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6 Ovarian Changes During Aging
Alain Gougeon
Faculté de Médecine Lyon-Sud - France

From the late thirties to the menopause onset, the ovary undergoes substantial morphological and functional changes. The major and most visible changes concern the ovarian reserve of nongrowing follicles. At birth, the human ovary contains between 266,000 and 472,000 follicles. With increasing age, the population of follicles progressively decreases leading to a stock at menopause estimated between 10 and 100 follicles per ovary. The nongrowing follicle-count decay rate is slow up to 38 years of age; it strongly accelerates thereafter. The reason for this accelerated depletion of the ovarian reserve remains to be elucidated. Although the entry of nongrowing follicles into the growth phase contributes, but at a low level, to attrition of the ovarian reserve, this latter is mainly due to apoptosis.

The number of all classes of growing follicles strongly decreases in the ageing ovary. The number of preantral follicles (0.2 - 0.4 mm) falls from 26.8 ± 2.5 to 6.9 ± 1.0 per ovary in young (19 - 30 years) and premenopausal („ 46 years) women, respectively. Similarly, the number of selectable follicles falls from 10.6 ± 1.7 to 1.1 ± 0.2 per ovary in young (19 - 30 years) and premenopausal („ 46 years) women, respectively. However, during the follicular phase of the menstrual cycle the proliferative activity of granulosa cells from selectable follicles is significantly higher in women older than 40 years than in younger women. This could explain the follicular phase shortening observed just before menopause onset.

Some changes can also be observed during the follicular terminal growth. The size of preovulatory follicles decreases significantly with ageing, and sometimes, atretic follicles can ovulate leading to an abnormal corpus luteum.

7 Hormone Evolution Profile
René Ecochard
CLER France

To characterize relationships between age and cycles characteristics, E1G, PDG, LH or FSH levels over the cycle in normal cyclic women.

Comparison of baseline characteristics, cycle characteristics and daily hormonal levels between women below 27 (20 women), 27-38 (62), and over 38 (25). Recently, a bank of first morning void specimens was established (Quidel Corporation, San Diego, CA. USA). Clinical, hormonal, and echographical data have been obtained from these female volunteers. The present study seized this opportunity to analyse the evolution of cycle characteristics with age. The protocol was written for a multicenter collaborative study under the auspices of Claude Bernard University, Lyon (France). The subjects were voluntary women recruited from 8 Natural Family Planning Centers at: Aix-en-Provence, Dijon and Lyon (France); Milano and Verona (Italy); Düsseldorf (Germany); Liege (Belgium); and Madrid (Spain).

There were no significant differences in BMI or life-style characteristics among the three groups. Higher age was significantly associated with higher shorter preovulatory phase (p=0.01), higher FSH, higher LH, higher E1G and lower PDG at J3 (P=0.01) and (P=0.01). No differences were observed between younger and older women in diameter of the dominant follicle, E1G-, PDG-, FSH- and LH-level during the fertile and post-ovulatory phases of the cycle.

Multivariate analysis of these results will be discussed during the presentation.

The author wish to thank Drs Sophie Dubus, Anne Leduy, Isabelle Ecochard, Marie Grisard Capelle, Michele Barbato, Enriqueta Barraco, Marion Gimmler, & Sandro Girotto from the natural family planning clinics as well as all the women who took part in this study.

8 The Cycle Evolution of Women Aged 20 Years Old up to the Menopause
Tatjana Barras-Kubski

In 1967 Treloar/ U.S.A. published a 27 yrs. study with 2700 women and over 250.000 menstrual intervals according to menstrual dates. Vollmann/ CH wrote in 1977 the analysis of a study lasting nearly 4 decades with 650 women and over 30.000 menstrual intervals according to the BBT curves, about 50 cases having no interruption between menarche and menopause! » The regular 28 day cycle is a myth . The level and range of variability of the cycles are a woman’s individual characteristic and form a U-shaped curve from menarche to menopause. The median cycle’s length decreases slightly and nearly on a horizontal line during the maturity years which extend between about the 8 th yr after menarche to about 6-8 yrs. before menopause (from 29 days (CH) - 30 days (USA) to 26 days). The climacteric phase of instability in the length of the menstrual cycles extends mainly over the last 54 cycles with an increase in short and long cycles. » The evolutions of the post and pre -menstrual phases by BBT curves, the mean temperature of the cycles etc are analyzed until the menopause.

