Executive Summary: Stages of Reproductive Aging Workshop (STRAW)

April 03, 2002

In This Article

Introduction

The Stages of Reproductive Aging Workshop (STRAW) was held in Park City, Utah, July 23/24, 2001. There were 27 invited participants, most of whom had extensive clinical and/or research experience in reproductive aging in women. The sponsors were the American Society for Reproductive Medicine (ASRM), the National Institutes on Aging (NIA), the National Institute of Child Health and Human Development (NICHD), and the North American Menopause Society (NAMS). The purpose of the workshop was to address the absence of a relevant staging system for female reproductive aging as well as the frustration with the current nomenclature.

The format of the workshop was focused presentations on menstrual cyclicity, endocrinology, pelvic anatomy, symptoms in other organ systems, nomenclature, fertility, and both clinical and basic research gaps in relation to reproductive aging. After each presentation there was a panel discussion followed by a group discussion. Later there were breakout groups that sought agreement on the practical utility of different signs and symptoms for a staging system. Subsequently, the leaders from each of the breakout groups presented their recommendations to all the participants that were then melded into a combined staging system (Figure). Each point in the proposed staging system was accepted by at least a super majority (70%) of the participants (there was unanimity on most points).

Women don't initiate reproductive function (puberty) nor end it (menopause) at a particular chronologic age. Both puberty and the menopausal transition are dynamic periods for the reproductive axis during which development or senescence occurs in a relatively rapid fashion. While there is a useful staging system for puberty (the Tanner/Marshall system[1]), heretofore there has been no similar staging system for late reproductive function. The need (demand) for a staging system has been most apparent to the biomedical research community, but the intended audience of the workshop also included two secondary groups: health practitioners and the public. The specific goals of the reproductive aging workshop were to:

  1. develop a relevant and useful staging system.

  2. revise the nomenclature.

  3. identify knowledge gaps (both clinical and basic) that should be addressed by the research community.

Aging can be defined as the natural progression of changes in structure and function that occur with the passage of time in the absence of known disease. The female reproductive axis is essentially composed of the hypothalamic-pituitary-ovarian axis and the mullerian derived structures (e.g., uterus). The reproductive axis ages to a non-functional state (menopause) much earlier than the other organ systems, at a time when a woman is otherwise healthy. The basis of reproductive senescence in women is oocyte depletion in the ovary. A woman is endowed at birth with a finite number of oocytes that are arrested in prophase I of meiosis. Reproductive aging consists of a steady loss of oocytes from atresia or ovulation, which does not necessarily occur at a constant rate. The relatively wide age range (42 to 58 years) for reproductive failure (menopause) in normal women would seem to indicate that females are either endowed with a highly variable number of oocytes and/or lose them at a highly variable rate.

Reproductive aging is a natural process that begins at birth and proceeds as a continuum. Clearly it is a process and not an event, and the end (menopause) is much easier to identify than the beginning. With the realization that chronologic age is a very poor indicator, the purpose of a staging system would be the identification of where a given woman was in the process of reproductive aging.

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