Gonadotropin Changes in the Perimenopause
It is widely accepted that the hallmark aging change in the menstrual cycle is an increase in basal follicle-stimulating hormone (FSH) levels in the face of normal luteinizing hormone (LH), presumably due to greater sensitivity of FSH to declining ovarian feedback on the hypothalamic-pituitary-ovarian (HPO) axis. The monotropic, age-related rise in FSH occurs as early as the mid-childbearing years when ovulations are still regular, but when the overall ovarian reserve of follicles begins to decline along with fertility rates. This view of the neuroendocrinology of reproductive aging is based on data from relatively few studies that have relied mainly on daily or weekly hormone measures. Although this work has provided global estimates of changes in the HPO axis, the underlying neuroendocrine and paracrine mechanisms responsible for these changes remain obscure. Thus, little is known about the dynamic secretory characteristics associated with the dysfunctional follicular development that typifies the perimenopause years, or the nature of the neuroendocrine signal responsible for the striking discordance in LH and FSH secretion.
KeywordsEstrogen Progesterone Androgen Estradiol Prolactin
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