Midlife and Menopause
Research on Midlife Women's Health
Until recently, medical research paid little attention to the health concerns of aging women. Even today, it focuses on the medical aspects of peri- and postmenopause, as though reproductive organs were the center of a woman’s life. It continues to overlook the basic biology of aging, occupational and environmental damage, racial and ethnic differences, and the influence of socioeconomic factors on our health. Studies are often designed and funded by corporate interests rather than objective researchers, and tend to focus on drugs rather than nonmedical interventions. They often neglect the needs of women of color, undermining the ability of health care practitioners to provide appropriate care. Three important studies are under way to remedy this long-standing neglect.
The Study of Women’s Health Across the Nation (SWAN) (www.swanstudy.org) is the first major longitudinal study of women of different racial and ethnic backgrounds as they transition through menopause. Since 1994, about 3,300 U.S. women from diverse backgrounds—white, African American, Hispanic, Chinese, and Japanese—have participated in SWAN at seven centers around the United States. The study examines psychological, social, and economic factors, in addition to health and medical components, including ovarian aging, its effects on bone and body composition, and risk factors for cardiovascular disease.
SWAN has generated a wealth of information about how women age. In 2010, the women in SWAN were fifty-six to sixty-six years old, and most had transitioned into postmenopause. By following various health issues, including diabetes, osteoporosis and fractures, osteoarthritis, heart disease, and depression, SWAN will continue to deepen our understanding of how menopause and other factors may play a role in later disease, disability, and quality of life, with the goal of finding better ways to prevent disease and maintain the health of older women.39
The Black Women’s Health Study (BWHS) (bu.edu/bwhs), funded by the National Cancer Institute and administered by the Slone Epidemiology Center at Boston University School of Medicine, enrolled 59,000 African-American women in 1995. The focus of the study is to identify and evaluate causes and preventives of cancers and other serious illness for African- American women. Although it focuses primarily on younger women, it is also looking at conditions more typical of midlife and older women, such as cardiovascular disease, diabetes, and breast cancer, which affect black women earlier.
The BWHS has identified modifiable risk factors for both breast cancer40 and type 2 diabetes.41 Mortality rates of breast cancer are greater in black women than white women. The BWHS found that the use of menopausal hormones was associated with an increased risk of breast cancer, as has also been found in white women. A high intake of vegetables, especially cruciferous vegetables such as broccoli and collard greens, was associated with a reduced risk of breast cancer. Future research in the BWHS will address the causes of urinary incontinence, another condition that affects older women. BWHS has been funded through 2013.42
The Kronos Early Estrogen Prevention Study (KEEPS) (keepstudy.org) includes 729 newly menopausal women of ethnic makeup intentionally similar to the women in the WHI study, with 70 percent non-Hispanic Caucasian, 8 percent African American, and 7 percent Hispanic. This large randomized study is comparing a low dose of the estrogen pills used in the WHI study (Premarin), a transdermal estrogen (a patch), and a placebo. (Those receiving active estrogen will also be given oral micronized progesterone to avoid increasing the risk of uterine cancer.) In effect, KEEPS is trying HT using what many now believe to be the safest approach. A limit of KEEPS is that it is studying only disease markers such as lipid levels and calcium in the heart and arteries, not heart attacks and strokes. But as many researchers now believe that transdermal estrogen may not increase the risk of thromboembolic events, a risk with oral estrogen, KEEPS findings could be quite significant. (For more on what’s known about the risks and benefits of transdermal estrogen, see “Hormones: Not All the Same” on page 538.) Results should be available in 2011 or 2012.
Keeping Up with New Research
To keep up with new information and research findings on perimenopause and menopause, visit the websites of the following organizations. For more on how to understand study findings, see Chapter 23, “Navigating the Health Care System.”
The Centre for Menstrual Cycle and Ovulation Research: www.cemcor.ubc.ca
National Institutes of Health (NIH): www.nih.gov
National Women’s Health Information Center: www.womenshealth.gov/menopause
National Women’s Health Network: www.nwhn.org
The North American Menopause Society* (NAMS): www.menopause.org
Society for Menstrual Cycle Research: www.menstruationresearch.org
* The North American Menopause Society has strong ties to the pharmaceutical industry, but many of its members have tried to minimize the direct influence of drug companies over the content of NAMS educational programs.
Excerpted from the 2011 edition of Our Bodies, Ourselves. © 2011, Boston Women's Health Book Collective.
39. Thanks to Karin Kolsky of the National Institute on Aging for adding to the information in this paragraph.
40. L. Rosenberg et al., “A Prospective Study of Female Hormone Use and Breast Cancer Among Black
Women,” Archives of Internal Medicine 166 (2006):760–65.
41. S. Krishnan, L. Rosenberg, and J. R. Palmer, “Physical Activity and Television Watching in Relation to Risk of Type 2 Diabetes in the Black Women’s Health Study,” American Journal of Epidemiology 169, no. 4 (2009): 428–34.
42. Thanks to Julie Palmer, a BWHS researcher, for adding to the information in this paragraph.
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