Considerations and practical recommendations for identifying perimenopause in longitudinal research

Approximately half of the global population will live to experience the menopausal transition, which is associated with significant quality of life concerns and economic costs. Due to research and funding inequities, there exist significant gaps in knowledge about the menopausal transition and how to improve health outcomes. One tool that is needed to push women's health research forward is the ability to prospectively and accurately identify reproductive stage throughout the female lifespan. In the current paper we review the current criteria for reproductive staging and historical research methods of determining stage, including retrospective and prospective approaches. We discuss important considerations surrounding recall intervals, limitations of the 2011 Stages of Reproductive Aging Workshop + 10 (STRAW+10) criteria, and data privacy concerns. We provide recommendations for the design and execution of future studies, including digital data processing algorithms that can clearly implement operational definitions of STRAW+ 10 reproductive stages. Standardizing STRAW+ 10 terminology and validating methods to collect, process, and analyze prospectively tracked vaginal bleeding data will facilitate more precise and reliable reproductive staging that are critically needed to increase our understanding of how perimenopause increases risk for adverse health outcomes and develop novel interventions to increase quality of life during reproductive aging.