The Menstrual Cycle as an Indicator of Overall Health (Text Version)

Slide presentation from the AHRQ 2011 conference.

On September 20, 2011, Larry Nelson made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (9 MB). Plugin Software Help.


Slide 1

The Menstrual Cycle as an Indicator of Overall Health

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
National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health & Human Services (HHS)

Slide 2

Disclosures

Disclosures

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

Slide 3

Objectives

Objectives

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

Slide 4

U.S. Public Health Service motto: "Protecting, promoting and advancing the health of the nation."

"Protecting, promoting and advancing the health and safety of the Nation."

Image: The U.S. Public Health Service logo is shown.

Slide 5

NIH Intramural Research Program on Reproductive and Adult Endocrinology

NIH Intramural Research Program on Reproductive and Adult Endocrinology.

Image: An aerial photograph of the NIH campus is shown. A red arrow points to the building where the Intramural Research Program on Reproductive and Adult Endocrinology is located.

Slide 6

HHS, NIH, and Women's Health Research at the NICHD logos

Images: The HHS, NIH, and Women's Health Research at the NICHD logos are shown.

Slide 7

Menstrual Cycle Consortium

Menstrual Cycle Consortium

Image: In the center, Rachel's Well logo for her study: The Science and Health of the Menstrual Cycle: Synchronizing the World of Women's Health is shown as a large bright red butterfly sitting at the intersection of two bright red rings. At the bottom are smaller logos for HHS, NIH, NICHD, OWH DHHS, and Rachel's Well.

Slide 8

Cover of a book titled The Menstrual Cycle and Adolescent Healt

Image: The cover of a book titled The Menstrual Cycle and Adolescent Health featuring a drawing of native women dancing around a central figure of a woman in a large cape is shown.

Slide 9

The Menstrual Cycle and the Science of Existential Well-Being

"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

Images: Photographs of young women smiling and dressed in red. On the left is a large red disk drawing attention to the Project Viral Sign logo.

Slide 10

Collaborate: Menstrual Cycle Consortium

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.

Slide 11

Integrated Care and Research

Integrated Care and Research

Image: Models of integrative and traditional systems of research and health care, viewed from the patient perspective. In each panel the solid black circle represents the patient. Each straight line represents a specialized area of research or health care, for example, bone health, reproductive health, emotional health, genetic health. In the traditional model for research and health care depicted on the left, the patient resides in one domain at a time, and frequently the data collection and relevant health care are carried out in one domain. In an integrative model for research and health care, depicted on the right, various domains come to meet the patient, and the result can be data and relevant health care coming together in one system and in one database.

Cooper AR et al. Fertil Steril 95(6):1890-7, 2011

Slide 12

Innovate: National Quality Strategy

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.

Slide 13

Scientific Opportunities: NICHD Vision for Reproduction

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 (Plugin Software Help).

Slide 14

Image: Wedding Portrait

Image: A wedding photo of a young man and a young woman dressed in white, adorned with flowers, with the beach and ocean in the background.

Slide 15

Image: Wedding Portraits

Image: On the left is a wedding picture of a young bride holding flowers with her husband in a black suit embracing her. On the right the bride stands with her father, who is dressed in a black suit.

Slide 16

Image: Wedding Portrait

Image: A young bride in a white dress holding red flowers. She is held in the arms of her husband dressed in a black tuxedo.

Slide 17

Image: Woman with a Baby

Image: A young woman dancing in her living room, baby in arms, music system in background, and a German shepherd dog sitting on the floor.

Slide 18

Image: Two Passports

Image: Two passports are shown.

Slide 19

Reproduction = Sustainability

Reproduction = Sustainability

Image: Side by side color images of the planet Earth as seen from space are shown.

NASA

Slide 20

Reproduction

Reproduction

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

Slide 21

Reproduction = Sustainability

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.

Wikipedia

Slide 22

Menstrual Cycle Consortium

Menstrual Cycle Consortium

Image: In the center, Rachel's Well logo is shown as a large bright red butterfly sitting at the intersection of two bright red rings. At the bottom are smaller logos for HHS, NIH, NICHD, OWH DHHS, and Rachel's Well.

Slide 23

Objectives

Objectives

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

Slide 24

Scientific Opportunities: NICHD Vision for Reproduction

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 (Plugin Software Help).

