Association of FSH with High-Density Lipoprotein In Postmenopausal Periods: A Systematic Review and Meta-Analysis

Prior researchers identified a number of studies on the metabolism of lipids among postmenopausal women. Though more recent studies have demonstrated that FSH has extragonadal effects on HDL, they still connected it to the amount of estrogen. Follicle-stimulating hormone (FSH) has been proposed as a potential determinant of lipid changes after menopause, but the evidence is inconsistent. Objective: To examine the association between FSH and high-density lipoprotein cholesterol (HDL-C) among post-menopausal women. We systematically searched PubMed, Scopus, Web of Science and Embase for studies published up to 15 August 2024. Eligible studies reported quantitative associations between circulating FSH and HDL-C in post-menopausal women. Random-effects meta-analysis pooled correlation coefficients; β-coefficients were transformed to r using the formula r= (β × sX) / sY. Heterogeneity and small-study effects were assessed with the Q-test, I², Galbraith plots, Egger’s regression and trim-and-fill adjustment. Meta-regression and subgroup analysis were employed to find possible modifiers for the overall correlation coefficient. Twelve studies (eleven cross-sectional studies and one prospective cohort) were included in this systematic review and meta-analysis. The pooled correlation coefficient between FSH and HDL was positive (r = 0.31; 95 % CI 0.09–0.53; p = 0.006), indicating a moderate positive relationship. Between-study heterogeneity was substantial (I² = 100 %, p < 0.001). Egger’s test suggested possible small-study effects, but trim-and-fill correction produced a similar estimate Higher FSH levels are moderately associated with higher HDL-C in post-menopausal women; however, the association is variable across studies and should be interpreted cautiously given extreme heterogeneity, residual confounding and predominance of cross-sectional designs. Further high-quality prospective studies are needed to clarify causality and clinical utility. Keywords: Postmenopausal; Association; Correlation; HDL; Estrogen