Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition
- PMID: 18978637
- DOI: 10.1097/GME.0b013e31817ee0c2
Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition
Abstract
Objective: The menopausal transition is characterized by irregular menstrual cycles and unpredictable hormone levels, including dramatic swings in estradiol (E2). An increasing number of studies have found variable high E2 and low luteal phase progesterone occur with progression of Stages of Reproductive Aging Workshop (STRAW)stage, but the cause remains unclear. To explore the causes of the erratic changes in E2, individual within-cycle secretion patterns of E2, progesterone, follicle-stimulating hormone, luteinizing hormone, inhibin A, and inhibin B were explored in detail.
Design: Blood samples taken three times per week over 1 1/3 menstrual cycles from 77 women aged 21 to 55 classified as mid-reproductive age (STRAW stages 5 and 4; n = 21), late-reproductive age (STRAW stages 4 and 3; n = 16), early menopausal transition (STRAW stage 2; n = 17), and late menopausal transition (STRAW stage 1; n = 23) were analyzed.
Results: Eleven of the 29 (37%) early and late menstrual transition ovulatory cycles exhibited a specific pattern of E2 secretion that was characterized by a second increase in E2 during the mid- and late luteal phases and that continued to a peak during the subsequent menstrual phase. This second rise and fall in E2 was typical in appearance of a normal follicular phase, except that it was superimposed on an existing ovulatory cycle(specifically during the luteal and menstrual phases). The pattern was therefore referred to as a luteal out-of-phase(LOOP) follicular event. In four of these LOOP cycles, a luteinizing hormone peak and ovulatory episode followed the second E2 peak early in the subsequent cycle. Compared with the typical ovulatory cycles, the cycles with LOOP events exhibited lower luteal phase progesterone, higher early cycle follicle-stimulating hormone, and lower early cycle inhibin B. They were also associated with abnormally short (<21 d) or long (>40 d) cycle length.
Conclusions: Many of the marked increases in ovulatory cycle E2 and cycle irregularities during the menopausal transition may be due to LOOP events and appear to be triggered by prolonged high follicular phase follicle-stimulating hormone levels.
Similar articles
-
The normal menstrual cycle in women.Anim Reprod Sci. 2011 Apr;124(3-4):229-36. doi: 10.1016/j.anireprosci.2010.08.030. Epub 2010 Sep 3. Anim Reprod Sci. 2011. PMID: 20869180 Review.
-
A proposed classification system for menstrual cycles in the menopause transition based on changes in serum hormone profiles.Menopause. 2008 Nov-Dec;15(6):1139-44. doi: 10.1097/gme.0b013e3181735687. Menopause. 2008. PMID: 18779761
-
Cycle and hormone changes during perimenopause: the key role of ovarian function.Menopause. 2008 Jul-Aug;15(4 Pt 1):603-12. doi: 10.1097/gme.0b013e318174ea4d. Menopause. 2008. PMID: 18574431
-
A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne Women's Midlife Health Project.Hum Reprod Update. 2007 Nov-Dec;13(6):559-65. doi: 10.1093/humupd/dmm020. Epub 2007 Jul 14. Hum Reprod Update. 2007. PMID: 17630397 Review.
-
Endocrine features of menstrual cycles in middle and late reproductive age and the menopausal transition classified according to the Staging of Reproductive Aging Workshop (STRAW) staging system.J Clin Endocrinol Metab. 2007 Aug;92(8):3060-7. doi: 10.1210/jc.2007-0066. Epub 2007 Jun 5. J Clin Endocrinol Metab. 2007. PMID: 17550960
Cited by
-
The FIGO Ovulatory Disorders Classification System†.Hum Reprod. 2022 Sep 30;37(10):2446-2464. doi: 10.1093/humrep/deac180. Hum Reprod. 2022. PMID: 35984284 Free PMC article.
-
The FIGO ovulatory disorders classification system.Int J Gynaecol Obstet. 2022 Oct;159(1):1-20. doi: 10.1002/ijgo.14331. Epub 2022 Aug 19. Int J Gynaecol Obstet. 2022. PMID: 35983674 Free PMC article.
-
Medroxyprogesterone Acetate for Abnormal Uterine Bleeding Due to Ovulatory Dysfunction: The Effect of 2 Different-Duration Regimens.Med Sci Monit. 2022 Jun 24;28:e936727. doi: 10.12659/MSM.936727. Med Sci Monit. 2022. PMID: 35746846 Free PMC article.
-
Premenstrual Mood Symptoms in the Perimenopause.Curr Psychiatry Rep. 2021 Oct 6;23(11):73. doi: 10.1007/s11920-021-01285-1. Curr Psychiatry Rep. 2021. PMID: 34613495 Review.
-
Levonorgestrel-Releasing Intrauterine System Use in Perimenopausal Women.J Menopausal Med. 2021 Aug;27(2):49-57. doi: 10.6118/jmm.20038. J Menopausal Med. 2021. PMID: 34463068 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical