The U.S. women's health research agenda for the twenty-first century.
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Female↗
Biomedical subjects
N F Woods
Publications and source records attributed to N F Woods.
Changes in LDL density across the menopausal transition.
BACKGROUND: The risk of coronary artery disease increases in women after menopause. This increased risk may be associated with alterations in the lipid profile characterized by changes in LDL particle size and buoyancy. Characterization of lipoprotein levels and LDL buoyancy across the stages of the menopausal transition has yet to be reported. METHODS: Plasma lipoprotein concentrations, LDL buoyancy, and body mass index (BMI) were studied cross-sectionally in five groups of women: premenopausal women (n = 42), women in early menopausal transition (n = 35), middle menopausal transition (n = 19), late menopausal transition (n = 20), and postmenopausal women (n = 14). No women were taking estrogen. RESULTS: The postmenopausal women had significantly higher low-density lipoprotein cholesterol (LDL-C) and total cholesterol than premenopausal women (P < 0.05). LDL-C and Apo B was significantly higher in women in the late menopausal transition compared to premenopausal women (P < 0.05). All women in the menopausal transition and postmenopause had significantly more dense LDL than premenopausal women (P < 0.05). Multiple regression analysis revealed that the change in LDL buoyancy associated with the menopausal transition period could be explained by changes in triglyceride and HDL-C, related to changes in body mass index. CONCLUSIONS: These data suggest that the menopausal transition is associated with more dense LDL and higher LDL-C levels in comparison to premenopausal women. It appears that whereas LDL-C may change late in the menopausal transition, the production of denser LDL particles appears early in the menopausal transition, both acting to worsen the lipoprotein profile. Increased triglyceride and decreased HDL appeared to account for the shift toward small, dense LDL, presumably related to increased BMI. The change in LDL density may contribute to the higher incidence of atherosclerosis in postmenopausal women.
Adult↗
Premenstrual symptoms: delineating symptom clusters.
The purposes of this study were to (1) identify the clusters of symptoms women experience during the premenstruum, (2) assess the reliability of the symptom clusters as reported by a population-based sample and a sample of women with three perimenstrual symptom patterns, (3) compare the levels of severity for the symptom clusters across menstrual cycle phases and by symptom patterns (e.g., premenstrual syndrome [PMS] vs. low severity), and (4) estimate the stability of the symptom cluster rankings across three menstrual cycle phases. Data from a cross-sectional population-based sample and a comparative sample of women screened for low-severity (LS), PMS, and premenstrual magnification (PMM) symptom patterns were analyzed using factor analysis, correlation coefficients, multivariate analysis of variance, and reliability and stability coefficients. Four symptom clusters accounted for >40% of the variance: turmoil, fluid retention, somatic symptoms, and arousal symptoms. Alpha (alpha) levels were >.70 for turmoil and fluid retention. None of the symptom clusters had correlations with other factors that exceeded a levels for sample 2. Symptom cluster scores varied by cycle phase and group (LS, PMS, PMM). Arousal and somatic symptoms were the most stable of the symptom clusters across cycle phases, and fluid retention and turmoil symptoms were less stable.
Adult↗
Use of hormone replacement therapy in Washington State: is prevention being put into practice?
BACKGROUND: American women are using hormone replacement therapy (HRT) for long-term disease prevention, as well as symptom control, in increasing numbers. Our study examined the role of prevention in women's decisions to initiate HRT and their intended duration of therapy. METHODS: We analyzed the mailed survey responses of 2023 women aged 50 to 70 years from the practices of 46 physicians in the Puget Sound region for knowledge and attitudes about HRT, current use, and intended duration of therapy. Multiple logistic regression was used to model current HRT use and intended treatment length. RESULTS: A total of 71% of our respondents were using HRT. Women with osteoporosis, coronary heart disease (CHD), or risk factors for CHD were not more likely to be using HRT, and women with CHD or risk factors for CHD were not targeted by their physicians for discussion of HRT. Of women using HRT, 77% expected lifelong use, and this was not more common among women initiating HRT for disease prevention. CONCLUSIONS: Despite the high rates of HRT use and expected lifelong duration, use of HRT for prevention was neither higher among women most likely to benefit nor a major determinant of expected lifetime use.
Aged↗
Symptoms among midlife women: cultural lenses, research, and health care.
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Adult↗
Anticipating menopause: observations from the Seattle Midlife Women's Health Study.
