Kathleen Smith-DiJulio

Is the menopausal transition stressful? Observations of perceived stress from the Seattle Midlife Women's Health Study

Objective: To describe changes in the levels of perceived stress in relation to menopausal transition (MT)-related factors (MT stage, hot flash severity, urinary estrone glucuronide, urinary follicle-stimulating hormone, hormone therapy), aging and age-related changes, and psychosocial factors (income adequacy, role burden, social support, parenting, employment, history of sexual abuse, depressed mood). Design: A subset of participants (N = 418) in the longitudinal Seattle Midlife Womens Health Study provided data during the late reproductive and early and late MT stages or early postmenopause (PM) from 1990 to 2005, including menstrual calendars for staging the MT, annual health reports, and first morning urine specimens (assayed for estrone and follicle-stimulating hormone). Multilevel modeling was used to test patterns of perceived stress related to MT-related and aging-related factors and psychosocial factors with as many as 1,814 observations from 418 women per factor. Age was centered at 47.9 years. Results: The effects of the MT-related factors were not significant, although the stress ratings decreased during PM by 0.11 units (P = 0.06). In analyses with age as a covariate and with each covariate added separately, employment was associated with significantly higher levels of stress (&bgr; = 0.14, P < 0.0001), as was history of sexual abuse (&bgr; = 0.11, P = 0.03) and depressed mood (&bgr; = 0.02, P < 0.0001). Improvement in each of the factorsof role burden, social support, and income adequacy was associated with significantly lower perceived stress (&bgr; = −0.19, −0.13, and −0.10, respectively; P < 0.0001 for all). Negative appraisal of aging changes and perceived poorer health were both associated with significantly higher stress levels (&bgr; = 0.08, P < 0.0001 for both) and depressed mood (&bgr; = −0.02, P < 0.0001). A multivariate model included significant effects of employment, perceived health, and depressed mood (&bgr; = 0.24, −0.04, and 0.02, respectively; P < 0.0001 for all). Conclusions: Being employed, experiencing depressed mood, and perceiving ones health as poor were more important in womens evaluation of their daily stress than severity of hot flashes, MT-related factors, or other social factors. Clinicians working with women going through the MT should remain vigilant to the impact of social circumstances of womens lives, especially employment, as well as focusing on the psychosocial and endocrine features of this transition.

Association of estrogen-related polymorphisms with age at menarche, age at final menstrual period, and stages of the menopausal transition.

Objective: To explore the association of estrogen-related polymorphisms with age at menarche, age at onset and duration of stages of the menopausal transition, and age at final menstrual period (FMP). Design: A total of 152 white women were genotyped for CYP17, CYP19 3-untranslated region, CYP19 TTTA7-13, HSDB1, CYP1A1, CYP1B1, and ESR1 polymorphisms. Analysis of variance was used to test a nonspecific model for differences among genotypes associated with each polymorphism. Results: Five of the 84 associations tested were significant at P < 0.05, which could be expected by chance. Women with two CYP19 7r alleles had menarche earlier (11.5 y) than those with one 7r allele (13.1 y). Women with two 11r alleles were 2 years older at onset of late stage than those with one 11r allele (50.7 y vs 48.6 y). Those with two 7r(-3) alleles were 2 years older at FMP than those without this allele (53.9 y vs 51.3 y). Women with the homozygous wild-type allele for HSDB1 (rs2830) were younger at FMP by 2 years than those with the heterozygous allele (50.8 y vs 52.9 y). Women with the heterozygous allele for CYP1B1*2 had a later age at menarche compared with women with the homozygous wild type (13 y vs 12.5 y). Conclusions: Age at onset of late stage and FMP and age at menarche are associated with specific genetic polymorphisms in the estrogen biosynthesis and metabolism genes. However, because of the number of comparisons, these associations may be false positives. These findings should be confirmed with a larger sample of white women.

