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Why Do Lh And Fsh Levels Increase After Menopause

Is There Anything Else I Need To Know About An Fsh Levels Test

Perimenopause: Management, Estrogens & Other Hormones â Gynecology | Lecturio

There is an at-home test that measures FSH levels in urine. The kit is designed for women who want to find out if certain symptoms such as irregular periods, vaginal dryness, and hot flashes may be due to menopause or perimenopause. The test can show whether you have high FSH levels, a sign of menopause or perimenopause. But it doesnt diagnose either condition. After taking the test, you should talk with your health care provider about the results.

Cardiovascular Issues And Menopause

Coronary artery disease is the leading cause of morbidity and mortality in men and postmenopausal women. Menopause increases the risk for women still further, independent of age. Before menopause, the risk of CAD for women lags behind the risk for men by approximately 10 years after menopause, it catches up. As a result, mortality from CAD is increasing in women. The Framingham study was pivotal in showing the relation between menopause and increased cardiovascular mortality.

The Womens Health Initiative was a randomized, controlled trial that addressed the issue of whether postmenopausal women should take hormone therapy or estrogen therapy for prevention of CAD more than 27,000 healthy women participated in the trial. The investigators concluded that hormone therapy and estrogen therapy are not indicated for the prevention of CAD.

Emerging analyses of WHI data from the Estrogen-Alone Triala double-blind, placebo-controlled, randomized clinical trial evaluating the effects of conjugated equine estrogens on chronic disease incidence among postmenopausal women with prior hysterectomy and after a mean of 7.1 years of follow-upsuggested that treatment effects differ by age. Compared with older women, younger women receiving CEE had a lower risk of CAD.

Status Of Hormone Replacement Therapy

Assessment of the risks versus the benefits of HRT has become a challenging task for the physicians. Controversial issues have surrounded the status of HRT for postmenopausal women lately. Several randomized controlled trials present contradicting evidence and have raised questions about the short-term risks of long-term benefits of HRT. Evidence from clinical trials like the WHI and The Heart and Estrogen/Progestin Replacement Study trial does not support HRT use for prevention of cardiovascular disease. The association of HRT with cancer, stroke, cognition, cardiovascular disease, venous thromboembolism, osteoporosis, gallbladder disease is under scrutiny. The latest controversial results of randomized controlled trials in recent years have posed newer challenges for the physicians in prescribing HRT for postmenopausal women.

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Potential Roles Of The Hypothalamus And Pituitary In Menopause

In rodents, ovaries from old donors undergo folliculogenesis and ovulation when transplanted to young ovariectomized hosts, providing evidence for a central contribution to reproductive failure with aging in rodents. Further studies have pointed to the importance of age-related alterations in estrogen positive feedback on GnRH secretion as at least one contributing mechanism. An important question is whether similar central mechanisms contribute to reproductive failure in women.

Studies in younger and older postmenopausal women suggest that there are effects of aging on the hypothalamus and pituitary that are independent of the loss of steroid feedback. After menopause there is a 3040% decrease in LH and FSH between the ages of 50 and 75, . Underlying these gonadotropin changes are complex effects of aging on GnRH secretion with a 22% decrease in GnRH pulse frequency that is partially compensated by a 14% increase in the overall amount of GnRH secreted over that due to the loss of ovarian function alone. There are also age-related effects at the pituitary with a 30% decrease in both LH and FSH responses to GnRH in older compared to younger postmenopausal women.

Relationships Between Cycle Characteristics And Patterns To Bleeding Sleep Symptoms And Other Correlates Of Health In Midlife Women

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Menstrual cycle hormone patterns have been related to several other symptoms, signs and risk factors in a series of studies performed in SWAN. The patterns of menstrual bleeding have been related to urinary hormone excretion patterns. For the most part, changes in cycle timing were associated with a failure of ovulation. Short and long duration of menstrual bleeding were also associated with anovulation. However, the relative self-reported heaviness of menstrual bleeding was more likely to be associated with leiomyomata and obesity. These findings suggest that unusually heavy menstrual bleeding typically does not have a hormonal basis, and such patterns, especially when they are persistent, should be investigated for an underlying anatomical, gynecologic cause.

Women who collected daily urine samples in the SWAN Study also completed a daily diary in which they reported mood, sexual interest, and sleep quality. Women recorded whether or not they had had trouble sleeping during the previous night. Overall, a 29% increase in the odds of reporting trouble sleeping was observed as women progressed from regular cycling into the early transition. Sleep quality was worst at the beginning and at the end of the menstrual cycle. The occurrence of vasomotor symptoms was also observed across the transition within a menstrual cycle.

