Hormonal changes in the menopause transition
Open accessAbstract
The menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is heralded by the menopausal transition, a period when the endocrine, biological, and clinical features of approaching menopause begin. A common initial marker is the onset of menstrual irregularity. The biology underlying the transition to menopause includes central neuroendocrine changes as well as changes within the ovary, the most striking of which is a profound decline in follicle numbers. Follicle-stimulating hormone (FSH) is an established indirect marker of follicular activity. In studies of groups of women, its concentration, particularly in the early follicular phase of the menstrual cycle, begins to increase some years before there are any clinical indications of approaching menopause. The rise in FSH is the result of declining levels of inhibin B (INH-B), a dimeric protein that reflects the fall in ovarian follicle numbers, with or without any change in the ability of the lining granulosa cells to secrete INH-B. Estradiol levels remain relatively unchanged or tend to rise with age until the onset of the transition and are usually well preserved until the late perimenopause, presumably in response to the elevated FSH levels. During the transition, hormone levels frequently vary markedly - hence, measures of FSH and estradiol are unreliable guides to menopausal status. Concentrations of testosterone have been reported to fall by about 50% during reproductive life, between the ages of 20 and 40. They change little during the transition and, after menopause, may even rise. Dehydroepiandrosterone (DHEA) and DHEAS, its sulphate, on the other hand, decline with age, without any specific influence of the menopause. Symptoms of the menopause can be interpreted as resulting primarily from the profound fall in estradiol, occurring over a 3- to 4-year period around final menses, a fall that presumably contributes importantly to the beginning, in the late perimenopause, of loss of bone mineral density.
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Flushes often begin during the perimenopausal period when there are wide fluctuations in serum estrogen.
“Flushes often begin during the perimenopausal period when there are wide fluctuations in serum estrogen (Burger et al., 2002).”
From Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: A novel hypothesis on the mechanism of hot flushes (2013) · cites this paper as Burger et al., 2002
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- Authors
- Burger, H. G.
- Affiliations
- Monash Medical Centre (AU)
- Corresponding author
- Burger, H. G.
- ORCID
- Burger, H. G.
- Venue
- Recent Progress in Hormone Research
- Publisher
- The Endocrine Society
- Published
- 2002-01-01
- Volume
- 57
- Issue
- 1
- Pages
- 257-275
- ISSN
- 0079-9963 (ISSN-L)
- OpenAlex
- W2124569831
- Cited by
- 530
- References
- 27
- Citations by year
- 2026: 27 · 2025: 48 · 2024: 25 · 2023: 31 · 2022: 29 · 2021: 13 · 2020: 15 · 2019: 13 · 2018: 17 · 2017: 20 · 2016: 20 · 2015: 23 · 2014: 24 · 2013: 21 · 2012: 24
- FWCI
- 7.98
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Recent Progress in Hormone Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Oxford Brookes University
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Keywords
- menopause, perimenopause, follicle-stimulating hormone, inhibin B, estradiol, testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, menstrual irregularity, bone mineral loss, neuroendocrine changes
- MeSH terms
- Adult, Aging, Androgens, Estradiol, Female, Follicle Stimulating Hormone, Hormones, Humans, Inhibins, Menopause, Middle Aged, Ovary, Pituitary Gland, Progesterone, World Health Organization
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