Memory functioning among midlife women: observations from the Seattle Midlife Women's Health Study

OBJECTIVE

As the number of midlife women increases, there is an increased interest in women's experiences of the perimenopause. Because of the evidence linking estrogen with cholinergic and serotonergic activity in the brain and with central nervous system development of dendritic arborization, and mixed evidence of estrogen use with incidence of Alzheimer's disease, the effects of the perimenopause on memory functioning are of interest. The purpose of these analyses, part of the Seattle Midlife Women's Health Study, was to describe changes in women's perceived memory functioning according to their perimenopausal group, age, perceived stress, health status, and mood.

DESIGN

Memory functioning was assessed with the Memory Functioning Questionnaire as part of a questionnaire mailed to study participants annually. Perimenopausal group was assessed using Mitchell's rating schema.

RESULTS

Age was unrelated to any of the Memory Functioning Questionnaire indicators except for retrospective memory; younger women reported more memory problems than older women. Perimenopausal groups were unrelated to most memory functioning ratings with few exceptions. Memory functioning ratings of current memory compared with the past were worse for women who were in early and middle transition and for those who were using hormone therapy than for those who were in late transition and postmenopause. Women reported more current memory problems compared with 10 and 20 years ago and at age 18. Health ratings were negatively correlated with memory functioning ratings, and depressed mood positively correlated with nearly every indicator of memory functioning (frequency of memory problems, ratings of current memory, past memory, and memory change). Greater perceived stress levels were associated with more memory problems.

CONCLUSIONS

Perceived memory functioning seems more closely related to perceived health, depressed mood, and perceived stress than to perimenopausal stage or age. Further work is needed to determine whether these ratings provided by the Seattle cohort will change over time as women age and as they make the transition to menopause and beyond.

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.

A hepatic lipase gene promoter polymorphism attenuates the increase in hepatic lipase activity with increasing intra-abdominal fat in women

High hepatic lipase (HL) activity is associated with an atherogenic lipoprotein profile of small, dense LDL particles and lower HDL(2)-C. Intra-abdominal fat (IAF) is positively associated with HL activity. A hepatic lipase gene (LIPC) promoter variant (G-->A(-250)) is associated with lower HL activity, higher HDL(2)-C, and less dense LDL particles. To determine whether the LIPC promoter polymorphism acts independently of IAF to regulate HL, 57 healthy, premenopausal women were studied. The LIPC promoter A allele was associated with significantly lower HL activity (GA/AA=104+/-34 versus GG=145+/-57 nmoles x mL(-1) x min(-1), P=0.009). IAF was positively correlated with HL activity (r=0.431, P<0.001). Multivariate analysis revealed a strong relationship between both the LIPC promoter genotype (P=0. 001) and IAF (P<0.001) with HL activity. The relationship between IAF and HL activity for carriers and noncarriers of the A allele was curvilinear with the carriers having a lower apparent maximum level of plasma HL activity compared with noncarriers (138 versus 218 nmoles x mL(-1) x min(-1), P<0.001). In addition, the LIPC A allele was associated with a significantly higher HDL(2)-C (GA/AA=16+/-7 versus GG=11+/-5 mg/dL, P=0.003). We conclude that the LIPC promoter A allele attenuates the increase in HL activity due to IAF in premenopausal women.

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.

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.

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.

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.

Women's images of midlife: observations from the Seattle Midlife Women's Health Study

Our purpose in conducting this study was to determine how a cohort of women born between 1935 and 1955 defined midlife, and what midlife events they viewed as important, distressing, and satisfying. A random sample of women enrolled in the Seattle Midlife Women's Health Study (n = 131) participated in a telephone interview about the meaning of midlife and important events occurring during the past year. They described midlife similarly to women from earlier birth cohorts with one important exception: the centrality of work and personal achievements in their lives. Contemporary midlife women's views of midlife reflect their roles in society.

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.

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.

Symptom experiences of midlife women: observations from the Seattle Midlife Women's Health Study

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.

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.

