Hormonal changes in the menopause transition.
Level 5 - mechanism / opinion, no new human data
Narrative review of endocrine mechanisms without systematic search methodology or primary dataset
PubMed 12017547 · doi:10.1210/rp.57.1.257
What was done
This review describes the endocrine and neuroendocrine mechanisms of the menopausal transition, focusing on follicular depletion and the longitudinal trajectories of follicle-stimulating hormone (FSH), inhibin B, estradiol, testosterone, and dehydroepiandrosterone (DHEA/DHEAS).
What was found
Early follicular phase FSH begins rising years before clinical symptoms emerge, resulting from declining inhibin B secreted by a depleted ovarian follicle pool. Estradiol levels remain preserved or slightly elevated until late perimenopause, followed by a profound drop over a 3- to 4-year period surrounding final menses. Marked hormonal fluctuations during the transition render isolated measures of FSH and estradiol unreliable for determining menopausal status. Testosterone declines by approximately 50% between ages 20 and 40 with little change during the transition, while DHEA and DHEAS decline steadily with age independent of menopause.
Why it matters
It highlights that single hormone measurements of FSH or estradiol are not reliable diagnostic markers for menopausal stage due to high within-woman variability, and it distinguishes ovarian-failure-driven hormone changes from age-related adrenal androgen decline.
Limits
This is a narrative review with no systematic search criteria, quality appraisal of cited studies, or primary human subject data presented in the abstract. Quantitative variance, effect estimates, and sample demographics are not reported.
Cited by
- context Estrogen, progesterone, and testosterone levels drop in women after ages 40 to 45.