Vasomotor symptoms and the risk of incident venous thrombosis in postmenopausal women

Essentials Vasomotor symptoms have been proposed as markers of changing cardiovascular risk. In this cohort study, we evaluated these symptoms as markers of venous thrombosis (VT) risk. We found no evidence that vasomotor symptom presence or severity were associated with VT risk. Among these postmenopausal women, vasomotor symptoms are not a useful marker of VT risk.

SUMMARY

Background Vasomotor symptoms may be markers of changes in cardiovascular risk, but it is unknown whether these symptoms are associated with the risk of venous thrombosis (VT). Objective To evaluate the association of vasomotor symptom presence and severity with incident VT risk among postmenopausal women, independent of potential explanatory variables. Methods This cohort study included participants of the Women's Health Initiative (WHI) Hormone Therapy Trials (n = 24 508) and Observational Study (n = 87 783), analyzed separately. At baseline, women reported whether hot flashes or night sweats were present and, if so, their severity. Using Cox proportional hazards models, we estimated the VT risk associated with vasomotor symptom presence and severity, adjusted for potential explanatory variables: age, body mass index, smoking status, race/ethnicity, and time-varying current hormone therapy use. Results At baseline, WHI Hormone Therapy Trial participants were aged 64 years and WHI Observational Study participants were aged 63 years, on average. In the WHI Hormone Therapy Trials over a median of 8.2 years of follow-up, 522 women experienced a VT event. In the WHI Observational Study, over 7.9 years of follow-up, 1103 women experienced a VT event. In adjusted analyses, we found no evidence of an association between vasomotor symptom presence (hazard ratio [HR]adj  0.91, 95% confidence interval [CI] 0.75-1.1 in the WHI Hormone Therapy Trials; HRadj  1.1, 95% CI 0.99-1.3 in the WHI Observational Study) or severity (HRadj for severe versus mild 0.99, 95% CI 0.53-1.9 in the WHI Hormone Therapy Trials; HRadj  1.3, 95% CI 0.89-2.0) in the WHI Observational Study) and the risk of incident VT. Conclusions Although vasomotor symptoms have been associated with the risk of other cardiovascular events in published studies, our findings do not suggest that vasomotor symptoms constitute a marker of VT risk.

Daily salivary cortisol patterns in midlife women with hot flashes

OBJECTIVE

Diurnal salivary cortisol patterns in healthy adults are well established but have not been studied in midlife women with hot flashes. We hypothesized that frequent hot flashes are associated with aberrant cortisol patterns similar to sleep-deficient individuals.

DESIGN

Cross-sectional.

PARTICIPANTS

A total of 306 women, ages 40-62, randomized to a behavioural intervention for hot flashes.

MEASUREMENTS

Baseline comparisons of cortisol geometric means (nmol/l) from four daily time points averaged over two consecutive days plus other calculated cortisol measures were made between groups defined by baseline: (i) mean daily hot flash frequency tertile (≤5·5, N = 103; >5·5-8·8, N = 103; >8·8, N = 100) and (ii) selected characteristics. Repeated-measures linear regression models of log-transformed cortisol evaluated group differences, adjusting for covariates.

RESULTS

Women were 67% White and 24% African American, with 7·6 (SD 3·9) hot flashes per day. Salivary cortisol geometric means (nmol/l) among all women were as follows: 75·0 (SD 44·8) total, 8·6 (SD 5·6) wake, 10·0 (SD 7·5) wake +30 min, 3·7 (SD 3·3) early afternoon and 1·6 (SD 1·8) bedtime. Wake + 30-minute values showed an 18% median rise from wake values (interquartile range -24 to 96%), and means varied by hot flash frequency tertile, from lowest to highest: 11·4(SD 7·3), 10·3 (SD 6·5) and 8·6 (SD 7·8), respectively, P = 0·003. Beside the early afternoon value (P = 0·02), cortisol values did not vary by hot flash frequency.

CONCLUSION

Taken together, these findings suggest that high frequency of moderate-to-severe hot flashes may be associated with subtle abnormalities in cortisol concentrations - a pattern consistent with chronic sleep disturbance.

MsFLASH participants' priorities for alleviating menopausal symptoms

OBJECTIVE

To describe self-reported menopausal symptom priorities and their association with demographics and other symptoms among participants in an intervention trial for vasomotor symptoms (VMS).

