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Gass M.L.S.,North American Menopause Society | Stuenkel C.A.,University of California at San Diego | Utian W.H.,North American Menopause Society | Croix A.L.,University of California at San Diego | And 2 more authors.
Menopause | Year: 2015

Objective: A national survey was conducted to determine the extent of use of compounded hormone therapy (C-HT) and to characterize the differences between C-HT users and users of hormone therapy approved by the US Food and Drug Administration (FDA-HT users). Methods: This Internet survey enrolled 3,725 women aged 40 to 84 years who were postmenopausal or experiencing the menopause transition. The sample was weighted slightly by age, region, education, and race to reflect population attributes based on US Census data. Results: Overall, 9% of women were current users of HT, and 28% of all respondents were ever-users of HT. C-HT users represented 31% of ever-users of HT, 35% of current users of HT, and 41% of ever-users aged 40 to 49 years. Approximately 13% of ever-users indicated current or past use of testosterone. The most cited reason for using HT was vasomotor symptoms (70%). Nonapproved indications for using HT were selected more often by C-HT users. There were four reports of endometrial cancer among the 326 C-HT users compared with none reported among the 738 FDA-HT users. Significance was not determined because of small numbers. Conclusions: This survey indicates substantial use of C-HT across the country and the possibility of higher rates of endometrial side effects with such products. There is a need for standardized data collection on the extent of use of compounded hormones and their potential risks. © 2015 by The North American Menopause Society.


Rillamas-Sun E.,Fred Hutchinson Cancer Research Center | Rillamas-Sun E.,Group Health Research Institute | LaCroix A.Z.,Fred Hutchinson Cancer Research Center | LaCroix A.Z.,Group Health Research Institute | And 10 more authors.
JAMA Internal Medicine | Year: 2014

IMPORTANCE The effect of obesity on late-age survival in women without disease or disability is unknown. OBJECTIVE To investigate whether higher baseline body mass index and waist circumference affect women's survival to 85 years of age without major chronic disease (coronary disease, stroke, cancer, diabetes mellitus, or hip fracture) and mobility disability. DESIGN, SETTING, AND PARTICIPANTS Examination of 36 611 women from the Women's Health Initiative observational study and clinical trial programs who could have reached 85 years or older if they survived to the last outcomes evaluation on September 17, 2012. Recruitment was from 40 US clinical centers from October 1993 through December 1998. Multinomial logistic regression models were used to estimate odds ratios and 95% CIs for the association of baseline body mass index and waist circumference with the outcomes, adjusting for demographic, behavioral, and health characteristics. MAIN OUTCOMES AND MEASURES Mutually exclusive classifications: (1) survived without major chronic disease and without mobility disability (healthy); (2) survived with 1 or more major chronic disease at baseline but without new disease or disability (prevalent diseased); (3) survived and developed 1 or more major chronic disease but not disability during study follow-up (incident diseased); (4) survived and developed mobility disability with or without disease (disabled); and (5) did not survive (died). RESULTS Mean (SD) baseline age was 72.4 (3.0) years (range, 66-81 years). The distribution of women classified as healthy, prevalent diseased, incident diseased, disabled, and died was 19.0%, 14.7%, 23.2%, 18.3%, and 24.8%, respectively. Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. Relative to healthy-weight women, adjusted odds ratios (95% CIs) of mobility disability were 1.6 (1.5-1.8) for overweight women and 3.2 (2.9-3.6), 6.6 (5.4-8.1), and 6.7 (4.8-9.2) for class I, II, and III obesity, respectively. Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability. CONCLUSIONS AND RELEVANCE Overall and abdominal obesity were important and potentially modifiable factors associated with dying or developing mobility disability and major chronic disease before 85 years of age in older women. Copyright 2014 American Medical Association. All rights reserved.


