ReviewsCurrent opinion in endocrine and metabolic research perimenopause: Utility of testing
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.
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