The menopause transition: an update

The menopausal transition is an area of active clinical investigation and epidemiological research. Recent results from several worldwide cohorts of women are beginning to provide a paradigm by which to explain the epidemiological and clinical manifestations of the ovarian process of follicle attrition. Genetic research has also provided some insight into differential ovarian ageing and disease/risk susceptibility in populations of women. Atresia of follicles occurs throughout reproductive life in women. The ever-shrinking follicle pool does not appear to result in any overt disruption of cycles for most women until they are in their forties. Subtle hormonal changes precede overt cycle disruption in mid-life. Obvious failures of ovulation or folliculogenesis lead to menstrual disturbances, and these provide the first clinical indication that the menopause transition is underway. A variety of hormonal patterns have been identified and an overall physiological progression appears to exist. The likelihood that reproductive hormone patterns influence symptomatology is high, although the analysis of the nature of such relationships is under way. For most women, effective lifestyle changes or hormonal therapy is available for symptoms associated with the menopause transition. This review will cover the existing body of knowledge, particularly regarding the clinical management of women who present with symptomatology during their menopausal transitions.