Beyond reproduction: the emerging role of FSH in postmenopausal aging

Follicle-stimulating hormone (FSH) is traditionally regarded as a biochemical marker of menopause and declining ovarian function. However, emerging evidence suggests that its role may extend beyond reproductive physiology. During the menopause transition, FSH concentrations rise progressively, initially due to declining inhibin B and later to loss of ovarian estradiol and inhibin production. Evidence of FSH effects in bone, adipose tissue, the cardiovascular system and brain has raised the possibility of broader physiological actions. Higher FSH levels have been associated with bone loss and hip fracture risk, adverse cardiometabolic and vascular changes, and cognitive decline and Alzheimer's disease. Although these associations do not establish causality, they suggest that FSH may contribute to some consequences of reproductive aging rather than simply reflect ovarian failure. Experimental studies indicate that reducing FSH may benefit bone and adiposity, while preliminary clinical evidence regarding cognition remains inconclusive. Thus, FSH may represent not only a marker of menopause, but also a potential marker of risk and, ultimately, a therapeutic target.