Sybil L. Crawford

Soluble endoglin for the prediction of preeclampsia in a high risk cohort

Sharon E. Maynard et al. — Thu, 01 Sep 2011 13:20:52 PDT

OBJECTIVES: To evaluate soluble endoglin (sEng) and the soluble fms-like tyrosine kinase 1 (sFlt1) to placental growth factor (PlGF) ratio for the prediction of preeclampsia in high-risk women, and to evaluate differences in sEng between women with high-risk singleton and multiple gestation pregnancies.

STUDY DESIGN: We collected serial serum specimens from 119 women at high preeclampsia risk. sEng, sFlt1 and PlGF were measured by ELISA.

RESULTS: Among subjects who did not develop preeclampsia, mean serum sEng was significantly higher in those with multiple gestation pregnancies vs. high-risk singletons. Among women with singleton gestations, mean serum sEng was higher in subjects who developed early-onset (<34>weeks) and late-onset (>or= 34 weeks) preeclampsia, as compared with subjects without preeclampsia, from 22 weeks and 28 weeks gestation onward, respectively. The within-woman rate of change of sEng was also higher in women who later developed preeclampsia.

CONCLUSIONS: sEng is higher in women with multiple gestations vs. high-risk singleton pregnancies. In high-risk women, serum sEng is increased prior to preeclampsia onset.

Advancing Stage of Female Reproductive Life Associated with Bipolar Illness Exacerbation

Wendy K. Marsh et al. — Thu, 01 Sep 2011 13:20:39 PDT

Introduction: Perimenopause confers an increased risk of depression in the general population, yet bipolar disorder mood course remains unknown.

Methods: Clinic visits in 519 premenopausal, 116 perimenopausal including 13 women transitioning from peri- to postmenopause, and 133 postmenopausal women with bipolar disorder who received naturalistic treatment in the multisite STEP-Bipolar Disorder study over 19.8 +/- 15.5 months were analyzed for mood state.

Results: Advancing female reproductive stage was significantly associated with percent of visits decreasing in euthymia (29.3%, 27%, 25%, respectively, p<0.05) decreasing in syndromal mood elevation (5.3%, 4.1%, and 3.0%, respectively, p<0.001). Thirteen women transitioning from peri- to postmenopause had a significantly greater proportion of visits in syndromal depression (24.4%, p<0.001) compared to premenopausal, perimenopausal and postmenopausal women, while depression in the latter three groups (18.1%, 18.1%, and 19.3% respectively) did not differ.

Conclusions: Advancing stage of female reproductive life was associated with bipolar illness exacerbation. Women transitioning from peri- to postmenopause had significantly greater depression than other female reproductive groups.

Constipation and Risk of Cardiovascular Disease among Postmenopausal Women

Elena Salmoirago Blotcher et al. — Fri, 24 Jun 2011 08:56:00 PDT

BACKGROUND: Constipation is common in Western societies, accounting for 2.5 million physician visits/year in the US. Because many factors predisposing to constipation also are risk factors for cardiovascular disease, we hypothesized that constipation may be associated with increased risk of cardiovascular events.

METHODS: We conducted a secondary analysis in 93,676 women enrolled in the observational arm of the Women's Health Initiative. Constipation was evaluated at baseline by a self-administered questionnaire. Estimates of the risk of cardiovascular events (cumulative end point including mortality from coronary heart disease, myocardial infarction, angina, coronary revascularization, stroke, and transient ischemic attack) were derived from Cox proportional hazards models adjusted for demographics, risk factors, and other clinical variables (median follow-up 6.9 years).

RESULTS: The analysis included 73,047 women. Constipation was associated with increased age, African American and Hispanic descent, smoking, diabetes, high cholesterol, family history of myocardial infarction, hypertension, obesity, lower physical activity levels, lower fiber intake, and depression. Women with moderate and severe constipation experienced more cardiovascular events (14.2 and 19.1 events/1000 person-years, respectively) compared with women with no constipation (9.6/1000 person-years). After adjustment for demographics, risk factors, dietary factors, medications, frailty, and other psychological variables, constipation was no longer associated with an increased risk of cardiovascular events except for the severe constipation group, which had a 23% higher risk of cardiovascular events.