Qi L.,University of California at Davis | Nassir R.,University of California at Davis | Kosoy R.,University of California at Davis | Garcia L.,University of California at Davis | And 4 more authors.
American Journal of Obstetrics and Gynecology | Year: 2013

Objective: Most studies suggest that hysterectomies are more common in African American women than in other ethnic groups. To assess this ethnic surgical disparity in a novel way, our main goal was to determine whether admixture (the proportion of sub-Saharan African or European origin in individuals) is associated with hysterectomy frequency in African American women in the Women's Health Initiative. Study Design: In this retrospective study, we used ancestry informative single nucleotide polymorphisms to estimate admixture proportions in >10,000 African American women from the Women's Health Initiative. Logistic regression models were used to assess the association between admixture and self-reported history of hysterectomy with and without controls for relevant covariates. Multinomial logistic regression models were used to assess the association between admixture and self-reported age of hysterectomy. We also considered other potential risk factors (adiposity, hypertension, and education) for hysterectomy accounting for admixture. Results: African admixture was a strong risk factor after the adjustment for multiple covariates (odds ratio, 1.85; P <.0001). The admixture risk for hysterectomy was highest for those procedures that were performed in the 35-39 age range (odds ratio, 3.08; P <.0001) and least evident in oldest ages (≥45 years old). Our analyses also suggest that adiposity, hypertension, and education were associated independently with hysterectomy in this population group. Conclusion: These results suggest that higher African admixture is associated with higher frequencies of hysterectomy and that genetic studies that specifically target African American women and diseases that are associated with hysterectomy may be especially useful in understanding the pathogenesis and underlying cause of this disparity in health outcome. © 2013 Mosby, Inc.


WINSTON-SALEM, N.C. - Nov. 2, 2016 - Women experience a notable decline in sexual function approximately 20 months before and one year after their last menstrual period, and that decrease continues, though at a somewhat slower rate, over the following five years, according to a study led by a researcher at Wake Forest Baptist Medical Center. The study, published ahead of print in the online issue of Menopause: The Journal of the North American Menopause Society, also found that various factors that frequently co-occur with menopause have less direct influence on declining sexual function than menopause itself. "Sexual functioning in women declines with age, and there has been much debate about how much this is due to menopause, aging or other physical, psychological or social factors," said the study's lead author, Nancy Avis, Ph.D., professor of public health sciences at Wake Forest School of Medicine, part of Wake Forest Baptist. "Our findings support that menopause has a negative effect on sexual functioning in many women." Additionally, the study found that women who have a hysterectomy before the onset of menopause do not experience a marked decline in sexual function immediately before undergoing the procedure but do so afterward, for as long as five years. The researchers based their findings on information collected from 1,390 participants in the federally funded Study of Women's Health Across the Nation (SWAN), which began in 1996. These women, who were between the ages of 42 and 52 at the time of enrollment in the study and who had a known date of final menstrual period during their participation, responded to questionnaires dealing with various aspects of sexual function - including desire, arousal, satisfaction and pain - between one and seven times over the course of the study. The researchers analyzed 5,798 of these self-assessments (4,932 from the 1,164 women in the natural menopause group and 866 from the 226 women in the hysterectomy group) and tracked the changes in the respondents' scores on the sexual-function questionnaires relative to either their final menstrual period among women who experienced a natural menopause or the hysterectomy. Of note, in the natural menopause group the researchers found that race/ethnicity played a major role in the decline of sexual function, with African-American women experiencing a significantly smaller decline and women of Japanese descent experiencing a much greater decline when compared with white women. "Sexual functioning is an important component of women's lives. More than 75 percent of the middle-aged women in the SWAN study reported that sex was moderately to extremely important to them when the study began," Avis said. "It is important for women and their health care providers to understand all the factors that may impact women's experience of sex in relation to both the natural menopausal transition and hysterectomy, and we hope our findings will contribute to better understanding in this area." The SWAN project received funding from the National Institutes of Health through the National Institute on Aging, National Institute of Nursing Research and NIH Office on Women's Health in grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554 and U01AG012495. Co-authors of the study are Alicia Colvin, Ph.D., Maria Brooks, Ph.D., and Ping D. Tepper, Ph.D., University of Pittsburgh School of Public Health; Arun S. Karlamangla, M.D., Ph.D., and Gail A. Greendale, M.D., David Geffen School of Medicine at UCLA; Sybil Crawford, Ph.D., University of Massachusetts Medical Center, Worcester; Rachel Hess, M.D., University of Utah School of Health Sciences; and L. Elaine Waetjen, UC Davis School of Medicine.


