1 00:00:05,520 --> 00:00:09,680 >>WELCOME TO THE 7th ANNUAL 2 00:00:09,680 --> 00:00:11,760 VIVIAN PINN SYMPOSIUM HONORING 3 00:00:11,760 --> 00:00:13,160 THE FIRST FULL-TIME DIRECTOR OF 4 00:00:13,160 --> 00:00:17,240 THE NIH OFFICE OF RESEARCH ON 5 00:00:17,240 --> 00:00:19,680 WOMEN'S HEALTH, VIVIAN PINN 6 00:00:19,680 --> 00:00:20,880 M.D., IN RECOGNITION OF NATIONAL 7 00:00:20,880 --> 00:00:22,760 WOMEN'S HEALTH WEEK. 8 00:00:22,760 --> 00:00:24,480 THIS EVENT SERVES AS A CRITICAL 9 00:00:24,480 --> 00:00:27,240 FORUM FOR EXPERTS ACROSS SECTORS 10 00:00:27,240 --> 00:00:28,240 TO COMMUNICATE AND COLLABORATE 11 00:00:28,240 --> 00:00:29,920 FOR THE ADVANCEMENT OF WOMEN'S 12 00:00:29,920 --> 00:00:32,560 HEALTH AND OUR TOPIC TODAY WILL 13 00:00:32,560 --> 00:00:34,320 BE MENOPAUSE AND OPTIMIZING THE 14 00:00:34,320 --> 00:00:35,880 MID-LIFE HEALTH OF WOMEN. 15 00:00:35,880 --> 00:00:40,480 MY NAME IS SARAH TEMKIN, 16 00:00:40,480 --> 00:00:42,760 ASSOCIATE DIRECTOR FOR CLINICAL 17 00:00:42,760 --> 00:00:44,080 RESEARCH AT THE NIH OFFICE OF 18 00:00:44,080 --> 00:00:45,480 RESEARCH ON WOMEN'S HEALTH. 19 00:00:45,480 --> 00:00:47,640 I WILL BEGIN WITH A FEW 20 00:00:47,640 --> 00:00:49,760 LOGISTICS FOR TODAY'S EVENT. 21 00:00:49,760 --> 00:00:51,520 THROUGHOUT THE SYMPOSIUM THOSE 22 00:00:51,520 --> 00:00:53,920 IN THE VIRTUAL ENVIRONMENT CAN 23 00:00:53,920 --> 00:00:56,880 USE THE Q&A FUNCTION TO SUBMIT 24 00:00:56,880 --> 00:00:57,800 QUESTIONS. 25 00:00:57,800 --> 00:01:01,280 IF YOU ARE VIEWING VIA VIDEOCAST 26 00:01:01,280 --> 00:01:03,240 YOU MAY SUBMIT QUESTIONS SHE A 27 00:01:03,240 --> 00:01:05,560 THAT PAGE AS WELL. 28 00:01:05,560 --> 00:01:07,600 TODAY'S EVENT IS VIDEOCAST BY 29 00:01:07,600 --> 00:01:10,080 THE NIH AND IS BEING RECORDED. 30 00:01:10,080 --> 00:01:11,680 IN THE COMING WEEKS RECORDINGS 31 00:01:11,680 --> 00:01:14,280 OF THE EVENT WILL BE MADE 32 00:01:14,280 --> 00:01:16,400 AVAILABLE THROUGH THE ORWH WEB 33 00:01:16,400 --> 00:01:19,000 SIEVMENT WE'RE EXCITED TO HAVE A 34 00:01:19,000 --> 00:01:21,800 GRAPHIC REPORTER JOIN US TODAY 35 00:01:21,800 --> 00:01:22,600 TO CREATE ILLUSTRATED NOTES. 36 00:01:22,600 --> 00:01:24,280 SOME VISUAL NOTES WILL BE 37 00:01:24,280 --> 00:01:25,880 DISPLAYED DURING THE BREAKS AND 38 00:01:25,880 --> 00:01:29,000 WILL BE AVAILABLE AS WELL AFTER 39 00:01:29,000 --> 00:01:32,360 THE EVENTS WITH SUMMARY OF 40 00:01:32,360 --> 00:01:33,840 TODAY'S SPEAKER. 41 00:01:33,840 --> 00:01:34,520 TODAY'S TALKS. 42 00:01:34,520 --> 00:01:37,240 AND NOW IT IS MY PLEASURE TO 43 00:01:37,240 --> 00:01:40,000 INTRODUCE OUR FIRST SPEAKER, DR. 44 00:01:40,000 --> 00:01:42,080 JANINE AUSTIN CLAYTON, NIH 45 00:01:42,080 --> 00:01:44,200 ASSOCIATE DIRECTOR FOR RESEARCH 46 00:01:44,200 --> 00:01:46,680 ON WOMEN'S HEALTH, NIH DIRECTOR 47 00:01:46,680 --> 00:01:48,520 FOR RESEARCH ON WOMEN'S HEALTH, 48 00:01:48,520 --> 00:01:50,400 OFFICE OF RESEARCH ON WOMEN'S 49 00:01:50,400 --> 00:01:51,320 HEALTH. 50 00:01:51,320 --> 00:01:57,600 DURING HER TENURE AT ORWH DR. 51 00:01:57,600 --> 00:01:59,920 CLAYTON HAS TIRELESSLY SUPPORTED 52 00:01:59,920 --> 00:02:02,840 HEALTH IN A WORLD WHERE WOMEN 53 00:02:02,840 --> 00:02:06,440 RECEIVE EVIDENCE-BASED HEALTH 54 00:02:06,440 --> 00:02:10,080 CARE TAILORED TO THEIR 55 00:02:10,080 --> 00:02:10,440 CIRCUMSTANCES. 56 00:02:10,440 --> 00:02:13,520 HER BIO MAY BE FOUND IN THE 57 00:02:13,520 --> 00:02:16,040 PROGRAM BOOKLET LINKED TO THE 58 00:02:16,040 --> 00:02:16,240 CHAT. 59 00:02:16,240 --> 00:02:16,480 WELCOME. 60 00:02:16,480 --> 00:02:17,720 >> THANK YOU. 61 00:02:17,720 --> 00:02:19,520 GOOD MORNING, EVERYONE. 62 00:02:19,520 --> 00:02:22,200 I'M EXCITED TO BE WITH YOU ALL 63 00:02:22,200 --> 00:02:23,400 TODAY TO TALK ABOUT A TOPIC THAT 64 00:02:23,400 --> 00:02:25,400 IS NEAR AND DEAR TO MY HEART, 65 00:02:25,400 --> 00:02:26,560 SOMETHING THAT'S SO IMPORTANT 66 00:02:26,560 --> 00:02:28,480 FOR THE HEALTH OF WOMEN. 67 00:02:28,480 --> 00:02:31,240 TODAY WE THINK OF MENOPAUSE AS 68 00:02:31,240 --> 00:02:33,560 AN INFLECTION POINT IN WOMEN'S 69 00:02:33,560 --> 00:02:37,160 MID-LIFE HEALTH. 70 00:02:37,160 --> 00:02:39,240 AND YOU HEARD FROM SARAH A 71 00:02:39,240 --> 00:02:39,960 PHRASE WE'VE INCORPORATED INTO 72 00:02:39,960 --> 00:02:41,880 THE NIH VISION FOR THE HEALTH OF 73 00:02:41,880 --> 00:02:42,400 WOMEN. 74 00:02:42,400 --> 00:02:44,840 WE IMAGINE A WORLD IN WHICH 75 00:02:44,840 --> 00:02:46,360 EVERY WOMAN RECEIVES 76 00:02:46,360 --> 00:02:47,400 EVIDENCE-BASED DISEASE 77 00:02:47,400 --> 00:02:48,760 PREVENTION AND TREATMENT, 78 00:02:48,760 --> 00:02:50,760 TAILORED TO HER OWN 79 00:02:50,760 --> 00:02:53,280 CIRCUMSTANCES, GOALS, AND NEEDS. 80 00:02:53,280 --> 00:02:54,600 WE THINK THAT THROUGH RESEARCH 81 00:02:54,600 --> 00:02:56,840 AND RESEARCH ADVANCES WE CAN GET 82 00:02:56,840 --> 00:02:59,400 CLOSER TO REALIZING THIS VISION 83 00:02:59,400 --> 00:03:02,560 AND BETTER ENABLING CLINICIANS 84 00:03:02,560 --> 00:03:03,520 TO DELIVER INDIVIDUALIZED CARE 85 00:03:03,520 --> 00:03:07,640 APPROPRIATE FOR EACH WOMAN'S AGE 86 00:03:07,640 --> 00:03:09,200 AND REPRODUCTIVE STAGE. 87 00:03:09,200 --> 00:03:13,080 YOU WILL HEAR OFTEN THAT ORWH 88 00:03:13,080 --> 00:03:15,520 FROM ITS OUTSET AND DR. PINN'S 89 00:03:15,520 --> 00:03:17,200 DIRECTION INCLUDED A LIFE COURSE 90 00:03:17,200 --> 00:03:18,640 PERSPECTIVE FROM THE BEGINNING. 91 00:03:18,640 --> 00:03:20,480 AND MID-LIFE IS A PART OF THE 92 00:03:20,480 --> 00:03:22,120 LIFE COURSE THAT IS OFTEN NOT 93 00:03:22,120 --> 00:03:25,080 CONSIDERED AS MUCH AS SOME OF 94 00:03:25,080 --> 00:03:25,640 THE EARLIER STAGES. 95 00:03:25,640 --> 00:03:28,720 WE KNOW OF COURSE THAT 96 00:03:28,720 --> 00:03:30,480 PERIMENOPAUSE CAN BEGIN AS EARLY 97 00:03:30,480 --> 00:03:32,600 AS IN OUR 40s, AND AVERAGE AGE 98 00:03:32,600 --> 00:03:38,080 OF MENOPAUSE MORE IN EARLY 99 00:03:38,080 --> 00:03:39,440 '50s, AND POST-MENOPAUSAL 100 00:03:39,440 --> 00:03:40,880 PERIOD IS AN IMPORTANT COMPONENT 101 00:03:40,880 --> 00:03:42,080 OF THE LIFE COURSE, FRAMED HERE 102 00:03:42,080 --> 00:03:45,560 WITH THE THOUGHT THAT MENOPAUSE 103 00:03:45,560 --> 00:03:47,480 BRINGS ITS OWN CHALLENGES BUT 104 00:03:47,480 --> 00:03:50,520 ITS OWN REWARDS AS WELL. 105 00:03:50,520 --> 00:03:51,400 IT'S A POTENTIALLY STRESSFUL 106 00:03:51,400 --> 00:03:53,800 TIME IN TERMS OF LIFE, CAREER, 107 00:03:53,800 --> 00:03:56,000 FAMILY, BUT IT'S ALSO AN 108 00:03:56,000 --> 00:03:57,320 OPPORTUNITY TO MAKE LIFESTYLE 109 00:03:57,320 --> 00:03:59,200 CHANGES, TALK TO A HEALTH CARE 110 00:03:59,200 --> 00:04:02,000 PROVIDER, UNDERSTAND YOUR OWN 111 00:04:02,000 --> 00:04:04,200 PERSONAL HEALTH RISKS, AND TO 112 00:04:04,200 --> 00:04:05,760 DELAY, INTERRUPT, OR PREVENT THE 113 00:04:05,760 --> 00:04:07,360 DEVELOPMENT OF CHRONIC DISEASE. 114 00:04:07,360 --> 00:04:09,840 WHY IS THAT SO IMPORTANT? 115 00:04:09,840 --> 00:04:12,440 HERE IS THE DATA THAT SHOW THAT 116 00:04:12,440 --> 00:04:14,240 CARDIOVASCULAR DISEASE IN WOMEN 117 00:04:14,240 --> 00:04:16,440 IS BOTH AGE ASSOCIATED AND AGE 118 00:04:16,440 --> 00:04:18,560 SPECIFIC, AND WE KNOW THAT 119 00:04:18,560 --> 00:04:21,080 THERE'S AN INCREASE IN 120 00:04:21,080 --> 00:04:21,720 CARDIOVASCULAR DISEASE INCIDENCE 121 00:04:21,720 --> 00:04:27,000 BY AGE IN WOMEN WITH 122 00:04:27,000 --> 00:04:30,240 POST-MENOPAUSAL WOMEN HAVING TWO 123 00:04:30,240 --> 00:04:34,920 TO SIX FOLD GREATER RISK FOR 124 00:04:34,920 --> 00:04:36,440 CARDIOVASCULAR DISEASE UP TO 54 125 00:04:36,440 --> 00:04:38,560 YEARS OF AGE. 126 00:04:38,560 --> 00:04:41,520 THAT MID-LIFE PERIOD AND 127 00:04:41,520 --> 00:04:43,240 MENOPAUSEALL TRANSITION WE SEE 128 00:04:43,240 --> 00:04:45,240 ONSET OF CHRONIC DISEASE IN 129 00:04:45,240 --> 00:04:51,680 WOMEN, WHY IT'S SO IMPORTANT TO 130 00:04:51,680 --> 00:04:52,600 ADDRESS MENOPAUSAL TRANSITION 131 00:04:52,600 --> 00:04:56,320 AND OPTIMIZE MANAGEMENT OF 132 00:04:56,320 --> 00:04:57,920 MENOPAUSAL SYSTEMS WHICH CAN 133 00:04:57,920 --> 00:05:00,280 RANGE FROM DIFFICULT TO 134 00:05:00,280 --> 00:05:00,840 DEBILITATING. 135 00:05:00,840 --> 00:05:02,080 IN TERMS OF CHRONIC DISEASES, 136 00:05:02,080 --> 00:05:04,640 THIS IS AN AREA OF INCREASED 137 00:05:04,640 --> 00:05:08,120 INTEREST BY MANY. 138 00:05:08,120 --> 00:05:13,560 IN FACT, THE U.S. SENATE AND 139 00:05:13,560 --> 00:05:17,280 HOUSE OF REPRESENTATIVES 140 00:05:17,280 --> 00:05:17,920 APPROPRIATION BILLS IDENTIFIED 141 00:05:17,920 --> 00:05:18,800 RISING CHRONIC CONDITIONS IN 142 00:05:18,800 --> 00:05:21,280 WOMEN AS AN AREA OF WOMEN AS A 143 00:05:21,280 --> 00:05:25,160 RESULT OF ORWH-LED ALONG WITH 144 00:05:25,160 --> 00:05:26,280 ADVISORY COMMITTEE, A CONFERENCE 145 00:05:26,280 --> 00:05:28,400 CALLED ADVANCING NIH RESEARCH ON 146 00:05:28,400 --> 00:05:30,240 HEALTH OF WOMEN AND SUMMARIZED 147 00:05:30,240 --> 00:05:32,200 THAT INFORMATION IN A REPORT 148 00:05:32,200 --> 00:05:34,800 THAT'S AVAILABLE ON OUR WEBSITE. 149 00:05:34,800 --> 00:05:38,560 MORE RECENTLY, DR. TEMKIN AND 150 00:05:38,560 --> 00:05:43,800 OUR CO-AUTHORS IN BMC WOMEN'S 151 00:05:43,800 --> 00:05:45,680 HEALTH HIGHLIGHTED CONDITIONS 152 00:05:45,680 --> 00:05:49,440 AND DEVELOPMENT OF FRAMEWORK, 153 00:05:49,440 --> 00:05:51,680 LAST DEFINED BY HHS MULTIPLE 154 00:05:51,680 --> 00:05:52,800 YEARS AGO, IMPORTANT TO THINK 155 00:05:52,800 --> 00:05:55,640 THROUGH THE LENS HOW WOMEN 156 00:05:55,640 --> 00:05:56,840 EXPERIENCE THEM, WHAT MAY BE 157 00:05:56,840 --> 00:05:58,560 FEMALE SPECIFIC AND HOW SEX 158 00:05:58,560 --> 00:05:59,680 DIFFERENCES MIGHT PLAY OUT. 159 00:05:59,680 --> 00:06:01,280 I WANT TO HIGHLIGHT THAT FOR YOU 160 00:06:01,280 --> 00:06:03,480 AND I WANT TO SHARE WITH YOU 161 00:06:03,480 --> 00:06:06,920 THAT THE NATIONAL ACADEMIES OF 162 00:06:06,920 --> 00:06:07,480 SCIENCE, ENGINEERING AND 163 00:06:07,480 --> 00:06:09,560 MEDICINE WITH SUPPORT FROM ORWH 164 00:06:09,560 --> 00:06:10,960 ARE CONDUCTING A STUDY LOOKING 165 00:06:10,960 --> 00:06:12,040 AT FRAMEWORK FOR CONSIDERATION 166 00:06:12,040 --> 00:06:19,160 OF CHRONIC DEBILITATING 167 00:06:19,160 --> 00:06:21,440 CONDITIONS IN WOMEN. 168 00:06:21,440 --> 00:06:22,720 UNDERSTANDING CHRONIC CONDITIONS 169 00:06:22,720 --> 00:06:25,840 IS ALSO OF IMPORTANCE IN TERMS 170 00:06:25,840 --> 00:06:27,920 OF HOW ORWH HAS COLLABORATED 171 00:06:27,920 --> 00:06:30,200 ACROSS THE NIH 27 INSTITUTES AND 172 00:06:30,200 --> 00:06:33,480 CENTERS, PARTNERING WITH THREE 173 00:06:33,480 --> 00:06:35,240 I.C.s LISTED HERE, SEVERAL 174 00:06:35,240 --> 00:06:38,560 I.C.s ON AN R01 AND R21 175 00:06:38,560 --> 00:06:39,720 RECENTLY RELEASED WITH FIRST 176 00:06:39,720 --> 00:06:43,760 RECEIPT DATE COMING UP IN JUNE. 177 00:06:43,760 --> 00:06:46,320 THIS FUNDING OPPORTUNITY ALLOWS 178 00:06:46,320 --> 00:06:48,520 APPLICATIONS ON CHRONIC 179 00:06:48,520 --> 00:06:49,400 CONDITIONS UNDERSTUDIED AMONG 180 00:06:49,400 --> 00:06:50,440 WOMEN OR THAT DISPROPORTIONATELY 181 00:06:50,440 --> 00:06:53,040 AFFECT PORTIONS OF WOMEN 182 00:06:53,040 --> 00:06:54,040 UNDERSTUDIED, UNDERREPRESENTED, 183 00:06:54,040 --> 00:06:55,160 AND UNDERREPORTED IN BIOMEDICAL 184 00:06:55,160 --> 00:06:56,440 RESEARCH AND THAT SHOULD ALIGN 185 00:06:56,440 --> 00:06:58,320 WITH GOAL 1 OF THE NIH-WIDE 186 00:06:58,320 --> 00:07:01,480 STRATEGIC PLAN WHICH IS 187 00:07:01,480 --> 00:07:02,480 ADVANCING RIGOROUS RESEARCH 188 00:07:02,480 --> 00:07:05,120 RELEVANT TO HEALTH OF WOMEN. 189 00:07:05,120 --> 00:07:07,720 WE HOPE THAT THESE FUNDING 190 00:07:07,720 --> 00:07:10,280 OPPORTUNITIES WILL PROVIDE THE 191 00:07:10,280 --> 00:07:13,560 SPACE FOR INVESTIGATORS TO 192 00:07:13,560 --> 00:07:15,640 ADDRESS A VARIETY OF CONDITIONS, 193 00:07:15,640 --> 00:07:17,440 DIFFERENCES BETWEEN MEN AND 194 00:07:17,440 --> 00:07:18,640 WOMEN IN TERMS OF LIFE COURSE 195 00:07:18,640 --> 00:07:21,680 TIME POINTS WHEN WE SEE DISEASES 196 00:07:21,680 --> 00:07:23,480 ACCELERATE LIKE MID-LIFE AND 197 00:07:23,480 --> 00:07:23,840 MENOPAUSE. 198 00:07:23,840 --> 00:07:27,480 AND OF COURSE, NIH HAS FUNDED 199 00:07:27,480 --> 00:07:30,200 MENOPAUSE RESEARCH FOR OVER 30 200 00:07:30,200 --> 00:07:31,000 YEARS, BEGINNING IN 1991, WITH 201 00:07:31,000 --> 00:07:36,320 THE LAND LANDMARK WOMEN'S HEALH 202 00:07:36,320 --> 00:07:38,800 INITIATIVE AND INVESTMENT UNDER 203 00:07:38,800 --> 00:07:40,160 FORMER NIH DIRECTOR BERNADINE 204 00:07:40,160 --> 00:07:43,120 HEALEY, TO THE SWAN STUDY, STUDY 205 00:07:43,120 --> 00:07:46,720 OF WOMEN'S HEALTH ACROSS THE 206 00:07:46,720 --> 00:07:48,720 NATION, WHICH CHARACTERIZED 207 00:07:48,720 --> 00:07:51,040 MENOPAUSAL TRANSITION INCLUDING 208 00:07:51,040 --> 00:07:54,600 BIOLOGICAL AND PSYCHOSOCIAL 209 00:07:54,600 --> 00:08:01,440 ANTECEDENTS IN AND SEQUELAE IN A 210 00:08:01,440 --> 00:08:05,240 DIVERSE SAMPLE OF MID-LIFE 211 00:08:05,240 --> 00:08:07,800 WOMEN, MSFLASH, INVESTIGATING 212 00:08:07,800 --> 00:08:09,440 TREATMENTS FOR MENOPAUSAL 213 00:08:09,440 --> 00:08:11,920 SYMPTOMS WITH A WIDE-RANGING 214 00:08:11,920 --> 00:08:14,920 COLLECTION OF INTERVENTIONS AND 215 00:08:14,920 --> 00:08:18,560 MS-BRAIN, EXPLORING HOW 216 00:08:18,560 --> 00:08:19,120 MENOPAUSAL SYMPTOMS AFFECT 217 00:08:19,120 --> 00:08:20,920 SHORT- AND LONG-TERM BRAIN 218 00:08:20,920 --> 00:08:30,080 HEALTH AND MENOPAUSE AND: 219 00:08:30,080 --> 00:08:32,640 CHRONOLOGICAL INFLUENCE ON THE 220 00:08:32,640 --> 00:08:33,680 BRAIN. 221 00:08:33,680 --> 00:08:35,640 RCDC CODE FOR MENOPAUSE RESEARCH 222 00:08:35,640 --> 00:08:38,280 WILL ALLOW US TO ASSESS THE 223 00:08:38,280 --> 00:08:41,920 PORTFOLIO ACCURATELY AND FOLLOW 224 00:08:41,920 --> 00:08:43,080 THAT OVER TIME. 225 00:08:43,080 --> 00:08:49,880 I WANT TO SHARE WITH OUR 226 00:08:49,880 --> 00:08:52,400 ATTENDEES MY MENOPLAN, AN 227 00:08:52,400 --> 00:08:54,280 EVIDENCE-BASED TOOL PROVIDES 228 00:08:54,280 --> 00:08:55,920 WOMEN WITH SCIENCE-BASED 229 00:08:55,920 --> 00:08:57,160 INFORMATION ABOUT TREATMENT 230 00:08:57,160 --> 00:09:00,160 OPTIONS AND HELPS EMPOWER HIM TO 231 00:09:00,160 --> 00:09:01,320 MAKE DECISIONS ABOUT MENOPAUSAL 232 00:09:01,320 --> 00:09:05,320 TRANSITION THAT WILL WORK FOR 233 00:09:05,320 --> 00:09:05,520 THEM. 234 00:09:05,520 --> 00:09:09,640 THE OFFICE OF RESEARCH ON 235 00:09:09,640 --> 00:09:17,320 WOMEN'S HEALTH HAS OPPORTUNITIES 236 00:09:17,320 --> 00:09:18,440 HAS OPPORTUNITIES, THE R01, THE 237 00:09:18,440 --> 00:09:21,640 FIRST EVER ON SEX AND GENDER, IS 238 00:09:21,640 --> 00:09:23,440 ONE OPPORTUNITY FOR THAT. 239 00:09:23,440 --> 00:09:27,200 WE HAVE ALSO SUPPORTED MENOPAUSE 240 00:09:27,200 --> 00:09:29,520 RESEARCH UNDER OUR U3 241 00:09:29,520 --> 00:09:30,560 ADMINISTRATIVE SUPPLEMENT 242 00:09:30,560 --> 00:09:35,200 PROGRAM FOCUSING ON WOMEN OF 243 00:09:35,200 --> 00:09:36,400 UNDERREPRESENTED POPULATIONS, 244 00:09:36,400 --> 00:09:38,160 GENDER R25 GALVANIZING HEALTH 245 00:09:38,160 --> 00:09:40,160 EQUITY THROUGH NOVEL AND DIVERSE 246 00:09:40,160 --> 00:09:42,120 EDUCATIONAL RESOURCES IS ANOTHER 247 00:09:42,120 --> 00:09:43,360 OPPORTUNITY TO EXPAND 248 00:09:43,360 --> 00:09:45,480 UNDERSTANDING OF MENOPAUSE AND 249 00:09:45,480 --> 00:09:48,000 MENOPAUSE RESEARCH, WHICH IS 250 00:09:48,000 --> 00:09:49,120 IMPORTANT, AND FAIRLY RECENTLY 251 00:09:49,120 --> 00:09:50,560 SUMMARIZED SOME EFFORTS THAT NIH 252 00:09:50,560 --> 00:09:55,520 HAS IN RESEARCH ON MENOPAUSE IN 253 00:09:55,520 --> 00:09:57,840 WOMEN'S HEALTH IN FOCUS 254 00:09:57,840 --> 00:09:59,520 QUARTERLY PUBLICATION, OUTLINING 255 00:09:59,520 --> 00:10:00,480 SEVERAL QUESTIONS THAT REMAIN 256 00:10:00,480 --> 00:10:02,480 GAPS IN KNOWLEDGE AND TALKED 257 00:10:02,480 --> 00:10:04,560 ABOUT HOW WE SHOULD ADDRESS 258 00:10:04,560 --> 00:10:08,160 FUTURE RESEARCH ABOUT QUESTIONS 259 00:10:08,160 --> 00:10:09,720 IN MENOPAUSE. 260 00:10:09,720 --> 00:10:10,640 OUR SIGNATURE PROGRAM 261 00:10:10,640 --> 00:10:12,200 SPECIALIZED CENTERS OF RESEARCH 262 00:10:12,200 --> 00:10:15,320 EXCELLENCE ON SEX DIFFERENCES 263 00:10:15,320 --> 00:10:17,560 HAS SEVERAL SCORE PROGRAMS THAT 264 00:10:17,560 --> 00:10:19,960 ADDRESS ISSUES RELEVANT TO 265 00:10:19,960 --> 00:10:22,240 RESEARCH WHETHER IT'S THE 266 00:10:22,240 --> 00:10:25,560 BRIGHAM AND WOMEN'S HOSPITAL 267 00:10:25,560 --> 00:10:28,520 FOCUSED ON PITUITARY GONADAL 268 00:10:28,520 --> 00:10:30,360 ACCESS, PRODUCING VASOMOTOR 269 00:10:30,360 --> 00:10:35,200 SYMPTOMS, AND STRESS RELATES TO 270 00:10:35,200 --> 00:10:39,720 NEUROLOGIC CONSEQUENCES, 271 00:10:39,720 --> 00:10:40,160 BRAIN-GUT MICROBIOME 272 00:10:40,160 --> 00:10:41,720 INTERACTIONS, PERIMENOPAUSAL, 273 00:10:41,720 --> 00:10:50,920 PRE AND POST MENOPAUSAL AT UCLA, 274 00:10:50,920 --> 00:10:52,440 OR RESEARCH ON CARDIOMETABOLIC 275 00:10:52,440 --> 00:10:56,200 HEALTH CHANGES THAT OCCUR IN THE 276 00:10:56,200 --> 00:10:58,040 MENOPAUSE TRANSITION OR SCORE 277 00:10:58,040 --> 00:11:00,120 THAT LOOKS AT MENOPAUSE BROUGHT 278 00:11:00,120 --> 00:11:03,520 ON BY SURGICAL REMOVELY OF BOTH 279 00:11:03,520 --> 00:11:10,880 OVARIES OR UCLA SCORE, OR THE 280 00:11:10,880 --> 00:11:11,520 CEDARS-SINAI SCORE, DIFFERENCE 281 00:11:11,520 --> 00:11:12,480 IN VASCULAR DISEASE, FROM THE 282 00:11:12,480 --> 00:11:14,360 LENS OF SEX DIFFERENCES FOR MANY 283 00:11:14,360 --> 00:11:15,760 YEARS AND WILL CONTINUE TO DO 284 00:11:15,760 --> 00:11:16,120 SO. 285 00:11:16,120 --> 00:11:20,240 I WANT TO MAKE SURE I SHARE 286 00:11:20,240 --> 00:11:21,200 EXCITING NEWS. 287 00:11:21,200 --> 00:11:22,440 THE OFFICE OF RESEARCH ON 288 00:11:22,440 --> 00:11:25,040 WOMEN'S HEALTH HAS FORMED AN 289 00:11:25,040 --> 00:11:26,840 OFFICE OF AUTOIMMUNE DISEASE 290 00:11:26,840 --> 00:11:29,680 RESEARCH, IN 2022 THE NATIONAL 291 00:11:29,680 --> 00:11:30,760 ACADEMIES REPORTED ON 292 00:11:30,760 --> 00:11:32,920 RECOMMENDATION FOR NIH TO FORM 293 00:11:32,920 --> 00:11:35,520 SUCH AN OFFICE AND FISCAL YEAR 294 00:11:35,520 --> 00:11:37,000 23 THE CONSOLIDATED 295 00:11:37,000 --> 00:11:39,640 APPROPRIATIONS ACT OF 2023 296 00:11:39,640 --> 00:11:40,800 CONGRESS ALLOCATED $10 MILLION 297 00:11:40,800 --> 00:11:43,280 TO ESTABLISH OADR IN THE OFFICE 298 00:11:43,280 --> 00:11:46,760 OF RESEARCH ON WOMEN'S HEALTH, 299 00:11:46,760 --> 00:11:47,760 LOOKING TOWARDS DEVELOPING 300 00:11:47,760 --> 00:11:48,920 OPPORTUNITIES FOR 301 00:11:48,920 --> 00:11:49,840 INTERDISCIPLINARY RESEARCH ON 302 00:11:49,840 --> 00:11:52,000 AUTOIMMUNE DISEASE IN THE 303 00:11:52,000 --> 00:11:54,960 CONTEXT OF A WOMAN'S LIFE COURSE 304 00:11:54,960 --> 00:12:00,560 INCLUDING PERSPECTIVES RELATED 305 00:12:00,560 --> 00:12:01,880 TO MENOPAUSE. 306 00:12:01,880 --> 00:12:06,480 AND THE FIRST FUNDING 307 00:12:06,480 --> 00:12:09,720 OPPORTUNITY ON THE EXPOSOME, 308 00:12:09,720 --> 00:12:10,880 WITH OUR COLLABORATING PARTNERS, 309 00:12:10,880 --> 00:12:14,680 RECEIPT DATE OF JUNE 16, 2023, 310 00:12:14,680 --> 00:12:16,640 STAY TUNED FOR MORE INFORMATION. 311 00:12:16,640 --> 00:12:18,920 WE WANT TO MANUAL A WORLD IN 312 00:12:18,920 --> 00:12:21,680 WHICH EVERY WOMAN RECEIVES 313 00:12:21,680 --> 00:12:22,320 EVIDENCE-BASED DISEASE 314 00:12:22,320 --> 00:12:23,000 PREVENTION AND TREATMENT 315 00:12:23,000 --> 00:12:25,920 TAILORED TO HER OWN NEEDS, 316 00:12:25,920 --> 00:12:26,600 CIRCUMSTANCES, AND GOALS. 