A longitudinal study of the perimenopausal transition: altered profiles of steroid and pituitary hormones, SHBG and bone mineral density.
Level 3 - non-randomized controlled study
Prospective longitudinal cohort study without randomized comparison
PubMed 19434880 · doi:10.1016/j.maturitas.2008.09.010
What was done
A prospective longitudinal cohort study tracked 160 women experiencing spontaneous natural menopause without steroid hormone therapy across a 12-year transition window (152 completed the study). Blood samples were collected every 6 months until 1 year postmenopause and every 12 months thereafter to evaluate pituitary gonadotropins (FSH, LH), steroid hormones (estrone, 17-beta-estradiol, progesterone, testosterone, delta4-androstenedione), and sex hormone-binding globulin (SHBG). Forearm bone mineral density (BMD) was assessed biennially, and climacteric symptoms were monitored via periodic questionnaires. All measurements were aligned chronologically relative to the onset of menopause.
What was found
Serum FSH and LH increased significantly starting approximately 5 years prior to menopause, peaking 1 year postmenopause for LH and 2–3 years postmenopause for FSH, followed by gradual declines over the next 4–8 years. Progesterone dropped as anovulatory cycles increased and remained consistently low postmenopause. Estradiol (E2) and estrone (E1) decreased markedly in the 6 months surrounding menopause, with E2 showing the sharpest drop. Testosterone, androstenedione, and SHBG decreased slightly around menopause and stabilized after 3 years postmenopause. Postmenopausal forearm BMD declined and correlated positively with estradiol from 3 years postmenopause onward. Body mass index correlated inversely with SHBG and positively with E1 and E2. The abstract provides no exact numerical values, effect sizes, or test statistics.
Why it matters
This study defines the multi-year timeline of endocrine shifts during the natural menopausal transition, demonstrating that gonadotropin elevations precede the final menstrual period by years and establishing the longitudinal link between endogenous estradiol decline and postmenopausal bone loss.
Limits
The abstract reports no numerical data, variance measures, or p-values. BMD measurements were restricted to the forearm rather than axial skeletal sites (lumbar spine or femoral neck). The sample size was modest (n = 160) and limited to healthy women with spontaneous menopause, limiting generalizability to surgical menopause or broader patient demographics.
Cited by
- supports During perimenopause, progesterone is the first hormone to decline.
- context Estrogen, progesterone, and testosterone levels drop in women after ages 40 to 45.