ABSTRACT
The hypothalamic-pituitary-gonadal axis changes functionally and structurally throughout life. It is becoming increasingly clear that the uterus is not merely a passive recipient of this dynamically changing input, but rather an exocrine, endocrine, and paracrine organ in its own right. The menopausal transition is a time in the life cycle of women during which complaints of bleeding irregularity and menorrhagia are common.The underlying changes in the hypothalamic-pituitary-gonadal axis that contribute to this clinical problem are beginning to be understood.There is little evidence that aging per se alters essential uterine and endometrial function. During the postmenopause, women not receiving hormonal replacement therapy are believed to have a quiescent endometrium. However, in this setting, aging favors the development of neoplasia. A basic appreciation of the contribution of the hormonal milieu and a woman’s life cycle to uterine function assists greatly in the differential diagnosis of abnormal bleeding in the older reproductive-aged and postmenopausal woman.
