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Featuring the Academy of Women’s Health President and Journal of Women’s Health Editor Dr. Susan Kornstein who is joined by Dr. Janine Austin Clayton, NIH Associate Director for Research on Women’s Health and Dr. George A. Mensah, Director, Center for Translation Research and Implementation Science at the NIH National Heart, Lung, and Blood Institute to discuss women of color and their unique health needs. Women of color are not a singular group, as health is determined by a wide range of factors including biology, genetics, culture, behavior, and access to care. The discussion also describes how the Women of Color Health Databook, 4th Edition, can assist clinicians in providing person-centered care for diverse populations of women.
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Professor Nanette Santoro is this year’s winner of the Journal of Women’s Health Award for Outstanding Achievement in Women’s Health Research. She has been an active clinician and researcher in Reproductive Endocrinology since 1983 and is currently Chair of the Department of Obstetrics and Gynecology at the University of Colorado, Denver. She is the author of more than 260 scientific publications plus she is a co-editor of the Textbook of Perimenopausal Gynecology and Amenorrhea: A Clinician’s Guide, as well as two new textbooks that will be released in 2015.
Editor: The Study of Women’s Health Across the Nation (SWAN) has played an important part in your career. What’s the story behind your involvement with SWAN?
Dr. Santoro: At the time that SWAN was started in 1994, I was looking at how hormone levels change across the menopause. I still remember the day back then when my technician brought in some crazy-looking, totally unexpected hormone patterns. Up until that day, we all expected that menopause meant a gradual decrease in hormones, sort of like Whistler’s mother sitting in a rocking chair, quietly waiting as the reproductive hormones would slowly fade away. However, the technician’s results were showing such dramatic fluctuations in the hormone pattern that I asked her to repeat the assays. The results held up: hormones don’t follow a gradual downhill pattern. I wanted to take a closer look at all of this, including the health factors that interact with menopause and how they may influence health later. I also wanted to look at how we could use this knowledge to avert problems later in life. At just this time, NIH was starting SWAN, one of the first cohort studies out there looking specifically at this menopause transition stage of life, and asking the same sorts of questions. I applied to be a part of it. SWAN began with a cohort of about 3000 women from five ethnic groups, and remarkably, we still have 2200 of the original participants.
Editor: What are some of the things we’ve learned from SWAN?
Dr. Santoro: SWAN has published over 250 manuscripts and presented at over 290 scientific meetings. One of the many things we’ve learned is that with menopause, the time when most of the action takes place is during the late transition period, that is, when it’s been 60 or more days since a woman’s last period. Her symptoms increase, the arteries in her neck start to thicken, there’s an increase in coronary calcium, and there are temporary deficits in short-term memory. These all seem to be linked to hormones, whether it’s because her estrogen is low, or because her estrogen levels are rapidly going up and down.
Another one of the many things we’ve learned is that obese women have lower hormone production, which in turn affects fertility (this latter observation is based on subsequent studies apart from SWAN). These women may have the same 28-day cycles as other women, but their progesterone levels get lower every year. They are also more likely to have bleeding abnormalities as they go through menopause.
Something else that’s important, we now have very sensitive ways of measuring the hormones that give insight on how many eggs a woman has left in her ovaries. With this tool, we will be better able to predict when a woman will enter menopause and when her symptoms will end.
Editor: In addition to the research side of women’s health, you’re also interested in the political side. Explain, please.
Dr. Santoro: Historically, women’s health has been politicized on many fronts. For example, hormone therapy was promulgated to keep women young forever, but it wasn’t driven by data. The idea of keeping women ‘feminine forever’ was driven by social mores, but it doesn’t really make sense. After all, how can you not be feminine, if you’re a girl? Even today, reproductive rights are profoundly politicized. Take the debates on egg donation and the age at which it’s appropriate for a woman to make use of this technology. You see people responding with profound disgust when an older woman uses this technology, with people saying, “How dare she do that!” Yet when we look at the actual data, the physical burden of pregnancy for an older women isn’t that great. Trying to reject these technologies because of the ‘ee-yew’ factor is not a good enough reason. There are also huge political forces influencing what medical procedures unique to women that their medical insurance will pay for.
Editor: Do you have advice for a beginning researcher in the field of women’s health?
Dr. Santoro: Choose a field that is interdisciplinary. This will help not only for getting results, but also for getting funding.
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Journal of Women's Health, published by Mary Ann Liebert, Inc., is the Official Journal of the Academy of Women's Health. On the forefront of women’s health policy and research, the Journal delivers cutting-edge advancements and clinical applications of new diagnostic procedures, therapeutic protocols for the management of diseases, and innovative research in gender-based biology that impacts diagnosis and therapy. This peer-reviewed journal is published monthly and indexed in MEDLINE, Current Contents, and all key indexing services.