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Is my LH normal? Breaking down the variability in levels and patterns of urinary luteinizing hormone

Is my LH normal? Breaking down the variability in levels and patterns of urinary luteinizing hormone

9 min read

If you’re someone looking to track when you ovulate, chances are you’ve heard of luteinizing hormone (LH). Of all the cycle-tracking methods out there, LH testing ranks high on our list of favorites because of its clear role in inducing and predicting ovulation — a mid-cycle surge in LH is absolutely necessary for ovulation to occur.

But just because mid-cycle surges in LH are necessary for ovulation doesn’t mean LH levels look the same across all people and all cycles. In fact, LH levels and LH patterns across the cycle are far from being one-size-fits-all.

In this post, we’ll highlight findings from a few of our favorite studies that lead us to question what “normal” really means in the context of LH across the cycle. More specifically, we’ll take a look at what science has to say about these two important questions:

  1. What is a “normal” LH level on different days of the cycle?
  2. What’s considered a “normal” pattern of LH around ovulation?

The main takeaway: There is a wide range of what's considered “normal” for urinary LH

  • One large study showed that the median LH on the day before ovulation was about 44.6 mIU/mL, but that LH could be as high as 101, or as low as 6.5. Yep — some women had an LH of 6.5 the day before ovulation!
  • Values considerably below the average lower limits and above the average upper limits might be indicative of an underlying condition that may impact ovulation. If you track your LH and discover this, it's worth bringing up to your doctor.
  • Another study shows that the average LH surge was characterized by a 7.7-fold increase in LH from baseline — but LH surges ranged from 2.5-fold to 14.8-fold increases from baseline.
  • According to a few studies (here, here, and here), there are many different LH surge patterns: 42-48% of cycles have a short LH surge before ovulation; 33-44% of cycles have two LH surges (an initial big rise, small drop, then a second rise in LH); and 11-15% of cycles have a "plateau" pattern (when LH levels remain high after an initial surge).

What is a "normal" LH level on different days of the cycle?

Many ovulation predictor kits (OPKs) are threshold-based, meaning they use a predetermined urine LH threshold to predict whether you’ll ovulate soon. (Note: The Modern Fertility Ovulation Test is not threshold-based — our test is semi-quantitative, which means you’ll be able to see your LH change daily and track low, high, or peak levels.)

The fact that many manufacturers use a single threshold for all uterus owners might lead you to think that there are thresholds that predict ovulation for everyone, and/or that there is a well-defined, narrow window of what “normal” LH looks like before ovulation and across different cycle days.

Just like there is a range of what’s considered “normal” for the Modern Fertility Hormone Test (we call this the reference range), we can use data from a large enough pool of people to figure out what typical levels of urinary LH are across different days of the cycle.

According to one of the largest studies that analyzed LH daily and used ultrasound to confirm the timing of ovulation, there is quite the range in what LH values we can expect across different cycle days, and this range is the largest on the day before ovulation.

In the graphic below, we show median LH (the black dots), and the distribution of reported LH values, minus the upper 10% and lower 10%. This is also called an 80% reference range — all the values that constitute the middle 80% of the distribution of LH. (Put in other words: What an 80% reference range tells us is that 10% of values fall below the bottom of the range’s lower limit, and 10% of values fall above the range’s upper limit.) While some studies or labs choose to report 80%, 90%, or 95% reference ranges, the study these data come from chose to use an 80% reference range.

Let’s first take a close look at the day before ovulation. In this sample, though the median LH on the day before ovulation was about 44.6 mIU/mL, it wasn’t abnormal for LH to be as high as 101, or as low as 6.5. Another way of putting it? Women with LH values that were 1/7th of the median to values that were more than double the median were all considered within the bounds of “normal.”

While not as pronounced, there was significant variation in LH on other cycle days, too. At 10 days before ovulation, for example, 80% of women had values anywhere between 2.8 and 11.9 mIU/mL. The general takeaway from this data is that there’s a big range of LH values that can be considered typical across all cycle days. This is important to keep in mind if you find yourself asking: “Is my LH today normal?”

That being said, values considerably below these lower limits and above these upper limits might be indicative of an underlying condition that may impact ovulation, and should be presented to and discussed with a physician. But, having LH values within these limits doesn’t 100% exclude the possibility of an underlying condition — if you consistently have “normal” LH values, but have other reasons to suspect you’re not ovulating regularly, you should discuss this with a physician as well.

What is a "normal" pattern of LH around ovulation?

Visuals and text from medical textbooks indicate that there is a single, large pre-ovulatory LH surge that lasts about one day. This pattern makes two assumptions about LH around ovulation: that the increase is always super dramatic, and that there is a single, transient peak. Let’s break those down one by one to see what science says is “normal” for each.

Variability in the percent that LH increases around ovulation

When talking about LH during ovulation, some sources are often vague about exactly how much of an increase in LH is characteristic of an LH surge and peak. If LH doubles, is that considered a surge? What if it quadruples? What if it increases 20-fold? For those using semi-quantitative LH tests (i.e., tests that actually tell you what your LH is, rather than just telling you whether you’re above or below a predetermined threshold value) to track ovulation, this is an important question.

