The endocrinology of the menopause
The endocrinology of the menopause
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DOI：
10.1016/s0960-0760(98)00145-9
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发表时间：
1999-04-01
影响因子：
4.1
通讯作者：
Burger, HG
中科院分区：
文献类型：
--
作者：
Burger, HG
绝经被定义为由于卵巢卵泡活动的丧失而导致月经的永久停止。卵巢原始卵泡数量随着年龄的增长而减少，大约在38岁之后，在最后12年左右的生殖寿命中有一个更急剧的下降。在绝经期，卵巢内的卵泡已经很少了。最近二聚体抑制素A和B特异性测定的可用性已经允许澄清导致最终月经前后发生的内分泌事件。那些40岁以上的女性血清中卵泡刺激素水平明显升高，但仍有规律地来月经，她们的抑制素B水平明显低于那些卵泡刺激素水平保持在生育期早期范围内的女性。在更年期过渡的早期，当第一次观察到周期不规律时，最初的事件是在早期卵泡期循环抑制素B水平下降。在绝经后期，雌二醇和抑制素A的水平也下降，抑制素B的水平仍然很低，FSH明显升高。40多岁的女性体内激素水平的变化，甚至是那些仍有规律来月经的女性，使得卵泡刺激素和雌二醇不可靠地成为绝经状态的标志。血清雄激素水平似乎随着年龄的增长而下降，而与更年期过渡或更年期没有任何明确的关系。在绝经过渡期和绝经后早期发生的内分泌变化在症状和骨量变化方面具有临床后果。1999爱思唯尔科学有限公司版权所有。
Menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Ovarian primordial follicle numbers decrease with increasing age up to about age 38 following which there is a much steeper decline in the last 12 or so years of reproductive life. At the time of the menopause itself, few follicles remain within the ovary. The recent availability of assays specific for the dimeric inhibins A and B has permitted clarification of the endocrine events leading up to and occurring around the time of final menses. Those women who show clear elevations in serum FSH above age 40, while continuing to cycle regularly have significantly lower inhibin B levels than those whose FSH levels remain in the range seen earlier in reproductive life. Early in the menopause transition, when cycle irregularity is first observed, the initial event is a decline in circulating inhibin B levels in the early follicular phase. In the late perimenopause, levels of estradiol and inhibin A also fall, inhibin B levels remain low and FSH is markedly elevated. The variability of hormone levels in women in their 40s, even in those who are continuing to cycle regularly makes FSH and estradiol unreliable markers of menopausal status. Serum androgen levels appear to fall with age rather than having any clear cut relationship to the menopause transition or menopause. The endocrine changes which occur during the menopausal transition and early postmenopausal period have clinical consequences in terms of symptoms and changes in bone mass. (C) 1999 Elsevier Science Ltd. All rights reserved.