Dr Nanette Santoro1
1Professor and E. Stewart Taylor Chair, Department of Obstetrics & Gynecology, University of Colorado School of Medicine
Biography:
Dr. Nanette Santoro is the E Stewart Taylor Chair of Obstetrics & Gynecology at the University of Colorado School of Medicine, where she has served for 15 years. She has been continuously funded by the NIH since 1989 for research in female reproduction. Her work has covered the processes of the pubertal and menopausal transition, as well as clinical trials in reproduction and menopause. She has headed studies of women with premature and age-appropriate menopause such as the Women’s Health Initiative and the Kronos Early Estrogen Prevention Study (KEEPS), and the Study of Womens Health Across the Nation (SWAN). She has held numerous leadership positions in local and national organizations. Dr. Santoro was elected to the National Academy of Medicine in 2018. She is Past President of the Society for Reproductive Investigation and President Elect of the Endocrine Society (2026-2027).
Abstract:
As ovarian reserve dwindles, a characteristic series of endocrine events occur. Reduced ovarian follicles result in decreased inhibin restraint, a rise in FSH, shorter follicular phases, and initially normal luteal phases with occasional ‘LOOP’ (luteal-out-of-phase) cycles. As ovarian reserve declines further, responsive follicles are only intermittently available, and periods of relatively low estrogen are followed by estrogen surges. The pace at which ovarian reserve is lost appears to follow two distinct trajectories and is associated with some phenotypic features. As the transition progresses, and amenorrhea becomes prolonged, a series of physiologic changes are also known to occur and these changes interact with additional, somewhat abrupt cardiometabolic manifestations of chronological aging. Teasing apart symptoms in perimenopausal women therefore requires an ability to correctly attribute symptoms to hormones and to address the overall health of the patient.