Revista Cientifica Internacional de Ciencias de la Salud · Mar 31, 2026
Physiology of the hypothalamic–pituitary–ovarian axis in the regulation of the menstrual cycle in perimenopausal women
By Lázaro BT, Carranza AS, Aguilar NS et al.
This review describes the physiology of the hypothalamic–pituitary–ovarian (HPO) axis, its neuroendocrine regulation, and its role in menstrual cycle variability during the perimenopausal transition. A narrative review was conducted focusing on pulsatile GnRH secretion, pituitary responses of FSH and LH, ovarian steroidogenesis, and age-related ovarian changes. Perimenopause is characterized by progressive disruption of negative feedback mechanisms, with decreased inhibin B and anti-Müllerian hormone levels, marked estradiol fluctuations, and irregular elevations of FSH, leading to anovulatory cycles and menstrual irregularity. Hormonal variability also affects the central nervous system, modulating neurotransmitters, thermoregulation, and cerebral metabolism. Understanding these mechanisms helps explain neuroendocrine symptoms and supports clinical strategies based on hormonal education, individualized management, and metabolic monitoring.