Chapter 11 – Menopause

Normal physiological and endocrine changes at perimenopause and post menopause

Menstrual irregularity 

The primary event in the menopause transition is the ageing of the ovaries and attrition of ovarian follicles. The critical change appears to be in the number of ovarian follicles. Rapid loss of follicles occurs when the total number of follicles reaches approximately 25,000. This usually occurs when women are around the age of 37–38 years.(7) The size of the ovarian reserve is the major determinant of both the transition from regular menses to the perimenopause, as well as to the menopause itself.(8) The menopausal transition occurs when the ovarian primordial follicle numbers decrease to around 100.(9)

The reduced quality and capability of ageing follicles is reflected in an increase in the serum follicle-stimulating hormone (FSH) from the pituitary, and reduced follicular secretion of B inhibin, which is produced by the granulosa cells of the ovary, and is implicated in the pituitary’s negative feedback influence over FSH secretion. Once menstruation has ceased, ovarian follicle attrition is complete, and there are few remaining follicles. The cardinal change after menopause is the hormonal profile, which is primarily responsible for the physiological changes in the postmenopausal woman.

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Hormonal changes 

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Oestrogen

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Testosterone 

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