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Perimenopause: The Complex Endocrinology of the Menopausal Transition

Department of Medicine, Division of Endocrinology, University of British Columbia, and Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada V5Z 1C6

I. Introduction

II. Defining the Perimenopause

III. Classic Studies of the Perimenopause

A. Historical studies

B. Early reports of women’s experiences in the perimenopause

C. Early prospective menstrual cycle interval and basal temperature documentation

IV. Prospective Epidemiological Studies of the Perimenopause

A. Manitoba Project on Women and Their Health in the Middle Years

B. Massachusetts Women’s Health Study

C. Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study

V. Systematic Studies of the Endocrinology of the Perimenopause

A. Cross-sectional (single-cycle) hormonal studies in the perimenopause

B. Prospective ovarian hormonal levels in the perimenopause

VI. Histological Studies of Ovarian Changes Across the Lifespan

VII. Physiological Studies of Changing Ovarian Hormones in Women in Their Forties and Fifties

A. Folliculogenesis and ovarian hyperstimulation for in vitro fertilization (IVF)

B. Inhibin physiology in women over forty

VIII. Hypotheses to Explain Perimenopausal Endocrinology

A. Pathophysiology of the proposed perimenopausal endogenous ovarian hyperstimulation syndrome

B. Five hypothesized phases of the perimenopausal transition

IX. Hormonal Physiology of the Clinical Changes in the Perimenopause

A. Endocrinology of menstrual flow and cycle-related symptoms

B. Vasomotor symptoms in the perimenopause

C. Perimenopause and the risk for osteoporosis

D. The endocrinology of perimenopausal psychosocial and emotional experiences

X. Summary and Necessary Research