Midlife Transitions: A Biomedical View

1. 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

2. Women’s Health: What I Learned in Medical School (c. 1985)

3. 1900 Tuberculosis Childbirth 2010 Heart Disease Cancer Lung Breast Colon Stroke Leading Causes of Death: US Women

4. 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

5. 0 / 300 Which of the following experience menopause? • Lions • Baboons • Guppies • Pilot whales Cross-Tab Label

6. 0 / 300 Which of the following experience menopause? Answer 3. Guppies Cross-Tab Label

7. 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

9. 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

10. 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”)

11. 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. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Improving Women’s Health: From Research to Policy • Family • Community • Employers • Government • Healthcare Reform

19. Yoga for Treatment of Osteoporosis

20. Thank You For Your Attention!