Slide 25

The Menstrual Cycle

The Menstrual Cycle

  • Gender-based health disparity.
  • Frequent delay in diagnosis of disorders.
  • Inadequate long term management.

Slide 26

Girls, Menarche, and Menstruation

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

Slide 27

The Menstrual Cycle is a Vital Sign®

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.

Slide 28

Polycystic Ovary Syndrome (PCOS) and Metabolic Syndrome

Polycystic Ovary Syndrome (PCOS) and Metabolic Syndrome

Images: On the left an ultrasound of a polycystic ovary shows many ovarian follicles aligned around the edge of the ovary. In the center the face of a woman with acne and hirsutism is shown. On the right an obese woman with a measuring tape around her abdomen is shown.

Slide 29

Cardiovascular Event-free Survival in Postmenopausal Women

Cardiovascular Event-free Survival in Postmenopausal Women

Image: A line graph shows that the cardiovascular event free survival of women with PCOS is significantly lower over 8 to 10 years as compared to women who do not have the condition (p=0.006). PCOS = 75%, No PCOS = 85%.

Shaw, L. J. et al. J Clin Endocrinol Metab. 2008;93:1276-1284

Slide 30

The Menstrual Cycle is a Vital Sign®

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.

Slide 31

Image: Family Portrait

Image: A family photo with father on the left, mother on the right, primary school son in the front, and a toddler son in mother's arms.

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

Slide 32

The Menstrual Cycle is a Vital Sign®

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.

Slide 33

Painting: Dido

Image: Classical painting of Dido gazing longingly over her shoulder; her hand grasps Aeneas' sword in anticipation of suicide.

The Death of Dido, Sacchi, 1599-1661.

Slide 34

The Menstrual Cycle is a Vital Sign®

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.

Slide 35

Image: Portrait of Identical Twin Sisters

Image: A photograph of identical twin young women standing in the lobby of the NIH Clinical Center.

Slide 36

Image: A microphotograph shows a three-dimensional view of osteoporotic bone cells

Osteoporosis

Image: A microphotograph shows a three-dimensional view of osteoporotic bone with thin and fragile struts.

Slide 37

46,XX Spontaneous Primary Ovarian Insufficiency

46,XX Spontaneous Primary Ovarian Insufficiency

  • Less than 40 years of age.
  • Amenorrhea.
  • Menopausal level serum FSH.
  • Normal karyotype.
  • No iatrogenic cause.

Slide 38

Primary Ovarian Insufficiency and Lower Bone Mineral Density

Image: A bar graph shows that women with primary ovarian insufficiency have significantly lower bone mineral density than contemporaneous control women and NHANES control women at the femoral neck (0.78, 0.82, 0.84), total hip (0.89, 0.92, 0.93), and lumbar spine (0.97,1.00).

Popat et al., JCEM 2009.

Slide 39

Risk Factors for Severe Osteopenia (Z less than or equal to 2.0)

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

Slide 40

Objectives

Objectives

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

Slide 41

A 3 Year Double Blind Placebo Controlled Trial of Hormone Replacement Therapy in POI

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.

Slide 42

Results in Femoral Neck Bone Mineral Density

Image: A bar graph shows percent change in femoral neck bone mineral density over three years in control women, women with primary ovarian insufficiency taking estradiol patch and placebo patch, and women with primary ovarian insufficiency taking estradiol patch and testosterone patch. The respective changes were as follows: year 1 (-0.1, +1.0, +3.0), year 2 (-1.0, +2.0, +3.5) and year 3 (-3.0, +2.5, +3.5).

Popat et al. manuscript in preparation.

Slide 43

Results in Lumbar Spine Bone Mineral Density

Image: A bar graph shows percent change in lumbar spine bone mineral density over three years in control women, women with primary ovarian insufficiency taking estradiol patch and placebo patch, and women with primary ovarian insufficiency taking estradiol patch and testosterone patch. The respective changes were as follows: year 1 (+0.2, +5.6.0, +5.4), year 2 (-0.1, +6.7, +6.0) and year 3 (+0.5, +7.5, +6.2).

Popat et al. manuscript in preparation.

