the topic of ageing and fertility, and there is no doubt that age is one of the single most important factors to consider when looking at chances of natural success and with fertility treatments. Ageing eggs and sperm can both have an impact on fertility but at different stages.

“Most women believe their chances to conceive naturally declines at the age of 35, but this is not accurate”.

Most women believe their chances to conceive naturally declines at the age of 35, but this is not accurate. At birth a female fetus has around 5 million eggs stored in the ovaries and by the time menstruation starts around 10% of these remain. Numbers continue to fall as an egg is recruited from a pool of follicles each menstrual cycle, so that by the age of 37 there are about 25,000 eggs remaining. It is around this age that a notable decline in female fertility begins. The number of eggs and the quality of eggs are both of importance.

Fertility should never be assumed at any age, so how do you know whether your egg number is above or below average. There have been several different markers used to assess this of varying success. There are different ways a doctor may check your ovarian reserve.

  • Follicle Stimulating Hormone(FSH) is measured in the blood between days 2-3 of the menstrual cycle starting can help diagnose low ovarian reserve. This hormone if raised in the blood at this time in the cycle, suggests a low ovarian reserve.
  • Anti-Mullerian Hormone (AMH)is produced from the granulosa cells surrounding the early follicles in the ovary and is probably the most accurate measure of a woman’s egg reserve. AMH is tested in the blood and used as a guide to predicting a woman’s ovarian reserve. As a woman ages this level in the blood will decline as the egg reserve falls. The rate at which AMH falls varies significantly and it gives no information about the quality of the eggs.
  • Antral Follicle Count (AFC)is assessed by your doctor using ultrasound between days 2-5 of the menstrual cycle. The AFC is basically a guide to the number of small follicles in the ovaries that month that have the potential to develop.
“An early sign of possible low ovarian reserve can be a change to a much shorter and more irregular menstrual cycles after years of them being regular”.

A low ovarian reserve may not be immediately obvious, and it can be diagnosed quite late if a woman has no symptoms or warning signs. This may have an impact on fertility and the chances of having a baby naturally if a low ovarian reserve is discovered too late. An early sign of possible low ovarian reserve can be a change to a much shorter and more irregular menstrual cycles after years of them being regular. If a woman has a family history of women reaching the menopause early, then they may wish to have an assessment of their own egg supply.

Egg quality can be as important as egg number as both can affect a woman’s chances to conceive. As a woman’s age increases egg quality will tend to decline but there is no specific blood test similar to an AMH level that can be used to test this. Certainly, some gynaecology conditions like endometriosis and polycystic ovaries have been linked with lower egg quality. However, thousands of women with these conditions conceive naturally every year and require no assistance. Quite often the old age problem of simply getting older may not be the whole picture.

All of the blood tests and ultrasound scans discussed here should be performed by a fertility specialist. Don’t let old age become a problem.

By: Dr. Ed Coats

The Hormone Health Associates are here to advise and support you through your fertility journey.

Get in touch. We can help.

+44 (0)808 196 1901

Top 10 fertility Apps

Using apps on our phones for our food shopping, clothes purchasing, and banking has become part of everyday life. But how reliable are apps for your health? Here our fertility experts review the top 10 fertility apps from the App Store. Combining personal health information with data driven models can assist in the timing prediction and suggested regime in order to fall pregnant.

#1 – Flo Period & Ovulation Tracker 

123k ratings 4.7 out of 5 rating

#2 – Clue Period, Ovulation Tracker

92k ratings 4.7 out of 5 rating

#3 – My Calendar – Period Tracker

28.7k ratings 4.8 out of 5 rating

#4 – Period Diary, Cycle Tracker

22k ratings 4.6 out of 5 rating

#5 – Natural Cycles – Contraception

8.8k ratings 4.8 out of 5 rating

#6 – Period Tracker – Eve

7.6k ratings 4.6 out of 5 rating

#7 – Glow Period Fertility Tracker 

6.8k ratings 4.6 out of 5 rating

#8 – Ovia Fertility & Cycle Tracker 

5.1k ratings 4.7 out of 5 rating

#9 – Cycles: Period & Cycle Tracker

4.4k ratings 4.5 out of 5 rating

#10 – Femometer Period Tracker

4.3k ratings 4.9 out of 5 rating


The Hormone Health Associates are here to advise and support you through your fertility journey.

