From the Research
No, in the early stages of menopause, it is more common for FSH (follicle-stimulating hormone) to rise before LH (luteinizing hormone). As ovarian function begins to decline during perimenopause, the ovaries become less responsive to FSH, which triggers the pituitary gland to secrete more FSH in an attempt to stimulate follicular development. This results in elevated FSH levels, which typically precede significant rises in LH. FSH levels can begin rising several years before actual menopause occurs, often fluctuating but showing an overall upward trend. LH levels also increase during perimenopause but generally do so later and less dramatically than FSH. This differential rise occurs because FSH is more sensitive to declining inhibin levels (a hormone produced by developing follicles) than LH is. The FSH:LH ratio therefore often increases during the perimenopausal transition, which is why FSH is typically the primary hormone measured when assessing menopausal status. This pattern reflects the body's attempt to maintain ovarian function as reproductive capacity gradually diminishes, as discussed in the context of menopausal transition and hormone changes 1, 2.
Some studies have explored the changes in hormone levels during menopause, including the effects of hormone replacement therapy on these levels 3. However, the most relevant information regarding the timing of FSH and LH rises comes from studies focusing on the natural progression of menopause, such as those examining inhibin levels and their impact on FSH and LH secretion 1. The Stages of Reproductive Aging Workshop + 10 (STRAW+10) system provides a framework for understanding the stages of menopause, including the hormonal changes that occur during this time 4.
Key points to consider include:
- FSH levels rise before LH levels in the early stages of menopause.
- The increase in FSH is due to the decreased responsiveness of the ovaries to FSH, leading to increased secretion by the pituitary gland.
- LH levels also increase but to a lesser extent and later than FSH.
- The FSH:LH ratio increases during the perimenopausal transition, making FSH a primary marker for menopausal status.
- Understanding these hormonal changes is crucial for managing menopause symptoms and assessing menopausal status, as discussed in the context of current recommendations for hormone replacement therapy 5.