Please cite this article in press as: Jaspers L, et al. Health in middle-aged and elderly women: A conceptual framework for healthy menopause. Maturitas (2015), http://dx.doi.org/10.1016/j.maturitas.2015.02.010 ARTICLE IN PRESS G Model MAT-6344; No. of Pages 6 Maturitas xxx (2015) xxx–xxx Contents lists available at ScienceDirect Maturitas jo u r n al hom ep age: www.elsevier.com/locate/maturitas Review Health in middle-aged and elderly women: A conceptual framework for healthy menopause Loes Jaspers a , Nadine M.P. Daan b , Gabriella M. van Dijk a , Tatjana Gazibara a,c , Taulant Muka a , Ke-xin Wen a , Cindy Meun d , M. Carola Zillikens e , Jeanine E. Roeters van Lennep f , Jolien W. Roos-Hesselink g , Ellen Laan h , Margaret Rees i , Joop S.E. Laven d , Oscar H. Franco a , Maryam Kavousi a,* a Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands b Woman and Baby Division, Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands c Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia d Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands e Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands f Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Erasmus Medical Center , Rotterdam, The Netherlands g Division of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands h Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands i Women’s Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK a r t i c l e i n f o Article history: Received 20 February 2015 Accepted 24 February 2015 Available online xxx Keywords: Health Menopause Aging Conceptual framework Measurement a b s t r a c t Middle-aged and elderly women constitute a large and growing proportion of the population. The peri and postmenopausal period constitutes a challenging transition time for women’s health, and menopausal health is a crucial aspect in healthy and successful aging. Currently, no framework for the concept of healthy menopause exists, despite its recognized importance. Therefore, we aimed to: (i) characterize healthy menopause; (ii) identify aspects that contribute to it; and (iii) explore potential approaches to measure it. We propose healthy menopause as a dynamic state, following the permanent loss of ovarian func- tion, which is characterized by self-perceived satisfactory physical, psychological and social functioning, incorporating disease and disability, allowing the attainment of a woman’s desired ability to adapt and capacity to self-manage. The concept of healthy menopause applies to all women from the moment they enter the menopausal transition, up until they reach early and late postmenopause and includes women with spontaneous, iatrogenic, and premature menopause. This conceptualization can be considered as a further step in the maintenance and improvement of health in menopausal women from different perspectives, foremost the woman’s own perspective, followed by the clinical, public health, and societal perspectives, and can be seen as a further step in delineating lines for future research. Furthermore, it could facilitate the improvement of adequate pre- ventive and treatment strategies, guide scientific efforts, and aid education and communication to health care practitioners and the general public, allowing women the achievement of their potential and the fulfillment of their fundamental role in society. © 2015 Elsevier Ireland Ltd. All rights reserved. Contents 1. Pushing the boundaries of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 2. Health. . .the holy grail? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 3. Contemporary approaches to health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 * Corresponding author at: Office NA-2905, Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Tel.: +31 10 704 42 28; fax: +31 10 704 46 57. E-mail address: m.kavousi@erasmusmc.nl (M. Kavousi). http://dx.doi.org/10.1016/j.maturitas.2015.02.010 0378-5122/© 2015 Elsevier Ireland Ltd. All rights reserved.