The SWAN Song: Study of Women’s Health Across the Nation’s Recurring Themes

Abstract

SYNOPSIS There is a belief that reproductive health is a reflection of whole-body health. It then follows that abnormalities of reproductive milestones may be a manifestation of aberrant or unhealthy aging. In order to assess how menopause per se and the process of the menopause transition may affect future health risks and outcomes, the Study of Women’s Health Across the Nation was begun in 1994. SWAN, now in its 14th follow-up year, has characterized the life experience of a multi-ethnic cohort of mid-life US women in an unprecedented level of detail. Several enduring themes have emerged from SWAN that have associated certain patterns of hormones and symptoms with metabolic status. Moreover, the nature of relationships between hormones, body size, ethnicity, metabolic status and cardiovascular disease symptoms risk vary as women traverse the menopause and ovarian hormone production eventually ceases. This review will describe these cross-cutting themes and their possible meaning for the health of the mid-life woman.

Perimenopause as a neurological transition state

“…3 The Stages of Reproductive Aging Workshop (STRAW), 3 which was an international collaborative effort, along with the Study of Women Across the Nation (SWAN), which studied an ethnically diverse population in the USA, 13 have contributed to the classification of the peri menopausal transition and characterized the complexity of symptoms and the ethnic diversity of perimenopausal phenotypes. Principal symptoms include variability in cycle length, vasomotor symptoms (hot flushes) and hor monal fluctuations (Figure 1b).…”

“…93 A shift in metabolism during perimenopause is also evident in women and has been associated with dys regulated glucose metabolism and insulin resistance. 13,61 Collectively, preclinical data in rodent models of peri menopause and clinical analyses of the human female brain indicate that the perimenopausal transition is an ordered and sequential process, during which the brain seems to undergo dismantling of the connections between the estrogen receptor network and the bio energetic system. 13,20,89,95 The disengagement of the estro gen receptor network from the bioenergetic system in the brain is also associated with a release of suppression of enzymes required to metabolize ketone bodies.…”

Symptoms of Depressed Mood, Disturbed Sleep, and Sexual Problems in Midlife Women: Cross-Sectional Data from the Study of Women's Health Across the Nation

“…35 Women in perimenopause, who have the greatest fluctuations in sex steroid hormones, are particularly likely to report menopausal symptoms including sleep disturbance, psychological symptoms, and vasomotor symptoms. 36 It can be difficult to tease out separate effects of age versus menopausal status. Given the cross-sectional nature of this study (in the context of our longitudinal cohort), our next step will be to examine these outcomes over time to facilitate the differentiation of aging versus menopausal status.…”

Menopause and Diabetes? No Sweat!

“…In many women, these symptoms are mild and temporary, but for others they persist. Women with persistent symptoms should seek advice on options to improve their quality of life [3].…”