The ReSTAGE Collaboration: defining optimal bleeding criteria for onset of early menopausal transition.
OBJECTIVE
Criteria for staging the menopausal transition are not established. This article evaluates five bleeding criteria for defining early transition and provides empirically based guidance regarding optimal criteria.


METHODS
Prospective menstrual calendar data from four population-based cohorts: TREMIN, Melbourne Women's Midlife Health Project (MWMHP), Seattle Midlife Women's Health Study (SMWHS), and Study of Women's Health Across the Nation (SWAN) with annual serum FSH from MWMHP and SWAN.


METHODS
735 TREMIN, 279 SMWHS, 216 MWMHP, and 2270 SWAN women aged 35-57 at baseline who maintained menstrual calendars.


METHODS
Age at and time to menopause for: standard deviation >6 and >8 days, persistent difference in consecutive segments >6 days, irregularity, and >or=45 day segment. Serum FSH concentration.


RESULTS
Most women experienced each of the bleeding criteria. Except for a persistent >6 day difference that occurs earlier, the criteria occur at a similar age and at approximately the same age as late transition in a large proportion of women. FSH was associated with all proposed markers.


CONCLUSIONS
The early transition may be best described by ovarian activity consistent with the persistent >6 day difference, but further study is needed, as other proposed criterion are consistent with later menstrual changes.
Harlow
Siobán D
SD
Epidemiology, University of Michigan, Ann Arbor, Michigan 48104, USA. harlow@umich.edu
Mitchell
Ellen S
ES
Crawford
Sybil
S
Nan
Bin
B
Little
Roderick
R
Taffe
John
J
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008594:Menopause, Premature / Q000097:blood; D008597:Menstrual Cycle; D008598:Menstruation; D008875:Middle Aged; D016017:Odds Ratio; D010060:Ovulation; D047648:Perimenopause / Q000097:blood / Q000502:physiology*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D014481:United States; D014739:Victoria; D016387:Women's Health
D015415:Biomarkers; D005640:Follicle Stimulating Hormone