CONCLUSION: In postmenopausal women, constipation is a marker for cardiovascular risk factors and increased cardiovascular risk. Because constipation is easily assessed, it may be a helpful tool to identify women with increased cardiovascular risk.

Mindfulness training for coping with hot flashes: results of a randomized trial

James Carmody et al. — Fri, 29 Apr 2011 11:49:19 PDT

Objective: The aim of this study was to analyze the effect of participation in a mindfulness training program (mindfulness-based stress reduction, [MBSR]) on the degree of bother from hot flashes and night sweats.

Methods: This study was a randomized trial of 110 late perimenopausal and early postmenopausal women experiencing an average of 5 or more moderate or severe hot flashes (including night sweats)/day. A wait-list control (WLC) was used with 3-month postintervention follow-up. The main outcome was the degree of bother from hot flashes and night sweats in the previous 24 hours. Secondary measures were hot flash intensity, quality of life, insomnia, anxiety, and perceived stress.

Results: Baseline average (SD) hot flash frequency was 7.87 (3.44) and 2.81 (1.76) night sweats/day. Mean (SD) bothersomeness score was 3.18 (0.55; "moderately bothered/extremely bothered"). All analyses were intention to treat and were controlled for baseline values. Within-woman changes in bother from hot flashes differed significantly by treatment arm (week x treatment arm interaction, P = 0.042). At completion of the intervention, bother in the MBSR arm decreased on average by 14.77% versus 6.79% for WLC. At 20 weeks, total reduction in bother for MBSR was 21.62% and 10.50% for WLC. Baseline-adjusted changes in hot flash intensity did not differ between treatment arms (week x treatment arm interaction, P = 0.692). The MBSR arm made clinically significant improvements in quality of life (P = 0.022), subjective sleep quality (P = 0.009), anxiety (P = 0.005), and perceived stress (P = 0.001). Improvements were maintained 3 months postintervention.

Conclusions: Our data suggest that MBSR may be a clinically significant resource in reducing the degree of bother and distress women experience from hot flashes and night sweats.

Characteristics of Dispositional Mindfulness in Patients With Severe Cardiac Disease

Elena Salmoirago Blotcher et al. — Fri, 29 Apr 2011 11:49:14 PDT

The characteristics of dispositional mindfulness have rarely been explored in unhealthy populations. The authors sought to evaluate its association(s) with psychological morbidity and disease severity in 30 outpatients with implantable cardioverter defibrillators who were naïve to mindfulness training. They used the Five Facets of Mindfulness and the Hospital Anxiety and Depression Scale to measure dispositional mindfulness and anxiety/depression, respectively. Associations were estimated using linear regression models. Higher dispositional mindfulness was observed in patients with lower anxiety scores (β = -1.10, CI = -1.71, -0.49) and no history of depression (β = -7.95; CI = -14.31, -1.6) by univariate analysis. No associations were observed with disease severity or other covariates. In conclusion, psychological well-being and psychological morbidity, and not disease severity, appear to be associated with dispositional mindfulness in patients with implantable cardioverter defibrillators. Further research is needed to confirm these findings.

Religion and Healthy Lifestyle Behaviors Among Postmenopausal Women: the Women's Health Initiative