METHODS

Cross-sectional study embedded in the MsFLASH 02 trial, a three-by-two factorial design of yoga vs. exercise vs. usual activity and omega-3-fatty acid vs. placebo. At baseline, women (n = 354) completed hot flush diaries, a card sort task to prioritize symptoms they would most like to alleviate, and standardized questionnaires.

RESULTS

The most common symptom priorities were: VMS (n = 322), sleep (n = 191), concentration (n = 140), and fatigue (n = 116). In multivariate models, women who chose VMS as their top priority symptom (n = 210) reported significantly greater VMS severity (p = 0.004) and never smoking (p = 0.012), and women who chose sleep as their top priority symptom (n = 100) were more educated (p ≤ 0.001) and had worse sleep quality (p < 0.001). ROC curves identified sleep scale scores that were highly predictive of ranking sleep as a top priority symptom.

CONCLUSIONS

Among women entering an intervention trial for VMS and with relatively low prevalence of depression and anxiety, VMS was the priority symptom for treatment. A card sort may be a valid tool for quickly assessing symptom priorities in clinical practice and research.

Hot flush severity during the menopausal transition and early postmenopause: beyond hormones

BACKGROUND

Understanding factors promoting symptom severity is essential to developing innovative symptom management models.

AIM

To investigate hot flush severity during the menopausal transition (MT) and early postmenopause and effects of age, MT stages, age of onset of late stage and final menstrual period (FMP), estrogen, follicle stimulating hormone (FSH), cortisol, anxiety, perceived stress, body mass index, smoking, alcohol use and exercise.

METHODS

A subset of participants in the Seattle Midlife Women's Health Study (n = 291 with up to 6973 observations) provided data during the late reproductive, early and late MT stages and early postmenopause, including menstrual calendars, annual health questionnaires, and symptom diaries and urine specimens assayed for hormones several times per year. Multilevel modeling with an R program was used to test models accounting for hot flush severity.

RESULTS

Hot flush severity persisted through the MT stages and peaked during the late MT stage, diminishing after the second year postmenopause. In individual analyses, hot flush severity was associated with being older, being in the late MT stage or early postmenopause, beginning the late MT stage at a younger age and reporting greater anxiety. In a model including only endocrine factors, hot flush severity was significantly associated with higher FSH and lower estrone levels. An integrated model revealed dominant effects of late MT stage and early postmenopause, with anxiety contributing to hot flush severity.

CONCLUSIONS AND IMPLICATIONS

Hot flush severity was affected largely by reproductive aging and anxiety, suggesting symptom management models that modulate anxiety and enhance women's experience of the menopausal transition and early postmenopause.

Effects of herbal preparations on symptom clusters during the menopausal transition

AIMS

To determine the effects of herbal therapies on hot flushes and at least one other symptom including, sleep, mood, cognition, and pain that women experience during the menopausal transition and early postmenopause.

METHODS

An extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized, controlled trials reported in English between January 2004 and July was conducted by an experienced reference librarian. There were 1193 abstracts identified but only 58 trials examined effectiveness of therapies for hot flushes and at least one additional co-occurring symptom.

RESULTS

Seventeen studies used herbal preparation including seven studies of black cohosh, two studies of black cohosh mixed with other herbals, and eight studies of other herbals. Of these, one study of black cohosh, two studies of black cohosh mixed with other herbals, and four other herbal studies had significant effects on hot flushes and at least one additional co-occurring symptom. The adverse events of herbal therapies were various, ranging from mild to moderate and women were generally tolerant of the preparations.

CONCLUSIONS

Black cohosh mixed with other herbals, Rheum rhaponticum, and French maritime pine bark had significant effects on hot flushes and at least one other symptom. These herbal therapies may be a promising alternative treatment to hormonal treatment. Future studies should classify women based on their menopausal stages, report each symptom separately, have adequate sample size, focus on multiple co-occurring symptoms, and target symptom management of menopausal symptoms.

Effects of mind-body therapies on symptom clusters during the menopausal transition

AIMS

Although most women experience symptom clusters during the menopausal transition and early postmenopause, investigators reporting clinical trial effects for hot flushes often omit co-occurring symptoms. Our aim was to review controlled clinical trials of mind-body therapies for hot flushes and at least one other co-occurring symptom from these groups: sleep, cognitive function, mood, and pain.

METHODS

An experienced reference librarian performed an extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized controlled trials reported in English between 2004 and July 2011. Of 1193 abstracts identified, 58 trials examining effectiveness of therapies for hot flushes and at least one additional co-occurring symptom of interest were identified.

