La salud de la mujer / Woman's HealthReglas frecuentes: primer aviso de la menopausia
El acortamiento del intervalo entre menstruaciones puede ser un signo indirecto y precoz de envejecimiento ovárico y que se aproxima la menopausia. El Dr. Bradley J. Van Voorhis, de la Universidad de Iowa, ha estudiado una población de mujeres de 42 a 52 años, encontrando que en los comienzos de la menopausia se producen reglas frecuentes llegando hasta cada 20 días.
A menudo esos ciclos son anovulatorios, es decir no producen óvulo susceptible de fecundación. En cambio los intervalos de más de 36 días se producen en una fase posterior de la evolución a la menopausia. Por otra parte, la menstruación abundante no guarda relación con la ovulación. Estas hemorragias abundantes son más frecuentes en mujeres obesas o que tienen miomas.
La investigación comentada se realizó en 804 mujeres controladas durante 3 años y se realizaron estudios hormonales en la orina de las pacientes que además llevaron un calendario menstrual. En las mujeres jóvenes los ciclos anovulatorios fueron en 44% de las ocasiones.
Van Voorhis BJ, Santoro N, Harlow S, Crawford SL, Randolph J. The relationship of bleeding patterns to daily reproductive hormones in women approaching menopause. Obstet Gynecol 2008 Jul;112:101-8.
University of Iowa College of Medicine, Iowa City, IA 52242, USA.
OBJECTIVE: To discover early hormonal predictors of menopause and the stages of the menopausal transition and to understand the hormonal basis behind the bleeding abnormalities common in the menopausal transition. METHODS: A cohort of 804 women aged 42-52 collected first void urine samples daily for one complete menstrual cycle or 50 days (whichever came first) once a year for 3 years. Urine was assayed for excreted levels of follicle-stimulating hormone, luteinizing hormone, estrogen metabolites, and progesterone metabolites, which were normalized for creatinine concentration. Anovulation was defined by an algorithm based on progesterone secretion. Menstrual bleeding parameters were derived from daily calendars. Correlations among bleeding characteristics, hormone concentrations, and other potential clinical predictors were analyzed using multivariable logistic regression models. RESULTS: An ethnically diverse population of women (mean age of 47) with a majority in the early perimenopause was studied. Approximately 20% of all cycles were anovulatory. Short cycle intervals (fewer than 21 days) were common early in the menopause transition and were associated with anovulation (44%). Long cycle intervals (more than 36 days) also were associated with anovulatory cycles (65%). Both short (1-3 days) and long (more than 8 days) duration of menstrual bleeding were associated with anovulation (18% and 23%, respectively). Women with anovulatory cycles were less likely to report heavy menstrual bleeding as compared with those with ovulatory cycles. Heavy bleeding was not associated with steroid hormone concentrations but was associated with obesity and with the self-reported presence of leiomyomata. CONCLUSIONS: Among women in the early menopause transition, abnormalities in timing of menstrual bleeding (cycle intervals or bleeding duration) have a hormonal basis and are frequently associated with anovulation. In contrast, abnormally heavy periods do not appear to have a steroid hormonal basis and are less likely after anovulatory cycles. Heavy periods are associated with obesity and leiomyomata.
menopausia climaterio
salud de la mujer
women's health
ginecologia
health