Abstract and Introduction
Abstract
Objective: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Introduction
The 2001 Stages of Reproductive Aging Workshop (STRAW) proposed nomenclature and a staging system for ovarian aging including menstrual and qualitative hormonal criteria to define each stage. The STRAW staging system is widely considered the gold standard for characterizing reproductive aging through menopause, just as the Marshall-Tanner Stages characterize pubertal maturation. Research conducted during the past 10 years has advanced knowledge of the critical changes in hypothalamic-pituitary and ovarian function that occur before and after the final menstrual period. These advances were the topic of a follow-up workshop "STRAW +10: Addressing the Unfinished Agenda of Staging Reproductive Aging" (STRAW + 10). STRAW + 10, held in Washington, DC, on September 20 and 21, 2011, reviewed these scientific advances and updated the STRAW criteria. The sponsors were the National Institute on Aging (NIA) and Office of Research on Women's Health (ORWH) of the National Institutes of Health, The North American Menopause Society (NAMS), the American Society for Reproductive Medicine (ASRM), the International Menopause Society (IMS), and the Endocrine Society. The STRAW + 10 workshop achieved the following aims:
to reevaluate criteria for the onset of late reproductive life and early menopausal transition, given new population-based data relating to follicle-stimulating hormone (FSH), antral follicle count (AFC), antimüllerian hormone (AMH), and inhibin-B;
to reevaluate criteria for staging postmenopause, given new population-based data on changes in FSH and estradiol concentrations after the final menstrual period (FMP);
to reevaluate applicability to women based on variations in body size, lifestyle characteristics, and health status; and
to identify remaining gaps in scientific knowledge and research priorities.