RESULTS

Eight trials (ten publications) examined relaxation, yoga, or exercise. Physical activity/exercise trials (six) yielded mixed results; only one significantly reduced hot flushes and mood symptoms. Of two relaxation therapy trials, only mindfulness-based stress reduction training reduced sleep and mood symptoms and had within-group treatment effects on hot flushes. Yoga (one trial) significantly reduced hot flushes and improved cognitive symptoms more than exercise, and also had within-group effects on sleep and pain symptoms.

CONCLUSIONS

Studies of mind-body therapies for hot flushes increasingly measure multiple symptom outcomes, but few report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies. Future studies need to measure and report results for individual symptoms or group like symptoms together into subscales rather than use subscales with mixed dimensions. Trials with larger numbers of participants are essential to allow evaluation of these therapies on multiple co-occurring symptoms.

Correlates of urinary incontinence during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study

BACKGROUND

Urinary incontinence (UI) becomes more prevalent as women age, but little is known about UI in midlife, including stress incontinence (SUI) and urge incontinence (UUI) and their relationship to reproductive aging, reproductive history, health-related factors, and personal and social factors associated with midlife.

OBJECTIVES

To determine the influence of age and reproductive aging factors (menopausal transition stages, follicle stimulating hormone (FSH), estrone glucoronide), reproductive history (number of live births), health-related factors (perceived health, body mass index (BMI), exercise, diabetes) and personal and social factors (race/ethnicity, education) on the experience of UI among midlife women during the menopausal transition and early postmenopause.

METHODS

A subset of the Seattle Midlife Women's Health Study participants (n = 298 with up to 2249 observations) provided data during the late reproductive, early and late menopausal transition stages and early postmenopause, including menstrual calendars, annual health questionnaire and provided health diaries since 1990. Generalized estimating equation analysis was used to test models accounting for SUI and UUI that included age as a measure of time with predictors.

RESULTS

Stress urinary incontinence was associated significantly with individual predictors of: worse perceived health (odds ratio (OR) 0.89, p = 0.025), history of ≥ three live births (OR 3.00, p = 0.002), being in the early menopausal transition stage (OR 1.53, p = 0.06), having less formal education (OR 0.33, p = 0.02), and being White/not Black (OR 0.32, p = 0.04). The most parsimonious model for SUI included: worse perceived health, ≥ three live births, and being White. Urge incontinence was associated significantly with individual predictors of: increasing age (OR 1.06, p = 0.001), worse perceived health (OR 0.78, p < 0.001), BMI ≥ 30 kg/m(2) (OR 2.96, p = 0.001), history of ≥ three live births (OR 2.81, p = 0.01), and lower FSH levels (OR 0.59, p = 0.08). The most parsimonious model for UUI included: being older, having worse perceived health, and having a high BMI.

CONCLUSIONS

SUI risk was a function of reproductive history, poor health, and being White. UUI risk was a function of aging, having worse health, and higher BMI. Further exploration of UI during the menopausal transition is needed to articulate a lifespan view of UI and its typology.

Identifying symptom clusters during the menopausal transition: observations from the Seattle Midlife Women's Health Study

OBJECTIVES

First, to explore the variability in how symptoms clustered together over the late reproductive stage, early and late menopausal transition (MT) stages, and early postmenopause; second, to determine whether the symptom factor structure of the preceding MT stage would predict the symptom factor structure of the MT stage immediately following.

METHODS

The sample consisted of a subset of Seattle Midlife Women's Health Study participants who were in late reproductive or early or late menopausal transition stages or early postmenopause and provided self-reported data on symptoms experienced between 1990 and 2005. Principal components analysis was used to determine how symptoms clustered together across the stages. Variables predicting the symptom factor structure were analyzed by multiple regression.

RESULTS

Principal components analysis with varimax rotation revealed different factor structures for each of the four stages. The three-factor solution in the late reproductive stage explained a total of 54.9% of the variance. The four-factor solutions in the early and late menopausal transition stages and postmenopause explained a total of 56.5%, 59.3%, and 60.7%, respectively.

CONCLUSIONS

This analysis revealed similar factor structures across the four stages in that each stage revealed a mood component, a vasomotor component, and a pain component. However, the symptoms differed somewhat in how they grouped from stage to stage. Regression analysis demonstrated that a relationship exists between the symptom factor structures across stages. Controlling for demographic and lifestyle variables, it was revealed that the symptom clusters at the early and late menopausal transition stages and early postmenopause were best predicted by the symptom factor structure of the previous stage.

