The evidence for lifestyle, nutrition, hormone therapy, and FemmenessencePRO (Maca-GO®) as interventions that may influence FSH dynamics during menopause.

Dr. Deanna Minich, PhD, MS, CNS, FMCP, FACN

Chief Science Officer, Symphony Natural Health

Several factors may influence FSH levels during the menopausal transition, with varying degrees of evidence: hormone replacement therapy directly and substantially suppresses FSH; structured exercise, sleep, and melatonin supplementation show modest and context-dependent effects; and certain botanicals — including FemmenessencePRO — have demonstrated statistically significant reductions in FSH in clinical studies, though effects are smaller than those of HRT. Other interventions, such as nutrition, sleep, and exercise, may indirectly influence FSH by shaping metabolic, environmental, and endocrine dynamics.

Follicle-stimulating hormone (FSH) is a dynamic and potentially pleiotropic signal in perimenopause. Because of this, it may be a reasonable target to consider strategies that may influence its levels and downstream effects.

"Menopause isn't a deficiency of one hormone. It is a recalibration of the entire endocrine network. That's why FemmenessencePRO™ was developed to support the hypothalamic-pituitary-thyroid-adrenal-ovarian axis rather than focusing on a single hormonal endpoint. When we support the system, improvements in biomarkers, symptoms, and overall physiological resilience can follow."

Lifestyle Influences on Neuroendocrine Function

This article provides an overview of the developing science of FSH as a systemic endocrine messenger in menopause. Subsequent articles will explore FSH biology in greater depth, including its possible roles in bone remodeling, body composition, metabolism, cognition, vascular health, endocrine aging, and clinical strategies.

"For decades we've viewed FSH through the narrow lens of reproduction. I believe it's time to recognize it as something much bigger: a window into the body's endocrine adaptation during midlife. Sometimes the most important scientific advances don't come from discovering a new biomarker, but from asking new questions about one we've had all along."

From Reproductive Hormone to Systemic Signal

Exercise

Exercise shows variable and modest effects on FSH levels. Postmenopausal women completing a 15-week resistance training program, averaging 2 sessions per week, experienced a non-significant 5.5% decrease in FSH levels, compared with a 3.8% increase in controls [1].

In a 12-week trial involving postmenopausal women in a Hatha yoga or structured exercise intervention, those completing structured exercise, which included stretching routines targeting the shoulder girdle, cervical musculature, and lower extremities, experienced a 12.3% decrease in FSH compared to a 2.6% increase in the Hatha yoga intervention [2]. The control group experienced a 29% increase in FSH.

Conversely, a Tai Chi Rouli Ball intervention resulted in a 12.4% increase in FSH compared to a 6.6% increase in the control [3].

Table: Exercise Interventions and FSH

Structured exercise may partially attenuate or suppress FSH during the transition, whereas yoga may provide a stabilizing effect.

Sleep and Circadian Biology

Melatonin research illustrates how dose and physiological context shape outcomes. Whereas low-dose melatonin (0.3 mg nightly) has not been shown to significantly change FSH in shift-working perimenopausal women [4], higher doses may have a greater effect on endocrine pathways.

Perimenopausal women with existing sleep concerns supplementing with melatonin (3 mg nightly) showed significant FSH reductions accompanied by parallel shifts in LH and estradiol, suggesting coordinated HPG axis effects [5]. In a similar trial, women with low baseline melatonin levels supplementing with melatonin (3 mg nightly) for six months experienced a decrease in FSH [6]. Baseline levels of FSH and melatonin also demonstrated an inverse relationship.

Table: Melatonin Dose and FSH Response

These findings imply that circadian status may shape the endocrine effect of melatonin supplementation.

Sleep and Circadian Biology

Melatonin research illustrates how dose and physiological context shape outcomes. Whereas low-dose melatonin (0.3 mg nightly) has not been shown to significantly change FSH in shift-working perimenopausal women [4], higher doses may have a greater effect on endocrine pathways.

Perimenopausal women with existing sleep concerns supplementing with melatonin (3 mg nightly) showed significant FSH reductions accompanied by parallel shifts in LH and estradiol, suggesting coordinated HPG axis effects [5]. In a similar trial, women with low baseline melatonin levels supplementing with melatonin (3 mg nightly) for six months experienced a decrease in FSH [6]. Baseline levels of FSH and melatonin also demonstrated an inverse relationship.

Environmental Exposures

Environmental exposures, including PFAS [7,8], cadmium [9], and lead [10], are associated with higher FSH levels in women. Smoking, which represents a significant non-dietary source of cadmium exposure, is associated with higher FSH levels in women [11,12]. These findings suggest that environmental exposure burden may influence FSH dynamics in midlife.

In comparison, urinary glyphosate has been associated with changes in sex steroids but not FSH, suggesting that certain exposures disrupt steroidogenesis without compensatory FSH increase [13].

Nutritional Influences on Neuroendocrine Function

Nutritional approaches may influence FSH by shaping endocrine and metabolic dynamics. However, the effects are more likely to be indirect rather than direct FSH suppression, and not all studies produce favorable results. For example, Lactobacillus and Bifidobacterium probiotics administered in a 12-week randomized, controlled study of perimenopausal women resulted in significantly increased FSH, suggesting that the gut microbiome may modulate endocrine signaling [14].

On the other hand, lower vitamin D status has been associated with higher FSH and lower estradiol levels in peri- and postmenopausal women [15,16]. Given the importance of vitamin D for maintaining bone health, evaluating both FSH and vitamin D may be helpful within a broader clinical approach.

