The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause. Early menopause LMP before age 45 Late menopause LMP after age 54 Primary ovarian insufficiency Menopause that occurs before age 40 Early menopause transition (stage -2) Persistent difference of 7 days or more in the length of consecutive cycles. Late menopause transition (stage -1) 60 or more consecutive days of amenorrhea Luteal out of phase event (LOOP) Explains why some perimenopausal women have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels are adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion superimposed on the mid-to-late luteal phase of the ongoing ovulatory cycle. Obese women and estradiol levels during menopause Obese women are more likely to have anovulatory cycles with high estradiol levels. They are also more likely to have lower premenopause yet higher postmenopause estradiol levels compared with women of normal weight. (why they are at higher risk of endometrial cancer) Chinese and Japanese women These ethnic groups have lower estradiol levels then white, black and hispanic women. stage +2 late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms. Stages +1a, +1b, +1c early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. Elevated FSH, LH Endocrine labs after menopause AMH, inhibin B These hormones work during reproductive years to not deplete follicle pool too quickly. Phases during menopause transition and PMS symptoms Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles. How to respond if a patient requests FSH lab