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45 is about 40-50% lower than before. Parallel to that proce- Additionally, during the premenopausal period, cycle
ss, there is a gradual increase in the level of follicle-stimula- disturbances are observed in the form of irregular bleeding,
ting hormone (FSH), while the level of luteinizing hormone caused by anovulation, prolonged action of estrogen, ina-
(LH) remains unchanged. An increased amount of FSH sti- dequate function of the corpus luteum, and low concentrati-
mulates the follicles to growth and development, but they ons of progesterone – thus, dysfunctional bleeding.
have regular growth in a decreasing percentage and reach
maturity, but secrete increased amounts of estradiol. The About 75% of women in perimenopause experience
more frequent anovulatory cycles are accompanied by a low vasomotor symptoms, so-called “hot flashes“. They occur
level of progesterone . most frequently during the first two years after menopau-
6, 7
se and decrease over time. In a very small number of wo-
At the level of the adrenal cortex, in perimenopause, re- men, hot flashes can persist for ten years or more. They
duced production of dehydro-epiandrosterone (DHEA) and often occur during the night, resulting in disrupted sleep
dehydroepiandrosterone sulfate (DHEAS) is recorded, and patterns, fatigue, and depression. Hot flashes are unpredi-
that concentration progressively decreases with age, actu- ctable, with their frequency ranging from nearly every hour
ally it already starts from the age of 25, and they call it a to once every few days. Due to low estradiol levels, there is a
biomarker of aging. disruption in hypothalamic thermoregulatory function. The
consequence of a drop in central temperature is peripheral
The main biochemical indicators in perimenopause are: vasodilation, an increase in temperature, and sweating 10, 11 .
increased levels of FSH and still normal levels of LH, incre-
ased concentration of estradiol, low levels of progesterone, The area of the external genitalia - vagina, urethra, and
and a decrease in the concentration of DHEA . part of the urinary bladder - is rich in estrogen receptors.
8
A decrease in estrogen levels leads to their atrophy. Vagi-
Over time, follicles become increasingly resistant to go- nal walls become atrophic, losing elasticity, and with redu-
nadotropi stimulation, resulting in an increase in levels FSH ced production of vaginal secretions. The vulva undergoes
and LH which leads to stimulation of the ovarian stroma atrophy due to collagen and adipose tissue loss. Estrogen
with a subsequent increasing the level of estrone, and by deficiency also results in the fibrosis of the bladder neck,
decrease in the concentration of estradiol. reduced collagen in the surrounding tissue, and a decrease
The most characteristic change in hormonal status in in the number and diameter of muscle fibers in the pelvic
postmenopause, represents the high concentrations of floor. Atrophy of the genitourinary tract increases the risk
gonadotropins, primarily FSH, and low concentrations of of vaginal and urinary infections (such as atrophic vaginitis
estradiol. After the end of the ovulatory function, the pro- and atrophic cystitis) as well as traumatization. Additionally,
duction of estrogen in a woman's body continues with the genital tract atrophy causes painful intercourse - dyspare-
12
aromatization of androgens produced in the ovarian stroma unia - reducing interest in sexual activity .
and adrenal cortex, which are not opposed by progesterone The postmenopausal uterus is reduced in size, as are the
production, so they can lead to endometrial hyperplasia ovaries, which cannot be palpated during examination. Due
and potential endometrial cancer. The main estrogen in to the loss of tone in the pelvic floor muscles, many pos-
postmenopausal women, is estrone and it is produced by tmenopausal women experience issues with the descent of
the aromatization of androstenedione of non-follicular ori- genital organs.
gin (production in ovarian stroma and adrenal production)
that takes place in adipose tissue, muscle, liver, bone, bone Due to estrogen deficiency, the activity of osteoclasts
marrow, fibroblasts and hair roots. The highest degree of and bone resorption increases while bone formation decre-
androgen conversion in estrogen occurs in adipose tissue ases. As a result, postmenopausal women are at a high risk
and that is why it is considered that obese women have less of developing osteoporosis and fractures, which will be furt-
pronounced menopausal vasomotor symptoms . her discussed in the following text.
7-9
In postmenopausal women, due to the lack of estrogen
(Pre)menopausal syndrome and and subsequently reduced synthesis of collagen and elastic
the effects of menopause fibers, the skin loses its tone, becomes dry, prone to flaking,
and wrinkled. Additionally, hair in postmenopausal women
The typical syndrome associated with declining ovarian tends to become dry, brittle, and thin in a large number of
function includes: vasomotor disturbances, psychological cases.
issues such as behavior changes, depression, decreased
concentration, insomnia, weight gain, urogenital issues, de- Postmenopausal women are at an increased risk of de-
creased libido, and changes in skin and hair. It is believed veloping cardiovascular diseases. Estrogen is believed to
that the irregular functioning of the ovaries during perime- reduce the risk of atherosclerosis. This is supported by the
nopause, with consequent fluctuating changes in estrogen fact that cardiovascular diseases are rare until menopause,
levels, is the main cause of the onset of this syndrome, rat- being even 6-7 times less common than in men of the same
her than just a decrease in estrogen production. age, while after menopause, this risk becomes comparable.

REVIEW PAPER Galenika Medical Journal, 2024; 3(9):62-68. 63