Elena Salmoirago Blotcher et al. — Fri, 29 Apr 2011 11:49:09 PDT

Worship attendance has been associated with longer survival in prospective cohort studies. A possible explanation is that religious involvement may promote healthier lifestyle choices. Therefore, we examined whether attendance is associated with healthy behaviors, i.e. use of preventive medicine services, non-smoking, moderate drinking, exercising regularly, and with healthy dietary habits. The population included 71,689 post-menopausal women enrolled in the Women's Health Initiative observational study free of chronic diseases at baseline. Attendance and lifestyle behaviors information was collected at baseline using self-administered questionnaires. Healthy behaviors were modeled as a function of attendance using logistic regression. After adjustment for confounders, worship attendance (less than weekly, weekly, and more than weekly vs. never) was positively associated with use of preventive services [OR for mammograms: 1.34 (1.19, 1.51), 1.41 (1.26, 1.57), 1.33 (1.17, 1.52); breast self exams: 1.14 (1.02, 1.27), 1.33 (1.21, 1.48), 1.25 (1.1, 1.43); PAP smears: 1.22 (1.01, 1.47-weekly vs. none)]; non-smoking: [1.41 (1.35, 1.48), 1.76 (1.69, 1.84), 2.27 (2.15, 2.39)]; moderate drinking [1.35 (1.27, 1.45), 1.60 (1.52, 1.7), 2.19 (2.0, 2.4)]; and fiber intake [1.08 (1.03, 1.14), 1.16 (1.11, 1.22), 1.31 (1.23, 1.39), respectively], but not with regular exercise or with lower saturated fat and caloric intake. These findings suggest that worship attendance is associated with certain, but not all, healthy behaviors. Further research is needed to get a deeper understanding of the relationship between religious involvement and healthy lifestyle behaviors and of the inconsistent patterns in this association.

The ReSTAGE Collaboration: defining optimal bleeding criteria for onset of early menopausal transition

Sioban D. Harlow et al. — Tue, 20 Apr 2010 11:41:06 PDT

OBJECTIVE: Criteria for staging the menopausal transition are not established. This article evaluates five bleeding criteria for defining early transition and provides empirically based guidance regarding optimal criteria.

DESIGN/SETTING: Prospective menstrual calendar data from four population-based cohorts: TREMIN, Melbourne Women's Midlife Health Project (MWMHP), Seattle Midlife Women's Health Study (SMWHS), and Study of Women's Health Across the Nation (SWAN) with annual serum FSH from MWMHP and SWAN.

PARTICIPANTS: 735 TREMIN, 279 SMWHS, 216 MWMHP, and 2270 SWAN women aged 35-57 at baseline who maintained menstrual calendars.

MAIN OUTCOME MEASURE(S): Age at and time to menopause for: standard deviation >6 and >8 days, persistent difference in consecutive segments >6 days, irregularity, and >or=45 day segment. Serum FSH concentration.

RESULT(S): Most women experienced each of the bleeding criteria. Except for a persistent >6 day difference that occurs earlier, the criteria occur at a similar age and at approximately the same age as late transition in a large proportion of women. FSH was associated with all proposed markers.

CONCLUSION(S): The early transition may be best described by ovarian activity consistent with the persistent >6 day difference, but further study is needed, as other proposed criterion are consistent with later menstrual changes.

Relation of daily urinary hormone patterns to vasomotor symptoms in a racially/ethnically diverse sample of midlife women: study of women's health across the nation

Ellen B. Gold et al. — Tue, 20 Apr 2010 11:41:04 PDT

The associations of urinary pregnanediol-glucuronide (PdG) levels and menstrual bleeding and their modification of associations of other risk factors with vasomotor symptoms (VMS) are examined. Daily urine samples were collected for 1 menstrual cycle or 50 days if no bleeding occurred. Participants (n = 742) were aged 43 to 54 years, not using exogenous hormones, not pregnant, had an intact uterus and > 1 ovary, and menstruated in the prior 3 months. Multivariate analyses were performed of urinary hormone metabolites and within-woman proportion of days reporting VMS. VMS reporting was 4-fold greater (P = .0005) in women whose urine collections ended without bleeding. In collections with PdG levels suggestive of ovulatory activity according to the work of Kassam et al, VMS are significantly associated with obesity, early perimenopause, and increasing PdG levels. In collections with lower PdG concentrations, VMS are significantly increased with no bleeding, smoking, higher age, physical activity, follicle-stimulating hormone, and luteinizing hormone and are significantly reduced with increasing estrogen concentrations.

