The perimenopausal woman: Endocrinology and management

•The updated STRAW + 10 (Stages of Reproductive Aging Workshop) convened in 2011.•STRAW + 10 introduced new sub-categories for stages −3 and +1 (early postmenopause).•Changes in follicle development wave patterns occurs with reproductive aging.•A disruption in normal follicle development occurs across in perimenopause.•Changes in follicle development underlie the hormonal changes in perimenopause.

This review focuses on the endocrine and physiological features of the transition to menopause, known as the menopausal transition or the perimenopause. The updated 2011 Stages of Reproductive Aging workshop (STRAW) system is presented with a discussion of the new subdivisions within stages −3 (late reproductive age) and +1 (postmenopause) and incorporation of FSH and other biomarkers in the supportive criteria. Ovarian follicle reserve and ovarian follicle dynamics are also discussed in terms of the changes that occur with reproductive aging, and the dramatic effect these changes have on the hypothalamic-pituitary-gonadal feedback system. Topics include the disruption of normal ovulatory function and related hormone secretion patterns, abnormal uterine bleeding, and the changes that occur in bone and the cardiovascular system. The review concludes with a discussion of management strategies.This article is part of a Special Issue entitled ‘Menopause’.