Stages of menopause

Question 1

STRAW+10

Answer 1

Stages of reproductive aging workshop uses menstrual-cycle bleeding, FSH, AFC, AMH, inhibin B, estradiol levels to define each stage. Staging can’t be applied to women without regular menstrual cycles

Question 2

endocrine and US evaluation

Answer 2

• Cycle day 3 FSH is the most commonly used test of ovarian reserve and should be measured with estradiol. The increase in FSH contributes to the advancement of follicles leaving the resting phase. Elevated estradiol can suppress FSH, giving “falsely” normal FSH levels

Question 3

AMH

Answer 3

• AMH is produced by the granulosa cells of preantral and small antral follicles, many of which are unmeasured by US. Its clinical application is based on its ability to represent the # of preantral and antral follicles and predict the response to ovarian hyperstimulation or assess iatrogenic damage. AMH levels capture quantitative but not qualitative data on ovarian reserve. And may be influence by exogenous hormone use and preegnancy.

Question 4

AFC

Answer 4

• defined by the number of US-detectable follicles 2mm to 10 mm
  -antral follicles are sensitive to FSH
• they correlate with the number of primordial follicles and are considered to represent the available pool of follicles

Question 5

For women with surgical menopause

Answer 5

Reproductive aging can be assessed by using endocrine markers starting 3 months after surgery (b/c FSH may be transiently elevated after pelvic surgery)

Question 6

4 Reproductive Stages

Answer 6

-5 (Early), -4 (Peak), -3b and -3a (Late)

Question 7

Stage -5

Answer 7

Menarche

Question 8

Stages -4 and -3b

Answer 8

It usually takes several years to assume regular cycles, which should then occur every 21-35 days

Question 9

Stages -3b, -3a (late reproductive years)

Answer 9

• 3b, menstrual cycles and early follicular-phase FSH remain normal. AMH and AFC are low. Inhibin is also low
• 3a, subtle menstrual-cycle changes in flow and length, w/ increasing frequency of shorter cycles, variable FSH levels, and other markers of ovarian again being low

Question 10

Stages -2, -1

Answer 10

Menopausal Transition

Question 11

Early menopause transition (-2)

Answer 11

the formal onset of this stage is marked by a persistent difference of 7 days or more in the length of consecutive cycles. These cycles are also characterized by elevated but variable early follicular-phase FSH levels and low AMH levels and AFC

Question 12

Late menopause transition (-1)

Answer 12

60 or more consecutive days of amenorrhea. One such episode is sufficient to stage women aged 45 years and older
- For women aged 40-44 years, recurrence if an episode of amenorrhea of 60 days or longer within a year improves prediction of entry into the late MT
- menstrual cycles are characterized by increased variability in cycle length, extreme fluctuations on hormone levels, and increased prevalence of anovulation.
- FSH levels fluctuate btw PM and those consistent with the reproductive stages
- a serum FSH level of 25 or higher in a random blood draw
-the stage can last 1-3 years

Question 13

Stages +1a, +1b, +1c, 2

Answer 13

Postmenopause

Question 14

Early post menopause

Answer 14

+1a +1b +1c
- First 2 years, FSH continues to rise and estradiol continues to decrease
+1a is 12 months after FMP
+1b is the 2nd year as FSH and estradiol begin to stabilize
-VMS are likely to occur
+1c is year 3-6

Question 15

Late Post menopause (stage +2)

Answer 15

• 5 to 8 years after FMP
• FSH levels are consistently > 20
• estradiol ranges from 10-25 (may be higher in obese women)
• ovary continues to produce androstenedione and testosterone
• surgical menopause results in lower testosterone levels