OBJECTIVE: The purpose of this study was to determine midlife women's images of menopause and their expectations of their own menopausal experiences. DESIGN: Participants in the Seattle Midlife Women's Health Study (n = 508) responded to a question about their definitions of menopause, and their expectations and concerns about their own menopausal experiences during an in-person interview conducted at entrance to the study between late 1990 and early 1993. At that time, women ranged in age from 35 to 55 years (median, 41 years); 80% were European American and were well educated (median, 15 years). RESULTS: Women defined menopause in the following ways: (1) cessation of their periods, (2) end of their reproductive ability, (3) a time of hormonal changes, (4) a change of life, (5) a changing body, (6) changing emotions, and (7) an aging process. Few women defined menopause as a time of symptoms or disease risk or a time for medical care. Women were most likely to be uncertain of their expectations of their own menopause, and many had no expectations. CONCLUSIONS: This cohort of midlife women did not seem to have adopted a medical model of menopause and were most likely to view menopause as a normal developmental process. Their uncertainty about what to expect provides an opportunity for health teaching and anticipatory guidance.
Adaptation, Physiological↗
Changing women's health, changing nursing practice.
Women's health is a field of study and health care that is of the highest concern for nurses, both from a professional and personal standpoint. It is imperative that those in nursing practice, education, and research be knowledgeable about, prepared for, able to advocate for, and participate in the transformation of health care policy and practice. The changing health care patterns and changing health care delivery system influencing the future of women's health are discussed. Recommendations for nursing practice, education, and research are proposed to advance women's health care.
Adolescent↗
Luteal phase ovarian steroids, stress arousal, premenses perceived stress, and premenstrual symptoms.
The purpose of this study was to examine the relationships among perceived stress, ovarian steroids (estradiol and pregnanediol), stress arousal indicators (cortisol, catecholamines) and premenstrual symptoms (turmoil, fluid retention). Women (N = 74) with low symptom severity (LS), premenstrual syndrome (PMS), or premenstrual magnification (PMM) symptom patterns provided daily urine samples over one cycle and recorded their symptoms and perceived stress levels in a health diary. Multiple regression analysis was used to test models of premenstrual symptoms in separate analyses for women with the LS and PMS symptom patterns and the LS and PMM symptom patterns. Data from the LS and PMS groups revealed that greater stress ratings accounted for turmoil symptoms and higher luteal phase cortisol levels for fluid retention symptoms. For LS and PMM groups, lower luteal phase norepinephrine levels, higher global stress ratings, and a more gradual drop in estradiol premenses accounted for turmoil symptoms. Premenses norepinephrine and epinephrine levels and premenses stress ratings accounted for fluid retention. These findings support an important relationship among perceived stress, stress arousal indicators, and premenstrual symptoms that differs for women with a PMS and PMM symptom pattern.
Adult↗
Perceived stress, physiologic stress arousal, and premenstrual symptoms: group differences and intra-individual patterns.
The purpose of this study was to examine evidence for perceived stress, hypothalamic-pituitary-adrenal, and autonomic nervous system involvement in premenstrual symptoms. Women with a low severity (LS, n = 40), premenstrual syndrome (PMS, n = 22), and premenstrual magnification symptom patterns (PMM, n = 26) rated perceived stress, turmoil, and fluid retention symptoms for one entire cycle. Daily late afternoon urine samples were assayed for epinephrine, norepinephrine, and cortisol. Using multivariate analysis of variance analyses, we found significant group and cycle phase and group by phase interaction effects for perceived stress. There were no group or cycle phase differences in cortisol, epinephrine, and norepinephrine. Intraindividual analyses using cross-correlation techniques revealed a positive time lagged relationship between perceived stress and norepinephrine and cortisol levels across all groups. Only women with a PMS pattern demonstrated perceived stress leading epinephrine levels. Cortisol, epinephrine, and norepinephrine levels led symptoms for all groups with one exception: there was no cross-correlation between epinephrine and turmoil for the PMS group. Perceived stress led both types of symptoms, regardless of group, and symptoms also led stress. The results provide evidence for a unique relationship between epinephrine, perceived stress, and symptoms for women with PMS, and for a reciprocal relationship between stress and symptoms for each of the groups.
Adult↗
Deciding about hormone therapy: validation of a model.