Social pathways to premenstrual symptoms

The purpose of this study was to explore feminine and menstrual socialization, expectations about experiencing symptoms, and the stressful nature of women's lives among women with three perimenstrual symptom patterns. Social learning and stress theory provided a theoretical framework for understanding why some menstruating women experience premenstrual syndrome or premenstrual magnification symptom patterns. Data about socialization, stressful life context, expectations about symptoms, depressed mood, and other health-related and demographic indicators were obtained from an interview. Subsequent daily recordings in a health diary for two or more menstrual cycles provided data with which to classify women's symptoms across the menstrual cycle as a low severity symptom (LS, n = 73), premenstrual syndrome (PMS, n = 36), or premenstrual magnification (PMM, n = 62) pattern. Stepwise discriminant function analysis demonstrated that stressful life context, menstrual socialization, and expectations about symptoms related to menstruation differentiated women with an LS from those with a PMS or PMM symptom pattern. In addition, depressed mood differentiated the three groups.

Fatigue as a response to environmental demands in women's lives

Fatigue is a significant health care problem of interest to professionals in many disciplines. Yet, it is poorly understood. Fatigue, as an indicator of adaptation, is examined in relationship to internal and external environmental demands in women's lives. From a secondary analysis of data collected from a large group of women in a Northwest urban community in the U.S., it was found that internal demands such as depression or anxiety are more significantly related to fatigue and vitality than external demands such as negative life events or employment status.

Arousal and stress response across the menstrual cycle in women with three perimenstrual symptom patterns

The purpose of this study was to compare arousal levels and stress response across menstrual cycle phases in women with three perimenstrual symptom patterns. Women with low symptom severity (LS, N = 28), were compared with those with a premenstrual syndrome (PMS, N = 15) and premenstrual magnification (PMM, N = 19) pattern across postmenses and premenses phases. Each woman was assessed during relaxation and in response to mental task and symptom imaging stressors during a postmenses and premenses day. Results of baseline skin conductance (SCL), electromyogram (EMG), and finger temperature (T) demonstrated arousal premenses in women with the PMS pattern, but not in women with the LS pattern. In addition, women with the PMS pattern experienced increased EMG and SCL response to stressors premenses. Women with the PMM pattern experienced a rise in finger temperature premenses, opposite the pattern of the women with LS or PMS. These results support development of symptom management strategies to reduce arousal and modulate stress response for women with PMS who seek help for their symptoms. In addition, the difference in arousal and stress response observed in women with PMS and PMM support development of different symptom management strategies for these two groups of women.

Differentiation of women with three perimenstrual symptom patterns

The purpose of this study was to differentiate women with three perimenstrual symptom severity patterns: premenstrual syndrome (PMS), premenstrual magnification (PMM), and low symptom (LS). Factors entered into the discriminant functions included social demands, personal resources, socialization, parity, age, personal health practices, and psychological distress. A community-based sample of 142 women taking no oral contraceptives was classified into one of the three symptom severity patterns. Three two-way discriminant analyses were performed. Women with PMS had more psychological distress, more education, and a mother with more premenstrual symptoms than those with an LS pattern. Women with PMM had more psychological distress and a mother with more premenstrual symptoms, but they also had more stress and were younger than those with an LS pattern. Finally, the women with PMS, when compared to the PMM subgroup, were older, had more education, engaged in more positive health practices, and had more nontraditional attitudes toward women. In addition, the women with PMM had more stress in their lives than women with PMS.

Effect of meclofenamic acid on the response of parasite-naive lambs and adult sheep to Ostertagia circumcincta

Meclofenamic acid was used to inhibit prostaglandin synthesis in lambs challenged with Ostertagia circumcincta. It lowered the number of parasites which established in treated animals but not significantly. In treated animals plasma pepsinogen values were elevated at the time of parasite emergence but had dropped below the values achieved in control lambs towards the end of the experiment when parasites were at the adult, lumenal dwelling stage. Meclofenamic acid administered to adult immune ewes during challenge with third stage O circumcincta larvae did not significantly affect the establishment of the parasites, nor did it affect the rise in pepsinogen concentration associated with the challenge.

Self-confidence as a critical factor in breast self-examination

This study was conducted to determine predictors of breast self-examination (BSE) frequency. One hundred ninety-one women completed questionnaires about their personal experiences with BSE, their risk factors, and their perceived risks of breast cancer. Satisfaction with BSE ability and explanation of BSE technique significantly predicted frequency of BSE. Perceived risk, history of breast cancer, BSE demonstration, and a BSE handout did not affect BSE frequency. Of the five BSE teaching variables, only explanation of technique significantly predicted BSE satisfaction. Clinicians can promote BSE frequency by helping women feel confident about their abilities to perform BSE.

