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Follicle Stimulating Hormone and Perimenopause

by | Last updated: Apr 7, 2022 | Menopause | 5 comments

Do you know the importance of knowing your FSH level whether you’re premenopausal, menopausal or post menopausal? FSH, or follicle stimulating hormone, is produced by your pituitary gland in response to your estrogen levels. During your reproductive years, your FSH shifts throughout your menstrual cycle. Low in the beginning, peaking before ovulation, and falling afterwards. Let me break it down.

#1 Follicle Stimulating Hormone Drawn at The Right Time

If you’re still getting periods but you have symptoms of perimenopause then you need to get your FSH drawn on day 3-5 of your cycle. Day one is the first day you bleed. Any other time of the month will not be accurate if you’re perimenopausal. That’s because, in the first few days of your menstrual cycle, your FSH should be low. By day seven, your FSH starts to rise. If you’re perimenopausal, your day 3-5 FSH will be over 15. That means you did not make enough estrogen in your last cycle. Now the problem in perimenopause is that some cycles you make enough estrogen, some you don’t. After you stop getting your periods, your FSH can be drawn at any time of the month.

#2 FSH Predicts Menopause

Once your FSH is over 30 and stays over 30 for at least a year, you’re in menopause. Now you may still have breakthrough bleeding that looks like a period. But your pituitary gland is clearly not satisfied with your level of estrogen production. Your developing follicles produce estrogen trying to be the egg of the month. Some young women with premature ovarian failure will have an elevated FSH. If you want to determine your egg reserve then get your AMH or anti-Mullerian Hormone drawn too.

Women approaching menopause want to know if they still need contraception. If your FSH is rising over 30 and your AMH is is below 0.5 — you are no longer fertile. If you’re over fifty with an FSH over 30 and you haven’t had a period in a year, you no longer need contraception.

#3 FSH Determines Your Estrogen Status

Once you’re in menopause, FSH can help determine if you have enough estrogen from adrenal production and fat storage. Of course if you’re suffering from hot flashes, insomnia, vaginal dryness, you may need to take estrogen either through your skin or under your tongue to prevent blood clots.

Most postmenopausal women feel balanced with an FSH between 30-40. Eventually your pituitary gland gets used to your low level of estrogen and stops screaming at your ovaries with super high FSH production. But it takes years to calm down if you’re not using hormone replacement therapy.

Some women glide through menopause because they have enough stored estrogen in their body fat and their adrenals are making enough DHEA to be converted into estrogen. About ten to fifteen years after a woman goes through menopause, her adrenals start slowing down too. Then her FSH rises again and she may get all the symptoms of menopause all over again. I call this the second menopause. Because of high-stress levels, second menopause happens to more and more women, earlier and earlier.

Download my menopause checklist to determine where you might be in the change.

About the Author - Deborah Maragopoulos FNP

Known as the Hormone Queen®️, I’ve made it my mission to help everyone – no matter their age – balance their hormones, and live the energy and joy their DNA and true destiny desires. See more about me my story here…



  1. Dorothy Mundy

    My hair done grow

  2. Tracy

    I’m 44 years old. On the 14th of the month I started getting the usual signs of the start of my period and that lasted 4 days (brown discharge). Four days later (18th) it turned the usual bright red and is still present 5 days after that. I’m not sure if I’m going through premenopausal symptoms or not. My husband says I’m not old enough yet🙄.

    • Deborah Maragopoulos FNP

      You are not too young to be going though perimenopause
      Irregular cycles and breakthrough bleeding are caused by low luteal phase progesterone – typical in perimenopause

      BTW I answered your question at length in our free Hormone Support Group
      You can get access by signing up for my free Hormone Reboot Training https://members.genesisgold.com/hrt

  3. Chris L

    I’m 54, and I’ve never missed a period. I have a Mirena IUD to help with HMB due to adenomyosis and fibroids. On the IUD, my periods are pretty regular, light, and last a few days, although I always have spotting between periods. Without the IUD, I quickly become iron deficient then anemic. Recently, I started having HMB, with periods every 2 weeks. I suspected I lost the IUD or was perimenopausal.

    Ultrasound in Sept 2023 showed the IUD was in the endocervical canal. (tan US in Jan 2023 showed it was in the uterus.) Lab tests in Sept showed serum ferritin of 10, FSH of 27.5 miu/mL and estradiol level < 25 pg/mL. My OB-GYN says I’m menopausal. How can I be menopausal if I have had regular periods up until June 2023, when I started having extra periods? I think I may be perimenopausal (although I have no obvious symptoms of menopause). I’d understand her point that this could be post-menopausal bleeding if the bleeding had been irregular, but it only recently became irregular due to the IUD displacement (which also happened in Sept 2022), can you be menopausal if you have cyclical bleeding? (I also don’t have any gray hair or wrinkles, which makes me think my estrogen is not normally low.)


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