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Luteal phase estrogen is decreased in regularly menstruating older women compared with a reference population of younger women

Mersereau, Jennifer E. MD1; Evans, Michele L. MD2; Moore, Dan H. PhD2; Liu, James H. MD3; Thomas, Michael A. MD4; Rebar, Robert W. MD5; Pennington, Ellen MD4; Cedars, Marcelle I. MD2

doi: 10.1097/gme.0b013e31815982cf
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Objective: To compare daily reproductive hormone secretion in regularly menstruating older versus younger women.

Design: This was a prospective cohort study.

Results: Daily morning urine samples were obtained from 106 women, 28 of whom were aged between 20 and 34 years (mean: 27.8 ± 3.7 y) and 78 of whom were aged between 35 and 50 years (mean: 40.3 ± 3.7 y). Lower luteal estrone-3-glucuronide levels were seen in the older versus the younger group (82.7 vs 93.5 ng/ml, P = 0.035). The pregnanediol-3-glucuronide levels in the older group were lower than those in the younger group throughout the entire cycle. The median length of the follicular phase was shorter in the older versus younger women (13 vs 14.5 d, P = 0.005). There was no significant difference in the median luteal phase lengths between groups.

Conclusions: We report the new finding that regularly menstruating older women not only have lower pregnanediol-3-glucuronide levels but also have a significant reduction in luteal phase estrone-3-glucuronide compared with a contemporaneous cohort of younger women. This combined deficit may play a key role during the luteal-follicular transition, potentially affecting follicle recruitment and decreasing fecundity in the subsequent cycle.

This prospective cohort study showed that regularly menstruating older women not only have lower urinary progesterone metabolites but also have a significant reduction in luteal phase urinary estrogen metabolites compared with a contemporaneous cohort of younger women. This combined deficit may play a key role during the luteal-follicular transition, potentially decreasing fecundity as women age.

From the 1Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; 2Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA; 3Department of Obstetrics and Gynecology, University Hospitals/MacDonald Women's Hospital, Case School of Medicine, Cleveland, OH; 4Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH; and 5American Society for Reproductive Medicine, Birmingham, AL.

Received June 5, 2007; revised and accepted August 27, 2007.

Financial disclosure: None reported.

Address correspondence to: Marcelle I. Cedars, REIRG, Women's Clinical Research Center, 1635 Divisadero Street, Suite 601, San Francisco, CA 94115. E-mail: marcelle.cedars@ucsfmedctr.org

©2008The North American Menopause Society