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Neuroendocrine Changes of the Menopausal Transition

  • Andrea Giannini
  • Marta Caretto
  • Tommaso SimonciniEmail author
Chapter
Part of the ISGE Series book series (ISGE)

Abstract

During menopausal transition, the ovaries are depleted of follicles, oestradiol and inhibin B production falls, and ovulation and menstruation no longer occur. The loss of ovarian sensitivity to follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and the loss of negative feedback of oestradiol and inhibin B on the hypothalamic–pituitary unit result in increased production and release of gonadotropin release hormone (GnRH), FSH and LH. Increased FSH levels are particularly specific to postmenopause. Modifications of gonadotropins, oestradiol (E2), alterations in the function of noradrenergic and serotoninergic pathways and opioid tone in the hypothalamus cause the onset of vasomotor symptoms and consequent sleep disruption. Thermoregulatory dysfunction might be a result of a maladaptation of the brain to kisspeptin, neurokinin B and dynorphin (KNDy) neuron hypertrophy, which project to the preoptic thermoregulatory area. Mood, cognitive functions and neuroendocrine activity, which are closely related to the impairment of GABAergic, opioid and neurosteroid neurotransmitter milieu in the central nervous system (CNS), occur with climacteric period and during ageing. Failure of the main target of neurosteroids, the GABA-A receptor, to adapt to changes in levels of allopregnanolone over the course of the menopausal transition might lead to depressive symptoms, mood and cognitive dysfunctions.

Keywords

Menopause Transition Neuroendocrine HPO axis Neurosteroids CNS 

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Copyright information

© International Society of Gynecological Endocrinology 2019

Authors and Affiliations

  • Andrea Giannini
    • 1
  • Marta Caretto
    • 1
  • Tommaso Simoncini
    • 1
    Email author
  1. 1.Division of Obstetrics and Gynecology, Department of Experimental and Clinical MedicineUniversity of PisaPisaItaly

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