Abstract
The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period. Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus. STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics. STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.
Highlights
AND SIGNIFICANCEThe menopausal transition marks a period of physiologic changes as women approach reproductive senescence
The Stages of Reproductive Aging Workshop (STRAW) staging system is widely considered the gold standard for characterizing reproductive aging through menopause, just as the Marshall-Tanner Stages characterize pubertal maturation [5]
J Clin Endocrinol Metab, April 2012, 97(4):1159 –1168 final menstrual period. These advances were the topic of a follow-up workshop “STRAW ϩ 10: Addressing the Unfinished Agenda of Staging Reproductive Aging” (STRAW ϩ 10)
Summary
The menopausal transition marks a period of physiologic changes as women approach reproductive senescence. As a standardized staging system for reproductive aging, STRAW made a substantial contribution to women’s health research by providing consistent classification of menopause status for studies of midlife women. Building upon previous consensus meetings of the World Health Organization and the Council of Affiliated Menopause Societies, [18] STRAW reevaluated nomenclature, proposed a standardized staging system, and recommended criteria for defining the onset of each stage. STRAW participants evaluated potential criteria including menstrual cycles; endocrinologic parameters including FSH, estradiol, AMH, and inhibin-B; symptoms; fertility; and ovarian imaging including AFC. Information on AFC and on the relationship among AMH, inhibin-B, and the timing of ovarian aging was limited. STRAW restricted staging recommendations to menstrual cycle bleeding criteria and qualitative FSH criteria
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