Rannevik G, Jeppsson S, Johnell O, Bjerre B, Laurell-Borulf Y, Svanberg L
Department of Obstetrics and Gynecology, University of Lund, Malmö General Hospital, Malmö, Sweden.
Maturitas. 2008 Sep-Oct;61(1-2):67-77. doi: 10.1016/j.maturitas.2008.09.010.
From a longitudinal prospective study, 160 women with spontaneous menopause and without steroid medication were followed during the transition from pre- to postmenopause. After 12 years 152 women were still participating in the study. Blood samples were drawn every 6 months until 1 year after the menopause and every 12 months thereafter. Measurements of bone mineral density (BMD) on the forearm were performed every second year. All women routinely completed a questionnaire concerning symptoms frequently attributed to the climacteric period. All data were grouped around the onset of the menopause, thereby allowing longitudinal evaluation of the changes in the variables from the premenopausal to the postmenopausal period. The beginning of the perimenopausal period was characterized by transitory elevations of follicle-stimulating hormone (FSH). A significant increase in serum levels of gonadotropins was observed for both FSH and luteinizing hormone (LH) from about 5 years before the menopause. Within the 6 month period around the menopause there was a further increase which culminated within the first postmenopausal year for LH and 2-3 years postmenopause for FSH. Thereafter, a continuous decrease in LH occurred over the following 8 years. With respect to FSH, there was a slight decline starting about 4 years postmenopause. During the premenopausal period an increasing frequency of inadequate luteal function or anovulation occurred and, in the postmenopausal years, the serum levels of progesterone (P) were invariably low. Gradually, the ratio between estrone (E1) and 17-beta-estradiol (E2) increased, reflecting the declining follicular steroidogenesis. A marked decrease in estrogen levels occurred during the 6 month period around the menopause, most pronounced in E2. During the next 3 years, the levels of E2 and E1 showed an essentially parallel, moderate decline. Around the menopause, serum levels of testosterone (T), delta4-androstenedione (A) and sex hormone-binding globulin (SHBG) showed small but significant decreases. From about 3 years postmenopause, the levels were relatively constant over the following 5 years. A decrease in BMD was observed in the postmenopause, and from about 3 years postmenopause, estradiol correlated positively with BMD. Before, as well as after the menopause, body mass index (BMI) showed an inverse correlation with SHBG. Postmenopausal androstenedione correlated positively with E1, E2 and T. BMI correlated positively with E1 and E2. The concentrations of the free fraction of E2 and T are dependent on the levels of SHBG, which in turn has a negative correlation with BMI. The impact of this will influence the severity of symptoms, the degree of bone loss and the need for supplementary therapy.
在一项纵向前瞻性研究中，对160名自然绝经且未使用类固醇药物的女性在绝经前到绝经后的过渡阶段进行了跟踪。12年后，仍有152名女性参与该研究。在绝经前每6个月采集一次血样，直至绝经后1年，此后每12个月采集一次。每两年对前臂进行一次骨密度（BMD）测量。所有女性都常规填写一份关于更年期常见症状的问卷。所有数据围绕绝经开始时间进行分组，从而能够纵向评估从绝经前到绝经后各变量的变化。围绝经期开始时的特征是促卵泡生成素（FSH）短暂升高。从绝经前约5年开始，促性腺激素（FSH和促黄体生成素（LH））的血清水平显著升高。在绝经前后6个月内，LH进一步升高，并在绝经后第1年达到峰值，FSH在绝经后2 - 3年达到峰值。此后，LH在接下来的8年中持续下降。关于FSH，在绝经后约4年开始略有下降。在绝经前，黄体功能不全或无排卵的发生率增加，在绝经后几年，孕酮（P）的血清水平始终较低。逐渐地，雌酮（E1）与17 - β - 雌二醇（E2）的比值增加，反映出卵泡类固醇生成的下降。在绝经前后6个月内雌激素水平显著下降，E2最为明显。在接下来的3年中，E2和E1水平基本呈平行的中度下降。在绝经前后，睾酮（T）、δ4 - 雄烯二酮（A）和性激素结合球蛋白（SHBG）的血清水平出现小幅但显著的下降。从绝经后约3年开始，在接下来的5年中这些水平相对稳定。绝经后观察到骨密度下降，从绝经后约3年开始，雌二醇与骨密度呈正相关。在绝经前和绝经后，体重指数（BMI）与SHBG呈负相关。绝经后雄烯二酮与E1、E2和T呈正相关。BMI与E1和E2呈正相关。E2和T的游离部分浓度取决于SHBG的水平，而SHBG又与BMI呈负相关。这一影响将对症状的严重程度、骨质流失程度和补充治疗的需求产生影响。