Changes in survival after transient ischemic attacks: observations comparing the 1970s and 1980s

We compared survival following transient ischemic attack (TIA) in 2 prospective cohorts of TIA patients admitted to Wake Forest University Medical Center. The 1st consisted of 177 patients admitted between 1961 and 1973, and the 2nd of 185 patients admitted between 1980 and 1983. Patients in the 2nd cohort had significantly greater longevity than patients in the 1st cohort, both univariately and after adjustment for cerebrovascular risk factors. The adjusted 1-year survival estimate increased from 91% in the 1st cohort to 98% in the 2nd, and the adjusted 3-year survival estimate increased from 83% in the 1st to 94% in the 2nd. The underlying causes for this dramatic improvement in survival may include early identification and aggressive management of TIAs or coexisting diseases, improved management of subsequent completed strokes or myocardial infarctions, or unadjusted differences in these cohorts. The data imply that reports of TIA survival from different periods may not be comparable.

Level of benzimidazole resistance in a strain of Ostertagia circumcincta studied over several infections in lambs

A benzimidazole-resistant strain of Ostertagia circumcincta (HFRO) was used experimentally to infect lambs. The level of resistance, measured by an egg hatch assay, was studied throughout each infection and also after treatment of the lambs with fenbendazole. The HFRO strain was highly resistant to benzimidazoles. There was day-to-day variation in the level of resistance throughout a single infection with a high level of resistance in the early part of the infection, around Day 27 post-inoculation of infective larvae, falling to a lower level later in the infection. Egg hatch assays on the 3 days immediately post-treatment with fenbendazole showed the resistance level was high then resistance fell to the pre-treatment level after 7 days. Selection for benzimidazole resistance using fenbendazole treatment at the normal dose rate of 5 mg kg-1 over five passages of the HFRO strain in lambs failed to increase the resistance level. Storage of larvae over a 5-month period at 4 degrees C, prior to infection of lambs, did not produce any alteration in the resistance level. The possible reasons for the variations in resistance found with the HFRO strain are discussed along with the implications for sheep parasite control and further development of benzimidazole resistance.

Medical student distress. A longitudinal study

This longitudinal study investigated the relative importance of correlates of psychological distress in first year medical students (N = 312) in September and May. Anxiety levels were one SD above the mean when compared with nonpatient levels in both September and May, and the percentage of students reporting depression doubled over the study period. Problem-focused coping decreased, emotion-focused coping increased, and satisfaction with social supports decreased over the year. In contrast, type A behavior and anger expression were more stable. Students distressed in September were at higher risk for distress in May. Students distressed in May were also characterized by higher scores for suppressed anger and type A behavior in May, even after controlling for distress in September.

Being healthy: women's images

Although the concept of health is central to nursing practice and science, measurement of the concept has lagged far behind theory development. The study presented extends Laffrey's earlier work by describing the meaning of health for a population of women representing multiple ethnic groups residing in the Pacific Northwest. A sample of 528 women from a cross-section of a community who had participated in a study of women's health was asked to respond to the question, "What does being healthy mean to you?" In addition to evidence of the clinical, role performance, and adaptive models of health, the women's responses yielded nine dimensions consistent with the eudaemonistic model. Each dimension included multiple descriptors identified through content analysis of the women's verbatim responses. The women's images of health were consistent with Smith's and Laffrey's four conceptions, but the eudaemonistic category included multiple dimensions. The women reported images of health consistent with contemporary nursing theorists' views. Moreover, their emphasis on eudaemonistic images crossed all categories of age, education, income, ethnicity, and employment status.

A biopsychosocial model of medical student distress

Medical student distress was examined in two consecutive first-year classes (N = 312) in September, before they interacted with the school regimen, and again in May before exams. Anxiety means were one SD above the normative mean for nonpatients at both times. The number of students reporting a significant level of depression doubled from September (N = 36) to May (N = 78). The correlation of distress in September and May was .40, indicating that for many students distress was enduring. A biopsychosocial model of initial distress explained more variance (36%) in the cross-validation sample than did any one variable alone. Distressed students had higher Type A scores. Also, anger held in was a risk factor for distress in students with a family history of cardiovascular disease (CVD). Students who hold anger in may experience prolonged stress which, coupled with a family history of CVD, could make them psychobiologically vulnerable to distress.