317 00:12:26,600 --> 00:12:29,200 IN ORDER TO DO THAT WE HAVE TO 318 00:12:29,200 --> 00:12:32,880 GENERATE THE EVIDENCE TO INFORM 319 00:12:32,880 --> 00:12:33,640 SUCH CLINICAL DECISION MAKING. 320 00:12:33,640 --> 00:12:36,200 AT THE BEGINNING OF MY REMARKS I 321 00:12:36,200 --> 00:12:37,840 SHOWED YOU THAT QUOTE AND ASKED 322 00:12:37,840 --> 00:12:40,640 THAT YOU ALL IMAGINE A WORLD 323 00:12:40,640 --> 00:12:42,360 THAT WE CAN BUILD WHERE TOGETHER 324 00:12:42,360 --> 00:12:44,520 THROUGH RIGOROUS RESEARCH THAT 325 00:12:44,520 --> 00:12:47,120 WORKS TO EXAMINE AND UNDERSTAND 326 00:12:47,120 --> 00:12:52,680 MENOPAUSE TO INCREASE RESEARCH 327 00:12:52,680 --> 00:12:54,040 FINDINGS TO ADVANCE THE HEALTH 328 00:12:54,040 --> 00:12:55,240 OF ALL WOMEN AT ALL STAGES. 329 00:12:55,240 --> 00:12:58,200 WE THINK NOW IS THE TIME TO 330 00:12:58,200 --> 00:12:59,040 CONNECT AND REDOUBLE MENOPAUSE 331 00:12:59,040 --> 00:13:00,920 RESEARCH EFFORTS ACROSS NIH AND 332 00:13:00,920 --> 00:13:01,440 WORK TOGETHER. 333 00:13:01,440 --> 00:13:03,960 WE WANT TO HIGHLIGHT THE WAYS WE 334 00:13:03,960 --> 00:13:06,040 THINK ABOUT THE HEALTH OF WOMEN, 335 00:13:06,040 --> 00:13:06,840 VERSUS WOMEN'S HEALTH. 336 00:13:06,840 --> 00:13:08,080 THE HEALTH OF WOMEN IS 337 00:13:08,080 --> 00:13:09,920 EVERYTHING THAT AFFECTED A WOMAN 338 00:13:09,920 --> 00:13:12,040 FROM HEAD TO TOE, INSIDE AND 339 00:13:12,040 --> 00:13:13,040 OUT, ACROSS THE LIFE COURSE, AND 340 00:13:13,040 --> 00:13:14,640 WE WANT TO CONNECT THE DOTS 341 00:13:14,640 --> 00:13:16,920 ACROSS THESE EFFORTS THAT ARE 342 00:13:16,920 --> 00:13:20,320 CONDUCTED IN THE INSTITUTES AND 343 00:13:20,320 --> 00:13:21,440 CENTERS, ALL CHRONIC DISEASES, 344 00:13:21,440 --> 00:13:22,720 CONDITIONS, THAT AFFECT MEN AND 345 00:13:22,720 --> 00:13:26,560 WOMEN ACROSS THE LIFE COURSE AND 346 00:13:26,560 --> 00:13:27,960 PROVIDE OPPORTUNITIES FOR GROWTH 347 00:13:27,960 --> 00:13:29,280 AND SYNERGY IN THE FUTURE. 348 00:13:29,280 --> 00:13:32,200 THIS IS THE WAY WE CAN PROVIDE 349 00:13:32,200 --> 00:13:33,200 INDIVIDUALIZED CARE FOR WOMEN IN 350 00:13:33,200 --> 00:13:36,440 THE FUTURE AS WE BETTER 351 00:13:36,440 --> 00:13:36,960 UNDERSTAND THE MENOPAUSAL 352 00:13:36,960 --> 00:13:41,240 TRANSITION, WE CAN IMPROVE THE 353 00:13:41,240 --> 00:13:43,080 HEALTH OF ALL WOMEN. 354 00:13:43,080 --> 00:13:44,520 AS RESEARCH ADVANCES WE COME 355 00:13:44,520 --> 00:13:46,400 CLOSER TO REALIZING THIS VISION 356 00:13:46,400 --> 00:13:48,920 AND BETTER ENABLING CLINICIANS 357 00:13:48,920 --> 00:13:50,520 TO DELIVER INDIVIDUALIZED CARE 358 00:13:50,520 --> 00:13:53,320 APPROPRIATE FOR EACH WOMAN'S AGE 359 00:13:53,320 --> 00:13:54,560 AND REPRODUCTIVE STAGE. 360 00:13:54,560 --> 00:13:58,960 AND WITH THAT, IT'S MY PLEASURE 361 00:13:58,960 --> 00:14:01,160 TO OVER THREE DECADES AFTER THE 362 00:14:01,160 --> 00:14:02,600 WOMEN'S HEALTH INITIATIVE WAS 363 00:14:02,600 --> 00:14:05,000 STARTED, TO INTRODUCE THE 7th 364 00:14:05,000 --> 00:14:10,240 ANNUAL VIVIAN PINN SYMPOSIUM 365 00:14:10,240 --> 00:14:14,040 KEYNOTE SPEAKER, DR. JOANN 366 00:14:14,040 --> 00:14:14,320 MANSON. 367 00:14:14,320 --> 00:14:16,880 DR. MANSON IS THE PROFESSOR OF 368 00:14:16,880 --> 00:14:18,840 MEDICINE AND MICHAEL AND LEE 369 00:14:18,840 --> 00:14:21,160 BELL PROFESSOR OF WOMEN'S HEALTH 370 00:14:21,160 --> 00:14:22,560 AT HARVARD MEDICAL SCHOOL, AND 371 00:14:22,560 --> 00:14:25,320 PROFESSOR IN THE DEPARTMENT OF 372 00:14:25,320 --> 00:14:27,640 EPIDEMIOLOGY AT THE HARVARD T H 373 00:14:27,640 --> 00:14:28,600 CHAN SCHOOL OF PUBLIC HEALTH, 374 00:14:28,600 --> 00:14:31,760 CHIEF OF THE DIVISION OF 375 00:14:31,760 --> 00:14:32,760 PREVENTIVE MEDICINE AT BRIGHAM 376 00:14:32,760 --> 00:14:36,760 AND WOMEN'S HOSPITAL, HAS 377 00:14:36,760 --> 00:14:37,480 RECEIVED NUMEROUS HONORS 378 00:14:37,480 --> 00:14:39,760 INCLUDING AMERICAN HEART 379 00:14:39,760 --> 00:14:41,600 ASSOCIATION POPULATION RESEARCH 380 00:14:41,600 --> 00:14:42,960 PRIZE, DISTINGUISHED SCIENTIST 381 00:14:42,960 --> 00:14:44,800 AWARD, AMONG MANY OTHERS, 382 00:14:44,800 --> 00:14:47,320 ELECTED INTO THE INSTITUTE OF 383 00:14:47,320 --> 00:14:47,920 MEDICINE, NOW NATIONAL ACADEMY 384 00:14:47,920 --> 00:14:51,280 OF MEDICINE, AND AS A MEMBER OF 385 00:14:51,280 --> 00:14:52,800 THE ASSOCIATION OF AMERICAN 386 00:14:52,800 --> 00:14:55,120 PHYSICIANS SHE IS A FELLOW OF 387 00:14:55,120 --> 00:14:58,560 THE AMERICAN ASSOCIATION FOR THE 388 00:14:58,560 --> 00:15:01,560 ADVANCEMENT OF SCIENCE, 389 00:15:01,560 --> 00:15:03,360 BERNADINE HEALEY AWARD FOR 390 00:15:03,360 --> 00:15:08,040 VISIONARY LEADERSHIP IN WOMEN'S 391 00:15:08,040 --> 00:15:10,800 HEALTH, AND RENAISSANCE WOMAN 392 00:15:10,800 --> 00:15:13,200 AWARD, JAMES BRUCE MEMORIAL 393 00:15:13,200 --> 00:15:13,800 AWARD, FROM THE AMERICAN COLLEGE 394 00:15:13,800 --> 00:15:16,760 OF PHYSICIANS AND SHE'S AN 395 00:15:16,760 --> 00:15:17,560 ELECTED MASTER OF AMERICAN 396 00:15:17,560 --> 00:15:19,880 COLLEGE OF PHYSICIANS. 397 00:15:19,880 --> 00:15:21,480 DR. MANSON HAS PUBLISHED MORE 398 00:15:21,480 --> 00:15:23,320 THAN 1200 PEER-REVIEWED ARTICLES 399 00:15:23,320 --> 00:15:24,720 IN MEDICAL LITERATURE, AUTHOR OR 400 00:15:24,720 --> 00:15:27,080 EDITOR OF SEVERAL BOOKS AND TEXT 401 00:15:27,080 --> 00:15:29,120 BOOKS, AND SERVES AS EDITOR IN 402 00:15:29,120 --> 00:15:30,480 CHIEF OF CONTEMPORARY CLINICAL 403 00:15:30,480 --> 00:15:30,920 TRIALS. 404 00:15:30,920 --> 00:15:33,760 SHE'S A PAST PRESIDENT OF THE 405 00:15:33,760 --> 00:15:34,320 NORTH AMERICAN MENOPAUSE 406 00:15:34,320 --> 00:15:38,360 SOCIETY, ONE OF THE MOST HIGHLY 407 00:15:38,360 --> 00:15:38,960 CITED PHYSICIANS, FEATURED IN 408 00:15:38,960 --> 00:15:40,360 THE NATIONAL LIBRARY OF MEDICINE 409 00:15:40,360 --> 00:15:42,000 EXHIBITION CALLED CHANGING THE 410 00:15:42,000 --> 00:15:44,600 FACE OF MEDICINE, I'M SO PLEASED 411 00:15:44,600 --> 00:15:46,040 DR. MANSON WILL SHARE VAST 412 00:15:46,040 --> 00:15:47,360 KNOWLEDGE AND RESEARCH WITH US 413 00:15:47,360 --> 00:15:47,560 TODAY. 414 00:15:47,560 --> 00:15:50,040 I LOOK FOR WASHED TO LEARNING 415 00:15:50,040 --> 00:15:51,440 MORE FROM HER KEYNOTE SPEECH. 416 00:15:51,440 --> 00:15:54,440 PLEASE JOIN ME IN WELCOMING DR. 417 00:15:54,440 --> 00:15:55,880 JOANN MANSON. 418 00:15:55,880 --> 00:15:59,040 >> THANK YOU SO MUCH, DR. 419 00:15:59,040 --> 00:16:00,560 CLAYTON, FOR THAT VERY KIND 420 00:16:00,560 --> 00:16:01,800 INTRODUCTION. 421 00:16:01,800 --> 00:16:03,800 SO IT'S A TREMENDOUS HONOR TO 422 00:16:03,800 --> 00:16:06,560 HAVE BEEN INVITED TO GIVE THE 423 00:16:06,560 --> 00:16:08,000 KEYNOTE ADDRESS THIS MORNING AT 424 00:16:08,000 --> 00:16:11,480 THE VIVIAN PINN SYMPOSIUM. 425 00:16:11,480 --> 00:16:12,800 DR. PINN HAS BEEN AN 426 00:16:12,800 --> 00:16:14,600 EXTRAORDINARY ROLE MODEL AND 427 00:16:14,600 --> 00:16:17,320 MENTOR TO ME OVER THE DECADES AS 428 00:16:17,320 --> 00:16:21,800 I KNOW SHE'S BEEN TO SO MANY 429 00:16:21,800 --> 00:16:22,040 OTHERS. 430 00:16:22,040 --> 00:16:23,840 I'M THRILLED THIS ANALYSIS POEM 431 00:16:23,840 --> 00:16:26,800 YUM IN HER NAME CONTINUES TO 432 00:16:26,800 --> 00:16:29,160 RECOGNIZE AND SERVES AS A 433 00:16:29,160 --> 00:16:32,560 TRIBUTE TO DR. PINN'S ENORMOUS 434 00:16:32,560 --> 00:16:33,960 CONTRIBUTION AND IMPACT. 435 00:16:33,960 --> 00:16:38,520 I CAN'T THANK YOU ENOUGH, DR. 436 00:16:38,520 --> 00:16:39,880 PINN, AND THANK YOU, DR. 437 00:16:39,880 --> 00:16:44,120 CLAYTON, FOR YOUR GREAT WORK AND 438 00:16:44,120 --> 00:16:44,560 FOR YOUR TREMENDOUS 439 00:16:44,560 --> 00:16:46,680 CONTRIBUTIONS OVER THE YEARS AS 440 00:16:46,680 --> 00:16:47,680 WELL. 441 00:16:47,680 --> 00:16:51,960 THIS YEAR THE WHI CELEBRATES THE 442 00:16:51,960 --> 00:16:55,600 30-YEAR ANNIVERSARY OF THE START 443 00:16:55,600 --> 00:16:58,280 OF STUDY RECRUITMENT, AND WHAT 444 00:16:58,280 --> 00:17:00,800 AN EPIC JOURNEY IT'S BEEN OVER 445 00:17:00,800 --> 00:17:01,200 THESE 30 YEARS. 446 00:17:01,200 --> 00:17:03,400 I'D LIKE TO SHARE SOME OF IT 447 00:17:03,400 --> 00:17:07,240 WITH YOU TODAY, AT LEAST THE 448 00:17:07,240 --> 00:17:13,320 LESSONS FROM THE HORMONE THERAPY 449 00:17:13,320 --> 00:17:16,440 COMPONENT. 450 00:17:16,440 --> 00:17:20,320 IT'S NOT ADVANCING. 451 00:17:20,320 --> 00:17:20,720 OKAY. 452 00:17:20,720 --> 00:17:22,320 THERE WE GO. 453 00:17:22,320 --> 00:17:24,720 I HAVE NO FINANCIAL CONFLICTS OF 454 00:17:24,720 --> 00:17:27,680 INTEREST RELATED TO THIS 455 00:17:27,680 --> 00:17:28,920 PRESENTATION. 456 00:17:28,920 --> 00:17:32,720 SO, I WANT TO START BY SAYING 457 00:17:32,720 --> 00:17:34,000 THAT AN OBSCURE HISTORICAL 458 00:17:34,000 --> 00:17:36,640 FIGURE ONCE SAID THINGS SHOULD 459 00:17:36,640 --> 00:17:40,160 BE AS SIMPLE AS POSSIBLE, BUT 460 00:17:40,160 --> 00:17:41,840 NOT ANY SIMPLER. 461 00:17:41,840 --> 00:17:44,440 AND I THINK THE HORMONE THERAPY 462 00:17:44,440 --> 00:17:49,120 SAGA IS A GREAT EXAMPLE OF THIS. 463 00:17:49,120 --> 00:17:52,840 THE ANSWER IS NOT 464 00:17:52,840 --> 00:17:53,440 ONE-SIZE-FITS-ALL IN TERMS OF 465 00:17:53,440 --> 00:17:53,920 HORMONE THERAPY. 466 00:17:53,920 --> 00:17:56,600 WHO IS A GOOD CANDIDATE, WHO 467 00:17:56,600 --> 00:17:59,520 ISN'T A GOOD CANDIDATE? 468 00:17:59,520 --> 00:18:04,520 WE REALLY NEED TO AVOID 469 00:18:04,520 --> 00:18:08,080 OVERSIMPLIFICATION, AND I THINK 470 00:18:08,080 --> 00:18:10,640 THAT THE TENDENCY TO 471 00:18:10,640 --> 00:18:12,880 OVERSIMPLIFY THE RESULTS OF THE 472 00:18:12,880 --> 00:18:14,280 VARIOUS STUDIES OF HORMONE 473 00:18:14,280 --> 00:18:19,280 THERAPY TO TURN IT INTO THIS 474 00:18:19,280 --> 00:18:20,720 ONE-SIZE-FITS-ALL SOLUTION IS 475 00:18:20,720 --> 00:18:26,120 REALLY WHAT'S LEADING TO THE 476 00:18:26,120 --> 00:18:27,920 SWINGING PENDULUM FROM HORMONE 477 00:18:27,920 --> 00:18:29,880 THERAPY IS GOOD FOR ALL WOMEN, 478 00:18:29,880 --> 00:18:33,160 WHICH WAS THE MESSAGE PRIOR TO 479 00:18:33,160 --> 00:18:35,680 THE WHI, TO THEN HORMONE THERAPY 480 00:18:35,680 --> 00:18:37,320 IS BAD FOR ALL WOMEN. 481 00:18:37,320 --> 00:18:40,160 I THINK THAT THE EVIDENCE IS 482 00:18:40,160 --> 00:18:43,560 SHOWING THAT HORMONE THERAPY IS 483 00:18:43,560 --> 00:18:47,840 GOOD FOR SOME BUT NOT ALL WOMEN, 484 00:18:47,840 --> 00:18:50,240 AND THE CHALLENGE IS REALLY TO 485 00:18:50,240 --> 00:18:53,480 IDENTIFY THE WOMEN WHO WILL 486 00:18:53,480 --> 00:18:53,720 BENEFIT. 487 00:18:53,720 --> 00:18:55,760 AND AVOID RISK AMONG THE WOMEN 488 00:18:55,760 --> 00:19:00,000 WHO DO NOT BENEFIT, OR DO NOT 489 00:19:00,000 --> 00:19:09,520 HAVE A FAVORABLE BENEFIT/RATIO. 490 00:19:09,520 --> 00:19:12,320 MANY PEOPLE DO NOT UNDERSTAND 491 00:19:12,320 --> 00:19:14,320 WHAT THE WHI WAS ACTUALLY 492 00:19:14,320 --> 00:19:15,840 DESIGNED TO ADDRESS. 493 00:19:15,840 --> 00:19:26,160 ITS GOAL WAS TO ASSESS THE 494 00:19:26,160 --> 00:19:27,080 BENEFIT-RISK PROFILE OF 495 00:19:27,080 --> 00:19:30,080 MENOPAUSAL PROFILE IN A WIDE AGE 496 00:19:30,080 --> 00:19:33,040 RANGE, 50 TO 79, MEAN AGE WAS 497 00:19:33,040 --> 00:19:33,200 63. 498 00:19:33,200 --> 00:19:37,200 ITS ROLE, THE ROLE OF THIS LARGE 499 00:19:37,200 --> 00:19:40,120 SCALE RANDOMIZED TRIAL WAS NOT 500 00:19:40,120 --> 00:19:42,920 TO EVALUATE HORMONE THERAPY'S 501 00:19:42,920 --> 00:19:45,760 REAL FOR MENOPAUSAL SYMPTOM 502 00:19:45,760 --> 00:19:48,480 MANAGEMENT OR FOR THE TREATMENT 503 00:19:48,480 --> 00:19:50,200 OF PREMATURE OR EARLY MENOPAUSE, 504 00:19:50,200 --> 00:19:52,200 FOR EXAMPLE WHEN HORMONE THERAPY 505 00:19:52,200 --> 00:19:53,840 IS STARTED AMONG WOMEN IN THEIR 506 00:19:53,840 --> 00:19:57,160 30s OR 40s, THAT WAS NOT ITS 507 00:19:57,160 --> 00:19:58,480 PURPOSE. 508 00:19:58,480 --> 00:20:00,640 LOOKING AT POST MENOPAUSAL WOMEN 509 00:20:00,640 --> 00:20:01,640 AGE 50-79. 510 00:20:01,640 --> 00:20:05,160 AND I WANT TO DESCRIBE RECENT 511 00:20:05,160 --> 00:20:07,720 FINDINGS FROM WHI AND OTHER 512 00:20:07,720 --> 00:20:09,520 RANDOMIZED TRIALS OF HORMONE 513 00:20:09,520 --> 00:20:15,600 THERAPY ON CLINICAL EVENT 514 00:20:15,600 --> 00:20:16,240 OUTCOMES, DESCRIBE PATIENT 515 00:20:16,240 --> 00:20:16,840 CHARACTERISTICS, PARTICULARLY 516 00:20:16,840 --> 00:20:19,120 AGE, NUMBER OF YEARS SINCE 517 00:20:19,120 --> 00:20:20,400 MENOPAUSE, UNDERLYING RISK 518 00:20:20,400 --> 00:20:23,600 FACTOR STATUS, EVEN WE'LL TALK 519 00:20:23,600 --> 00:20:27,440 ABOUT SOME BIOMARKER LEVELS THAT 520 00:20:27,440 --> 00:20:29,560 MODIFY HEALTH OUTCOMES ON HT AND 521 00:20:29,560 --> 00:20:33,760 WILL ALSO ADDRESS THE ROLE OF 522 00:20:33,760 --> 00:20:35,480 RECENT RESEARCH IN IMPROVING 523 00:20:35,480 --> 00:20:38,000 CLINICAL DECISION MAKING FOR 524 00:20:38,000 --> 00:20:42,760 HORMONAL VERSUS NON-HORMONAL 525 00:20:42,760 --> 00:20:43,320 THERAPY. 526 00:20:43,320 --> 00:20:45,520 MY COLLEAGUE DR. ANDY KAUNITZ 527 00:20:45,520 --> 00:20:50,160 PUBMED FANNED 528 00:20:50,160 --> 00:20:53,040 PUBMED FANNED -- PUBLISHED A 529 00:20:53,040 --> 00:20:54,920 PIECE, GETTING CLINICAL CARE 530 00:20:54,920 --> 00:20:57,640 BACK ON TRACK, NOTED THAT AS IS 531 00:20:57,640 --> 00:21:01,120 WELL KNOWN MORE THAN 75% OF 532 00:21:01,120 --> 00:21:02,880 PERIPOST MENOPAUSAL WOMEN HAVE 533 00:21:02,880 --> 00:21:06,400 HOT FLASHES, NIGHT SWEATS, NOT 534 00:21:06,400 --> 00:21:08,160 ALL NEED HORMONE THERAPY, MAYBE 535 00:21:08,160 --> 00:21:11,480 20% OR SO WOULD HAVE REALLY 536 00:21:11,480 --> 00:21:13,040 BOTHERSOME MODERATE TO SEVERE 537 00:21:13,040 --> 00:21:16,600 SYMPTOMS WHERE THEY BENEFIT FROM 538 00:21:16,600 --> 00:21:19,720 PRESCRIPTION MEDICATIONS, BUT 539 00:21:19,720 --> 00:21:21,280 THESE SYMPTOMS CAN HAVE A 540 00:21:21,280 --> 00:21:23,960 SUBSTANTIAL IMPACT ON SLEEP, 541 00:21:23,960 --> 00:21:24,760 QUALITY OF LIFE, WORK 542 00:21:24,760 --> 00:21:25,560 PRODUCTIVITY, AND HORMONE 543 00:21:25,560 --> 00:21:28,680 THERAPY IS THE MOST EFFECTIVE 544 00:21:28,680 --> 00:21:29,800 TREATMENT FOR VASOMOTOR 545 00:21:29,800 --> 00:21:36,480 SYMPTOMS, MANY WOMEN ARE HAVING 546 00:21:36,480 --> 00:21:37,240 DIFFICULTY FINDING A CLINICIAN 547 00:21:37,240 --> 00:21:38,440 WHO HAS TRAINING IN THESE 548 00:21:38,440 --> 00:21:39,760 DISCUSSIONS WITH WOMEN TO 549 00:21:39,760 --> 00:21:41,400 DETERMINE IF THEY ARE A GOOD 550 00:21:41,400 --> 00:21:44,160 CANDIDATE TO HAVE THE WOMEN 551 00:21:44,160 --> 00:21:47,120 SHARE IN DECISION MAKING ABOUT 552 00:21:47,120 --> 00:21:49,920 HORMONE THERAPY OR NON-HORMONAL 553 00:21:49,920 --> 00:21:51,600 TREATMENT FOR THESE VASOMOTOR 554 00:21:51,600 --> 00:21:52,840 SYMPTOMS AND OTHER MENOPAUSEALL 555 00:21:52,840 --> 00:21:53,360 SYMPTOMS. 556 00:21:53,360 --> 00:21:55,680 SO IN SOME WAYS MANY CLINICIANS 557 00:21:55,680 --> 00:21:58,160 ARE MISSING IN ACTION FOR THIS 558 00:21:58,160 --> 00:21:59,160 PATIENT POPULATION. 559 00:21:59,160 --> 00:22:00,160 AND I THINK IT'S REALLY 560 00:22:00,160 --> 00:22:03,000 IMPORTANT THAT WE TAKE THIS 561 00:22:03,000 --> 00:22:09,000 ISSUE SERIOUSLY AND GET CLINICAL 562 00:22:09,000 --> 00:22:13,160 CARE FOR MENOPAUSE BACK ON 563 00:22:13,160 --> 00:22:13,360 TRACK. 564 00:22:13,360 --> 00:22:17,760 WE KNOW HORMONE THERAPY IS A 565 00:22:17,760 --> 00:22:22,440 VERY EFFECTIVE AND THE MOST 566 00:22:22,440 --> 00:22:24,600 EFFECTIVE TREATMENT VASOMOTOR 567 00:22:24,600 --> 00:22:27,400 SYMPTOMS, HOT FLASHES, NIGHT 568 00:22:27,400 --> 00:22:33,080 SWEATS, AND THESE ARE RANDOMIZED 569 00:22:33,080 --> 00:22:35,520 TRIALS SHOWING EFFECTIVENESS OF 570 00:22:35,520 --> 00:22:37,040 HARMONY THERAPY REGARDLESS OF 571 00:22:37,040 --> 00:22:38,680 DOSE, THERE'S 80 TO 90% 572 00:22:38,680 --> 00:22:45,280 REDUCTION IN HOT FLASHES PER DAY 573 00:22:45,280 --> 00:22:46,280 WITH ANY FORMULATION. 574 00:22:46,280 --> 00:22:48,360 HORMONE THERAPY IS VERY 575 00:22:48,360 --> 00:22:48,640 EFFECTIVE. 576 00:22:48,640 --> 00:22:59,080 LET'S LOOK AT SOME OF THE 577 00:23:02,960 --> 00:23:06,480 NON-HORMONAL TREATMENTS. 578 00:23:06,480 --> 00:23:17,040 FOR NON-HORMONAL REMEDIES THERE 579 00:23:19,520 --> 00:23:21,640 ARE SSRIS, GABAPENTIN, OFF 580 00:23:21,640 --> 00:23:24,760 LABEL, THESE OTHERS ARE AT LEAST 581 00:23:24,760 --> 00:23:26,800 AS EFFECTIVE 30 TO 50% REDUCTION 582 00:23:26,800 --> 00:23:32,200 IN SYMPTOMS, AND YOU MAY HAVE 583 00:23:32,200 --> 00:23:34,560 HEARD JUST LAST WEEK NK 3 584 00:23:34,560 --> 00:23:39,360 RECEPTOR ANTAGONIST WAS JUST 585 00:23:39,360 --> 00:23:40,920 APPROVED BY THE FDA. 586 00:23:40,920 --> 00:23:41,960 NONE OF THESE TREATMENTS WOULD 587 00:23:41,960 --> 00:23:47,000 BE FREE OF RISK. 588 00:23:47,000 --> 00:23:49,920 WE KNOW SSRIs ARE NOT FREE OF 589 00:23:49,920 --> 00:23:50,640 RISK. 590 00:23:50,640 --> 00:23:52,640 NK 3 RECEPTOR AGONIST REQUIRES 591 00:23:52,640 --> 00:23:53,440 LIVER FUNCTION MONITORING AT 592 00:23:53,440 --> 00:23:56,200 BASELINE AND EVERY THREE MONTHS, 593 00:23:56,200 --> 00:23:58,200 AT LEAST THROUGH NINE MONTHS. 594 00:23:58,200 --> 00:24:00,080 THERE IS CONCERN ABOUT SOME RISK 595 00:24:00,080 --> 00:24:07,320 OF ALL OF THESE MEDICATIONS. 596 00:24:07,320 --> 00:24:09,920 WHAT IS IMPORTANT IS TO BALANCE 597 00:24:09,920 --> 00:24:12,000 BENEFITS AND RISKS AND IDENTIFY 598 00:24:12,000 --> 00:24:19,120 WOMEN WHO WILL HAVE A VERY 599 00:24:19,120 --> 00:24:19,680 FAVORABLE BENEFIT/RISK RATIO 600 00:24:19,680 --> 00:24:20,040 WITH TREATMENT. 601 00:24:20,040 --> 00:24:24,360 YOU MAY HAVE HEARD ABOUT TIMING 602 00:24:24,360 --> 00:24:26,360 HYPOTHESIS OR CRITICAL WINDOW 603 00:24:26,360 --> 00:24:27,560 HYPOTHESIS, WHICH HAS GAINED A 604 00:24:27,560 --> 00:24:29,160 LOT OF TRACTION OVER THE YEARS. 605 00:24:29,160 --> 00:24:31,120 I'LL SHOW YOU SOME EVIDENCE 606 00:24:31,120 --> 00:24:33,000 SUPPORTING IT AND SOME EVIDENCE 607 00:24:33,000 --> 00:24:36,600 THAT RAISES SOME QUESTIONS ABOUT 608 00:24:36,600 --> 00:24:36,760 IT. 609 00:24:36,760 --> 00:24:41,560 BUT BASICALLY, WHAT THIS THEORYS 610 00:24:41,560 --> 00:24:52,120 IN THE HEALTHY BLOOD VESSEL, THE 611 00:24:56,120 --> 00:24:58,280 LINING OF THE CORONARY ARTERIES 612 00:24:58,280 --> 00:25:03,320 AND ENDOTHELIUM IS QUITE 613 00:25:03,320 --> 00:25:06,800 HEALTHY, ABLE TO RESPOND TO 614 00:25:06,800 --> 00:25:08,680 ESTROGEN BY INCREASING NITRIC 615 00:25:08,680 --> 00:25:11,600 OXIDE SYNTHESIS, AND HAVING 616 00:25:11,600 --> 00:25:13,080 VASODILATION. 617 00:25:13,080 --> 00:25:15,440 THERE'S ALSO SOME EVIDENCE THAT 618 00:25:15,440 --> 00:25:17,160 ESTROGEN WHEN GIVEN TO A WOMAN 619 00:25:17,160 --> 00:25:19,760 WITH HEALTHY BLOOD VESSELS WILL 620 00:25:19,760 --> 00:25:21,560 HAVE AN ANTI-INFLAMMATORY 621 00:25:21,560 --> 00:25:23,760 EFFECT, WILL ACTUALLY DECREASE 622 00:25:23,760 --> 00:25:26,200 THE LEUKOCYTE ADHESION TO THE 623 00:25:26,200 --> 00:25:28,040 BLOOD VESSEL WALL, AND MAY 624 00:25:28,040 --> 00:25:29,160 DECREASE PLAQUE PRODUCTION. 625 00:25:29,160 --> 00:25:31,640 THERE ARE SOME FAVORABLE EFFECTS 626 00:25:31,640 --> 00:25:33,520 ON LIPIDS. 627 00:25:33,520 --> 00:25:35,080 HOWEVER, QUITE A DIFFERENT 628 00:25:35,080 --> 00:25:39,880 SCENARIO IS PRESENT IN A WOMAN 629 00:25:39,880 --> 00:25:41,160 WITH ADVANCED ATHEROSCLEROSIS, 630 00:25:41,160 --> 00:25:42,600 ADVANCED PLAQUES. 