Characterization of reproductive hormonal dynamics in the perimenopause.
Characterization of reproductive hormonal dynamics in the perimenopause.
复制标题
DOI：
10.1210/jcem.81.4.8636357
复制
发表时间：
1996-04
期刊：
影响因子：
--
通讯作者：
N. Santoro;Julianne R. Brown;Tovaghgol Adel;J. Skurnick
中科院分区：
文献类型：
--
作者：
N. Santoro;Julianne R. Brown;Tovaghgol Adel;J. Skurnick
围绝经期妇女的药物治疗存在争议，部分原因是这一时期的卵巢激素分泌程度不同。为了扩大我们对围绝经期妇女生殖内分泌环境的了解，我们对6名47岁及以上的骑车妇女进行了为期6个月的研究，每天收集第一次晨间排尿。另外5名老年育龄妇女(43-47岁)在一个月经周期进行每日尿液和血清采样；她们的尿激素数据与前一组相结合进行月经周期比较。测定尿液中促黄体生成素、卵泡刺激素、雌酮结合物和孕二醇葡萄糖醛酸苷，并将其归一化为肌酐(Cr)。11名生育中期(19-38岁)正常骑行的妇女，5名明确的卵巢早衰妇女，以及5名54岁及以上绝经后至少1年的妇女作为对照。围绝经期妇女卵泡期较短(11+/-2天比14+/-1天；P=0.031)，因此月经周期比生育中期对照组短。围绝经期妇女促卵泡刺激素排泄量高于年轻妇女(均值范围4~32对3~7IU/g肌酸；P=0.0005)。黄体生成素的分泌总体上高于年轻的正常受试者(平均值范围为1.4-6.8IU/gCr；P<；0.026)。总体而言，围绝经期妇女的雌酮结合物排泄量高于年轻妇女[76.9ngmgCr13.1-135vs.40.7ngmgCr22.8-60.3；P=0.023]，在卵泡期和黄体期也有类似的升高。与年轻的正常人相比，围绝经期妇女黄体期的孕二醇排泄量减少(孕二醇积分范围为1.0-8.4vs.1.6-12.7微克/mg铬/黄体期；P=0.015)。与绝经后妇女相比，围绝经期妇女的雌酮排泄量较多(绝经后妇女为2.5~6.2 ng/mg Cr值，P=0.0 2)，平均FSH值(绝经后均值为24~85IU/gCr值，P=0.017)和LH值(绝经后均值为4.3~14.8IU/gCr值，P=0.041)较低。与过早绝经的妇女相比，围绝经期妇女再次具有更低的卵泡刺激素(绝经前的平均值范围，36-82IU/g铬；P=0.0022)，更低的黄体生成素(提前绝经的平均值范围，5.5-23.8IU/克铬；P=0.0092)，更高的平均雌酮结合物(提前绝经的平均值范围，4-44 ng/mg铬；P=0.064)，以及更长的卵巢活动期(过早绝经妇女为一至两个周期，而围绝经期妇女为三至六个周期)。我们得出结论，围绝经期卵巢功能的改变可以早在43岁时观察到，包括高雌激素、高促性腺激素和黄体期黄体酮排泄减少。这些荷尔蒙变化很可能是妇科发病率增加的原因，这是这一生命阶段的特征。
Medical therapy for women in the perimenopausal period is controversial, in part due to varying degrees of ovarian hormone secretion characteristic of this time of life. To extend our understanding of the reproductive endocrine milieu of perimenopausal women, we studied 6 cycling women, aged 47 yr and older, for 6 months with daily collections of first morning voided urine. Five additional older reproductive aged (43-47 yr old) women were studied with daily urine and serum sampling for a single menstrual cycle; their urinary hormone data were combined with the former group for menstrual cycle comparisons. Urine was assayed for LH, FSH, estrone conjugates, and pregnanediol glucuronide and normalized for creatinine (Cr). Eleven midreproductive aged (19-38 yr old) normally cycling women, 5 women with well defined premature ovarian failure, and 5 women aged 54 yr and older who were at least 1 yr postmenopausal were used for comparison. Perimenopausal women had shorter follicular phases (11 +/- 2 days vs. 14 +/- 1 days; P = 0.031) and, hence, shorter menstrual cycles than midreproductive aged controls. FSH excretion in perimenopausal women was greater than that in younger women (range of means, 4-32 vs 3-7 IU/g Cr; P = 0.0005). LH secretion was overall greater than that in younger normal subjects (range of means, 1.4-6.8 vs. 1.1-4.2 IU/g Cr; P < 0.026). Overall mean estrone conjugate excretion was greater in the perimenopausal women compared to that in the younger women [76.9 ng/mg Cr (range, 13.1-135) vs. 40.7 ng/mg Cr (range, 22.8-60.3); P = 0.023] and was similarly elevated in both follicular and luteal phases. Luteal phase pregnanediol excretion was diminished in the perimenopausal women compared to that in younger normal subjects (range for integrated pregnanediol, 1.0-8.4 vs. 1.6-12.7 microg/mg Cr/luteal phase; P = 0.015). Compared to postmenopausal women, perimenopausal women had more overall estrone excretion (2.5-6.2 ng/mg Cr in postmenopausal women; P = 0.02) and lower mean FSH (range of means for postmenopause, 24-85 IU/g Cr; P = 0.017) and LH (range for postmenopause, 4.3-14.8 IU/g Cr; P = 0.041). Compared to women with premature menopause, perimenopausal women again had lower FSH (range of means for premature menopause, 36-82 IU/g Cr; P = 0.0022), lower LH (range of means for premature menopause, 5.5-23.8 IU/g Cr; P = 0.0092), borderline higher mean estrone conjugates (range of means for premature menopause, 4-44 ng/mg Cr; P = 0.064), and far longer periods of ovarian activity (one to two cycles in prematurely menopausal women vs. three to six cycles in perimenopausal women). We conclude that altered ovarian function in the perimenopause can be observed as early as age 43 yr and include hyperestrogenism, hypergonadotropism, and decreased luteal phase progesterone excretion. These hormonal alterations may well be responsible for the increased gynecological morbidity that characterizes this period of life.