Staging Reproductive Aging in Five Cohort Studies

描述(申请人提供)：更年期标志着女性生理和健康状况发生重大变化的时期。与青春期不同的是，还没有建立生殖衰老的分期系统。生殖老龄化分期系统将促进卫生干预措施的发展，使提供者能够更好地向妇女提供关于更年期症状和预防性治疗的咨询，并使研究人员能够更好地对妇女的生殖状况进行分类。2001年7月，NIA和其他组织举办了一次研讨会，提出生殖老龄化分期制度(稻草)。尽管Straw的建议建立在对中年女性的队列研究的新结果之上，并代表了专家的共识，但它们并不是由数据库驱动的。虽然在概念上与先前的定义一致，但Straw的早期和晚期过渡阶段的出血标准包括与当前临床和研究实践的重要背离。此外，STRAW没有为这些出血标准提供明确的操作定义。该应用程序的目标是经验性地评估5个建议的绝经早期过渡的出血标准和4个建议的晚期过渡的出血标准，作为STRAN建议的基础。我们将使用从五项关于更年期转变的大型综合队列研究(Tremin Trust、墨尔本妇女中年健康项目、西雅图中年妇女健康研究、密歇根州骨健康研究和全国多地点、多种族妇女健康研究)积累的月经日历、激素和症状数据。我们建议评估1)每个标准被明确定义的频率(即，我们是否能够使用该标准按生殖阶段对女性进行分类？)，2)在队列内和跨队列的标准中，过渡年龄是否不同，3)过渡年龄和绝经年龄之间的关系，4)绝经年龄的预测是否通过纳入FSH或潮热等预测因子而得到改善，以及它是否因种族、吸烟状况或体重指数而异。这项研究将提供关于哪些标准在不同人群和不同绝经年龄范围内具有广泛代表性的经验证据，进一步努力建立更年期过渡的分期标准。这些信息将有助于澄清我们对卵巢老化的理解，使研究人员能够更充分地控制更年期状态，并促进女性及其提供者的决策。

DESCRIPTION (provided by applicant): The menopause marks a period of critical change in women's biology and health status. Unlike puberty, no staging system for reproductive aging has been established. A staging system for reproductive aging would facilitate development of health interventions, enable providers to better counsel women about menopausal symptoms and preventative therapy, and permit researchers to better classify women's reproductive status. In July 2001, NIA and other organizations held a workshop to propose a staging system for reproductive aging (STRAW). Although STRAW's recommendations built upon emerging results from cohort studies of midlife women and represent an expert consensus, they were not database driven. STRAW's bleeding criteria for the early and late transition stages, although conceptually consistent with prior definitions, include important departures from current clinical and research practice. Also, STRAW did not provide unambiguous operational definitions for these bleeding criteria. The goal of this application is to empirically evaluate 5 proposed bleeding criteria for onset of the early menopausal transition and 4 proposed bleeding criteria for onset of the late transition that served as the basis for the STRAW recommendations. We will use menstrual calendar, hormone and symptom data accumulated from five of the large and comprehensive cohort studies of the menopausal transition (the Tremin Trust, Melbourne Women's Midlife Health Project, Seattle Midlife Women's Health Study, Michigan Bone Health Study and the multi-site, multi-ethnic Study of Women's Health Across the Nation). We propose to assess 1) how frequently each criterion is well defined (i.e., are we able to categorize women by reproductive stage using the criterion?), 2) whether the age at transition differs among the criteria within and across cohorts, 3) the relationship between age at transition and age at menopause, and 4) whether prediction of age at menopause is improved by including predictors such as FSH, or hot flash, and whether it varies by ethnicity, smoking status or body mass index. This study will provide empirical evidence regarding which criteria are broadly representative across populations and across the range of menopausal ages, furthering efforts to establish staging criteria for the menopausal transition. This information will help clarify our understanding of ovarian aging, permit researchers to more adequately control for menopausal status, and facilitate decision-making among women and their providers.