Nomenclature and endocrinology of menopause and perimenopause

Abstract

The early and late perimenopausal transition is characterized by changing cycle length as well as by menopausal symptoms in some women, including increasing hot flashes and night sweats. Breast tenderness decreases as women enter the late transition. This review, as part of the clinical reviews on the menopausal woman with comorbidity, covers the endocrine phenomena of perimenopause, terminology and the observed clinical characteristics of the transition. It should be noted that the definitions covering this period vary between publications. The average duration of perimenopause is approximately 5A years. The earliest detectable hormonal change is a fall in ovarian secretion of inhibinA B, with a subsequent rise in follicle-stimulating hormone and maintained or increased levels of estradiol. As women transit the perimenopause, cycle irregularity increases, with the more frequent occurrence of prolonged ovulatory and anovulatory cycles. Levels of follicle-stimulating hormone and estradiol fluctuate increasingly and luteal function declines. Vasomotor symptoms tend to be most frequent around the time of final menses. The perimenopause is thus a time of cycle and hormone variability and single hormone measurements provide little useful information, with the clinical history being the most appropriate method of assessing menopausal status. This information will be very helpful to the clinician treating the concerned and symptomatic patient. It will also aid clinicians to avoid unnecessary laboratory testing and help them educate their patients about their perimenopause.

Factors That May Influence the Experience of Hot Flushes by Healthy Middle-Aged Women

“…As a result of a longitudinal prospective study, Freeman et al 12 reported that the risk of HFs increased throughout the menopausal transition and was greatest in postmenopausal women (odds ratio [OR] 2.87, 95% confidence interval [CI] 1.76-4.67, p < 0.001). In addition, VMS were most strongly related to the late menopausal transition stage in all racial=ethnic groups 10,14,16,17 and nearly as strongly related to postmenopause, even after adjusting for covariates, 10,12,[18][19][20][21][22] as reported in several other published cross-sectional, 10,[16][17][18]20,22 longitudinal prospective, 12,21 and review 14,19 23 Therefore, when performing analysis on factors that affect the incidence or severity of HFs, the nomenclature of the menopausal stages should be introduced along with other covariates in the final multivariate analysis. In summary, the menopausal stages (mainly the menopausal transition and postmenopause) are strongly associated with HFs, but there is still no single menopausal stage that has been identified as the critical time point for experiencing HFs.…”

“…Therefore, in 2001, the Stages of Reproductive Aging Workshop (STRAW) proposed conventional terminology for menopause stages. Later, the ReSTAGE Collaboration added supplementary definitions to reproductive aging, 14 thus allowing a comparable distinction between reproductive aging and general aging events. Burger et al…”

A novel mechanism: Erxian Decoction, a Chinese medicine formula, for relieving menopausal syndrome

“…Menopause is a process of normal aging, during which the level of estradiol secreted by the ovaries gradually declines, and menopausal women therefore have irregular menses and much higher incidences of physiological and mental changes, which severely disrupt their quality of life (Burger et al, 2007). The solution to overcome menopausal symptoms seems simple-hormone replacement therapy.…”

Neuroprotection in Perimenopausal Women

“…The central and peripheral hormonal changes in menopausal transition and perimenopause were assessed in many research centers from Western Europe [37], Australia [24,38], North America [25], and besides these, the rat models on gene expression analyses demonstrated that there are two distinct aging programs: chronological and endocrine, regarding bioenergetic gene expression involved in brain metabolism and synaptic plasticity [39].…”