Susan R. Miller

Correlates of sexual functioning among mid-life women

Objective Studies have reported a decline in sexual functioning among women undergoing the menopausal transition. Few studies, however, have examined the associations between hormones and sexual dysfunction during this time period. Therefore, the purpose of this study was to examine the associations between participant characteristics and endogenous hormones with sexual functioning in mid-life women. Methods Data were analyzed from a community-based sample of 441 women aged 45–54 years who stated that they were sexually active at the time of the study. Each participant completed a survey that included questions pertaining to sexual functioning and provided a blood sample that was used to measure estrogen and androgen concentrations. Results Among women who reported being sexually active, poorer self-reported health and the experiencing of depressive symptoms were significantly associated with not being satisfied with sexual relations after adjustment for other covariates. None of the hormones examined were significantly associated with overall sexual satisfaction. However, statistically significant associations between both total testosterone levels and the free testosterone index with satisfaction with the frequency of sexual relations were observed. Conclusions Our findings indicate that the experiencing of depressive symptoms and the reporting of poor overall health are important correlates of sexual dysfunction. Further, our results suggest that higher total and free testosterone levels are significantly associated with a desire for increased frequency of sexual relations among mid-life women.

Cytochrome gene polymorphisms, serum estrogens, and hot flushes in midlife women

OBJECTIVE: The purpose of this study was to evaluate whether genetic polymorphisms in selected cytochrome P450 enzymes (CYPc17α, CYP1A1, and CYP1B1), estradiol (E2) levels, and estrone levels were associated with hot flushes. METHODS: Women with hot flushes were those aged 45–54 years who reported ever experiencing hot flushes (n = 354). Women without hot flushes were those aged 45–54 years who reported never experiencing hot flushes (n = 258). Each participant completed a questionnaire and provided a blood sample for determination of genotypes, E2 levels, and estrone levels. RESULTS: Carriers of the CYP1B1 (Val432Leu) polymorphism were more likely to report having any hot flushes (risk ratio [RR] 1.16, 95% confidence interval (CI) 0.98–1.37) and at least weekly hot flushes (RR 1.29, 95% CI 0.98–1.70) than women without the polymorphism, although these associations were of borderline statistical significance. In addition, carriers of the CYP1B1 polymorphism were likely to have a statistically significant 30% increased risk of reporting moderate to severe hot flushes (RR 1.30, 95% CI 1.02–1.67) and a statistically significant 27% increased risk of reporting hot flushes lasting a year or more (RR 1.27, 95% CI 1.00–1.61) compared with women without the polymorphism. There were no associations between CYP1A1 or CYPc17α polymorphisms and hot flushes. Low E2 and estrone levels were associated with hot flushes, but they did not alter the association between the CYP1B1 polymorphism and hot flushes. CONCLUSION: These data suggest that a CYP1B1 polymorphism may be associated with severe and persistent hot flushes, independent of E2 and estrone levels. LEVEL OF EVIDENCE: III

Relation of body mass and sex steroid hormone levels to hot flushes in a sample of mid-life women

Objective Previous studies indicate that obesity is associated with a higher risk of experiencing hot flushes in mid-life women. The reasons for this association are unknown, although altered hormone levels have been associated with both hot flushes and obesity. Thus, this current study tested the hypothesis that obesity is associated with hot flushes in mid-life women through a mechanism involving levels of total and free androgen, free estrogen, progesterone, and sex hormone binding globulin (SHBG). Methods Women aged 45–54 years were recruited from Baltimore and its surrounding counties. Each participant (n = 628) was weighed, measured, completed a questionnaire, and provided a blood sample that was used to measure estradiol, estrone, testosterone, androstenedione, dehydroepiandrosterone sulfate, progesterone, and SHBG. Results Obese mid-life women (body mass index (BMI) ≥ 30.0 kg/m2) had significantly higher testosterone, and lower estradiol, estrone, progesterone, and SHBG levels than normal-weight mid-life women (BMI ≤ 24.9 kg/m2) after adjustment for age, race, smoking, and number of days since last menstrual period. The association between obesity and hot flushes was no longer significant after adjustment for estrogens and progesterone, and/or SHBG. Conclusion These data suggest that obesity may be associated with hot flushes through a mechanism involving multiple hormones and SHBG.

Cigarette smoking, androgen levels, and hot flushes in midlife women.