Pain symptoms during the menopausal transition and early postmenopause

AIM

The aim of this study was to describe changes in levels of back pain and joint pain during the stages of menopausal transition stages and early postmenopause, including the effects of age, menopausal transition-related factors (estrone, follicle stimulating hormone (FSH), testosterone), menopausal transition stages, symptoms (hot flush, sleep, mood, cognitive), health-related factors (body mass index, alcohol use, smoking, well-being), stress-related factors (perceived stress, history of sexual abuse, cortisol, catecholamines) and social factors (partner and parenting status, education).

METHODS

A subset was studied of the participants in the Seattle Midlife Women's Health Study who provided data during the late reproductive, early and late menopausal transition stages or postmenopause (n = 292) including menstrual calendars for staging the menopausal transition, annual health reports completed between 1990 and 2006, and morning urine samples assayed for estrone glucuronide (E(1)G), testosterone, FSH, cortisol and catecholamines, and symptom diary ratings several times each year. Multilevel modeling with an R program was used to test patterns of pain symptoms related to age, menopausal transition-related factors, symptoms, health-related, stress-related and social factors, with as many as 6812 observations. Age was centered at 47.4 years.

RESULTS

Women experienced a slight, non-significant rise in back pain with age and a significant increase in back pain during the early (p = 0.003) and late menopausal transition stages (p = 0.002) and early postmenopause (p = 0.02), but urinary E(1)G, FSH and testosterone levels were unrelated. Of the stress-related factors, perceived stress (p = 0.01) and lower overnight urinary cortisol levels were associated with more severe back pain (p = 0.03); history of sexual abuse and catecholamines did not have a significant effect. Those most troubled by symptoms of hot flushes, depressed mood, anxiety, night-time awakening, and difficulty concentrating reported significantly greater back pain (all p < 0.0001). Of the health-related factors, having worse perceived health (p < 0.0001), exercising more (p = 0.005), using analgesics (p < 0.0001), and having a higher body mass index (p < 0.0001) were associated with more back pain, but alcohol use and smoking did not have significant effects. Of the social factors, only having a more formal education (p = 0.004) was associated with less back pain; parenting, having a partner, and employment were not significant. Factors associated with joint pain included age (p < 0.0001), but not menopausal transition-related factors. Symptoms of hot flushes, night-time awakening, depressed mood, and difficulty concentrating were each significantly associated with joint pain (p < 0.0001). Poorer perceived health, more exercise, higher body mass index, and greater analgesic use were all associated similarly with joint pain. History of sexual abuse was the only stress-related factor significantly related to joint pain severity (p = 0.024).

IMPLICATIONS

Clinicians working with women traversing the menopausal transition should be aware that managing back and joint pain symptoms among mid-life women requires consideration of their changing biology as well as their ongoing life challenges and health-related behaviors.

Midlife women making hormone therapy decisions

This study focuses on midlife women aged 40-65 years who were in transition to menopause, were menopausal or had a hysterectomy, to examine and better understand hormone therapy (HT) choices women make. Among the nationally representative sample of women in the Commonwealth Fund 1998 Survey of Women's Health (n = 884), 39% of the menopausal women reported current HT use. The two primary reasons for initiating HT are following a doctor's recommendation and seeking relief of menopausal symptoms. Age, education, race, hysterectomy status, having health insurance, use of calcium supplements and comfort in communicating with a doctor are important factors associated with HT use. This study underscores the importance of physicians and other health professionals providing accurate HT information to assist women in making HT decisions.

Three stages of the menopausal transition from the Seattle Midlife Women's Health Study: toward a more precise definition

OBJECTIVES

As more interest centers on the years surrounding menopause, the inconsistent use of nonspecific terminology to define these years becomes a problem. Our objective was to describe the development of specific criteria that define stages within the menopausal transition and to apply these criteria to classify midlife women into a stage of transition.

DESIGN

A total of 184 midlife women from the Seattle Midlife Women's Health Study taking no hormones and for whom data were available about initial menstrual cycle changes were studied. Questionnaires about menstrual cycle changes and menstrual calendars were mailed yearly. Intra-individual analyses for type and chronology of menstrual cycle changes during midlife for change in flow amount or duration, cycle length change, cycle irregularity, or skipped periods were conducted.

