Menstrual Changes In The Value Of The Process Of Premature Ovarian Failure In Prompt

Background:The ovary aging is dynamic process.The main body changes during the process include:decrease of ovary size and amounts of follicular,decrease of the fertility,the change of sexual hormone,and the menstruation changes.The increasing FSH is one of the earliest sign of ovary aging,but it may lead the increase of medical cost.STRAW system considered the changes of menstrual cycle as one the important standard of different stages of ovary aging process.Although is one the popular receipted aging system.It still had some conflict.Menstruation is easily to obtain symptoms which are the response of the ovary ageing.Objective:To analyze the relationship between the changes of menstruation(length of menstrual cycle and it's veribility,length of mens and it's veribility,menstrual blood loss and veribility) and the process of ovary aging.1.To describe the changes of menstruation with age increasing.2.To describe the changes of menstruation with FSH increasing.3.To choose a veribale of the changes of menstruation that can describe ovary aging used in clinics.Materials and methodsPerspective longitudinal study design was used in the present study.The study belonged to Community Perimenopausal Women's Health Promotion Project.We analysis data of the baseline investigation and 12 months±15 days follow up.377 women aged 30-54 years who lived Beijing community attended our survey by the purposive sample method.We conducted the survey by face-to-face interview with the questionnaire.The items of the questionnaire are detailed as follow:the basic conditions (such as age,career,education,income,etc),illness medical history,sex hormone treatment history,menstruation condition.12 months±15 days later these women were investigated again for changes of the above situations and re-measured the indexes below.Examination items included: 1.Serum E₂:Using the electrochemiluminescence(Elecsys 2010 automatic electrochemiluminescence instrument made of American Roche Company).The cv are 6.4%of interest and 6%of intraset respectively as baseline,and 1.3%of interest and 5.8%of intraset respectively as the follow up.2.Serum FSH:Using the electrochemiluminescence(Elecsys 2010 automatic electrochemiluminescence instrument made of American Roche Company).The cv are 1.4%of interest and 4.6%ofintraset respectively as baseline,and 0.74%of interest and 3.6%of intraset respectively as the follow up.3.The biggest section proportion of ovary(BSPO):The ovary size was assessed by transvaginal ultrasound(LOGIQ5 Expert,GE) to measure the two perpendicularly maximum diameters of the biggest section of ovary.Statistics:All data were entered into database Epidata 3.02 and were analyzed by SPSS 12.0 (Statistics Software Package for Social Science).Qualitative data were analyzed by frequency,proportion;quantitative data were analyzed by mean and standard deviation. General Linear Model was used to analyze the difference of hormone level and ovary size among difference menstruation group.Results1.377 women aged 30-54 years participated in the baseline data collection,among which 325 women finished the follow-up,with the follow-up rate at 85.7%.The average age is 44.20±4.72 years(range 30.03-53.91) with means of BMI as 24.40±3.46kg/m². Totally recorded menstrual cycles are 3596 with average lengths as 33.09±23.74 days (median 28 days)。The recorded mens are 3919 totally,with average lengths as 4.70±2.09 days(median 4 days).The percentage of regular menstrual cycle at baseline is 22.6%(73),and no menstrual cycle longer than 180 days.At the 12^th month,the percentage of regular menstrual cycle is17.3%(56),and the menstrual cycle of 15 women(4.6%)＞180 days,8 women(2.5%) 's menstrual cycle＞365.FSH level at baseline(14.96±15.31IU/L,median 8.74 IU/L) is lower than follow up (19.78±21.14IU/L,median 9.86 IU/L).E₂ at baseline(73.67±75.83 pg/ml,median 52.20 pg/ml) is higher than follow up(68.46±76.29pg/ml,median 45.90 pg/ml).The right BSPO at baseline(3.49±1.20 cm²,median 3.34 cm² ) is larger than follow up(3.27±1.28 cm²,3.07 cm²).2.The LMC changes in the study perioda.The shortest of average menstrual cycle length was found at 40-42 years of age group with mean as 29.67±3.96 days(median 28.21 days) with the average of menstrual cycle variability which described as SD were lowest as this group(mean as 4.88±5.21 day,median 2.59) based on the 323 women.The menstrual cycle and its' variability increased gradually after 40 years of age.The mean length of menstrual blood flow and its' variability,and the mean of average menstrual blood loss and its'variability