OBJECTIVE: To test the hypothesis that cigarette smoking is associated with hot flushes through a mechanism involving androgen levels, progesterone levels, sex hormone–binding globulin levels, or the ratio of androgens to estrogens. METHODS: Women with and without hot flushes were recruited from Baltimore, Maryland, and the surrounding counties. Women were between 45 and 54 years of age, with at least three menstrual periods in the previous 12 months, and were not postmenopausal. Study participants completed a questionnaire and gave a blood sample for hormone measurements. RESULTS: Current smokers had significantly higher androstenedione levels and a higher androgen-to-estrogen ratio than never smokers. Current smokers had significantly lower progesterone levels compared with never smokers. Former and current cigarette smokers had increased odds of experiencing hot flushes compared with never smokers (former: odds ratio [OR] 1.41, 95% confidence interval [CI] 0.99–2.01; current: OR 2.43, 95% CI 1.28–4.62). This association, however, was not attenuated by the addition of hormones to the smoking and hot-flush model. CONCLUSION: Cigarette smoking is associated with hot flushes through a mechanism that may not involve alterations in hormone levels or their ratios. LEVEL OF EVIDENCE: II

Age at menopause in women participating in the postmenopausal estrogen/progestins interventions (PEPI) trial: An example of bias introduced by selection criteria

Our objective is to illustrate the bias introduced in assessing factors associated with age at menopause when the population sample has been selected using restricted criteria, i.e. number of years since menopause, by using a cross-sectional analysis of baseline data from a population-based randomized clinical trial. The participants were women who participated in the Postmenopausal Estrogen/Progestins Intervention (PEPI) trial, had not had a hysterectomy, were between 45 and 64 years old, and were menopausal for at least 1 but not greater than 10 years. The outcome measures were self-reported age at menopause and factors thought to be associated with it, including smoking, alcohol use, oral contraceptive use, number of pregnancies, education, income, body mass index, waist-hip ratio, thigh girth, and systolic and diastolic blood pressures. At entry, the mean age of the 601 women was 56.2 years. Mean age at menopause was 51.0 years. Chronologic (current) age was strongly correlated with age at menopause (r = 0.74, p = 0.0001). In bivariate analyses, factors associated with younger age at menopause were ever-use of cigarettes, former oral contraceptive use, and higher thigh girth; factors associated with later age at menopause were greater number of pregnancies, higher waist-hip ratio, and higher systolic blood pressure. After stratification by 5-year age intervals, these associations were no longer statistically significant. Because of restricted sampling, an artificial association was observed between chronologic age and age at time of menopause. This artifact made it difficult to distinguish between factors associated with chronologic age and those that may be independently associated with menopause. Failure to recognize this bias could lead to erroneous conclusions.

Cosmetologists and Reproductive Outcomes

OBJECTIVE: To test the hypothesis that cosmetologists are at increased risk of poor pregnancy outcomes compared with women of the same age who are not cosmetologists. METHODS: Participants were recruited through mass mailing of questionnaires. To be included in the study, respondents to the survey had to be aged between 21 and 55 years and not have had a hysterectomy or oophorectomy. This analysis focused on 350 cosmetologists and 397 women in other occupations who met these inclusion criteria and who reported five or fewer singleton pregnancies. The main outcome measures were miscarriage, stillbirth, the occurrence of maternal health conditions during pregnancy (preeclampsia, high blood pressure, diabetes), hospitalization or physician-ordered bed rest during pregnancy, preterm labor, and premature delivery (before 37 weeks at delivery). RESULTS: There were no statistically significant associations between occupation and the pregnancy outcomes after adjustment for age, race, education, and smoking and alcohol use at the time of pregnancy. A statistically significant association was found between race and low birth weight such that nonwhite women were at increased risk of reporting a low birth weight neonate compared with white women (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.53–7.26). Similarly, current smoking was found to be positively associated with miscarriage (OR 1.53, CI 1.09–2.16) and miscarriage or stillbirth (OR 1.64, 95% CI 1.18–2.28). CONCLUSION: Risk of adverse pregnancy outcomes among cosmetologists is not increased compared with women of the same age working in other occupations. LEVEL OF EVIDENCE: II

Change in body mass index, weight, and hot flashes: a longitudinal analysis from the midlife women's health study.

