From the Guidelines
In primary ovarian insufficiency, FSH levels are typically elevated within the menopausal range, while LH levels are also raised, as indicated by the definition of POI which includes raised FSH levels recorded at least twice four weeks apart in patients younger than 40 years 1. The diagnosis of primary ovarian insufficiency (POI) is based on the combination of oligo/amenorrhea and elevated follicle-stimulating hormone (FSH) levels, as stated in the study published in Blood Reviews 1.
- Key characteristics of POI include:
- Elevated FSH levels within the menopausal range
- Raised LH levels, although typically to a lesser extent than FSH
- Oligo/amenorrhea in patients younger than 40 years
- Hormone levels recorded at least twice four weeks apart to confirm the diagnosis The study highlights the importance of hormonal therapy (HT) in reducing the risk of osteoporosis, cardiovascular diseases, and urogenital atrophy, and improving the quality of life of women with POI 1.
- The management of POI should involve a multidisciplinary team, including gynecologists, pediatricians, endocrinologists, dietitians, and psychologists, to address the complex needs of patients with POI 1. The elevated FSH levels in POI are a key diagnostic feature, and the FSH:LH ratio can help distinguish POI from other causes of amenorrhea, such as polycystic ovary syndrome 1.
From the Research
FSH and LH Levels in Primary Ovarian Insufficiency
- Typical levels of Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) in primary ovarian insufficiency are elevated, with FSH levels often above 30 IU/L 2, 3.
- Studies have shown that women with primary ovarian insufficiency may have varying levels of FSH and LH, with some patients having higher levels of these hormones than others 4, 5.
- The use of estrogen therapy has been shown to down-regulate serum FSH and LH levels in women with hypergonadotrophic ovarian failure, with FSH levels decreasing in response to increasing doses of ethinyl estradiol 5.
- In some cases, women with primary ovarian insufficiency may also have elevated levels of prolactin, which can persist for several months after ovarian failure 6.
- The presence of antral follicles in women with primary ovarian insufficiency suggests that down-regulation of FSH receptors is not the predominant mechanism of follicle dysfunction, and that follicle luteinization may be a more significant factor 4.
Factors Influencing FSH and LH Levels
- Estrogen therapy can influence FSH and LH levels in women with primary ovarian insufficiency, with high-dose estrogen supplementation down-regulating these hormones and leading to functional follicle growth 2.
- The size of antral follicles can also impact FSH and LH levels, with patients having larger follicles tend to have lower FSH and LH levels 4.
- The age of diagnosis and the presence of other hormonal imbalances, such as hyperprolactinemia, can also affect FSH and LH levels in women with primary ovarian insufficiency 3, 6.