HENRY G. BURGER zyxwvuts 295 menstruated 5 days later and a follicular blood sample was obtained on day zyxwvutsrqp 6 of the succeedingcycle. An FSH level in the post menopausal range (23.9 IUA) was found with a marginally elevated LH level and post meno- pausal range values for oestradiol and inhibin. Despite these findings the cycle length was again 28 days. The following cycle was however prolonged to 47 days. Despite the hormonal findings this and the other 2 subjects did not report any menopausal symptoms. CONCLUSIONS Several studies have demonstrated increasing FSH levels in regularly cycling women of increasingage. The prevalence of raised FSH and low oestradiol and inhibin increases as cycle irregularity becomes manifest in such women. Changes in reproductive hormones may occur abruptly at the time of declining ovarian function. It is concluded that the rise in FSH seen in regularly cycling older women reflects decreased ovarian feedback from a declining pool of follicles. The finding of post- menopausal FSH levels in regularly cycling or irregu- larly cycling women invalidates FSH measurement as a reliable marker that menopause has occurred or that further fertility is not possible. Careful clinical assessment is essential in answering the question, ‘is it all over?’. Refeerences 1. Richardson zyxwvu SJ, zyxwvuts Senikas zyxwvut V zyxwvu & Nelson JF. Follicular depletion during the menopausal transition: evidence for accelerated loss and ultimate exhaustion. J Clin Endocrinol Metab 1987; 6 5 1231-1237. 2. Sherman BM, West JH. & Korenman SG. The menopausal transition: analysis of LH, FSH, oestradiol, and progesterone concentrations during menstrual cycles of older women. J Clin Endocrinol Metab 1976; 42: 629-636. 3. Sherman BM & Korenman SG. Hormonal characteristics of the human menstrual cycle throughout reproductive life J Clin Invest 1975; 55: 699-706. 4. Lee SJ, Lenton EA, Sexton L zyxwv 8r Cooke ID. The effect of age on the cyclical patterns of plasma LH, FSH, oestradiol and progesterone in women with regular menstrual cycles. Hum Reprod 1988; 3: 851-855. 5. MacNaughton J, Bangah M, McCloud P, He J, Burger HG. Age related changes in follicle stimulating hormone, luteinizing hormone, oestradiol and immunoreactiveinhibin in women of reproductive age. Clin Endocrinol 1992; 36: 339-345. 6. Dennerstein L, Smith AMA, Morse C, Burger HG, Green A, Hopper J, Ryan M. Menopausal symptoms in Australian women. Med J Aust 1993; 159: 232-236. 7. Hee J, MacNaughton J, Bangah M. & Burger HG. Peximeno- pausal patterns of gonadotrophins, immunoreactive inhibin, oestradiol and progesterone. Maturitas 1993; (in press). Aust NZ J Obstet Gynaecol 1994, 34: 3: 295 The Global View of Reproductive Health Mahmoud F. Fathalla‘ The Rockfeller Foundation, New York Summary: Reproductive health is a condition in which the reproductive process is accomplished in a state of complete physical, mental and social well-being and is not merely the absence of disease or disorders of the reproductive process. The Daily Reproductive Health News in our global village does not paint a bright picture. The past few decades have witnessed a revolution in reproductive behaviour, with a major expansion in contraceptive use in developing countries. Between 1960-65 and 1985-90, the number of contraceptive users in all developing countries has increased from an estimate of 31 million to 381 million. The major expansion in contraceptive use in developing countries has consequences for the quality of life, for the present and for the future, for the society at large and for the individuals and their families. Major challenges, however, still lie ahead. There is a major unmet need for family planning. The rhetoric about population and family planning is not matched by allocation of resources. 1. Senior Adviser, Biomedical and Reproductive Health Researeh and Training.