631 00:25:42,600 --> 00:25:45,520 FIRST THE ESTROGEN RECEPTOR IS 632 00:25:45,520 --> 00:25:47,960 NOT -- IS DOWNREGULATED AND NOT 633 00:25:47,960 --> 00:25:49,080 EASILY ACCESSIBLE TO ESTROGEN, 634 00:25:49,080 --> 00:25:54,800 AS A RESULT YOU DO NOT SEE 635 00:25:54,800 --> 00:25:56,160 NITRIC OXIDE SYNTHESIS OR 636 00:25:56,160 --> 00:26:04,320 DILATION, YOU SEE A PARADOXICAL 637 00:26:04,320 --> 00:26:05,040 PRO-INFLAMMATORY RESPONSE, 638 00:26:05,040 --> 00:26:08,080 INCREASED RISK IF IT'S ORAL IN 639 00:26:08,080 --> 00:26:09,240 PARTICULAR OF THROMBOTIC EFFECT 640 00:26:09,240 --> 00:26:13,840 THAT CAN OCCLUDE A STENOTIC 641 00:26:13,840 --> 00:26:16,600 CORONARY ARTERY LEADING TO 642 00:26:16,600 --> 00:26:18,520 VASOOCCLUSION, ALSO EFFECT ON 643 00:26:18,520 --> 00:26:21,600 MMP WHERE THERE MAY BE EROSION 644 00:26:21,600 --> 00:26:23,360 OF PLAQUES AND GREATER RISK OF 645 00:26:23,360 --> 00:26:24,560 PLAQUE RUPTURE. 646 00:26:24,560 --> 00:26:26,400 SO IT'S ALMOST THE OPPOSITE 647 00:26:26,400 --> 00:26:30,200 EFFECT BASED ON ANIMAL STUDIES 648 00:26:30,200 --> 00:26:34,360 AND LABORATORY STUDIES, REALLY 649 00:26:34,360 --> 00:26:35,440 SUGGESTING THAT ESTROGEN'S 650 00:26:35,440 --> 00:26:36,840 FAVORABLE EFFECTS IN EARLY 651 00:26:36,840 --> 00:26:39,400 MENOPAUSE WAY NOT APPLY TO LATER 652 00:26:39,400 --> 00:26:42,560 MENOPAUSE OR TO WOMEN WITH 653 00:26:42,560 --> 00:26:44,320 UNDERLYING ATHEROSCLEROSIS. 654 00:26:44,320 --> 00:26:47,040 WHERE DID THIS HYPOTHESIS COME 655 00:26:47,040 --> 00:26:49,080 FROM THAT ESTROGEN COULD BE 656 00:26:49,080 --> 00:26:50,480 CARDIO PROTECTIVE? 657 00:26:50,480 --> 00:26:54,000 WELL, MANY OF US REMEMBER IN THE 658 00:26:54,000 --> 00:26:56,120 1980s, 1990s, THERE WERE 659 00:26:56,120 --> 00:26:58,280 MANY OBSERVATIONAL STUDIES, 660 00:26:58,280 --> 00:27:00,360 THESE ARE OBSERVATIONAL 661 00:27:00,360 --> 00:27:02,160 CORRELATIONAL STUDIES BEING 662 00:27:02,160 --> 00:27:04,840 PUBLISHED OF HORMONE THERAPY AND 663 00:27:04,840 --> 00:27:10,760 CHD WHERE THE WOMEN WHO WERE 664 00:27:10,760 --> 00:27:11,680 TAKING HORMONE THERAPY, WHO 665 00:27:11,680 --> 00:27:13,880 ASKED TO TAKE HORMONE THERAPY, 666 00:27:13,880 --> 00:27:18,120 THEY GENERALLY HAD ABOUT 40 TO 667 00:27:18,120 --> 00:27:21,240 50% LOWER RISK OF CORONARY HEART 668 00:27:21,240 --> 00:27:23,760 DISEASE THAN WOMEN NEVER USERS. 669 00:27:23,760 --> 00:27:25,200 THESE WERE SIGNIFICANT 670 00:27:25,200 --> 00:27:28,360 DIFFERENCES SHOWED UP IN 671 00:27:28,360 --> 00:27:29,160 META-ANALYSES. 672 00:27:29,160 --> 00:27:32,480 AND SYSTEMIC HORMONE THERAPY WAS 673 00:27:32,480 --> 00:27:34,720 INCREASINGLY BEING PRESCRIBED 674 00:27:34,720 --> 00:27:36,640 FOR PREVENTION OF CHRONIC 675 00:27:36,640 --> 00:27:40,400 DISEASES, SUCH AS CORONARY HEART 676 00:27:40,400 --> 00:27:41,800 DISEASE, STROKE, COGNITIVE 677 00:27:41,800 --> 00:27:45,120 DECLINE, OTHER CHRONIC DISEASES 678 00:27:45,120 --> 00:27:50,000 IN THE 1980s, 1990s, MANY OF 679 00:27:50,000 --> 00:27:52,400 US IN CLINICAL PRACTICE REMEMBER 680 00:27:52,400 --> 00:27:55,600 HOW COMMONLY HORMONE THERAPY WAS 681 00:27:55,600 --> 00:27:56,280 BEING PRESCRIBED BY MANY 682 00:27:56,280 --> 00:27:58,280 CLINICIANS FOR THIS PURPOSE. 683 00:27:58,280 --> 00:28:00,720 IT WAS AN INCREASING TREND. 684 00:28:00,720 --> 00:28:02,840 THIS WAS TRUE ACROSS ALL 685 00:28:02,840 --> 00:28:05,200 MENOPAUSAL AGE GROUPS, NOT ONLY 686 00:28:05,200 --> 00:28:07,200 IN WOMEN WHO WERE JUST ENTERING 687 00:28:07,200 --> 00:28:08,200 MENOPAUSE. 688 00:28:08,200 --> 00:28:10,520 THIS WAS AMONG WOMEN, MANY WHO 689 00:28:10,520 --> 00:28:13,120 WERE MORE THAN TEN YEARS PAST 690 00:28:13,120 --> 00:28:16,680 ONSET OF MENOPAUSE, IN THEIR 691 00:28:16,680 --> 00:28:17,440 70s AND '80s, PRESCRIBED 692 00:28:17,440 --> 00:28:20,200 HORMONE THERAPY FOR CHRONIC 693 00:28:20,200 --> 00:28:20,640 DISEASE PREVENTION. 694 00:28:20,640 --> 00:28:22,960 LET'S LOOK AT SOME DIFFERENCES 695 00:28:22,960 --> 00:28:25,680 BETWEEN THE WHI ANDS 696 00:28:25,680 --> 00:28:26,880 OBSERVATIONAL STUDIES. 697 00:28:26,880 --> 00:28:29,120 FIRST THERE ARE SOME BIOLOGICAL 698 00:28:29,120 --> 00:28:32,240 DIFFERENCES IN TERMS OF AGE AND 699 00:28:32,240 --> 00:28:35,560 TIME SINCE MENOPAUSE. 700 00:28:35,560 --> 00:28:37,560 WHI FOCUSED ON WOMEN ACROSS THE 701 00:28:37,560 --> 00:28:43,400 SPECTRUM OF 50 TO 79, MEAN AGE 702 00:28:43,400 --> 00:28:44,680 WAS 63. 703 00:28:44,680 --> 00:28:45,680 OBSERVATIONAL STUDIES WERE 704 00:28:45,680 --> 00:28:47,880 GENERALLY WOMEN, MANY OF THESE 705 00:28:47,880 --> 00:28:51,280 STUDIES WERE STARTED IN THE 706 00:28:51,280 --> 00:28:53,560 1970s AND 1980s, WOMEN 707 00:28:53,560 --> 00:28:55,040 SEEKING HORMONE THERAPY FOR HOT 708 00:28:55,040 --> 00:28:57,200 FLASH, NIGHT SWEATS, IN THEIR 709 00:28:57,200 --> 00:28:57,760 EARLY 50s. 710 00:28:57,760 --> 00:28:59,880 THE TIME SINCE MENOPAUSE IS 711 00:28:59,880 --> 00:29:01,600 QUITE DIFFERENT, IN THE WHI IT'S 712 00:29:01,600 --> 00:29:03,440 MORE THAN 12 YEARS ON AVERAGE 713 00:29:03,440 --> 00:29:05,640 SINCE ONSET OF MENOPAUSE. 714 00:29:05,640 --> 00:29:07,160 SO ON EVERYTHING WOMEN IN WHI 715 00:29:07,160 --> 00:29:11,200 ARE MORE THAN A DECADE PAST 716 00:29:11,200 --> 00:29:12,280 ONSET OF MENOPAUSE, IN 717 00:29:12,280 --> 00:29:14,200 OBSERVATIONAL STUDIES JUST A FEW 718 00:29:14,200 --> 00:29:14,600 YEARS. 719 00:29:14,600 --> 00:29:16,760 AND THE HEALTH STATUS WAS QUITE 720 00:29:16,760 --> 00:29:17,000 DIFFERENT. 721 00:29:17,000 --> 00:29:19,240 AS YOU KNOW, THE GOLD STANDARD 722 00:29:19,240 --> 00:29:20,960 RANDOMIZED CLINICAL TRIAL, THE 723 00:29:20,960 --> 00:29:23,400 BEAUTY IS THAT YOU RANDOMIZE AND 724 00:29:23,400 --> 00:29:24,840 THE GROUPS, PLACEBO AND ACTIVE 725 00:29:24,840 --> 00:29:25,960 TREATMENT GROUPS ARE VERY 726 00:29:25,960 --> 00:29:29,680 SIMILAR IN TERMS OF HEALTH 727 00:29:29,680 --> 00:29:31,080 STATUS BASELINE CHARACTERISTICS, 728 00:29:31,080 --> 00:29:32,880 OBSERVATIONAL STUDIES THE USERS 729 00:29:32,880 --> 00:29:35,600 TENDED TO BE HEALTHIER, HIGHER 730 00:29:35,600 --> 00:29:40,000 SES, THAN NON-USERS, IT'S VERY 731 00:29:40,000 --> 00:29:41,680 CHALLENGING TO ADJUST COMPLETELY 732 00:29:41,680 --> 00:29:42,160 FOR VARIABLES. 733 00:29:42,160 --> 00:29:46,760 LET'S TURN TO WHAT WE'VE LEARNED 734 00:29:46,760 --> 00:29:49,000 FROM THE RANDOMIZED CLINICAL 735 00:29:49,000 --> 00:29:50,800 TRIALS OF HORMONE THERAPY. 736 00:29:50,800 --> 00:29:53,880 SO, FIRST I CAN SUMMARIZE IN ONE 737 00:29:53,880 --> 00:29:57,200 SENTENCE WHAT THE SECONDARY 738 00:29:57,200 --> 00:29:58,680 PREVENTION RANDOMIZED TRIALS 739 00:29:58,680 --> 00:29:59,040 SHOW. 740 00:29:59,040 --> 00:30:04,000 THEY DID NOT SHOW A BENEFIT OF 741 00:30:04,000 --> 00:30:06,280 HORMONE THERAPY FOR REDUCING 742 00:30:06,280 --> 00:30:08,280 RECURRENT CLINICAL EVENTS OR 743 00:30:08,280 --> 00:30:10,680 DEATH FROM CARDIOVASCULAR 744 00:30:10,680 --> 00:30:11,120 DISEASE. 745 00:30:11,120 --> 00:30:13,920 IN FACT, JUST THERE WERE SO MANY 746 00:30:13,920 --> 00:30:16,960 OF THESE SECONDARY PREVENTION 747 00:30:16,960 --> 00:30:20,000 TRIALS EVIDENCE THERE WAS A 748 00:30:20,000 --> 00:30:20,760 HYPOTHESIS THAT HORMONE THERAPY 749 00:30:20,760 --> 00:30:26,200 MIGHT BE CARDIO PROTECTIVE IN 750 00:30:26,200 --> 00:30:27,840 WOMEN WITH HIGHEST RISK, PRIOR 751 00:30:27,840 --> 00:30:33,080 CARDIOVASCULAR DISEASE, WOMEN 752 00:30:33,080 --> 00:30:33,880 WITH EVIDENCE OF 753 00:30:33,880 --> 00:30:36,680 ATHEROSCLEROSIS, NOT A SINGLE 754 00:30:36,680 --> 00:30:40,640 ONE SHOWED CARDIO PROTECTION, IN 755 00:30:40,640 --> 00:30:42,720 FACT THEY SHOWED NEUTRAL RESULT 756 00:30:42,720 --> 00:30:45,400 OR HARM IN INCREASED RISK. 757 00:30:45,400 --> 00:30:51,280 THIS IS IRRESPECTIVE OF WHETHER 758 00:30:51,280 --> 00:30:53,880 THEY TESTED, CONJUGATED EQUINE 759 00:30:53,880 --> 00:30:55,960 ESTROGEN OR ESTRADIOL, OR OTHER 760 00:30:55,960 --> 00:30:58,040 FORMULATIONS, LEAVING US WITH 761 00:30:58,040 --> 00:31:00,440 PRIMARY PREVENTION TRIALS OF THE 762 00:31:00,440 --> 00:31:02,080 WOMEN'S HEALTH INITIATIVE, WHICH 763 00:31:02,080 --> 00:31:06,240 THERE ARE TWO SEPARATE PARALLEL 764 00:31:06,240 --> 00:31:09,680 TRIALS, ESTROGEN PLUS PROGESTIN 765 00:31:09,680 --> 00:31:14,600 AND ESTROGEN ALONE. 766 00:31:14,600 --> 00:31:17,440 THE WHI TRIAL, THE TWO WHI 767 00:31:17,440 --> 00:31:20,280 TRIALS WERE BASED ON WHETHER THE 768 00:31:20,280 --> 00:31:22,160 WOMEN HAD A PRIOR HYSTERECTOMY 769 00:31:22,160 --> 00:31:23,960 AT START OF THE STUDY. 770 00:31:23,960 --> 00:31:25,920 IF SHE DID, AND THERE WERE MORE 771 00:31:25,920 --> 00:31:29,240 THAN 10,000 WOMEN IN THAT 772 00:31:29,240 --> 00:31:36,880 CATEGORY, SHE WAS RANDOMIZED TO 773 00:31:36,880 --> 00:31:39,600 CONJUGATED EQUINE ESTROGENSES, 774 00:31:39,600 --> 00:31:41,400 CEE, TRADITIONAL DOSE 0.65 775 00:31:41,400 --> 00:31:44,120 MILLIGRAMS A DAY VERSUS PLACEBO. 776 00:31:44,120 --> 00:31:49,080 IF SHE HAD INTACT UTERUS, 16,000 777 00:31:49,080 --> 00:31:51,480 WOMEN IN THAT TRIAL, RANDOMIZED 778 00:31:51,480 --> 00:32:01,200 TO COMBINATION OF CEE, SAME 779 00:32:01,200 --> 00:32:02,400 DOSE, PLUS MPA, 2.5 MILLIGRAMS A 780 00:32:02,400 --> 00:32:04,760 DAY VERSUS PLACEBO. 781 00:32:04,760 --> 00:32:06,120 WERE WHY THESE FORMULATIONS 782 00:32:06,120 --> 00:32:06,640 CHOSEN? 783 00:32:06,640 --> 00:32:08,320 WE DON'T USE THEM VERY MUCH 784 00:32:08,320 --> 00:32:08,560 ANYMORE. 785 00:32:08,560 --> 00:32:10,240 WELL, THE REASON THEY WERE 786 00:32:10,240 --> 00:32:14,040 CHOSEN IS THAT THESE WERE THE 787 00:32:14,040 --> 00:32:15,680 MOST COMMON HORMONE THERAPY 788 00:32:15,680 --> 00:32:17,120 FORMULATIONS THAT WERE USED AT 789 00:32:17,120 --> 00:32:20,240 THE TIME THE WHI WAS BEING 790 00:32:20,240 --> 00:32:22,880 DESIGNED IN THE VERY EARLY 791 00:32:22,880 --> 00:32:25,920 1990s, AND THESE WERE THE 792 00:32:25,920 --> 00:32:28,240 FORMULATIONS THAT WERE THE 793 00:32:28,240 --> 00:32:30,640 PREDOMINANT ONES IN THE 794 00:32:30,640 --> 00:32:32,240 OBSERVATIONAL STUDIES THAT WERE 795 00:32:32,240 --> 00:32:33,800 SHOWING CARDIO PROTECTION. 796 00:32:33,800 --> 00:32:36,720 SO TO HAVE TESTED A DIFFERENT 797 00:32:36,720 --> 00:32:38,800 FORMULATION COULD HAVE LED TO 798 00:32:38,800 --> 00:32:40,800 OTHER TYPES OF CRITICISM, WELL, 799 00:32:40,800 --> 00:32:43,680 YOU NEVER TESTED THE 800 00:32:43,680 --> 00:32:45,280 FORMULATIONS THAT WERE 801 00:32:45,280 --> 00:32:45,760 ASSOCIATED WITH CARDIO 802 00:32:45,760 --> 00:32:48,280 PROTECTION IN ALL OF THOSE 803 00:32:48,280 --> 00:32:49,400 OBSERVATIONAL STUDIES AND 804 00:32:49,400 --> 00:32:50,240 META-ANALYSES. 805 00:32:50,240 --> 00:32:53,640 AGAIN, I WANT TO EMPHASIZE THAT 806 00:32:53,640 --> 00:32:57,200 THE WHI HORMONE THERAPY TRIALS 807 00:32:57,200 --> 00:32:58,320 WERE NOT ADDRESSING HT 808 00:32:58,320 --> 00:33:01,160 INITIATION AT AGES LESS THAN 40 809 00:33:01,160 --> 00:33:02,920 OR LESS THAN 45, PREMATURE EARLY 810 00:33:02,920 --> 00:33:06,240 MENOPAUSE, AND I KNOW THERE WILL 811 00:33:06,240 --> 00:33:08,480 BE TALKS ABOUT SOME ISSUES 812 00:33:08,480 --> 00:33:12,240 REGARDING RISKS WITH EARLY 813 00:33:12,240 --> 00:33:12,800 PREMATURE MENOPAUSE, WERE 814 00:33:12,800 --> 00:33:17,040 HORMONE THERAPY SHOULD BE USED, 815 00:33:17,040 --> 00:33:19,040 NOT WHAT WHI WAS DESIGNED TO 816 00:33:19,040 --> 00:33:23,400 ADDRESS, ALSO NOT ADDRESSING HT 817 00:33:23,400 --> 00:33:32,080 USE IN PERIMENOPAUSE OR 818 00:33:32,080 --> 00:33:35,880 MENOPAUSE TRANSITION. 819 00:33:35,880 --> 00:33:38,200 NOW, BOMBSHELL FINDINGS OF THE 820 00:33:38,200 --> 00:33:44,200 WHI E PLUS P TRIAL SHOWN ON THIS 821 00:33:44,200 --> 00:33:44,520 SLIDE. 822 00:33:44,520 --> 00:33:46,240 IN JULY OF 2002, MANY PEOPLE, 823 00:33:46,240 --> 00:33:48,240 MANY OF US CAN REMEMBER WHERE WE 824 00:33:48,240 --> 00:33:51,840 WERE AT THAT TIME. 825 00:33:51,840 --> 00:33:54,480 THESE RESULTS WERE SURPRISING. 826 00:33:54,480 --> 00:33:56,880 MOST -- MOST INVESTIGATORS, MOST 827 00:33:56,880 --> 00:33:57,880 VIN IDENTIFICATIONS WERE 828 00:33:57,880 --> 00:34:00,360 EXPECTING THAT THE BENEFITS 829 00:34:00,360 --> 00:34:05,720 WOULD OUTWEIGH THE RISK, WHI 830 00:34:05,720 --> 00:34:07,400 TRIAL RESULTS WERE PUBLISHED 831 00:34:07,400 --> 00:34:10,520 EARLY THE TRIAL WAS STOPPED 3.3 832 00:34:10,520 --> 00:34:11,160 YEARS EARLY. 833 00:34:11,160 --> 00:34:15,280 I THINK IT'S QUITE CLEAR THAT 834 00:34:15,280 --> 00:34:19,320 THE RISKS DID OUTWEIGH BENEFITS. 835 00:34:19,320 --> 00:34:20,440 NUMBERS MAY SOUND ALARMING. 836 00:34:20,440 --> 00:34:23,360 WHEN YOU'RE TALKING ABOUT 837 00:34:23,360 --> 00:34:24,920 PERCENTAGE INCREASES, IT SEEMS 838 00:34:24,920 --> 00:34:26,080 VERY, VERY FRIGHTENING. 839 00:34:26,080 --> 00:34:28,400 AND WE'VE LEARNED WITH SOME 840 00:34:28,400 --> 00:34:30,880 SURVEYS OVER THE YEARS THAT MANY 841 00:34:30,880 --> 00:34:33,480 CLINICIANS AND PATIENTS HAVE 842 00:34:33,480 --> 00:34:36,680 INTERPRETED THE PERCENT INCREASE 843 00:34:36,680 --> 00:34:38,120 IN RISK AS RISK THEY ARE GOING 844 00:34:38,120 --> 00:34:39,720 HAVE BE A EVENT ON HORMONE 845 00:34:39,720 --> 00:34:43,160 THERAPY SUCH AS YOU HAVE NOT A 846 00:34:43,160 --> 00:34:45,680 29% INCREASE IN CORONARY HEART 847 00:34:45,680 --> 00:34:48,200 DISEASE BUT 29% OVERALL RISK OF 848 00:34:48,200 --> 00:34:50,640 HAVING A HEART ATTACK, 41% RISK 849 00:34:50,640 --> 00:34:52,280 OF HAVING STROKE, THAT'S NOT 850 00:34:52,280 --> 00:34:54,400 WHAT THE WHI SHOWED. 851 00:34:54,400 --> 00:34:57,840 BUT IN TERMS OF RELATIVE RISKS, 852 00:34:57,840 --> 00:34:59,440 HAZARD RATIOS, IT DID SHOW AT 853 00:34:59,440 --> 00:35:03,120 THE TIME IT WAS STOPPED EARLY IN 854 00:35:03,120 --> 00:35:08,600 JULY OF 2002 THAT CORONARY HEART 855 00:35:08,600 --> 00:35:19,160 DISEASE WAS 29% INCREASE, STROKE 856 00:35:24,960 --> 00:35:32,520 41%, PULMONARY EMBOLISN AND 857 00:35:32,520 --> 00:35:34,200 BREAST CANCER INCREASED, 65 AND 858 00:35:34,200 --> 00:35:37,040 OLDER INCREASED RISK OF 859 00:35:37,040 --> 00:35:38,680 DEMENTIA, DOUBLING BUT LATER 860 00:35:38,680 --> 00:35:41,320 STUDIES SHOWED NO INCREASE IN 861 00:35:41,320 --> 00:35:43,560 COGNITIVE DECLINE AMONG WOMEN 862 00:35:43,560 --> 00:35:53,160 WHO WERE 50 TO 55. 863 00:35:53,160 --> 00:35:56,240 IN 2004 ESTROGEN ALONE TRIAL 864 00:35:56,240 --> 00:35:57,760 RESULTS, CEE ALONE TRIAL, 865 00:35:57,760 --> 00:35:59,640 RESULTS PUBLISHED, IT WENT ON 866 00:35:59,640 --> 00:36:01,560 TWO YEARS LONGER, STOPPED ONLY 867 00:36:01,560 --> 00:36:02,440 ONE YEAR EARLY. 868 00:36:02,440 --> 00:36:05,080 THE REASON IT WAS STOPPED EARLY 869 00:36:05,080 --> 00:36:07,320 WAS THAT INCREASED RISK OF 870 00:36:07,320 --> 00:36:10,400 STROKE WAS FOUND, SIMILAR TO 871 00:36:10,400 --> 00:36:13,400 INCREASED RISK WITH ESTROGEN 872 00:36:13,400 --> 00:36:16,480 PLUS PROGESTIN, BUT THERE WAS A 873 00:36:16,480 --> 00:36:17,320 SIMILAR MAGNITUDE REDUCTION IN 874 00:36:17,320 --> 00:36:19,600 HIP FRACTURE BUT I DON'T KNOW 875 00:36:19,600 --> 00:36:21,840 THAT THESE ENDPOINTS TOTALLY 876 00:36:21,840 --> 00:36:22,560 BALANCE EACH OTHER OUT, CAN 877 00:36:22,560 --> 00:36:25,960 LEAVE THAT UP TO WHAT A WOMAN 878 00:36:25,960 --> 00:36:28,720 CONSIDERS MORE IMPORTANT. 879 00:36:28,720 --> 00:36:31,120 BUT THERE WERE MANY NULL 880 00:36:31,120 --> 00:36:33,400 FINDINGS THAT HAD SHOWN RISK 881 00:36:33,400 --> 00:36:37,600 WITH E PLUS P BUT WERE VERY NULL 882 00:36:37,600 --> 00:36:43,680 WITH ESTROGEN ALONE, INCLUDING 883 00:36:43,680 --> 00:36:45,200 CORONARY HEART DISEASE, .91, 884 00:36:45,200 --> 00:36:50,280 BREAST CANCER WAS TRENDING 885 00:36:50,280 --> 00:36:52,720 DOWNWARD, NEUTRAL, NOT 886 00:36:52,720 --> 00:36:53,920 SIGNIFICANT DIFFERENCES, 887 00:36:53,920 --> 00:36:56,520 ALL-CAUSE MORTALITY, GLOBAL 888 00:36:56,520 --> 00:36:58,760 INDECEMBER WERE ALL NEUTRAL, AND 889 00:36:58,760 --> 00:37:00,280 DEMENTIA WAS JUST BORDERLINE 890 00:37:00,280 --> 00:37:03,040 INCREASED IN WOMEN 65 AND OLDER 891 00:37:03,040 --> 00:37:07,600 BUT NO INCREASE LATER FOUND WITH 892 00:37:07,600 --> 00:37:14,320 COGNITIVE DECLINE IN WOMEN 50- 893 00:37:14,320 --> 00:37:15,160 55. 894 00:37:15,160 --> 00:37:19,400 IN JAM A IN 2013 PUBLISHED A 895 00:37:19,400 --> 00:37:23,480 STUDY OF RESULTS DURING THE 896 00:37:23,480 --> 00:37:24,560 INTERVENTION AND EXTENDED POST 897 00:37:24,560 --> 00:37:26,920 INTERVENTION PHASES THROUGH 13 898 00:37:26,920 --> 00:37:28,160 YEARS OF CUMULATIVE FOLLOW-UP, 899 00:37:28,160 --> 00:37:30,000 I'LL GO THROUGH RESULTS WITH 900 00:37:30,000 --> 00:37:30,440 YOU. 901 00:37:30,440 --> 00:37:33,600 FIRST, I WANT TO GIVE YOU THE 902 00:37:33,600 --> 00:37:35,000 BOTTOM LINE. 903 00:37:35,000 --> 00:37:36,680 THE GREEN SHOWS INTERVENTION 904 00:37:36,680 --> 00:37:38,680 PHASE, I'VE GONE THROUGH. 905 00:37:38,680 --> 00:37:39,960 THESE RESULTS DIDN'T CHANGE MUCH 906 00:37:39,960 --> 00:37:43,040 IN TERMS OF WHAT WAS INCREASED 907 00:37:43,040 --> 00:37:47,640 WITH E PLUS P, BREAST CANCER 908 00:37:47,640 --> 00:37:50,240 STROKE, GLOBAL INDEX, CEE ALONE, 909 00:37:50,240 --> 00:37:55,520 STROKE, WHAT WAS DIFFERENT IS 910 00:37:55,520 --> 00:37:56,600 THAT FURTHER EVENTS ACCRUING, 911 00:37:56,600 --> 00:37:58,720 THIS IS DURING THE INTERVENTION 912 00:37:58,720 --> 00:38:00,760 PHASE, CORONARY HEART DISEASE 913 00:38:00,760 --> 00:38:03,160 WAS NO LONGER SIGNIFICANTLY 914 00:38:03,160 --> 00:38:03,440 INCREASED. 915 00:38:03,440 --> 00:38:06,760 IT WAS JUST BORDERLINE BUT NOT 916 00:38:06,760 --> 00:38:07,240 SIGNIFICANT. 917 00:38:07,240 --> 00:38:09,200 DURING THE POST INTERVENTION 918 00:38:09,200 --> 00:38:11,400 FOLLOW-UP UP TO 13 YEARS, THERE 919 00:38:11,400 --> 00:38:13,880 WERE ONLY A FEW RESULTS THAT 920 00:38:13,880 --> 00:38:14,840 PERSISTED. 921 00:38:14,840 --> 00:38:17,840 BASICALLY ALL OF THE 922 00:38:17,840 --> 00:38:19,640 CARDIOVASCULAR EVENTS RETURNED 923 00:38:19,640 --> 00:38:22,480 TO BASELINE, AND FRACTURE 924 00:38:22,480 --> 00:38:23,720 EVENTS, ALL-CAUSE MORTALITY 925 00:38:23,720 --> 00:38:25,560 CONTINUED TO BE NEUTRAL, ZERO IS 926 00:38:25,560 --> 00:38:27,360 NO EFFECT. 927 00:38:27,360 --> 00:38:29,440 VERY NEUTRAL THROUGHOUT THE 928 00:38:29,440 --> 00:38:33,120 ENTIRE TRIAL AND FOLLOW-UP, 929 00:38:33,120 --> 00:38:35,240 GLOBAL INDEX, SUMMATION OF ALL 930 00:38:35,240 --> 00:38:38,680 OF THESE CHRONIC DISEASE 931 00:38:38,680 --> 00:38:41,480 OUTCOMES, INTERESTINGLY WE DID 932 00:38:41,480 --> 00:38:42,000 IDENTIFY A SIGNIFICANT 933 00:38:42,000 --> 00:38:48,600 REDUCTION, ABOUT 1/3 REDUCTION 934 00:38:48,600 --> 00:38:50,000 IN ENDOMETRIAL CANCER, MAYBE 935 00:38:50,000 --> 00:38:51,720 BECAUSE THE FORMULATION IS GOOD 936 00:38:51,720 --> 00:38:56,560 AT PROTECTING THE UTERUS, QUITE 937 00:38:56,560 --> 00:38:56,880 INTERESTING. 938 00:38:56,880 --> 00:38:59,200 WHAT WAS MOST SURPRISING WAS THE 939 00:38:59,200 --> 00:39:00,920 BREAST CANCER RISK CONTINUED 940 00:39:00,920 --> 00:39:02,840 WITH E PLUS P, CONTINUED TO BE 941 00:39:02,840 --> 00:39:06,920 INCREASED AND WITH ESTROGEN 942 00:39:06,920 --> 00:39:08,600 ALONE BECAME EVEN LOWER, AND 943 00:39:08,600 --> 00:39:09,960 STATISTICALLY SIGNIFICANT. 944 00:39:09,960 --> 00:39:15,640 I WANT TO SHOW YOU HOW THE 945 00:39:15,640 --> 00:39:20,200 RESULTS FOR CEE PLUS MPA AND CEE 946 00:39:20,200 --> 00:39:24,400 ALONE WERE ALMOST MIRROR, REALLY 947 00:39:24,400 --> 00:39:31,080 MIRROR IMAGES OF EACH OTHER, AND 948 00:39:31,080 --> 00:39:33,720 DELVED DEEPLY. 