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.
STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive and the early postmenopause stages, provided information on the duration of the late transition and early postmenopause, and recommended application regardless of women’s age, ethnicity, body size, or lifestyle characteristics.
From the 1Department of Epidemiology, University of Michigan; Ann Arbor, MI; 2The North American Menopause Society; Mayfield Heights, OH; 3The Endocrine Society; Department of Medicine, Harvard Medical School; Boston, MA; 4Department of Obstetrics and Gynecology, Columbia University; New York, NY; 5Department of Psychiatry and Psychology, University of Illinois; Chicago, IL; 6American Society for Reproductive Medicine; Birmingham, AL; 7National Institute of Aging; Bethesda, MD; 8Department of Pathology, Harvard Medical School; Boston, MA and 9International Menopause Society; Cape Town, South Africa.
Received December 10, 2011; revised and accepted January 23, 2012.
This article is being simultaneously published in the journals Climacteric, Fertility and Sterility, the Journal of Clinical Endocrinology and Metabolism, and Menopause
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.
This article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, ORWH, or NIH.
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 buthas in the past received consultancy fees from Adcock Ingram and Pfizer; speaker’s fees from Servier; and travel support from Amgen, Pfizer, and Bayer.
Address correspondence to: Siobán D. Harlow, PhD, Department of Epidemiology, University of Michigan 1415 Washington Heights, Ann Arbor MI 48109. E-mail: firstname.lastname@example.org