AimsNo study explores the association between follicle-stimulating hormone (FSH) and glucose metabolism in general women. We aim to investigate whether the variation of FSH is associated with prediabetes and diabetes in postmenopausal women.MethodsOur data were from survey on prevalence in East China for metabolic diseases and risk factors in 2014. Thousand six hundred and ten postmenopausal women at the age of 55–89 who were not using hormone replacement therapy were selected. Prediabetes and diabetes were defined according to American Diabetes Association 2014 criteria. FSH, luteinizing hormone, total testosterone and estradiol were measured by chemiluminescence. Multinomial logistic analyses were used for the association of FSH with prediabetes and diabetes, and linear regression for the association of FSH with fasting plasma glucose (FPG) and HbA1c.ResultsAmong the participants, 778 (48.3 %) had prediabetes and 121 (7.5 %) had newly diagnosed diabetes. In linear regression, after full adjustment for demographic variables, metabolic factors, E2 and LH, FSH was associated with FPG and HbA1c (P < 0.05). In logistic regression, increased quartiles of FSH were associated with significantly decreased odds ratios of prediabetes and diabetes (P for trend <0.01). This association was attenuated by waist circumference and HOMA-IR, but persisted in fully adjusted model (P for trend <0.05) in which, for the lowest compared with the highest quartile of FSH, the odds ratios of prediabetes and diabetes were 1.93 (95 % CI 1.21–3.08; P < 0.01) and 3.02 (95 % CI 1.10–8.31; P < 0.05), respectively.ConclusionsLow FSH was associated with prediabetes and diabetes in postmenopausal women. The associations might be partially explained by adiposity and insulin resistance.