Studying women at midlife Health: Large-scale project aims to throw light on area that has attracted little research so far: what happens as the female body ages.

April 02, 1996|By Shari Roan | Shari Roan,LOS ANGELES TIMES

What happens to a woman's body at age 40 or 45 or 50? We know, only too well, that things start to look different on the outside. But, surprisingly, this time period represents a big unknown in women's health research.

The '90s decade has been a rich one in understanding diseases such as breast cancer, osteoporosis and heart disease, generally ailments of old age.

But how do women end up with those diseases?

What does it mean to your long-term health to have a baby at 41?

What is the significance of having hot flashes throughout your 40s?

Why do women tend to gain weight in this period of the 40s and early 50s called midlife?

By the turn of the century, those questions won't hold as much mystery, say the leaders of a transformative new study, the first large-scale look at women's experiences at midlife.

The investigators expect that the Study of Women's Health Across the Nation, or SWAN, may confirm their hunch that what women do in the decade before menopause is just as important as what they do afterward.

"Women in this age period have been understudied," says Dr. Sherry Sherman, who is directing the project, launched last year, at the National Institute on Aging. "There is almost nothing [in medical literature] with respect to their physiology. And it's pivotal. The question is: How does a healthy, vigorous woman end up as a frail, older woman?"

Sponsored by the NIA, the $17.5 million study will follow for at least four years 2,500 women between ages 42 and 52 who are still having menstrual periods. In a novel twist to the study, each of the seven research sites will focus on these ethnic groups: women of Japanese descent, Chinese descent, black, Puerto Rican descent, Mexican descent and Caucasian.

At the University of California, Los Angeles, for example -- one of two California study sites -- researchers will follow 250 Japanese and 200 Caucasian women. The women will undergo periodic physical exams and tests as well as answer questions about their lifestyles, attitudes and experiences at midlife.

Exhaustive in scope, the study will examine smoking and alcohol consumption, exercise, premenstrual syndrome, commitment to work, attitudes about aging, reproductive health, environmental exposures, genetics and many other facets of health, says Dr. Gail Greendale, director of research at the Iris Cantor-UCLA Women's Health Center.

Eye opener

The study had its roots in an eye-opening meeting that Dr. Sherman convened a few years ago to explore what was known about women at midlife.

"The bottom line from this brainstorming session was 'not much,' " Dr. Greendale says. "But what the NIA realized is that what happens to women all along the life span impacts them in old age. And the major transition is going on at midlife."

Vicki Cohen, 43, a Redondo Beach, Calif., mother of three who is participating in the study at UCLA, says she sometimes feels unsettled by the mysteries of aging.

"There are so many changes occurring in myself," she says. "My hair is turning gray, my face is aging. Everything is changing. It's not the same anymore. It's scary. I'm feeling older."

Like Ms. Cohen, many of the women contacted to participate in the study have responded with enthusiasm.

The women who participate won't be disappointed with the outcome of the study, Dr. Sherman says. "Our findings should help change the way women view this time in their lives and change the way health care providers approach both the physical and emotional issues women face."

In general, the study will look at the biological, emotional, environmental and behavioral changes that alter a woman's risk factors for disease. By giving equal attention to emotions and lifestyle, the researchers hope to learn which changes at midlife are attributable to biology and which are more influenced by lifestyle.

Each study site will explore dozens of specific questions. For example, UCLA researchers will study a hypothesis that hormone levels fluctuate wildly in the years preceding menopause. To examine this, a group of women will collect a urine sample each day for one month. The routine will be repeated each of the four years. The urine samples provide information on hormone levels.

Moreover, the women will keep daily diaries about their moods and feelings. Their entries will be matched to their daily hormone levels to explore whether hormone changes trigger mood changes.

"This will help us try to figure out what is biological and what is not biological," Dr. Greendale says. "We can then learn which problems may be amenable to biological remedies and which are not."

UCLA will also study hot flashes in women to see if they are markers for significant hormonal changes. Some women will even stay overnight for one weekend at the UCLA clinic for hourly monitoring that will record their hot flashes and hormone levels.

A team at Massachusetts General Hospital in Boston will evaluate whether blood tests for a material called Mullerian inhibitory substance can predict the onset of menopause before other symptoms appear.

Researchers at the University of California, Davis, will examine alternative therapies used to deal with premenstrual and menopausal symptoms.

Teams at work

A University of Michigan team will study black and Caucasian women and their risk factors for obesity, osteoporosis, hypertension and arthritis.

A University of Pittsburgh group will look at rates of clinical depression and anxiety during midlife.

And a New Jersey group will use ultrasound examinations to study how fibroids change in midlife.

"We have no good data on what happens with uterine fibroids at midlife and why some women bleed so badly," Dr. Greendale says of the study at the University of Medicine and Dentistry of New Jersey. "Why do fibroids tend to grow at midlife? What are the risk factors for fibroids?"

Pub Date: 4/02/96

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