Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA.
School of Nursing, University of Washington, Seattle, WA.
Menopause. 2021 Jan 15;28(4):447-466. doi: 10.1097/GME.0000000000001707.
In 2001 Staging Reproductive Aging Workshop conferees described the late reproductive stage (LRS) of reproductive aging as preceding the onset of the menopausal transition, yet there has been little attention to this aspect of reproductive aging. The aim of this scoping review was to examine scientific publications characterizing the LRS to map what is known about this stage with particular focus on reproductive endocrine patterns, menstrual cycle changes, and symptoms.
The initial search strategy included PubMed and CINAHL searches for the phrase LRS and "human." Given a low yield of research articles, a second stage used "late reproductive age" (LRA) as a search term. These strategies yielded 9 and 26 research articles, respectively. Publications meeting inclusion criteria (data-based research studies, focus on LRS or LRA and hormonal patterns, menstrual characteristics, and symptoms) published in English were reviewed by coinvestigators. Excluded studies were related to specific diseases, such as cardiovascular disease, and treatment studies. Data were summarized using qualitative methods. To ensure adequate coverage of published research we expanded our review to a third phase in which we identified longitudinal studies of the menopausal transition.
Studies of the LRS focused on: symptoms (anxiety and mood symptoms, bladder symptoms, urinary incontinence, urinary frequency, and nocturia) and associated factors, such as endocrine levels and gene polymorphisms; symptom clusters women experienced during the LRS; cognitive function testing results; changing patterns of physiology such as cytokines and chemokines, lipids, hormone patterns/levels; and association of lifestyle factors such as smoking with hormone levels and symptoms. The LRA search yielded a preponderance of studies of reproductive hormones (such as anti-Mullerian hormone) and menstrual cycle patterns. Remaining studies focused on symptoms, gene variants, health-related behaviors and approaches to classifying menstrual cycles. Longitudinal studies revealed reports of symptoms as well as attempts to classify the progression from the reproductive years to the menopausal transition. Study of the LRS has not been systematic and the limited number and scope of completed studies have yet to contribute a clear and complete picture of the LRS. In some, LRS provided a comparison stage against which to evaluate menopausal transition hormonal and cycle patterns and symptoms. Harmonizing the results of studies of the LRS and LRA is essential to understand more completely women's experiences of the LRS and to allow clinicians to provide better support for women during this time. The LRS also represents an ideal inflection point to promote lifestyle choices that could alter the trajectories of chronic diseases that arise in the fifth, sixth, and seventh decades of women's lives.
2001 年，生殖衰老研讨会的与会者将生殖衰老的晚期生殖阶段（LRS）描述为绝经过渡前的开始，但对生殖衰老的这一方面关注甚少。本范围综述的目的是检查描述 LRS 的科学出版物，以绘制该阶段的已知内容，特别关注生殖内分泌模式、月经周期变化和症状。
最初的搜索策略包括 PubMed 和 CINAHL 对短语 LRS 和“human”的搜索。由于研究文章的产量较低，第二阶段使用“late reproductive age”（LRA）作为搜索词。这两种策略分别产生了 9 篇和 26 篇研究文章。符合纳入标准（基于数据的研究、专注于 LRS 或 LRA 以及激素模式、月经特征和症状的研究）的出版物由共同研究者进行审查。排除的研究与特定疾病有关，如心血管疾病和治疗研究。使用定性方法总结数据。为了确保充分涵盖已发表的研究，我们将审查扩展到第三阶段，其中包括对绝经过渡的纵向研究。
LRS 的研究重点是：症状（焦虑和情绪症状、膀胱症状、尿失禁、尿频和夜尿症）以及相关因素，如内分泌水平和基因多态性；女性在 LRS 期间经历的症状群；认知功能测试结果；生理变化模式，如细胞因子和趋化因子、脂质、激素模式/水平；以及生活方式因素（如吸烟）与激素水平和症状的关联。LRA 搜索产生了大量关于生殖激素（如抗苗勒管激素）和月经周期模式的研究。其余的研究侧重于症状、基因变异、健康相关行为以及分类月经周期的方法。纵向研究报告了症状以及试图将从生殖期到绝经过渡的进展分类。对 LRS 的研究并非系统性的，已完成研究的数量和范围有限，尚未为 LRS 提供清晰完整的图景。在某些情况下，LRS 提供了一个比较阶段，用于评估绝经过渡的激素和周期模式以及症状。协调对 LRS 和 LRA 的研究结果对于更全面地了解女性对 LRS 的体验以及使临床医生能够在此期间为女性提供更好的支持至关重要。LRS 也是促进生活方式选择的理想转折点，这些选择可能会改变女性生命的第五、第六和第七个十年中出现的慢性疾病的轨迹。