Get in touch. We can help.

+44 (0)808 196 1901

Case Study – Hormone replacement therapy (HRT)

Michelle at the age of 45, had a bilateral salpingo oophorectomy operation (removal of both ovaries and fallopian tubes) at a time in her life that she least expected. Prior to this operation she had experienced some typical perimenopausal symptoms such as lack of energy, occasional night sweats, hot flushes etc.

Post operation resulted in her going into early menopause. Given her age, it was highly recommended that she took hormone replacement therapy (HRT).

Understanding the pros and cons of HRT

Michelle initially was wary of taking medication and was concerned about the myths around HRT. She was fortunate to receive advice from Nick Panay at Hormone Health to understand the pros and cons of HRT and the long-term benefits of taking it. Mr Panay also advised best course of treatment with recommended reviews including blood tests going forward.

Within days of taking the treatment, Michelle felt amazing. She had more energy and did not have any hot flushes or sweats. Her skin felt better, and she had clearer focus. Even her children think she looks younger!

HRT – a healthy change

Nine months on she still feels full of energy and the best health wise in a long time. In fact, as a regular gym goer she is at her strongest she has ever been in her life. She passionately believes the HRT has made a healthy change to her life.

Michelle is thankful to Nick Panay for the continued advice she receives on HRT and would urge any woman seeking advice on HRT to contact Nick at Hormone Health.

Hormones are for life!

‘I feel so full of energy, focussed and at my best and I strongly believe this is due to the HRT and advice given by Nick Panay at Hormone Health.’

The UK Government are getting serious

The UK Government are getting serious about women’s health. What this means for women with PMS and PMDD.

Ministers said that women were too often let down by a healthcare system “designed by men for men” as they called for female issues to be given a higher priority.

Last June the UK government released an open invitation for women as well as health organisations and charities to come forward and share experiences on women’s health. The feedback would then be reviewed by health officials, who would then use this material to build the inaugural women’s health strategy, which is due to be published later in the year.

Maria Caulfield, the women’s health minister, said: “For generations, women have lived in a healthcare system primarily designed by men, for men. We are committed to tackling the gender health gap, and the publication of our strategy later this year will mark a significant step forward.”

The call for evidence focused on six key areas:

  1. Placing women’s voices at the centre of their health and care
  2. Improving the quality and accessibility of information and education on women’s health
  3. Ensuring the health and care system understands and is responsive to women’s health and care needs across the life course
  4. Maximising women’s health in the workplace
  5. Ensuring research, evidence and data support improvements in women’s health
  6. Understanding and responding to the impacts of COVID-19 on women’s health

Health organisations have advised the UK government ahead of the first publication of the report that Premenstrual syndrome (PMS) must be taken more seriously because it caused women anxiety and depression. 

Very often these symptoms are woefully underplayed and often laughed at but it has been called for more to be done to understand the impact of PMS on quality of life, as well as work to train health professionals to support women going through the menopause.

The new research, summarising responses from 436 organisations with an interest in women’s health, said that too often female health concerns were “dismissed” or “not taken seriously”.

Dr Nick Panay, from the Royal College of Obstetricians and Gynaecologists (RCOG), said that he was pleased to see the Government highlight PMS as a priority area.

He said: “Both premenstrual syndrome and premenstrual dysphoric disorder [PMDD] can severely impact on women’s daily lives and their mental health.

“There are over 150 symptoms linked to PMS, which cover psychological and behavioural symptoms such as anxiety and depression, as well as physical symptoms, including headaches and breast tenderness.

“There are no blood tests that can con rm PMS or PMDD, and currently diagnosis depends on the timing of symptoms in the menstrual cycle.”

Dr Panay, who is also the chairman of the National Association for Premenstrual Syndromes, said that he hoped the strategy would mean more research into menstrual health and better information and education, both for women and healthcare professionals.

He said: “It is estimated as many as 30 per cent of women experience moderate to severe PMS, while five to eight per cent of the female population in the UK have PMDD. These conditions should not be overlooked, and women suffering with PMS and PMDD deserve more support.”

