1. AHRQ: Leading Change Through Innovation & Collaboration The Menstrual Cycle as an Indicator of Overall Health September 20, 2011 Lawrence M. Nelson Head, Integrative Reproductive Medicine Group Program in Reproductive and Adult Endocrinology NICHD, NIH, DHHS

2. Disclosures United States Patents on MATER with associated royalties. No other potential conflict of interest.

3. Objectives Introduce the Menstrual Cycle Consortium Present menstruation as a health focal point. Report on an NIH collaborative comparative effectiveness trial on bone health.

4. “Protecting, promoting and advancing the health and safety of the Nation.”

5. NIH Intramural Research Program on Reproductive and Adult Endocrinology

7. Menstrual Cycle Consortium

9. “The Menstrual Cycle and the Science of Existential Well-Being” March 29 – April 1, 2012 NIH Clinical Center, Bethesda, MD Organizing Committee Evelina Sterling, Rachel’s Well Stephanie Alexander, OWH, DHHS Lawrence M. Nelson, NIH, DHHS

10. Collaborate: Menstrual Cycle Consortium Components Patients Clinicians Investigators Patient Associations Professional Societies Industry Philanthropy Government Operating Principles Community-based participatory research Integrative care Patient registries

11. Integrated Care and Research Cooper AR et al. Fertil Steril. 95(6):1890-7, 2011

12. Innovate: National Quality Strategy Theme Better Care Healthy People and Communities Affordable Care Approach to meet the theme Patient-centered and integrative care Community-based participatory research Patient registry to facilitate preventative care

13. Scientific Opportunities NICHD Vision for Reproduction Quality of Life Reproductive Health as a Window to Overall Health http://www.nichd.nih.gov/vision/comments/whitepapers/NICHD_Reproduction_Vision_White_paper_030511.pdf

15. © Rennard Photography

18. Mattias Nelson Land

19. Reproduction = Sustainability NASA

20. Reproduction Interpersonal relationships Conception Pregnancy Birth Parenting Preservation of wisdom heritages Preservation of our planet Survival of our species

21. Reproduction = Sustainability Sustainability is the capacity to endure. In ecology, the word describes how biological systems remain diverse and productive over time. For humans, sustainability is the potential for long-term maintenance of well being, which has environmental, economic, and social dimensions. ecologydiverse Wikipedia

22. Menstrual Cycle Consortium

23. Objectives Introduce the Menstrual Cycle Consortium Present menstruation as a health focal point. Report on an NIH collaborative comparative effectiveness trial on bone health.

24. Scientific Opportunities NICHD Vision for Reproduction Quality of Life Reproductive Health as a Window to Overall Health http://www.nichd.nih.gov/vision/comments/whitepapers/NICHD_Reproduction_Vision_White_paper_030511.pdf

25. The Menstrual Cycle Gender-based health disparity Frequent delay in diagnosis of disorders Inadequate long term management

26. Girls, Menarche, and Menstruation Girls lack knowledge Education provides mixed messages –Normal and natural event –Should be hidden Attitudes and expectations negatively biased –Body shame –Self objectification –Lack of agency in sexual decision making Good preparation not well defined Stubbs ML, ANYAS 1135:58-66, 2008

27. The Menstrual Cycle is a Vital Sign ® Wake up call on cardiovascular health Wake up call on genetic health Wake up call on emotional health Wake up call on bone health

28. PCOS and Metabolic Syndrome

29. Copyright ©2008 The Endocrine Society Shaw, L. J. et al. J Clin Endocrinol Metab 2008;93:1276-1284 Cardiovascular event-free survival in postmenopausal women

30. The Menstrual Cycle is a Vital Sign ® Wake up call on cardiovascular health Wake up call on genetic health Wake up call on emotional health Wake up call on bone health

31. Corrigan et al, Fertil Steril 84:1508, 2005

32. The Menstrual Cycle is a Vital Sign ® Wake up call on cardiovascular health Wake up call on genetic health Wake up call on emotional health Wake up call on bone health

33. The Death of Dido, Sacchi, 1599-1661

34. The Menstrual Cycle is a Vital Sign ® Wake up call on cardiovascular health Wake up call on genetic health Wake up call on emotional health Wake up call on bone health

36. Osteoporosis

37. 46,XX Spontaneous Primary Ovarian Insufficiency Less than 40 years of age Amenorrhea Menopausal level serum FSH Normal karyotype No iatrogenic cause

38. Popat et al., JCEM 2009

39. Risk Factors for Severe Osteopenia (Z<-2.0) FactorPPR95% CIP Onset before age 202.721.7, 4.3<0.0001 Delay in DX > 1 year1.961.1, 3.40.018

40. Objectives Introduce the Menstrual Cycle Consortium Present menstruation as a health focal point. Report on an NIH collaborative comparative effectiveness trial on bone health.