Angiogenic factors for the prediction of preeclampsia in high-risk women

Tiffany A. Moore Simas et al. — Tue, 20 Apr 2010 11:41:02 PDT

OBJECTIVE: The objective of the study was to evaluate angiogenic factors for the prediction of preeclampsia in high-risk women.

STUDY DESIGN: We collected serial serum specimens from 94 women at high preeclampsia risk between 22 and 36 weeks' gestation. Soluble fms-like tyrosine kinase-1 (sFlt1) and placental growth factor (PlGF) were measured by enzyme-linked immunosorbent assay.

RESULTS: Mean serum sFlt1 and the sFlt1/PlGF ratio were higher in subjects who developed early-onset (less than 34 weeks) preeclampsia, as compared with subjects without preeclampsia, from 22 weeks gestation onward. In subjects who developed late-onset (34 weeks or later) preeclampsia, sFlt1 was significantly increased after 31 weeks' gestation. The sFlt1/PlGF ratio at 22-26 weeks was highly predictive of early-onset preeclampsia. The within-woman rate of change of the sFlt1/PlGF ratio was predictive of overall preeclampsia risk.

CONCLUSIONS: In high-risk women, serum sFlt1 and the sFlt1:PlGF ratio are altered prior to preeclampsia onset and may be predictive of preeclampsia. Larger studies are needed to confirm these findings.

Superiority of sonographic hematoma guided resection of mammogram only visible breast cancer: wire localization should be an exception--not the rule

Rakhshanda Layeequr Rahman et al. — Tue, 20 Apr 2010 11:41:00 PDT

BACKGROUND: The goal of breast conservation in cancer treatment is to obtain adequate margins with minimum tissue loss to achieve acceptable oncologic and cosmetic outcome. The standard for resection of breast cancers visible only on mammogram is wire localization (WL), which has a high rate of positive margins. We hypothesized that sonographic hematoma guided (SHG) resection achieves better margin clearance while minimizing volume of resection by more accurate lesion localization.

METHODS: This retrospective study was conducted at the University Comprehensive Breast Center. Consecutive patients over the span of one year, undergoing breast conservation for stereotactic biopsy proven cancers that were not visualized on ultrasound were studied. SHG and WL technique were compared for age, mammographic abnormality, and tumor characteristics. Outcome variables included closest margin of resection, volume of resection, resection index (resection volume/tumor volume), and rate of margin revision.

RESULTS: Forty-five patients had SHG, while 51 had WL lumpectomy. The SHG and WL groups were similar in age, mammographic abnormality, tumor type, and stage. Median (25th-75th centile) tumor size was larger in SHG group vs WL group [1.2 (1.1-1.3) vs 0.8 (0.4-1.4) cm; P = .009]. Median (25th-75th centile) closest margin in SHG vs WL group was 5.0 (5.0-8.0) vs 4.0 (1.0-10) mm [P = .0041]. Median (25th-75th centile) resection volume in SHG vs WL group was 85.0 (60.0-128.0) vs 142.2 (54.4-229.0) cm(3) [P = .0127]. Median (25th-75th centile) resection index in SHG vs WL group was 77.3 (59.3-285.7) vs 337.1 (88.9-3982.2) [P = .0004]. Margin was revised in 2 (4.4%) SHG vs 8 (15.7%) WL patients [P = .0978].

CONCLUSION: Sonographic hematoma guided lumpectomy is superior to wire localization in obtaining adequate margins with minimal volume of resection.

