Perimenopause

Endocrinology of Menopause

-Depletion of # of follicles -Decreased sensitivity of the few remaining follicles -Gonadotrophins elevated: FSH increasing more than LH -estrogen decreased (peripheral conversion of androstenedione to estrone increase) -95% of androstenedione is secreted by the adrenal

Fertility starts to wane at _______ years of age

35 y/o *transition into menopause may start 10 yrs prior so usually in early 30's (length changes occur 8 yrs before menopause)

What is the average duration of perimenpause?

5 years can last 8 years. 95% of women experience perimenopasue from 2-8 years

A 50-year-old female comes to the general clinic for hot flushes and sweating. She also feels mild bloating sensation and feels she has put on weight. She insists on a hormonal profile which reveals testosterone being decreased and FSH, LH and inhibin to increase. What is next best step of management? Explain that the profile matches a normal postmenopausal woman. Explain that the profile matches a normal perimenopausal woman. Explain that the profile matches a normally menstruating woman. Explain the need to screen and monitor ovarian cancer. Explain that the hormonal profile is inconclusive and is NOT the best way diagnose her condition.

Explain the need to screen and monitor ovarian cancer.

T/F We test hormones levels to Dx women going through perimenopause

False. Don't ever test

T/F FSH and E1 are reliable to measure and Dx perimenopause because they do not fluctuate

False: FSH and E1 are variable in perimenopausal Woman which makes Dx perimenopause unreliable

Which symptoms are the most reported?

Interrupted Sleep Hot flashes

What is the average age of onset for perimenopause?

Mean age 46 y/o with 95% of women starting b/t 39-51 years

10 Staging System for Reproductive Aging in Women: Stage -2

Menopausal transition in early stage (perimenopause) Duration: variable length persistent > 7 day difference in length of consecutive cycles FSH: high or variable AMH (anti-Müllerian hormone): low Inhibin B: low Antral follicle count: low

10 Staging System for Reproductive Aging in Women: Stage -1

Menopausal transition in late stage (perimenopause) Duration: 1-3 years of interval amenorrhea of > or = 60 days FSH: high > 25 IU/L AMH (anti-Müllerian hormone): low Inhibin B: low Antral follicle count: low Vasomotor Sx likely

43 year old healthy woman presents with monthly menses complaining of 2 months of what she now knows are hot flashes. She is confused. She thought hot flashes came with menopause. What is her Dx?

Perimenpause

T/F Testosterone secretion is unchanged in the early years of menopause

True

T/F The neuroendocrine axis controls transition from regular cycles to irregular cycles but ovary determines ultimate cessation of cycles

True

T/F Menopause is the deterioration of "biological clock" meaning that the circadian rhythm is important to the reproductive cycle

True **Deterioration in neural pacemaker (suprachiasmic nuclei) or coupling of its outputs may initiate the gradual disintegration of the temporal organization of neurotransmitter rhythms

Perimenopausal Symptoms

Vasomotor symptoms Hot flashes Night sweats Insomnia Psychological symptoms Anxiety Emotional lability / irritability Impaired memory, concentration

Which of the following best describes the hormonal profile of a female with perimenopause in comparison to normal menstruating female? a) Testosterone - decreases, LH - increases, FSH - increases, Anti-mullerian hormone - Decreases, Inhibin - Increases b) Testosterone - decreases, LH - increases, FSH - increases, Anti-mullerian hormone - Decreases, Inhibin - decreases c) Testosterone - decreases, LH - decreases, FSH - decreases, Anti-mullerian hormone - decreases, Inhibin - increases d) Testosterone - decreases, LH - decreases, FSH - decreases, Anti-mullerian hormone - Increases Inhibin - increases

b) Testosterone - decreases, LH - increases, FSH - increases, Anti-mullerian hormone - Decreases, Inhibin - decreases

Perimenopause is characterized by changes in all levels of the ____________________________ axis and in all of the reproductive organs

hypothalamic-pituitary-ovarian