The physiology of the perimenopausal years: a minireview

Premenopausal bleeding associated with hyperprolactinaemia

A sample of 54 climacteric women (mean age 48.1 years) being treated for premenopausal bleeding was assessed. The mean serum prolactin value was 23.04 ng/ml. A separate group of 28 hyperprolactinaemic patients showing a mean level of 34.43 mg/ml was compared. No abnormalities of the sella turcica at skull X-ray examination were disclosed. Predominant anovulatory bleeding was found in the endometrial tissue specimens obtained by curettage. The mean serum prolactin level of the climacteric women was significantly increased in comparison with that of 35 healthy women with normal menstrual cycle (P < 0.001). An influence of age on serum prolactin levels in women was found (r = 0.406). Similar results were not reported until now, although this study does not help to explain exactly the role of elevated prolactin level in climacteric impairment of ovarian function.

Very low estrogen-desogestrel contraceptive in perimenopausal hormonal replacement

New oral contraceptives (OC) with lower estrogen contents are potentially useful for menopausal replacement. An OC with 20 micrograms ethinyl estradiol and 150 micrograms desogestrel was used for this purpose in perimenopausal women with climacteric syndrome. The treated group (N = 30), was given OC for 6 months. The control group (N = 29) was kept under observation. Serum FSH, luteinizing hormone, estradiol, cholesterol, HDL-cholesterol and triglycerides were measured. OC treatment induced prompt and clear relief of the climacteric syndrome. Endogenous serum estradiol was greatly reduced with treatment. Serum cholesterol, initially high in relation to young women, diminished with OC treatment, while HDL-cholesterol increased, significantly reducing the cholesterol/HDL-cholesterol ratio. This possibly beneficial estrogen effect was apparently not counteracted by desogestrel (a nearly non-androgenic progestogen). The initially high triglycerides were not modified by the OC. Cyclical bleeding was induced in all treated women, no atypical endometrial hyperplasia was found. This lower estrogen OC preparation may be a good alternative for estrogen replacement in perimenopausal women; its contraceptive properties may strongly appeal those needing fertility control.