949 00:39:33,720 --> 00:39:37,080 WITH E PLUS P INCIDENCE, THIS IS 950 00:39:37,080 --> 00:39:39,960 A FOLLOW-UP OVER EVEN 20 YEARS, 951 00:39:39,960 --> 00:39:41,480 YOU CAN SEE AROUND 4 YEARS YOU 952 00:39:41,480 --> 00:39:44,960 START TO GET THE INCREASE IN 953 00:39:44,960 --> 00:39:47,760 INCIDENCE OF BREAST CANCER, WITH 954 00:39:47,760 --> 00:39:52,200 E PLUS P, THIS KIND OF LEVELED 955 00:39:52,200 --> 00:39:54,520 OFF AT 28% INCREASE, FOR 956 00:39:54,520 --> 00:39:59,040 MORTALITY IT WAS -- HAZARD RATIO 957 00:39:59,040 --> 00:40:00,920 1.35, NOT QUITE A SIGNIFICANT 958 00:40:00,920 --> 00:40:02,800 INCREASE FOR BREAST CANCER, THIS 959 00:40:02,800 --> 00:40:05,480 IS BREAST CANCER MORTALITY. 960 00:40:05,480 --> 00:40:10,040 FOR ESTROGEN ALONE, QUITE 961 00:40:10,040 --> 00:40:11,120 INTERESTINGLY, THE REDUCTION WAS 962 00:40:11,120 --> 00:40:15,080 22% AND IT WAS STATISTICALLY 963 00:40:15,080 --> 00:40:17,160 SIGNIFICANT FOR BREAST CANCER 964 00:40:17,160 --> 00:40:20,880 INCIDENCE, AND A 40% REDUCTION 965 00:40:20,880 --> 00:40:23,600 IN BREAST CANCER MORTALITY. 966 00:40:23,600 --> 00:40:26,560 SO VERY DIFFERENT FINDINGS FOR 967 00:40:26,560 --> 00:40:28,960 ESTROGEN PLUS PROGESTIN AND 968 00:40:28,960 --> 00:40:31,160 ESTROGEN ALONE, THIS IS 969 00:40:31,160 --> 00:40:32,160 CONJUGATED EQUINE ESTROGEN IN 970 00:40:32,160 --> 00:40:33,240 TERMS OF BREAST CANCER. 971 00:40:33,240 --> 00:40:37,200 THE KEY QUESTION RIGHT NOW, IS 972 00:40:37,200 --> 00:40:38,920 THIS A FINDING SPECIFIC TO 973 00:40:38,920 --> 00:40:40,240 CONJUGATED ESTROGEN OR IS THIS 974 00:40:40,240 --> 00:40:42,960 GOING TO BE FOUND, THIS ESTROGEN 975 00:40:42,960 --> 00:40:44,520 ALONE FINDING, IS THIS GOING TO 976 00:40:44,520 --> 00:40:47,640 BE FOUND WITH ALL FORMULATIONS 977 00:40:47,640 --> 00:40:51,080 OF ESTROGEN AND ALSO INCREASED 978 00:40:51,080 --> 00:40:53,200 RISK WITH CEE PLUS MPA, IS THIS 979 00:40:53,200 --> 00:40:58,440 ALSO GOING TO BE FOUND WITH 980 00:40:58,440 --> 00:41:04,440 OTHER ESTROGEN FORMULATIONS AND 981 00:41:04,440 --> 00:41:05,520 OTHER PRO GESTOGINE 982 00:41:05,520 --> 00:41:05,880 FORMULATIONS. 983 00:41:05,880 --> 00:41:08,680 I HOPE YOU GET FROM THIS TALK 984 00:41:08,680 --> 00:41:12,640 THAT THE ABSOLUTE RISK, NUMBER 985 00:41:12,640 --> 00:41:16,160 OF CASES PER LET'S SAY 10,000 986 00:41:16,160 --> 00:41:17,560 PERSON-YEARS ARE VERY DIFFERENT 987 00:41:17,560 --> 00:41:21,120 BY AGE GROUP, WHEN YOU'RE 988 00:41:21,120 --> 00:41:22,920 TALKING ABOUT THE EFFECTS OF 989 00:41:22,920 --> 00:41:23,400 HORMONE THERAPY. 990 00:41:23,400 --> 00:41:25,200 ACTUALLY, WHETHER YOU LOOK AT 991 00:41:25,200 --> 00:41:29,000 THE ACTIVE GROUP, WHICH IS SOLID 992 00:41:29,000 --> 00:41:30,200 BAR, OR PLACEBO GROUP, CROSS 993 00:41:30,200 --> 00:41:33,080 HATCH, YOU CAN SEE THAT THE 994 00:41:33,080 --> 00:41:34,600 TREATMENT IS MAKING VERY LITTLE 995 00:41:34,600 --> 00:41:37,920 DIFFERENCE ESPECIALLY AMONG THE 996 00:41:37,920 --> 00:41:39,240 YOUNGER WOMEN BUT THEIR ABSOLUTE 997 00:41:39,240 --> 00:41:41,640 RISKS, NUMBER OF CASES PER 998 00:41:41,640 --> 00:41:44,880 10,000 PER YEAR, IS JUST VERY 999 00:41:44,880 --> 00:41:46,560 LOW, ESPECIALLY COMPARED TO 1000 00:41:46,560 --> 00:41:50,120 WOMEN 70 TO 79, IT'S ABOUT FOUR 1001 00:41:50,120 --> 00:41:51,720 TO FIVE TIMES HIGHER AMONG WOMEN 1002 00:41:51,720 --> 00:41:55,120 70 TO 79. 1003 00:41:55,120 --> 00:41:57,920 AND INTERMEDIATE IN 60 TO 69. 1004 00:41:57,920 --> 00:42:00,120 NOW, IN TERMS OF THE RELATIVE 1005 00:42:00,120 --> 00:42:02,800 RISK, WE JUST TALKED ABOUT THE 1006 00:42:02,800 --> 00:42:06,040 ABSOLUTE RISK, WHICH IS SO 1007 00:42:06,040 --> 00:42:06,760 IMPORTANT TO DISCUSS WITH 1008 00:42:06,760 --> 00:42:08,800 PATIENTS WHEN THEY ARE MAKING 1009 00:42:08,800 --> 00:42:11,520 DECISIONS, THEY WANT TO KNOW 1010 00:42:11,520 --> 00:42:15,000 WHAT ABSOLUTE RISKS ARE, YOU 1011 00:42:15,000 --> 00:42:18,480 KNOW, IF RISK IS 1 IN A MILLION 1012 00:42:18,480 --> 00:42:22,200 INCREASED BY 20%, IT'S STILL A 1013 00:42:22,200 --> 00:42:23,520 VERY LOW RISK. 1014 00:42:23,520 --> 00:42:25,520 PATIENTS ARE INTERESTED IN 1015 00:42:25,520 --> 00:42:28,240 ABSOLUTE LOW RISK BUT IN TERMS 1016 00:42:28,240 --> 00:42:30,440 OF THE HAZARD RATIOS IN BOTH 1017 00:42:30,440 --> 00:42:32,960 TRIALS THE HAZARD RATIOS WERE 1018 00:42:32,960 --> 00:42:38,600 SIMILAR BY AGE FOR MOST OF THE 1019 00:42:38,600 --> 00:42:42,240 HEALTH OUTCOMES, INCLUDING 1020 00:42:42,240 --> 00:42:44,040 STROKE, VENOUS THROMBOSIS, 1021 00:42:44,040 --> 00:42:49,480 BREAST CANCERS, OTHER CANCERS, 1022 00:42:49,480 --> 00:42:50,640 PULMONARY EMBOLISM, BUT MUCH 1023 00:42:50,640 --> 00:42:52,080 LOWER ABSOLUTE RISK IN YOUNGER 1024 00:42:52,080 --> 00:42:58,160 COMPARED TO OLDER WOMEN. 1025 00:42:58,160 --> 00:42:59,520 DIDN'T SEE MAJOR DIFFERENCES 1026 00:42:59,520 --> 00:43:02,080 BY -- WERE LIMITED IN POWER TO 1027 00:43:02,080 --> 00:43:05,920 ADDRESS THAT, AND ALSO NOT GOING 1028 00:43:05,920 --> 00:43:07,840 TO BE PRESENTING UPCOMING SLIDES 1029 00:43:07,840 --> 00:43:12,320 CHANGES IN BODY WEIGHT, WEIGHT 1030 00:43:12,320 --> 00:43:13,120 COMPOSITION, MANY BIOMARKERS, 1031 00:43:13,120 --> 00:43:15,320 THERE WILL BE OTHER 1032 00:43:15,320 --> 00:43:16,920 PRESENTATIONS ON THAT SUBJECT. 1033 00:43:16,920 --> 00:43:19,840 I DO WANT TO HIGHLIGHT THAT 1034 00:43:19,840 --> 00:43:23,640 THERE WERE SOME SPECIFIC 1035 00:43:23,640 --> 00:43:25,360 OUTCOMES, IMPORTANT OUTCOMES, 1036 00:43:25,360 --> 00:43:27,800 WHERE EVEN THE HAZARD RATIOS 1037 00:43:27,800 --> 00:43:29,720 DIFFERED, AND IT WAS NOT ONLY 1038 00:43:29,720 --> 00:43:33,520 THE LOWER ABSOLUTE RISK BUT IT 1039 00:43:33,520 --> 00:43:37,160 WAS ALSO THE LOWER RELATIVE 1040 00:43:37,160 --> 00:43:37,480 RISK. 1041 00:43:37,480 --> 00:43:40,760 AND THIS DOES INTRODUCE 1042 00:43:40,760 --> 00:43:41,520 ADDITIONAL NUANCES. 1043 00:43:41,520 --> 00:43:45,880 SO, FOR EXAMPLE, FOR TOTAL M.I., 1044 00:43:45,880 --> 00:43:47,320 THE MOST RIGOROUSLY ADJUDICATED 1045 00:43:47,320 --> 00:43:49,360 CORONARY ENDPOINT, WE DID SEE 1046 00:43:49,360 --> 00:43:58,360 FOR THE 50 TO 59 YEAR AGE GROUP 1047 00:43:58,360 --> 00:44:00,680 .55, WHICH WAS SIGNIFICANT, 1048 00:44:00,680 --> 00:44:03,640 69.95, STARTED TO SEE INCREASE 1049 00:44:03,640 --> 00:44:04,760 WITH ESTROGEN ALONE, STARTING 1050 00:44:04,760 --> 00:44:07,920 WITH ESTROGEN ALONE HERE. 1051 00:44:07,920 --> 00:44:12,320 THE P FOR TREND BY AGE GROUP WAS 1052 00:44:12,320 --> 00:44:15,320 STATISTICALLY SIGNIFICANT, 0.02, 1053 00:44:15,320 --> 00:44:18,000 ALSO FOR ALL-CAUSE MORTALITY WE 1054 00:44:18,000 --> 00:44:22,200 SAW THIS SIGNAL FOR REDUCTION 1055 00:44:22,200 --> 00:44:25,160 WITH ESTROGEN ALONE IN ALL-CAUSE 1056 00:44:25,160 --> 00:44:27,040 MORTALITY, 0.70, NOT 1057 00:44:27,040 --> 00:44:28,480 STATISTICALLY SIGNIFICANT, VERY 1058 00:44:28,480 --> 00:44:30,760 NEUTRAL FOR 60 TO 69, TRENDING 1059 00:44:30,760 --> 00:44:36,040 UPWARD FOR WOMEN IN THEIR 70s, 1060 00:44:36,040 --> 00:44:38,040 AND, AGAIN, A SIGNIFICANT 1061 00:44:38,040 --> 00:44:42,600 P-VALUE FOR TREND BY INCREASING 1062 00:44:42,600 --> 00:44:43,160 AGE. 1063 00:44:43,160 --> 00:44:44,560 NOW, WITH ESTROGEN PLUS 1064 00:44:44,560 --> 00:44:48,520 PROGESTIN THE RISK OF M.I. WAS A 1065 00:44:48,520 --> 00:44:49,600 LITTLE MORE COMPLEX. 1066 00:44:49,600 --> 00:44:53,760 IN FACT, WHEN LOOKED AT BY AGE 1067 00:44:53,760 --> 00:44:56,680 GROUP, THERE REALLY WAS NO 1068 00:44:56,680 --> 00:44:57,440 SIGNAL OF DIFFERENCE, THIS MAY 1069 00:44:57,440 --> 00:45:01,200 BE WHY IN THE EARLY YEARS WHEN 1070 00:45:01,200 --> 00:45:02,880 THE TRIAL RESULTS WERE BEING 1071 00:45:02,880 --> 00:45:04,600 PUBLISHED THERE WASN'T A LOT OF 1072 00:45:04,600 --> 00:45:06,720 ATTENTION TO AGE BUT WE LATER 1073 00:45:06,720 --> 00:45:11,160 LOOKED AT THE NUMBER OF YEARS 1074 00:45:11,160 --> 00:45:13,160 SINCE MENOPAUSE AND HOW THAT 1075 00:45:13,160 --> 00:45:17,360 RELATED TO RISK OF M.I. ON 1076 00:45:17,360 --> 00:45:18,920 ESTROGEN PLUS PROGESTIN AND WE 1077 00:45:18,920 --> 00:45:22,800 SAW THAT THERE WAS QUITE A 1078 00:45:22,800 --> 00:45:25,320 STRONG TREND, NO INCREASED RISK 1079 00:45:25,320 --> 00:45:28,200 OF M.I. AMONG WOMEN WITHIN TEN 1080 00:45:28,200 --> 00:45:30,320 YEARS SINCE ONSET OF MENOPAUSE 1081 00:45:30,320 --> 00:45:33,200 BUT A DOUBLING IN RISK OF M.I. 1082 00:45:33,200 --> 00:45:36,240 AMONG WOMEN 20 OR MORE YEARS 1083 00:45:36,240 --> 00:45:39,600 SINCE MENOPAUSE, A STRONG TEST 1084 00:45:39,600 --> 00:45:40,480 FOR TREND. 1085 00:45:40,480 --> 00:45:42,640 NOW, WHAT OTHER EVIDENCE IS 1086 00:45:42,640 --> 00:45:43,800 THERE FOR THIS TIMING 1087 00:45:43,800 --> 00:45:46,880 HYPOTHESIS, AT LEAST AS IT 1088 00:45:46,880 --> 00:45:48,040 RELATES TO CARDIOVASCULAR 1089 00:45:48,040 --> 00:45:50,360 CORONARY DISEASE? 1090 00:45:50,360 --> 00:45:54,400 WELL, THE ELITE TRIAL, EARLY 1091 00:45:54,400 --> 00:45:55,960 VERSUS LATE WITH ESTRADIOL, THIS 1092 00:45:55,960 --> 00:45:57,320 WAS ACTUALLY DESIGNED 1093 00:45:57,320 --> 00:46:00,200 SPECIFICALLY TO TEST THE TIMING 1094 00:46:00,200 --> 00:46:01,520 HYPOTHESIS, VERY SMALL TRIAL. 1095 00:46:01,520 --> 00:46:04,040 I MEAN, YOU KNOW, WHI, WE'RE 1096 00:46:04,040 --> 00:46:06,240 TALKING ABOUT 10,000, AND THEN 1097 00:46:06,240 --> 00:46:08,240 16,000 PARTICIPANTS IN EACH OF 1098 00:46:08,240 --> 00:46:08,520 THE TRIALS. 1099 00:46:08,520 --> 00:46:10,080 THIS IS 1/10. 1100 00:46:10,080 --> 00:46:12,360 I MEAN, THIS IS VERY, VERY 1101 00:46:12,360 --> 00:46:17,320 SMALL, LESS THAN 1/10 THE SIZE, 1102 00:46:17,320 --> 00:46:18,720 643 HEALTHY POST MENOPAUSAL 1103 00:46:18,720 --> 00:46:22,760 WOMEN, LOOKING AT A SURROGATE 1104 00:46:22,760 --> 00:46:23,920 ENDPOINT, NOT CLINICAL EVENTS 1105 00:46:23,920 --> 00:46:27,280 BUT RATHER CHANGE IN CAROTID 1106 00:46:27,280 --> 00:46:30,200 INTERMEDIATAL THICKNESS UP TO 6 1107 00:46:30,200 --> 00:46:32,760 YEARS, RANDOMIZED TRIAL DESIGN 1108 00:46:32,760 --> 00:46:36,160 LOOKING AT ORAL ESTRADIOL VERSUS 1109 00:46:36,160 --> 00:46:38,880 PLACEBO IN TWO GROUPS, LESS THAN 1110 00:46:38,880 --> 00:46:40,400 SIX YEARS SINCE ONSET, EARLY 1111 00:46:40,400 --> 00:46:41,640 MENOPAUSE GROUP, AND THOSE WHO 1112 00:46:41,640 --> 00:46:45,360 WERE AT LEAST ONE DECADE SINCE 1113 00:46:45,360 --> 00:46:50,000 ONSET OF MENOPAUSE, AND THE 1114 00:46:50,000 --> 00:46:51,840 INTERVENTION WAS 17 BETA 1115 00:46:51,840 --> 00:46:57,680 ESTRADIOL 1 MILLIGRAM A DIE, 1116 00:46:57,680 --> 00:46:58,880 PROGRESS AT VAGINAL MICRONIZED 1117 00:46:58,880 --> 00:47:02,280 GEL 12 DAYS A MONTH, CAROTID TID 1118 00:47:02,280 --> 00:47:03,400 AS ENDPOINT. 1119 00:47:03,400 --> 00:47:06,480 THERE WAS A DIFFERENCE, THE TOP 1120 00:47:06,480 --> 00:47:07,640 TWO CURVES SHOW THE WOMEN WHO 1121 00:47:07,640 --> 00:47:10,640 WERE MORE THAN A DECADE PAST 1122 00:47:10,640 --> 00:47:12,440 MENOPAUSE, THERE'S VERY LITTLE 1123 00:47:12,440 --> 00:47:15,880 DIFFERENCE IN TWO CURVES IN 1124 00:47:15,880 --> 00:47:18,040 TERMS OF INCREASED CAROTID IMT 1125 00:47:18,040 --> 00:47:18,520 THICKNESS. 1126 00:47:18,520 --> 00:47:21,680 IN THE WOMEN WHO WERE LESS THAN 1127 00:47:21,680 --> 00:47:23,320 6 YEARS SINCE ONSET OF MENOPAUSE 1128 00:47:23,320 --> 00:47:29,560 YOU SEE VERY ALSO INCREASE IN 1129 00:47:29,560 --> 00:47:35,400 CAROTID IMT, MORE IN THE GROUP 1130 00:47:35,400 --> 00:47:39,200 RECEIVING PLACEBO, SIGNIFICANT 1131 00:47:39,200 --> 00:47:41,080 DIFFERENCE IN CURVES, 1132 00:47:41,080 --> 00:47:42,080 SIGNIFICANT INTERACTION BETWEEN 1133 00:47:42,080 --> 00:47:44,120 OLDER AND YOUNGER WOMEN, MORE 1134 00:47:44,120 --> 00:47:45,760 DISTANT FROM ONSET OF MENOPAUSE. 1135 00:47:45,760 --> 00:47:48,680 THIS HAS BEEN CITED AS FURTHER 1136 00:47:48,680 --> 00:47:51,360 EVIDENCE OF THE TIMING 1137 00:47:51,360 --> 00:47:53,640 HYPOTHESIS IN ADDITION TO THOSE 1138 00:47:53,640 --> 00:47:55,440 OBSERVATIONAL STUDIES AND 1139 00:47:55,440 --> 00:47:58,280 SUBGROUP FINDINGS IN WHI. 1140 00:47:58,280 --> 00:48:00,560 NOW, NOT ALL RANDOMIZED TRIALS 1141 00:48:00,560 --> 00:48:05,160 OF WOMEN IN EARLY MENOPAUSE HAVE 1142 00:48:05,160 --> 00:48:06,560 SHOWN DIFFERENCES IN CAROTID 1143 00:48:06,560 --> 00:48:09,800 IMT, LOOKED AT IN THE PREVENTION 1144 00:48:09,800 --> 00:48:13,680 STUDY, THE KEEPS TRIAL, IT WAS 1145 00:48:13,680 --> 00:48:16,120 LOOKED AT BEFORE -- THIS IS 1146 00:48:16,120 --> 00:48:18,400 ABOUT A FOUR-YEAR TRIAL, LOOKING 1147 00:48:18,400 --> 00:48:20,920 AT CAROTID IMT AS ENDPOINT, 1148 00:48:20,920 --> 00:48:22,360 THERE WERE NO SIGNIFICANT 1149 00:48:22,360 --> 00:48:24,200 DIFFERENCES ACROSS THE TREATMENT 1150 00:48:24,200 --> 00:48:32,480 GROUPS LOOKING AT ORAL CEE BUT 1151 00:48:32,480 --> 00:48:34,880 LOWER DOSE, TRANSDERMAL 1152 00:48:34,880 --> 00:48:35,760 ESTRADIOL OR PLACEBO, LOWER 1153 00:48:35,760 --> 00:48:37,840 DOSES OF ESTROGEN MAY BE A 1154 00:48:37,840 --> 00:48:39,720 FACTOR BUT NOT YET CLEAR HOW 1155 00:48:39,720 --> 00:48:41,360 IMPORTANT, ALSO BECAUSE THESE 1156 00:48:41,360 --> 00:48:45,560 WERE EXTREMELY HEALTHY WOMEN 1157 00:48:45,560 --> 00:48:48,280 HAVING LITTLE CHANGE IN THIS 1158 00:48:48,280 --> 00:48:49,600 ENDPOINT. 1159 00:48:49,600 --> 00:48:50,880 NOW, THIS SLIDE SUMMARIZES 1160 00:48:50,880 --> 00:48:53,240 SOMETHING THAT CAN BE HELPFUL IN 1161 00:48:53,240 --> 00:48:55,880 DISCUSSIONS WITH PATIENTS. 1162 00:48:55,880 --> 00:49:03,280 IT'S FOCUSING, THIS SLIDE, IS 1163 00:49:03,280 --> 00:49:06,960 FOCUS ON 50- 59 AGE GROUP WITH 1164 00:49:06,960 --> 00:49:08,320 THE MOST COMMON VASOMOTOR 1165 00:49:08,320 --> 00:49:09,440 SYMPTOMS, MOST DECISION MAKING 1166 00:49:09,440 --> 00:49:14,240 ABOUT USE OF HORMONE THERAPY AND 1167 00:49:14,240 --> 00:49:15,560 TYPICAL TREATMENT PERIOD MIGHT 1168 00:49:15,560 --> 00:49:18,320 BE 5 YEARS. 1169 00:49:18,320 --> 00:49:24,000 SO IT'S LOOKING IN A GROUP OF 1170 00:49:24,000 --> 00:49:28,920 POST MENOPAUSAL WOMEN 50-59, 1171 00:49:28,920 --> 00:49:30,480 BENEFITS AND RISKS OF HORMONE 1172 00:49:30,480 --> 00:49:33,120 THERAPY FOR PER 1,000 WOMEN OVER 1173 00:49:33,120 --> 00:49:34,960 FIVE YEARS OF TREATMENT, THIS IS 1174 00:49:34,960 --> 00:49:36,920 OVER THEIR FULL FIVE-YEAR COURSE 1175 00:49:36,920 --> 00:49:38,120 OF TREATMENT. 1176 00:49:38,120 --> 00:49:41,960 THIS IS THE NUMBER OF ADVERSE 1177 00:49:41,960 --> 00:49:46,840 EVENTS SHOWN HERE IS ENDPOINT, 1178 00:49:46,840 --> 00:49:50,080 CHD, STROKE, DVT, BREAST CANCER, 1179 00:49:50,080 --> 00:49:52,800 COLORECTAL AND OTHER CANCERS, 1180 00:49:52,800 --> 00:49:59,000 FRACTURE, SOME REDUCTION 1181 00:49:59,000 --> 00:50:01,800 FRACTURE, ALL-CAUSE MORTALITY, 1182 00:50:01,800 --> 00:50:06,800 DIABETES, E PLUSP IN THE TOP 1183 00:50:06,800 --> 00:50:08,240 PANEL COMPLEX PATTERN. 1184 00:50:08,240 --> 00:50:10,640 WITH CEE ALONE IT LOOKED PRETTY 1185 00:50:10,640 --> 00:50:12,720 GOOD FOR THE WOMEN 50-59. 1186 00:50:12,720 --> 00:50:16,000 THERE WAS A SLIGHT INCREASE IN 1187 00:50:16,000 --> 00:50:19,080 DEEP VENOUS THROMBOSIS ENDPOINT 1188 00:50:19,080 --> 00:50:21,160 BUT OVERALL THE STROKE LOOKED 1189 00:50:21,160 --> 00:50:23,320 PRETTY NEUTRAL, EVEN THOUGH WE 1190 00:50:23,320 --> 00:50:24,120 DON'T SEE SIGNIFICANT 1191 00:50:24,120 --> 00:50:27,000 INTERACTION BY AGE GROUP BUT IT 1192 00:50:27,000 --> 00:50:29,640 WAS NEUTRAL IN THIS PARTICULAR 1193 00:50:29,640 --> 00:50:30,440 AGE GROUP. 1194 00:50:30,440 --> 00:50:33,480 AND THERE WAS A REDUCTION IN 1195 00:50:33,480 --> 00:50:34,880 CORONARY DISEASE WE TALKED ABOUT 1196 00:50:34,880 --> 00:50:37,320 THAT, THERE WAS NO INCREASE IN 1197 00:50:37,320 --> 00:50:40,400 ANY OF THESE CANCERS, BREAST 1198 00:50:40,400 --> 00:50:42,320 CANCER TRENDING DOWNWARD, 1199 00:50:42,320 --> 00:50:44,280 REDUCTION IN FRACTURE, REDUCTION 1200 00:50:44,280 --> 00:50:47,800 IN ALL-CAUSE MORTALITY, 1201 00:50:47,800 --> 00:50:48,720 REDUCTION IN DIABETES, LOOKED 1202 00:50:48,720 --> 00:50:50,160 QUITE GOOD OVERALL BUT WE HAVE 1203 00:50:50,160 --> 00:50:54,480 TO BE CONCERNED ESPECIALLY WITH 1204 00:50:54,480 --> 00:50:55,360 ORAL ESTROGEN, VENOUS THROMBOSIS 1205 00:50:55,360 --> 00:50:55,720 AND STROKE. 1206 00:50:55,720 --> 00:50:57,600 THIS IS ANOTHER WAY OF LOOKING 1207 00:50:57,600 --> 00:50:59,720 AT WHAT I JUST SHOWED YOU. 1208 00:50:59,720 --> 00:51:04,400 SO, AGAIN, THESE ARE THE CASES 1209 00:51:04,400 --> 00:51:06,680 PER THOUSAND WOMEN USING HORMONE 1210 00:51:06,680 --> 00:51:08,040 THERAPY OVER FIVE-YEAR TREATMENT 1211 00:51:08,040 --> 00:51:10,520 PERIOD, THIS SHOWS ALL OF THE 1212 00:51:10,520 --> 00:51:13,880 AGE GROUPS FOR TWO REALLY 1213 00:51:13,880 --> 00:51:15,640 IMPORTANT ENDPOINTS OF ALL-CAUSE 1214 00:51:15,640 --> 00:51:17,320 MORTALITY, AND GLOBAL INDEX 1215 00:51:17,320 --> 00:51:20,800 WHICH IS A COMPOSITE OF ALL OF 1216 00:51:20,800 --> 00:51:22,800 THESE ADVERSE EVENTS. 1217 00:51:22,800 --> 00:51:26,280 AND WHAT WE FOUND BLUE IS RISK 1218 00:51:26,280 --> 00:51:27,560 REDUCTION, ACTUALLY SHOWING 1219 00:51:27,560 --> 00:51:30,120 FEWER CASES, AND RED IS SHOWING 1220 00:51:30,120 --> 00:51:31,560 SOME INCREASE. 1221 00:51:31,560 --> 00:51:34,800 WHAT WE FOUND IS THAT OVERALL 1222 00:51:34,800 --> 00:51:38,240 FOR THE WOMEN 50-59 IN THE E 1223 00:51:38,240 --> 00:51:42,120 PLUS P TRIAL THEY DID REASONABLY 1224 00:51:42,120 --> 00:51:43,400 WELL, FIVE FEWER DEATHS PER 1225 00:51:43,400 --> 00:51:46,880 THOUSAND WOMEN OVER FIVE YEARS, 1226 00:51:46,880 --> 00:51:51,360 GLOBAL INDEX SIX EXTRA ADVERSE 1227 00:51:51,360 --> 00:51:52,600 EVENTS IN TOTAL, PER THOUSAND 1228 00:51:52,600 --> 00:51:56,320 WOMEN OVER FIVE YEARS. 1229 00:51:56,320 --> 00:51:58,880 IN THE ESTROGEN ALONE, 50-59 1230 00:51:58,880 --> 00:52:03,200 YEAR AGE GROUP HAD SIX FEWER 1231 00:52:03,200 --> 00:52:05,800 DEATHS, TEN FEWER ADVERSE EVENTS 1232 00:52:05,800 --> 00:52:09,000 OVER FIVE YEARS, PER THOUSAND 1233 00:52:09,000 --> 00:52:09,440 WOMEN. 1234 00:52:09,440 --> 00:52:11,840 AND SO THAT LOOKS PRETTY 1235 00:52:11,840 --> 00:52:12,160 FAVORABLE. 1236 00:52:12,160 --> 00:52:15,240 BUT DO NOTICE THAT THESE RISKS, 1237 00:52:15,240 --> 00:52:16,960 ESPECIALLY FOR GLOBAL INDEX, ARE 1238 00:52:16,960 --> 00:52:18,640 GETTING QUITE SUBSTANTIAL IN THE 1239 00:52:18,640 --> 00:52:22,520 70 TO 79 YEAR AGE GROUP. 1240 00:52:22,520 --> 00:52:24,640 EVEN GETTING UP THERE, 60 TO 69 1241 00:52:24,640 --> 00:52:26,960 FOR THE E PLUS P TRIAL, EVEN IN 1242 00:52:26,960 --> 00:52:30,360 THE ESTROGEN ALONE WHERE THE 1243 00:52:30,360 --> 00:52:32,280 RESULTS WERE GENERALLY MORE 1244 00:52:32,280 --> 00:52:34,600 FLAVORRABLE THAN E PLUS P, 70 TO 1245 00:52:34,600 --> 00:52:36,440 79 DID HAVE 13 EXTRA DEATHS PER 1246 00:52:36,440 --> 00:52:38,880 THOUSAND WOMEN OVER FIVE YEARS 1247 00:52:38,880 --> 00:52:43,600 AND 25 EXTRA ADVERSE EVENTS PER 1248 00:52:43,600 --> 00:52:47,720 THOUSAND WOMEN OVER FIVE YEARS. 