Menopause: a natural event Henry Burger. Relationships between different time periods surrounding...
-
Upload
virgil-hart -
Category
Documents
-
view
212 -
download
0
Transcript of Menopause: a natural event Henry Burger. Relationships between different time periods surrounding...
Menopause:Menopause:a natural eventa natural event
Henry Burger
Relationships between different time Relationships between different time periods surrounding the menopauseperiods surrounding the menopause
International Position Paper: Women’s Health and Menopause, NIH (2002)
Final menstrual period (FMP)Menopause
Postmenopause
Perimenopause
Menopausal transition
Climacteric
Mean age51 years
1 yearlater
Women in Block's study
Women from the present study with regular menses
Postmenopausal women
Perimenopausal women
Richardson et al. JCEM 1987
Ovarian follicle numbers with ageOvarian follicle numbers with age
BB
BB
B
J
F
FF
F
F
F
F
Age (years)
1
10
100
1000
10000
100000
0
0 10 20 30 40 50 60
Pri
mo
rdia
l fo
llic
les/
ova
ry
GnRH
Inhibin
Pituitary
Gonadotropins: - LH, FSH
Steroids
HypothalamusFeedbackhormones
Hypothalamo-pituitary ovarian Hypothalamo-pituitary ovarian axisaxis
Ovary
Log (inhibin B)
5.04.54.03.53.02.52.01.5
Lo
g (
FS
H)
4.5
4.0
3.5
3.0
2.5
2.0
1.5
Burger HG et al. Climacteric 2000
Relationships betweenRelationships betweenFSH and inhibin BFSH and inhibin B
< 40 years of age
> 40 years of age
Geometric mean annual hormone Geometric mean annual hormone levels relative to date of final menseslevels relative to date of final menses
*
Burger HG et al. JCEM 1999
0
10
20
30
40
50
60
-4 -3 -2 -1 0 1 2 3 4 5
Years around menopause
Inh
ibin
A (
ng
/l)
0
10
20
30
40
50
60
Inh
ibin
B (
ng
/l)
0
50
100
150
200
250
300
-4 -3 -2 -1 0 1 2 3 4 5
Est
rad
iol
(pm
ol/
l)
0
20
40
60
80
100
120
FS
H (
IU/l
)
(InhB)(InhA)
41%36%
71%43%
62%57%
80%65%
80%80%
78%78%
94%94%
* Percent of samples with undetectable inhibin
AndrogensAndrogensin the menopausal transitionin the menopausal transition
• In normal women, there is a 50% decrease in circulating concentrations of testosterone and dehydroepiandrosterone sulfate (DHEAS) from age 20 to age 451,2
• There is little if any decline in testosterone during the transition2,3
• DHEAS levels continue to fall with age, with no specific association with the transition
• The medical ‘myth’ that menopause is associated with an acute drop in androgens does not appear to be tenable any longer
1Zumoff 1995, 2Davison 2005; 3Burger 2000
Other endocrine featuresOther endocrine features
• Loss of LH response to an estradiol challenge in the perimenopause1,2
• Predominant circulating estrogen in reproductive life is estradiol, secreted by the ovary; postmenopausally it is estrone, produced by peripheral androgen aromatization3
• Anti-Müllerian hormone (also called Müllerian inhibiting substance), a member of the TGF super family and a product of preantral and small antral follicles, is under investigation as a marker for the size of the ovarian follicle pool4 and a promising predictor for the occurrence of the transition5
1Van Look 1977; 2Weiss 2004; 3Maroulis 1976; 4Visser 2006; 5van Rooij 2004