Currently Anxiety and depression are not included in the core curriculum for psychiatrists as symptoms of PMS despite being a common occurrence, a new government report noted.

It called for more to be done to understand the impact of PMS on quality of life, as well as work to train health professionals to support women going through the menopause.

It said that too often, women were advised that problematic periods did not warrant further investigation, or could simply be managed by improvements in diet and exercise.

The report also called for better public campaigns and greater awareness among employers to help women going through the menopause in the workplace.

“The menopause is still a taboo topic in many workplace settings, and there are variations in menopause support policies and awareness of the different symptoms women can experience beyond hot flushes (such as “brain fog”),” it said.

“This can contribute to productivity and retention issues – issues which are set to increase, with more women aged 50 and above participating in employment.”

The data show that since the pandemic, waiting lists for gynaecology faced the biggest increase of all medical specialities. The news followed warnings that more than half a million women face long waits for gynaecological care.

Ms Caulfield said: “I want to thank the expert individuals and organisations who took the time to respond to our call for evidence. The insights you have provided have been stark and sobering but will be pivotal to ensuring our strategy represents the first-hand experiences of the health care system.

Get in touch. We can help.

+44 (0)808 196 1901

Menopause: the Latest Advice and Treatment Options – Event 24th May 2022

Nick Panay, Director of Hormone Health and Dr Justine Setchell will be sharing the latest advice and treatment options for peri menopause and menopause on 24th May at 1-2.15pm.

The advice about how to treat the peri menopause and menopause is ever changing and it is important to seek advice from the experts and to keep up to date. This talk will cover the following topics

  • Changes during the Menopause
  • Symptoms – what bothers women the most
  • How to recognise the symptoms of the menopause
  • The latest treatments that are available including complementary therapies
  • How to start a conversation with a family or team member about the menopause
  • Menopause and the workplace
  • What can be done to improve the working conditions of a menopausal woman

To book your ticket, please visit the Really Helpful Club events page –

Menopause: the Latest Advice and Treatment Options

A recording of the talk will be available to all those who book in so please do not worry if you cannot attend live

Fibre is Your Best Friend

This is the third in a series of articles written by our Hormone Health Associate, Nigel Denby on the challenges of IBS.

Fibre is one of our favourite topics and we want to make sure that you are getting enough in your diet. Why? Your gut health is important and affects your physical well-being. Your gut is home to good bacteria which we want to maintain and these bacteria feed on the fibre in your diet to produce beneficial substances including short-chain fatty acids.

What is fibre?

Fibre is a carbohydrate, but it is non-digestible, meaning, unlike with nutrients, it is not broken down in the small intestine but travels onto the large intestine which is where it performs its important job.


The benefit of fibre

The most commonly understood benefit of fibre is that it helps to prevent constipation, although too much fibre can also cause this. Fibre bulks out your stools which eases your stool movements through your bowel. This is partly because one type of fibre called soluble fibre forms a gel-like substance when mixed with water, which softens your stools.

Whole grains are a great source of fibre and oats also contain beta-glucans which have been linked to reducing cholesterol levels, which in turn helps reduce the risk of heart disease, stroke, and type 2 diabetes. Specifically, research has shown that for each 8g increase in your daily fibre intake, you reduce your likelihood of heart disease by 19% and type 2 diabetes by 15%.

The fibre in our diet means we feel fuller for longer as it takes longer to digest than “simple” carbohydrates and so can aid weight management. For the same reason, fibre also helps prevent sharp increases in your blood sugar levels.

Finally, research has shown a reduced risk of bowel cancer linked to a high fibre diet.

How much fibre do we need?

In the UK the daily recommendation for an adult is 30g of fibre per day. On average adults are eating 18g per day which is much less than this recommendation and so there is lots of room for improvement.

Where can I find fibre?

High fibre foods include fruits, vegetables and whole grains. You can increase your fibre intake by making a few easy substitutions, swapping white rice for brown rice, and switching to whole grain bread. Increasing your consumption of fruits and vegetables, nuts and seeds will also make a difference.

As you increase your fibre intake, also take care to increase your water consumption as fibre soaks up a lot of water.

A small word of warning that making drastic changes to your fibre intake could make you feel gassy and so it would be sensible to make small changes over a period of time. Allow yourself to develop new long-term habits to ensure a high fibre diet becomes your norm.

