Hormone changes associated with the menopausal transition.

The menopausal transition (MT) is the time in each woman's reproductive life that precedes the final menstrual period (FMP). MT is associated with changes in bleeding pattern and hormone profiles. In recent years, research efforts have characterized changes in reproductive hormones over MT in order to elucidate the process of late reproductive aging and potentially identify predictors of time to menopause. Follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B and estradiol represent the four primary hormone measures of these investigations. Current data show an increase in FSH and decreases in AMH, inhibin B and estradiol over MT. AMH appears to be the first marker to change, followed by FSH and inhibin B. Estradiol declines in late MT. To date, there are no validated hormone cutpoints that predict the length of MT or FMP. There are very preliminary data on AMH as a predictor of menopause. Until further evidence identifies clinically useful hormone levels for predicting MT or FMP, diagnosis of MT and FMP should be based on clinical signs and symptoms only.