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The ReSTAGE Collaboration: defining optimal bleeding criteria for onset of early menopausal transition
Women’s Health Research Faculty Publications
  • Sioban D. Harlow, University of Michigan
  • Ellen S. Mitchell, University of Washington
  • Sybil L. Crawford, University of Massachusetts Medical School
  • Bin Nan, University of Michigan
  • Roderick Little, University of Michigan
  • John R. Taffe, Monash University
UMMS Affiliation
Department of Medicine, Division of Preventive and Behavioral Medicine
Publication Date
Document Type
Adult; Age Distribution; Age Factors; Biological Markers; Female; Follicle Stimulating Hormone; *Health Status Indicators; Humans; Logistic Models; *Menopause, Premature; *Menstrual Cycle; *Menstruation; Middle Aged; Odds Ratio; *Ovulation; Perimenopause; Population Surveillance; Practice Guidelines as Topic; Prospective Studies; Reproducibility of Results; Time Factors; United States; Victoria; Women's Health

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.

DESIGN/SETTING: 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.

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

MAIN OUTCOME MEASURE(S): 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.

RESULT(S): 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.

CONCLUSION(S): 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.

DOI of Published Version
Fertil Steril. 2008 Jan;89(1):129-40. Epub 2007 Aug 6. Link to article on publisher's site
Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Sioban D. Harlow, Ellen S. Mitchell, Sybil L. Crawford, Bin Nan, et al.. "The ReSTAGE Collaboration: defining optimal bleeding criteria for onset of early menopausal transition" Vol. 89 Iss. 1 (2008) ISSN: 0015-0282 (Linking)
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