Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
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FSH (follicle-stimulating hormone)

Sex hormones · specimen: blood

Indicated in specific situations

Also called: follicle-stimulating hormone, LH, luteinizing hormone, FSH/LH, gonadotropins

Chart note

Pick Ordered or Not ordered to see the note.

Indicated when

  • Suspected premature ovarian insufficiency in a woman under 40: diagnosed on menopause-associated symptoms plus elevated FSH on 2 blood samples 4-6 weeks apart [1, 2]
  • Amenorrhea in a woman under 45, to help establish the cause [2]
  • In men, once testosterone deficiency is confirmed: LH, to classify it as primary (high LH) or secondary (low/normal LH) [4]

Not indicated when

  • Diagnosing perimenopause or menopause in a woman 45 or older: diagnosis is by symptoms and menstrual history alone [1, 2, 3]
  • A woman using combined estrogen-progestogen contraception or high-dose progestogen: FSH is not reliable for identifying menopause in this situation [1]
  • During perimenopause generally, as a stand-alone 'confirmation' test, since levels fluctuate too much to be reliable [2]

Why not

FSH fluctuates considerably from cycle to cycle and even within a cycle during perimenopause, so a normal or low result in a symptomatic 48-year-old does not rule out perimenopause, and an elevated one does not change management [2]. NICE specifically advises against using it to identify menopause in people 45 or over [1]. Ordering it in this age group mainly adds cost, a confusing result, and sometimes repeat testing, without changing a diagnosis that history already answers.

Better first step

In a woman 45 or older with typical symptoms, diagnose from history and menstrual pattern alone. Reserve FSH, paired with estradiol, for amenorrhea under 45 or suspected premature ovarian insufficiency under 40 [1, 2].

Typical ND rationale

An ND may order FSH, often together with LH and estradiol, in a perimenopausal-aged woman to 'confirm' menopause or explain symptoms, reasoning that an objective lab value settles the question more clearly than timeline and symptoms alone.

Where the ND is right

The ND is right to test FSH in a woman under 40-45 with amenorrhea, or under 40 with suspected premature ovarian insufficiency: this is exactly where NICE and the Canadian Menopause Society recommend it [1, 2]. In women 45 and older with typical symptoms, guidelines agree that testing adds nothing to the clinical diagnosis.

Ontario coverage & CONO orderability

OHIP status
insured
FSH (L315) and LH (L328) are both listed by name in the 2026 Schedule of Benefits for Laboratory Services with no restricting condition noted, so both are insured when a physician orders them after clinically assessing the patient (Reg. 552 s.22). ND-ordered testing is patient-paid regardless [8].
CONO orderable
Yes — CONO list #66, #89
CONO list items 66 (FSH, blood) and 89 (Luteinizing Hormone, blood). No saliva or urine variant of either is listed on the CONO list.

Linked conditions

Counselling script

“If you're 45 or older with typical symptoms, I can diagnose perimenopause or menopause from your history, so an FSH level wouldn't add anything. It bounces around too much at this stage to be reliable. It is genuinely useful if periods stop before 45 without a clear reason, or before 40.”

Revisit if

  • Menstrual periods change or stop before age 45 without an established cause
  • Periods stop before age 40 (assess for premature ovarian insufficiency, repeat FSH in 4-6 weeks)

References

  1. [1]NICE (2026). Menopause: identification and management (NG23) (published 2015, last updated 15 April 2026). linkDo not use FSH to identify perimenopause or menopause in people 45 or over, or in those on combined hormonal or high-dose progestogen contraception; diagnose premature ovarian insufficiency under 40 with elevated FSH on 2 samples 4-6 weeks apart
  2. [2]Canadian Menopause Society (2026). Diagnosis and Management (Menopause HUB). linkMenopause diagnosis is primarily clinical; FSH reserved for amenorrhea under 45 and suspected POI under 40, and is not reliable during perimenopause
  3. [3]Society of Obstetricians and Gynaecologists of Canada / Choosing Wisely Canada (2021). Obstetrics and Gynaecology recommendations. linkDon't routinely order hormone levels including FSH and LH in postmenopausal women or after a hysterectomy
  4. [4]Canadian Urological Association (2021). Canadian Urological Association guideline on testosterone deficiency in men: Evidence-based Q&A. linkIn men with confirmed testosterone deficiency, measure LH to classify it as primary or secondary
  5. [5]Ontario Ministry of Health (2026). Schedule of Benefits for Laboratory Services (effective April 1, 2026) — L315 FSH. linkFSH (L315) listed in the 2026 OHIP Schedule of Benefits for Laboratory Services
  6. [6]Ontario Ministry of Health (2026). Schedule of Benefits for Laboratory Services (effective April 1, 2026) — L328 LH. linkLH (L328) listed in the 2026 Schedule
  7. [7]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
  8. [8]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services
Evidence notes

This single record covers both FSH and its alias LH, since Ontario ND requisitions and patient questions typically bundle them and the CONO list, OHIP Schedule and clinical use overlap closely; the record's indications section notes where LH's use (male hypogonadism classification) diverges from FSH's (female reproductive-axis assessment). If clinical review prefers a split into separate fsh and lh records, that is a reasonable alternative and is flagged here rather than decided.