Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging

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.

Key words::

• REPRODUCTIVE AGING
• OVARIAN AGING
• MENOPAUSE
• FOLLICLE-STIMULATING HORMONE
• ANTIM LLERIAN HORMONE
• ANTRAL FOLLICLE COUNT
• INHIBIN-B

ACKNOWLEDGEMENT

STRAW +10 In Memoriam: MaryFran Sowers, PhD, University of Michigan.

APPENDIX

STRAW +10 Program Committee

Siobán D. Harlow, PhD, Program Chair, Professor, Department of Epidemiology, University of Michigan

Margery Gass, MD, NCMP, Executive Director, The North American Menopause Society

Janet E. Hall, MD, President, The Endocrine Society; Professor, Department of Medicine, Harvard Medical School

Roger Lobo, MD, President, American Society of Reproductive Medicine, Professor, Department of Obstetrics and Gynecology, Columbia University

Pauline Maki, PhD, Professor, Departments of Psychiatry and Psychology, University of Illinois

Robert W. Rebar, MD, Executive Director, American Society for Reproductive Medicine

Sherry Sherman, PhD, National Institute on Aging

Tobie J. de Villiers, MBChB, FRCOG, FCOG (SA), President, International Menopause Society (South Africa)

STRAW +10 Collaborative Group

Susan E. Appt, DVM, Wake Forest School of Medicine (United States); Valerie L. Baker, MD, Stanford University (United States); Frank J. Broekmans, MD, PhD, University Medical Center Utrecht (Netherlands); Marcelle I. Cedars, MD, Ruth Greenblatt, MD, University of California at San Francisco (United States); Sybil Crawford, PhD, Lynnette L. Sievert, PhD, University of Massachusetts (United States); Lorraine Dennerstein, MD, University of Melbourne (Australia); Ellen W. Freeman, PhD, Mary Sammel, ScD, University of Pennsylvania (United States); Marjorie Gass, MD, NCMP, The North American Menopause Society (United States); Georgina Hale, MD, PhD, University of Sydney (Australia); Janet E. Hall, MD, Harvard Medical School (United States); Karl R. Hansen, MD, PhD, University of Oklahoma (United States); Siobán D. Harlow, PhD, Rod Little, PhD, Pangaja Paramsothy, MPH, John F. Randolph, MD, University of Michigan (United States); Nicole Jaff, NCMP, PhD, Research Fellow, University of the Witwatersrand (South Africa) Hadine Joffe, MD MSc, Jan Shifren, MD, Patrick M. Sluss, PhD, Massachusetts General Hospital (United States); Roger Lobo, MD, Michelle Warren, MD, Columbia University (United States); Pauline Maki, PhD, Professor, University of Illinois (United States); Kathleen O’Connor, PhD, Nancy Fugate Woods, RN, PhD, University of Washington (United States); Robert Rebar, MD, American Society for Reproductive Medicine (United States); Gloria Richard-Davis, MD, Meharry Medical College (United States); David M. Robertson PhD, Prince Henry's Institute of Medical Research, Monash University (Australia); Sherry Sherman, PhD, National Institute on Aging (United States); Claudio N. Soares, MD, PhD, McMaster University (Canada); H. Irene Su, MD, University of California at San Diego (United States); Josefina Romaguera, MD, MPH, University of Puerto Rico (Puerto Rico); Wulf Utian, MD, Case Western Reserve School of Medicine (United States); Heidi VandenBrink, University of Saskatchewan (Canada); Tobie J. de Villiers, MBChB, FRCOG, FCOG (SA), International Menopause Society (South Africa); Miriam T. Weber, PhD, University of Rochester (United States); Melissa F. Wellons, MD, University of Alabama (United States).

Financial disclosure/conflicts of interest P.M.S. and S.S. declare no conflict of interest. M.G. receives salary support from The North American Menopause Society (NAMS). S.D.H. has grant support from the National Institute on Aging (NIA) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and receives travel support from NAMS. J.E.H. has grant support from NIA and receives travel support from the Endocrine Society. R.L. is past president of the American Society for Reproductive Medicine (ASRM). P.M. receives grant support from the National Institute on Mental Health (NIMH), the NIA, the National Institute of Allergy and Infectious Diseases (NIAID), and the National Institute on Drug Abuse (NIDA); is on the Board of Trustees for NAMS; and has previously consulted for Noven Pharmaceuticals, received lecture fees from the Royal Ottawa Foundation for Mental Health, the Mayo Clinic, Baycrest, and Northwestern University and received travel support from the Society for Women's Health Research, the International Menopause Society, Pfizer, the Australasian Pacific Menopause Society, Virginia Commonwealth University Institute for Women's Health. R.W.R. receives salary support from ASRM. T.J.d.V. declares no direct conflict of interest as regards the submitted article but has in the past received consultancy fees from Adcock Ingram and Pfizer; speaker's fees from Servier; and travel support from Amgen, Pfizer, and Bayer.

Funding/support The Stages of Reproductive Aging Workshop (STRAW) +10 had grant support from the National Institutes of Health (NIH), Department of Health and Human Services (DHHS), through the National Institute on Aging (NIA) (AG039961), and the NIH Office of Research on Women's Health (ORWH) as well as from The North American Menopause Society (NAMS), the American Society for Reproductive Medicine (ASRM), the International Menopause Society (IMS), and the Endocrine Society.