RESULTS

Changes in flow or cycle length most frequently preceded irregularity without skipped periods, which preceded skipped periods. Initial changes began in the early 30s and most frequently between ages 40 and 44. Only 14% had irregularity as the initial change. Three stages of the menopausal transition were identified: early (flow and/or cycle length changes), middle (irregularity without skipping), and late (skipped periods). Age did not differentiate the three stages.

CONCLUSIONS

These findings provide evidence for a progression of menstrual cycle events through the menopausal transition, which form the basis for three stages of the transition: early, middle, and late transition. Studies about the entire transition need to include women younger than 45. Both menstrual calendars and questionnaire data are needed to identify these three stages, and precise definitions of irregularity and skipped period are necessary.

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.

The North American Menopause Society 1998 menopause survey: Part II. Counseling about hormone replacement therapy: association with socioeconomic status and access to medical care

OBJECTIVE

The purpose of this study was to examine two predictors of women's obtaining hormone replacement therapy (HRT) counseling: socioeconomic status and access to health care.

DESIGN

During May-July 1998, by means of random-digit telephone dialing, 749 postmenopausal women who were living in the United States and aged 50-65 years were interviewed. On average, they were 56.8 years and 11.8 years postmenopausal. Most (86.0%) were Caucasian, and their median annual income was approximately $40,000. Nearly all (90.8%) had medical insurance coverage; 47.6% of those insured received care from a managed care organization. Access to medical care was evidenced by 92.3% being under the care of a primary care physician, 92.3% ever having had a mammogram, 96.9% ever having had a pelvic examination, and 91.1% ever having had a serum cholesterol determination.

RESULTS

Of these 749 women, 75.4% reported that they had received counseling about post-menopausal HRT from healthcare providers. Both level of education and level of income were associated with an increased likelihood that HRT counseling would be obtained. Having a personal physician, and particularly receiving care from a gynecologist, increased the likelihood that counseling would be available. There were no substantial differences in counseling frequency between women in managed care plans and those having other types of health insurance. In a multivariate model, adjusted odds ratios for receiving HRT counseling were 2.9 (95% confidence interval [CI] = 1.7-4.8) for having an annual income of $50,000 or more versus less than $30,000, 2.8 (95% CI = 1.7-4.5) for receiving care from a gynecologist versus other primary care physician, 1.9 (95% CI = 1.1-3.2) for being Caucasian versus not, and 1.5 (95% CI 1.0-2.2) for having a hysterectomy versus not.

CONCLUSIONS

Three quarters of a sample of US postmenopausal women aged 50-65 years reported that they had been counseled about HRT. However, women of lowest socioeconomic status and those who did not have a primary care physician were least likely to have received counseling. No differences were observed in prevalence of counseling between women in managed care settings and those with other types of health insurance. The findings suggest that special efforts are necessary to provide menopause education and counseling to underserved women.

Bone resorption levels by age and menopausal status in 5,157 women

OBJECTIVE

The purpose of this study was to describe bone resorption activity using a biochemical marker according to the categories of age, menopausal status, and selected drug/supplement use in middle-aged and elderly community-based women.

DESIGN

This was a cross-sectional study that assessed urinary cross-linked N-telopeptide of type I collagen (NTx) and used self-report data to group women as premenopausal (Pre), perimenopausal (Peri), postmenopausal without hormone replacement therapy (Post), and postmenopausal with hormone replacement therapy (HRT).

RESULTS

Mean NTx values were found to be significantly different by group and controlling for age (p = 0.001), with post hoc tests showing all pairwise group comparisons as significantly different (p = 0.001), except that the Pre and HRT groups were not significantly different. Both the Peri and the Post NTx levels were significantly higher than the Pre and the HRT groups'. NTx values in the Peri group varied with age-the youngest Peri women were similar to Pre women, and the oldest Peri women were similar to Post women. Significantly lower NTx levels were found only in the Post (p = 0.009) and HRT (p < 0.001) groups using diuretics compared with nonuse and only in the HRT group using calcium supplements compared with nonuse (p = 0.006). No differences by thyroid use were found. With a biochemical marker, the results showed that bone resorption activity differences could be demarcated in women according to age, estimated menopausal stage, and selected drug/supplement use.

CONCLUSIONS

These results support the usefulness of NTx assessment for indicating bone resorption activity and therefore the potential for osteoporosis or for monitoring the efficacy of antiresorptive therapies.