1249 00:52:47,720 --> 00:52:51,120 WE DELVED MORE DEEPLY INTO 1250 00:52:51,120 --> 00:52:53,200 MORTALITY FINDINGS IN JAMA IN 1251 00:52:53,200 --> 00:52:55,640 2017, OVER 18 YEARS OF 1252 00:52:55,640 --> 00:52:57,520 FOLLOW-UP, AND WE DID SEE PRETTY 1253 00:52:57,520 --> 00:53:01,160 FAVORABLE RESULTS IN THE 50-59 1254 00:53:01,160 --> 00:53:03,560 YEAR AGE GROUP FOR ALL-CAUSE 1255 00:53:03,560 --> 00:53:06,800 MORTALITY, PULLING THE TWO 1256 00:53:06,800 --> 00:53:08,360 TRIALS SIGNIFICANT 31% 1257 00:53:08,360 --> 00:53:10,160 REDUCTION, CBD AND CANCER 1258 00:53:10,160 --> 00:53:13,840 MORTALITY ON THE SIDE OF 1259 00:53:13,840 --> 00:53:17,600 BENEFIT, IN THE 50-59 YEAR AGE 1260 00:53:17,600 --> 00:53:19,240 GROUP AND OTHER NON-CBD 1261 00:53:19,240 --> 00:53:21,200 NON-CANCER MORTALITY ON THE SIDE 1262 00:53:21,200 --> 00:53:22,440 OF BENEFIT. 1263 00:53:22,440 --> 00:53:24,560 WE WERE INTERESTED IN THE 1264 00:53:24,560 --> 00:53:27,880 QUESTION OF IN THE ESTROGEN 1265 00:53:27,880 --> 00:53:30,320 ALONE TRIAL THIS BENEFIT SEEN 1266 00:53:30,320 --> 00:53:31,840 FOR ALL-CAUSE MORTALITY AND SOME 1267 00:53:31,840 --> 00:53:34,920 OUTCOMES, DID IT DIFFER FOR 1268 00:53:34,920 --> 00:53:36,320 WOMEN WITH BILATERAL 1269 00:53:36,320 --> 00:53:39,280 OOPHORECTOMY AND WOMEN ARE 1270 00:53:39,280 --> 00:53:39,720 CONSERVED OVARIES? 1271 00:53:39,720 --> 00:53:42,800 AND WE ACTUALLY DID SEE A 1272 00:53:42,800 --> 00:53:43,120 DIFFERENCE. 1273 00:53:43,120 --> 00:53:46,200 KEEP IN MIND THIS IS NOT 1274 00:53:46,200 --> 00:53:47,640 STARTING ESTROGEN AT THE TIME 1275 00:53:47,640 --> 00:53:52,520 THEY HAD THE BILATERAL BILATERL 1276 00:53:52,520 --> 00:53:54,480 OOPHORECTOMY, SOMETIMES IT WAS 1277 00:53:54,480 --> 00:53:57,880 MORE THAN TEN YEARS. 1278 00:53:57,880 --> 00:54:01,720 NONETHELESS, WE SAW THAT THE 1279 00:54:01,720 --> 00:54:02,480 REDUCTION THAT WE'RE SEEING IN 1280 00:54:02,480 --> 00:54:04,520 ALL-CAUSE MORTALITY WITH 1281 00:54:04,520 --> 00:54:06,840 ESTROGEN ALONE, THAT SIGNAL FOR 1282 00:54:06,840 --> 00:54:09,240 REDUCTION IS ALMOST ENTIRELY IN 1283 00:54:09,240 --> 00:54:12,560 THE WOMEN WITH BILATERAL 1284 00:54:12,560 --> 00:54:14,160 OOPHORECTOMY, AND OVER 18 YEARS 1285 00:54:14,160 --> 00:54:20,200 OF FOLLOW-UP THIS BECAME A 1286 00:54:20,200 --> 00:54:21,880 SIGNIFICANT 32% REDUCTION IN 1287 00:54:21,880 --> 00:54:25,160 WOMEN WITH BSO, OTHER FINDINGS, 1288 00:54:25,160 --> 00:54:27,240 OTHER AGE GROUPS DID NOT HAVE 1289 00:54:27,240 --> 00:54:28,360 THESE SIGNIFICANT REDUCTIONS, 1290 00:54:28,360 --> 00:54:31,000 ALSO WOMEN WITH CONSERVED 1291 00:54:31,000 --> 00:54:32,480 OVARIES DID NOT HAVE A 1292 00:54:32,480 --> 00:54:35,360 SIGNIFICANT REDUCTION. 1293 00:54:35,360 --> 00:54:38,280 FOR EXAMPLE, THEIR HAZARD RATIO 1294 00:54:38,280 --> 00:54:39,960 FOR ALL-CAUSE MORTALITY WAS 1295 00:54:39,960 --> 00:54:40,160 0.93. 1296 00:54:40,160 --> 00:54:42,920 I MEAN STILL TO THE LEFT OF 1297 00:54:42,920 --> 00:54:46,000 UNITY BUT IT WAS NOTHING TO 1298 00:54:46,000 --> 00:54:47,120 WRITE HOME ABOUT. 1299 00:54:47,120 --> 00:54:49,120 >> I'M LETTING YOU KNOW ABOUT 1300 00:54:49,120 --> 00:54:49,320 TIME. 1301 00:54:49,320 --> 00:54:50,880 >> OKAY. 1302 00:54:50,880 --> 00:54:54,200 I WILL RUSH THROUGH. 1303 00:54:54,200 --> 00:54:55,520 LDL, WE LOOKED AT BIOMARKERS TO 1304 00:54:55,520 --> 00:54:58,640 SEE WHETHER THEY MADE A 1305 00:54:58,640 --> 00:55:00,560 DIFFERENCE, GENERALLY WOMEN WITH 1306 00:55:00,560 --> 00:55:02,240 GOOD BIOMARKER STATUS TENDED TO 1307 00:55:02,240 --> 00:55:06,520 DO BETTER WITH HORMONE THERAPY 1308 00:55:06,520 --> 00:55:10,440 IN TERMS OF CHD RISK THAN WOMEN 1309 00:55:10,440 --> 00:55:20,960 WITH ADVERSE BIOMARKER RATIO. 1310 00:55:23,600 --> 00:55:24,880 TRANSDERMAL ESTRADIOL, NO 1311 00:55:24,880 --> 00:55:25,760 RANDOMIZED TRIAL ASSESSING 1312 00:55:25,760 --> 00:55:28,600 RELATIVE SAFETY OR CLINICAL 1313 00:55:28,600 --> 00:55:34,600 EVENTS, THESE ARE OBSERVATIONAL 1314 00:55:34,600 --> 00:55:35,680 STUDIES. 1315 00:55:35,680 --> 00:55:37,200 ARE LOWER DOSES SAFER FOR BLOOD 1316 00:55:37,200 --> 00:55:39,280 PRESSURE, SOME EVIDENCE FROM 1317 00:55:39,280 --> 00:55:41,480 OBSERVATIONAL VERSUS HEALTH 1318 00:55:41,480 --> 00:55:44,280 STUDY THAT .3 MILLIGRAMS MAY NOT 1319 00:55:44,280 --> 00:55:46,640 INCREASE STROKE THE WAY .65 DOES 1320 00:55:46,640 --> 00:55:49,280 BUT OTHER STUDIES HAVE SHOWN 1321 00:55:49,280 --> 00:55:49,840 MIXED RESULTS. 1322 00:55:49,840 --> 00:55:53,600 I'LL MENTION QUICKLY THAT ONE OF 1323 00:55:53,600 --> 00:55:54,520 THE CONCERNS ABOUT NON-PROVIDING 1324 00:55:54,520 --> 00:55:56,880 THE CLINICAL CARE TO WOMEN WHO 1325 00:55:56,880 --> 00:55:59,160 ARE SEEKING TREATMENT FOR THEIR 1326 00:55:59,160 --> 00:56:00,360 HOT FLASHES AND MENOPAUSAL 1327 00:56:00,360 --> 00:56:03,320 SYMPTOMS IS THAT THEY ARE 1328 00:56:03,320 --> 00:56:04,840 TURNING TO CUSTOM COMPOUNDED 1329 00:56:04,840 --> 00:56:08,240 HORMONE THERAPY WHICH IS NOT FDA 1330 00:56:08,240 --> 00:56:10,000 REGULATED. 1331 00:56:10,000 --> 00:56:12,480 THIS USE HAS SKYROCKETED, 1332 00:56:12,480 --> 00:56:13,800 BILLION DOLLAR HEAVILY MARKETED 1333 00:56:13,800 --> 00:56:14,680 INDUSTRY. 1334 00:56:14,680 --> 00:56:16,480 NO DATA ON EFFICACY, SAFETY, 1335 00:56:16,480 --> 00:56:19,120 QUALITY CONTROL. 1336 00:56:19,120 --> 00:56:21,520 WE DO HAVE FDA APPROVED 1337 00:56:21,520 --> 00:56:23,440 BIOIDENTICAL HORMONE THERAPY 1338 00:56:23,440 --> 00:56:25,960 FORMULATIONS SUCH AS ESTRADIOL, 1339 00:56:25,960 --> 00:56:28,200 YOU'LL HEAR MORE IN OTHER TALKS. 1340 00:56:28,200 --> 00:56:33,200 AND BUT MANY WOMEN THINK 1341 00:56:33,200 --> 00:56:34,840 COMPOUNDED HORMONE THERAPY IS 1342 00:56:34,840 --> 00:56:37,960 SAFER BECAUSE IT'S WITHOUT A 1343 00:56:37,960 --> 00:56:39,760 PACKAGE INSERT OR WARNING. 1344 00:56:39,760 --> 00:56:41,720 OTHERS WILL TALK ABOUT DECISION 1345 00:56:41,720 --> 00:56:43,080 MAKING. 1346 00:56:43,080 --> 00:56:46,560 WE PUBLISHED IN JAMA A FEW YEARS 1347 00:56:46,560 --> 00:56:48,240 AGO, CRANDALL AND SCHIFRIN AND 1348 00:56:48,240 --> 00:56:49,720 I, THAT STILL THE DECISION 1349 00:56:49,720 --> 00:56:53,040 SHOULD BE BASED ON VASOMOTOR 1350 00:56:53,040 --> 00:56:56,280 SYMPTOM, PRIMARILY THIS IS THE 1351 00:56:56,280 --> 00:56:57,520 INDICATION FOR TREATMENT, 1352 00:56:57,520 --> 00:56:59,920 CONFIRM HOT FLASHES ARE NIGHT 1353 00:56:59,920 --> 00:57:01,200 SWEATS ARE ADVERSELY AFFECTING 1354 00:57:01,200 --> 00:57:02,880 SWEET, DAYTIME FUNCTION, QUALITY 1355 00:57:02,880 --> 00:57:07,400 OF LIFE, ASSESS FOR 1356 00:57:07,400 --> 00:57:08,920 CONTRAINDICATIONS, ASSESS FOR 1357 00:57:08,920 --> 00:57:10,720 UNDERLYING RISK, GREEN LIGHT FOR 1358 00:57:10,720 --> 00:57:13,960 WOMEN LESS THAN 60 YEARS OLD, 1359 00:57:13,960 --> 00:57:15,160 MENOPAUSE ON SET WITHIN 10 1360 00:57:15,160 --> 00:57:16,600 YEARS, LOW RISK OF BREAST 1361 00:57:16,600 --> 00:57:21,160 CANCER, CARDIOVASCULAR DISEASE. 1362 00:57:21,160 --> 00:57:29,160 OTHER GROUPS COULD CONSIDER 1363 00:57:29,160 --> 00:57:30,720 TRANSDERMAL, OF COURSE AN OPTION 1364 00:57:30,720 --> 00:57:34,920 FOR ALL WOMEN, AND OTHERS SHOULD 1365 00:57:34,920 --> 00:57:41,200 PROBABLY AVOID HORMONE THERAPY. 1366 00:57:41,200 --> 00:57:43,000 TRANSDERMAL WITH DIABETES, 1367 00:57:43,000 --> 00:57:44,440 INCREASED RISK OF THROMBOSIS, 1368 00:57:44,440 --> 00:57:48,440 SOME EVIDENCE THAT IT'S 1369 00:57:48,440 --> 00:57:49,520 PREFERABLE WITH LOWER LIBIDO 1370 00:57:49,520 --> 00:57:51,160 ISSUES OR SEXUAL FUNCTION ISSUES 1371 00:57:51,160 --> 00:57:53,880 BECAUSE IT DOESN'T HAVE AS MUCH 1372 00:57:53,880 --> 00:57:57,120 EFFECT IN LOWERING 1373 00:57:57,120 --> 00:58:02,200 TESTOSTERONE,, MIGRAINES. 1374 00:58:02,200 --> 00:58:03,560 HORMONE THERAPY HAS AN IMPORTANT 1375 00:58:03,560 --> 00:58:05,400 ROLE IN MANAGE OF SYMPTOMS. 1376 00:58:05,400 --> 00:58:07,960 THIS IS NOT REFUTED OR EVEN 1377 00:58:07,960 --> 00:58:09,920 ADDRESSED BY THE WHI. 1378 00:58:09,920 --> 00:58:11,680 THE CURRENT EVIDENCE DOES NOT 1379 00:58:11,680 --> 00:58:14,720 SUPPORT USE OF HORMONE THERAPY 1380 00:58:14,720 --> 00:58:16,800 FOR PREVENTION OF CVD OR CHRONIC 1381 00:58:16,800 --> 00:58:19,360 DISEASES BECAUSE IT'S NOT A GOOD 1382 00:58:19,360 --> 00:58:22,440 TRADEOFF DUE TO AN INCREASED 1383 00:58:22,440 --> 00:58:24,000 RISK OF ETE, POSSIBLY STROKE, 1384 00:58:24,000 --> 00:58:26,880 WITH E PLUS P BREAST CANCER 1385 00:58:26,880 --> 00:58:28,800 ACROSS AGE GROUPS. 1386 00:58:28,800 --> 00:58:30,320 BEST CANDIDATES FOR SYSTEMIC 1387 00:58:30,320 --> 00:58:32,920 HORMONE THERAPY ARE RECENTLY 1388 00:58:32,920 --> 00:58:34,400 MENOPAUSAL, SYMPTOMATIC WOMEN IN 1389 00:58:34,400 --> 00:58:35,760 GENERALLY GOOD HEALTH WITH LOW 1390 00:58:35,760 --> 00:58:37,160 ABSOLUTE RISK, GREATER QUALITY 1391 00:58:37,160 --> 00:58:39,440 OF LIFE BENEFITS. 1392 00:58:39,440 --> 00:58:41,160 AND FOR PREVENTION PURPOSES, WE 1393 00:58:41,160 --> 00:58:44,840 HAVE A LARGE NUMBER OF 1394 00:58:44,840 --> 00:58:46,800 MODALITIES AND OPTIONS, 1395 00:58:46,800 --> 00:58:48,240 LIFESTYLE MODIFICATION, 1396 00:58:48,240 --> 00:58:48,760 GUIDELINE-DIRECTED CARE, 1397 00:58:48,760 --> 00:58:50,640 STATINS, ET CETERA. 1398 00:58:50,640 --> 00:58:53,120 RISK STRATIFICATION IS IMPORTANT 1399 00:58:53,120 --> 00:58:54,680 FOR APPROPRIATE DECISION MAKING 1400 00:58:54,680 --> 00:58:56,880 ABOUT HORMONE THERAPY AND SO 1401 00:58:56,880 --> 00:58:57,680 IMPORTANT TO HAVE SHARED 1402 00:58:57,680 --> 00:58:59,920 DECISION MAKING WITH THE 1403 00:58:59,920 --> 00:59:00,160 PATIENT. 1404 00:59:00,160 --> 00:59:04,720 WE DO NEED ADDITIONAL RESEARCH 1405 00:59:04,720 --> 00:59:07,520 ON DIFFERENT FORMULATION, ROUTES 1406 00:59:07,520 --> 00:59:08,080 OF DELIVERY, NON-HORMONAL 1407 00:59:08,080 --> 00:59:08,320 OPTIONS. 1408 00:59:08,320 --> 00:59:13,160 I WANT TO THANK ALL OF THE WOMEN 1409 00:59:13,160 --> 00:59:15,760 WHO PARTICIPATED IN THE WHI WHO 1410 00:59:15,760 --> 00:59:19,000 OVER THE 30 YEARS HAVE BEEN SO 1411 00:59:19,000 --> 00:59:22,000 DEDICATED TO THE WHI, ALL OF THE 1412 00:59:22,000 --> 00:59:23,720 INVESTIGATORS AND STAFF WHO HAVE 1413 00:59:23,720 --> 00:59:26,080 BEEN INVOLVED WITH WHI AND SO 1414 00:59:26,080 --> 00:59:29,920 MANY OTHER RESEARCH STUDIES OVER 1415 00:59:29,920 --> 00:59:30,480 THE YEARS. 1416 00:59:30,480 --> 00:59:33,080 AND THANK YOU FOR YOUR 1417 00:59:33,080 --> 00:59:33,360 ATTENTION. 1418 00:59:33,360 --> 00:59:33,720 I'LL END THERE. 1419 00:59:33,720 --> 00:59:36,080 >> THANK YOU SO MUCH FOR THAT 1420 00:59:36,080 --> 00:59:37,280 TALK, DR. MANSON. 1421 00:59:37,280 --> 00:59:39,120 IT WAS TERRIFIC TO HEAR YOUR 1422 00:59:39,120 --> 00:59:40,480 THOUGHTS ABOUT THE FOLLOW-UP 1423 00:59:40,480 --> 00:59:42,960 FROM THE WOMEN'S HEALTH 1424 00:59:42,960 --> 00:59:43,280 INITIATIVE. 1425 00:59:43,280 --> 00:59:46,880 I'D LIKE TO NOW INTRODUCE DR. 1426 00:59:46,880 --> 00:59:48,120 HADINE JOFFE, PROFESSOR OF 1427 00:59:48,120 --> 00:59:50,280 PSYCHIATRY AND BRIGHAM AND 1428 00:59:50,280 --> 00:59:52,520 WOMEN'S HOSPITAL IN BOSTON, 1429 00:59:52,520 --> 00:59:56,280 MODERATING THE NEXT SESSION AND 1430 00:59:56,280 --> 00:59:59,360 WILL INTRODUCE THE NEXT 1431 00:59:59,360 --> 00:59:59,920 SPEAKERS. 1432 00:59:59,920 --> 01:00:02,240 WE'RE GOING TO HOLD THIS Q&A 1433 01:00:02,240 --> 01:00:03,720 UNTIL THE Q&A WITH ALL OF THE 1434 01:00:03,720 --> 01:00:08,200 SPEAKERS IN THE INTEREST OF 1435 01:00:08,200 --> 01:00:08,480 TIME. 1436 01:00:08,480 --> 01:00:11,120 WELCOME, DR. JOFFE. 1437 01:00:11,120 --> 01:00:12,280 >> THANK YOU. 1438 01:00:12,280 --> 01:00:14,320 WHAT A GREAT START TO THE 1439 01:00:14,320 --> 01:00:14,720 PROGRAM. 1440 01:00:14,720 --> 01:00:17,880 THANK YOU, DR. MANSON. 1441 01:00:17,880 --> 01:00:18,400 AND DR. TEMKIN. 1442 01:00:18,400 --> 01:00:20,120 IT'S A PLEASURE TO INTRODUCE THE 1443 01:00:20,120 --> 01:00:22,840 NEXT SET OF SPEAKERS. 1444 01:00:22,840 --> 01:00:24,400 FIRST DR. GREENDALE, SHE CAN PUT 1445 01:00:24,400 --> 01:00:32,200 HER SCREEN ON AND JOIN ME HERE. 1446 01:00:32,200 --> 01:00:35,040 PROFESSOR OF MEDICINE AND 1447 01:00:35,040 --> 01:00:37,720 OBSTETRICS AND GYNECOLOGY, DAVID 1448 01:00:37,720 --> 01:00:40,120 GEFFIN SCHOOL OF MEDICINE, UCLA. 1449 01:00:40,120 --> 01:00:43,000 HER TALK IS ON MENOPAUSE 1450 01:00:43,000 --> 01:00:44,440 TRANSITION DEFINITIONS, HEALTH 1451 01:00:44,440 --> 01:00:49,240 IMPLICATIONS, FUTURE DIRECTIONS. 1452 01:00:49,240 --> 01:00:52,960 1453 01:00:52,960 --> 01:00:54,520 1454 01:00:54,520 --> 01:00:55,920 >> GOOD MORNING, EVERYONE. 1455 01:00:55,920 --> 01:01:01,000 THANK YOU FOR ALLOWING ME TO 1456 01:01:01,000 --> 01:01:03,320 SHARE INSIGHTS ABOUT DEFINITION, 1457 01:01:03,320 --> 01:01:04,280 HEALTH IMPLICATION, GAIN FROM 1458 01:01:04,280 --> 01:01:06,240 WORK IN THE STUDY OF WOMEN'S 1459 01:01:06,240 --> 01:01:08,640 HEALTH ACROSS THE NATION, AND TO 1460 01:01:08,640 --> 01:01:13,480 SHARE A FEW IDEAS ABOUT WHERE WE 1461 01:01:13,480 --> 01:01:17,320 THINK THIS WILL INFORM FUTURE 1462 01:01:17,320 --> 01:01:21,680 INVESTIGATIONS. 1463 01:01:21,680 --> 01:01:23,520 OUR AGENDA FOR THE NEXT 20 1464 01:01:23,520 --> 01:01:25,440 MINUTES IS AS FOLLOWS. 1465 01:01:25,440 --> 01:01:26,880 FIRST, A VERY BRIEF DESCRIPTION 1466 01:01:26,880 --> 01:01:29,320 OF THE STUDY OF WOMEN'S HEALTH 1467 01:01:29,320 --> 01:01:33,200 ACROSS THE NATION, AND NEXT 1468 01:01:33,200 --> 01:01:33,720 ENCAPSULATED TRANSLATIONAL 1469 01:01:33,720 --> 01:01:36,880 ADVENTURE, IN WHICH I'LL DISCUSS 1470 01:01:36,880 --> 01:01:38,400 SOME NEW CONCEPTUALIZATIONS OF 1471 01:01:38,400 --> 01:01:42,440 THE TRANSITION, HOW A VERY FEW 1472 01:01:42,440 --> 01:01:44,200 SELECTED BIOLOGICAL OUTCOMES 1473 01:01:44,200 --> 01:01:44,680 CHANGE DURING MENOPAUSE 1474 01:01:44,680 --> 01:01:46,720 TRANSITION, AND HONE IN ON 1475 01:01:46,720 --> 01:01:50,440 EXAMPLE OF ONE OUTCOME THAT CAN 1476 01:01:50,440 --> 01:01:52,760 INFORM OPPORTUNITIES FOR 1477 01:01:52,760 --> 01:01:57,720 MAINTAINING HEALTH. 1478 01:01:57,720 --> 01:02:00,680 SWAN IS A MULTI-CENTER, 1479 01:02:00,680 --> 01:02:10,440 MULTI-HETEROGENEITY NICK 1480 01:02:10,440 --> 01:02:12,240 COMMUNITY -- MULTI-ETHNIC STUDY 1481 01:02:12,240 --> 01:02:14,800 TO STUDY EFFECTS ON HEALTH BEING 1482 01:02:14,800 --> 01:02:16,840 AND LATER LIFE. 1483 01:02:16,840 --> 01:02:18,280 OVERARCHING AND HIGHLY IMPORTANT 1484 01:02:18,280 --> 01:02:21,200 GOAL IS TO DESCRIBE NATURAL 1485 01:02:21,200 --> 01:02:25,160 HISTORY OF MENOPAUSE IN ORDER TO 1486 01:02:25,160 --> 01:02:29,160 DRAW CLINICALLY RELEVANT 1487 01:02:29,160 --> 01:02:30,960 THERAPEUTIC TARGETS. 1488 01:02:30,960 --> 01:02:36,200 THE SWAN LONGITUDINAL COHORT 1489 01:02:36,200 --> 01:02:45,840 WHICH WAS INCETTED IN THE 1490 01:02:45,840 --> 01:02:49,400 1990s, 42 TO 52, PRE-OR EARLY 1491 01:02:49,400 --> 01:02:51,840 PERIMENOPAUSAL, A MEMBER OF EACH 1492 01:02:51,840 --> 01:02:53,360 SITE'S RACIAL OFFER ETHNIC 1493 01:02:53,360 --> 01:02:57,160 GROUP, WHICH WERE WHITE, BLACK, 1494 01:02:57,160 --> 01:03:02,600 HISPANIC, CHINESE, JAPANESE. 1495 01:03:02,600 --> 01:03:04,080 JAPANESE, CHINESE AND HISPANIC 1496 01:03:04,080 --> 01:03:06,560 WOMEN AT ONE SITE, BLACK AT FOUR 1497 01:03:06,560 --> 01:03:09,400 SITES, AND WHITE WOMEN AT ALL 1498 01:03:09,400 --> 01:03:12,200 SEVEN CLINICAL SITES, AND THE 1499 01:03:12,200 --> 01:03:15,000 NUMBERS OF INITIALLY ENROLLED 1500 01:03:15,000 --> 01:03:18,640 WOMEN BY EACH ETHNIC GROUP ARE 1501 01:03:18,640 --> 01:03:19,800 SHOWN ON THE SLIDE. 1502 01:03:19,800 --> 01:03:23,240 NOW, I SAID WE'RE GOING TO TALK 1503 01:03:23,240 --> 01:03:25,520 ABOUT CONCEPTUALIZATIONS OF THE 1504 01:03:25,520 --> 01:03:27,880 MENOPAUSE AND MENOPAUSE 1505 01:03:27,880 --> 01:03:30,120 TRANSITION, SO STARTING FROM 1506 01:03:30,120 --> 01:03:34,520 PRIOR TO MENOPAUSE TRANSITION 1507 01:03:34,520 --> 01:03:35,480 ORIENTED STUDIES MEDICAL 1508 01:03:35,480 --> 01:03:38,280 COMMUNITY USED TO CONCEIVE OF 1509 01:03:38,280 --> 01:03:40,160 MENOPAUSE AS BINARY CONDITION, 1510 01:03:40,160 --> 01:03:42,360 YOU'RE PRE OR POST MENOPAUSAL, 1511 01:03:42,360 --> 01:03:45,440 AND POST WAS JUST DEFINED AS 12 1512 01:03:45,440 --> 01:03:47,200 MONTHS WITHOUT A PERIOD. 1513 01:03:47,200 --> 01:03:51,240 WITH THE ADVENT OF MENOPAUSE 1514 01:03:51,240 --> 01:03:58,840 TRANSITION-BASED THINKING IN THE 1515 01:03:58,840 --> 01:04:01,280 1980s INVESTIGATORS NEEDED A 1516 01:04:01,280 --> 01:04:05,440 WAY TO CATEGORIZE, USING 1517 01:04:05,440 --> 01:04:06,560 MENSTRUAL PATTERNS. 1518 01:04:06,560 --> 01:04:10,040 EARLY PERIMENOPAUSE WAS DEFINED 1519 01:04:10,040 --> 01:04:12,560 AS LESS PREDICTABLE CYCLES BUT 1520 01:04:12,560 --> 01:04:15,200 NO GAPS, LATE PERIMENOPAUSE WAS 1521 01:04:15,200 --> 01:04:17,600 DEFINDS AS OVERT GAP OF LESS 1522 01:04:17,600 --> 01:04:21,960 THAN OR EQUAL TO 3 MONTHS. 1523 01:04:21,960 --> 01:04:23,680 THESE CATEGORIZATIONS HAVE BEEN 1524 01:04:23,680 --> 01:04:26,560 REFINED A BIT OVER THE LAST 1525 01:04:26,560 --> 01:04:29,000 COUPLE DECADES BUT I WILL NOT GO 1526 01:04:29,000 --> 01:04:31,280 INTO MORE DETAIL ABOUT THE 1527 01:04:31,280 --> 01:04:32,240 MENSTRUALLY DEFINED STAGES IN 1528 01:04:32,240 --> 01:04:34,680 THE INTEREST OF TIME. 1529 01:04:34,680 --> 01:04:37,160 I AM GOING TO CONCENTRATE ON THE 1530 01:04:37,160 --> 01:04:40,480 FINAL MENSTRUAL PERIOD TIME 1531 01:04:40,480 --> 01:04:42,000 FRAMEWORK, WHICH IS ONE OF THE 1532 01:04:42,000 --> 01:04:45,960 LARGE SHIFTS IN HOW WE THINK 1533 01:04:45,960 --> 01:04:47,960 ABOUT THE MENOPAUSE TRANSITION. 1534 01:04:47,960 --> 01:04:51,000 AND THIS SLIDE ILLUSTRATES HOW 1535 01:04:51,000 --> 01:04:54,560 TO THINK ABOUT FMP TIME. 1536 01:04:54,560 --> 01:04:57,960 FMP TIME IS DEFINED AS TIME 1537 01:04:57,960 --> 01:05:00,920 ZERO, THE DATE WHEN YOU'VE HAD 1538 01:05:00,920 --> 01:05:02,840 YOUR FINAL MENSTRUAL PERIOD. 1539 01:05:02,840 --> 01:05:05,440 YEARS PRIOR TO THE FMP ARE GIVEN 1540 01:05:05,440 --> 01:05:06,840 NEGATIVE NUMBERS. 1541 01:05:06,840 --> 01:05:12,000 YEARS AFTER THE FMP ARE GIVEN 1542 01:05:12,000 --> 01:05:12,400 POSITIVE NUMBERS. 1543 01:05:12,400 --> 01:05:14,520 OBVIOUSLY, WE CANNOT DATE A 1544 01:05:14,520 --> 01:05:17,360 WOMAN'S FMP TIME UNTIL SHE HAS 1545 01:05:17,360 --> 01:05:18,560 HAD HER FMP. 1546 01:05:18,560 --> 01:05:22,000 SO WE DID THIS IN SWAN AFTER 1547 01:05:22,000 --> 01:05:24,320 WOMEN HAD GONE THROUGH THEIR 1548 01:05:24,320 --> 01:05:28,880 MENOPAUSE TRANSITION AFTER 12 1549 01:05:28,880 --> 01:05:29,680 MONTHS OF AMENORREAH BACKED UP 1550 01:05:29,680 --> 01:05:33,080 12 MONTHS AND SAID THAT'S YOUR 1551 01:05:33,080 --> 01:05:34,040 FMP DATE. 1552 01:05:34,040 --> 01:05:36,120 NOW, WHY WOULD WE WANT TO BOTHER 1553 01:05:36,120 --> 01:05:36,960 TO DO THIS? 1554 01:05:36,960 --> 01:05:40,280 WHY DO WE HAVE TO THINK ABOUT 1555 01:05:40,280 --> 01:05:42,240 TIME TO FMP? 1556 01:05:42,240 --> 01:05:48,120 ONE GOOD REASON TO REDEFINE THE 1557 01:05:48,120 --> 01:05:49,280 MENOPAUSE TRANSITION OR ADD IT 1558 01:05:49,280 --> 01:05:55,480 TO OUR CADRE OF DEFINITIONS IS 1559 01:05:55,480 --> 01:05:56,720 MENSTRUALLY DEFINED STAGES ARE 1560 01:05:56,720 --> 01:06:00,600 NOT STRONG INDICATORS OF TIME TO 1561 01:06:00,600 --> 01:06:01,280 FINAL MENSTRUAL PERIOD. 