Executive Summary of the Stages of Reproductive Aging
STRAW + 10 revised and extended the STRAW recommendations to include additional criteria for defining specific stages of reproductive life. The revised staging system provides a more comprehensive basis for classification and assessment, from the late reproductive stage through the menopausal transition and into postmenopause. Its application should improve comparability of studies of midlife women by establishing clear criteria for ascertaining women's reproductive stage. The STRAW + 10 recommendations are expected to improve guidance for classifying the ovarian status of midlife women in the research setting while advancing efforts to translate this new science for clinicians and women.
Although scientific understanding of ovarian aging has advanced considerably in the last decade, important gaps in scientific knowledge persist. The workshop participants identified seven research priorities.
Conclusions and Research Priorities
STRAW + 10 revised and extended the STRAW recommendations to include additional criteria for defining specific stages of reproductive life. The revised staging system provides a more comprehensive basis for classification and assessment, from the late reproductive stage through the menopausal transition and into postmenopause. Its application should improve comparability of studies of midlife women by establishing clear criteria for ascertaining women's reproductive stage. The STRAW + 10 recommendations are expected to improve guidance for classifying the ovarian status of midlife women in the research setting while advancing efforts to translate this new science for clinicians and women.
Although scientific understanding of ovarian aging has advanced considerably in the last decade, important gaps in scientific knowledge persist. The workshop participants identified seven research priorities.
Lack of standardized assays for key biomarkers remains an important limitation in efforts to stage reproductive aging and to translate research findings to cost-effective clinical tools. Given the importance of AMH in relation to fertility and its relative stability across the menstrual cycle, the development of an international standard for the assessment of AMH is of paramount importance.
Empirical analysis across multiple cohorts is needed to specify precise menstrual cycle criteria for Stages -3b and - 3a.
Studies are needed to characterize the hormonal changes of postmenopause from Stage +1 to +2 because data across these stages are limited; several cohort studies are well positioned to provide this information. The development of highly sensitive, well characterized assays is needed.
Given that the large cohort studies of midlife women were initiated before the STRAW staging system was developed, these cohorts should be supported to apply the STRAW + 10 staging criteria to reanalyze key findings on the clinical changes that occur across the menopausal transition.
Improved characterization of the pattern, timing, and level of reproductive biomarkers across nations is necessary, especially to provide data on the experience of women from low-resource countries.
Research is needed to better understand the process of reproductive aging and appropriate staging criteria for women with PCOS and POI and those who have had removal of a single ovary and/or hysterectomy.
Research is needed to better evaluate staging in women with chronic illness such as HIV infection and those undergoing cancer treatment.
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