The menopausal transition is a period of gynecologic instability for most women and potential morbidity for some. Disturbances of menstrual pattern, ovulation, reproductive hormonal status and associated psychological and adaptational disruptions have been reported commonly. Surgical approaches to these poorly defined symptoms are equally common. Thirty per cent of American women undergo hysterectomy. Most of these procedures are performed during the postreproductive, premenopausal years, chiefly for benign disease. The present proposal seeks to define the hormonal, gynecologic and psychosocial/sexual milieu of the postreproductive, premenopausal woman to understand more fully the factors leading to this high utilization of hysterectomy and to define symptomatology which places a woman at risk for functional or surgical morbidity in the perimenopause. We plan to prospectively follow a cohort of 1000 women enriched in African American and Hispanic populations and determine annual measures of menstrual bleeding, reproductive hormonal status, endometrial and ovarian morphology, uterine blood flow and a battery of psychosocial and sexual behavioral measures to determine the normative patterns of function in the perimenopause and to define dysfunction and determine its correlates. A subgroup of 150 women will be followed annually throughout an intensively monitored menstrual cycle with repeated measures to determine across-cycle hormonal and functional dynamics. Specific hypotheses regarding the linkage of reproductive hormonal abnormalities to gynecologic and psychosocial adaptational morbidities will be tested. These data are expected to lead to a firm determination of normative standards for reproductive hormonal milieu uterine bleeding, ovarian morphology uterine blood flow and adaptational status, as significant pathophysiology may well require redefinition for the woman in menopausal transition. Minority women will be assessed both separately and with the longer group. Women experiencing true distress and impairment may be identified prospectively and proactive medical measures to prevent morbidity and avoid hysterectomy and other surgical interventions well be a desirable result of these efforts.
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