Changing women's health, changing nursing practice

Women's health is a field of study and health care that is of the highest concern for nurses, both from a professional and personal standpoint. It is imperative that those in nursing practice, education, and research be knowledgeable about, prepared for, able to advocate for, and participate in the transformation of health care policy and practice. The changing health care patterns and changing health care delivery system influencing the future of women's health are discussed. Recommendations for nursing practice, education, and research are proposed to advance women's health care.

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.

Use of hormone replacement therapy in Washington State: is prevention being put into practice?

BACKGROUND

American women are using hormone replacement therapy (HRT) for long-term disease prevention, as well as symptom control, in increasing numbers. Our study examined the role of prevention in women's decisions to initiate HRT and their intended duration of therapy.

METHODS

We analyzed the mailed survey responses of 2023 women aged 50 to 70 years from the practices of 46 physicians in the Puget Sound region for knowledge and attitudes about HRT, current use, and intended duration of therapy. Multiple logistic regression was used to model current HRT use and intended treatment length.

RESULTS

A total of 71% of our respondents were using HRT. Women with osteoporosis, coronary heart disease (CHD), or risk factors for CHD were not more likely to be using HRT, and women with CHD or risk factors for CHD were not targeted by their physicians for discussion of HRT. Of women using HRT, 77% expected lifelong use, and this was not more common among women initiating HRT for disease prevention.

CONCLUSIONS

Despite the high rates of HRT use and expected lifelong duration, use of HRT for prevention was neither higher among women most likely to benefit nor a major determinant of expected lifetime use.

Women and menopause: beliefs, attitudes, and behaviors. The North American Menopause Society 1997 Menopause Survey

OBJECTIVE

The main purpose in organizing this survey was to collect information relevant to The North American Menopause Society's (NAMS) educational mission and to document women's knowledge of, and attitudes toward, menopause.

DESIGN

During June-July 1997, The Gallup Organization conducted 750 telephone interviews with a randomly selected sample of women 45-60 years of age from across the United States. Women were asked about their sources of information on menopause, what changes in health they anticipated as a result of menopause, why they used hormone therapy, and their attitudes toward menopause as a natural or a medical event.

RESULTS

Women are more likely to believe that depression and irritability are associated with menopause than heart disease, but only a few associate menopause with an increasing vulnerability to either memory loss or Alzheimer's disease. Relief of physical symptoms of menopause was mentioned as the reason for starting hormone therapy more often than to protect against osteoporosis (25% relative to 15%), or to prevent stroke or a heart attack (10%), or to reduce the risk of developing Alzheimer's disease (2%). The single main source of women's information on menopause was a health professional (49%). The majority of women who were already menopausal or experiencing menstrual changes expressed an attitude toward menopause that was either neutral (42%) or positive (36%).

CONCLUSIONS

Women are divided in their views of menopause, some seeing it as a medical condition requiring medical treatment, whereas others see it as a natural transition to be managed by "natural" means. Providing women with accurate, up-to-date information and enhancing communication between healthcare providers and menopausal women remain the challenges for NAMS.

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.

Attitudes toward menopause and hormone therapy among women with access to health care

OBJECTIVE

To explore the relationship between women's attitudes toward menopause and hormone therapy and paradigms of menopause as a natural life event versus a biomedical phenomenon.

DESIGN

Women (N = 2092) sampled from physicians' practices in Washington state completed mailed questionnaires with a response rate of 72%.

RESULTS

Women's attitudes toward menopause were unrelated to their adoption of a biomedical versus developmental paradigm of menopause. In contrast, women's adoption of the view that menopause was an endocrine deficiency and that symptoms should be treated with hormones were correlated. Endorsement of the endocrine deficiency model of menopause was related to women's attitudes toward hormone therapy as more efficacious, less risky, and requiring daily use of a drug. Women's experiences of a hysterectomy and hormone use were associated with their attitudes.

CONCLUSIONS

Women's attitudes toward menopause are multidimensional and not influenced wholly by adoption of a biomedical or developmental paradigm. Women embraced menopause as part of life and simultaneously accepted changes in their endocrine production. Attitudes toward hormone therapy were closely aligned with adoption of a biomedical view of menopause and use of hormone therapy.

Deciding about hormone therapy: validation of a model

OBJECTIVE

The purposes of this study were to (1) validate components of a decision process regarding adoption of hormone therapy and (2) compare the decision processes women used with respect to their evaluation of decision quality.

DESIGN

A sample of women participating in a population-based study of midlife women's health participated in individual in-depth interviews.

