Menopause, one of those life-changing situations for women, comes with a variety of emotions. It is that stage, wherein a woman realizes that she has lost her reproductive capacity and is no longer young. Wantedly or unwantedly, she gets to experience specific signs and symptoms that have her naturally transcend from a premenopausal to a postmenopausal state.
And while there exist various diagnostic tests to prove it, FSH levels happen to be a definitive indicator of the same. This being stated, the current article attempts to establish the link between FSH Levels and menopause by first and foremost communicating the importance of referring to the menopause chart to understand what levels of FSH indicate the end of the menstrual cycle in women.
FSH, short for follicle-stimulating hormones, is produced by the pituitary gland situated at the base of our brain. Referred to as the ‘master’ gland of the endocrine system. The presence and functioning of the pituitary gland are critical to the proper functioning of the other endocrine glands present in the human body (The Johns Hopkins University, 2023; OHSU, 2023).
Figure 1: Pituitary gland assisting in FSH production
Returning to the FSH, it has been also been learnt that its levels vary according to age. Please refer to the table below for noting the appropriate level of FSH for each age groups provided there.
|Age Group||FSH Levels|
|Before Puberty||0-4.0 mIU/mL|
|During Puberty||0.3-10.0 mIU/mL|
|Women still menstruating||4.7-21.5 mIU/mL|
|Women attained menopause||25.8-134.8 mIU/mL|
The rising levels of FSH are shown in each of the stages. Such as before puberty, during puberty, still menstruating, and menopause. This does indicate that these are extremely high in women who have stopped menstruating. This statement is truly indicative of the fact that there exists a significant relationship between FSH levels and menopause.
FSH Levels and Menopause
The data presented in Table 1 is enough to suggest the connection between FSH levels and menopause. The Facts provided by Whelan (2022) have even more served to reinforce this point. The author has effectively clarified that an increase in FSH levels is directly proportional to advanced age. If women experience irregular periods, by age 48 or 49, this is directly indicative of them reaching the threshold of menopause. In such a state, a physician is likely to recommend measuring FSH levels or an FSH test to assess their hormonal activity.
What must be understood in this scenario is that it is these FSH levels that assist in the production of estrogen. Other reproductive processes in a body, as well as help regulate both ovum and sperm production, thus rendering them appropriate for conducting fertility tests. When lab results specify increased FSH levels in a woman is enough to indicate that she is nearing menopause. This fact, however, necessitates the query as to why there is an increased level of FSH in women that are nearing the end of their menstrual cycle. As such, this will be explained in the upcoming section of this article.
One ought to note that though a single test is not sufficient to indicate menopause, accompanying this with an FSH level test is a sure-shot way to confirm the same, observed Whelan (2022).
Why Are FSH Levels High In Menopause?
Having noted that FSH levels support estrogen production, the physiologic processes there do involve the stimulation and enlargement of the ovarian follicles by these hormones, which, in turn, yield the production of estrogen, as explained in the Perelman School of Medicine .
In addition to these, signs leading to menopause do include both early and late transitions. The former involves lesser predictability of the next menstruation because of significant differences in the cycle length at each period. In the second case, however, women tend to go for a considerable period, say 2-11 months without having any menstruation. Estrogen production decreases when a woman reaches her perimenopausal or menopausal state. This results in increased FSH levels to ultimately cause the ‘shutting down’ of FSH.
Importance Of Menopause Chart With Reference To The FSH Levels
Based on the facts presented, it must have become clear to all you women out there as to why there is an increased level of FSH to denote your perimenopausal or menopausal state. Similarly, referring to the menopause chart will be an added benefit when it comes to predicting when you will attain menopause.
Figure 2: Menopause Chart and FSH Levels
The menopause chart represented by Figure 2 demonstrates the decrease in estradiol levels, the main form of estrogen. This is against the rising FSH level, creating no positive impact on estrogen/estradiol production, further signaling the brain to produce more FSH. The consistently higher levels of FSH, say over 30 mIU/mL is what mechanically suggests that a woman is entering a menopausal state, as represented by the menopausal chart above (Figure 2).
What FSH Levels Indicate Menopause?
The previous section depicting the menopausal chart specified that a high FSH level of over 30 mIU/mL helps confirm menopause in women. However, the levels may vary with intermittent waxing and waning of the same, especially during menstruation. Nevertheless, if these are consistently high and any concerned individual has clinically presented with no menstruation for 12 months at a stretch does truly indicate the end of the menstrual cycle, explained Agatowski (2023).
Do High FSH Levels Always Indicate Menopause?
The answer is ‘yes’ most of the time unless a woman does not present with varied FSH levels on continual planes. Diagnostically, high FSH levels of more than 30 mIU/mL are always indicative of menopause because this heavily signifies that a woman has not menstruated for a year (12 months).
Accuracy Of The FSH Levels in Detecting Menopause
Because high FSH levels are closely associated with menopausal signs, this should highly indicate the reliability of the former in confirming whether a woman is in her pre-menopausal, menopausal, or post-menopausal state. FSH levels increase with each passing age until a woman can no longer predict the length of her menstrual cycle. This fact should impose no doubt regarding the accuracy and reliability of the FSH levels in confirming menopause. As if to reinforce this fact, the U.S. Food & Drug (2018) has specified that the rate of accuracy of FSH in determining menopause is 9/10. One thing to note here is that when menstrual cycles demonstrate a temporary drop in FSH levels. This leads to rise in both perimenopausal and menopausal phases, causing the brain to turn off the production of FSH.
Reliability Of FSH Levels To Confirm Menopause
The consistently higher FSH levels are enough to signal the attainment of menopause. Even if a physician is unable to confirm the same through any other techniques or tests. Considering the FSH level will help in determining whether a woman has indeed reached the end of her menstrual cycle. Thereby ascertaining the reliability of the FSH Level test proves the purpose. These statements may not sound convincing to establish the association between FSH Level tests and menopause. The chart below will successfully help in proving this. To this end, indicating the gradual transition from the premenopausal stage to menopause. The role of the FSH Test in this regard as indicated through the estrogen level here.
Figure 3: Chart representing the different transitional stages of menopause via FSH Level test
Reflecting on what has been stated above on the use and role of FSH in determining a menopausal transition, this leaves no room for doubt regarding the correlation between FSH levels and attaining menopause, and how existing clinical practice can genuinely benefit from relying on the latter. The brain generates increasing amounts of FSH levels to stimulate the ovarian follicles to enlarge and produce estrogen. there comes a stage in which there remain not any more eggs, further prompting the brain to produce more FSH with no real effect, and this assists in confirming menopause.
- The menopausal chart and the FSH levels are critical to determining the early or late transition to menopause in women.
- A stage at which it is impossible to predict the time of the next period in her menstrual cycle. Because of differing cycle lengths indicates perimenopause and an early transition to menopause.
- Late transition is when a woman has gone 2 to 11 months without menstruation. Again suggesting the end of the menstrual cycle.
- Increased production of FSH to boost estrogen levels likely suggest the transition. From perimenopause to a stage of zero menstruation (menopause).