Menopause

Objective We have previously characterized the reproductive hormone profile in infertile women with diminished ovarian reserve (DOR) as being distinct from that seen in age comparable healthy controls. Hypothesizing that DOR reflects accelerated reproductive aging, we herein compare urinary reproductive hormone dynamics between young women with DOR and a population of chronologically older perimenopausal controls. Methods In this prospective observational study, urinary levels of pituitary gonadotropins (FSH and LH) and metabolites of estrogen (E1c) and progesterone (Pdg) were assessed in daily morning urine samples collected in a spontaneous menstrual cycle in 8 infertile premenopausal women with DOR and in 11 perimenopausal controls. Areas under the curves (AUC) were calculated for the respective measured hormones, and comparisons were made using Mann-Whitney U test. Results Urinary E1c levels were significantly attenuated in premenopausal women with DOR compared to the older perimenopausal cohort. Despite the relatively lower estrogen, a significantly more pronounced LH surge was evident in the younger population. Early follicular FSH was lower in the women with DOR, but luteal urinary Pdg excretion was comparable in the two groups. Conclusion Our data suggest distinctions in functioning of the central (hypothalamic-pituitary) and peripheral (ovarian) components of the hypothalamic-pituitary-ovarian axis in premenopausal women with DOR compared to chronologically older perimenopausal controls. Increased hypothalamic-pituitary sensitivity to estrogen positive feedback is suggested in premenopausal women with DOR. Our observations identify DOR as a distinct entity in the paradigm of reproductive senescence.

21712737

PMC5816680

CDC Public Access