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Factors Including Bmi And Race/ethnicity That Influence Hormones And Patterns Of Hormones

Initial cross-sectional analyses of baseline annual serum hormone levels demonstrated variation in all hormones by body size, positively for T and negatively for all others. Ethnic variation in hormones was noted but was highly confounded by body size, and only FSH correlated with menopausal stage.

The longitudinal analyses in SWAN of FSH and E2 noted similar patterns in the decline of E2 and the increase in FSH with age across ethnic groups, but the levels of these hormones differed by race/ethnicity. The ethnic differences in E2 and FSH were independent of menopausal status while the effect of BMI on serum E2 and FSH levels varied by menopausal status. Obesity markedly attenuated the FSH rise and delayed the initial increase, while obesity, smoking behavior, and being Chinese or Japanese were associated with some variation in E2 levels, but not the pattern of E2 change. Thus, timespans and overall patterns of change in serum FSH and E2 across the menopausal transition were not related to age at FMP or smoking, while timespans but not overall patterns were related to obesity and race/ethnicity.

Clinical Assessment Of Reproductive Aging And Menopause

In 2001, the first Stages or Reproductive Aging Workshop , utilized the findings from important cohort studies of women across the menopause transition, based primarily on changes in menstrual bleeding patterns and qualitative changes in FSH, and introduced standardized terminology referenced to the final menstrual period. This staging system provided a critical scaffold for further studies and was updated a decade later to incorporate the results of longitudinal studies across the menopause transition and studies of fertility in older women. FSH cut-off levels are now possible because of international standardization of this measure. AFC and AMH have been limited to qualitative descriptors as these measures have not been standardized across centers and are used primarily in infertility populations and particularly in women over 35.

Addition of changes in estradiol to this schema permits us to understand the the clinical symptons of changes in menstrual cyclicity, vasomotor symptoms and GSM, which will be discussed in Chapter 2 in the context of evolving hormonal changes with progressive loss of ovarian function .

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What If Luteinizing Hormone Levels Are Out Of Balance

A low LH level suggests that your pituitary gland might be malfunctioning, preventing the LH surge thatâs involved with menstruation. Higher-than-normal LH levels â when seen with high FSH levels â can be a sign of ovarian failure (which can result in infertility. Another possible cause of an elevated LH concentration can be a syndrome known as polycystic ovarian syndrome â or PCOS.

What Are Symptoms Of High Fsh Levels

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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.

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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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Hormones To Help Get Pregnant

Getting pregnant, a complicated hormonal event, requires an interplay of hormones released at exactly the right time to develop, mature and release an egg from the ovary, and then to implant it in the uterus. Women having trouble getting pregnant may be prescribed different hormones at different times of the menstrual cycle to help them achieve pregnancy 1.

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Fsh Levels Before Pregnancy

Before pregnancy, FSH levels typically range between 1.4-9.9 mIU/mL during the follicular phase, and 1.1-9.2 mIU/mL during the luteal phase.

During the follicular phase, FSH helps to stimulate the development of the ovarian follicle, so that it can eventually develop an egg and ovulate. During the luteal phase, FSH levels drop slightly but continue to stimulate the ovaries to produce estrogen and progesterone.

What Is The Menopausal Transition


The menopausal transition is the period that links a womans reproductive years and menopause. A woman is said to be in menopause if she has had no menstrual periods for 1 year. Once in menopause, the ovaries essentially stop making hormones and women lose their ability to become pregnant. The average age for menopause is 51 years.

During the menopause transition, women often have changing menstrual cycles, vaginal dryness, hot flashes or flushes , and problems with sleep. Some of these symptoms happen all the time while others come and go. Symptoms can be mild to unbearable and can interfere with daily activities and sleep. Perimenopause is different for each woman but usually lasts about 5 years.

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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 .

The Hypothalamus And The Pituitary

The hypothalamus is located centrally in the brain and communicates by way of an exchange of blood with the pituitary gland. Several neuroendocrine agents, or hormones, are produced by the hypothalamus. The most important hormone for reproduction is called gonadotropin releasing hormone, better known as GnRH. It is released in a rhythmic fashion every 60 to 120 minutes.

GnRH stimulates the pituitary gland to produce follicle stimulating hormone , the hormone responsible for starting follicle development and causing the level of estrogen, the primary female hormone, to rise. Leutinizing hormone , the other reproductive pituitary hormone, aids in egg maturation and provides the hormonal trigger to cause ovulation and the release of eggs from the ovary.

