Understanding the Link Between FSH & Menopause

On average, the transition to menopause occurs at age 52¹, marking the end of a woman’s reproductive years. By definition, menopause is officially achieved after 12 consecutive months without a period (amenorrhea), and is often accompanied by a specific set of symptoms, often including changes in mood, vasomotor symptoms, such as hot flashes and night sweats, and sleep disturbances. Shifts in specific hormones, such as estrogen and progesterone, as well as Follicle-Stimulating Hormone, typically play a central role in this transitional time.²

What Is FSH?

Follicle-Stimulating Hormone (often referred to as FSH) is a hormone produced by the pituitary gland that plays an important role in sexual development in the body, specifically reproduction.³ During a person’s reproductive years, FSH helps to stimulate the development of ovarian follicles – small, fluid sacs which contain eggs. While FSH works to regulate menstruation, it specifically focuses on preparing eggs for ovulation.⁴

Along with FSH, sex hormones like estrogen and progesterone also work together to control menstruation and ovulation in the body as well. Estrogen has a variety of responsibilities, one of which is for normal sexual development and reproductive function in the body, while progesterone prepares the endometrial lining in the uterus for the implantation of a fertilized egg.⁵

When the ovaries reduce and eventually stop releasing eggs as menopause approaches, FSH hormone levels tend to rise as the body attempts to stimulate the ovaries. However, the ovaries eventually become less responsive, leading to hormonal changes that contribute to the onset of menopause.⁶

FSH Changes During Menopause

Often, as women enter their mid-40s (and for some it may occur as early as their late 30s), irregular periods and a set of other symptoms can signal the beginning of perimenopause, the transitional years leading up to menopause.⁷ During perimenopause, FSH levels rise while estrogen levels become more volatile and begin to drop.⁸ This hormone shift is often to blame for common symptoms such as hot flashes, mood swings, and vaginal dryness experienced during this time.

Though some women may note very clear signs of perimenopause, others may not have many, or even notice distinct symptoms. In fact, it’s not uncommon for menopause symptoms to be confused with other health conditions.

Laboratory Testing for Menopause

As mentioned earlier, during menopause, FSH levels increase as the body works hard to stimulate the ovaries. If you have a feeling that you may be in the early stages of menopause, your healthcare provider can measure your FSH, estrogen, and luteinizing hormone levels (or LH – which stimulates ovulation) via blood tests, which can help support if you are transitioning through menopause.⁹

As estrogen levels drop, FSH levels above 30 IU/L typically indicate diminished ovarian function and signal that menopause has been reached.¹⁰ While hormone levels typically fluctuate throughout a woman’s lifespan, tracking FSH over time can potentially provide a clearer picture of whether or not you’re approaching menopause. Menstrual history and physical symptoms are often the primary factors used in diagnosing menopause,¹¹ while the abovementioned bloodwork results can also be a helpful support tool.

Typical FSH Levels Across Life Stages

FSH levels vary throughout different life stages – it’s important to note that FSH levels don’t preclude perimenopause. Below are typical FSH levels in women based on these stages: ¹²

• Before Puberty: 0-4 IU/L
• During Puberty:3-10 IU/L
• Reproductive Years:7-21.5 IU/L
• After Menopause:8-134.8 IU/L

While FSH levels provide some insight into if menopause is occurring, they are only one part of the larger hormonal landscape that healthcare providers often consider prior to making any conclusions. FSH levels alone can’t determine the exact timing of menopause but, when combined with other factors, they can offer valuable information.¹³

High FSH Levels After Menopause

After completing the menopause transition and entering postmenopause, a woman’s reproductive phase is considered complete. As mentioned earlier, a notable increase in the body’s FSH is a natural response to decreasing estrogen production. It’s important to note that with this decrease in estrogen, a variety of symptoms may occur.

Common symptoms like hot flashes, night sweats, vaginal dryness, and changes in mood often result from the decrease in estrogen in the body during and after the menopause transition. Fortunately, while these symptoms are not uncommon, they can be addressed with a variety of management options such as prescription medications, certain lifestyle changes, or over the counter products, such as dietary supplements.

Shifts in FSH Levels Associated with Other Conditions

It’s important to note that FSH levels can fluctuate due to other factors besides menopause. Conditions such as Polycystic Ovary Syndrome (PCOS), Primary Ovarian Insufficiency (POI), and thyroid disorders can also impact these hormone levels, in addition to use of oral contraception.¹⁴ And remember, FSH levels alone don’t always provide a complete picture, so it’s important to talk with your healthcare provider about any symptoms you may be experiencing or concerns you may have to determine what you may be experiencing, and why.  

Additionally, pregnancy, ovarian cysts, and certain medications can influence FSH levels as well.¹⁵ If you are experiencing notable changes in your menstrual cycle, along with hot flashes, or other symptoms and you’re not near the age of menopause, a thorough evaluation is recommended to rule out other potential causes.

A Final Word on Follicle Stimulating Hormones

While FSH is a key hormone in understanding menopause, it’s just one piece of the puzzle. High FSH levels, especially when combined with 12 months of no period, usually signal the end of your reproductive years, but it’s imperative you check in with your healthcare provider in case you’re unsure.

Remember, menopause is a natural stage of life and doesn’t require treatment unless its symptoms are bothersome or negatively impacting your quality of life. Be sure to speak to your healthcare provider about any symptoms you’re finding to be disruptive to ensure that you have access to the right care for your needs. Hormonal changes are a natural part of aging, and understanding FSH levels can help you navigate this transition with confidence.

Resources

1. https://www.womenshealth.gov/menopause/menopause-basics
2. https://my.clevelandclinic.org/health/articles/24638-follicle-stimulating-hormone-fsh
3. https://www.ncbi.nlm.nih.gov/books/NBK535442/
4. https://my.clevelandclinic.org/health/articles/24638-follicle-stimulating-hormone-fsh
5. https://www.ncbi.nlm.nih.gov/books/NBK441996/
6. https://medlineplus.gov/lab-tests/follicle-stimulating-hormone-fsh-levels-test
7. https://www.cuimc.columbia.edu/news/everything-you-need-know-about-perimenopause
8. https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause
9. https://www.medicalnewstoday.com/articles/317746
10. https://www.medicalnewstoday.com/articles/317746
11. https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatm30ent/drc-20353401
12. https://www.mountsinai.org/health-library/tests/follicle-stimulating-hormone-fsh-blood-test
13. https://www.med.upenn.edu/womenswellness/menopause.html
14. https://www.ncbi.nlm.nih.gov/books/NBK441996/
15. https://www.medicalnewstoday.com/articles/317746