Objective To assess whether the risk of vulvodynia is associated with previous use of oral contraceptives (OCs). Design Longitudinal population-based study. Setting Four counties in south-east Michigan, USA. Population A population-based sample of women, aged 18 years and older, enrolled using random-digit dialling. Methods Enrolled women completed surveys that included information on demographic characteristics, health status, current symptoms, past and present OC use, and a validated screen for vulvodynia. The temporal relationship between OC use and subsequent symptoms of vulvodynia was assessed using Cox regression, with OC exposure modelled as a time-varying covariate. Main outcome measure Vulvodynia, as determined by validated screen. Results Women aged <50 years who provided data on OC use, completed all questions required for the vulvodynia screen, and had first sexual intercourse prior to the onset of vulvodynia symptoms were eligible (n = 906). Of these, 71.2% (n = 645) had used OCs. The vulvodynia screen was positive in 8.2% (n = 74) for current vulvodynia and in 20.8% (n = 188) for past vulvodynia. Although crude cross-tabulation suggested that women with current or past vulvodynia were less likely to have been exposed to OCs prior to the onset of pain (60.7%), compared with those without this disorder (69.3%), the Cox regression analysis identified no association between vulvodynia and previous OC use (HR 1.08, 95% CI 0.81–1.43, P = 0.60). This null finding persisted after controlling for ethnicity, marital status, educational level, duration of use, and age at first OC use. Conclusion For women aged <50 years of age, OC use did not increase the risk of subsequent vulvodynia.

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Objective Prior studies describing menses duration and heaviness of flow during the menopausal transition (MT) have been short in duration and limited to white women. We estimated the frequency of and risk factors for prolonged bleeding, spotting, and heavy bleeding during the MT in an ethnically diverse population. Design Prospective community–based cohort study. Setting United States: Southeastern Michigan, Northern California, and Los Angeles, California. Population 1320 midlife women who participated in the Study of Women’s Health Across the Nation (SWAN) Menstrual Calendar Substudy. Participants included African-American, white, Chinese, and Japanese women. Methods Women completed daily menstrual calendars from 1996–2006, and provided information on hormone therapy, smoking and physical activity. Annual measures included height and weight. Kaplan-Meier survival analysis and multivariable regression were used to analyze the data. Main Outcome Measures Menses of 10+ days, spotting of 6+ days, heavy bleeding of 3+ days. Results At least three occurrences of menses 10+ days was reported by 77.7% (95%CI: 56.7, 93.2), of 6+ days of spotting by 66.8% (95%CI: 55.2, 78.0) and of 3+ days of heavy bleeding by 34.5% (95%CI: 30.2, 39.2) of women. Menses of 10+ days, 6+ days of spotting, and 3+ days of heavy bleeding were associated with MT stage, uterine fibroids, hormone use, and ethnicity. BMI was associated with 3+ days of heavy bleeding. Conclusions These data provide clinicians and women with important information about the expected frequency of prolonged and heavy bleeding and spotting during the menopausal transition that may facilitate clinical decision making.

Anti-Müllerian hormone (AMH) is expressed by antral stage ovarian follicles in women. Consequently, circulating AMH levels are detectable until menopause. Variation in age-specific AMH levels has been associated with breast cancer and polycystic ovary syndrome (PCOS), amongst other diseases. Identification of genetic variants underlying variation in AMH levels could provide clues about the physiological mechanisms that explain these AMH-disease associations. To date, only one variant in MCM8 has been identified to be associated with circulating AMH levels in women. We aimed to identify additional variants for AMH through a GWAS meta-analysis including data from 7049 premenopausal women of European ancestry, which more than doubles the sample size of the largest previous GWAS. We identified four loci associated with AMH levels at p < 5x10-8: the previously reported MCM8 locus and three novel signals in or near AMH, TEX41, and CDCA7. The strongest signal was a missense variant in the AMH gene (rs10417628). Most prioritized genes at the other three identified loci were involved in cell cycle regulation. Genetic correlation analyses indicated a strong positive correlation among SNPs for AMH levels and for age at menopause (rg= 0.82, FDR=0.003). Exploratory Mendelian randomization analyses did not support a causal effect of AMH on breast cancer or PCOS risk, but should be interpreted with caution as they may be underpowered and the validity of genetic instruments could not be extensively explored. In conclusion, we identified a variant in the AMH gene and three other loci that may affect circulating AMH levels in women.

Aims The prevalence of hepatic steatosis may differ between post-menopausal African-Americans and non-Hispanic white women and by sex hormone binding globulin level. We examined prevalence of hepatic steatosis by race/ethnicity and associations with sex hormone binding globulin. Methods Participants included post-menopausal women who underwent hepatic ultrasound (n = 345) at the Michigan site of the Study of Women’s Health Across the Nation, a population-based study. We examined hepatic steatosis prevalence by race/ethnicity and used logistic regression models to calculate the odds of hepatic steatosis with race/ethnicity and sex hormone binding globulin, after adjustment for age, alcohol use, waist circumference, HDL cholesterol, triglycerides, systolic blood pressure and use of medications reported to lower intrahepatic fat. Results Fewer African-Americans than non-Hispanic white women had hepatic steatosis (23 vs. 36%, P = 0.01). African-Americans had lower triglyceride and LDL cholesterol levels, but higher blood pressure and follicle-stimulating hormone levels (P < 0.05). In the optimal-fitting multivariable models, women in the highest tertile of sex hormone binding globulin (60.2–220.3 nmol/l) had a lower odds of hepatic steatosis (odds ratio 0.43, 95% CI 0.20–0.93) compared with women in the lowest tertile of sex hormone binding globulin (10.5–40.3 nmol/l). There was an interaction between race/ethnicity and medication use whereby non-Hispanic white women using medications had three times higher odds of hepatic steatosis compared with African-Americans not using medications (odds ratio 3.36, 95% CI 1.07–10.58). Interactions between race/ethnicity and other variables, including sex hormone levels, were not significant. Conclusions Hepatic steatosis on ultrasound may be more common in post-menopausal non-Hispanic white women than African-Americans and was associated with lower levels of sex hormone binding globulin.