The Menstrual Cycle as an Indicator of Overall Health (Text Version)
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
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
United States Patents on MATER with associated royalties. No other potential conflict of interest.
Slide 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.
Slide 4
"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.
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
Images: The HHS, NIH, and Women's Health Research at the NICHD logos are shown.
Slide 7
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
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"
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
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
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
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
- 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: 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: 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: 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: 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 are shown.
Slide 19
Reproduction = Sustainability
Image: Side by side color images of the planet Earth as seen from space are shown.
NASA
Slide 20
Reproduction
- Interpersonal relationships.
- Conception.
- Pregnancy.
- Birth.
- Parenting.
- Preservation of wisdom heritages.
- Preservation of our planet.
- Survival of our species.
Slide 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.
Wikipedia
Slide 22
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
- 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
- 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
- Gender-based health disparity.
- Frequent delay in diagnosis of disorders.
- Inadequate long term management.
Slide 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
Slide 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.
Slide 28
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
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®
- 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: 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®
- 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
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®
- 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: A photograph of identical twin young women standing in the lobby of the NIH Clinical Center.
Slide 36
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
- Less than 40 years of age.
- Amenorrhea.
- Menopausal level serum FSH.
- Normal karyotype.
- No iatrogenic cause.
Slide 38
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≤-2.0)
Factor | PPR | 95% CI | P |
---|---|---|---|
Onset before age 20 | 2.72 | 1.7, 4.3 | <0.0001 |
Delay in DX > 1 year | 1.96 | 1.1, 3.4 | 0.018 |
Slide 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.
Slide 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.
Slide 42
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
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
- 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
Image: Photo of a stone pathway in an autumn scene.
Slide 46
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"
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
- 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
Image: A photograph of a large mansion.
Slide 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.
Slide 51
Innovation Economics
↑ Innovation → ↑ Productivity
↑ Productivity → ↓ Jobs
↓ Jobs → ↑ Unemployed
Slide 52
Innovation Economics
↑ Unemployed → ↑ Available Workforce
↑ Available Workforce → ↑ Capacity
↑ Capacity → ↑ Opportunity
Slide 53
Gross National Product
Sympathetic "Fight or Flight"
Gross National Happiness
Parasympathetic "Rest and Digest"
Slide 54
Image: Graph shows increase in hospitalizations and increase in foreclosures.
Wall Street Journal, August 31, 2011
Slide 55
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
Sympathetic
Excess Capacity Opportunity ↓
Gross National Happiness
Parasympathetic
Slide 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% |
Slide 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/ .
Slide 59
Parasympathetic Stimulation
A Place of Peace and Healing—The American Spa
Image: A photograph of Hot Springs National Park is shown.
Slide 60
Image: The logo of the National Park Service is shown.
Slide 61
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
Image: A photograph of a large mansion
Slide 63
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 by a group of Lilliputians.
Slide 65
Image: The "I Want You for U.S. Army" Uncle Sam recruiting poster is shown.
Slide 66
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
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