STRAW+10: Addressing the Unfinished Agenda of Staging Reproductive Aging - RESUBM

Harlow, Sioban

Abstract

We propose a multi-disciplinary symposium """"""""STRAW+10: Addressing the Unfinished Agenda of Staging Reproductive Aging"""""""" to update the 2001 Stages of Reproductive Aging Workshop (STRAW) recommendations. The menopausal transition is a period of critical change, including loss of fertility, increased bone resorption, change in lipid profiles and temporal increases in symptoms, sleep disturbances and depression. STRAW proposed nomenclature, a staging system, and menstrual and endocrine criteria to define stages of ovarian aging. It has become the gold standard for characterizing reproductive aging, as the Tanner Stages characterize puberty. In the past decade, understanding of the critical junctures in hypothalamic and ovarian function before and after the final menstrual period and their implications for women's health has advanced considerably. We will convene 30 investigators from key research groups in the United States and worldwide.
The specific aims are to refine criteria for the early menopausal transition given new population-based data relating to follicle-stimulating hormone, antral follicle count, anti-mullerian hormone and inhibin-B;to assess how to include women with higher body-mass-index and who smoke in staging algorithms;to provide recommendations regarding staging of women following gynecological surgery, chemotherapy, and hormone therapy and in women with polycystic ovarian syndrome and chronic diseases such as HIV/AIDS;and to assess potential criteria for staging the post-menopause. The Day 1 public scientific sessions will present recent advances and discuss implications of new data for staging. On Day 2, small working groups will propose modifications to the STRAW criteria. Following discussion, final recommendations will be adopted and research priorities defined. The expected outcome will be a set of recommendations for modifying the STRAW criteria that characterize the end stages of reproductive life including their extension to be more broadly applicable to the range of women's experience. Short- and long-term research priorities will be specified including studies needed to replicate and validate proposed criteria as well as to address gaps in knowledge. The meeting, co-sponsored by The North American Menopause Society (NAMS), The American Society for Reproductive Medicine, The International Menopause Society and The Endocrine Society, will be held September 20-21, 2011 prior to the NAMS Annual Meeting in Washington D.C. STRAW+10 recommendations will be presented at the NAMS meeting. A peer-reviewed executive summary will be published simultaneously in the co-sponsors'journals, Climacteric, Menopause, Fertility and Sterility;with a non-technical version published on their websites. The STRAW+10 staging system will facilitate consistent classification of menopausal status, ensuring comparability of research studies and clinical trials. Once specified, a staging system can be developed into a clinical tool to guide assessment of fertility and contraceptive choices, and healthcare decision-making. Funds will be allocated to support participation of 4 trainees/new investigators.

Public Health Relevance

The purpose of this multi-disciplinary 2-day symposium is to organize and synthesize knowledge accumulated during the past decade in order to update the 2001 Stages of Reproductive Aging Workshop (STRAW) model for staging the end of reproductive life in women. We also propose to extend the STRAW recommendations to be more broadly applicable to the range of women's diverse experience of reproductive aging.