Midlife transitions a biomedical view
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Midlife Transitions: A Biomedical View. Janet P. Pregler, MD Director, Iris Cantor-UCLA Women ’ s Health Center Center Director UCLA National Center of Excellence in Women ’ s Health. Women ’ s Health: What I Learned in Medical School (c. 1985). 1900 Tuberculosis Childbirth.

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Midlife Transitions: A Biomedical View

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Midlife transitions a biomedical view

Midlife Transitions: A Biomedical View

Janet P. Pregler, MD

Director, Iris Cantor-UCLA

Women’s Health Center

Center Director

UCLA National Center of Excellence in Women’s Health


Midlife transitions a biomedical view

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

Leading Causes of Death: US Women


The health of women has been inadequately addressed

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

0 / 300

Which of the following experience menopause?

  • Lions

  • Baboons

  • Guppies

  • Pilot whales

Cross-Tab Label


Which of the following experience menopause1

0 / 300

Which of the following experience menopause?

Answer

3. Guppies

Cross-Tab Label


Menopause is rare in the animal kingdom

No primates undergo menopause in the fashion that human women do

Menopause is rare in the animal kingdom

Source: Fogle J Clin Endocrinol Metab 2007


Perimenopause impact on health and wellbeing varies for each woman

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

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

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


Midlife transitions a biomedical view

Many Women Develop Conditions During the Reproductive Years that Contribute to CVD Risk in Later Life

Pregnancy-induced HTN, GDM PCOS

Lifestyle Factors

Diabetes, HTN, Inc. Lipids

CVD Mortality

per 100,000

Women

Age

Source: Adapted from “CVD Prevention and the Primary Care Partnership”,

Deborah Ehrenthal, MD, FACP


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

0 / 300

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

  • A Euro-American Woman

  • An Asian-American Woman

  • An African-American Woman

  • A Latina

Cross-Tab Label


If all other risk factors are equal who of the following is least likely to develop type 2 diabetes1

0 / 300

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

Answer

  • A Euro-American Woman

Cross-Tab Label


Age adjusted death rates for american women u s 2006

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

Per

100,000

Population

15

Source: Adapted from American Heart Association 2010

* NCHS, Health Data Interactive, 2005-2007


Risk of cardiac events by adherence to low risk lifestyle compared to non adherence

Risk of Cardiac Events By Adherence to Low Risk Lifestyle, Compared to Non-adherence

Relative

Risk of

Coronary

Events*

P< .05 compared to expected risk based on known risk factors

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

Source: Adapted from Stampfer NEJM 2000


Improving women s health structural issues for the community

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

Improving Women’s Health: From Research to Policy

  • Family

  • Community

  • Employers

  • Government

  • Healthcare Reform


Midlife transitions a biomedical view

Yoga for Treatment of Osteoporosis


Thank you for your attention

Thank

You

For

Your

Attention!


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