Cortisol levels during the menopausal transition and early postmenopause

Objective:Cortisol levels rise among some women during the late stage of the menopausal transition (MT), but we know little about changes in cortisol levels in relation to menopause-related factors (MT stage, urinary estrone glucuronide [E1G], testosterone, follicle-stimulating hormone [FSH]), stress-related factors (epinephrine, norepinephrine, and perceived stress), symptoms (hot flashes, mood, memory, and sleep), social factors (income adequacy, role burden, social support, employment, parenting, and history of sexual abuse), and health-related factors (depressed mood, perceived health, physical appraisal, body mass index, and smoking). The aim of the study was to examine the influence of menopause-related factors, stress-related factors, symptoms, social factors, and health-related factors on cortisol levels during the MT. Methods:Participants were a subset of Seattle Midlife Womens Health Study who provided data during the late reproductive, early and late MT stages, or early postmenopause and who were not using hormone therapy or corticosteroids (N = 132 women, up to 5,218 observations). Data provided included menstrual calendars for staging the MT, annual health reports, health diaries, and overnight urine specimens (assayed for cortisol, catecholamines, E1G, and FSH) between 1990 and 2005 were included. Perceived stress, symptoms, and health behaviors were assessed in a health diary. Health-related and social factors were assessed in an annual health update. Multilevel modeling was used to test the effects of menopause-related and other factors on overnight cortisol levels. Results:When tested with age as a measure of time, menopause-related covariates, including E1G, FSH, and testosterone, were associated with significant increases in overnight cortisol levels (P < 0.0001). Likewise, epinephrine and norepinephrine were each associated significantly with overnight cortisol levels (P < 0.0001). In multivariate analyses, E1G, FSH, and testosterone constituted the best set of predictors. Conclusions:Overnight cortisol levels during the MT were associated with E1G, testosterone, and FSH levels. In addition, they were significantly and positively associated with epinephrine and norepinephrine. MT stage, symptoms, and social, stress-related, and health-related factors had little relationship to overnight cortisol levels when other biological indicators were considered.

The Shaping of Midlife Women’s Views of Health and Health Behaviors

The menopausal transition is a marker of aging for women and a time when health professionals urge women to prevent disease. In this research we adopted a constructivist, inductive approach in exploring how and why midlife women think about health in general, about being healthy, and about factors that influence engaging in healthy behaviors. The sample constituted 23 women who had participated in a women’s wellness program intervention trial and subsequent interviews. The women described lives of healthy eating and exercise, yet, their perceptions of health and healthy behavior at midlife contradicted that history. Midlife was associated with risk and guilt at not doing enough to be healthy. Health professionals provided a very limited frame within which to judge what is healthy. Mostly this was left up to individual women. Those who were successful framed health as “being able to do what you want to do when you want to do it.” In this article we present study findings of how meanings attached to health and being healthy were constructed through social expectations, family relationships, and life experiences.

Well-being during the menopausal transition and early postmenopause: a longitudinal analysis.

Objective:To examine relationships between well-being and the menopausal transition (MT) to determine (1) whether womens well-being varies over the course of the MT and early postmenopause (PM) and (2) whether any observed variation is predicted by MT variables, other midlife transitions, or personal resources. Design:Women from the Seattle Midlife Womens Health Study (N = 334) provided data for these analyses from at least one annual health questionnaire and a menstrual calendar. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide and follicle-stimulating hormone. Mixed-effects modeling using the R library was used to investigate whether MT-related factors, including MT stage, presence of hot flashes, hot flash severity and levels of estrone glucuronide and follicle-stimulating hormone, number of negative life events, or personal resources of mastery and satisfaction with social support are significant predictors of well-being. Results:The model that best fit the data showed that mastery and satisfaction with social support predicted increases in well-being, whereas negative life events predicted decreases in well-being. None of the MT-related factors predicted change in well-being. Conclusion:The variability in womens well-being in this study was more affected by life events other than the MT and early PM and by the personal resources available to meet transition demands. These findings suggest that for most women, the MT is not a predictor of level of well-being when considered in a broader life context.

