FSH levels and menopause: what your result means

A high FSH value often fits menopause, but one measurement proves little. FSH drives your ovaries. When they make less estrogen, FSH rises. In perimenopause, though, that value swings so much it can differ from month to month. In the Netherlands the last period falls around age 51 on average.

My experience with this question: people hope for one number that brings clarity. FSH usually isn't that number, certainly not in the years when symptoms begin.

Below you'll read what FSH is, which value fits which stage, and why you need other hormones alongside it.

What is FSH and what does it do?

FSH stands for follicle-stimulating hormone. It's made in your pituitary, a small gland in your brain, and prompts your ovaries to mature eggs. So FSH has a key role in your menstrual cycle.

As your ovaries respond less approaching menopause, your brain raises FSH production to spur them on. So FSH tends to rise as menopause nears. That rise is a consequence, not a standalone diagnosis.

FSH works together with LH, luteinising hormone. Together they drive your cycle, from the maturing of an egg to ovulation. When the ovaries respond less, both hormones often rise.

Which FSH value fits menopause?

There's no fixed cut-off that proves menopause. Different stages do go with different patterns. The table below gives an indicative picture. Reference ranges differ per laboratory, so always read your result next to your own lab's values.

You can see the catch straight away: in perimenopause, exactly when you want an answer, FSH is least stable. More on those stages in our piece on recognising perimenopause.

Why doesn't one FSH measurement say everything?

In perimenopause, FSH jumps from cycle to cycle. One month the value can be raised, the next almost normal. A single measurement captures only a snapshot of a moving picture.

The international STRAW+10 framework describes menopause as a series of stages, where the pattern over time matters more than one number. That explains why, in a typical transition, doctors prefer to look at your symptoms and cycle rather than a single FSH.

Which other hormones belong with it?

FSH rarely stands alone. It's often viewed with other hormones to form a fuller picture. Each hormone adds a piece.

• Estradiol: the main estrogen; falls gradually towards menopause.
• LH: often moves with FSH around menopause.
• AMH: reflects your ovarian reserve and falls as menopause approaches.

To measure these together, a menopause panel may fit. For your full hormone picture, see our guide to menopause and your hormones.

When should you test your FSH?

Testing adds most when you're younger than 45 and still have menopause symptoms, or when your symptoms are unclear. In a typical transition around 50, the result is usually not decisive.

If you're unsure what your value means, discuss it with your GP. They can set your result against your symptoms and your cycle, which often says more than the number alone.

What does a high or low FSH value mean?

A high FSH value often fits ovaries that are less active, so it appears more often around menopause. Still, a single high value in perimenopause can fall again in the next cycle. So one high result doesn't prove menopause.

A low or normal FSH value doesn't rule out menopause either. In early perimenopause especially, FSH can still be normal while you already have symptoms. That's why doctors set your value against your age, your cycle and your symptoms.

If you still menstruate, the day in your cycle sometimes counts. Ask at the collection point whether a particular day is preferred, so your result is easier to compare.

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.

Sources

• Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop +10. J Clin Endocrinol Metab. 2012. PMID 22344196.
• Thuisarts.nl. I am going through menopause. Dutch College of General Practitioners (NHG).