The beautiful graphs in both studies remain a high source of information on the dynamic developmental stages of the woman’s reproductive physiology.

9 The effect of age on the Average Length and Variability of the Pre-Ovulatory Phase of Women Above 35
Francesco C. Billari, Ester Rizzi, Alessandro Rosina
Independent Research Group on the Demography of Early Adulthood
Max Planck Institute for Demographic Research Rostock (Germany)

In this paper, we study the effect of age on the number of days until ovulation in female menstrual cycles. This is both of direct interest and of specific relevance to daily fecundability studies, in which waiting time until ovulation constitutes the key variable. The literature has so far investigated the problem either from a cross-sectional point of view or within a time-series framework. We re-exploit here some data that were used by Marshall, and possibly a new data source, with several cycles for each woman in the sample. The day of ovulation is identified on the basis of shifts in the basal body temperature. After performing some descriptive analyses, we develop a Gaussian linear mixed model that allows for the analysis of age effects by explicitly taking into account the correlation between the observations for each woman. We subsequently allow variability to become age-specific and separately model age effects on the mean length and on the variability of pre-ovulatory phases. As we shown in a previous paper (Billari and Rosina, 2000), the length of the pre-ovulatory phase declines with age and that at ages close to menopause, there is some extra variability due to exceptionally long cycles. When one disregards such cycles, the variability within women is almost constant. This pattern could be connected to some findings concerning the surprisingly high level of female sterility and infecundity at higher ages. In this paper we focus on the ages above 35.

Key words: linear mixed models, multilevel models, fecundability, menstrual cycles, pre-ovulatory phase, follicular phase, biodemography, modelling age effects,pre-menopause Corresponding author: Alessandro Rosina, XXXX

10 Family Planning From Pre-Menopause to Menopause: A Symptothermic Method Teacher's Experience
Bozzo G., Boerci M:, Barbato M., Bonacina G.

From several years, the teaching of Natural Family Planning at CAMeN allows us to meet women who start or are getting through their climacteric period, with all its difficulties. For the teacher, two different situations come up:

  • the case of a woman asking to learn NFP when she is already in the climacteric age
  •  the case in which a woman comes to the threshold of climacteric already practiced in self-knowledge and in fertility awareness.

The possibility to offer competent company in both situations exists if the teacher himself or herself is aware of how cycles change, of how symptoms vary, but also of the singularity of the real life of the woman and of the couple in that period.

The changes in the menstrual cycle, the occurrence of irritating disorders, the feeling of no longer knowing oneself, the necessity of assuming drugs, also hormonal drugs, are obstacles that can be faced and overcome through a method allowing to look at and know one’s personal reality, even if this is so strange and unpredictable as compared with the past. In this way, the woman is helped to be more aware of what happens to her and to be an active collaborator of her NFP teacher and often also of the doctor treating her.

We propose, then, a close exam of the typical climacteric problems from the physiological point of view and going into the ways of teaching the symptothermal method more adequate to that period of woman’s life.

We also propose the creation of a workgroup which can be a point of reference for the study, the exam and the data collecting on NFP teaching in climacteric.

11 Women's New Self-Appraisal During Menopause
Raffaella Magnoli
Psychologist with clinical practices in the fields of psychiatry and psycho-analysis. Research and psychotherapy counselling of couples and families.  Centro Studi di Psicoterapia of Milan 

Women, like every human being, experience continual changes in their internal representation. This representation may be either more, or less, close to their personal ideal image (young, beautiful, mother of babies, successful career woman, physically attractive, useful, etc.) from which derives the phrase "a feeling of security and well being" (J.Sandler).

The menopause constitutes a particularly delicate period of crisis: between the ideal personal image and reality there may be a strong discrepancy that generates psychological distress.

A woman may respond to this suffering by depressive capitulation, or by adopting defensive mechanisms already familiar to her, to restore a minimum feeling of well being, or else, she may re-elaborate the grieving for the ideal state through a process of individuation which allows her to turn towards new ideals which are more adaptive to reality and sources of new satisfactions.

This communication will describe some clinical cases in which it is possible to discern the intra-psychical and relational dynamics of crises experienced during menopause. The crisis may be expressed through an individual symptom, a difficulty within the couple or a symptom shown by one of their children which may lead to a request for psycho-therapeutic help. This can result in an occasion to assign a new adaptation through initiating a process of recognition of the woman and, in parallel, also often of the spouse and other members of the family.

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