Staging Reproductive Aging in Five Cohort Studies

描述（由申请人提供）：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，目前还没有建立起生殖衰老的分期系统。生殖衰老的分期系统将促进健康干预措施的发展，使提供者能够更好地就更年期症状和预防性治疗向妇女提供咨询，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等组织举办了一个研讨会，提出了生殖老龄化分期系统（STRAW）。尽管STRAW的建议建立在中年妇女队列研究的新结果之上，代表了专家的共识，但它们不是基于数据库的。STRAW对早期和晚期过渡阶段的出血标准，虽然在概念上与先前的定义一致，但与当前的临床和研究实践有重大偏差。此外，STRAW没有为这些出血标准提供明确的操作定义。本研究的目的是对绝经早期过渡期的5项出血标准和绝经晚期过渡期的4项出血标准进行实证评估，这些标准是STRAW建议的基础。我们将使用从五个大型综合绝经期队列研究（Tremin Trust、墨尔本妇女中年健康项目、西雅图中年妇女健康研究、密歇根骨骼健康研究和全国多地点、多民族妇女健康研究）中积累的月经日历、激素和症状数据。我们建议评估每个标准是1)频率定义良好的(也就是,我们能够使用标准按女性生殖阶段进行分类?),2)过渡不同年龄是否在标准内,穿过人群,3)年龄在过渡和绝经的年龄之间的关系,以及4)预测绝经的年龄是否提高了包括预测如FSH、或潮热,以及是否不同的种族、吸烟状态或身体质量指数。本研究将提供关于哪些标准在人群和绝经年龄范围内具有广泛代表性的经验证据，进一步努力建立绝经过渡的分期标准。这些信息将有助于澄清我们对卵巢衰老的理解，使研究人员能够更充分地控制绝经状态，并促进妇女及其提供者的决策。

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.