What happens to the level of SHBG during the menopause transition?

During the menopause transition, the level of sex hormone-binding globulin (SHBG) typically increases. This increase is primarily due to changes in hormone levels that occur, particularly the decline of estrogen. As estrogen levels decrease, the liver produces more SHBG, which binds to sex hormones, particularly testosterone and estradiol, thus reducing the levels of free bioavailable hormones in the circulation.

Understanding the role of SHBG is crucial as it influences the amount of free estrogen and testosterone that is available to tissues and can have various implications for health during menopause. Higher SHBG levels can lead to lower levels of bioactive sex hormones, which may contribute to menopausal symptoms and changes in sexual function.

The other options do not accurately reflect the physiological changes during menopause, as SHBG does not decrease, remain constant, or fluctuate randomly but rather shows a clear pattern of increase in response to hormonal changes.