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Why Are Fsh Levels High In Menopause

Effects On Cardiovascular Risk

Follicle Stimulating Hormone and Perimenopause | 3 Tips to Understanding Your FSH Levels.

Although several studies have reported an association between serum FSH levels and markers of cardiovascular risk, it remains a controversial subject with lack of consistent findings. The Assessment of the Transition of Hormonal Evaluation and Noninvasive Imaging of Atherosclerosis study used contrast-enhanced CT angiography and carotid ultrasound to find that subclinical atherosclerosis is prevalent in perimenopausal women, with the prevalence of any coronary plaque being as high as 35.5% . Of note was that the number of aortic plaques was associated directly with serum FSH levels, but was unrelated to serum estrogen .

Similarly, a study from Brazil noted a significant positive correlation between serum FSH and carotid intima-media thickness, a surrogate for atherosclerosis . Furthermore, data from a SWAN cohort showed lower serum FSH levels to be associated with a lower carotid intima-media thickness compared to the mid and high FSH groups, although the latter had a superior cardiovascular disease risk profile . To the contrary, the SPECT-China study, a large, multi-center study on 2658 postmenopausal women, showed a negative association between serum FSH levels and atherosclerotic cardiovascular risk .

What Is The Menopause

Simply, the menopause is when the ovaries no longer respond to the hormonal messages sent from the pituitary gland in the brain. Eventually, this leads to the end of ovulation and the menstrual cycle.

During the build-up to the menopause, known as perimenopause, womens hormones go through a transformation process. Their levels fluctuate and can alter their physical, mental and emotional wellbeing.

Im feeling hormonal can sometimes be bandied about to describe how women feel at a given moment in time, but that feeling can soon become a reality for many women entering the menopausal transition.

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Difference Between Fsh And Lh Levels

The roles of FSH and LH are different, but they work together to regulate fertility. These two hormones are so vital that a normal menstrual cycle can be divided into distinct phases, using an FSH and LH surge as reference.

Similarly to FSH, LH is a glycoprotein hormone secreted by the anterior pituitary. If youre undergoing fertility testing, your doctor might order both FSH and LH blood tests. These tests can be used to:

  • Determine what is causing your fertility problems
  • Discover abnormalities in your ovarian function
  • Establish the cause for irregular or absent menstrual cycles
  • Confirm whether youre entering perimenopause or menopause

Doctors might also use the LH-to-FSH ratio to diagnose polycystic ovary syndrome , a relatively common hormonal disorder. The diagnostic criteria for PCOS is a 3:1 LH-to-FSH ratio .

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Why Does Fsh Increase In Menopause

FSH causes ovarian follicles to enlarge and produce estrogen. Over time, fewer and fewer follicles remain to be stimulated and thus estrogen levels decline as a woman ages. This decline in estrogen leads to an increase in FSH as there is not enough estrogen being produced to turn off the brains production of FSH.

If It’s Not Menopause What Is It Project FSH

Depression, anaemia and hypothyroidism are the most common conditions that may mimic menopausal symptoms or indeed occur concurrently. Unstable diabetes may cause hot flushes. Medication, such as the SSRI family of anti-depressants, may also cause hot flushes.

Doing a blood count, iron studies, ferritin and/or a TSH level will usually establish the diagnosis. However, if a woman presents with low mood or anxiety, there is a need to evaluate whether this is a primary anxiety/depression or one aggravated by the lack of oestrogen. A previous history of depression or an elevated FSH may help to differentiate between the two. Hair loss may be a sign of iron deficiency or hypothyroidism rather than menopause.

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Does A High Fsh Level Signal The Onset Of Menopause

It was an FSH level of 42, at age 42, that according to fertility specialists placed me among the irreversibly infertile. Which is why Ive engaged with the subject of FSH levels such as: The link between high FSH levels and menopause, so called Premature Ovarian Failure, the likelihood of pregnancy in spite of rising FSH, and every related questionmore than any other fertility linked diagnosis.

Having heard thousands of women in my workshops and private practice report mixed messages about high FSH from their fertility specialists and surprisingly also from their fertility acupuncture sessions, the subject begs for a deeper discussion. Here is what I have learned as a result of direct observation in the laboratory of my own body, and from reports and observations of countless women who, with the help of the Fertile Heart Ovum tools have turned their high FSH crisis into a journey of self discovery. For many of them it became an opportunity to strengthen their bodies and hearts and quite possibly give birth to healthier children than they would have without the sobering diagnosis.

The only time your goal is to lower FSH is if you want to fool your endocrinologist and sneak into an IVF program in spite of your rising levels. Or your doctor is choosing to do you a great favor and push for performance when your body is screaming for help.

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Reproductive Function In Normal Women

Regular reproductive cycles are established within the first 13 years after the first menstrual period in normal women. Although cycles between 25 and 35 days are considered normal, cycle-to-cycle variability in an individual woman is considerably smaller .

