1 The menopausal transition

The menopausal transition is that period beginning with the first indications of the approach of menopause and ending with the final menses. Its morphological basis is a rapidly declining number of primordial follicles within the ovary; a decline which appears to result from an increased rate of follicular atresia. The most characteristic hormonal change in the menopausal transition is a progressive, though often fluctuating, rise in the level of serum FSH. Oestradiol and inhibin levels fluctuate markedly when observed in individual subjects but remain relatively preserved during the follicular phase of the cycle, until late in the menopausal transition. The frequency of anovulatory cycles increases as the final menstrual period approaches. The rate of symptom reporting varies among different populations of women, with maximum symptom frequency being seen during the menopausal transition. There are some indications that cardiovascular and osteoporosis risk factors may change adversely during the menopausal transition and medical practitioners should be ready to offer hormonal supplementation to women at increased risk of cardiovascular disease and osteoporotic fracture.