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Perimenopause: Rocky Road To Menopause

What are the signs of perimenopause? You’re in your 40s, you wake up in a sweat at night, and your periods are erratic and often accompanied by heavy bleeding: Chances are, you’re going through perimenopause. Many women experience an array of symptoms as their hormones shift during the months or years leading up to menopause that is, the natural end of menstruation. Menopause is a point in time, but perimenopause is an extended transitional state. It’s also sometimes referred to as the menopausal transition, although technically, the transition ends 12 months earlier than perimenopause .

What Are The Signs That Perimenopause Is Ending

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And it can still be years before your last menstrual period. Some common, normal signs include irregular periods, hot flashes, vaginal dryness, sleep disturbances, and mood swingsall results of unevenly changing levels of ovarian hormones in your body. Read more about how youll know youre near menopause.

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What Is The Fsh Blood Test

To measure your FSH levels, your doctor will use a thin needle to take a blood sample from a vein in your arm and send it to a lab for processing. Giving a blood sample is a quick procedure that only takes a few minutes. It might hurt a little, and there might be a small bruise where the needle was inserted.

Your doctor may schedule this test during a specific point in your menstrual cycle. Its also possible to determine FSH levels through a urine test. In this instance, your doctor may ask you to collect a single sample of urine or multiple samples throughout a 24-hour period.

High levels of FSH could indicate:

  • Primary ovarian insufficiency or premature ovarian failure
  • PCOS
  • The presence of an ovarian tumor
  • Turner syndrome, a genetic disorder that affects female development
  • Perimenopause or menopause

Low FSH levels, on the other hand, could indicate:

  • Malnutrition or severely low weight
  • Your pituitary gland or hypothalamus isnt working correctly

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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Signs And Symptoms Of Menopause

The hypoestrogenic state seen at menopause is manifested in many women by signs and symptoms of hormonal deficiency in tissues containing estrogen receptors, including the ovary, endometrium, vaginal epithelium, urethra, hypothalamus, and skin. The most common complaints are vasomotor disturbances characterized by hot flushes, genital atrophy, and psychologic symptoms. The decline in estrogen also causes an increased risk of osteoporosis.

Vasomotor Flushes

Vasomotor instability appears to arise not from a lack of estrogen but rather from its withdrawal. Estrogen-deficient patients with gonadal dysgenesis fail to develop hot flushes unless given estrogen replacement therapy that is subsequently withdrawn.22 Castrated women with androgen insensitivity experience vasomotor symptoms after the discontinuation of estrogen. Similarly, premenopausal women treated with the antiestrogen clomiphene and postpartum women with very low estrogen levels often complain of hot flushes.

There is a subjective awareness of an impending hot flush, with an aura that may be perceived as a headache accompanied by heart palpitations occurring up to 4 minutes before the actual flush. The subjective sensation of the flush is followed by a change in skin conductance. There is then a rise in finger temperature that reflects cutaneous vasodilation .32,33,34 The pulse rate increases an average of nine beats per minute, and a rapid rise is seen in blood flow to the hand before the flush35 .

What Should Fsh Level Be On Day 2


If the cycle day 2 FSH level returns to a normal level of What happens when LH is higher than FSH?

With PCOS, LH levels are often high when the menstrual cycle starts. The levels of LH are also higher than FSH levels. Because the LH levels are already quite high, there is no LH surge. Without this LH surge, ovulation does not occur, and periods are irregular.

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What If I Have Low Lh Levels

If your results come back and show that your LH levels are below the normal range, this could be a sign of any of the following:

  • You may have problems with your pituitary gland, and/or
  • You may be malnourished or suffering from an eating disorder.

To improve your LH levels, there are a few different things you can do both naturally and medically.

In terms of natural solutions, a great place to start is by simply making healthy lifestyle choices. This includes getting plenty of sleep, eating a nutritious diet, avoiding alcohol and tobacco, and reducing overall stress levels. You can also try taking natural supplements like D-aspartic acid or Chasteberry, as some women have found these to be helpful for boosting LH levels.

If you have exhausted all natural options and still not having any luck, there are also medical treatments that you can try. This includes estrogen and progesterone replacement therapy, agonist and antagonist of gonadotropin releasing hormone agonists and antagonists, gonadotropins, and human chorionic gonadotropin injections to stimulate ovulation. Again, your doctor will have a better understanding of your background and can speak with you further about the best treatment option for your situation.

Medically Reviewed by Katerina Shkodzik, M.D., OB-GYN

Dr. Katerina Shkodzik is a certified OB-GYN with a special focus on reproductive endocrinology and infertility issues. She has been practising since 2015.


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