1562 01:06:01,280 --> 01:06:03,120 SHOWN ON THIS SLIDE WE HAVE 1563 01:06:03,120 --> 01:06:05,600 NUMBER OF MONTHS BEFORE THE FMP, 1564 01:06:05,600 --> 01:06:09,080 OR FMP TIME ON THE Y-AXIS. 1565 01:06:09,080 --> 01:06:11,880 AND MENOPAUSE STAGES BY BLEEDING 1566 01:06:11,880 --> 01:06:13,400 PATTERNS ON THE X-AXIS. 1567 01:06:13,400 --> 01:06:17,160 AND I CALL YOUR ATTENTION TO THE 1568 01:06:17,160 --> 01:06:18,960 LAST ROW. 1569 01:06:18,960 --> 01:06:20,560 WOMEN IN THIS LAST ROW ARE 1570 01:06:20,560 --> 01:06:24,520 WITHIN 12 MONTHS OF THEIR FMP, 1571 01:06:24,520 --> 01:06:32,720 SO FMP TIME MINUS 12 TO ZERO, 1572 01:06:32,720 --> 01:06:35,200 68.7% CLINICAL DEFINED BY 1573 01:06:35,200 --> 01:06:40,920 BLEEDING PATTERNS AS EARLY 1574 01:06:40,920 --> 01:06:42,440 PERIMENOPAUSAL, THERE'S NOTHING 1575 01:06:42,440 --> 01:06:43,880 EARLY ABOUT BEING ONE YEAR PRIOR 1576 01:06:43,880 --> 01:06:45,920 TO YOUR FMP I WOULD ARGUE. 1577 01:06:45,920 --> 01:06:46,680 SO WHAT? 1578 01:06:46,680 --> 01:06:52,840 DOES KNOWING HOW FAR AWAY YOUR 1579 01:06:52,840 --> 01:06:53,800 FMP IS MATTER? 1580 01:06:53,800 --> 01:06:55,760 I THINK THE ANSWER TO THAT 1581 01:06:55,760 --> 01:06:56,680 QUESTION IS YES. 1582 01:06:56,680 --> 01:07:00,080 AND HERE IS SOME EVIDENCE TO 1583 01:07:00,080 --> 01:07:03,320 SUPPORT MY CONTENTION. 1584 01:07:03,320 --> 01:07:07,920 SHOWN HERE IS A LOESS PLOT OF 1585 01:07:07,920 --> 01:07:13,160 TRAJECTORY BY FMP TIME, WITH 1586 01:07:13,160 --> 01:07:16,200 BASELINE NORMALIZED LUMBAR SPINE 1587 01:07:16,200 --> 01:07:21,000 BMD, EVERY WOMAN NORMALIZED TO 1588 01:07:21,000 --> 01:07:24,600 HER OWN BASELINE, AND FMP TIME 1589 01:07:24,600 --> 01:07:28,240 ON THE X-AXIS WITH OUR FRIEND 1590 01:07:28,240 --> 01:07:32,360 FMP TIME ZERO SHOWN BY SOLID 1591 01:07:32,360 --> 01:07:40,040 LINE, MINE MINUS YEARS ARE YEAS 1592 01:07:40,040 --> 01:07:40,280 BEFORE. 1593 01:07:40,280 --> 01:07:42,040 IF YOU LOOK AT THE LOWEST PLOT 1594 01:07:42,040 --> 01:07:46,440 YOU'LL SEE WOMEN'S BONE DENSITY 1595 01:07:46,440 --> 01:07:49,240 IS STABLE UNTIL THEY HIT ABOUT A 1596 01:07:49,240 --> 01:07:52,920 YEAR PRIOR TO THEIR FMP, WHERE 1597 01:07:52,920 --> 01:07:55,360 THERE IS A STRIKING ACCELERATION 1598 01:07:55,360 --> 01:07:57,360 IN THE RATE OF BONE LOSS, 1599 01:07:57,360 --> 01:08:01,160 THERE'S THE ONSET OF BONE LOSS, 1600 01:08:01,160 --> 01:08:05,400 FROM MINUS 1 TO PLUS 2 FMP 1601 01:08:05,400 --> 01:08:05,960 YEARS. 1602 01:08:05,960 --> 01:08:10,000 AND THEN THIS RATE SLOWS BUT 1603 01:08:10,000 --> 01:08:12,400 DOES NOT CEASE AT ABOUT 2 YEARS 1604 01:08:12,400 --> 01:08:13,960 AFTER THE FMP. 1605 01:08:13,960 --> 01:08:17,240 AND TO DR. CLAYTON'S POINT ABOUT 1606 01:08:17,240 --> 01:08:20,720 INFLECTION, IF THIS ISN'T AN 1607 01:08:20,720 --> 01:08:23,040 INFLECTION, I DON'T KNOW WHAT 1608 01:08:23,040 --> 01:08:23,960 IS. 1609 01:08:23,960 --> 01:08:25,280 NOW, THAT'S A LOESS PLOT, THOSE 1610 01:08:25,280 --> 01:08:26,920 OF YOU THAT ARE FAMILIAR WILL 1611 01:08:26,920 --> 01:08:29,800 KNOW THOSE ARE BASED ON 1612 01:08:29,800 --> 01:08:30,560 CROSS-SECTIONAL DATA, NOT 1613 01:08:30,560 --> 01:08:35,640 PARAMETRIC BUT WHAT YOU CAN DO 1614 01:08:35,640 --> 01:08:44,960 IS YOU CAN GENERATE A PIECE-WISE 1615 01:08:44,960 --> 01:08:46,800 LINEAR MODEL THAT CAPTURES BE ON 1616 01:08:46,800 --> 01:08:50,400 VACCINATIONS IN THE LOESS PLOT 1617 01:08:50,400 --> 01:08:56,360 AND DIVIDE FMP INTO 1618 01:08:56,360 --> 01:09:01,240 PRE-MENOPAUSE TRANSITION, MINUS 1619 01:09:01,240 --> 01:09:03,600 1, AND PLUS 2 TO PLUS 5. 1620 01:09:03,600 --> 01:09:05,920 AGAIN, I'M GOING TO UNDERSCORE 1621 01:09:05,920 --> 01:09:09,000 THE FACT THAT THESE ARE 1622 01:09:09,000 --> 01:09:12,160 FMP-BASED DEFINITIONS, DO NOT 1623 01:09:12,160 --> 01:09:13,960 CORRESPOND TO MENSTRUAL CATEGORY 1624 01:09:13,960 --> 01:09:15,000 DEFINITION. 1625 01:09:15,000 --> 01:09:17,640 AT THE LUMBAR SPINE, AS 1626 01:09:17,640 --> 01:09:20,360 SUGGESTED BY THE PLOT, THERE IS 1627 01:09:20,360 --> 01:09:23,240 NO BONE LOSS, THESE ARE MEAN 1628 01:09:23,240 --> 01:09:25,360 RATES, THERE'S NO BONE LOSS 1629 01:09:25,360 --> 01:09:29,040 PRIOR TORE FMP MINUS 1 AT EITHER 1630 01:09:29,040 --> 01:09:32,320 BONE SITE, LUMBAR SPINE OR 1631 01:09:32,320 --> 01:09:33,160 FEMORAL NECK. 1632 01:09:33,160 --> 01:09:34,080 DURING THE TRANSITION WHEN 1633 01:09:34,080 --> 01:09:38,320 THINGS TAKE OFF RATE OF LOSS AT 1634 01:09:38,320 --> 01:09:43,680 LUMBAR SPINE IS 2.5% PER YEAR, 1635 01:09:43,680 --> 01:09:47,680 FEMORAL NECK 1.78% PER YEAR WITH 1636 01:09:47,680 --> 01:09:49,960 DECREASE IN THAT LOSS RATE 1637 01:09:49,960 --> 01:09:52,560 DROPPING DOWN TO ABOUT A PERCENT 1638 01:09:52,560 --> 01:09:55,280 PER YEAR IN EARLY POST 1639 01:09:55,280 --> 01:09:55,800 MENOPAUSE. 1640 01:09:55,800 --> 01:09:58,000 AS I MENTIONED, THESE ARE MEAN 1641 01:09:58,000 --> 01:09:59,880 VALUES, AND I'D LIKE TO CALL 1642 01:09:59,880 --> 01:10:05,160 YOUR ATTENTION TO A VERY 1643 01:10:05,160 --> 01:10:06,120 STRIKING ESTIMATE. 1644 01:10:06,120 --> 01:10:10,520 IF WE CONSIDER WHO IS IN THE TOP 1645 01:10:10,520 --> 01:10:12,360 QUARTILE OF LUMBAR SPINE BONE 1646 01:10:12,360 --> 01:10:17,880 LOSS RATE, THESE ARE WOMEN WHOSE 1647 01:10:17,880 --> 01:10:23,960 BONE LOSS RANGE FROM MINUS 3.6 1648 01:10:23,960 --> 01:10:29,200 TO MINUS 10.8% A YEAR, 1649 01:10:29,200 --> 01:10:29,960 ASTRONOMICALLY HIGH RATES OF 1650 01:10:29,960 --> 01:10:30,480 BONE LOSS. 1651 01:10:30,480 --> 01:10:33,680 THIS SLIDE IS A BIT OF A 1652 01:10:33,680 --> 01:10:37,920 DIGRESSION, BUT I WANTED TO 1653 01:10:37,920 --> 01:10:40,680 UNDERSCORE THE NOTION THAT THE 1654 01:10:40,680 --> 01:10:42,880 ACCELERATED CHANGES IN BIOLOGY 1655 01:10:42,880 --> 01:10:45,880 THAT OCCUR DURING THE MENOPAUSE 1656 01:10:45,880 --> 01:10:49,520 TRANSITION ARE NOT ISOLATED TO 1657 01:10:49,520 --> 01:10:51,600 BONE DENSITY ALONE. 1658 01:10:51,600 --> 01:10:55,400 BUT BEING A BONE HEAD I CAN'T 1659 01:10:55,400 --> 01:11:00,000 HELP MYSELF, I HAVE A LOSS OF 1660 01:11:00,000 --> 01:11:02,440 TRABECULAR BONE SCORE, A MEASURE 1661 01:11:02,440 --> 01:11:05,120 OF BONE STRENGTH AND APPROXIMATE 1662 01:11:05,120 --> 01:11:06,040 ESTIMATE OF BONE 1663 01:11:06,040 --> 01:11:06,440 MICROARCHITECTURE. 1664 01:11:06,440 --> 01:11:09,720 AND AS YOU CAN SEE FROM LOOKING 1665 01:11:09,720 --> 01:11:14,320 AT THIS FIRST PANEL, IT IS 1666 01:11:14,320 --> 01:11:16,000 STABLE UP TO FMP MINUS 1 1/2. 1667 01:11:16,000 --> 01:11:19,080 LET ME POINT OUT FOR MANY 1668 01:11:19,080 --> 01:11:20,000 BIOLOGICAL OUTCOMES THESE 1669 01:11:20,000 --> 01:11:20,920 INFLECTION POINTS DIFFER A BIT, 1670 01:11:20,920 --> 01:11:24,040 IF I SHOWED YOU OTHER SLIDES YOU 1671 01:11:24,040 --> 01:11:28,720 WOULD FIND DIFFERENT INFLECTION 1672 01:11:28,720 --> 01:11:29,160 POINTS. 1673 01:11:29,160 --> 01:11:32,400 MINUS 1 1/2 TO PLUS 2 THERE'S A 1674 01:11:32,400 --> 01:11:35,640 SHARP ACCELERATION IN THE LOSS 1675 01:11:35,640 --> 01:11:37,960 OF TRABECULAR BONE SCORE OR BONE 1676 01:11:37,960 --> 01:11:41,240 STRENGTH, AND SLOWING IN THE 1677 01:11:41,240 --> 01:11:42,560 POST-MENOPAUSE. 1678 01:11:42,560 --> 01:11:44,320 SWITCHING OVER TO ANOTHER 1679 01:11:44,320 --> 01:11:46,080 BIOLOGICAL SYSTEM, THE AMOUNT OF 1680 01:11:46,080 --> 01:11:56,240 FAT MASS AS MEASURED BY DUAL 1681 01:11:56,240 --> 01:12:02,360 ENERGY X-RAY ABSORBTOMETR, IT'S 1682 01:12:02,360 --> 01:12:03,520 STATISTICALLY SIGNIFICANT 1683 01:12:03,520 --> 01:12:07,560 POSITIVE LINE, BUT ACCELERATING 1684 01:12:07,560 --> 01:12:10,280 IN THE MENOPAUSE TRANSITION AND 1685 01:12:10,280 --> 01:12:16,760 LEVELING OUT AFTER MENOPAUSE 1686 01:12:16,760 --> 01:12:18,080 TRANSITION, I WILL MENTION THESE 1687 01:12:18,080 --> 01:12:22,680 DO DIFFER BY BIOLOGICAL OUTCOME, 1688 01:12:22,680 --> 01:12:25,280 FOR BONES THEY CONTINUE TO TREND 1689 01:12:25,280 --> 01:12:26,560 DOWN AFTER MENOPAUSE TRANSITION, 1690 01:12:26,560 --> 01:12:30,200 FOR FAT MASS WE HAVE SEEN 1691 01:12:30,200 --> 01:12:31,200 STABILIZATION. 1692 01:12:31,200 --> 01:12:34,000 IF YOU'RE INTERESTED IN THE 1693 01:12:34,000 --> 01:12:34,680 PIECE-WISE LINEAR REGRESSIONS 1694 01:12:34,680 --> 01:12:38,560 YOU CAN LOOK UP THE JOURNAL OF 1695 01:12:38,560 --> 01:12:40,520 CLINICAL AND ENDOCRINOLOGY OR 1696 01:12:40,520 --> 01:12:46,200 JCI INSIGHT REFERENCES TO GET 1697 01:12:46,200 --> 01:12:47,040 THOSE EXACT ESTIMATES. 1698 01:12:47,040 --> 01:12:49,640 SO THIS BRINGS US TO A 1699 01:12:49,640 --> 01:12:50,480 TRANSLATIONAL OPPORTUNITY, AND I 1700 01:12:50,480 --> 01:12:55,840 AM GOING TO HONE IN ON BONE 1701 01:12:55,840 --> 01:12:57,480 BECAUSE IT'S VERY, VERY 1702 01:12:57,480 --> 01:12:59,120 DEVELOPED BIOLOGICAL OUTCOME IN 1703 01:12:59,120 --> 01:13:00,520 SWAN AND IT'S BECAUSE I KNOW A 1704 01:13:00,520 --> 01:13:02,320 LOT ABOUT BONE RELATIVE TO OTHER 1705 01:13:02,320 --> 01:13:05,360 THINGS, SO THAT'S WHAT I SHOULD 1706 01:13:05,360 --> 01:13:06,640 TALK ABOUT. 1707 01:13:06,640 --> 01:13:09,560 THE QUESTION OF GOING TO POST, 1708 01:13:09,560 --> 01:13:14,000 SHOULD WE TRY TO STOP MENOPAUSE 1709 01:13:14,000 --> 01:13:16,400 TRANSITION-RELATED BONE LOSS? 1710 01:13:16,400 --> 01:13:18,920 AGAIN, MY RESPONSE TO THIS 1711 01:13:18,920 --> 01:13:20,440 QUESTION IS YES. 1712 01:13:20,440 --> 01:13:28,240 WE SHOULD TRY TO STOP MENOPAUSE 1713 01:13:28,240 --> 01:13:30,000 TRANSITION-RELATED BONE LOSS AND 1714 01:13:30,000 --> 01:13:30,920 THIS SUMMARIZES THE THREE 1715 01:13:30,920 --> 01:13:36,600 REASONS I RESPOND WITH A YES 1716 01:13:36,600 --> 01:13:37,280 ANSWER. 1717 01:13:37,280 --> 01:13:40,280 ONE, MORE BONE IS BETTER THAN 1718 01:13:40,280 --> 01:13:40,560 LESS BONE. 1719 01:13:40,560 --> 01:13:43,040 WE DID NOT DISCOVER THIS IN 1720 01:13:43,040 --> 01:13:44,360 SWAN. 1721 01:13:44,360 --> 01:13:46,400 MANY, MANY, MANY OTHER COHORTS 1722 01:13:46,400 --> 01:13:49,400 HAVE SHOWN THAT THE STRONGEST 1723 01:13:49,400 --> 01:13:52,080 PREDICTOR OF FUTURE FRACTURE IS 1724 01:13:52,080 --> 01:13:53,400 YOUR ABSOLUTE BONE DENSITY. 1725 01:13:53,400 --> 01:13:56,840 I DID SHOW YOU THAT DURING THE 1726 01:13:56,840 --> 01:13:58,080 MENOPAUSE TRANSITION BONE IS 1727 01:13:58,080 --> 01:13:59,720 LOST AT ABOUT TWICE THE AGING 1728 01:13:59,720 --> 01:14:01,280 RATE, IF YOU CONSIDER THE AGING 1729 01:14:01,280 --> 01:14:04,120 RATE TO BE THE ONE THAT I SHOWED 1730 01:14:04,120 --> 01:14:05,760 YOU IN EARLY POST MENOPAUSE, 1731 01:14:05,760 --> 01:14:09,360 WHICH IS A REASONABLE ESTIMATE. 1732 01:14:09,360 --> 01:14:13,080 AND BONE ARCHITECTURE IS DAMAGED 1733 01:14:13,080 --> 01:14:14,840 DURING THE MENOPAUSE TRANSITION. 1734 01:14:14,840 --> 01:14:17,040 NOW, HERE IS THE REALLY STRIKING 1735 01:14:17,040 --> 01:14:20,200 PART AND UNIQUE PART ABOUT THE 1736 01:14:20,200 --> 01:14:22,000 MENOPAUSE TRANSITION. 1737 01:14:22,000 --> 01:14:25,200 INDEPENDENT OF STARTING LEVEL, 1738 01:14:25,200 --> 01:14:27,440 SO INDEPENDENT OF ABSOLUTE BMD, 1739 01:14:27,440 --> 01:14:28,840 MORE MENOPAUSE 1740 01:14:28,840 --> 01:14:32,240 TRANSITION-RELATED BONE LOSS 1741 01:14:32,240 --> 01:14:33,720 PREDICTS GREATER FRACTURE RISK. 1742 01:14:33,720 --> 01:14:41,680 FASTER YOU LOSE, MORE RISK YOU 1743 01:14:41,680 --> 01:14:41,880 HAVE. 1744 01:14:41,880 --> 01:14:43,400 GREATER TURNOVER LEADS TO 1745 01:14:43,400 --> 01:14:45,560 GREATER RISK INDEPENDENT OF BMD 1746 01:14:45,560 --> 01:14:45,920 LOSS. 1747 01:14:45,920 --> 01:14:49,320 SO INDEPENDENT OF YOUR LOSS 1748 01:14:49,320 --> 01:14:51,600 RATE, YOU ARE AT HIGHER RISK IN 1749 01:14:51,600 --> 01:14:53,000 YOU HAVE HIGHER BONE TURNOVER. 1750 01:14:53,000 --> 01:14:57,240 I DON'T HAVE TIME TO EXPLAIN 1751 01:14:57,240 --> 01:14:58,400 BONE TURNOVER BUT IF YOU WOULD 1752 01:14:58,400 --> 01:15:00,800 LIKE TO ASK ME ABOUT WHAT THAT 1753 01:15:00,800 --> 01:15:05,640 MEANS, PLEASE DO SO IN THE Q&A. 1754 01:15:05,640 --> 01:15:08,120 SO, A FEW STATISTICS TO SUPPORT 1755 01:15:08,120 --> 01:15:15,120 POINTS 2 AND 3, FOR STANDARD 1756 01:15:15,120 --> 01:15:17,960 DEVIATION, THERE'S 78% INCREASE 1757 01:15:17,960 --> 01:15:18,680 IN FRACTURE HAZARD, 1758 01:15:18,680 --> 01:15:19,800 DEMONSTRATING THAT THIS RELATION 1759 01:15:19,800 --> 01:15:22,080 BETWEEN ABSOLUTE BONE DENSITY 1760 01:15:22,080 --> 01:15:25,600 AND RISK OF FRACTURE HOLDS IN 1761 01:15:25,600 --> 01:15:29,000 PRE AND POST MENOPAUSE, AND 1762 01:15:29,000 --> 01:15:32,320 IMPORTANTLY PER 1% PER YEAR OF 1763 01:15:32,320 --> 01:15:34,240 FASTER DECLINE IN LUMBAR SPINE 1764 01:15:34,240 --> 01:15:37,680 BMD THERE'S 56% INCREASE IN 1765 01:15:37,680 --> 01:15:39,480 FRACTURE HAZARD. 1766 01:15:39,480 --> 01:15:46,160 IN SUPPORT OF POINTS 3, FASTER 1767 01:15:46,160 --> 01:15:47,000 INCREASE PREDICTS FRACTURE 1768 01:15:47,000 --> 01:15:50,240 INDEPENDENT OF BMD LOSS RATE, 1769 01:15:50,240 --> 01:15:52,760 THAT FRACTURE HAZARD IS 24% 1770 01:15:52,760 --> 01:15:53,360 GREATER PER STANDARD DEVIATION 1771 01:15:53,360 --> 01:15:57,560 INCREMENT IN THE RATE OF 1772 01:15:57,560 --> 01:16:02,080 INCREASE OF NTX IN TRANSITION, 1773 01:16:02,080 --> 01:16:12,640 AND THIS HAZARD IS IMPERVIOUS TO 1774 01:16:13,920 --> 01:16:14,200 ADJUSTMENT. 1775 01:16:14,200 --> 01:16:16,480 IF YOU ACCEPT IT MIGHT BE A GOOD 1776 01:16:16,480 --> 01:16:19,240 IDEA TO TRY TO PREVENT MENOPAUSE 1777 01:16:19,240 --> 01:16:20,040 TRANSITION-RELATED BONE LOSS 1778 01:16:20,040 --> 01:16:24,080 THEN YOU NEED TO ASK YOURSELF 1779 01:16:24,080 --> 01:16:26,160 CAN WE PREVENT MENOPAUSE 1780 01:16:26,160 --> 01:16:27,720 TRANSITION-RELATED BONE LOSS? 1781 01:16:27,720 --> 01:16:28,760 THAT'S A DIFFICULT PROPOSITION 1782 01:16:28,760 --> 01:16:31,280 BECAUSE THE FIRST THING WE NEED 1783 01:16:31,280 --> 01:16:34,520 TO DO IS IDENTIFY THE ONSET OF 1784 01:16:34,520 --> 01:16:36,720 BONE LOSS, AND AS I SHOWED IN 1785 01:16:36,720 --> 01:16:41,600 PRIOR SLIDES THE DECLINE OF BONE 1786 01:16:41,600 --> 01:16:43,040 DENSITY AND TRABECULAR BONE 1787 01:16:43,040 --> 01:16:45,800 SCORE STARTS AT 1 TO 2 YEARS 1788 01:16:45,800 --> 01:16:49,360 PRIOR TO FMP AND THAT IS A 1789 01:16:49,360 --> 01:16:50,800 CLINICALLY OCCULT PHENOMENON. 1790 01:16:50,800 --> 01:16:54,320 AND IT IS NOT WELL MARKED BY 1791 01:16:54,320 --> 01:16:55,960 YOUR MENSTRUAL CHARACTERISTICS. 1792 01:16:55,960 --> 01:17:01,200 SO HOW DO WE KNOW WHEN WOMEN ARE 1793 01:17:01,200 --> 01:17:02,680 STARTING TO LOSE BONE? 1794 01:17:02,680 --> 01:17:05,200 WELL, WE CAN LOOK TO SOME 1795 01:17:05,200 --> 01:17:07,800 SIGNALS THAT PRECEDE THE ONSET 1796 01:17:07,800 --> 01:17:09,120 OF BMD LOSS AS POTENTIAL 1797 01:17:09,120 --> 01:17:11,440 CANDIDATES FOR THINGS THAT COULD 1798 01:17:11,440 --> 01:17:12,440 PREDICT IT. 1799 01:17:12,440 --> 01:17:17,120 SO HERE I'VE SHOWN A SCHEMATIC 1800 01:17:17,120 --> 01:17:19,280 OF THE BMD PIECE-WISE LINEAR 1801 01:17:19,280 --> 01:17:20,480 REGRESSION, REMEMBER THAT FOR 1802 01:17:20,480 --> 01:17:22,480 LUMBAR SPINE BMD THIS IS AVERAGE 1803 01:17:22,480 --> 01:17:25,200 OF 2.4% PER YEAR, AND THIS IS 1804 01:17:25,200 --> 01:17:30,320 MINUS 1 AND PLUS 2 FOR BRACKETS. 1805 01:17:30,320 --> 01:17:34,400 HERE IS NTX ON Y-AXIS, A MARKER 1806 01:17:34,400 --> 01:17:36,160 OF BONE TURNOVER, LOW S PLOT 1807 01:17:36,160 --> 01:17:39,640 SHOWS THAT IT STARTS TO 1808 01:17:39,640 --> 01:17:42,080 ACCELERATE ABOUT MINUS 2, SO WE 1809 01:17:42,080 --> 01:17:46,240 HAVE THIS WINDOW OF OPPORTUNITY 1810 01:17:46,240 --> 01:17:47,000 WHERE AN ACCELERATING NTX 1811 01:17:47,000 --> 01:17:49,440 PROFILE MIGHT TELL US THAT THE 1812 01:17:49,440 --> 01:17:51,880 ONSET OF BMD LOSS IS IMMINENT 1813 01:17:51,880 --> 01:17:53,360 AND MIGHT ALSO TELL US WHAT THE 1814 01:17:53,360 --> 01:17:56,640 RATE OF LOSS WOULD LOOK LIKE. 1815 01:17:56,640 --> 01:18:07,160 AND ANALOGOUS SITUATION HOLDS 1816 01:18:07,600 --> 01:18:08,400 FOR ANTI--MULLERIAN HORMONE, 1817 01:18:08,400 --> 01:18:10,200 DECLINES IN YEARS LEADING TO 1818 01:18:10,200 --> 01:18:14,360 FMP, SO IT IS A LOVELY CANDIDATE 1819 01:18:14,360 --> 01:18:16,960 FOR A WARNING SIGNAL THAT BMD IS 1820 01:18:16,960 --> 01:18:27,480 GOING TO START TO BE LOST OR ITS 1821 01:18:30,920 --> 01:18:34,200 RATE OF LOSS. 1822 01:18:34,200 --> 01:18:39,840 WE'VE DONE STUDIES, EARLY 1823 01:18:39,840 --> 01:18:41,840 PERIMENOPAUSAL NTX IS SHOWN 1824 01:18:41,840 --> 01:18:45,200 HERE, HAZARD OF STARTING TO LOSE 1825 01:18:45,200 --> 01:18:47,760 BONE FOR STANDARD DEVIATION 1826 01:18:47,760 --> 01:18:51,440 INCREMENT IN NTX HIGHER IS 1827 01:18:51,440 --> 01:18:57,280 WORSE, IS SHOWN HERE 1.18 IS 1828 01:18:57,280 --> 01:19:00,560 HAZARD RATIO, 1.2 AT FEMORAL 1829 01:19:00,560 --> 01:19:00,760 NECK. 1830 01:19:00,760 --> 01:19:02,880 ONSET OF BONE LOSS IS THRESHOLD, 1831 01:19:02,880 --> 01:19:07,080 WE USE A THRESHOLD OF MINUS -- 1832 01:19:07,080 --> 01:19:10,320 OF 1.23% PER YEAR IN THIS STUDY, 1833 01:19:10,320 --> 01:19:11,880 REMEMBER THAT NUMBER. 1834 01:19:11,880 --> 01:19:14,080 WE THINK THAT NUMBER IS A LITTLE 1835 01:19:14,080 --> 01:19:15,200 BIT TOO TIGHT. 1836 01:19:15,200 --> 01:19:17,560 WE'RE HARD ON OURSELVES. 1837 01:19:17,560 --> 01:19:19,800 AND ALSO THIS MODEL PREDICTS 1838 01:19:19,800 --> 01:19:21,920 ONSET OF BONE LOSS IN THE NEXT 1839 01:19:21,920 --> 01:19:23,200 TWO TO THREE YEARS, AND WE THINK 1840 01:19:23,200 --> 01:19:25,240 WE NEED TO WORK ON THAT A LITTLE 1841 01:19:25,240 --> 01:19:25,520 BIT. 1842 01:19:25,520 --> 01:19:29,160 I'LL GET TO THAT AT THE END. 1843 01:19:29,160 --> 01:19:34,960 THE SAME BASIC PARADIGM IS SHOWN 1844 01:19:34,960 --> 01:19:38,120 HERE, PRE-OR EARLY 1845 01:19:38,120 --> 01:19:38,920 PERIMENOPAUSAL ANTI-MULLERIAN 1846 01:19:38,920 --> 01:19:48,520 HUER -- 1847 01:19:48,520 --> 01:19:49,400 HORMONE. 1848 01:19:49,400 --> 01:19:50,480 HERE A THRESHOLD, RELATED TO 1849 01:19:50,480 --> 01:19:52,200 DOUBLING OF THE RISK THAT YOU'RE 1850 01:19:52,200 --> 01:19:54,360 GOING TO START TO LOSE BONE AT 1851 01:19:54,360 --> 01:19:56,640 THE FEMORAL NECK, AND ABOUT A 1852 01:19:56,640 --> 01:19:58,080 1.68 HAZARD THAT YOU'RE GOING TO 1853 01:19:58,080 --> 01:20:01,000 LOSE BONE AT THE FEMORAL NECK, 1854 01:20:01,000 --> 01:20:03,960 WITHIN THE NEXT TWO TO THREE 1855 01:20:03,960 --> 01:20:08,160 YEARS, AT THAT SAME 1.23% PER 1856 01:20:08,160 --> 01:20:10,600 YEAR THRESHOLD. 1857 01:20:10,600 --> 01:20:15,400 WHICH BRINGS US TO FUTURE 1858 01:20:15,400 --> 01:20:16,200 DIRECTIONS. 1859 01:20:16,200 --> 01:20:19,040 THE INFORMATION WE'VE GAINED SO 1860 01:20:19,040 --> 01:20:21,160 FAR I BELIEVE PROVIDES A STRONG 1861 01:20:21,160 --> 01:20:24,640 IMPETUS FOR US TO STRONGLY 1862 01:20:24,640 --> 01:20:28,280 CONSIDER TRYING TO PREVENT 1863 01:20:28,280 --> 01:20:29,000 MENOPAUSE TRANSITION-RELATED 1864 01:20:29,000 --> 01:20:29,880 BONE LOSS. 1865 01:20:29,880 --> 01:20:37,600 WE'VE SHOWN IN PRINCIPLE AMT 1866 01:20:37,600 --> 01:20:39,480 BONE TURNOVER MARKER, NTX, 1867 01:20:39,480 --> 01:20:43,040 CLINICAL FEATURES CAN PREDICT 1868 01:20:43,040 --> 01:20:47,320 THE ONSET AND RATE OF MENOPAUSE 1869 01:20:47,320 --> 01:20:48,480 TRANSITION RELATED BONE LOSS, WE 1870 01:20:48,480 --> 01:20:50,680 NEED TO WORK ON THIS MODEL OF 1871 01:20:50,680 --> 01:20:53,120 PREDICTION TO GET IT SUITABLE 1872 01:20:53,120 --> 01:20:54,200 FOR CLINICAL PREDICTION, WE'RE 1873 01:20:54,200 --> 01:20:58,800 STARTING TO DO THAT NOW BY 1874 01:20:58,800 --> 01:21:00,200 COMBINING PREDICTORS, BY 1875 01:21:00,200 --> 01:21:03,520 CONSIDERING NEWER BONE TURNOVER 1876 01:21:03,520 --> 01:21:05,680 MARKERS THAT ARE CURRENT 1877 01:21:05,680 --> 01:21:06,880 REFERENCE REPRESENTS STANDARDS, 1878 01:21:06,880 --> 01:21:09,240 BY SHORTENING THIS WINDOW OF 1879 01:21:09,240 --> 01:21:11,600 PREDICTION DOWN TO ABOUT 1 TO 2 1880 01:21:11,600 --> 01:21:13,440 YEARS FROM 2 TO 3 YEARS, AND BY 1881 01:21:13,440 --> 01:21:14,320 PLAYING WITH OUR THRESHOLD A 1882 01:21:14,320 --> 01:21:17,520 LITTLE TO MAKE IT WHAT WE THINK 1883 01:21:17,520 --> 01:21:18,720 IS MORE APPROPRIATE. 