Abstract

The perimenopause, which literally means “around the menopause”. The term perimenopause should include the period immediately before the menopause (when the endocrinological, biological and clinical features of approaching menopause commence) and the 1 year after menopause (usually final menses by approximately 2 to 8 years). The term menopausal transition is used by the WHO to include only the portion of the perimenopause before the final menstrual period. It is heralded by the menopausal transition. A common initial marker is the onset of menstrual irregularity. The biology underlying the transition to menopause includes central neuroendocrine changes as well as changes within the ovary, the most striking of which is a profound decline in follicle numbers. Follicle-stimulating hormone (FSH) is an established indirect marker of follicular activity. Perimenopause begins in a woman’s 40s, although it may start in her 30s. Subtle hormonal changes usually commence in a woman’s 30s. Defining subsets of perimenopausal women by menstrual cycle patterns (menstrual cycle irregularity has been suggested as a risk factor for CVD) and hormonal profiles is a promising tool for identifying susceptibility to increased cardiovascular risks. This review provides the background for a novel approach to modelling the hormonal changes during the transition, the role of estrogen in the pathogenesis of atherosclerosis, altered lipid profiles and the risk of cardiovascular diseases.

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