midlife transitions: a biomedical view janet p. pregler, md director, iris cantor-ucla women ’ s...
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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
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Women’s Health:
What I Learned in Medical School (c. 1985)
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Leading Causes of Death: US Women
1900
• Tuberculosis• Childbirth
2010
• Heart Disease• Cancer
– Lung– Breast– Colon
• Stroke
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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
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Which of the following experience menopause?
1. Lions
2. Baboons
3. Guppies
4. Pilot whales
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Which of the following experience menopause?
Answer
3. Guppies
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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
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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
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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”)
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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
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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
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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
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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
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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
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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
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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
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Improving Women’s Health: From Research to Policy
• Family
• Community
• Employers
• Government
• Healthcare Reform
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Yoga for Treatment of Osteoporosis
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ThankYou For
Your Attention!