Comparative evaluation of menstrual patterns and hormonal profiles in normal and abnormal perimenopause

ABSTRACT

Background: Currently there is only one marker to objectively establish perimenopause ie menstrual irregularities. Due to the wide variation in hormones like LH, FSH, estradiol, they become unreliable in predicting approaching menopause. This study was conducted to study and compare the patterns of LH, FSH and Estradiol in normal and abnormal perimenopause using the Stages of Reproductive Ageing Workshop (STRAW) criteria.Methods: A comparative evaluation was done after enrolling 200 patients out of which 100 women were in normal perimenopause (early-25 and late perimenopause-75, depending upon menstrual characteristics as defined by STRAW criteria) and 100 having AUB. Sociodemographic data, presence of menopausal symptoms were recorded. S. LH, S.FSH and S. estradiol we determined by adapted solid phase direct sandwich ELISA.Results: FSH was in menopausal ranges (>20IU/L) in early and late perimenopause. LH and FSH in women with AUB ranged from pre to post menopausal ranges. There was significant difference in LH and FSH between normal perimenopause and abnormal uterine bleeding. Estradiol levels showed a significant difference between late perimenopause and AUB p=0.015.Conclusions: This study shows that there is a progressive incremental trend in FSH and LH and decremental trend in Estradiol from early to late perimenopause due to decrease in ovarian follicular reserve, although the difference is not significant. Clinical symptoms present in 50% of late perimenopausal women showed that besides menstrual characteristics we can correlate these menopausal symptoms with raised FSH and low Estradiol. These women can be picked up and preventive therapy may be provided.