1. Midlife Transitions: A Biomedical View Janet P. Pregler, MD Director, Iris Cantor-UCLA Women ’ s Health Center Center Director UCLA National Center of Excellence in Women ’ s Health

2. Women’s Health: What I Learned in Medical School (c. 1985)

3. Leading Causes of Death: US Women 1900 Tuberculosis Childbirth 2010 Heart Disease Cancer –Lung –Breast –Colon Stroke

4. The Health of Women Has Been Inadequately Addressed Lack of focus on women within the biomedical model Lack of focus on non-biomedical factors that impact women ’ s health Lack of focus on women who are not “ reproducing ” /of reproductive age

5. Which of the following experience menopause? 1.Lions 2.Baboons 3.Guppies 4.Pilot whales

6. Which of the following experience menopause? Answer 3. Guppies

7. Menopause is rare in the animal kingdom No primates undergo menopause in the fashion that human women do Source: Fogle J Clin Endocrinol Metab 2007

9. Perimenopause: Impact on Health and Wellbeing Varies for Each Woman “Hormone related” –Hot flashes –Sleep disturbance –Memory problems –Vaginal dryness Also occurring/continuing –Loss of sexual desire - Increased risk of depression

10. Perimenopause: Treatment Varies for Each Woman Holistic –Exercise –Weight loss –Whole foods/fruits and vegetables based diet –Avoiding smoking, alcohol Alternative/Complementary –-Herbal treatments –Acupuncture Biomedical –-Non-hormonal treatments: Antidepressants that also treat hot flashes, drugs for migraine that also treat hot flashes –-Local treatments: Vaginal estrogen –-Systemic hormones (includes “bioidentical”)

11. Playing the Odds: Leading Causes of Death for Women In Los Angeles County #1 Heart Disease #2 Cancer · Lung · Breast · Colon #3 Cerebrovascular Disease #4 Chronic Obstructive Pulmonary Disease #5 Pneumonia and Influenza #6 Diabetes #7 Alzheimer’s Disease #8 Accidents Source: Los Angeles County Office of Women’s Health

12. 12 Pregnancy-induced HTN, GDM PCOS Lifestyle Factors Diabetes, HTN, Inc. Lipids Source: Adapted from “CVD Prevention and the Primary Care Partnership”, Deborah Ehrenthal, MD, FACP CVD Mortality per 100,000 Women Age Many Women Develop Conditions During the Reproductive Years that Contribute to CVD Risk in Later Life

13. If all other risk factors are equal, who of the following is least likely to develop type 2 diabetes? 1.A Euro-American Woman 2.An Asian-American Woman 3.An African-American Woman 4.A Latina

14. If all other risk factors are equal, who of the following is least likely to develop type 2 diabetes? Answer 1.A Euro-American Woman

15. Age-adjusted Death Rates for American Women: U.S. 2006 15 Source: Adapted from American Heart Association 2010 * NCHS, Health Data Interactive, 2005-2007 Per 100,000 Population

16. Risk of Cardiac Events By Adherence to Low Risk Lifestyle, Compared to Non-adherence Low Risk Factors: Healthy diet, Non-smoking, Moderate-Vigorous Exercise > 30 minutes daily, Body Mass Index 5 grams/day Relative Risk of Coronary Events* Source: Adapted from Stampfer NEJM 2000 P<.05 compared to expected risk based on known risk factors

17. Improving Women’s Health: Structural Issues for the Community Safe places to exercise Neighborhood markets that sell healthy food at low prices Accessible sources of primary preventive care Continue and expand upon policies that discourage smoking Provide alternatives to unhealthy fast food

18. Improving Women’s Health: From Research to Policy Family Community Employers Government Healthcare Reform

19. Yoga for Treatment of Osteoporosis

20. Thank You For Your Attention!