Nancy Fugate Woods

Stages of Reproductive Aging Workshop (STRAW)

A select group of clinicians and investigators met recently for the express purpose of developing a staging system for female reproductive aging. The group also addressed the confusing and redundant nomenclature that is commonly used to describe the late reproductive years. A summary and recommendations are presented.

The family's functioning with newly diagnosed breast cancer in the mother: The development of an explanatory model.

Despite the high rates of breast cancer in the child-rearing mother, there is extremely limited research on the effects of the illness on the children, marriage, and parent-child relationship. The current study tested an explanatory model of family functioning with breast cancer based on data obtained from standardized questionnaires from 80 diagnosed mothers and partners with young school-age children. Path analysis results for data obtained from both the mothers and the partners revealed a similar pattern. More frequently experienced illness demands were associated with higher levels of parental depressed mood which negatively affected the marriage. When the marriage was less well adjusted, it negatively affected the familys coping behavior. Household functioning was positively affected by heightened coping activity and by higher levels of marital adjustment. Children functioned better when the non-ill parent more frequently interacted with them and their families coped more frequently with their problems.

Protein intake and incident frailty in the Women's Health Initiative observational study.

OBJECTIVES: To evaluate the association between protein intake and incident frailty.

The family's functioning with chronic illness in the mother: The spouse's perspective

While previous research has studied the impact of chronic illness on the patient or spouse, the impact on the marriage, the child, the parent-child relationship, and the familys functioning have been relatively ignored. To date ther is no known study of the impact of a mothers chronic illness on the family. The purpose of the current exploratory study was to test a set of interrelated hypotheses about family functioning with the mothers chronic illness from the spouses perspective based on a family systems perspective. Data were obtained from standardized questionnaires from 48 fathers with young school-age children whose wife had either breast cancer, diabetes, or fibrocystic breast disease. Results of a path analysis revealed that the number of illness demands the father experienced was a significant predictor of his level of depression. More demands resulted in higher depression scores. Marital adjustment was significantly affected by both the fathers level of depression as well as by his wifes type of disease. Spouses of women with breast cancer had significantly higher levels of marital adjustment than did partners of the other women. More depressed spouses had lower levels of marital adjustment. Both illness demands and level of marital adjustment significantly predicted the type of coping behavior the family used. More frequent illness demands and higher levels of marital adjustment were associated with familial introspection, that is, coping behavior characterized by frequent feedback, reflection, and discussion in the family. The quality of the father-child relationship was significantly affected by this type of coping behavior. Families characterized as introspective had fathers who reported more frequent interchange with their children.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer and comorbidity

A narrow subspecialty model of cancer care has led to cancer treatment often being given outside the full medical context of the patient. The full range of comorbid illness must be considered in all aspects of diagnosis and treatment. This study was conducted to describe the prevalence of comorbidity in cancer patients and examine its relation with multiple demographic and clinical variables.

Adipokines, inflammation, and visceral adiposity across the menopausal transition: a prospective study.

CONTEXT Postmenopausal women have greater visceral adiposity compared with premenopausal women. Adipokines are associated with increased adiposity, insulin resistance, and atherosclerosis. OBJECTIVE The objective of the study was to assess changes in adipokines and inflammatory markers through the menopausal transition and correlate them with changes in visceral adiposity. DESIGN AND SETTING This was a prospective cohort study of women through the menopausal transition conducted at the University of Washington. PARTICIPANTS Sixty-nine healthy women were followed up longitudinally from premenopausal (aged 45-55 yr) to postmenopausal status (aged 49-60 yr). OUTCOME On premenopausal and postmenopausal visits, fasting blood was drawn for adiponectin, leptin, serum amyloid A (SAA), C-reactive protein (CRP), monocyte-chemotactic protein-1, tissue plasminogen activator antigen (tPA), IL-6, and TNF-alpha. Body composition measures were assessed by body mass index, whole-body dual x-ray absorptiometry scan, and computed tomography scan of the abdomen at the lumbar 4-5 level. RESULTS Women had a statistically significant increase in SAA, tPA, monocyte-chemotactic protein-1, and adiponectin between the two measurement occasions (P = 0.04, P = 0.02, P = 0.001, and P < 0.001, respectively). The increase in intraabdominal fat was correlated positively with the change in SAA (r = 0.31, P = 0.02), CRP (r = 0.56, P < 0.001), tPA (r = 0.40, P = 0.002), and leptin (r = 0.41, P = 0.002) and negatively correlated with the change in adiponectin (r = -0.37, P = 0.005). After adjustment for change in sc abdominal fat, the correlation between change in CRP, tPA, leptin, and adiponectin remained significantly associated with change in intraabdominal fat. CONCLUSIONS Women going through the menopausal transition have deleterious changes in inflammatory markers and adipokines that correlate with increased visceral adiposity.

Pathways to depressed mood for midlife women: Observations from the Seattle Midlife Women's Health Study

To differentiate women who experience patterns of depressed mood with respect to their perceptions of menopausal changes and those that were part of everyday life, women (N=347) from the Seattle Midlife Womens Health Study were studied. Women participated in in-depth interviews, kept symptom diaries, and responded to mailed health updates. Data for years 1 and 2 on the Center for Epidemiologic Studies Depression Scale revealed four patterns of depressed mood: consistent depressed mood, emerging depressed mood, resolving depressed mood, and absence of depressed mood. Discriminant function analyses differentiated women with consistent, emerging, and resolving depressed mood from those with absence of depressed mood. Patterns of depressed mood were related to stressful life context, past/present health status, and social learning about midlife. Menopausal status did not differentiate women with patterns of depressed mood from those without depressed mood. Vasomotor symptoms, history of premenstrual syndrome, and postpartum blues helped differentiate women with consistently depressed mood from those recovering from depressed mood.

