Reproductive hormones and the menopause transition

Abstract

The hormonal correlates of reproductive aging and the menopause transition reflect an initial loss of the follicle cohort, while a responsive ovary remains, and an eventual complete loss of follicle response, with persistent hypergonadotropic amenorrhea. The physiology of the process is described, along with key findings of relevant studies, with an emphasis on the Study of Women's Health Across the Nation. A clinical framework is provided to help clinicians to forecast the major milestones of the menopausal transition and to predict potential symptoms or disease.

Figures

Figure 1

Rates of change in FSH and estradiol shown anchored to the final menstrual period. Panel A shows the log transformed values, panel B shows back-transformed values. Reprinted with permission. A. Segmented mean profiles for natural logarithm-transformed FSH and E2. B. Segmented mean profiles for FSH and E2.

Figure 1

Rates of change in FSH and estradiol shown anchored to the final menstrual period. Panel A shows the log transformed values, panel B shows back-transformed values. Reprinted with permission. A. Segmented mean profiles for natural logarithm-transformed FSH and E2. B. Segmented mean profiles for FSH and E2.

Figure 2

Adjusted mean whole-cycle urinary reproductive hormones (with CI) by age and elapsed years since baseline (ovulatory cycles only). Note the prominent rise in FSH and decrease in Pdg with both age and years on study. A more modest rise in LH is observed, and E1c does not decline with age. Reprinted with permission.

Figure 3

Baseline serum hormones in the SWAN Study sample. Each of the ethnic groups in SWAN are shown as clusters of bars; within each cluster, individual bars show BMI tertiles. Reprinted with permission.

Figure 4

The effect of obesity (4A and B) and smoking (4C and D) on FSH and estradiol. Data are shown anchored to the FMP. Reprinted with permission. A. Population mean and 95% CI for mean FSH: obese vs. non-obese. B. Population mean and 95% CI for mean E2: obese vs. non-obese. C. Population mean and 95% CI for mean FSH: smoker vs. non-smoker. D. Population mean and 95% CI for mean E2: smoker vs. non-smoker.

Figure 4

The effect of obesity (4A and B) and smoking (4C and D) on FSH and estradiol. Data are shown anchored to the FMP. Reprinted with permission. A. Population mean and 95% CI for mean FSH: obese vs. non-obese. B. Population mean and 95% CI for mean E2: obese vs. non-obese. C. Population mean and 95% CI for mean FSH: smoker vs. non-smoker. D. Population mean and 95% CI for mean E2: smoker vs. non-smoker.

Figure 4

The effect of obesity (4A and B) and smoking (4C and D) on FSH and estradiol. Data are shown anchored to the FMP. Reprinted with permission. A. Population mean and 95% CI for mean FSH: obese vs. non-obese. B. Population mean and 95% CI for mean E2: obese vs. non-obese. C. Population mean and 95% CI for mean FSH: smoker vs. non-smoker. D. Population mean and 95% CI for mean E2: smoker vs. non-smoker.

Figure 4

The effect of obesity (4A and B) and smoking (4C and D) on FSH and estradiol. Data are shown anchored to the FMP. Reprinted with permission. A. Population mean and 95% CI for mean FSH: obese vs. non-obese. B. Population mean and 95% CI for mean E2: obese vs. non-obese. C. Population mean and 95% CI for mean FSH: smoker vs. non-smoker. D. Population mean and 95% CI for mean E2: smoker vs. non-smoker.