The ReSTAGE Collaboration: defining optimal bleeding criteria for onset of early menopausal transition
Objective
Criteria for staging the menopausal transition are not established. This article evaluates five bleeding criteria for defining early transition and provides empirically based guidance regarding optimal criteria.
Design/Setting
Prospective menstrual calendar data from four population-based cohorts: TREMIN, Melbourne Women's Midlife Health Project (MWMHP), Seattle Midlife Women's Health Study (SMWHS), and Study of Women's Health Across the Nation (SWAN) with annual serum FSH from MWMHP and SWAN.
Participants
735 TREMIN, 279 SMWHS, 216 MWMHP, and 2270 SWAN women aged 35–57 at baseline who maintained menstrual calendars.
Main Outcome Measure(s)
Age at and time to menopause for: standard deviation >6 and >8 days, persistent difference in consecutive segments >6 days, irregularity, and ≥45 day segment. Serum FSH concentration.
Result(s)
Most women experienced each of the bleeding criteria. Except for a persistent >6 day difference that occurs earlier, the criteria occur at a similar age and at approximately the same age as late transition in a large proportion of women. FSH was associated with all proposed markers.
Conclusion(s)
The early transition may be best described by ovarian activity consistent with the persistent >6 day difference, but further study is needed, as other proposed criterion are consistent with later menstrual changes.
Key Words: Menopausal transition, menopause, menstrual cycle, aging, ovarian function, FSH
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ReSTAGE has grant support from the National Institute of Aging (Grant AG 021543, Siobán Harlow, PI). The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health, Department of Health and Human Services, through the National Institute on Aging, the National Institute of Nursing Research, and the National Institutes of Health Office of Research on Women's Health (Grants NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495). The Seattle Midlife Women's Health Study has grant support from the National Institute of Nursing Research (Grants NR004141 and NR04001, Ellen Mitchell, PI). Data collection for the Melbourne Women's Midlife Health Project was supported by the Victorian Health Promotion Foundation and the National Health and Medical Research Council of Australia (Lorraine Dennerstein, PI).
The ReSTAGE Collaboration: University of Michigan, Ann Arbor, Michigan: Siobán D. Harlow (Principal Investigator), Roderick Little, Bin Nan, John Randolph, MaryFran Sowers, Matheos Yosef; University of Washington, Seattle, Washington: Ellen S. Mitchell, Nancy Fugate Woods, Kevin Cain; University of Massachusetts Medical School, Worcester, Massachusetts: Sybil Crawford; University of Melbourne, Melbourne, Australia: Lorraine Dennerstein; Monash University, Melbourne Australia: John Taffe, Henry Burger.
PII: S0015-0282(07)00404-9
doi:10.1016/j.fertnstert.2007.02.015
© 2008 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