BACKGROUND The goals of this study were to examine the associations between body mass index (BMI), as well as BMI change and weight change, with midlife hot flashes. METHODS Data were analyzed from an ongoing 5-year cohort study of 631 midlife women (ages 45-54 years) recruited from Baltimore, Maryland, and its surrounding counties. Height and weight were measured at clinic visits conducted annually. Questionnaires administered at each clinic visit collected detailed data on hot flashes, including the severity and frequency, and other covariates. Data were analyzed using logistic regression and generalized estimated equation models, adjusting for potential confounders. RESULTS Among women enrolled in the study, 45.2% reported hot flashes and 32.0% were categorized as being obese (BMI ≥30 kg/m(2)) at baseline. At baseline, BMI was not significantly associated with ever experiencing hot flashes (BMI ≥30 versus <25 kg/m(2): odds ratio [OR] 0.92; 95% confidence interval [CI]: 0.58, 1.15) or any of the other hot flashes outcomes (recent, frequent, or severe). In addition, no statistically significant associations between BMI, BMI change, or weight change, and the hot flash outcomes were observed in the longitudinal models (for example, any hot flashes: BMI ≥30 versus <25 kg/m(2): OR 0.81; 95% CI: 0.56, 1.17). CONCLUSION BMI, BMI change, and weight change during midlife were not related to hot flashes in this study. The data suggest that other factors, such as smoking habits, are more important in determining hot flashes risk during midlife.

Infertility among cosmetologists

Although chemicals used in hair salons have been linked to infertility in animal models, little is known about whether exposures in hair salons are associated with infertility in women. Thus, a survey-based study was performed to investigate infertility in 448 cosmetologists and 508 non-cosmetologists working in Baltimore, Maryland and its surrounding counties. Infertility was assessed with questions addressing time-to-pregnancy (TTP) length (>or=12 months), consulting a medical professional about fertility problems, and taking medication to become or maintain a pregnancy. Occupational exposure was assessed by job tasks and customers served per week. There were no statistically significant associations between working as a cosmetologist and the odds of TTP>or=12 months, consulting a medical professional about infertility, or taking medication to either become or maintain a pregnancy. The data suggest that cosmetologists are not at increased risk for infertility compared to women of the same age working in other occupations.

Risk factors for hot flashes among women undergoing the menopausal transition: baseline results from the Midlife Women's Health Study.

Objective:The aim of this study was to examine the associations of demographic characteristics, health behaviors, and hormone concentrations with the experience of any, current, more severe, and more frequent midlife hot flashes. Methods:Baseline data from 732 women aged 45 to 54 years who were enrolled in the Midlife Womens Health Study were analyzed. A clinic visit was conducted to collect blood samples for hormone assays and to measure ovarian volume using transvaginal ultrasound. A self-administered questionnaire ascertained information on demographic factors, health habits, and hot flash history. Multivariable logistic regression was conducted to examine associations between potential risk factors and hot flash outcomes. Results:Approximately 45% of participants reported experiencing midlife hot flashes. In covariate-adjusted models, older age, perimenopause status, current and past cigarette smoking, and depressive symptoms were significantly associated with increased odds of all of the hot flash outcomes. In addition, history of oral contraceptive use was associated with increased odds of any hot flashes. In contrast, higher current alcohol intake was significantly associated with decreased odds of any, current, and more severe hot flashes. Higher estradiol and progesterone concentrations were significantly associated with decreased odds of all hot flash outcomes. Conclusions:Although the temporality of such associations is not known because of the cross-sectional nature of the data, these observed relationships can help to identify women at risk for hot flashes.

Premature ovarian failure among hairdressers

BACKGROUND Hairdressers constitute a major occupational group of female workers who are exposed to chemicals that cause reproductive abnormalities in animal models. The purpose of this study was to examine whether hairdressers are at increased risk of premature ovarian failure (POF) compared with women of similar age in other occupations. METHODS This study analyzed data from a population-based sample of 443 hairdressers and 508 women in other occupations, who responded to a mailed survey. POF was assessed in all eligible participants by self-report of a doctors diagnosis. RESULTS Among 443 hairdressers and 508 women in other occupations, 14 (3.2%) and 7 (1.4%) developed POF, respectively. A non-significant increase in the risk of POF was observed among hairdressers compared with non-hairdressers (adjusted relative risk (RR) 1.90; 95% confidence interval (CI) 0.76, 4.72). When limited to Caucasian women only (approximately 85% of respondents), the increased risk was statistically significant (RR 3.24; 95% CI 1.06, 9.91). Among Caucasian women of 40-55 years of age, hairdressers were more than five times as likely to report POF compared with non-hairdressers (RR 5.58; 95% CI 1.24, 25.22). CONCLUSIONS Hairdressers may be at increased risk for POF compared with women employed in other occupations.