Characterizing daily urinary hormone profiles for women at midlife using functional data analysis

Peter M. Meyer et al. — Tue, 20 Apr 2010 11:40:59 PDT

The availability of daily hormone values for entire menstrual cycles offers an opportunity to apply new analytic techniques that confirm current knowledge and provide new insights into patterns of changing hormone profiles in women as they transition to the menopause. The Study of Women's Health Across the Nation (SWAN) collected urine samples during 1997-1999 from one menstrual cycle or up to 50 days from 848 women who live in seven cities across the United States. These samples were assayed for the urinary forms of estrogen, progesterone, follicle-stimulating hormone, and luteinizing hormone. The authors used functional data analysis to study variability in the hormone patterns of 572 of the 848 pre- and early-perimenopausal women with evidence of a luteal transition. Functional data analysis enabled the authors to identify asymmetries in women's hormone patterns related to cycle length that are not captured with single hormone value comparisons. Longer cycles were characterized by increasing dyssynchrony between follicle-stimulating hormone and luteinizing hormone in the luteal phase.

Vaginal pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines

Katharine K. O'Dell et al. — Tue, 20 Apr 2010 11:40:56 PDT

We recorded vaginal pressure in 12 women without risk factors for prolapse during two activity and exercise sessions, compared exercise and cough pressure, and evaluated method reproducibility and patterns of relative pressure. Portable urodynamic equipment, repeated measures descriptive design, and purposeful sampling were used with nonparametric analysis and visual comparison of pressure graphs. Mean participant age was 31.1 years (range 20-51), and mean body mass index was 22.7 (range 18.5-29.3). Mean pressures (in cm H(2)O): cough, 98.0 (48.0-133.7); standing, 24.0 (15.9-28.5); supine exercise, 34.0 (6.3-91.9); exercise machines, 37.0 (20.3-182.3). Repeated measures correlations for selected measures ranged from 0.66 (p

Sensitivity and specificity of recalled vasomotor symptoms in a multiethnic cohort

Sybil L. Crawford et al. — Tue, 20 Apr 2010 11:40:55 PDT

Many epidemiologic studies include symptom checklists assessing recall of symptoms over a specified time period. Little research exists regarding the congruence of short-term symptom recall with daily self-reporting. The authors assessed the sensitivity and specificity of retrospective reporting of vasomotor symptoms using data from 567 participants in the Study of Women's Health Across the Nation (1997-2002). Daily assessments were considered the "gold standard" for comparison with retrospective vasomotor symptom reporting. Logistic regression was used to identify predictors of sensitivity and specificity for retrospective reporting of any vasomotor symptoms versus none in the past 2 weeks. Sensitivity and specificity were relatively constant over a 3-year period. Sensitivity ranged from 78% to 84% and specificity from 85% to 89%. Sensitivity was lower among women with fewer symptomatic days in the daily assessments and higher among women reporting vasomotor symptoms in the daily assessment on the day of retrospective reporting. Specificity was negatively associated with general symptom awareness and past smoking and was positively associated with routine physical activity and Japanese ethnicity. Because many investigators rely on symptom recall, it is important to evaluate reporting accuracy, which was relatively high for vasomotor symptoms in this study. The approach presented here would be useful for examining other symptoms or behaviors.

"Persistence" improves the 60-day amenorrhea marker of entry to late-stage menopausal transition for women aged 40 to 44 years

John R. Taffe et al. — Tue, 20 Apr 2010 11:40:49 PDT

OBJECTIVE: The ReSTAGE collaboration evaluated four menstrual markers of entry to late-stage menopausal transition. The aim of this study was to assess the additional usefulness of "persistence" in relation to a clinically accessible menstrual marker of late menopausal transition, taking age into account.

METHODS: In this study, a secondary analysis of menstrual calendar data in two ReSTAGE-collaborating studies with comparatively low age at beginning of menstrual calendar observation was performed.

RESULTS: Sixty days of amenorrhea is as useful for predicting time to the final menstrual period as the currently accepted 90-day marker for women older than 45 years. For those aged between 40 and 44 years, recurrence of the 60-day marker within the next 10 cycles is a better indicator than a single occurrence of the 60-day marker or the 90-day marker.

CONCLUSIONS: Sixty-day amenorrhea is as reliable a marker of late menopausal transition as the traditional 90-day marker for women older than 45 years. For those aged 40 to 44 years, keeping menstrual records to check for a recurrence of the 60-day marker will be useful.