Article was written by Nigel Denby, BSc Hons, RD Registered Dietitian

Founder of www.harleystathome.com

HRT shortages – Nick Panay shares his thoughts

Women’s health and quality of life is of paramount importance for the individual, their families and for society as a whole.

It is therefore very concerning that many women have experienced difficulties in accessing their HRT supplies in the UK.

Interruption of treatment can lead to a recurrence of symptoms and bleeding problems thereby impacting on quality of life and wellbeing.

Unplanned discontinuation of HRT can also increase the risks of certain conditions such as heart disease and mental health issues.

It is therefore vital that pharmaceutical companies are as responsive as possible to any increases in demand for hormone therapy and are able to upscale their production of their HRT products accordingly. It is also important that the national distribution of HRT is efficient and equitable.

The recent increase in demand for HRT has occurred due a general improvement in awareness of the problems which can be associated with the menopause, and also due to the increase in awareness that the pros of using HRT usually outweigh the cons in the majority of women with distressing symptoms.

The excellent work of Carolyn Harris MP in lobbying parliament to bring HRT costs down has also increased pressure on HRT supplies because doctors are now starting to issue longer NHS prescriptions to keep the costs down for patients; in the future it is likely that annual prescriptions will be made available.

It is timely that the Health Secretary Sajid Javid has announced that he will be “urgently convening a meeting with suppliers to look at ways we can work together to improve supply in the short and long term.”

In the meantime, implementation of the advice from the Royal Pharmaceutical Society to allow pharmacists to use their expertise to dispense equivalent HRT options where the original product is not available could considerably mitigate supply difficulties and avoid unnecessary suffering for women.

There is usually, although not always, a similar HRT preparation available which can be used temporarily where the usual regimen is not available.

The current shortages are sadly just one manifestation of the long-term neglect there has been for effective management of the menopause, due to inadequate funding of training and research, and insufficient provision of healthcare facilities and treatments.

It is high time that menopause was put at the forefront of the healthcare agenda!

Professor Nick Panay

Founder and Director of Hormone Health, UK

Professor of Practice: Imperial College London

Medical Advisory Council Member: British Menopause Society

President Elect: International Menopause Society


Get in touch. We can help.

+44 (0)808 196 1901

Foods to Improve Your Gut Health

This is the second in a series of four articles written by our Hormone Health Associate, Nigel Denby on the challenges of IBS.

Improving the health of your gut can benefit your physical health overall and also help to alleviate symptoms such as bloating, abdominal pain, and painful bowel conditions.

We all have trillions of gut bacteria, and it is believed that bacteria in our gut (our gut microbiome) is influential to our physical health and especially our digestive health.   The connection between our brains and our gut is crucial to ensure our digestive system works correctly.

The bacteria in our gut can be affected by several factors including our diet, any medication we are taking such as antibiotics, and the levels of stress we experience.

If you are keen to improve your gut health then a good place to start is to focus on introducing foods that are known to be beneficial. You may feel overwhelmed by claims of wonder foods that will provide miracle cures so we want to provide you with information on some readily available foods that you can easily incorporate into your diet.

Dark chocolate

Music to the ears of all chocolate lovers and those with a sweet tooth, dark chocolate is a good choice to improve gut health due to its high fibre content. It contains 10g of fibre per 100g, similar to a bowl of bran flake-style cereal.

Dark chocolate is very high in polyphenols which are compounds high in antioxidants that help combat certain forms of stress in the body. Polyphenols act like fibre in the body and feed gut bacteria such as Lactobacillus.

dark chocolate


Kefir is sold in most supermarkets making it a readily available and affordable option for improving gut health. Kefir is produced by adding special grains to milk. These grains then ferment to produce bacteria such as Lactobacillus. It is believed that this type of bacteria will arrive in your gut alive and may then stay forever and colonise or simply pass on through. They produce compounds such as metabolites that help to boost our immune system and improve our mental health.

Kefir may taste sour initially but soon becomes a favourite. It can be added to high fibre cereals and chia seeds for a quick and easy breakfast or snack. Some brands of Kefir are suitable for vegan and lactose intolerant diets and so it is a great option for many people.

