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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

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

slide2

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

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

slide12

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
thank you for your attention
Thank

You

For

Your

Attention!