Normal menstrual cycle function requires tightly integrated interactions between the hypothalamus, pituitary and ovary while the endometrium serves as a gonadal steroid end organ and clinical marker of reproductive cycles . Estradiol secretion from developing follicles causes follicular phase proliferation of the endometrium. After ovulation, the combination of progesterone and estrodial produces the secretory changes that prepare the endometrium for implantation if conception occurs. In the absence of pregnancy, the function of the corpus luteum declines, hormonal support of the endometrium is lost and menses results .

The hormonal, follicular, and endometrial dynamics of the normal menstrual cycle from the late luteal phase through menses and the beginning of a new cycle of follicle development, ovulation, and corpus luteum function and decline. inhibin B inhibin A From Hall JE. Neuroendocrine control of the menstrual cycle. In: Strauss JF, Barbieri RL, editors. Yen and Jaffes Reproductive Endocrinology, 7th Edition. Philadelphia, PA: Elsevier Publishing, pp 141156 2013, with permission.

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What Is A Follicle

This test measures the level of follicle-stimulating hormone in your blood. FSH is made by your pituitary gland, a small gland located underneath the brain. FSH plays an important role in sexual development and functioning.

  • In women, FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation.
  • In men, FSH helps control the production of sperm. Normally, FSH levels in men do not change very much.
  • In children, FSH levels are usually low until puberty, when levels begin to rise. In girls, it helps signal the ovaries to make estrogen. In boys, it helps signal the testes to make testosterone.

Too much or too little FSH can cause a variety of problems, including infertility , menstrual difficulties in women, low sex drive in men, and early or delayed puberty in children.

Other names: follitropin, FSH, follicle-stimulating hormone: serum

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Fsh And Ovarian Reserve

What is FSH? Follicle-stimulating #Hormone and What Affects #FSH Levels Explained

In women who want to become pregnant later in life, FSH levels are used to test ovarian reserve . Your healthcare provider will have blood work drawn on the third day of your menstrual cycle. The results are typically available within 24 hours depending on the lab.

Based on the results of the lab studies, a fertility specialist will be able to estimate your likelihood of getting pregnant even if you are approaching menopause.

Baseline FSH levels will increase as women enter perimenopause, indicating a decreasing number of oocytes . Perimenopause lasts four years on average and ends when a woman has not had a period in 12 months.

At that point, menopause begins. FSH levels at menopause are consistently elevated to 30 mIU/mL and above.

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Ovarian Aging In Women

In women, the finite pool of resting follicles in the ovary reaches its maximum in neonatal life. Thereafter, there is a steady decline due to atresia such that, at birth, only one million follicles remain with a further reduction to 250,000 by the time of puberty . During and after puberty, follicles will leave the pool of resting follicles by activation of further growth or by degeneration. Rising levels of FSH provide a critical stimulus for recruitment of resting follicles into the growing follicle pool while antimullerian hormone , produced in granulosa cells from small growing follicles, restrains this effect of FSH within the ovary. Throughout early reproductive life the number of growing follicles is highly correlated with the size of the resting pool. However, between the ages of 30 and 35, the percentage of growing follicles increase and the trajectory of follicle loss is accelerated until the pool of resting follicles is reduced to between 100 and 1000 when there is cessation of reproductive cycles. Age-related changes in oocyte quality parallel the decrease in follicle number with reported decrease in fertilization and conception rates and higher rates of pregnancy loss. Chemotherapy, radiation and smoking are all factors that accelerate follicle loss through damage to the oocyte and/or dividing granulosa cells.

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Fsh Effects On Cholesterol Metabolism

There is an increased prevalence of dyslipidemia and cholesterol accumulation around the menopausal transition, which has traditionally been linked to estrogen deficiency . However, there has been recent evidence that FSH might play a role in increasing hepatic cholesterol production, independent of serum estrogen. A recent study of 278 pre- and perimenopausal women found that serum FSH, total cholesterol and LDL cholesterol levels were higher in the perimenopausal group compared with pre-menopausal women, despite similar serum estrogen levels . Serum FSH levels displayed a positive correlation with TC and LDL-C after adjustment for estrogen. Similarly, another study of 588 postmenopausal women noted that subjects with higher serum FSH levels had higher levels of both TC and LDL-C . In a cohort of 400 postmenopausal Chinese women with a similar relationship between serum FSH, TC and LDL-C, it was noted that significant improvement of lipid levels after hormone-replacement therapy was seen only in women who had 30% reduction in serum FSH levels .

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How Do I Manage Symptoms Of Postmenopause On My Own

Certain lifestyle or at-home changes can help you manage symptoms of postmenopause. Some of these include:

  • Using a water-based vaginal lubricant during sex to make it more pleasurable. Lubricating the vagina helps with dryness and pain.
  • Regular exercise, meditation and other relaxing activities can help with depression and other side effects of postmenopause.
  • Eating a diet rich in phytoestrogens such as whole-grain cereals, flaxseed, chickpeas and legumes. Reducing caffeine and alcohol intake has also been shown to help.

How Do Fsh Levels Affect Fertility Treatment Success Rates


While each fertility clinic uses a different assay to measure FSH, most centers say that anything above 15 is considered abnormal. On average, patients in the 10-to-15 range, have a 50% lower success rate of bringing home a baby than others in their age group with FSH levels of 9.5 or below. When FSH levels are above 15, the success rate goes down to less than 5% and there is an increased chance of chromosomal abnormality.

