Sowers MaryFran R, Zheng Huiyong, McConnell Daniel, Nan Bin, Harlow Sioban, Randolph John F
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109, USA.
J Clin Endocrinol Metab. 2008 Oct;93(10):3958-64. doi: 10.1210/jc.2008-0482. Epub 2008 Jul 22.
CONTEXT/OBJECTIVE: The objective of the study was to identify menopause transition stages using acceleration or deceleration patterns of FSH rates of change from the late reproductive years to postmenopause.
SETTING/PARTICIPANTS: Participants were the Michigan Bone Health and Metabolism Study cohort of 629 women, aged 24-44 yr (in 1992/3), with 5757 annual FSH data points over a 14-yr period. DESIGN/MAIN OUTCOME MEASURES: The study was designed to relate acceleration/deceleration patterns in FSH rate of change to time to final menstrual period (FMP) and chronological age using nonparametric and piecewise regression modeling.
Four major FSH stages, based on rate of FSH change patterns, were identifiable in relation to the FMP. In FSH stage 1, the rate of FSH change increased modestly up to -7 yr prior to the FMP; in FSH stage 2 (-7 to -2 yr prior to FMP), there was a major acceleration in FSH rate of change. FSH stage 3 had an acute increase in FSH rate of change (-2 to +1 yr around the FMP), with average FSH level of 34 mIU/ml. The fourth, or plateau, FSH stage began at 1 yr after FMP when the average FSH level was 54 mIU/ml. During the yr 28-60, there were eight age-specific epochs defined by significant changes of FSH trajectory accelerations or decelerations and rate of change.
Four menopause transition stages bounding the FMP and eight epochs in chronological aging from age 28 to 60 yr were defined by changes of FSH trajectory accelerations/decelerations and rates of change. This timing information, combined with knowledge of FSH levels and menstrual cycle characteristics, can help discern the likely status of women with respect to their reproductive viability and menopause transition stage.
背景/目的:本研究的目的是利用促卵泡生成素(FSH)从生殖后期到绝经后变化率的加速或减速模式来确定绝经过渡阶段。
设置/参与者:参与者为密歇根骨健康与代谢研究队列中的629名女性,年龄在24 - 44岁(1992/1993年),在14年期间有5757个年度FSH数据点。设计/主要观察指标:本研究旨在使用非参数和分段回归模型,将FSH变化率的加速/减速模式与末次月经时间(FMP)和实际年龄相关联。
根据FSH变化模式,可确定与FMP相关的四个主要FSH阶段。在FSH第1阶段,FSH变化率在FMP前7年适度增加;在FSH第2阶段(FMP前7至2年),FSH变化率有大幅加速。FSH第3阶段FSH变化率急剧增加(FMP前后2至1年),平均FSH水平为34 mIU/ml。第四个阶段,即平台期FSH阶段,始于FMP后1年,此时平均FSH水平为54 mIU/ml。在28至60岁期间,有八个特定年龄时期,由FSH轨迹的加速或减速以及变化率的显著变化定义。
通过FSH轨迹的加速/减速和变化率的变化,定义了围绕FMP的四个绝经过渡阶段以及28至60岁按年龄划分的八个时期。这些时间信息,结合FSH水平和月经周期特征的知识,有助于判断女性在生殖能力和绝经过渡阶段的可能状态。