Slide 44

Objectives

Objectives

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

Slide 45

The Way Ahead

The Way Ahead

Image: Photo of a stone pathway in an autumn scene.

Slide 46

Quote from Rumi

Images: On the left is a photo of a yellow rose in bloom. On the right is a photo of a jasmine flower in bloom.

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 jasmime

Rumi (1207-1273)

Slide 47

The Menstrual Cycle and the Science of Existential Well-Being

"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

Images: Photographs of young women smiling and dressed in red. On the left is a large red disk drawing attention to the Project Viral Sign logo.

Slide 48

Economics

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.

Slide 49

The American Dream

The American Dream

Image: A photograph of a large mansion.

Slide 50

Innovation Economics

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.

Slide 51

Innovation Economics

Innovation Economics

↑ Innovation → ↑ Productivity

↑ Productivity → ↓ Jobs

↓ Jobs → ↑ Unemployed

Slide 52

Innovation Economics

Innovation Economics

↑ Unemployed → ↑ Available Workforce

↑ Available Workforce → ↑ Capacity

↑ Capacity → ↑ Opportunity

Slide 53

Gross National Product versus Gross National Happiness

Gross National Product
Sympathetic "Fight or Flight"

Gross National Happiness
Parasympathetic "Rest and Digest"

Slide 54

Increase in Hospitalization and Increase in Foreclosures

Image: Graph shows increase in hospitalizations and increase in foreclosures.

Wall Street Journal, August 31, 2011

Slide 55

Gross National Happiness

Gross National Happiness

"In Bhutan, a smile on your face is more important than a coin in your pocket."

Images: On the left is a photo of blooming trees, a building, and a mountain in the background. In the center is the state seal of Bhutan. On the right is the flag of Bhutan showing a white dragon.

Boyd Matson, Happily Ever After, National Geographic, July-August 2010

Slide 56

Gross National Product versus Gross National Happiness

Gross National Product
Sympathetic

Excess Capacity Opportunity ↓
Gross National Happiness
Parasympathetic

Slide 57

International Spa Association

International Spa Association

 2009
(Year End)
2010
(Year End)
Percent Change
Revenue$12.3 billion$12.8 billion+4.3%
  Spa Visits143 million150 million+4.7%
  Locations20,60019,900-3.3%
 2010
(May)
2011
(May)
Percent Change
Total Employees332,000338,600+2.0%
  Full-time138,100149,200+8.0%
  Part-time137,200134,200-2.2%
  Contract56,80055,200-2.8%

Slide 58

The Economics of Happiness

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...

Slide 59

Parasympathetic Stimulation

Parasympathetic Stimulation

A Place of Peace and Healing—The American Spa

Image: A photograph of Hot Springs National Park is shown.

Slide 60

National Park Service

Image: The logo of the National Park Service is shown.

Slide 61

Healthy Parks Healthy People

Healthy Parks Healthy People

  • Nature.
  • Family Time.
  • Celebration of Wisdom Heritage.

Image: The logo of the National Park Service is shown.

Slide 62

The American Dream

The American Dream

Image: A photograph of a large mansion

Slide 63

The New American Dream: Happy, Healthy, Productive People

The New American Dream: Happy, Healthy, Productive People

  • Confident.
  • Creative.
  • Compassionate.
  • Courageous.

Images: On the right center is the seal of the United States showing an eagle holding an olive branch on the left and arrows on the right. At the bottom from left to right are small logos of HHS, NPS, NIH, NICHD, and the Menstrual Cycle Consortium.

Slide 64

Image: A cartoon drawing shows Uncle Sam tied down like Gulliver

Image: A cartoon drawing shows Uncle Sam tied down like Gulliver by a group of Lilliputians.

Slide 65

Image: The "I Want You for U.S. Army" Uncle Sam recruiting poster

Image: The "I Want You for U.S. Army" Uncle Sam recruiting poster is shown.

Slide 66

The Menstrual Cycle and the Science of Existential Well-Being

Images: Photographs of young women smiling and dressed in red. On the left is a large red disk drawing attention to the Project Viral Sign logo.

"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

Slide 67

The Menstrual Cycle as an Indicator of Overall Health

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, HHS

Current as of March 2012
Internet Citation: The Menstrual Cycle as an Indicator of Overall Health (Text Version). March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/nelson/index.html