Elevated FSH levels also indicate diminished ovarian reserve which means there are fewer follicles or eggs and these are often of questionable quality.

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What Are Symptoms Of High Fsh Levels

Follicle stimulating hormone levels can be elevated for many reasons. Though high FSH can have genetic components, not all causes of DOR, indicated by high FSH, have been elucidated. Symptoms of high FSH in females often mimic those of menopause, including irregular periods, hot flashes, and headaches.

Why Are Fsh Levels High In Menopause

FSH causes ovarian follicles to enlarge and produce estrogen. Over time, fewer and fewer follicles remain to be stimulated and thus estrogen levels decline as a woman ages. This decline in estrogen leads to an increase in FSH as there is not enough estrogen being produced to turn off the brains production of FSH.

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Fsh Levels During Your Cycle

Throughout your menstrual cycle, levels of FSH vary. Healthcare provider s often test FSH levels on day 3 of your cycle. These are considered your baseline levels. FSH is part of a complex dance of hormones that includes luteinizing hormone , estradiol, and gonadotropin-releasing hormone . FSH stimulates an immature follicle to grow. Once it is grown, it releases estradiol, which signals the release of GnRH and LH, prompting ovulation.

Prior to ovulation, FSH levels will peak, signaling the ovary to release an egg. Once ovulation has occurred, the levels will return to or dip slightly below the baseline.

Normal baseline FSH levels are between 4.7 and 21.5 mIU/ml in women who are menstruating.

Certain medications, such as birth control pills, clomiphene, digitalis, and levodopa, can alter the test results. Your healthcare provider will instruct you to stop taking those drugs before taking an FSH test. In the case of hormonal birth control, it should be stopped at least four weeks prior to taking the test.

What Symptoms Am I Most Likely To Experience

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Symptoms vary greatly from woman to woman. They may occur at different times and with different degrees of severity. The information below is meant only as a guide about what you may experience, and does not cover all possible symptoms.

Change in menstrual bleeding patterns: As women age, menstrual periods change. They may be more or less frequent, shorter or longer, and heavier or lighter. It is important to know that ovulation can still occur, and women in perimenopause can sometimes get pregnant. Women who do not wish to get pregnant should continue to use birth control until they have not had a menstrual period for 12 months.

Changes in a womans menstrual cycle are common and expected during perimenopause. However, worsening bleeding or irregular bleeding should be discussed with a health-care provider. Abnormal bleeding may be the result of other problems with the uterus, such as polyps, fibroids, hyperplasia , or even cancer.

Mood symptoms/sleep disturbances: During perimenopause, some women also have problems with sleeping, forgetfulness, and depression/anxiety. Decrease in sex drive is also quite common. While many of these symptoms can be a result of dropping estrogen levels, they may also be a sign of other medical conditions. If you experience any of these symptoms, please talk to your doctor to get the proper care.

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Conditions Related To High Fsh

Does high FSH definitely mean that you are entering menopause? If you are under 35, high FSH levels are not considered normal, and may indicate one of several things.

It could be premature menopause also known as premature ovarian failure or ovarian insufficiency. If this is the case, you will have other signs of menopause as well, like missing your period and low levels of estrogen. These symptoms may be more severe than in women in natural menopause, and is considered atypical as it begins much earlier. About one percent of women have this condition.

High FSH levels could also indicate poor ovarian reserve also known as impaired ovarian reserve, premature ovarian aging, premature ovarian insufficiency, or declining ovarian reserve. In this condition, you either have relatively few eggs left in the ovaries, or impaired development or recruitment of the eggs. Recent research suggests that this condition may be a precursor to premature ovarian failure.

There are also some congenital or genetic conditions that can result in high levels of FSH, such as Turner Syndrome or Congenital Adrenal Hyperplasia. However, these are usually identified early in life, and are unlikely to be responsible for newly diagnosed high FSH levels.

Also, extremely rarely, high FSH levels could be the result of a pituitary tumor.

The bottom line is that high levels of FSH are, unfortunately, an indicator of infertility or decreased fertility.

What Is Normal Day 2 Fsh Level

At this time, E2 is at its lowest so FSH should be at its highest. If the E2 level on Day 2 is > 200pmol/l, then follicle growth will have already started, and the measurement of the FSH is not reliable because the raised E2. will have already started to suppress the FSH level. This commonly happens in older women.

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Do People In Postmenopause Lose Interest In Sex

No, not all people lose interest in sex after menopause. Vaginal dryness and discomfort during sex can make sex less pleasurable. Using a vaginal lubricant can help with dryness. Some people are less interested in sex because of other symptoms like depression or feeling tired. If your feelings about sex have changed, ask your healthcare provider for help.

How Often Do I Need To See My Doctor After Menopause


You should still see your healthcare provider for routine gynecological care even though you aren’t menstruating. This includes Pap tests, pelvic exams, breast exams and mammograms. You should continue to schedule annual wellness appointments. Since you are at an increased risk for osteoporosis, providers usually recommend bone density screenings as well. Talk to your healthcare provider to determine how often you should make check-up appointments based on your health history.

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