RESULTS

Content analysis of 30 recorded interviews provided evidence that each component of the decision process (precontemplation, contemplation, commitment, critical evaluation, and continuance) was replicated. Few additional codes were identified, and these could be subsumed under the phases of the original decision model.

CONCLUSIONS

Women's self-reported statuses on a screening questionnaire corresponded to the stages of the decision model coded from their interviews. What women actually decided to do (use hormone therapy or something else) was not associated with their decision process. Satisfaction with the decision, uncertainty about the decision, and other factors related to the decision were independent of the decision phases.

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.

Physician policies on the use of preventive hormone therapy

BACKGROUND

Current guidelines recommend that most postmenopausal women be offered preventive hormone therapy (PHT), but there have been no surveys of U.S. physicians' policies since these guidelines appeared. We sought to measure physicians' policies and attitudes about PHT and compare them with the American College of Physicians' guideline on the use of PHT.

METHODS

We used a stratified, randomized survey of gynecologists, family physicians, and general internists in Washington, Alaska, Montana, and Idaho.

RESULTS

Nearly all respondents reported strong belief in the benefits of PHT and felt that the vast majority of their patients should be offered PHT. Where they differed, gynecologists believed even more strongly in its benefits than other respondents. Physicians estimated that 3% of their patients with a uterus were on regimens without any progestin and 23% were on regimens including time without any hormones. Gynecologists ranked mammography first and PHT use second on a list of eight preventive services, while the other respondents ranked smoking cessation first and PHT fourth (P < .0001 for differences).

CONCLUSIONS

Among surveyed physicians, there was near unanimous adoption of policies favoring the recommendation of PHT. Gynecologists believed in it even more strongly than family physicians and general internists and ranked it as more important than counseling about smoking cessation.

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.

Sleep, psychological distress, and stress arousal in women with fibromyalgia

The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in alpha-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an etiologic factor but, contrary to several literature assertions, alpha-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options.

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.

Changing women's health, changing nursing practice

Women's health is a field of study and health care that is of the highest concern for nurses, both from a professional and personal standpoint. It is imperative that those in nursing practice, education, and research be knowledgeable about, prepared for, able to advocate for, and participate in the transformation of health care policy and practice. The changing health care patterns and changing health care delivery system influencing the future of women's health are discussed. Recommendations for nursing practice, education, and research are proposed to advance women's health care.

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.

Increased urine catecholamines and cortisol in women with irritable bowel syndrome

OBJECTIVES

There are few data on the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis in individuals with chronic GI symptoms. The current study was designed to describe and compare urine catecholamine (norepinephrine, epinephrine) and cortisol levels in women diagnosed with irritable bowel syndrome (IBS-patients), women who report similar symptom levels but had not sought health care services (IBS-nonpatients; IBS-NP), and asymptomatic (control) women.

METHODS

Seventy-three women (24 IBS; 24 IBS-NP; 25 controls) were interviewed for demographic, GI, gynecological, and psychological data and then followed for two menstrual cycles with a daily health diary. Urine samples were obtained in the evening and morning at specific phases across two menstrual cycles.

RESULTS

Women in the IBS group had significantly higher PM and AM urine norepinephrine levels. Urine epinephrine and cortisol levels were also generally higher in women with IBS. Differences in neuroendocrine indicators of arousal were not accounted for by differences in demographic variables, lifestyle characteristics, menstrual distress, or average daily measures of anxiety or depression.

CONCLUSIONS

Increases in indicators of sympathetic nervous system activation in women seeking health care for IBS may reflect greater symptom distress or may contribute to increased symptom distress.

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.

Older women and their images of health: a replication study

Older women view themselves as healthy despite the fact that they suffer from chronic illnesses and some functional limitations. The study presented in this article replicates the work of Woods and associates by asking, "What does being healthy mean to you?" to a sample of 10 older women aged 70 to 91 years. The images presented by older women were remarkably consistent with the images presented by the younger cohort. As found in the original Woods et al study, there were nine dimensions that were reflective of the eudaemonistic model of health.

The impact of marital status and quality on family functioning in maternal chronic illness

Married individuals tend to enjoy greater health and well-being than nonmarried. However, investigators disagree about whether this is related to the quality of the marriage or to participation in the socially accepted role of marriage. In the present study, we examined the roles of marital quality and marital status as predictors of the family's adjustment processes in the context of maternal chronic illness. We found that the family functioning of single women and unhappily married women was similar and that happily married women enjoyed higher levels of family functioning and family coping. Unhappily married women reported more illness demands, particularly on their time and energy, than did happily married or single women. We suggest it is the quality of the marital interaction, and not the role benefits of marriage, that facilitates family adjustment under conditions of maternal chronic illness.

