Comparative evaluation of menstrual patterns and hormonal profiles in normal and abnormal perimenopause

Harshiba Kaur, Neerja Goel


Background: Currently there is only one marker to objectively establish perimenopause ie menstrual irregularities. Due to the wide variation in hormones like LH, FSH, estradiol, they become unreliable in predicting approaching menopause. This study was conducted to study and compare the patterns of LH, FSH and Estradiol in normal and abnormal perimenopause using the Stages of Reproductive Ageing Workshop (STRAW) criteria.

Methods: A comparative evaluation was done after enrolling 200 patients out of which 100 women were in normal perimenopause (early-25 and late perimenopause-75, depending upon menstrual characteristics as defined by STRAW criteria) and 100 having AUB. Sociodemographic data, presence of menopausal symptoms were recorded. S. LH, S.FSH and S. estradiol we determined by adapted solid phase direct sandwich ELISA.

Results: FSH was in menopausal ranges (>20IU/L) in early and late perimenopause. LH and FSH in women with AUB ranged from pre to post menopausal ranges. There was significant difference in LH and FSH between normal perimenopause and abnormal uterine bleeding. Estradiol levels showed a significant difference between late perimenopause and AUB p=0.015.

Conclusions: This study shows that there is a progressive incremental trend in FSH and LH and decremental trend in Estradiol from early to late perimenopause due to decrease in ovarian follicular reserve, although the difference is not significant. Clinical symptoms present in 50% of late perimenopausal women showed that besides menstrual characteristics we can correlate these menopausal symptoms with raised FSH and low Estradiol. These women can be picked up and preventive therapy may be provided.


E2- Estradiol, Enzyme linked immunosorbant assay, Endometrial thickness, Follicular stimulating hormone, Luteinising hormone, Stages of reproductive ageing workshop

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World Health Organization Research on the Menopause in the 90s. Technical Report Ser 866, Geneva, Switzerland: World Health Organization; 1996.

McKinlay SM, Brambilla DJ, Posner JG. The normal menopausal transition. Maturitas. 1992;14:103-15.

Gupta B, Goel N, Sharma G. Symptoms and Signs. Menopause In Eds Goel N Gupta B Jaypee Brothers Med Publishers P Ltd, Delhi; 2014:27-36.

Burger HG, Hale GE, Dennerstein L. Cycle and hormone changes during perimenopause: the key role of ovarian function. Menopause. 2008;15:603-12.

Harlow SD, Gass M, Hall JE. STRAW + 10 collaborative group. Executive summary of the stages of reproductive aging workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159-68.

Petsos P, Buckler H, Mamtora H, Anderson D. Ovulation after treatment with ethinyl estradiol and medroxprogesterone acetate in a woman approaching premature menopause. Br J Obstet Gynaecol. 1986;93:1155-60.

Brambilla DJ, McKinlay SM, Johannes CB. Defining the perimenopause for application in epidemiologic investigations. Am J Epidemiol. 1994;140(12):1091-5.

Hale GE, Hughes CL, Burger HG, Robertson DM, Fraser IS. Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition. Menopause. 2009;16:50-9.

Kuppuswamy B. Manual of socioeconomic status (urban). Delhi: Manasayan; 1981.

Vaidya R, Shah M, Vaidya A. Menopausal transition: a signal to prevent and offset sarcopenic obesity. In eds Goel N, Gupta B Menopause Jaypee Brothers Med Publishers P Ltd, Delhi; 2014:177-8.

Cesari M, Kritchevsky SB, Baumgartner RN. Sarcopenia, obesity and inflammation- results from the trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. Am J Clin Nutr. 2005;82:428-34.

Peppa M, Koliaki C, Dimitriadis G. Body composition as an important determinant of metabolic syndrome in postmenopausal women. Endocrinol Metabol Syndrome. 2012;S1:009.

Miles TP, Bernard MA, Morbidity, disability, and health status of black American elderly: a new look at the oldest-old. J Am Geriatr Soc. 1992;40:1047.

Day JC. Bureau of the Census, Current population reports. Population projections of the United States, by age, sex, race, and Hispanic origin: 1993 to 2050, U.S. Government Printing Office, Washington, D.C. 1993.

Fries JF, The sunny side of aging. JAMA. 1990;263:2354.

Fries JF. Strategies for reduction of morbidity. Am J Clin Nutr. 1992;55:1257S.

Vollman RF. The menstrual cycle, In: Friedman E, ed. Major Problems in Obstetrics and Gynecology, W.B. Saunders Co., Philadelphia; 1977.

Klein NA, Harper AJ, Houmard BS, Sluss PM, Soules MR. Is the short follicular phase in older women secondary to advanced or accelerated dominant follicle development? J Clin Endocrinol Metab. 2002;87:5746.

Spearoff L, Fritz MA. Menopause and the perimenopausal transition. Clin Gyne Endocrinol Infert. 2010:689.

Randolph JF, Crawford S, Dennerstein L. The value of follicle-stimulating hormone concentration and clinical findings as markers of the late menopausal transition. J Clin Endocrinol Metab. 1992;91(8):3034-40.

Prior JC. Perimenopause: the complex endocrinology of the menopausal transition. Endocr Rev. 1998;19:397-428.

Burger HG, Dudley EC, Hopper JL. Prospectively measured levels of follicle stimulating hormone, oestradiol and the dymeric inhibins during the menopausal transition in a population based cohort of women. J Clin Endocrinol Metab. 1999;84:4025-30

Shobha S. Pillai Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2014;3(1):113-7.

Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle aged women with atypical uterine bleeding - a study of 219 cases. J Midlife Health. 2013;4:216-20.