Soy isoflavones have been researched for their weak estrogenic effects, providing a rationale for potential effects on FSH signaling. However, soy isoflavones show variable effects on FSH levels without consistent reductions in FSH, including in interventions with higher isoflavone doses used over longer periods of time [17-19]. In some instances, FSH levels increased after isoflavone supplementation in postmenopausal women [20].

Botanical Approaches in Neuroendocrine Function: FemmenessencePRO™ (Maca-GO®) and Neuroendocrine Adaptation During Menopause

Botanicals have modest to moderate effects on FSH and may contribute to the broader endocrine and symptom-management picture for appropriate patients. However, changes in FSH vary widely across botanicals, may be preparation-specific, and could be influenced by an individual’s baseline endocrine state.

In clinical trials on FemmenessencePRO™ POST, a specific preparation of concentrated maca (Lepidium peruvianum) phenotypes, showed FSH changes ranging from approximately -11 to -55% after 2–8 months, depending on study protocol, in early postmenopausal women [21-23]. However, interesting research on Maca-GO® in perimenopausal women saw increases in FSH.

“What we have found most interesting with Maca-GO is the different physiological effects in women in different stages of life. As Maca-GO’s primary function is on the HPTAO axis in menstruating perimenopausal women we saw their bodies respond by increasing FSH to have the intended fertility and downstream impact, however once a woman was in postmenopause we saw the opposite as the body tried to recalibrate to an optimal hormonal profile for a woman in that stage of life.” Dr Henry Meissner head of R&D Symphony Natural Health

Contrarily non-standardized maca preparations show no effects on FSH, suggesting preparation-specific effects [24-26].

Along with changes in FSH, women taking FemmenessencePRO™ experienced improvements in other hormones including estradiol, progesterone and downstream biomarkers including lipids and bone density emphasizing the impact on the whole endocrine system [21-23].

Below is a selection of botanicals and their effect on FSH in peri- and postmenopausal women.

"One of the most important lessons from our clinical research on FemmenessencePRO™ is that the goal isn't simply to suppress FSH. It's to support the body's own endocrine intelligence. As endocrine function changes across the menopause transition, the body is constantly adapting. Our role is to nourish that adaptation, not override it."

Table: Botanical Interventions and FSH Effects

Hormone Therapy and FSH Suppression: What the Research Shows

Research shows that FSH is highly responsive to estrogen therapy, which appears to be driven by the suppressive effects of estrogen and, ultimately, the restoration of hypothalamic-pituitary feedback [37,38]. While oral and transdermal hormone replacement therapy (HRT) consistently reduces FSH, vaginal HRT has not demonstrated significant effects [39].

FSH suppression via HRT may translate to bone health benefits. In one study, peri- and postmenopausal women undergoing oral or transdermal HRT, FSH decreased by approximately -29.5% at 12 months and -33.3% at 24 months from baseline, alongside increased lumbar spine bone mineral density during the first 12 months. However, further gains were not observed at 24 months [40]. However, FSH levels do not tend to return to premenopausal levels, suggesting that FSH may function as a responsive biomarker of the endocrine milieu rather than a therapeutic target that should be normalized. In this context, it’s important to consider FSH alongside other biomarkers and clinical symptoms.

Clinical Summary

HRT remains the most direct and consistently effective intervention for reducing elevated FSH, with rapid, dose-dependent suppression through restoration of estrogen feedback to the hypothalamic-pituitary axis. However, most importantly, menopause represents more than declining ovarian hormone production. It reflects a coordinated adaptation of the entire endocrine system, involving the hypothalamic, pituitary, thyroid, adrenal, pancreatic, and ovarian axes. While HRT effectively addresses one aspect of this transition, a root-cause, systems-based approach seeks to optimize the health and resilience of the broader endocrine network through nutrition, targeted supplementation, physical activity, restorative sleep, circadian rhythm regulation, stress management, and reduction of environmental toxicant burden. Within this framework, FSH may be viewed less as a solo therapeutic target to suppress and more as a clinically informative biomarker of whole-endocrine adaptation and physiological resilience

Dr. Deanna Minich, PhD, MS, CNS, FMCP, FACN

Chief Science Officer, Symphony Natural Health

Nutrition scientist, researcher, educator, and author with 25+ years across academia and the supplement industry, including most recently as a featured expert in nutrition and functional medicine in the PBS documentary The (M) Factor 2.

PhD in Medical Sciences; MS in Human Nutrition and Dietetics; Certified Nutrition Specialist. Recipient of the 2025 Linus and Ava Helen Pauling Award, the highest honor in Functional Medicine, with past winners including Dr. Mark Hyman, Dr. Dean Ornish, and Dr. Terry Wahls.

She spent ten years working with Dr. Jeffrey Bland on the research and development team at Metagenics, engaged in global strategy and education related to functional medicine and natural products, and helped establish his Personalized Lifestyle Medicine Institute (PLMI) in 2014. She is currently on the Board of Directors for PLMI. Past President, American College of Nutrition; fellow of the American College of Nutrition (FACN); Board of Directors for 7 years, American Nutrition Association; Nutrition Advisory Board, Institute for Functional Medicine; and has been an educator for the Institute for Functional Medicine and University of Western States for over a decade.

Author of seven consumer books including the Rainbow Diet, and 50+ scientific publications. Oversees and guides Symphony's Medical and Science Team focusing on researching the root cause of women's health and hormone imbalance conditions. She is the lead author on the most recent FSH paper and is dedicated to empowering women to understand their whole health and supporting endocrine health throughout life. Has trained thousands of healthcare professionals and educated consumers worldwide over the past 25 years through her presentations and courses.

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