The Menopausal Transition: Analysis of LH, FSH, Estradiol, and Progesterone Concentrations During Menstrual Cycles of Older Women

Abstract

Studies of menstrual cycle length in large populations demonstrated that there is a striking increase in the variability of intermenstrual intervals just before menopause. The changes in serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), and progesterone (P) during menstrual cycles in a group of perimenopausal women were compared with the findings in young normal women. In 8 women, 46-56 years old with regular cycles, cycle length was shorter and the mean E2 concentration was lower than in younger women. There was a striking increase in FSH concentration throughout the cycle while LH remained in the normal range. In 2 women, 14 cycles of variable length were studied during 2 years of the menopausal transition. In some instances, hormonal changes associated with follicular maturation and corpus luteum function occurred in the presence of high, menopausal levels of LH and FSH with a diminished secretion of E2 and P. In others vaginal bleeding occurred during a fall in serum E2 with no associated rise in P. Cycles of variable length during the menopausal transition may be due either to irregular maturation of residual follicles with diminished responsiveness to gonadotropin stimulation, or to anovulatory vaginal bleeding that may follow estrogen withdrawal without evidence of corpus luteum function. The observation of elevated FSH concentrations and normal LH levels in perimenopausal women emphasizes the complexity of the hypothalamic-pituitary-ovarian regulatory system and suggests that LH and FSH are modulated independently at the level of the pituitary.

Assessing menstrual cycles with urinary hormone assays

“…Older women also appear to suffer from relative luteal inadequacy. This finding has been reported in some (26,31) but not all (4,22,32) previous studies. Thus the initial consequences of a dwindling supply of follicles include changes in all of the key characteristic hormones in terms of both relative quantity and pattern.…”

“…In the cycles of women who are in their 40s, follicular phase shortening is often observed, along with increased FSH levels, especially in the early follicular phase of the cycle (16,18,(31)(32). The presumption that progesterone production follows ovulation and that corpus luteum function is Fig.…”

Effects of a low-fat high-carbohydrate diet on plasma sex hormones in premenopausal women: results from a randomized controlled trial

“…The effect of dietary intervention on oestradiol levels appears to be due to longer menstrual cycles in a relatively small number of subjects in the intervention group, and this result should, therefore, be replicated in a larger number of subjects. However, blood levels of oestradiol are known to fall in the years that precede the menopause (Sherman et al, 1976), and an acceleration of these changes might explain the reduction in oestradiol levels and the long intervals between last menstrual period and the day of blood sampling observed in premenopausal women in the present study. The effects of the dietary intervention on progesterone and FSH levels are also suggested by these data but, in the absence of significant interaction terms, require further investigation.…”

The effects of body mass index on age at menopause

“…26 Although the affinity of estrone for the receptor is one-half to one-third that of estradiol, 26 plasma estrone may supplement the effects of estradiol, which starts to decrease in the mid-thirties. 32,33 Therefore, we think that increased peripheral production of estrone in obese women may contribute patho-physiologically to the delay in age at menopause resulting from obesity.…”