1884 01:21:18,720 --> 01:21:22,880 IF WE CAN SUCCEED AT THAT, THEN 1885 01:21:22,880 --> 01:21:24,840 WE COULD TEST A PREVENTIVE AGENT 1886 01:21:24,840 --> 01:21:27,200 AND THERE ARE -- THERE'S ONE 1887 01:21:27,200 --> 01:21:29,400 CANDIDATE BEING BANDIED AROUND 1888 01:21:29,400 --> 01:21:32,200 FOR THAT, WHICH IF GIVEN WHEN 1889 01:21:32,200 --> 01:21:33,600 BONE LOSS IS IMMINENT BEFORE IT 1890 01:21:33,600 --> 01:21:37,960 STARTS WHICH IS WHY WE NEED THIS 1891 01:21:37,960 --> 01:21:39,840 PREDICTION MODEL COULD TRANSFORM 1892 01:21:39,840 --> 01:21:42,880 THIS BLUE LINE INTO THIS PINK 1893 01:21:42,880 --> 01:21:43,880 LINE. 1894 01:21:43,880 --> 01:21:47,160 THERE BY ALLOWING WOMEN TO BEGIN 1895 01:21:47,160 --> 01:21:50,560 THEIR POST MENOPAUSAL YEARS WITH 1896 01:21:50,560 --> 01:21:54,600 HIGHER ABSOLUTE BMD AND ALSO 1897 01:21:54,600 --> 01:21:56,280 OBVIATING UNIQUE TRANSMENOPAUSAL 1898 01:21:56,280 --> 01:21:58,680 NEGATIVE CONSEQUENCES OF RAPID 1899 01:21:58,680 --> 01:22:02,320 BONE LOSS AND HIGH BONE TURNOVER 1900 01:22:02,320 --> 01:22:04,880 WHICH ARE INDEPENDENTLY RELATED 1901 01:22:04,880 --> 01:22:06,760 TO POST MENOPAUSAL FRACTURE RISK 1902 01:22:06,760 --> 01:22:07,560 APART FROM ABSOLUTE BMD. 1903 01:22:07,560 --> 01:22:14,520 THANK YOU FOR YOUR ATTENTION. 1904 01:22:14,520 --> 01:22:22,840 >>THANK YOU, DR. GREENDALE. 1905 01:22:22,840 --> 01:22:27,640 >> REALLY IMPORTANT TALK, DR. 1906 01:22:27,640 --> 01:22:28,000 GREENDALE. 1907 01:22:28,000 --> 01:22:29,200 I'M GOING TO ASK PEOPLE TO 1908 01:22:29,200 --> 01:22:31,880 CONTINUE TO PUT QUESTIONS IN THE 1909 01:22:31,880 --> 01:22:34,880 Q&A, WE'LL HAVE A SESSION AFTER 1910 01:22:34,880 --> 01:22:36,320 THE NEXT THREE SPEAKERS. 1911 01:22:36,320 --> 01:22:41,120 SO NOW IT'S MY PLEASURE TO 1912 01:22:41,120 --> 01:22:42,800 INTRODUCE DR. GENEVIEVE 1913 01:22:42,800 --> 01:22:43,560 NEAL-PERRY, ROBERT ROSS 1914 01:22:43,560 --> 01:22:44,920 DISTINGUISHED PROFESSOR AND 1915 01:22:44,920 --> 01:22:49,200 CHAIR AT THE DEPARTMENT OF 1916 01:22:49,200 --> 01:22:52,280 OB/GYN AT UNC-CHAPEL HILL, HER 1917 01:22:52,280 --> 01:22:54,680 TALK ABOUT ON IS IT'S HOT IN 1918 01:22:54,680 --> 01:22:59,520 HERE, UNDERSTANDING BASIC 1919 01:22:59,520 --> 01:23:00,160 BIOLOGY OF MENOPAUSE TRANSITION. 1920 01:23:00,160 --> 01:23:01,560 >> THANK YOU FOR THAT 1921 01:23:01,560 --> 01:23:01,920 INTRODUCTION. 1922 01:23:01,920 --> 01:23:06,080 THANK YOU FOR THE OPPORTUNITY TO 1923 01:23:06,080 --> 01:23:07,080 TALK ABOUT MENOPAUSE, SOMETHING 1924 01:23:07,080 --> 01:23:08,360 I AM REALLY INTERESTED IN 1925 01:23:08,360 --> 01:23:11,000 LEARNING MORE ABOUT AS WELL AS 1926 01:23:11,000 --> 01:23:11,440 HEARING INFORMATION. 1927 01:23:11,440 --> 01:23:14,400 MY GOAL TODAY IS REALLY TO HELP 1928 01:23:14,400 --> 01:23:15,520 YOU UNDERSTAND SOME OF THE 1929 01:23:15,520 --> 01:23:18,800 THINGS THAT WE NOW KNOW ABOUT 1930 01:23:18,800 --> 01:23:21,880 THE -- WHAT LEADS TO MENOPAUSE 1931 01:23:21,880 --> 01:23:25,960 AND THE CAUSE OF HOT FLASHES. 1932 01:23:25,960 --> 01:23:28,080 I DON'T HAVE ANY SPECIFIC 1933 01:23:28,080 --> 01:23:29,560 DISCLOSURE RELATED TO THIS TALK 1934 01:23:29,560 --> 01:23:39,960 BUT I AM ON THE ASTELASS 1935 01:23:40,680 --> 01:23:41,000 ADVISORY BOARD. 1936 01:23:41,000 --> 01:23:44,440 YOU SHOULD BE ABLE TO UNDERSTAND 1937 01:23:44,440 --> 01:23:48,360 BASIC PHYSIOLOGY OF MENOPAUSE 1938 01:23:48,360 --> 01:23:48,760 AND SYMPTOMS. 1939 01:23:48,760 --> 01:23:49,920 DATA PRESENTED TODAY REFLECT 1940 01:23:49,920 --> 01:23:51,240 CLINICAL DATA FROM PEOPLE WHO 1941 01:23:51,240 --> 01:23:56,200 IDENTIFY AS WOMEN AND WHO WERE 1942 01:23:56,200 --> 01:23:58,200 BORN WITH OVARIES. 1943 01:23:58,200 --> 01:24:02,440 PHYSIOLOGY AND NATURAL HISTORY 1944 01:24:02,440 --> 01:24:04,920 OF MENOPAUSE, IMTHINK WHEN WE 1945 01:24:04,920 --> 01:24:07,320 THINK ABOUT MENOPAUSE, WE TEND 1946 01:24:07,320 --> 01:24:12,760 TO THINK ABOUT THE OVARY, WE 1947 01:24:12,760 --> 01:24:14,560 KNOW THAT THERE ARE 1948 01:24:14,560 --> 01:24:16,960 (INDISCERNIBLE) AND CHANGES IN 1949 01:24:16,960 --> 01:24:24,080 LOSS OF OVARIAN HORMONES, SUCH 1950 01:24:24,080 --> 01:24:25,320 AS ESTROGEN, DRIVING SOME 1951 01:24:25,320 --> 01:24:25,800 SYMPTOMS. 1952 01:24:25,800 --> 01:24:29,360 SOME THINGS HAPPEN AT THE LEVEL 1953 01:24:29,360 --> 01:24:34,480 OF AX IT DIFFERENT THAN ELEVATED 1954 01:24:34,480 --> 01:24:35,600 RISE. 1955 01:24:35,600 --> 01:24:37,880 CHANGES IN THE WAY NEURONS 1956 01:24:37,880 --> 01:24:40,480 RESPOND TO ESTROGEN AND THIS MAY 1957 01:24:40,480 --> 01:24:44,440 OR MAY NOT CONTRIBUTE TO 1958 01:24:44,440 --> 01:24:44,920 FOLLICULAR DEVELOPMENT, 1959 01:24:44,920 --> 01:24:46,080 FOLLICULAR DEPLETION, BUT 1960 01:24:46,080 --> 01:24:49,480 THERE'S MORE EVIDENCE IN TERMS 1961 01:24:49,480 --> 01:24:52,200 OF HOW HORMONAL CHANGES ACTUALLY 1962 01:24:52,200 --> 01:24:53,040 TRIGGER HOT FLASHES. 1963 01:24:53,040 --> 01:24:55,040 THAT'S WHAT I'M GOING TO TALK 1964 01:24:55,040 --> 01:24:55,840 ABOUT TODAY. 1965 01:24:55,840 --> 01:25:00,080 THERE ARE A NUMBER OF MODIFIERS 1966 01:25:00,080 --> 01:25:05,120 IN TERMS OF AN INDIVIDUAL 1967 01:25:05,120 --> 01:25:09,920 EXPERIENCING TRANSITION. 1968 01:25:09,920 --> 01:25:12,600 AUTOIMMUNE DISORDERS WHICH 1969 01:25:12,600 --> 01:25:14,440 INVOLVES THE OVARY THAT MAY HAVE 1970 01:25:14,440 --> 01:25:17,200 IMPACT ON TIMING OF MENOPAUSE, 1971 01:25:17,200 --> 01:25:19,760 THERE'S FAMILY GENES OF 1972 01:25:19,760 --> 01:25:22,520 POLYMORPHISMS, WE KNOW SMOKING 1973 01:25:22,520 --> 01:25:33,040 HAS AN EARLIER IMPACT ON TIME OF 1974 01:25:33,280 --> 01:25:35,360 MENOPAUSE, EARLIER SPECIFICALLY, 1975 01:25:35,360 --> 01:25:37,200 CHEMOTHERAPY, AND INDUSTRIAL 1976 01:25:37,200 --> 01:25:38,440 EXPOSURES. 1977 01:25:38,440 --> 01:25:41,000 IN ADDITION THERE ARE GENETIC 1978 01:25:41,000 --> 01:25:43,560 DEFECTS SUCH AS TURNER SYNDROME, 1979 01:25:43,560 --> 01:25:47,680 FRAG 1980 01:25:47,680 --> 01:25:52,040 FRAGILE X. 1981 01:25:52,040 --> 01:25:53,200 WHEN WE THINK ABOUT VASOMOTOR 1982 01:25:53,200 --> 01:25:56,440 SYMPTOMS I THINK THEY ARE ONE OF 1983 01:25:56,440 --> 01:25:57,680 THE SYMPTOMS OF MENOPAUSE, 1984 01:25:57,680 --> 01:25:59,080 TYPICALLY WHY INDIVIDUALS MAY 1985 01:25:59,080 --> 01:26:00,200 PRESENT TO ME. 1986 01:26:00,200 --> 01:26:04,240 WE KNOW TO SOME DEGREE IT'S 1987 01:26:04,240 --> 01:26:05,680 RELATED TO HYPO ESTROGENNISM, 1988 01:26:05,680 --> 01:26:08,560 BUT IF YOU MEASURE AROUND A TIME 1989 01:26:08,560 --> 01:26:13,160 OF WHEN SOMEONE IS HAVING A HOT 1990 01:26:13,160 --> 01:26:16,400 FLASH TO PREDICT, IT'S NOTE BEEN 1991 01:26:16,400 --> 01:26:16,880 DEMONSTRATED. 1992 01:26:16,880 --> 01:26:22,280 WE KNOW UP TO 75% OF WOMEN WILL 1993 01:26:22,280 --> 01:26:23,480 ACTUALLY REPORT HOT FLASHES, 1994 01:26:23,480 --> 01:26:25,960 OFTEN THE REASON THEY SEEK HELP. 1995 01:26:25,960 --> 01:26:28,720 THEY CAN LAST FROM SIX MONTHS TO 1996 01:26:28,720 --> 01:26:29,720 MORE THAN SEVEN YEARS, AND 1997 01:26:29,720 --> 01:26:31,400 YOU'LL HEAR SOME OTHER 1998 01:26:31,400 --> 01:26:32,800 DISCUSSIONS LATER ABOUT SOME 1999 01:26:32,800 --> 01:26:36,520 RACIAL DISPARITIES IN TERMS OF 2000 01:26:36,520 --> 01:26:40,040 THE SYMPTOMS AND DURATION OF 2001 01:26:40,040 --> 01:26:40,280 SYMPTOMS. 2002 01:26:40,280 --> 01:26:41,760 GENERALLY WHEN WE THINK ABOUT 2003 01:26:41,760 --> 01:26:44,200 BOTHERSOME HOT FLASHES WE THINK 2004 01:26:44,200 --> 01:26:46,880 ABOUT MODERATE TO SEVERE. 2005 01:26:46,880 --> 01:26:50,640 TYPICALLY 7 TO 8 PER DAY, 50 TO 2006 01:26:50,640 --> 01:26:55,520 60 PER WEEK, YOU CAN IMAGINE HOW 2007 01:26:55,520 --> 01:26:57,200 DISRUPTIVE THIS MIGHT BE. 2008 01:26:57,200 --> 01:27:00,360 WHAT ARE SOME GENETIC MODIFIERS 2009 01:27:00,360 --> 01:27:03,880 OF HOT FLASHES? 2010 01:27:03,880 --> 01:27:06,520 WHAT WE KNOW IS THERE IS 2011 01:27:06,520 --> 01:27:09,200 NEUROREGULATORY SYSTEMS ARE 2012 01:27:09,200 --> 01:27:19,720 AFFECTED, AND SPECIFICALLY WE 2013 01:27:21,160 --> 01:27:30,040 KNOW SEROTONERGIC, H 2014 01:27:30,040 --> 01:27:36,520 ISTAMINEERGIC AND OTHERS. 2015 01:27:36,520 --> 01:27:42,760 WE KNOW THESE AS WELL AS CYP 3A4 2016 01:27:42,760 --> 01:27:49,600 CAN AFFECT SEVERITY OF HOT 2017 01:27:49,600 --> 01:27:50,200 FLASHES, FREQUENCY, AND 2018 01:27:50,200 --> 01:27:52,480 UDP-UGT1A 1 ASSOCIATED WITH 2019 01:27:52,480 --> 01:27:53,480 FEWER HOT FLASHES. 2020 01:27:53,480 --> 01:27:54,920 THERE ARE GENETIC POLYMORPHISMS 2021 01:27:54,920 --> 01:27:58,520 IN TERMS OF HOW HORMONES ARE 2022 01:27:58,520 --> 01:27:59,360 METABOLIZED THAT RECEPTORS 2023 01:27:59,360 --> 01:28:01,400 FUNCTION THAT WILL HAVE THE 2024 01:28:01,400 --> 01:28:04,120 SIGNIFICANT IMPACT ON THE 2025 01:28:04,120 --> 01:28:08,800 EXPERIENCE OF THOSE EXPERIENCING 2026 01:28:08,800 --> 01:28:09,560 HOT FLASHES. 2027 01:28:09,560 --> 01:28:13,560 WHAT IS THE BLACK BOX BEHIND HOT 2028 01:28:13,560 --> 01:28:16,040 FLASHES? 2029 01:28:16,040 --> 01:28:17,200 IT'S A NEURAL DERIVED 2030 01:28:17,200 --> 01:28:17,480 PHENOMENON. 2031 01:28:17,480 --> 01:28:21,760 AND WHAT WE ALSO KNOW IS THAT 2032 01:28:21,760 --> 01:28:23,680 ESTROGEN CAN REDUCE HOT FLASHES. 2033 01:28:23,680 --> 01:28:26,280 YOU'VE SEEN SOME DATA FROM OUR 2034 01:28:26,280 --> 01:28:27,720 TWO PREVIOUS SPEAKERS. 2035 01:28:27,720 --> 01:28:32,920 BUT IS IT ACTUALLY ESTROGEN THAT 2036 01:28:32,920 --> 01:28:37,120 IS SOLELY LOSS THAT EXPLAINS THE 2037 01:28:37,120 --> 01:28:38,040 HOT FLASH? 2038 01:28:38,040 --> 01:28:40,120 I ALWAYS LIKE TO REVIEW AND GO 2039 01:28:40,120 --> 01:28:49,000 BACK TO THIS STUDY DONE LOOKING 2040 01:28:49,000 --> 01:28:51,280 AT DAILY HORMONAL LEVELS IN 2041 01:28:51,280 --> 01:28:53,120 INDIVIDUALS WHO WERE 2042 01:28:53,120 --> 01:28:54,920 REPRODUCTIVE AGE, PERIMENOPAUSE, 2043 01:28:54,920 --> 01:29:00,280 TO LOOK AT WHAT WAS HAPPENING 2044 01:29:00,280 --> 01:29:01,480 WITH ESTRADIOL, PROGESTERONE, 2045 01:29:01,480 --> 01:29:04,040 BECAUSE WE DID THINK THAT IT WAS 2046 01:29:04,040 --> 01:29:07,280 A REDUCTION IN ESTROGEN 2047 01:29:07,280 --> 01:29:09,760 TRIGGERING THESE. 2048 01:29:09,760 --> 01:29:11,880 SHE SHOWED WE DO SEE INCREASE IN 2049 01:29:11,880 --> 01:29:19,560 FSH WE WERE NOT SEEING 2050 01:29:19,560 --> 01:29:21,640 REDUCTIONS IN ESTROGEN OR 2051 01:29:21,640 --> 01:29:22,360 ESTRADIOL. 2052 01:29:22,360 --> 01:29:23,480 IT RAISED QUESTIONS WHAT'S 2053 01:29:23,480 --> 01:29:24,400 HAPPENING WITHIN THE BRAIN, ARE 2054 01:29:24,400 --> 01:29:26,440 THERE SOME CHANGES IN THE WAY 2055 01:29:26,440 --> 01:29:29,200 THE BRAIN IS RESPONDING TO 2056 01:29:29,200 --> 01:29:29,480 ESTROGEN. 2057 01:29:29,480 --> 01:29:32,160 THIS LED TO ANOTHER STUDY THAT 2058 01:29:32,160 --> 01:29:34,240 WAS DONE WITH THE STUDY OF WOMEN 2059 01:29:34,240 --> 01:29:38,440 ACROSS THE NATION THAT ACTUALLY 2060 01:29:38,440 --> 01:29:42,280 LOOKED AT THE LIKELIHOOD OF 2061 01:29:42,280 --> 01:29:47,960 SURGE, WHAT THEY DID WAS TO 2062 01:29:47,960 --> 01:29:49,520 ORGANIZE HORMONE LEVELS RELATIVE 2063 01:29:49,520 --> 01:29:52,200 TO HIGHEST LEVEL OF ESTROGEN AND 2064 01:29:52,200 --> 01:29:55,440 Y-AXIS IS DAY OF CYCLE, ZERO 2065 01:29:55,440 --> 01:29:59,040 REFLECTS HIGHEST LEVEL OF 2066 01:29:59,040 --> 01:30:01,360 ESTROGEN, AND Y-AXIS RECOMMENDS 2067 01:30:01,360 --> 01:30:02,280 URINARY ESTRONES. 2068 01:30:02,280 --> 01:30:05,760 ALTHOUGH WE HAVE TWO GROUPS OF 2069 01:30:05,760 --> 01:30:07,160 INDIVIDUALS WHO REACH RELATIVELY 2070 01:30:07,160 --> 01:30:09,000 SIMILAR ESTROGEN LEVELS, THAT 2071 01:30:09,000 --> 01:30:10,120 DID NOT MEAN THEY WOULD EACH 2072 01:30:10,120 --> 01:30:11,120 HAVE A SURGE. 2073 01:30:11,120 --> 01:30:12,520 THE GROUP ON THE LEFT HAD A 2074 01:30:12,520 --> 01:30:16,920 SURGE BUT THE GROUP ON THE RIGHT 2075 01:30:16,920 --> 01:30:21,280 DID NOT IMPLYING THE 2076 01:30:21,280 --> 01:30:24,360 HYPOTHALAMIC AXIS WAS NOT 2077 01:30:24,360 --> 01:30:25,080 RESPONDING AS THE UPPER 2078 01:30:25,080 --> 01:30:26,440 REPRODUCTIVE AGE WOMEN. 2079 01:30:26,440 --> 01:30:29,080 WE HAVE DONE SOME STUDIES 2080 01:30:29,080 --> 01:30:36,720 LOOKING AT WHETHER IT'S 2081 01:30:36,720 --> 01:30:42,480 PITUITARY OR HYPOTHALAMIC 2082 01:30:42,480 --> 01:30:43,760 RESPONSE. 2083 01:30:43,760 --> 01:30:45,520 PITUITARY RESPONSE ROBUSTLY 2084 01:30:45,520 --> 01:30:47,160 GENERATES AGONIST OR CHALLENGE, 2085 01:30:47,160 --> 01:30:50,520 AT THE LEVEL OF HYPOTHALAMUS. 2086 01:30:50,520 --> 01:30:52,560 WHAT ARE THE KNOWLEDGE GAPS? 2087 01:30:52,560 --> 01:30:55,400 FOR MANY YEARS WHILE WE KNEW HOT 2088 01:30:55,400 --> 01:30:57,040 FLASHES OCCURRED, WE KNOW 2089 01:30:57,040 --> 01:30:59,360 ESTROGEN COULD REDUCE THEM, WE 2090 01:30:59,360 --> 01:31:01,320 DIDN'T UNDERSTAND WHAT THE BASIC 2091 01:31:01,320 --> 01:31:02,440 BIOLOGY WAS. 2092 01:31:02,440 --> 01:31:05,200 AND IN MY OPINION SOME OF THE 2093 01:31:05,200 --> 01:31:09,840 SEMINAL WORK THAT HELPED US 2094 01:31:09,840 --> 01:31:11,400 UNDERSTAND WHAT'S DRIVING HOT 2095 01:31:11,400 --> 01:31:13,480 FLASHES AND REALLY HELP US 2096 01:31:13,480 --> 01:31:16,640 UNDERSTAND A MORE SPECIFIC WAY 2097 01:31:16,640 --> 01:31:19,600 THEY APPROACH WAS BORN OUT OF 2098 01:31:19,600 --> 01:31:22,520 WORK COMING FROM NAOMI RANCE, 2099 01:31:22,520 --> 01:31:27,360 SHE LOOKED AT THE BRAINS OF PRE 2100 01:31:27,360 --> 01:31:34,320 ANDS POST MENOPAUSAL WOMEN, 2101 01:31:34,320 --> 01:31:35,360 SPECIFICALLY FOUND 2102 01:31:35,360 --> 01:31:37,600 PRE-MENOPAUSAL WOMEN COMPARED TO 2103 01:31:37,600 --> 01:31:38,560 POST-MENOPAUSAL THERE WAS THIS 2104 01:31:38,560 --> 01:31:42,640 BIG CHANGE IN THE DENSITY OF 2105 01:31:42,640 --> 01:31:44,400 THESE NEURONS HERE LOCATED RIGHT 2106 01:31:44,400 --> 01:31:44,600 HERE. 2107 01:31:44,600 --> 01:31:48,080 SHE WENT ON TO DO A SIMILAR 2108 01:31:48,080 --> 01:31:58,560 STUDY A FEW YEARS LATER IN 2109 01:31:59,640 --> 01:32:00,760 MONKEYS WHERE SHE REMOVED 2110 01:32:00,760 --> 01:32:02,440 OVARIES, WAS ABLE TO SEE THE 2111 01:32:02,440 --> 01:32:07,400 SAME NEURONS IN THE BRAIN, THEY 2112 01:32:07,400 --> 01:32:10,640 HAVE COME FATTER AND MORE ROBUST 2113 01:32:10,640 --> 01:32:11,640 IN ANIMALS THAT DID NOT HAVE 2114 01:32:11,640 --> 01:32:13,520 ESTROGEN AND DID A SIMILAR STUDY 2115 01:32:13,520 --> 01:32:17,120 INFUSED ESTROGEN AND WAS ABLE TO 2116 01:32:17,120 --> 01:32:18,760 REDUCE THE SIZE OF THESE NEURONS 2117 01:32:18,760 --> 01:32:23,560 AND WITH THE ADVENT OF BETTER 2118 01:32:23,560 --> 01:32:25,400 HISTOCHEMISTRY WERE ABLE TO 2119 01:32:25,400 --> 01:32:29,200 IDENTIFY THE NEURONS. 2120 01:32:29,200 --> 01:32:33,200 THEY WERE KNDY NEURONS. 2121 01:32:33,200 --> 01:32:37,960 THEY EXPRESS A PEPTIDE KISSPEP 2122 01:32:37,960 --> 01:32:44,400 TIN, NEUROKININ B AND DNYORPHIN. 2123 01:32:44,400 --> 01:32:45,400 THEY ACTUALLY COMMUNICATE WITH 2124 01:32:45,400 --> 01:32:47,200 ONE ANOTHER, AND SO IN THE 2125 01:32:47,200 --> 01:32:49,040 ABSENCE OF ESTROGEN THEY 2126 01:32:49,040 --> 01:32:56,080 ACTUALLY STIMULATE EACH OTHER 2127 01:32:56,080 --> 01:32:57,360 WITH THIS NKB, PROJECTING TO 2128 01:32:57,360 --> 01:32:59,280 AREAS OF THE BRAIN, IMPORTANT 2129 01:32:59,280 --> 01:33:00,000 FOR SENSING. 2130 01:33:00,000 --> 01:33:03,160 IN THE ABSENCE OF ESTROGEN THEY 2131 01:33:03,160 --> 01:33:08,360 ARE PRETTY MUCH RELEASED FROM 2132 01:33:08,360 --> 01:33:09,080 ESTROGEN NEGATIVE FEEDBACK, 2133 01:33:09,080 --> 01:33:10,920 HYPERACTIVE, STIMULATE EACH 2134 01:33:10,920 --> 01:33:12,280 OTHER AND STIMULATE NEURONS THAT 2135 01:33:12,280 --> 01:33:16,200 ARE IMPORTANT FOR DEGENERATION 2136 01:33:16,200 --> 01:33:18,280 OF HOT FLASHES. 2137 01:33:18,280 --> 01:33:20,440 AND SO THE HYPOTHESIS WAS THAT 2138 01:33:20,440 --> 01:33:22,520 THESE NEURONS WERE WHAT WERE 2139 01:33:22,520 --> 01:33:25,920 DRIVING HOT FLASHES, AND SEVERAL 2140 01:33:25,920 --> 01:33:30,160 STUDIES HAVE SHOWN THAT IF YOU 2141 01:33:30,160 --> 01:33:31,720 INFUSE AN AGONIST WITHIN THE 2142 01:33:31,720 --> 01:33:34,160 BRAIN AND TRIGGER SOME SIMILAR 2143 01:33:34,160 --> 01:33:35,680 SYMPTOMS, IN MICE. 2144 01:33:35,680 --> 01:33:37,840 AND I'M GOING TO SHOW WORK IN 2145 01:33:37,840 --> 01:33:48,360 THE LAB TO ACTUALLY TEST THIS 2146 01:33:49,320 --> 01:33:56,360 HYPOTHESIS, THE AGONIST FOR THE 2147 01:33:56,360 --> 01:33:56,640 NEUROKININ. 2148 01:33:56,640 --> 01:33:58,080 ONE THING THAT'S IMPORTANT TO 2149 01:33:58,080 --> 01:34:07,320 KNOW HOT FLASHES ARE NOT EASY 2150 01:34:07,320 --> 01:34:09,920 TO -- WE DEVELOPED A 2151 01:34:09,920 --> 01:34:12,360 THERMOCLINE, WERE ABLE TO CREATE 2152 01:34:12,360 --> 01:34:14,960 A WARM PORTION AND COOL PORTION, 2153 01:34:14,960 --> 01:34:16,960 AND WE COULD USE THIS TO SEE 2154 01:34:16,960 --> 01:34:20,480 WHICH DIRECTION, WITH THE 2155 01:34:20,480 --> 01:34:21,960 ANIMALS, REFERRED IF THEY ARE 2156 01:34:21,960 --> 01:34:23,600 GIVEN INJECTION THAT CAUSES THEM 2157 01:34:23,600 --> 01:34:24,760 TO FEEL HOT. 2158 01:34:24,760 --> 01:34:26,600 AND THIS IS A STUDY WHERE WE 2159 01:34:26,600 --> 01:34:28,840 SHOW THAT YOU HAVE YOUR MICE 2160 01:34:28,840 --> 01:34:32,480 LINED UP ON THE WARM SIDE. 2161 01:34:32,480 --> 01:34:36,080 YOU SEE NONE PREFERRED COOL 2162 01:34:36,080 --> 01:34:37,200 SIDE. 2163 01:34:37,200 --> 01:34:42,400 WHEN WE ACTUALLY INJECT THEM 2164 01:34:42,400 --> 01:34:50,360 WITH SENK, A NEUROKININ AGONIST, 2165 01:34:50,360 --> 01:34:52,000 THIS IS THE EXPERIMENT WE DID. 2166 01:34:52,000 --> 01:34:53,360 IN ADDITION TO SEEING THEM MOVE 2167 01:34:53,360 --> 01:34:56,280 TO THE COOLER SIDE WE ALSO 2168 01:34:56,280 --> 01:34:57,800 EVALUATED THEIR TAIL, BECAUSE 2169 01:34:57,800 --> 01:35:00,760 MICE USE THE TAIL TO DISSIPATE 2170 01:35:00,760 --> 01:35:02,400 HEAT TO SEE WHETHER ANIMALS HAD 2171 01:35:02,400 --> 01:35:03,280 HOT FLASHES. 2172 01:35:03,280 --> 01:35:06,320 AND WHAT YOU SEE HERE IS AN 2173 01:35:06,320 --> 01:35:08,400 EXPERIMENT WHERE ANIMALS WERE 2174 01:35:08,400 --> 01:35:11,560 INJECTED WITH VEHICLE, PREFERRED 2175 01:35:11,560 --> 01:35:16,600 WARMER SIDE, ALSO INJECTED WITH 2176 01:35:16,600 --> 01:35:20,560 NK3 AGONIST WHICH INDUCES 2177 01:35:20,560 --> 01:35:21,760 SENSATION OF FEELING WARM AND 2178 01:35:21,760 --> 01:35:25,800 THEY MOVED TO THE COOLER SIDE. 2179 01:35:25,800 --> 01:35:28,920 SIMILARLY, ANIMALS THAT RECEIVED 2180 01:35:28,920 --> 01:35:30,480 OF THE SENKTIDE HAD HIGHER 2181 01:35:30,480 --> 01:35:32,400 TEMPERATURE IN TAIL, AGAIN 2182 01:35:32,400 --> 01:35:33,160 DISTATING HEAT. 2183 01:35:33,160 --> 01:35:35,800 WE HAVE THIS DATA IN NON-HUMAN 2184 01:35:35,800 --> 01:35:38,200 PRIMATE THAT SUGGESTS THAT IF 2185 01:35:38,200 --> 01:35:43,080 YOU TRIGGER -- USE THIS NK3 2186 01:35:43,080 --> 01:35:44,640 AGONIST YOU CAN TRIGGER HOT 2187 01:35:44,640 --> 01:35:47,120 FLASHES. 2188 01:35:47,120 --> 01:35:49,240 CAN WE DO THIS IN HUMAN? 