Clinical effects of ovulation disturbances

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The focus on ovulation disturbances in this paper has so far only discussed their prevalence and incidence. It is likely however, that any SLP or persistent ovulation disturbances present in phases A and B when cycles are still regular causes dysfunctional bleeding and menorrhagia in women experiencing high oestradiol levels. It is also likely that premenstrual symptoms are increased in cycles with ovulation disturbances in addition to high oestradiol levels (Wang et al 1996). Severe mood swings, increased stretchy mucus and breast tenderness prior to and during £ow commonly coexist with disturbed perimenopausal ovulation. Ballinger described heavy £ow in such cycles (Ballinger et al 1987). In addition, the cycles with ovulation disturbances may be at increased risk for VMS based on data suggesting increased VMS prior to

FIG. 4. The ovulatory characteristics of three or four consecutive cycles from three perimenopausal women. The cycle lengths are shown as open bars and luteal phase lengths are shown in black. Using 10 days as the lower limit of normal, each woman had at least one SLP and two of three women had anovulatory cycles (*). Redrawn from data by Shideler et al (1989).

FIG. 4. The ovulatory characteristics of three or four consecutive cycles from three perimenopausal women. The cycle lengths are shown as open bars and luteal phase lengths are shown in black. Using 10 days as the lower limit of normal, each woman had at least one SLP and two of three women had anovulatory cycles (*). Redrawn from data by Shideler et al (1989).

flow and that progesterone/progestin therapy is an effective treatment. Ovulation disturbances are related to rapid cancellous bone loss in regularly cycling, initially ovulatory premenopausal women (Prior et al 1990a) and cyclic medroxyprogesterone therapy increases bone density in women with menstrual cycle and ovulation disturbances (Prior et al 1994). It is probable, therefore, that ovulation disturbances in any phase of perimenopause, but especially phases C and D contribute to the increased bone loss that occurs at that stage of the transition (Okano et al 1998, Prior 1998).

In summary, ovulation disturbances are probably of clinical as well as physiological consequence in the perimenopause and may relate to menorrhagia, VMS, mood disturbances and accelerated bone loss. Studies are needed to document this because therapy with cyclic progesterone or medroxyprogesterone may well be effective in symptomatic perimenopausal women.

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