Kiwi fruit

Kiwi fruit is a great choice of fruit simply because they taste great but they have other benefits too.

Snacking on Kiwi fruit helps to ease constipation as they contain a lot of soluble fibre. Scientists also believe they contain the enzyme Actinidin which helps to speed up gut movements. This was confirmed by a scientific study of people suffering from Irritable Bowel Syndrome (IBS) which found that eating two kiwis fruits a day resulted in fewer people suffering from constipation. Most people don’t need to eat two each day but it is sensible to include kiwi fruits on your weekly shopping list.

Kiwi fruit

Article written by Nigel Denby, BSc Hons, RD Registered Dietitian

Founder of www.harleystathome.com

April is the IBS Awareness Month

This is the first in a series of four articles written by our Hormone Health Associate, Nigel Denby on the challenges of IBS.

What is Irritable bowel syndrome (IBS)?

There is a greater awareness of what IBS is nowadays and many articles are written on the subject but there remains a lack of clarity about what causes IBS and what the symptoms are. This lack of clarity is somewhat understandable given that symptoms of IBS vary from one person to another, and diagnosis is more of a process of elimination of other possible causes of the symptoms.

IBS is a chronic functional gastrointestinal disorder, and it is estimated that between 10% and 20% of the population suffer from IBS so if you worry that you may be affected, read on to understand more about the symptoms and potential treatments.

What are the common symptoms?

Symptoms differ between individuals but tend to include bloating, abdominal pain and changes in bowel movements. Some patients may experience diarrhoea, others constipation and some people find their symptoms change from one to the other. You may also experience nausea, backache, urgency, incomplete evacuation and other bladder symptoms.

How is IBS diagnosed?

There is no specific test for IBS and your doctor will diagnose the condition by eliminating other possible health conditions, for example, coeliac disease. Your doctor will want to run tests that may include blood and stool samples.

Causes of IBS

There is no specific cause of IBS, and this is why diagnosis is not simple but there are links between symptoms and potential causes. We all have trillions of gut bacteria, and it is believed that bacteria in our gut (our gut microbiome) is influential to our physical health and especially our digestive health.  The connection between our brains and our gut is crucial to ensure our digestive system works correctly.

The bacteria in our gut can be affected by several factors including our diet, any medication we are taking such as antibiotics and the levels of stress we experience. If our gut bacteria are adversely affected, then our physical health may suffer.

There may ale be a possibility that genetics play a part, and you may be more likely to suffer from IBS if other members of your family have experienced the condition.

Treatment of IBS

There is no known cure or treatment for IBS, but the symptoms can generally be alleviated by careful management mainly through lifestyle changes.

In the UK, doctors will follow the NICE guidelines for the treatment of IBS which recommend regular meals, mindful, slow eating plenty of fluids and careful monitoring of fibre intake taking care to balance insoluble and soluble fibre.

Your doctor may also recommend taking probiotics as these can help restore the gut bacteria, particularly the variety of bacteria leading to improved gut health. Some probiotics are better than others though and you are recommended to try them for at least four weeks to allow your gut time to benefit.

You may also hear about the benefits of following a low FODMAP diet as a method to alleviate IBS symptoms. FODMAP is an abbreviation for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.  A low FODMAP diet is an investigation through a process of elimination to determine which changes to your diet improve your symptoms. You will need to eliminate FODMAPs for a short period and then you will reintroduce the FODMAPS one by one, monitoring the return of symptoms. This process will allow you to identify which FODMAPS your body can tolerate, and which need to be excluded. It is really important to understand that a low FODMAP diet is a short-term initiative as eliminating foods from your diet needs to be managed very carefully. You may need the support of a qualified, registered dietician or registered nutritionist to support you as this can be a complex area.


If you think you may be suffering from IBS, you should make an appointment to discuss your symptoms with your GP or a registered dietician/ nutritionist who will be able to help you diagnose your symptoms and support you with a treatment plan.

Many people are deterred from seeking help as they fear diagnosis is not simple and treatment is complex, but IBS research is ever evolving, and more is known about the condition than ever before.

Article written by Nigel Denby, BSc Hons, RD Registered Dietitian

Founder of www.harleystathome.com