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Staging reproductive aging using Stages of Reproductive Aging Workshop + 10 in black urban African women in the Study of Women Entering and in Endocrine Transition

Jaff, Nicole G. NCMP1,2; Snyman, Tracy BScHon2; Norris, Shane A. PhD1; Crowther, Nigel J. PhD2

doi: 10.1097/GME.0000000000000235
Original Articles

Objective There has been limited research on accurate staging of the menopausal transition in sub-Saharan African women. Our aim was to assess the usefulness of the Stages of Reproductive Aging Workshop + 10 (STRAW + 10) criteria in staging ovarian aging in black South African women, examining whether obesity has any effect on the menopausal transition.

Methods The study enrolled 702 women aged 40 to 60 years. STRAW + 10 criteria were used to categorize the stages of reproductive aging. The Menopause Rating Scale was used to measure the prevalence of vasomotor symptoms. Follicle-stimulating hormone (FSH) and estradiol levels were used as supportive criteria for staging. Human immunodeficiency virus status was assessed using a point-of-care method.

Results Reported age at final menstrual period (FMP) was higher in women interviewed within 4 years of FMP (mean [SD], 49.0 [3.80] y) than in women interviewed 10 years or more after FMP (mean [SD], 42.0 [4.06] y; P < 0.0005). In women within 4 years of FMP, lower body mass index was associated with earlier age at FMP. FSH levels increased and estradiol levels decreased (P < 0.0005 for both trends) across seven staging groups. Human immunodeficiency virus status had no effect on menopause symptoms. Obesity (body mass index ≥35.0 kg/m2) was associated with severe vasomotor symptoms.

Conclusions Reporting of age at FMP is unreliable in women interviewed 4 years or more after the event. STRAW + 10 seems accurate in staging reproductive aging, as confirmed by the strong association of FSH and estradiol levels with the menopausal transition stage. STRAW + 10 may be appropriate for use in resource-limited settings in the absence of biomarkers. Biocultural methods may be useful in assessing the menopausal transition in culturally diverse women.

From the 1Medical Research Council/Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa; and 2Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa.

Received November 21, 2013; revised and accepted February 13, 2014.

Funding/support: This study was funded by the Medical Research Council of South Africa, the National Health Laboratory Service, and the University of the Witwatersrand Iris Ellen Hodges Cardiovascular Research Trust.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Nicole G. Jaff, NCMP, Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg 2193, South Africa. E-mail:

© 2014 by The North American Menopause Society.