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.

Cancer research: future agendas for women's health

This report reviews the national research priorities for women's health, focusing on future research needed to address women's experiences with cancer. The agenda for cancer research was considered in light of recent efforts of the Office of Women's Health Research of the National Institutes of Health to help set an agenda to guide future work. Nursing's contribution to developing science to support women's health care is also addressed.

Women and depression

As Western society increases in complexity and becomes more reliant on technology, women who thrive as integrators in interactional modes will face new dilemmas. Many women will view these changes as challenges, but for many other women, who view these changes as threats, the response will be depression. We lay a foundation to an understanding of depression in women, evaluating the current concept of depression and pointing out its limitations. We then review the traditional theories of women's increased vulnerability to depressive disorders, which have failed to explain adequately this phenomenon. A more recent theory of women's depression, based on the self-in-relation theory of women's development, is offered as an alternative.

Women with chronic illness: their views of their families' adaptation

Although research has characterized the effects of chronic illness on patients and their spouses, little work has addressed the effects of a woman's chronic illness on her family. We tested a model of family functioning during a woman's chronic illness. Data were obtained from standardized questionnaires from 48 women who resided with an adult partner and one or more school age children and had breast cancer, diabetes, or fibrocystic breast disease. Path analysis indicated that the women experienced more demands associated with their illness as the time since their initial diagnosis lengthened. The number of demands associated with the illness in turn produced problems with marital adjustment. Introspective coping behaviors were used more frequently by families in which the woman experienced high marital adjustment but depressed mood than by families in which the woman was not depressed but experienced marital difficulties. Women's relationships with their children were positively influenced by better marital adjustment, and women who had positive relationships with their children described their children's relationships with their peers as positive. Family functioning was optimum when the family frequently engaged in introspective coping behavior, when the woman had a low level of depressed mood, and when marital adjustment was positive.

The United States women's health research agenda analysis and critique

This article describes the process used to develop a United States women's health research agenda and the published critiques of that agenda. Consideration of methods to develop knowledge about women's health from a feminist standpoint raises questions about the process and products of research that can have emancipatory ends for women.

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.

Menopause--challenges for future research

Menopause is a transition in women's lives with biological, personal, social, and cultural dimensions that together influence women's health. Scientists have not yet integrated the perspectives of multiple disciplines to provide a full account of women's experiences. Studies are underway to assess the effects of hormonal therapies used to treat symptoms that may be related to menopause or to prevent future disease. These studies will provide information women need to weigh the benefits and risks associated with hormone therapy. Although the biological dimensions of menopause warrant further study, the behavioral, social, and cultural dimensions also merit further attention. Moreover, there has been limited use of integrative perspectives, and as a result, the possibilities of cultural effects on biological processes of midlife remained understudied. The concerns of women who have been invisible, e.g., women of color, need to be brought into focus. Challenges in developing or refining methods for human research lie in studies that span the traditional disciplinary boundaries to create a more complete account of menopause and health.

Depressed mood and self-esteem in young Asian, black, and white women in America

During the last two decades, investigators have explored the relationship between women's life conditions and their mental health. Some have related women's socially disadvantaged status, or their socialization to a traditional feminine role, to depression and low self-esteem. Others have emphasized the consequences of women's roles, or the balance of social demands and resources, on their well-being. More recently, feminist scholars have proposed a developmental account of depression. We tested a model comparing the effects of personal resources, social demands and resources, socialization, and women's roles, on self-esteem and depressed mood in young adult Asian, Black, and White women in America. Women who resided in middle-income and racially mixed neighborhoods were interviewed in their homes. Personal resources were indicated by education and income and social resources by unconflicted network size as measured by Barrera's (1981) Arizona Social Support Interview Schedule. Social demands were assessed by conflicted network size as measured by the Barrera scale and by the Positive Life Events and Negative Life Events scales from Norbeck's (1984) revision of the Sarason Life Events Scale. Women's roles included employment, parenting, and partnership with an adult (e.g., marriage). Self-esteem was assessed with the Rosenberg Self Esteem Scale (Rosenberg, 1965) and depressed mood with the Center for Epidemiologic Studies Depression scale (Radloff, 1977). Although models for Asian, Black, and White women differed, social network and social demands as well as personal resources were common to each group as predictors of self-esteem and depression.

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.