Longitudinal changes in hypothalamic and ovarian function in perimenopausal women with anovulatory cycles: relationship with vasomotor symptoms

Joan H. Skurnick et al. — Tue, 20 Apr 2010 11:40:42 PDT

OBJECTIVE: To determine whether the transition to menopausal status is unidirectional and predictable with aging.

DESIGN: Longitudinal evaluation of the menstrual cycle hormone patterns and experience of vasomotor symptoms in an anovulatory, perimenopausal cohort, during cycles that occurred 1 and 2 years after an anovulatory cycle.

SETTING: Academic center.

PATIENT(S): One hundred fifty-nine of 840 women in the Daily Hormone Study, a substudy of the Study of Women's Health across the Nation (SWAN), had anovulatory cycles. Their menstrual cycle patterns were previously described. This report describes their cycle patterns and vasomotor symptoms in the subsequent 2 years.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Daily urinary hormone levels of FSH, LH, and estrogen and P metabolites and reports of daily occurrence of vasomotor symptoms.

RESULT(S): While a tendency to develop cycles having a loss of negative feedback of estrogen on LH secretion was seen before menopause, there is no clear progression of cycle patterns in anovulatory women. Anovulation did not predict menopause within 2 years. Vasomotor symptoms occur before menopause, as experienced by 73% of the women. Vasomotor symptoms were not related to cycle pattern.

CONCLUSION(S): Any cycle pattern may be related to vasomotor symptoms. The best predictor of vasomotor symptoms is a prior history of vasomotor symptoms.

Survival analysis of 97 cats with nasal lymphoma: a multi-institutional retrospective study (1986-2006)

S.M. Haney et al. — Tue, 20 Apr 2010 11:40:40 PDT

BACKGROUND: Feline nasal lymphoma (NLSA) is a condition for which no standard of care exists.

HYPOTHESIS: There is no difference in survival times of cats with NLSA treated with single or multimodality therapy.

ANIMALS: Records from 97 cats diagnosed with NLSA were examined.

METHODS: The purpose of this retrospective study was to compare the survival times of cats with NLSA treated with radiation therapy (RT) alone, chemotherapy alone, or RT + chemotherapy and identify potential prognostic variables that affected survival. Cats were grouped according to therapy: RT + chemotherapy (n = 60), RT alone (n = 19), or chemotherapy alone (n = 18).

RESULTS: Survival was calculated with 2 methods. The 1st survival analysis (method A) included all cats, but counted only deaths caused by progressive NLSA. The median survival time (MST), regardless of therapy modality, was 536 days. The 2nd survival analysis (method B) also included all cats and counted all deaths, regardless of cause, as events. The overall MST calculated for all deaths was 172 days. A negative independent prognostic variable identified was anemia (P < .001), and positive independent prognostic variables were a complete response to therapy (P < .001) and total radiation dose >32 Gy (P= .03).

CONCLUSIONS AND CLINICAL IMPORTANCE: There were no significant differences in survival times among the 3 treatment groups but these results suggest that the addition of higher doses of RT to a cat's treatment protocol may control local disease and therefore influence survival.

Oestrogen metabolites in relation to isoprostanes as a measure of oxidative stress

Mary Fran R. Sowers et al. — Tue, 20 Apr 2010 11:40:38 PDT

OBJECTIVE: Oestradiol (E2) and its metabolites 2-hydroxyoestrone (2-OHE1) and 16alpha-hydroxyoestrone (16alpha-OHE1) are thought to curtail the greater oxidative stress found in the development and progression of disease conditions including atherosclerosis. We related oestrogen levels to F(2a)-isoprostane levels, a biomarker of oxidative stress.

DESIGN AND PARTICIPANTS: Data were obtained from 1647 women, aged 47-57 years, participating in the fifth annual follow-up of the Study of Women's Health Across the Nation (SWAN), a study of the menopausal transition.