OBJECTIVE: The purposes of this study were to (1) validate components of a decision process regarding adoption of hormone therapy and (2) compare the decision processes women used with respect to their evaluation of decision quality. DESIGN: A sample of women participating in a population-based study of midlife women's health participated in individual in-depth interviews. RESULTS: Content analysis of 30 recorded interviews provided evidence that each component of the decision process (precontemplation, contemplation, commitment, critical evaluation, and continuance) was replicated. Few additional codes were identified, and these could be subsumed under the phases of the original decision model. CONCLUSIONS: Women's self-reported statuses on a screening questionnaire corresponded to the stages of the decision model coded from their interviews. What women actually decided to do (use hormone therapy or something else) was not associated with their decision process. Satisfaction with the decision, uncertainty about the decision, and other factors related to the decision were independent of the decision phases.
Adult↗
Attitudes toward menopause and hormone therapy among women with access to health care.
OBJECTIVE: To explore the relationship between women's attitudes toward menopause and hormone therapy and paradigms of menopause as a natural life event versus a biomedical phenomenon. DESIGN: Women (N = 2092) sampled from physicians' practices in Washington state completed mailed questionnaires with a response rate of 72%. RESULTS: Women's attitudes toward menopause were unrelated to their adoption of a biomedical versus developmental paradigm of menopause. In contrast, women's adoption of the view that menopause was an endocrine deficiency and that symptoms should be treated with hormones were correlated. Endorsement of the endocrine deficiency model of menopause was related to women's attitudes toward hormone therapy as more efficacious, less risky, and requiring daily use of a drug. Women's experiences of a hysterectomy and hormone use were associated with their attitudes. CONCLUSIONS: Women's attitudes toward menopause are multidimensional and not influenced wholly by adoption of a biomedical or developmental paradigm. Women embraced menopause as part of life and simultaneously accepted changes in their endocrine production. Attitudes toward hormone therapy were closely aligned with adoption of a biomedical view of menopause and use of hormone therapy.
Aged↗
Women and menopause: beliefs, attitudes, and behaviors. The North American Menopause Society 1997 Menopause Survey.
OBJECTIVE: The main purpose in organizing this survey was to collect information relevant to The North American Menopause Society's (NAMS) educational mission and to document women's knowledge of, and attitudes toward, menopause. DESIGN: During June-July 1997, The Gallup Organization conducted 750 telephone interviews with a randomly selected sample of women 45-60 years of age from across the United States. Women were asked about their sources of information on menopause, what changes in health they anticipated as a result of menopause, why they used hormone therapy, and their attitudes toward menopause as a natural or a medical event. RESULTS: Women are more likely to believe that depression and irritability are associated with menopause than heart disease, but only a few associate menopause with an increasing vulnerability to either memory loss or Alzheimer's disease. Relief of physical symptoms of menopause was mentioned as the reason for starting hormone therapy more often than to protect against osteoporosis (25% relative to 15%), or to prevent stroke or a heart attack (10%), or to reduce the risk of developing Alzheimer's disease (2%). The single main source of women's information on menopause was a health professional (49%). The majority of women who were already menopausal or experiencing menstrual changes expressed an attitude toward menopause that was either neutral (42%) or positive (36%). CONCLUSIONS: Women are divided in their views of menopause, some seeing it as a medical condition requiring medical treatment, whereas others see it as a natural transition to be managed by "natural" means. Providing women with accurate, up-to-date information and enhancing communication between healthcare providers and menopausal women remain the challenges for NAMS.
Attitude to Health↗
Invited commentary: how would we know a Gulf War syndrome if we saw one?
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Causality↗
Pathways to depressed mood for midlife women: observations from the Seattle Midlife Women's Health Study.
The purpose of this study was to develop and test a multidimensional model of depressed mood experienced by women during midlife. Three pathways to depressed mood were tested for their explanatory power, including menopausal transition, stressful life context, and health status pathways in a multiethnic sample (N = 337). Multiple measures for each variable in the three paths included the CESD and SCL 90 depression scales, menopausal changes questions, vasomotor symptoms rated in a daily health diary. Life Events Scale, Attitudes toward Menopause and Attitudes toward Aging Scales, and chronic health problems and perceived health ratings. The stressful life context pathway was most influential in accounting for depressed mood. Health status had a direct effect on depressed mood and an indirect effect through stress. The menopausal changes pathway had little explanatory power. These results support the need for clinicians to look beyond menopausal status to the broader context of midlife women's lives.