Sustainability of a Multimodal Intervention to Promote Lifestyle Factors Associated With the Prevention of Cardiovascular Disease in Midlife Australian Women: A 5-year Follow-Up

We evaluated sustainability of an intervention to reduce womens cardiovascular risk factors, determined the influence of self-efficacy, and described womens current health. We used a mixed method approach that utilized forced choice and open-ended questionnaire items about health status, habits, and self-efficacy. Sixty women, average age 61, returned questionnaires. Women in the original intervention group continued health behaviors intended to reduce cardiovascular disease (CVD) at a higher rate than the control group, supporting the feasibility of a targeted intervention built around womens individual goals. The role of self-efficacy in behavior change is unclear. The original intervention group reported higher self-reported health.

Well-Being During the Menopausal Transition and Early Postmenopause: A Within-Stage Analysis

PURPOSE To identify whether menopausal transition (MT)-related factors--including MT stage, hot flash severity, levels of estrone glucuronide (E1G) and follicle stimulating hormone (FSH); number of negative life events; or personal resources of mastery and social support--are associated with stage specific well-being. METHODS Women from the Seattle Midlife Womens Health Study (N=334) provided at least one annual health questionnaire and a menstrual calendar; a subset provided first morning voided urine specimens assayed for E1G and FSH. Descriptive statistics were calculated and Pearsons product-moment correlations were estimated. RESULTS Mean levels of well-being were the same across MT stages (4.1, range 1.8-5.9). Physiologic variables were not significantly correlated with well-being: E1G levels (r = - .11 to 0.16), FSH levels (r = - .17 to .20) and hot flash severity (r = - .07 to .05). Significant correlations were observed between well-being and number of negative life events (r = - .48 to - .33, p < or = 0.01), mastery (r = .51-.64, p < or = 0.01), and satisfaction with social support (r = .04 non-significant) to r =.41, (p < or = 0.01). CONCLUSION The association of well-being with life events and personal resources, and not MT-related indicators, hormone levels or vasomotor symptoms, supports work by other researchers. Further study is needed to determine whether patterns of well-being vary across the MT, and if so, what might predict that variability.

Interoceptive Awareness Is Important for Relapse Prevention: Perceptions of Women Who Received Mindful Body Awareness in Substance Use Disorder Treatment.

BackgroundIt is postulated that interventions aimed at facilitating interoceptive awareness (i.e., awareness of inner body sensations) may facilitate regulation and improve substance use disorder (SUD) treatment outcomes. ObjectiveThe aim of the study was to better understand the role of interoceptive training in SUD treatment, an identified gap in the literature. MethodsOn the basis of a National Institute on Drug Abuse (NIDA)-funded pilot randomized clinical trial that used a two-group repeated measures design to examine mindful awareness in body-oriented therapy (MABT) for women in SUD treatment, this study examined the experience of a subset of participants that received and completed MABT intervention in the larger original study. In a qualitative study using a single focus group, participants were asked to respond to multiple questions regarding their current use of interoceptive awareness skills, perceived benefit, learning processes, and suggestions for program development. Interpretive analysis was used to describe the themes that emerged from the focus group responses. ResultsParticipants consistently used interoceptive awareness self-care skills learned in MABT. Interoceptive awareness training and daily practice were perceived as critical for emotional awareness, regulation, and relapse prevention. In addition, findings highlight the relevance of MABT educational strategies such as touch and individual delivery to teach interoceptive awareness and self-care skills for women in SUD treatment. ConclusionThese findings suggest the positive role of interoceptive awareness in promoting relapse prevention among women in SUD treatment, important for guiding future research, and program development for this population that apply across healthcare disciplines.

Professional Nursing Education about the Alcohol and Drug Dependent Person

The Alcoholism Nursing Program at the University of Washington School of Nursing was initiated in the fall of 1972. Supported by a grant from the National Institute of Alcohol Abuse and Alcoholism, it is the only nursing program of its kind in the United States. In the fall of 1978 the program will be expanded to include drugs of abuse other than alcohol and will be retitled the Alcoholism and Drug Abuse Nursing Program.