The Menopausal Transition: Interface Between Gynecology and by Claudio N. Soares, Michelle Warren

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By Claudio N. Soares, Michelle Warren

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This situation may differ from that in rodents, who do not undergo critical decreases in follicular reserve. Recent data in the mouse identifying germline stem cells in adult animals [4] has not been reproduced in women. Ovarian reserve is the major predictor of the age at which natural menopause will occur. Toxic exposures to agents that destroy ovarian follicles such as smoking [1], ionizing radiation, medically treated depression [5], low socioeconomic status [6] and possibly galactose consumption [7] have all been shown to reduce the reproductive life span of women.

There is evidence that folliculogenesis is accelerated [27], however, and that follicle growth dynamics are altered. For example, studies examining follicle growth directly and comparing findings in perimenopausal women to mid-reproductive aged women have observed that follicles begin to grow earlier, but grow at a slower pace and ovulate at a smaller size [28]. There is a strong and consistent association between the monotropic FSH rise that is the hallmark of the perimenopause and decreased inhibin B concentrations, thought to reflect the diminished number of competent primordial follicles available for recruitment in older reproductive-age women [19, 29–33].

Obstet Gynecol 2005;105:161–166. 47 Speroff L, Gass M, Constantine G, Olivier S: Efficacy and tolerability of desvenlafaxine succinate treatment for menopausal vasomotor symptoms: a randomized controlled trial. Obstet Gynecol 2008; 111:77–87. 48 Stearns V, Beebe KL, Iyengar M, Dube E: Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA 2003;289:2827–2834. 49 Soares CN, Arsenio H, Joffe H, Bankier B, Cassano P, Petrillo LF, Cohen LS: Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women: impact on depression, vasomotor symptoms, sleep, and quality of life.

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