The continuum of ovarian aging and clinicopathologies associated with the menopausal transition

The increased length of time that women live after the menopause has provided the impetus for the scientific and public communities to better understand the relationship between ovarian aging and pathologic conditions that present later in life. The maximal size of the ovarian germ cell pool occurs at midgestation and is followed by a continuous decline in oogonia through birth, puberty, the reproductive years, and finally, the menopause. The association between the relative hypoestrogenemia that occurs in the menopausal transition and the symptomatology of that stage of life has been widely studied. Similarly, the disease processes associated with prolonged lack of exposure to gonadal steroids has received a great deal of scientific inquiry. Although much progress has been made regarding our understanding of the clinicopathologies that occur later in the life of women, firm conclusions of associations and causality continue to elude physicians and scientists, prompting the need for additional research on this patient population.