Biochemistry of the Menopause: Diagnostic Assays and Hormone Reference Intervals
This review covers the endocrine changes of the menopausal transition including declining sex steroids, rising gonadotrophins, and inhibin shifts, with a focus on their laboratory measurement. Distinguishing premature ovarian failure from other causes of infertility requires careful biochemical investigation. The need for age- and menopause-specific reference intervals, along with ongoing assay standardization efforts, is emphasized for accurate clinical interpretation.
The original study
Biochemistry of the menopause.
- Authors
- Honour JW
- Journal
- Annals of clinical biochemistry
- Type
- Journal Article, Review
- PMID
- 29027807
Original abstract
The life of a human female is characterized from teenage years by monthly menstruation which ceases (the menopause) typically between the age of 40 and 60 years. The potential for reproduction declines and ceases as the ovaries become depleted of follicles. A transition period in mid-life, for 2 to 10 years, when menstruation is less regular is called the perimenopause. The menopause is associated with a significant decline in plasma concentrations of sex hormones, an increase in the concentrations of the gonadotrophins and changes in other hormones such as the inhibins. These changes are superimposed with effects of aging, social and metabolic factors, daily activity and well-being. Although the menopause is entirely natural, in some cases ovarian failure can occur earlier than usual; this is pathological and warrants careful biochemical investigations to distinguish it from conditions causing infertility. Elderly females are affected by a range of clinical disorders including endocrine, cardiovascular, skeletal, urogenital tract and immunological systems, body mass, vasomotor tone, mood and sleep pattern. Reference intervals for many diagnostic biochemical tests for the menopause need to be used when interpreting results in clinical investigations for patient management. The standardization and harmonization of assays are being addressed. Many women now choose to develop their career before bearing children, and the health service has had to change services around this. This review does not cover screening for and tests during pregnancy. The review is timely since the population is aging and there will be more demand on healthcare services.