Reviews
Current opinion in endocrine and metabolic research perimenopause: Utility of testing

https://doi.org/10.1016/j.coemr.2022.100402Get rights and content

Abstract

The menopausal transition (MT) consists of an early MT (median age at onset 47 years) and late MT (median age at onset 49 years). However, large variation in duration of these stages and their associated symptoms is observed in large samples of women studied over time. There are many proposed biomarkers to predict the onset, progress, and end of the MT. This review will discuss transition staging and the strengths and weaknesses of tests proposed to assist the clinician and patient in predicting the time course of a woman's latter reproductive life span.

Section snippets

The menopausal transition

Menopause is defined when 12 months of amenorrhea have occurred after the final menstrual period (FMP) [1]; its median age is 49.6 years, with an interquartile range of 46.4–52.5 years [2]. The transition to menopause, also known as perimenopause, usually takes several years and entails a variety of symptoms accompanied by measurable changes in reproductive hormones [3,4]. In 2000, the Seattle Midlife Women's Health Study (SMWHS) defined stages of reproductive aging (early, middle, and late

Late reproductive stage

The Penn Ovarian Aging Study (POAS), a 5-year longitudinal study that followed women who were premenopausal at study onset to varying stages of menopause, defined a stage prior to the early menopause transition termed late pre-menopause. POAS linked very early changes in menstrual cycle length to significant underlying hormonal changes [9]. In 2011, when STRAW updated menopausal staging and nomenclature, a late reproductive stage (LRS; -3a and -3b, see Figure 1) was added [1], immediately prior

Pathophysiology of the menopause transition

As women approach the MT, their follicle cohort size decreases to a point where either menstrual cycle variability increases by more than 7 days or an entire menstrual cycle is skipped because there are no available follicles to grow to the preovulatory stage. This is a clinically definable event based on menstrual tracking. The reduced follicle cohort is associated with less circulating inhibin B, and this is believed to be the earliest event in the MT [12]. Inhibin B, TGF-beta superfamily

Clinical presentation

Patients experience a wide variety of symptoms. At one extreme, some women note almost no symptoms with an abrupt end of their menses. At the other, women report increasing hot flashes, worsening headaches, adverse mood and hot flashes as early as their late 30s. In general, women who begin the transition earlier in life have a longer and more symptomatic menopausal experience [20]. Symptoms typically begin in the early MT, peak in the late MT, and have variable duration, dependent upon many

Diagnostic testing

Perimenopausal patients often want to be able to predict when menstrual periods and fertility will end, as well as to forecast their symptom trajectory will be. This information is empowering and can inform decisions about when to discontinue contraception [28], whether to initiate medical therapy for symptoms, or how to select medical or surgical options for abnormal uterine bleeding due to structural causes [29]. Many diagnostic tests are available to assist in the diagnosis of perimenopause,

Conclusions

Perimenopause is likely not distinct, but a continuum of hormonal and cycle changes throughout the reproductive lifespan occurring in subtle ways. There are many diagnostic tests used to assist in the diagnosis of the MT, including most commonly FSH and AMH, but also more recently at home commercial testing. Currently, data are lacking on laboratory tests' ability to predict the exact timing of the FMP and there is limited support for their added predictive value beyond age and menstrual

Conflict of interest statement

NS reports being a member of the Scientific Advisory Board for Astellas, Menogenix, Inc and Que Oncology; she is a consultant for Ansh Labs and receives grant support to her institution from Menogenix, Inc.

References (38)

  • D. Zhao et al.

    Menopausal symptoms in different substages of perimenopause and their relationships with social support and resilience

    Menopause

    (2019)
  • E.W. Freeman et al.

    Symptoms associated with menopausal transition and reproductive hormones in midlife women

    Obstet Gynecol

    (2007)
  • E.S. Mitchell et al.

    Three stages of the menopausal transition from the Seattle Midlife Women's Health Study: toward a more precise definition

    Menopause

    (2000)
  • M.R. Soules et al.

    Executive summary: stages of reproductive aging workshop (STRAW) Park City, Utah, July, 2001

    Menopause

    (2001)
  • S.D. Harlow et al.

    Evaluation of four proposed bleeding criteria for the onset of late menopausal transition

    J Clin Endocrinol Metab

    (2006)
  • C.R. Gracia et al.

    Defining menopause status: creation of a new definition to identify the early changes of the menopausal transition

    Menopause

    (2005)
  • N.F. Woods et al.

    Transitioning to the menopausal transition: a scoping review of research on the late reproductive stage in reproductive aging

    Menopause

    (2021)
  • N. Coslov et al.

    Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey

    Menopause

    (2021)
  • D.M. Robertson et al.

    A proposed classification system for menstrual cycles in the menopause transition based on changes in serum hormone profiles

    Menopause

    (2008)
    • View full text
    © 2022 Elsevier Ltd. All rights reserved.