PubMed · 10445993
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1999. Perimenopause.. https://pubmed.ncbi.nlm.nih.gov/10445993/
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DEFINITION: Menopause begins one year after the last menstrual period. Symptoms often begin in the perimenopausal years. INCIDENCE/PREVALENCE: In the United Kingdom the mean age for the menopause is 50 years 9 months. The median onset of the perimenopause is between 45.5 and 47.5 years. One Scottish survey (of 6096 women aged 45 to 54 years) found that 84% had experienced at least one of the classic menopausal symptoms, with 45% finding one or more symptoms a problem. AETIOLOGY/RISK FACTORS: Urogenital symptoms of menopause are caused by decreased oestrogen concentrations, but the cause of vasomotor symptoms and psychological effects is complex and remains unclear. PROGNOSIS: Menopause is a physiological event. Its timing may be genetically determined. Although endocrine changes are permanent, menopausal symptoms such as hot flushes, which are experienced by about 70% of women, usually resolve with time. However, some symptoms, such as genital atrophy, may remain the same or worsen. AIMS: To reduce or prevent menopausal symptoms, and to improve quality of life with minimum adverse effects. OUTCOMES: Frequency and severity of vasomotor, urogenital, and psychological symptoms; quality of life. METHODS: Clinical Evidence search and appraisal December 1999. We included only randomised controlled trials (RCTs) and systematic reviews that met Clinical Evidence quality criteria.
OBJECTIVES: To provide specific estimates of the likely occurrence of the six fertile days (the "fertile window") during the menstrual cycle. DESIGN: Prospective cohort study. PARTICIPANTS: 221 healthy women who were planning a pregnancy. MAIN OUTCOME MEASURES: The timing of ovulation in 696 menstrual cycles, estimated using urinary metabolites of oestrogen and progesterone. RESULTS: The fertile window occurred during a broad range of days in the menstrual cycle. On every day between days 6 and 21, women had at minimum a 10% probability of being in their fertile window. Women cannot predict a sporadic late ovulation; 4-6% of women whose cycles had not yet resumed were potentially fertile in the fifth week of their cycle. CONCLUSIONS: In only about 30% of women is the fertile window entirely within the days of the menstrual cycle identified by clinical guidelines-that is, between days 10 and 17. Most women reach their fertile window earlier and others much later. Women should be advised that the timing of their fertile window can be highly unpredictable, even if their cycles are usually regular.
Hot flushes are experienced in those periods of the female life when estrogen levels are low. Hormone replacement therapy is thus the first choice for treatment of hot flushes. However this treatment is not always accepted or contraindicated for a variety of reasons. Estrogen (and progestogen) strongly interact with a number of neurotransmitters and this has led to a range of non-hormonal treatments including compounds that act via the noradrenergic or dopaminergic systems as well as herbal remedies. These treatments (which are shortly reviewed) are not always successful. Surprisingly, apart from treatment with some selective serotonin (5-HT) reuptake inhibitors (SSRI's), up till now, little attention is given to the strong interaction of estrogens with the serotonergic system. These interactions are shortly reviewed. Based on these interactions, a hypothesis on the genesis of hot flushes is postulated. Especially the 5-HT(2A) receptor subtype may play a key role in the occurrence of hot flushes. A number of arguments that support this hypothesis are discussed.