At what point does an increase signal that ovulation is likely around the corner, versus just being “normal,” daily variability in LH production? Because threshold-based tests (i.e., tests that compare your LH to a predetermined baseline to make inferences about ovulation) do not rely on patterns over time, this question is not so relevant to their users.

We’ll again turn to one of our favorite studies that examines the variability in how much LH increases around ovulation, when ovulation is confirmed by ultrasound. According to this study of 43 premenopausal women, on average, the LH surge was characterized by a 7.7-fold increase in LH from baseline. (Earlier studies had pinned this number at being slightly lower — closer to a 4-fold or 6-fold increase — but we’ll put more trust in data that is more recent and based on a larger sample size.)

But here’s the important thing: In confirmed ovulatory cycles in this study, LH increases ranged from 2.5-fold to 14.8-fold. Other studies have since replicated this effect, meaning we can be confident that there truly is a wide range in the amount that LH has to increase to induce ovulation across women.

Now, let’s take a made-up example to really drive home what this variability in percent increases in LH can look like. Let’s say there are two people who have baseline LH values of around 6 mIU/mL from the beginning of their cycles to the few days before ovulation. For one, their peak LH value would be around 15, and for the other, their peak LH value would be around 89 — and they’d both ovulate.

Variability in what LH peaks look like around ovulation

Because the general narrative says the menstrual cycle is characterized by one quick LH surge before ovulation, you might be surprised to learn that according to some studies, less than half of women have LH patterns that look like that (though it is the most commonly observed out of all the noted patterns).

Of studies that have characterized what patterns of LH might look like for different people, there are three recent ones (here, here, and here) that stand out as being particularly strong, and all three have converged on around the same estimates for what percent of women display which patterns:

  • Between 42% and 48% of cycles follow the “short surge” pattern. This is the one we’re most familiar with, because this is the pattern talked about in medical textbooks and in most descriptions of the menstrual cycle.
  • Between 33% and 44% of cycles follow the “two surges” pattern, which — yup, you guessed it — is characterized by an initial big rise, a small drop, and then a second rise in LH.
  • Between 11% and 15% of cycles are characterized by the “plateau” pattern, which is when LH levels remain high after an initial surge (rather than quickly falling back down).

There are other patterns as well, including multiple surges (think the two surges pattern, and then some), though they are less frequent.

While some studies suggest that the pattern of LH around ovulation should look the same within an individual from cycle to cycle, others report the opposite (i.e., that LH surge characteristics differ across cycles). Our take? If you have a short surge one cycle and a plateau next, it isn’t something to lose sleep over.

Two LH surges do not mean you ovulate twice (and sustained LH levels don’t mean you ovulate for longer)

Now, we know we said earlier that an LH surge indicates that ovulation is likely coming up soon, so it may be tempting to think that two LH peaks means you ovulate twice, or that a sustained high level of LH means you’re ovulating for longer. Both of these are not true.

For the purposes of ovulation tracking, the main thing to keep an eye out for is that initial LH surge, because it’s that initial surge that’s predictive of ovulation.

  • If you fall in the “short surge” camp, you can be fairly confident that if you detect high LH (whatever “high” means for you), ovulation is around the corner.
  • But for those who fall in the “two surge” or “plateau” camp, a high LH doesn’t always indicate your first LH surge — it could be indicative of a second LH surge, or of sustained high LH after a first surge.

Starting to test about 19 days before the start of your next period is important because it will give you the best chance of detecting your initial surge. To figure out when that is, you’ll need to determine your average cycle length and subtract 19 days from that number — the number you end up with is the cycle day you should start testing. For example: If you have a 28-day cycle, you’d begin taking ovulation tests starting on cycle day 9.

Bottom line: "Normal" has more than just one look

Tracking your LH is one of the most powerful at-home tools science has given us to predict ovulation and our fertile window, but it’s easy for the worries of “is my LH normal?” to put a major damper on the LH-tracking experience. By understanding that there’s a range of LH values considered “normal” on each cycle day and that the patterns of LH around ovulation can take different forms, you’ll be better armed to embrace your unique pattern of LH, and also have a better understanding of when something might be off.

The Modern Fertility Ovulation Test helps you pinpoint your luteinizing hormone (LH) levels to predict your 2 most fertile days. With our test, you’ll get more insight than just a positive or negative result — you’ll be able to see your LH change daily and track low, high, or peak levels. You can use it to see what your LH values are each day, how much they surge mid-cycle, and what your overall LH pattern looks like around ovulation. When LH meets antibodies on the test strip, the test line darkens — the darker the line, the more LH there is in your urine.

Unlike other ovulation tests, you'll be able to match the shade of your test line to the corresponding LH level (kind of like those pH strips you played with in middle school). Or if you’re using our free app, you can automatically scan and log your tests with your camera, so you always know where you are in your cycle.

This article was reviewed by Dr. Jennifer Conti, MD, MS, MSc. Dr. Conti is an OB-GYN and serves as an adjunct clinical assistant professor at Stanford University School of Medicine.

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Talia Shirazi

Talia is a biological anthropology PhD candidate at Penn State, passionate about women's reproductive health and behavioral neuroendocrinology.

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