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HYPOTHALAMIC‐PITUITARY‐OVARIAN FUNCTION IN PERIMENOPAUSAL WOMEN
Author(s) -
LOOK PAUL F. A.,
LOTHIAN HELEN,
HUNTER WILLIAM M.,
MICHIE EILEEN A.,
BAIRD DAVID T.
Publication year - 1977
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1977.tb02936.x
Subject(s) - anovulation , pregnanediol , endocrinology , medicine , follicular phase , ovulation , menstrual cycle , basal (medicine) , biology , urinary system , hormone , polycystic ovary , insulin , insulin resistance
SUMMARY In a group of nine perimenopausal women, aged 37–52 years, with dynsfunctional uterine bleeding (DUB), serial measurements were made of urinary total oestrogen and pregnanediol excretion and of plasma gonadotrophin and steroid levels under basal conditions and during dynamic tests (oestrogen provocation and LHRH‐tests). Results were compared to those obtained in a control group of regularly menstruating women, 23–45 years of age. Four different patterns of hypothalamic‐pituitary‐ovarian (H.P.O.) activity were identified in the perimenopausal subjects with DUB. In two patients with a history of persistent anovulation and cystic glandular hyperplasia of the endometrium, basal plasma gonadotrophin levels were normal but there was a failure to release an adequate amount of LH in response to endogenous and exogenous oestrogen stimulation. One subject had regular ovulatory cycles but the follicular phase was shorter and circulating levels of FSH, 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 five women follicular development was infrequent and anovulation the rule. FSH and LH levels in these women were elevated despite the presence of circulating 17β‐oestradiol levels in the early‐mid follicular phase range. At the time of menopausal transition in one of these subjects, the decline of plasma 17β‐oestradiol to undetectable levels was associated with a further rise of both gonadotrophins. Conversely, following a prolonged period of follicular development with elevated urinary total oestrogen excretion in another subject, the raised gonadotrophin concentrations were suppressed and the pituitary response to LHRH was within the normal range. LHRH responses in the other four women were augmented. Oestrogen administration failed to induce a normal LH surge in three out of the five subjects. The results indicate that marked changes in the pattern of pituitary gonadotrophin secretion can be found in perimenopausal women with DUB. The observed increase in peripheral levels of FSH (with or without concomitant increase in LH) may be due to a change in hypothalamic‐pituitary sensitivity to the feedback effects of oestrogen. Alternatively, it is possible that these changes result from a decrease in the ovarian secretion of a hypothetical ‘inhibin‐like' substance produced by the growing follicle and for which the name ‘FSH‐release inhibiting substance’ (‘FRIS’) is proposed.