Midlife Transitions: A Biomedical View

Janet P. Pregler, MDDirector, Iris Cantor-UCLA

Women’s Health CenterCenter Director

UCLA National Center of Excellence

in Women’s Health

Women’s Health:

What I Learned in Medical School (c. 1985)

Leading Causes of Death: US Women

1900

• Tuberculosis• Childbirth

2010

• Heart Disease• Cancer

– Lung– Breast– Colon

• Stroke

The Health of Women Has Been Inadequately Addressed

• Lack of focus on women within the biomedical model

• Lack of focus on non-biomedical factors that impact women’s health

• Lack of focus on women who are not “reproducing”/of reproductive age

Which of the following experience menopause?

1. Lions

2. Baboons

3. Guppies

4. Pilot whales

Which of the following experience menopause?

Answer

3. Guppies

Menopause is rare in the animal kingdom

• No primates undergo menopause in the fashion that human women do

Source: Fogle J Clin Endocrinol Metab 2007

Perimenopause: Impact on Health and Wellbeing Varies for Each Woman

• “Hormone related”– Hot flashes

– Sleep disturbance

– Memory problems

– Vaginal dryness

• Also occurring/continuing– Loss of sexual desire

- Increased risk of depression

Perimenopause: Treatment Varies for Each Woman

• Holistic– Exercise

– Weight loss

– Whole foods/fruits and vegetables based diet

– Avoiding smoking, alcohol

• Alternative/Complementary– -Herbal treatments

– Acupuncture

• Biomedical– -Non-hormonal treatments: Antidepressants that also treat hot flashes, drugs for

migraine that also treat hot flashes

– -Local treatments: Vaginal estrogen

– -Systemic hormones (includes “bioidentical”)

Playing the Odds: Leading Causes of Death for Women In

Los Angeles County#1 Heart Disease

#2 Cancer· Lung

· Breast· Colon

#3 Cerebrovascular Disease#4 Chronic Obstructive Pulmonary Disease

#5 Pneumonia and Influenza#6 Diabetes

#7 Alzheimer’s Disease#8 Accidents

Source: Los Angeles County Office of Women’s Health

12

Pregnancy-induced HTN, GDM PCOS

Lifestyle FactorsDiabetes, HTN, Inc. Lipids

Source: Adapted from “CVD Prevention and the Primary Care Partnership”, Deborah Ehrenthal, MD, FACP

CVD Mortality

per 100,000Women

Age

Many Women Develop Conditions During the Reproductive Years that Contribute to CVD

Risk in Later Life

If all other risk factors are equal, who of the following is least likely to develop type 2 diabetes?

1. A Euro-American Woman

2. An Asian-American Woman

3. An African-American Woman

4. A Latina

If all other risk factors are equal, who of the following is least likely to develop type 2 diabetes?

Answer

1. A Euro-American Woman

Age-adjusted Death Rates for American Women: U.S. 2006

15 15Source: Adapted from American Heart Association 2010* NCHS, Health Data Interactive, 2005-2007

Per100,000

Population

Risk of Cardiac Events By Adherence to Low Risk Lifestyle, Compared to

Non-adherence

Low Risk Factors: Healthy diet, Non-smoking, Moderate-Vigorous Exercise > 30 minutes daily, Body Mass Index < 25, Alcohol > 5 grams/day

RelativeRisk of

CoronaryEvents*

Source: Adapted from Stampfer NEJM 2000

P< .05 compared to expected risk

based on known risk factors

Improving Women’s Health: Structural Issues for the Community

• Safe places to exercise

• Neighborhood markets that sell healthy food at low prices

• Accessible sources of primary preventive care

• Continue and expand upon policies that discourage smoking

• Provide alternatives to unhealthy fast food

Improving Women’s Health: From Research to Policy

• Family

• Community

• Employers

• Government

• Healthcare Reform

Yoga for Treatment of Osteoporosis

ThankYou For

Your Attention!