Adult↗
Sleep, psychological distress, and stress arousal in women with fibromyalgia.
The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in alpha-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an etiologic factor but, contrary to several literature assertions, alpha-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options.
Adult↗
PMS after 40: persistence of a stress-related symptom pattern.
The purpose of this study was to compare women over 40 years of age with premenstrual syndrome (PMS) to women with a low-severity (LS) symptom pattern with respect to physiologic indicators of stress arousal and response, stress hormone arousal, stressful life circumstances, anger, self- and social control, and interpersonal sensitivity. Women with PMS experienced more negative life events, more difficulty with anger, and more concerns about self- and social control, than women with an LS pattern. These experiences were coupled with increased physiologic arousal and stress responses (skin conductance and muscle tension levels) and relatively higher norepinephrine levels than for women with an LS pattern, but with dampened cardiovascular responses to stressors. As they age, women with a PMS symptom pattern demonstrate persistent differences in stress arousal and response from women with an LS pattern.
Adult↗
Patterns of depressed mood in midlife women; observations from the Seattle Midlife Women's Health Study.
To differentiate women who experience patterns of depressed mood with respect to their perceptions of menopausal changes and those that were part of everyday life, women (N=347) from the Seattle Midlife Women's Health Study were studied. Women participated in in-depth interviews, kept symptom diaries, and responded to mailed health updates. Data for years 1 and 2 on the Center for Epidemiologic Studies Depression Scale revealed four patterns of depressed mood: consistent depressed mood, emerging depressed mood, resolving depressed mood, and absence of depressed mood. Discriminant function analyses differentiated women with consistent, emerging, and resolving depressed mood from those with absence of depressed mood. Patterns of depressed mood were related to stressful life context, past/present health status, and social learning about midlife. Menopausal status did not differentiate women with patterns of depressed mood from those without depressed mood. Vasomotor symptoms, history of premenstrual syndrome, and postpartum blues helped differentiate women with consistently depressed mood from those recovering from depressed mood.
Adult↗
Symptom experiences of midlife women: observations from the Seattle Midlife Women's Health Study.
UNLABELLED: Symptoms experienced by perimenopausal women are varied with little agreement about their nature, cause or stability. OBJECTIVE: To describe the type and stability of symptoms experienced by midlife women. METHODS: A community-based sample of 301 women ages 35-55 (Mean 41.1; S.D. = 4.2), had at least one menstrual period in the past year, and took no ovarian hormones. Women completed a daily symptom diary for at least one cycle for 3 consecutive years. Symptoms were rated from zero to four. The 5 premenses days were targeted for consistency and as those most symptomatic. Twenty-eight symptoms commonly reported as perimenopausal were factor analyzed using principal components analysis with varimax rotation. Test-retest reliability and stability estimates were calculated according to the method of Heise (Heise, D. Am Sociol Rev 1969; 34: 93-101) that accounts for expected change over time. RESULTS: Twenty-five of the 28 symptoms loaded on five factors labeled dysphoric mood, vasomotor, somatic, neuromuscular, and insomnia together accounting for 51.7% of the variance. Test-retest reliability estimates were highest for dysphoric mood (r = 0.78) and somatic (r = 0.70) symptoms. The reliability for the other three clusters ranged from r = 0.65 to r = 0.53). The stability of the clusters across 3 years was high for dysphoric mood, neuromuscular, and insomnia. The vasomotor and somatic clusters had the most change between years 1 and 3. DISCUSSION: These results indicate that dysphoric mood is not a part of vasomotor symptoms or insomnia or other somatic symptoms suggesting an origin for vasomotor symptoms apart from the other symptoms. The stability of dysphoric mood across 3 years suggests a chronic situation possibly due to high stress, overwork, or an ongoing emotional illness. The stability of the neuromuscular and insomnia symptoms suggests underlying chronic physical conditions. The reduction in stability of vasomotor symptoms may reflect the changing nature of hormones as women approach menopause. Finally, the low stability of somatic symptoms suggests that they represent acute episodic illnesses. Together the identification of five distinct symptom clusters with varying stability over 3 years suggests that they are due to different underlying mechanisms and are not all attributed to the changing hormone patterns associated with the menopausal transition. Many other events in a midlife woman's life can account for these symptoms including life stress and acute and chronic illnesses.
Adult↗