316 Obstetrics and Gynecology Board Review •••
❍ How much earlier does menopause occur in smokers?
About 2 years.
❍ What percentage of women will undergo premature menopause (before age 40)?
1%.
❍ What percentage of women will undergo late menopause (after age 55)?
5%.
❍ What percentage of women will undergo early menopause (between ages 40 and 45)?
5%.
❍ What is the weight of the postmenopausal ovary?
5 g.
❍ What histological changes occur in the ovary with menopause?
Lack of follicles and a prominent stroma.
❍ What are the common changes associated with estrogen depletion?
Menstrual cycle changes, cardiovascular disease, osteoporosis, genitourinary atrophy, vasomotor psychological, and
sexual symptoms.
HORMONE PRODUCTION
❍ What happens to the menstrual cycle with age?
Initially, the follicular phase and cycle decreases and then increases prior to menopause, and luteal phase defects
may occur.
❍ What happens to gonadotropin levels in the premenopausal years?
Follicle-stimulating hormone (FSH) increases (as a result of decreased inhibin production from granulosa cells) and
luteinizing hormone (LH) remains the same.
❍ Why cannot FSH levels be suppressed in menopause?
Inhibin production from granulosa cells is lost. Inhibin normally suppresses FSH levels prior to menopause.
Inhibin is the hormone that starts to decline first in the climacteric.
❍ What FSH values are indicative of menopause?
Levels >35 IU/L, but may vary based on laboratory.
❍ What are the expected changes in gonadotropin levels after menopause?
FSH increases 10- to 20-fold and LH increases 3-fold, reaching a maximum 1 to 3 years after menopause.