Gass M.L.S.,North American Menopause Society | Cochrane B.B.,University of Washington | Larson J.C.,Fred Hutchinson Cancer Research Center | Manson J.E.,Harvard University | And 7 more authors.
Menopause | Year: 2011

Objective: The aim of this study was to determine the patterns and predictors of sexual activity in the Hormone Therapy (HT) Trials of the Women's Health Initiative (WHI). Methods: Sexual activity questions were administered to 27,347 women ages 50 to 79 years at baseline and at year 1 and to a random 8.6% subsample at years 3 and 6. The associations with demographic and health characteristics were determined. Results: Sexual activity at baseline was 60.7%, 44.9%, and 28.2% in the 50-to 59-, 60-to 69-, and 70-to 79-year-old age groups, respectively. Most of the participants were satisfied with their current sexual activity (63.2%). Of those dissatisfied, 57% preferred more sexual activity. Vaginal atrophy correlated with sexual inactivity at baseline (P < 0.001). The correlates associated with stopping sexual activity at year 1 included poor/fair self-rated health, lack of satisfaction with quality of life, depression, and loss of partner (P < 0.001). The strongest predictor of sexual activity at year 1 was sexual activity at baseline (odds ratio, 96.71; 95% CI, 81.90-114.20). A subset analysis of women adherent with HT or placebo at years 3 and 6 suggested that HT was associated with a higher percentage of participants reporting sexual activity (P = 0.01). Conclusions: Most women in the WHI HT Trials were satisfied with their sexual activity. Of those who were dissatisfied, the majority preferred more, rather than less, sexual activity. Vaginal atrophy at baseline correlated with sexual inactivity, and sexual activity at baseline was the strongest identified predictor of sexual activity at year 1. HT use was not predictive of ongoing sexual activity in the intent-to-treat analysis. This report further characterizes the participants in the WHI HT trials and reveals the complexity of factors related to the prevalence of sexual activity and satisfaction. © 2011 The North American Menopause Society.


The International Association of HealthCare Professionals is pleased to welcome Heidi J. Purcell, MD, OB/GYN Physician, to their prestigious organization with her upcoming publication in The Leading Physicians of the World. She is a highly trained and qualified obstetrician and gynecologist with expertise in all facets of her work, especially reproductive and postmenopausal care. Dr. Purcell has been in practice for over three years and is currently serving patients at Women’s Health Group in Houston, Texas. Her clinical areas of focus include teenage and first gynecologic visits, as well as contraception. She is passionate about the diversity that the field of women’s health encompasses. Dr. Purcell attended the University of Utah School of Medicine where she received her Medical Degree in 2009. Her postgraduate training includes her internship and OB/GYN residency at Baylor College of Medicine in Houston, Texas. Furthermore, she maintains professional memberships with the American Congress of Obstetrics and Gynecology, the American Association of Laparoscopic Gynecologists, the Harris County Medical Society, the Texas Medical Association, and the North American Menopause Society. Dr. Purcell received several teaching awards during her residency. She attributes her success to her wonderful mentors, hard work, and love for the profession. When she is not assisting patients, Dr. Purcell enjoys scuba diving, music, visiting local museums, and spending time with her dogs. Learn more about Dr. Purcell here: http://womanshealthgroup.com/physicians/profile/Dr-Heidi-J-Purcell and read her upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics.  Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review.  FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  For more information about FindaTopDoc, visit:http://www.findatopdoc.com


Harlow S.D.,University of Michigan | Gass M.,North American Menopause Society | Hall J.E.,Harvard University | Lobo R.,Columbia University | And 5 more authors.
Fertility and Sterility | Year: 2012

Objective: The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period. Method(s): Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus. Result(s): STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics. Conclusion(s): STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified. © 2012 by American Society for Reproductive Medicine.


Women experience a notable decline in sexual function approximately 20 months before and one year after their last menstrual period, and that decrease continues, though at a somewhat slower rate, over the following five years, according to a study led by a researcher at Wake Forest Baptist Medical Center. The study, published ahead of print in the online issue of Menopause: The Journal of the North American Menopause Society, also found that various factors that frequently co-occur with menopause have less direct influence on declining sexual function than menopause itself. "Sexual functioning in women declines with age, and there has been much debate about how much this is due to menopause, aging or other physical, psychological or social factors," said the study's lead author, Nancy Avis, Ph.D., professor of public health sciences at Wake Forest School of Medicine, part of Wake Forest Baptist. "Our findings support that menopause has a negative effect on sexual functioning in many women." Additionally, the study found that women who have a hysterectomy before the onset of menopause do not experience a marked decline in sexual function immediately before undergoing the procedure but do so afterward, for as long as five years. The researchers based their findings on information collected from 1,390 participants in the federally funded Study of Women's Health Across the Nation (SWAN), which began in 1996. These women, who were between the ages of 42 and 52 at the time of enrollment in the study and who had a known date of final menstrual period during their participation, responded to questionnaires dealing with various aspects of sexual function -- including desire, arousal, satisfaction and pain -- between one and seven times over the course of the study. The researchers analyzed 5,798 of these self-assessments (4,932 from the 1,164 women in the natural menopause group and 866 from the 226 women in the hysterectomy group) and tracked the changes in the respondents' scores on the sexual-function questionnaires relative to either their final menstrual period among women who experienced a natural menopause or the hysterectomy. Of note, in the natural menopause group the researchers found that race/ethnicity played a major role in the decline of sexual function, with African-American women experiencing a significantly smaller decline and women of Japanese descent experiencing a much greater decline when compared with white women. "Sexual functioning is an important component of women's lives. More than 75 percent of the middle-aged women in the SWAN study reported that sex was moderately to extremely important to them when the study began," Avis said. "It is important for women and their health care providers to understand all the factors that may impact women's experience of sex in relation to both the natural menopausal transition and hysterectomy, and we hope our findings will contribute to better understanding in this area."


