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Health Information SWAN Study at Rush

Menopause and various treatments to relieve its symptoms have been the subjects of many research studies, the findings of which can be confusing. As one of seven designated research centers for the Study of Women’s Health Across the Nation (SWAN) and one of 40 U.S. centers involved in the Women’s Health Initiative (WHI). Rush is dedicated to helping increase knowledge about the special health concerns of women during their menopausal transition years and in doing so clarifying some of the confusion.

What is menopause?
When a woman permanently stops having menstrual periods, she has reached the stage of life called menopausal or post-menopausal. The menopausal transition is said to be complete when menstrual periods have ceased for one continuous year.

The transition from pre-menopausal to post-menopausal is referred to as perimenopause. During this transition, the supply of mature eggs in a woman’s ovaries diminishes and ovulation becomes irregular. At the same time, the production of estrogen and progesterone decreases. It is the enormous drop in estrogen levels that causes most of the symptoms commonly associated with menopause.

When does the menopausal transition begin?
The menopausal transition generally takes about four years with the average age of menopause or postmenopause being about 51years. There is considerable variability, however, across women in when it starts, stops and its duration, with some women starting as early as age 40 and others starting as late as age 55.

Women who smoke and are underweight tend to experience an earlier menopause, while women who are overweight often experience a later menopause. Generally, a woman tends to experience menopause at about the same age as her mother did.

What are the symptoms of menopause?
Hot flashes, vaginal dryness, relaxation of the pelvic muscles, a change in hair growth and insomnia are common symptoms.

How can the symptoms of menopause be treated?
Specific treatment for menopausal symptoms will best be determined by your physician based on:

  • Your age, overall health and medical history
  • Current symptoms
  • Your tolerance for specific medications, procedures or therapies
  • Your opinion or preference

For some women, hormone replacement therapy or estrogen replacement therapy are recommended. Although menopausal hormone therapy was once believed to help ward off heart disease, osteoporosis and cancer, 2002 research findings from the Women’s Health Initiative showed this was not the case.

The study showed that estrogen plus progestin significantly increased the risk of invasive breast cancer and blood clots in the legs and lungs and did not protect women from heart disease and stroke. In fact, the study showed that women taking this drug had a higher risk of heart attack and stroke.

For information about hormone therapy and menopause, read Facts About Menopause and Hormone Therapy by the U.S. Department of Health and Human Services. Other women choose alternatives to hormone therapy, such as over-the-counter lubricants for vaginal dryness, antidepressants for hot flashes, and physical activity to help manage mood swings and prevent insomnia. Some suggest soybeans and soy-based products because they contain phytotestrogens; however, there is no solid evidence that the phytoestrogens found in soybeans, soy-based foods, other plant sources or dietary supplements relieve hot flashes.

More information about alternatives, can be found in Facts About Menopause and Hormone Therapy by the U.S. Department of Health and Human Services. This also includes information about dietary supplements, which are often sold without the review or approval of the FDA and should be used with caution.

About SWAN at Rush
The Study of Women’s Health Across the Nation (SWAN) was designed to examine women’s health during their middle years. The study examines the physical, biological, psychological and social changes during this transitional period. The goal of SWAN’s research is to help scientists, health care providers and women learn how mid-life experiences affect health and quality of life during aging. The study involves a large number of African-American, Caucasian, Chinese, Hispanic and Japanese women. Because the women were recruited from community samples, not clinic samples, all socioeconomic groups are represented.

The Rush site of the SWAN study is called the Women in the Southside Health Project (WISH), is located on Chicago’s south side, and involves three Chicago community areas: Beverly, Morgan Park and Washington Heights.

Led by Lynda H. Powell, PhD, SWAN researchers at Rush recently found that an increase in the ratio of testosterone to estrogen during the “transitional years” is related to an increase in cardiovascular disease in women. Unlike men in whom the narrowing of coronary arteries occurs gradually over adulthood, women’s arteries don’t narrow ? or occlude - until they hit their menopausal years. And by the time they’re in their 60s, their arteries are just as occluded as men’s arteries. 

These findings highlight why it’s important for women to practice healthful lifestyle habits and maintain their health by visiting their primary care physicians regularly, especially during the critical menopausal years. Exercise and well-balanceddiets are important. The American Heart Association makes the following dietary recommendations:

  • Eat a variety of fruits and vegetables. Choose 5 or more servings per day.
  • Eat a variety of grain products, including whole grains. Choose 6 or more servings per day.
  • Include fat-free and low-fat milk products, fish, legumes (beans), skinless poultry and lean meats.
  • Choose fats and oils with 2 grams or less saturated fat per tablespoon, such as liquid and tub margarines, canola oil and olive oil.
  • Balance the number of calories you eat with the number you use each day. (To find that number, multiply the number of pounds you weigh now by 15 calories. This represents the average number of calories used in one day if you’re moderately active. If you get very little exercise, multiply your weight by 13 instead of 15. Less-active people burn fewer calories.)
  • Maintain a level of physical activity that keeps you fit and matches the number of calories you eat. Walk or do other activities for at least 30 minutes on most days. To lose weight, do enough activity to use up more calories than you eat every day.
  • Limit your intake of foods high in calories or low in nutrition, including foods like soft drinks and candy that have a lot of sugar.
  • Limit foods high in saturated fat, trans fat and/or cholesterol, such as full-fat milk products, fatty meats, tropical oils, partially hydrogenated vegetable oils and egg yolks. Instead choose foods low in saturated fat, trans fat and cholesterol from the first four points above.
  • Eat less than 6 grams of salt (sodium chloride) per day (2,400 milligrams of sodium).
  • Enjoy no more than 1-2 alcoholic drinks per day, preferably wine.

The AHA also provide exercise tips to help combat cardiovascular disease.

About the Women’s Health Initiative

The National Institutes of Health (NIH) established the Women’s Health Initiative (WHI) in 1991 to address the most common causes of death, disability and impaired quality of life in postmenopausal women. The WHI examined risk factors for cardiovascular disease, cancer, and osteoporosis. The WHI was a 15 year multi-million dollar effort, and one of the largest U.S. prevention studies of its kind. Rush is one of 40 centers involved in this study and is led at Rush by Henry Black, MD; Lynda Powell, PhD, and Ellen Mason, MD, are co-principal investigators.

The clinical trials were designed to test the effects of postmenopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer.

Recently, the WHI released findings on the effects of calcium and vitamin D on the health of postmenopausal women. The use of these supplements for an average of 7 years was shown to slow down the loss of bone density and may help protect against hip fractures. It was also shown that, in the dosage used for this study and for 7 years of duration, the use of these supplements did not prevent colorectal cancer in healthy postmenopausal women.

More about WHI and its findings can be found at the WHI Web site.


Women’s Health Services at
Rush University Medical Center in Chicago

Rush University Medical Center offers comprehensive health care services for women of all ages.

At Rush University Medical Center in Chicago, medical science blends with a sincere commitment to provide women with the absolute finest, most compassionate care. Specialists and subspecialists work together to address the special needs of women, from common to complex to the everyday needs of women and their families. We offer direct access to the latest innovations and options — from prenatal care for high risk pregnancies, to diagnosis and treatment of a wide range of abdominal and pelvic disorders, to leading-edge research.

For more information about health services and medical care for women at Rush visit the Women’s Health Services home page.

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