Consequences of the fall in circulating oestradiol

The clinical markers signalling the end of reproductive function in the female are symptoms resulting from loss of ovarian oestradiol secretion. The most striking and characteristic symptom is the hot flush which shows a variable prevalence in different communities, but affects 65—75% of women in developed countries. Broad correlations between circulating oestradiol concentrations and hot flush frequency have been documented in various studies (Guthrie et al 1996). In the Melbourne Women's Midlife Health project, longitudinal observations have confirmed that the only symptoms clearly related to the transition from early to late perimenopause when the profound fall in oestradiol levels occurs are hot flushes, night sweats and vaginal dryness (Dennerstein et al 2000). The other symptom which changes at this time is that of breast tenderness which falls significantly as oestradiol levels fall. The profound drop in oestradiol concentrations, more than 90% across the menopausal transition, may have later important health consequences. There is a clear-cut acceleration in the rate of loss of bone mineral at the time of menopause (Guthrie et al 1998), continuing for five to eight years and predisposing women, in particular, to later postmenopausal osteoporotic fracture. Whether the change in circulating oestradiol also predisposes to the occurrence of cardiovascular disease, independently of the ageing process, remains a controversial issue. Long-term consequences of oestrogen deprivation may result in an increased risk of the development of Alzheimer's dementia and possibly other disorders.

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