Ovarian reserve shrinks throughout life and reaches a critical threshold level at the inception of the menopause. At this point, a woman notes her first skipped menstrual period. The menopausal transition begins with the onset of first menstrual irregularity, or skipped menses, and ends with the final menstrual period. Progressive loss of ovarian follicles results in decreased production of inhibin and a loss of restraint on FSH secretion. The monotropic increase in FSH leads to variable hormonal patterns, depending on the available ovarian follicles and their degree of responsiveness. Once follicles reach a critically low level, ovulation becomes progressively less likely and prolonged amenorrhea ensues. In addition to.
