AUTHOR=Grub Jessica , Süss Hannah , Willi Jasmine , Ehlert Ulrike 

TITLE=Steroid Hormone Secretion Over the Course of the Perimenopause: Findings From the Swiss Perimenopause Study

JOURNAL=Frontiers in Global Women's Health

VOLUME=Volume 2 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2021.774308

DOI=10.3389/fgwh.2021.774308

ISSN=2673-5059

ABSTRACT=The perimenopause is characterized by a decline of the steroid hormones estradiol and progesterone. By contrast, the steroid hormone cortisol, a marker of the HPA axis, increases. Recent longitudinal studies reported fluctuations of steroid hormone levels during perimenopause and even increases in estradiol levels. To understand these confounding results, it is necessary to conduct longitudinal, highly standardized assessments of steroid hormone secretion patterns in perimenopausal women.
Methods
This longitudinal study investigated 127 perimenopausal women aged 40–56 years for 13 months. Estradiol, progesterone, and cortisol were assessed using saliva samples, which were collected for two (months 2, 12 for estradiol and progesterone) or three (months 2, 7, 12 for cortisol) non-consecutive months over the course of the study. A total of 14 saliva samples per participant were analyzed to investigate courses of estradiol and progesterone. The cortisol awakening response and fluctuations throughout the day were measured using a total of 11 saliva samples per participant (awakening, +30min, +60min, 12:00pm, before going to bed) for months 2, 7, and 12. 
Results
Multilevel analyses revealed variance in intercept and slope across participants for estradiol (intercept: SD=5.16 (95% CI; 4.28, 6.21), slope: SD=0.50 (95% CI: 0.39, 0.64)), progesterone (intercept: SD=34.77 (95% CI; 25.55, 47.31), slope: SD=4.17 (95% CI: 2.91, 5.99)), and cortisol (intercept: SD=0.18 (95% CI; 0.14, 0.23), slope: SD=0.02 (95% CI; 0.01, 0.02)). Time predicted cortisol levels (b=-0.02, t(979)=-6.63, p< .0001). Perimenopausal status (early vs. late) did not predict estradiol (b=-0.36, t(1608)=-0.84, p=.400), progesterone (b=-4.55, t(1723)=-0.87, p=.385), or cortisol (b=0.01, t(1124)=0.61, p=.542) scores over time.
Discussion
Our results are consistent with previous findings emphasizing highly individual fluctuations of estradiol and progesterone levels during perimenopause. However, our findings do not suggest a continuous decline during the observed transition phase, implying relatively stable periods of fluctuating hormone levels. Furthermore, given the lack of significant group differences, it may not be necessary to differentiate between early and late perimenopause from the standpoint of hormonal progression.