A review of menopause nomenclature

Abstract

Menopause nomenclature varies in the scholarly literature making synthesis and interpretation of research findings difficult. Therefore, the present study aimed to review and discuss critical developments in menopause nomenclature; determine the level of heterogeneity amongst menopause definitions and compare them with the Stages of Reproductive Aging Workshop criteria. Definitions/criteria used to characterise premenopausal and postmenopausal status were extracted from 210 studies and 128 of these studies were included in the final analyses. The main findings were that 39.84% of included studies were consistent with STRAW classification of premenopause, whereas 70.31% were consistent with STRAW classification of postmenopause. Surprisingly, major inconsistencies relating to premenopause definition were due to a total lack of reporting of any definitions/criteria for premenopause (39.84% of studies). In contrast, only 20.31% did not report definitions/criteria for postmenopause. The present findings indicate that there is a significant amount of heterogeneity associated with the definition of premenopause, compared with postmenopause. We propose three key suggestions/recommendations, which can be distilled from these findings. Firstly, premenopause should be transparently operationalised and reported. Secondly, as a minimum requirement, regular menstruation should be defined as the number of menstrual cycles in a period of at least 3 months. Finally, the utility of introducing normative age-ranges as supplementary criterion for defining stages of reproductive ageing should be considered. The use of consistent terminology in research will enhance our capacity to compare results from different studies and more effectively investigate issues related to women's health and ageing.

Keywords: Menopause; Nomenclature; STRAW; WHO.

Fig. 1

Visual representation of the relationship between different time periods surrounding menopause as established by a World Health Organization Scientific Group on Research in the Menopause. Figure is a modification of work found in World Health Organization [9]

Fig. 2

Updated visual representation of the relationship between different time periods surrounding menopause, which includes the term Climacteric as defined by The Council of Affiliated Menopause Societies. Figure is a modification of work found in Utian [13]

Fig. 3

STRAW staging system. *Stages most likely to be characterised by vasomotor symptoms; FSH, follicle stimulating hormone; ↑, elevated. Figure is a modification of work found in Soules et al. [14]

Fig. 4

STRAW + 10 staging system. *, blood drawn on cycle days 2–5; FSH, follicle stimulating hormone; AMH, anti-mullerian hormone; ↑, elevated. Figure is a modification of work found in Harlow et al. [11]

Fig. 5

Consistency of definitions with STRAW criteria

Fig. 6

Recommended revision to the STRAW + 10 staging system to include the transparent operationalisation of premenopause and define regular menstruation as the number of menstrual cycles per 3 months, as a minimum requirement, which would be a practical reporting timeframe both clinically and for women to recall accurately. *, blood drawn on cycle days 2–5; FSH, follicle stimulating hormone; AMH, anti-mullerian hormone; ↑, elevated. Figure is a modification of work found in Harlow et al. [11]