News Article | November 11, 2016
Site: www.techtimes.com

Ticked Off! Here's What You Need To Know About Lyme Disease Women have been found to have generally better memory than men but their memories start to fade as estrogen levels drop once menopause sets in, new research has found. In a study published in the journal Menopause, researchers from the North American Menopause Society confirmed what women have long claimed about having better memory, showing that middle-aged women outperformed men from the same age group across all memory measures. However, the researchers also discovered that women's memories do decline after menopause begins. Memory loss has long been established as a consequence of aging, with epidemiological estimates suggesting about 75 percent of older adults are dealing with problems related to memory. For the study, the researchers worked with 212 men and women between the ages of 45 and 55. The subjects were assessed for estimated verbal intelligence, semantic processing, executive function and episodic memory using cognitive tests. Episodic verbal and associative memories were assessed via the Selective Reminding Test and Face-Name Associative Memory Exam. For women transitioning into menopause, "brain fog" and forgetfulness are common issues. They are also disproportionately at risk for dementia and memory impairment compared to their male counterparts but the study showed that they still have better memory performance than men. Once estrogen levels drop, however, postmenopausal women report trouble with initial learning and difficulty retrieving previously known information. The upside is that memory consolidation and storage are not affected. "Brain fog and complaints of memory issues should be taken seriously. This study and others have shown that these complaints are associated with memory deficits," said JoAnn Pinkerton, executive director for NAMS. According to a study released in April, women who enter natural menopause at 45 years old are likelier to develop heart problems and die younger than those who experienced menopause later in life. This means that menopause age could be used to predict future risk for cardiovascular problems, allowing for early intervention that will not only address heart disease but also prevent it where possible. In another study, researchers found that risk factors for type 2 diabetes, stroke and heart disease, like abnormal levels of cholesterol, high levels of blood sugar and elevated blood pressure, manifest before a woman enters menopause, not after as previously thought by health experts. "The years transitioning to menopause may represent a ‘teachable moment,' when patients are especially receptive to learning and putting into practice healthy habits that can make a difference in their cardiovascular disease risk," said Mark DeBoer, one of the authors of the study. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.


Utian W.H.,North American Menopause Society
Climacteric | Year: 2012

The sudden decision by the National Heart, Lung, and Blood Institute of the National Institutes of Health to terminate the estrogenprogestogen therapy arm of the Women's Health Initiative (WHI) Study a decade ago now begs two questions: has women's health after menopause been helped or harmed as a result of the findings and the way in which they were presented, and, if harmed, what needs to be done to put things right? Time and multiple reviews of specific publications from the WHI lead to the serious question whether a project designed to be of benefit to women's health has boomeranged, and instead may have resulted in significant impairment to both the quality of life and physical health of postmenopausal women. It is therefore urgent to confirm whether this is so and whether corrective action needs be taken to prevent even more harm. There are two obvious and immediate actions to be called for: (1) The Food and Drug Administration (FDA) needs to revisit the black-box warnings on postmenopausal hormones. Specifically, there needs to be a separation of the advisories for estrogen alone from estrogen and progestogen combined usage. (2) Justification is given to call for an independent commission to scrutinize every major WHI paper to determine whether the data justified the Conclusions: drawn. Women progressing through and beyond menopause in the next decade need to be spared the unnecessary harm that may have been inflicted on their sisters of the previous decade. © 2012 International Menopause Society.

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