Menopur: how it works, side effects and the difference with FSH

Menopur is an injection that stimulates your ovaries, and the difference with Gonal-f or Puregon is that Menopur contains LH activity alongside FSH. The side effects closely resemble those of the other stimulation drugs: a tender injection site, headache, abdominal pain and bloating.

There is one question almost everyone asks at some point: why am I getting this and not the pen my friend was given? The answer is less dramatic than expected, and that is good news.

What does Menopur do in your body?

Menopur contains menotrophin, a mixture with both FSH and LH activity. FSH grows the follicles in your ovary. LH plays a role in maturing the egg and in hormone production around the follicle.

So you get two signals in one injection instead of only the growth signal.

Whether that extra LH improves your outcome is the question researchers have chewed on for years. For most women the answer appears to be no, and below is why that is reassuring anyway.

How is Menopur made?

Menopur is obtained and purified from the urine of women after the menopause. That sounds unusual, but there is a logical reason: after menopause the body makes a lot of FSH and LH, and those hormones end up in the urine.

The material is then heavily purified before it becomes a medicine. This production method has existed for decades.

Gonal-f and Puregon are made differently, in cell lines in the laboratory. That is the distinction between urinary and recombinant products.

Menopur or recombinant FSH: does it make a difference?

For the chance of a live birth, probably not. A Cochrane review of 42 trials with 9,606 couples found no meaningful difference between recombinant FSH and urinary gonadotrophins, neither in live births nor in the risk of hyperstimulation (PMID 21328276).

The reviewers concluded the choice may rest on availability, convenience and cost. That is exactly what clinics do.

So if you are given Menopur, that is not a lesser treatment. Read also our explanation of Gonal-f and Puregon.

Side effects of Menopur

The side effects reported most are pain or redness at the injection site, headache, abdominal pain, bloating, nausea and tender breasts. They belong to the rising oestradiol level during stimulation.

The Farmacotherapeutisch Kompas also lists ovarian cysts and ovarian hyperstimulation syndrome. The latter is rare but is the reason for the frequent monitoring.

Call your clinic if your belly swells quickly, or with severe abdominal pain, vomiting, shortness of breath or clearly reduced urine output.

Some women say the injection site stings a little more with Menopur than with a pen. That may relate to the solvent. Injecting slowly and changing the spot usually helps.

How do you dissolve and inject Menopur?

Menopur comes as a powder with a separate solvent. You draw up the solvent, inject it gently into the powder, and let it dissolve without shaking. Then you draw up the solution and inject under the skin, usually in your abdomen.

Shaking creates foam, and foam makes it hard to draw up the right amount.

If you use several vials at once, the clinic sometimes shows you how to combine them in the same solvent. Ask about it during the instruction, it saves injections.

Store the package as the leaflet describes and use the dissolved liquid according to that instruction. Ask your pharmacy if in doubt, because storage times differ per package.

Menopur experiences: what do users report?

Dissolving it is again what gets mentioned most, as with other powder forms. After a few days it becomes routine.

What women mention positively:

• After two or three times, preparing it goes quickly
• The needle is thin and injecting is easier than expected
• Combining several vials in one injection saves injection moments

What comes back as difficult:

• The dissolving ritual takes more time than a pen
• A burning feeling at the injection site in some women
• A bloated belly in the second week
• Doubt about whether the drug is as good as the pens

Picture two women of 36 both given Menopur in an antagonist schedule. One has eight mature follicles after nine days and barely any complaints. The other grows more slowly, injects two days longer and then has a fuller belly. Same drug, different pace, and that is normal.

Which values does the clinic track?

Oestradiol and the ultrasound steer your dose. Oestradiol rises with the number of maturing follicles, the scan counts and measures them. Together they decide when you may trigger.

Before the start, AMH is the most important predictor of your response. LH and FSH give additional information about the signalling.

You can have an AMH test or the broader IVF blood test beforehand, assessed by a BIG-registered doctor. See also AMH value by age and the full IVF route.

Frequently asked questions

How long do you use Menopur?

Usually about 8 to 12 days, until your follicles are large enough. The scan decides that, not a fixed number of days. A slower response can take longer.

How quickly do follicles grow with Menopur?

Maturing follicles grow on average about one to two millimetres a day in the active phase. The clinic triggers when the largest reach a certain diameter. That threshold differs per protocol.

Can you combine Menopur with a pen?

Some schedules combine recombinant FSH with Menopur for the LH activity. Whether that suits you is for your gynaecologist to decide based on your response. Combining them yourself is not a good idea.

Does Menopur hurt more than other drugs?

Some women experience a bit more stinging at the injection site. Injecting slowly, letting the liquid reach room temperature and changing the spot often helps. If it stays unpleasant, raise it at the clinic.

Is Menopur safe, given it comes from urine?

The material is heavily purified and the drug has been used and monitored by medicines authorities for decades. The large review found no difference in safety compared with recombinant products (PMID 21328276).

To my mind this is the drug carrying the most unnecessary worry. The origin sounds odd and the dissolving takes time, but on the numbers that matter it performs equally. Ask during the instruction whether you may combine several vials in one injection. That is the adjustment that genuinely shortens the daily ritual.

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP or your gynaecologist.

References

• Farmacotherapeutisch Kompas. Menotrophin. Accessed 2026.
• Thuisarts.nl. I am having IVF. Accessed 2026.
• van Wely M, Kwan I, Burt AL, Thomas J, Vail A, Van der Veen F, Al-Inany HG. Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles. Cochrane Database of Systematic Reviews, 2011. PMID 21328276.
• Al-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database of Systematic Reviews, 2016. PMID 27126581.
• Tang H, Mourad SM, Wang A, Zhai SD, Hart RJ. Dopamine agonists for preventing ovarian hyperstimulation syndrome. Cochrane Database of Systematic Reviews, 2021. PMID 33851429.