1. Menopause Professor Susan Davis Women’s Health Program
Department of Medicine
Alfred Hospital, Monash University.

2. Menopause The last menstrual bleed in a woman with an intact uterus
Permanent loss of ovarian follicular development
Loss of cyclical production of estradiol, progesterone and testosterone.

3. Primordial follicles Fundamental reproductive units of the ovary
pool of non-growing follicles from which all dominant preovulatory follicles are selected
formed between 6-9 months of gestation
Only 400 will complete development and undergo ovulation/corpus luteum formation → others die by atresia
Continued decline in number - by menopause primordial follicles difficult to find

4. AFTER MENOPAUSE FEW/ NONE LEFT
FOLLICULAR DEPLETION AND AGE
20 WEEK FETUS
7.5 MILLION
BIRTH
300,000
Age of reaching critical threshold
of 25,000 varies from
late 20’s to 40’s
→ age alone has
limited predictive value
for determining ovarian reserve
37 YEARS
25,000
51 YEARS
1000
AFTER MENOPAUSE FEW/ NONE LEFT

5. Natural menopause is a consequence of follicular depletion
Autopsy data,
women 7-44yrs
100000 B B
10000
Women in menopausal
transition J B B
1000 J
with regular menses
Primordial Follicles / Ovary F F B
100 F
Perimenopausal
women F F 10 F F
Postmenopausal
women 1 H H H H 10 20 30 40 50 60
Age in Years
Richardson et al., J.C.E.M., 1987

6. Follicular health
Every month ~ 500 ova develop activated by BMP15 and GDF9
Ova go through phase of growth, then atresia
As oocyte numbers decline so does the oocyte quality.
The ANTRAL follicle count in the follicular phase is a good predictor of IVF outcome
AGE predicts fertility