Three stages of the menopausal transition from the Seattle Midlife Women's Health Study: toward a more precise definition.

Objectives: As more interest centers on the years surrounding menopause, the inconsistent use of nonspecific terminology to define these years becomes a problem. Our objective was to describe the development of specific criteria that define stages within the menopausal transition and to apply these criteria to classify midlife women into a stage of transition. Design: A total of 184 midlife women from the Seattle Midlife Womens Health Study taking no hormones and for whom data were available about initial menstrual cycle changes were studied. Questionnaires about menstrual cycle changes and menstrual calendars were mailed yearly. Intra‐individual analyses for type and chronology of menstrual cycle changes during midlife for change in flow amount or duration, cycle length change, cycle irregularity, or skipped periods were conducted. Results: Changes in flow or cycle length most frequently preceded irregularity without skipped periods, which preceded skipped periods. Initial changes began in the early 30s and most frequently between ages 40 and 44. Only 14% had irregularity as the initial change. Three stages of the menopausal transition were identified: early (flow and/or cycle length changes), middle (irregularity without skipping), and late (skipped periods). Age did not differentiate the three stages. Conclusions: These findings provide evidence for a progression of menstrual cycle events through the menopausal transition, which form the basis for three stages of the transition: early, middle, and late transition. Studies about the entire transition need to include women younger than 45. Both menstrual calendars and questionnaire data are needed to identify these three stages, and precise definitions of irregularity and skipped period are necessary. (Menopause 2000;7:334‐349.

Symptom experiences of midlife women: observations from the Seattle midlife women's health study

UNLABELLED Symptoms experienced by perimenopausal women are varied with little agreement about their nature, cause or stability. OBJECTIVE To describe the type and stability of symptoms experienced by midlife women. METHODS A community-based sample of 301 women ages 35-55 (Mean 41.1; S.D. = 4.2), had at least one menstrual period in the past year, and took no ovarian hormones. Women completed a daily symptom diary for at least one cycle for 3 consecutive years. Symptoms were rated from zero to four. The 5 premenses days were targeted for consistency and as those most symptomatic. Twenty-eight symptoms commonly reported as perimenopausal were factor analyzed using principal components analysis with varimax rotation. Test-retest reliability and stability estimates were calculated according to the method of Heise (Heise, D. Am Sociol Rev 1969; 34: 93-101) that accounts for expected change over time. RESULTS Twenty-five of the 28 symptoms loaded on five factors labeled dysphoric mood, vasomotor, somatic, neuromuscular, and insomnia together accounting for 51.7% of the variance. Test-retest reliability estimates were highest for dysphoric mood (r = 0.78) and somatic (r = 0.70) symptoms. The reliability for the other three clusters ranged from r = 0.65 to r = 0.53). The stability of the clusters across 3 years was high for dysphoric mood, neuromuscular, and insomnia. The vasomotor and somatic clusters had the most change between years 1 and 3. DISCUSSION These results indicate that dysphoric mood is not a part of vasomotor symptoms or insomnia or other somatic symptoms suggesting an origin for vasomotor symptoms apart from the other symptoms. The stability of dysphoric mood across 3 years suggests a chronic situation possibly due to high stress, overwork, or an ongoing emotional illness. The stability of the neuromuscular and insomnia symptoms suggests underlying chronic physical conditions. The reduction in stability of vasomotor symptoms may reflect the changing nature of hormones as women approach menopause. Finally, the low stability of somatic symptoms suggests that they represent acute episodic illnesses. Together the identification of five distinct symptom clusters with varying stability over 3 years suggests that they are due to different underlying mechanisms and are not all attributed to the changing hormone patterns associated with the menopausal transition. Many other events in a midlife womans life can account for these symptoms including life stress and acute and chronic illnesses.

Sexual desire during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study.

AIMS To describe levels of sexual desire across the menopausal transition (MT) and early postmenopause (PM), including effects of age, MT-related factors, health, stress, symptoms (hot flash, sleep, mood), and social opportunity factors. METHODS A subset of Seattle Midlife Womens Health Study (SMWHS) participants who provided data during the early reproductive, early and late menopausal transition stages, or postmenopause (n = 286), including menstrual calendars for staging the MT, annual health reports between 1990 and 2005, and morning urine samples assayed for estrone glucuronide (E(1)G), testosterone (T), and follicle-stimulating hormone (FSH) was included. Multilevel modeling using the R program was used to test factors related to sexual desire. RESULTS Women experienced a significant decrease in sexual desire during the late MT stage (p < 0.01) and early PM (p < 0.0001). Those with higher urinary E(1)G and T reported significantly higher levels of sexual desire, whereas those with higher FSH levels reported significantly lower sexual desire (p < 0.0001, 0.06, and 0.0002, respectively). Women using hormone therapy also reported higher sexual desire (p = 0.02). Those reporting higher perceived stress reported lower sexual desire (p < 0.0001), but history of sexual abuse did not have a significant effect. Those most troubled by symptoms of hot flashes, fatigue, depressed mood, anxiety, difficulty getting to sleep, early morning awakening, and awakening during the night also reported significantly lower sexual desire (p range from <0.03 to 0.0001), but there was no effect of vaginal dryness. Women with better perceived health reported higher sexual desire (p < 0.0001), and those reporting more exercise and more alcohol intake also reported greater sexual desire (p < 0.0001). Having a partner was associated with lower sexual desire. CONCLUSIONS Clinicians working with women traversing the MT should be aware that promoting healthy sexual functioning among midlife women requires consideration of their changing biology as well as ongoing life challenges.