didn't show the trends like the length of menstrual cycle.b.After divided the participants into difference FSH level groups as≤10 IU/L group, 10IU/L＜FSH≤15IU/L group,15IU/L＜FSH≤20IU/L group,20IU/L＜FSH≤40IU/L group and＞40IU/Lgroup,statistical difference of the length of menstrual cycle was found among difference FSH group(p＜0.05),except≤10IU/L group and 10IU/L＜FSH≤15 IU/Lgroup,10IU/L＜FSH≤15 IU/L group and与15IU/L＜FSH≤20IU/L group(p＞0.05). The statistical difference of the variability of menstrual cycle was found among difference FSH groups(p＜0.05).No statistical difference of the length menstrual flow and the amount of menstrual blood loss was found among those FSH groups(p＞0.05).3.Participants were divided in to different groups based on STRAW aging system.a.Pared t test was used to compare the serum FSH,E₂ and right BSPO between baselines and follow up in each group.No statistical difference was found in serum FSH,E₂ and right BSPO in premenopause group between baseline and follow up(p＞0.05).Follow up FSH level in early menopause transition group and late menopause transition group was significantly higher th an baseline level(p＜0.05).Follow up E₂ level in late menopause transition group was significantly lower than baseline level(p＜0.05);Right BSPO of follow up in early menopause transition were significant smaller than baseline(p＜0.05).b.Baseline and follow up serum FSH and E₂ levels and BSPO were analyzed by General Linear Model adjusted age and BMI.Statistical differences of all variables except baseline right BSPOs were found among the three groups(premmenopaus,early menopause transition and late menopause transition). Statistical difference of Baseline and Follow up FSH level was found between late menopause transition group(baseline:25.68±22.47 IU/L,95%CI:19.76-25.69:follow up:37.98±28.80 IU/L,95%CI:29.86-37.34) and premenopause group(baseline: 8.02±2.00 IU/L,95%CI:7.24-13.32;follow up:8.60±3.23 IU/L,95%CI:8.18-15.84), between late menopause transition group and early menopause transition group (baseline:11.81±8.85 IU/L,95%CI:10.37-14.70;follow up:14.12±11.33IU/L,95 %CI:12.41-17.88).No statistical difference was found between premenopause group and early menopause transition group.Statistical difference of Baseline and Follow up E₂ level was found between late menopause transition group and premenopause group,and late menopause group and early menopause transition group.No statistical difference was found between premenopause group and early menopause transition group.The E₂ levels are significantly higher than the other two groups as baselines and lower than the other two groups as follow up.No statistical significant was found between premenopause group and early menopause transition group.Right BSPO of follow up in premenopause group was significantly larger than early menopause group and late menopause group(p＜0.05).No statistical difference was found between early menopause group and late menopause group in follow up(p＞0.05).4.The present study divided participants into 3 groups based on the length of menstrual cycle and its variability.The standard is:SD＜7days within 1 year,SD≥7 days within 1 year,and the length of menstrual cycle≥60 days.Statistical differences were found in baseline and follow up FSH level,mean FSH level of baseline and follow up,adjusted by age and BMI between every two group(p＜0.05).Two new standards were set up and analyzed in the present study.No statistical differences in baseline and follow up FSH lever were found between premenopause group and early menopause group based on the new standards(p＞0.05).Conclusion1.The length of menstrual cycle was shortest in 40-42 years group with lowest variability.The variability of menstrual cycle was prolonged with the increase of age. The length of menstrual flow and its variability,the amount of menstrual loss and its variability did not show the trends with age.2.The length and the variability of menstrual cycle could reflect the different levels of FSH.The length and the variability of menstrual cycle are the indicators of ovary aging.3.STRAW system can describe the ovary aging based on the present study.But it could not differenciate FSH between premenopausal stage and early menopause transition stage.4.The present study provided new standard based on variability of menstrual cycle which were:SD＜7days with 1 year as premenopause,SD＞7 days within one year as early menopause transition,1 cycle length≥60 days as the standard of late menopause transition.We recommended "3 times of conjunctive cycle change≥8 days with 1 year" as the definition of early menopause transition and needed to be validated.