Hypothalamic-pituitary-ovarian function in perimenopausal women
van Look, P.F.; Lothian, H.; Hunter, W.M.; Michie, E.A.; Baird, D.T.
Clinical Endocrinology 7(1): 13-31
1977
ISSN/ISBN: 0300-0664 PMID: 328187 Document Number: 439508
In a group of 9 perimenopausal women aged 37-52 yr with dysfunctional uterine bleeding (DUB), serial measurements were made of urinary total estrogen and pregnanediol excretion and of plasma gonadotropin and steroid levels under basal conditions and during dynamic tests (estrogen provocation and LHRH, but not of LH, were higher than in controls. A similar monotropic increase in FSH was also present in a further patient whose cycles were irregular and included an ovulatory cycle with short follicular phase, an ovulatory cycle of normal length and an anovulatory cycle. In the remaining 5 women follicular development was infrequent and anovulation the rule. FSH and LH levels in these women were elevated despite the presence of circulating 17.beta.-estradiol levels in the early-mid follicular phase range. At the time of menopausal transition in 1 of these subjects, the decline of plasma 17.beta.-estradiol to undetectable levels was associated with a further rise of both gonadotropins. Conversely, following a prolonged period of follicular development with elevated urinary total estrogen excretion in another subject, the raised gonadotropin concentrations were suppressed and the pituitary response to LHRH was within the normal range. LHRH responses in the other 4 women were augmented. Estrogen administration failed to induce a normal LH range in 3 out of the 5 subjects. Marked changes in the pattern of pituitary gonadotropin secretion can be found in perimenopausal women with DUB.