41. A 3 year double blind placebo controlled trial of hormone replacement therapy in POI Transdermal estradiol, progestin, and testosterone Transdermal estradiol, progestin, and placebo Normal control women

42. Popat et al. manuscript in preparation

44. Objectives Introduce the Menstrual Cycle Consortium Present menstruation as a health focal point. Report on an NIH collaborative comparative effectiveness trial on bone health.

45. The Way Ahead

46. Do not sit long with a sad friend. When you go to a garden, do you look at thorns or flowers? Spend more time with roses and jasmine. Rumi (1207-1273)

47. “The Menstrual Cycle and the Science of Existential Well-Being” March 29 – April 1, 2012 NIH Clinical Center, Bethesda, MD Organizing Committee Evelina Sterling, Rachel’s Well Stephanie Alexander, OWH, DHHS Lawrence M. Nelson, NIH, DHHS

48. Economics 1776 –Adam Smith –The Wealth of Nations –The invisible hand 1936 –John Maynard Keynes –The General Theory of Employment, Interest and Money –Macroeconomics 1942 –Joseph Schumpeter –Capitalism, Socialism and Democracy –Innovation economics

49. The American Dream

50. Innovation Economics Capital is only part of the story. Central tenets –Knowledge, technology, entrepreneurship, and innovation –Spur higher productivity through innovation –Thereby, foster economic growth while delivering benefits to society

51. Innovation Economics Innovation Productivity Jobs Productivity Jobs Unemployed

52. Innovation Economics Unemployed Available Workforce Capacity Available Workforce Capacity Opportunity

53. Gross National Product Sympathetic “Fight or Flight” Gross National Happiness Parasympathetic “Rest and Digest”

54. Wall Street Journal, August 31, 2011

55. Gross National Happiness “In Bhutan, a smile on your face is more important than a coin in your pocket.” Boyd Matson, Happily Ever After, National Geographic, July-August 2010

56. Excess Capacity Opportunity Gross National Product Sympathetic Gross National Happiness Parasympathetic

57. International Spa Association 2009 (Year End) 2010 (Year End) Percent Change Revenue $12.3 billion $12.8 billion +4.3% Spa Visits 143 million 150 million +4.7% Locations 20,600 19,900 -3.3% 2010 (May) 2011 (May) Percent Change Total Employees 332,000 338,600 +2.0% Full-time 138,100 149,200 +8.0% Part-time 137,200 134,200 -2.2% Contract 56,800 55,200 -2.8%

58. The Economics of Happiness 'Going local' is a powerful strategy to help repair our fractured world – our ecosystems, our societies and our selves. Far from the old institutions of power, people are starting to forge a very different future... –A film by Helena Norberg-Hodge, Steven Gorelick & John Page –http://www.theeconomicsofhappiness.org/http://www.theeconomicsofhappiness.org/

59. Parasympathetic Stimulation A Place of Peace and Healing – The American Spa

61. Healthy Parks Healthy People Nature Family Time Celebration of Wisdom Heritage

62. The American Dream

63. The New American Dream Happy, Healthy, Productive People Confident Creative Compassionate Courageous

66. “The Menstrual Cycle and the Science of Existential Well-Being” March 29 – April 1, 2012 NIH Clinical Center, Bethesda, MD Organizing Committee Evelina Sterling, Rachel’s Well Stephanie Alexander, OWH, DHHS Lawrence M. Nelson, NIH, DHHS

67. AHRQ: Leading Change Through Innovation & Collaboration The Menstrual Cycle as an Indicator of Overall Health September 20, 2011 Lawrence M. Nelson Head, Integrative Reproductive Medicine Group Program in Reproductive and Adult Endocrinology NICHD, NIH, DHHS