MEASUREMENTS: Serum E2 and urinary 2-OHE1 and 16alpha-OHE1 concentrations were determined by enzyme-linked immunosorbent assay (ELISA) and urinary F(2a)-isoprostanes were measured by enzyme immunoassay (EIA).

RESULTS: F(2a)-isoprostane concentrations were elevated in women who smoked, a behaviour associated with increased oxidative stress, but not in stages of the natural menopause. Mean F(2a)-isoprostane concentrations among pre- and postmenopausal women who smoked were 1082 and 1064 pg/ml, respectively, values double those in pre- (343 pg/ml) and postmenopausal (379 pg/ml) nonsmoking women. 2-OHE1 and F(2a)-isoprostane concentrations were positively and highly correlated (partial correlations rho(Y|X) = 0.44 and rho(Y|X) = 0.43 in pre- and postmenopausal women, respectively). Similarly, 16alpha-OHE1 concentrations were positively and highly correlated with F(2a)-isoprostane concentrations (rho(Y|X) = 0.52 and rho(Y|X) = 0.59 in pre- and postmenopausal women, respectively). E2 was significantly correlated with F(2a)-isoprostanes only in postmenopausal women (rho(Y|X) = 0.20). Associations were adjusted for age, body mass index (BMI), race/ethnicity, lipids, physical activity level and alcohol consumption.

CONCLUSIONS: This study does not support the commonly held hypothesis that levels of endogenous E2 or its oestrone metabolites favourably modify oxidative stress by decreasing F2(a)-isoprostane levels.

SWAN: A Multicenter, Multiethnic, Community-Based Cohort Study of Women and the Menopausal Transition

Mary Fran R. Sowers et al. — Tue, 20 Apr 2010 11:40:37 PDT

Sowers M, Crawford S, Sternfeld B, Morganstein D, Gold E, Greendale G, Evans D, Neer R, Matthews K, Sherman S, Lo A, Weiss G, Kelsey J. SWAN: a multi-center, multi-ethnic, community-based cohort study of women and the menopausal transition. In: Menopause: Biology and Pathobiology, eds. RA Lobo, J Kelsey, R Marcus. San Diego: Academic Press, 2000, pp. 175-188. ISBN 0124537901, 9780124537903.

Recommendations from a multi-study evaluation of proposed criteria for staging reproductive aging

Sioban D. Harlow et al. — Tue, 20 Apr 2010 11:40:36 PDT

In 2001, the Stages of Reproductive Aging Workshop (STRAW) proposed bleeding and endocrine criteria for defining the early and late menopausal transition stages. Based on expert consensus, STRAW recommended a shorter interval of amenorrhea than the commonly used 90-day amenorrhea criteria for late transition and a >7-day change in cycle length for early transition. The ReSTAGE collaboration used prospective menstrual calendar data from four cohorts (TREMIN, Melbourne Women's Midlife Health Project, Seattle Midlife Women's Health Study, and Study of Women's Health Across the Nation) to quantitatively evaluate STRAW's recommendations. This empirical assessment supported the STRAW recommendations that (1) > or =60 days of amenorrhea be used to define the late menopausal transition and (2) that early transition is consistent with a persistent 7 or more day difference in length of consecutive cycles. Serum follicle stimulating hormone (FSH) values > or =40 IU/l was an independent marker of the transition and, when occurring together with a bleeding marker, increased prediction of final menstrual period. Such a FSH criterion could be incorporated into the STRAW paradigm to facilitate prediction of proximity of the final menstrual period.

Menopause: Recent Research Findings

Nancy E. Avis et al. — Tue, 20 Apr 2010 11:40:35 PDT

Avis N, Crawford S. Menopause: Recent research findings. In: The Baby Boomers Grow Up: Contemporary Perspectives on Midlife, Whitbourne S, Willis S, eds. Mahwah, NJ: Lawrence Erlbaum, 2006, p. 75-108. ISBN 0805848762, 9780805848762.

Limited preview available via Google Book Search.