2189 01:35:49,240 --> 01:35:53,400 IT WAS INJECTED IN 2190 01:35:53,400 --> 01:35:55,160 PRE-MENOPAUSAL WOMEN, IN 2191 01:35:55,160 --> 01:36:01,160 INDIVIDUALS WHO HAD THE NKB 2192 01:36:01,160 --> 01:36:04,600 AGONIST, FELT HOT, RECEIVED 2193 01:36:04,600 --> 01:36:06,240 VEHICLE AND RECEIVED NKB AND 2194 01:36:06,240 --> 01:36:08,440 ALSO FELT HOT. 2195 01:36:08,440 --> 01:36:09,760 WHAT WAS IMPORTANT IS THEY WERE 2196 01:36:09,760 --> 01:36:13,480 ABLE TO SHOW OTHER SYMPTOMS THAT 2197 01:36:13,480 --> 01:36:16,560 ARE REPORTED WITH HOT FLASHES, 2198 01:36:16,560 --> 01:36:20,160 HEART RATE CHANGE, THERE WAS 2199 01:36:20,160 --> 01:36:22,760 ALSO A CHANGE IN TERMS OF 2200 01:36:22,760 --> 01:36:26,480 TEMPERATURE, BUT ALSO IN TERMS 2201 01:36:26,480 --> 01:36:27,760 OF PEOPLE FEELING ANXIOUS. 2202 01:36:27,760 --> 01:36:30,680 WHAT IS THE CURRENT MODEL? 2203 01:36:30,680 --> 01:36:35,000 WELL, IN A NORMAL STATE THE 2204 01:36:35,000 --> 01:36:37,440 MODEL IS KNDY NEURONS IN AN 2205 01:36:37,440 --> 01:36:39,880 ESTROGEN RICH ENVIRONMENT FIRE, 2206 01:36:39,880 --> 01:36:40,640 THERE'S NEGATIVE FEEDBACK, 2207 01:36:40,640 --> 01:36:43,040 NEURONS ARE KIND OF BEHAVING 2208 01:36:43,040 --> 01:36:47,200 DOING WHAT THEY SHOULD BE DOING. 2209 01:36:47,200 --> 01:36:49,240 IN THE ABSENCE OF ESTROGEN OR 2210 01:36:49,240 --> 01:36:53,200 LOSS OF ESTROGEN NEGATIVE 2211 01:36:53,200 --> 01:36:56,080 FEEDBACK THESE NEURONS BECOME 2212 01:36:56,080 --> 01:36:57,200 HYPERTROPHIED, RELEASING NKB 2213 01:36:57,200 --> 01:37:00,440 WHICH WILL STIMULATE OTHER KNDY 2214 01:37:00,440 --> 01:37:01,840 NEURONS, AS WELL AS THEY ARE 2215 01:37:01,840 --> 01:37:05,920 PROJECTING TO AREAS WITHIN THE 2216 01:37:05,920 --> 01:37:07,920 MEDIAL PRE-OPTIC AREA WHERE 2217 01:37:07,920 --> 01:37:09,320 THERMOREGULATION OCCURS, TRIGGER 2218 01:37:09,320 --> 01:37:19,000 THIS SENSATION OF HOT FLASHES. 2219 01:37:19,000 --> 01:37:24,280 WOMEN SWEAT TO DISSIPATE THE 2220 01:37:24,280 --> 01:37:28,360 SENSATION OF FEELING WARM. 2221 01:37:28,360 --> 01:37:30,200 BECAUSE OF THEIR OVERACTIVATION 2222 01:37:30,200 --> 01:37:36,880 AND KIND OF ALTERED 2223 01:37:36,880 --> 01:37:38,440 RESPONSIVENESS TO ESTROGEN. 2224 01:37:38,440 --> 01:37:42,040 NOW, I THINK THERE WAS -- JOANN 2225 01:37:42,040 --> 01:37:44,440 MENTIONED ABOUT THE NKB 2226 01:37:44,440 --> 01:37:47,200 ANTAGONIST THAT WAS RECENTLY 2227 01:37:47,200 --> 01:37:50,000 NOTED TO REDUCE -- RECENTLY 2228 01:37:50,000 --> 01:37:55,240 APPROVED BY THE FDA, IT WORKS AS 2229 01:37:55,240 --> 01:37:56,320 ANTAGONIST, BOTH AT THE LEVEL 2230 01:37:56,320 --> 01:38:04,920 OF -- NEURONS WITHIN THE MEDIAL 2231 01:38:04,920 --> 01:38:07,280 PRE-OPTIC AREA THAT EXPRESS NK3 2232 01:38:07,280 --> 01:38:10,200 RECEPTOR TO BLOCK THE HOT 2233 01:38:10,200 --> 01:38:11,240 FLASHES. 2234 01:38:11,240 --> 01:38:12,800 SO, IS THIS REALLY RELEVANT IN 2235 01:38:12,800 --> 01:38:14,560 TERMS OF WHEN WE THINK ABOUT 2236 01:38:14,560 --> 01:38:16,160 HUMANS, THIS IS A STUDY THAT I 2237 01:38:16,160 --> 01:38:18,080 WOULD LIKE TO SHARE WITH YOU 2238 01:38:18,080 --> 01:38:21,480 THAT WAS PART OF WHI, AND WHAT 2239 01:38:21,480 --> 01:38:25,200 THEY SHOWED WAS THAT INDIVIDUALS 2240 01:38:25,200 --> 01:38:29,160 WHO HAD MORE INTOLERABLE HOT 2241 01:38:29,160 --> 01:38:31,680 FLASHES ALSO HAD POLYMORPHISMS 2242 01:38:31,680 --> 01:38:38,440 OF THE TACK 3 RECEPTOR THAT 2243 01:38:38,440 --> 01:38:41,160 RESPONSE TO NEUROKININ B. 2244 01:38:41,160 --> 01:38:44,480 WE KNOW THE KNDY NEURONS UNDER 2245 01:38:44,480 --> 01:38:47,320 NORMAL ESTROGEN STATE ARE NOT AS 2246 01:38:47,320 --> 01:38:51,200 ACTIVE AND THEY ARE NOT 2247 01:38:51,200 --> 01:38:53,200 PROJECTING AND STIMULATING THE 2248 01:38:53,200 --> 01:38:56,240 HEAT SENSING REGION OF THE BRAIN 2249 01:38:56,240 --> 01:38:57,440 IN AN ABNORMAL WAY. 2250 01:38:57,440 --> 01:39:03,680 IN ABSENCE OF ESTROGEN FEEDBACK 2251 01:39:03,680 --> 01:39:06,640 WE KNOW THESE NEURONS HERE WITH 2252 01:39:06,640 --> 01:39:07,320 OVERSTIMULATED FROM KNDY 2253 01:39:07,320 --> 01:39:07,720 NEURONS. 2254 01:39:07,720 --> 01:39:08,760 WE DON'T KNOW WHETHER THE 2255 01:39:08,760 --> 01:39:11,520 NEURONS HAVE IMPACT ON SOME OF 2256 01:39:11,520 --> 01:39:13,360 THE METABOLIC AND DYSREGULATION 2257 01:39:13,360 --> 01:39:14,840 WE SEE REPORTED DURING 2258 01:39:14,840 --> 01:39:17,360 MENOPAUSE, AS WELL AS THERE'S 2259 01:39:17,360 --> 01:39:18,800 NOT AS MUCH INFORMATION, THERE 2260 01:39:18,800 --> 01:39:20,520 SEEMS TO BE SOME SUGGESTION THAT 2261 01:39:20,520 --> 01:39:22,320 THESE NATIONAL HURRICANE CENTER 2262 01:39:22,320 --> 01:39:24,400 MAY ALSO PROJECT AND AFFECT 2263 01:39:24,400 --> 01:39:26,560 AREAS WITHIN THE BRAIN THAT ARE 2264 01:39:26,560 --> 01:39:28,680 IMPORTANT FOR SLEEP. 2265 01:39:28,680 --> 01:39:30,920 SO, I WANT TO SAY THANK YOU FOR 2266 01:39:30,920 --> 01:39:33,560 THE NUMBER OF PEOPLE WHO HELPED 2267 01:39:33,560 --> 01:39:35,120 AS WELL AS FUNDING, SUPPORTED 2268 01:39:35,120 --> 01:39:36,960 MUCH OF THIS WORK. 2269 01:39:36,960 --> 01:39:40,360 AND THANK YOU FOR BEING PRESENT 2270 01:39:40,360 --> 01:39:42,960 >> THANK YOU FOR THAT REALLY 2271 01:39:42,960 --> 01:39:44,480 FASCINATING TALK. 2272 01:39:44,480 --> 01:39:47,280 I LOVE THOSE LITTLE MICE 2273 01:39:47,280 --> 01:39:52,080 CRAWLING BACK ACROSS THEIR BOX. 2274 01:39:52,080 --> 01:39:58,840 AND THE NEXT SPEAKER IS 2275 01:39:58,840 --> 01:40:00,360 PRE-RECORDED, DR. WALTER ROCCA 2276 01:40:00,360 --> 01:40:02,480 FROM THE MAYO CLINIC IS GOING TO 2277 01:40:02,480 --> 01:40:05,640 GIVE A TALK ABOUT THE 2278 01:40:05,640 --> 01:40:07,280 ACCUMULATION OF MORBIDITY 2279 01:40:07,280 --> 01:40:09,800 FOLLOWING MENOPAUSE. 2280 01:40:09,800 --> 01:40:12,520 >> I'LL BE PLAYING THE 2281 01:40:12,520 --> 01:40:13,480 RECORDING AND HE WILL BE AT THE 2282 01:40:13,480 --> 01:40:14,800 Q&A AT THE END. 2283 01:40:14,800 --> 01:40:17,680 DR. ROCCA IS PROFESSOR OF 2284 01:40:17,680 --> 01:40:19,200 EPIDEMIOLOGY AND NEUROLOGY AT 2285 01:40:19,200 --> 01:40:21,360 MAYO CLINIC COLLEGE OF MEDICINE 2286 01:40:21,360 --> 01:40:23,720 AND SCIENCE, WE LOOK FORWARD TO 2287 01:40:23,720 --> 01:40:26,480 HEARING HIS PRESENTATION. 2288 01:40:26,480 --> 01:40:32,480 2289 01:40:32,480 --> 01:40:34,680 >> LADIES AND GENTLEMEN, GOOD 2290 01:40:34,680 --> 01:40:34,920 MORNING. 2291 01:40:34,920 --> 01:40:37,240 I WOULD LIKE FIRST TO THANK THE 2292 01:40:37,240 --> 01:40:39,440 ORGANIZERS OF THE SYMPOSIUM FOR 2293 01:40:39,440 --> 01:40:42,840 THE KIND INVITATION, IT IS OF 2294 01:40:42,840 --> 01:40:43,720 COURSE A GREAT PLEASURE AND 2295 01:40:43,720 --> 01:40:45,760 HONOR TO TALK TO YOU TODAY. 2296 01:40:45,760 --> 01:40:48,120 I WILL BE TALKING ABOUT 2297 01:40:48,120 --> 01:40:52,440 PREMATURE OR EARLY MENOPAUSE AND 2298 01:40:52,440 --> 01:40:53,680 ACCELERATED ACCUMULATION OF 2299 01:40:53,680 --> 01:40:54,040 MULTI-MORBIDITY. 2300 01:40:54,040 --> 01:41:00,480 AND I DO NOT HAVE ANY FINANCIAL 2301 01:41:00,480 --> 01:41:02,320 RELATIONSHIP TO DISCLOSE. 2302 01:41:02,320 --> 01:41:04,440 I WILL TALK FOR 20 MINUTES, 2303 01:41:04,440 --> 01:41:10,120 FOCUSING ON STUDIES OF WOMEN 2304 01:41:10,120 --> 01:41:11,120 WITH BILATERAL OOPHORECTOMY 2305 01:41:11,120 --> 01:41:13,600 BECAUSE IT'S BEEN AND REMAINS 2306 01:41:13,600 --> 01:41:16,760 THE MOST COMMON CAUSE OF 2307 01:41:16,760 --> 01:41:19,480 PREMATURE EARLY MENOPAUSE IN THE 2308 01:41:19,480 --> 01:41:20,440 GENERAL POPULATION. 2309 01:41:20,440 --> 01:41:24,120 I WILL REVIEW SOME EVIDENCE FROM 2310 01:41:24,120 --> 01:41:26,440 CLINICAL RESEARCH. 2311 01:41:26,440 --> 01:41:29,240 I WILL REVIEW EVIDENCE THAT IS 2312 01:41:29,240 --> 01:41:31,480 AGAINST THE POSSIBILITY OF 2313 01:41:31,480 --> 01:41:34,960 CAUSE-EFFECT INVERSION, AND THEN 2314 01:41:34,960 --> 01:41:37,040 MOVE INTO EVIDENCE FROM 2315 01:41:37,040 --> 01:41:38,280 BIOMARKER RESEARCH IN ANIMAL 2316 01:41:38,280 --> 01:41:38,520 STUDIES. 2317 01:41:38,520 --> 01:41:41,560 AT THE END OF THE PRESENTATION 2318 01:41:41,560 --> 01:41:44,520 YOU WILL DRAW CONCLUSIONS AND 2319 01:41:44,520 --> 01:41:47,800 PRESENT GENERAL THEORY AND GIVE 2320 01:41:47,800 --> 01:41:49,400 BRIEF CLINICAL RECOMMENDATIONS. 2321 01:41:49,400 --> 01:41:51,600 MANY OF THE DATA THAT I'M 2322 01:41:51,600 --> 01:41:53,000 PRESENTING TODAY HAVE BEEN 2323 01:41:53,000 --> 01:41:54,920 PUBLISHED, AND YOU WILL SEE AT 2324 01:41:54,920 --> 01:41:58,160 THE BOTTOM OF MY SLIDES THE 2325 01:41:58,160 --> 01:41:58,920 NUMBER OF KEY REFERENCES. 2326 01:41:58,920 --> 01:42:01,920 LET US BEGIN WITH THE EVIDENCE 2327 01:42:01,920 --> 01:42:03,760 FROM CLINICAL RESEARCH. 2328 01:42:03,760 --> 01:42:07,000 AND I WILL FOCUS PRIMARILY ON 2329 01:42:07,000 --> 01:42:10,000 DATA THAT CAME FROM WORK DONE BY 2330 01:42:10,000 --> 01:42:14,520 OUR GROUP AT THE MAYO CLINIC. 2331 01:42:14,520 --> 01:42:16,720 WE PUBLISHED A NUMBER OF DATA 2332 01:42:16,720 --> 01:42:19,440 UNDER THE LABEL OF THE MAYO 2333 01:42:19,440 --> 01:42:21,560 CLINIC COHORT STUDY OF 2334 01:42:21,560 --> 01:42:25,200 OOPHORECTOMY AND AGING NUMBER 2 2335 01:42:25,200 --> 01:42:26,720 THAT WE CALL MOA-2. 2336 01:42:26,720 --> 01:42:28,520 THIS IS NUMBER 2 BECAUSE THERE'S 2337 01:42:28,520 --> 01:42:29,760 BEEN A NUMBER 1 IN THE PAST AND 2338 01:42:29,760 --> 01:42:36,480 THIS IS A NEW COHORT OF WOMEN 2339 01:42:36,480 --> 01:42:38,560 WHO UNDERWENT BILATERAL 2340 01:42:38,560 --> 01:42:40,000 OOPHORECTOMY IN MINNESOTA 2341 01:42:40,000 --> 01:42:41,880 BETWEEN 1988 AND 2007. 2342 01:42:41,880 --> 01:42:43,800 SO WE'RE DEALING WITH 20 YEARS 2343 01:42:43,800 --> 01:42:45,200 OF RECRUITMENT. 2344 01:42:45,200 --> 01:42:48,920 WE WERE ABLE TO RECRUIT 1653 2345 01:42:48,920 --> 01:42:52,160 WOMEN, THAT HAD THE OOPHORECTOMY 2346 01:42:52,160 --> 01:42:56,920 AT AGE 50, BELOW AGE 50, AND 2347 01:42:56,920 --> 01:43:02,520 MATCHED 1:1 TO THE SAME BE IN 2348 01:43:02,520 --> 01:43:05,120 WHO HAD NOT UNDERGONE 2349 01:43:05,120 --> 01:43:07,680 OOPHORECTOMY. 2350 01:43:07,680 --> 01:43:09,160 OF THESE 1653, APPROXIMATELY 2351 01:43:09,160 --> 01:43:11,280 1,000 HAD OOPHORECTOMY AT 2352 01:43:11,280 --> 01:43:13,440 PARTICULARLY YOUNG AGE, THAT IS 2353 01:43:13,440 --> 01:43:18,160 AT THE AGE 45 OR YOUNGER, AND 2354 01:43:18,160 --> 01:43:23,280 THEY WERE MEASURED WITH EQUAL 2355 01:43:23,280 --> 01:43:25,200 ENOUGH OF REFERENT. 2356 01:43:25,200 --> 01:43:32,520 REAR WE FOLLOWED OVER TIME, 2357 01:43:32,520 --> 01:43:33,920 APPROXIMATELY 14 YEARS, COHORTS 2358 01:43:33,920 --> 01:43:35,480 ARE STILL RELATIVELY YOUNG BUT 2359 01:43:35,480 --> 01:43:36,280 FORTUNATELY WE'RE CONTINUING TO 2360 01:43:36,280 --> 01:43:37,840 FOLLOW THESE WOMEN AND WE WILL 2361 01:43:37,840 --> 01:43:42,120 BE ABLE IN THE FUTURE TO REPORT 2362 01:43:42,120 --> 01:43:44,600 DATA WITH THE MORE MATURE 2363 01:43:44,600 --> 01:43:45,280 COHORT. 2364 01:43:45,280 --> 01:43:50,200 THE OUTCOMES OF THE STUDY WERE 2365 01:43:50,200 --> 01:43:51,080 18 CHRONIC CONDITIONS, WHICH 2366 01:43:51,080 --> 01:43:54,600 WERE PICKED BY U.S. DEPARTMENT 2367 01:43:54,600 --> 01:43:56,880 OF HEALTH AND HUMAN SERVICES AS 2368 01:43:56,880 --> 01:43:58,280 BEING THE MOST IMPORTANT CHRONIC 2369 01:43:58,280 --> 01:44:02,200 DISEASES IN THE UNITED STATES. 2370 01:44:02,200 --> 01:44:07,200 AND THEY WERE SELECTED TO BE 2371 01:44:07,200 --> 01:44:10,560 USED TO DEFINE MULTI-MORBIDITY. 2372 01:44:10,560 --> 01:44:13,520 WE STUDIED FIVE MENTAL HEALTH, 2373 01:44:13,520 --> 01:44:14,400 FIVE CARDIOVASCULAR OR 2374 01:44:14,400 --> 01:44:15,560 METABOLICS, SIX OTHER SOMATIC 2375 01:44:15,560 --> 01:44:16,160 CONDITIONS. 2376 01:44:16,160 --> 01:44:17,680 YOU WILL SEE EACH ONE OF THESE 2377 01:44:17,680 --> 01:44:20,520 CONDITIONS IN THE COMING SLIDES. 2378 01:44:20,520 --> 01:44:23,480 HOWEVER, IN ADDITION TO LOOKING 2379 01:44:23,480 --> 01:44:27,440 AT THEM INDIVIDUALLY, WE ALSO 2380 01:44:27,440 --> 01:44:30,640 COMBINED THE CHRONIC CONDITIONS 2381 01:44:30,640 --> 01:44:34,440 INTO A CONCEPT MULTI-CHRONIC 2382 01:44:34,440 --> 01:44:36,480 CONDITION OR MULTI-MORBIDITY AND 2383 01:44:36,480 --> 01:44:40,120 CONSIDER THAT AS A CLINICAL 2384 01:44:40,120 --> 01:44:41,720 MARKER OF ACCELERATED AGING. 2385 01:44:41,720 --> 01:44:45,720 HOWEVER, BECAUSE THE TWO GROUPS, 2386 01:44:45,720 --> 01:44:48,000 TWO COHORTS WERE DIFFERENT AT 2387 01:44:48,000 --> 01:44:49,680 BASELINE IN A NUMBER OF 2388 01:44:49,680 --> 01:44:51,840 CHARACTERISTICS WE USED 2389 01:44:51,840 --> 01:44:52,480 STATISTICAL METHOD OF INVERSE 2390 01:44:52,480 --> 01:44:57,520 POP -- PROBABILITY WEIGHTS TO 2391 01:44:57,520 --> 01:45:00,520 MAKE SIMILAR AT TIME OF SURGERY 2392 01:45:00,520 --> 01:45:02,600 FOR 18 CHRONIC CONDITIONS 2393 01:45:02,600 --> 01:45:08,400 ALREADY PRESENT AT THE SURGERY, 2394 01:45:08,400 --> 01:45:11,880 BY EDUCATION, RACE, BODY MASS 2395 01:45:11,880 --> 01:45:13,240 INDEX, SMOKING, AGE, CALENDAR 2396 01:45:13,240 --> 01:45:13,560 YEAR. 2397 01:45:13,560 --> 01:45:15,520 LET'S START BY LOOKING AT 2398 01:45:15,520 --> 01:45:19,280 RESULTS, LOOKING AT DISEASES ONE 2399 01:45:19,280 --> 01:45:20,760 BY ONE. 2400 01:45:20,760 --> 01:45:24,640 FIRST SLIDE, FIVE MALTED 2401 01:45:24,640 --> 01:45:27,920 MENTAL HEALTH 2402 01:45:27,920 --> 01:45:28,200 CONDITIONS. 2403 01:45:28,200 --> 01:45:30,560 VERTICAL DOTTED LINE MEANS TWO 2404 01:45:30,560 --> 01:45:31,640 INCREASE OR DECREASE RISK. 2405 01:45:31,640 --> 01:45:36,440 AND ON THE RIGHT SIDE YOU HAVE 2406 01:45:36,440 --> 01:45:39,000 INCREASED RISK, LEFT SIDE 2407 01:45:39,000 --> 01:45:40,560 DECREASED RISK. 2408 01:45:40,560 --> 01:45:43,560 FOR EACH DISEASE WE HAVE THREE 2409 01:45:43,560 --> 01:45:46,440 MEASURES, ONE IN BLUE IS EFFECT 2410 01:45:46,440 --> 01:45:47,560 ON THE GROUP OVERALL. 2411 01:45:47,560 --> 01:45:50,520 IN RED WE HAVE THE EFFECT IN 2412 01:45:50,520 --> 01:45:53,440 WOMEN WHO HAD THE YOUNGER 2413 01:45:53,440 --> 01:45:53,920 OOPHORECTOMY. 2414 01:45:53,920 --> 01:45:57,960 IN BLACK RESULT FOR WOMEN WITH 2415 01:45:57,960 --> 01:45:58,920 LATER OOPHORECTOMY. 2416 01:45:58,920 --> 01:46:02,560 WHEN THE RESULT WAS SIGNIFICANT, 2417 01:46:02,560 --> 01:46:04,280 I ADDED A RED ARROW. 2418 01:46:04,280 --> 01:46:06,240 SO AS YOU CAN SEE MANY OF THE 2419 01:46:06,240 --> 01:46:08,120 RESULTS WERE SHIFTED TO THE 2420 01:46:08,120 --> 01:46:11,840 RIGHT SIDE OF THE VERTICAL LINE 2421 01:46:11,840 --> 01:46:13,640 AND SOME REACHED STATISTICAL 2422 01:46:13,640 --> 01:46:16,440 SIGNIFICANCE, CERTAINLY FOR NOW 2423 01:46:16,440 --> 01:46:18,600 THE DEPRESSION AND ANXIETY. 2424 01:46:18,600 --> 01:46:21,160 IF YOU LOOK AT CARDIOVASCULAR 2425 01:46:21,160 --> 01:46:22,440 AND METABOLIC CONDITIONS, AGAIN 2426 01:46:22,440 --> 01:46:25,360 WE HAVE A LOT OF FINDINGS 2427 01:46:25,360 --> 01:46:30,360 SHIFTED TO THE RIGHT OF THE NULL 2428 01:46:30,360 --> 01:46:32,560 RISK, AND SOME REACHED 2429 01:46:32,560 --> 01:46:36,880 STATISTICAL SIGNIFICANCE EVEN IN 2430 01:46:36,880 --> 01:46:38,520 RELATIVELY YOUNG WOMEN, 2431 01:46:38,520 --> 01:46:39,880 HYPERLIPIDEMIA, DIABETES, 2432 01:46:39,880 --> 01:46:40,760 CARDIAC ARRHYTHMIA, CORONARY 2433 01:46:40,760 --> 01:46:42,800 ARTERY DISEASE. 2434 01:46:42,800 --> 01:46:44,520 THERE WAS ONE ESTIMATION, 2435 01:46:44,520 --> 01:46:46,240 ESTIMATE THAT WAS IN THE 2436 01:46:46,240 --> 01:46:48,800 OPPOSITE DIRECTION, AND THIS WAS 2437 01:46:48,800 --> 01:46:50,240 CONGESTIVE HEART FAILURE, AND 2438 01:46:50,240 --> 01:46:53,080 THIS IS AN ARTIFACT DUE TO THE 2439 01:46:53,080 --> 01:46:56,120 FACT THAT WOMEN AT HIGH RISK OF 2440 01:46:56,120 --> 01:46:58,240 CONGESTIVE HEART FAILURE HAVE A 2441 01:46:58,240 --> 01:46:59,880 CONTRAINDICATION TO SURGERY AND 2442 01:46:59,880 --> 01:47:02,680 THEY WERE NOT -- DID NOT UNDERGO 2443 01:47:02,680 --> 01:47:05,160 SURGERY, THIS IS AN ARTIFACT OF 2444 01:47:05,160 --> 01:47:09,920 THE SELECTION FOR THE SURGERY. 2445 01:47:09,920 --> 01:47:11,000 LOOK AT OTHER SOMATIC CONDITIONS 2446 01:47:11,000 --> 01:47:15,400 AGAIN YOU HAVE A LOT OF FINDINGS 2447 01:47:15,400 --> 01:47:17,400 SHIFTED TO RIGHT SIDE INDICATING 2448 01:47:17,400 --> 01:47:21,840 INCREASE IN RISK, AND SOME WERE 2449 01:47:21,840 --> 01:47:23,280 SIGNIFICANT SUCH AS ARTHRITIS, 2450 01:47:23,280 --> 01:47:28,440 CANCER IN OLDER WOMEN, ASTHMA, 2451 01:47:28,440 --> 01:47:29,080 CHRONIC OBSTRUCTIVE PULMONARY 2452 01:47:29,080 --> 01:47:32,520 DISEASE AND OF COURSE AS 2453 01:47:32,520 --> 01:47:33,280 EXPECTED OSTEOPOROSIS. 2454 01:47:33,280 --> 01:47:35,880 THE KIDNEY FINDINGS WERE VERY 2455 01:47:35,880 --> 01:47:37,560 INTERESTING, SUGGESTIVE, BUT DID 2456 01:47:37,560 --> 01:47:39,080 NOT REACH SIGNIFICANCE BECAUSE 2457 01:47:39,080 --> 01:47:42,160 THE NUMBER OF COURSE WERE STILL 2458 01:47:42,160 --> 01:47:43,760 RELATIVELY SMALL. 2459 01:47:43,760 --> 01:47:47,040 AS YOU CAN SEE WE HAVE VERY 2460 01:47:47,040 --> 01:47:49,000 IMPORTANT FINDINGS IN THESE 2461 01:47:49,000 --> 01:47:51,600 WOMEN IN THE DIRECTION OF 2462 01:47:51,600 --> 01:47:53,080 INCREASED RISK LOOKING AT 2463 01:47:53,080 --> 01:47:54,760 DISEASES ONE BY ONE, BUT IF WE 2464 01:47:54,760 --> 01:47:58,440 NOW PUT TOGETHER ALL OF THESE 2465 01:47:58,440 --> 01:48:01,800 DISEASES, CAN GIVE TO EACH WOMAN 2466 01:48:01,800 --> 01:48:04,760 A SCORE WHICH CAN STUDY 2467 01:48:04,760 --> 01:48:06,080 ACCUMULATION OF 18 CONDITIONS 2468 01:48:06,080 --> 01:48:08,480 OVER TIME. 2469 01:48:08,480 --> 01:48:10,680 AND I'M SHOWING ANALYSIS 2470 01:48:10,680 --> 01:48:13,840 RESTRICTED TO WOMEN AGE 45 OR 2471 01:48:13,840 --> 01:48:14,480 YOUNGER AT OOPHORECTOMY BECAUSE 2472 01:48:14,480 --> 01:48:19,800 THIS IS THE GROUP THAT SHOWS THE 2473 01:48:19,800 --> 01:48:20,240 MORE EXTREME RESULTS. 2474 01:48:20,240 --> 01:48:22,640 ON THE X-AXIS, YOU HAVE THE 2475 01:48:22,640 --> 01:48:25,360 TIME, ZERO IS TIME OF 2476 01:48:25,360 --> 01:48:25,800 OOPHORECTOMY. 2477 01:48:25,800 --> 01:48:29,200 AND WE HAVE TEN YEARS BEFORE 2478 01:48:29,200 --> 01:48:30,920 OOPHORECTOM AND 15 YEARS AFTER. 2479 01:48:30,920 --> 01:48:33,200 ON THE Y-AXIS YOU HAVE THE 2480 01:48:33,200 --> 01:48:35,200 NUMBER OF CHRONIC CONDITIONS. 2481 01:48:35,200 --> 01:48:40,440 IN BLACK IS THE CURVE OF WOMEN 2482 01:48:40,440 --> 01:48:42,200 THAT ARE REFERENT, REPRESENTING 2483 01:48:42,200 --> 01:48:43,360 THE GENERALLY POPULATION OF 2484 01:48:43,360 --> 01:48:45,560 WOMEN, SLOPE OF INCREASE OF 2485 01:48:45,560 --> 01:48:47,920 MORBIDITY WITH AGE IN NORMAL 2486 01:48:47,920 --> 01:48:48,120 WOMEN. 2487 01:48:48,120 --> 01:48:53,600 THE WOMEN THAT UNDERWENT 2488 01:48:53,600 --> 01:48:55,440 OOPHORECTOMY WERE ALREADY 2489 01:48:55,440 --> 01:48:56,080 ACCUMULATING DISEASES IN 2490 01:48:56,080 --> 01:48:57,640 ACCELERATED FASHION BUT AT THE 2491 01:48:57,640 --> 01:49:03,760 TIME OF SURGERY THEY FURTHER 2492 01:49:03,760 --> 01:49:08,920 INCREASED ACCELERATION AND 2493 01:49:08,920 --> 01:49:11,000 REACHED SIGNIFICANT ACCELERATION 2494 01:49:11,000 --> 01:49:11,320 IN FOLLOW-UP. 2495 01:49:11,320 --> 01:49:12,520 THERE WAS DIFFERENCE EVEN AT THE 2496 01:49:12,520 --> 01:49:16,000 TIME OF SURGERY, WE TRIED TO 2497 01:49:16,000 --> 01:49:17,840 ADDRESS THIS DIFFERENCE USING 2498 01:49:17,840 --> 01:49:20,600 WEIGHTING, BUT WE ALSO DID SOME 2499 01:49:20,600 --> 01:49:24,560 ADDITIONAL ANALYSIS TO MAKE SURE 2500 01:49:24,560 --> 01:49:28,440 THERE WAS NOT A CAUSE-EFFECT 2501 01:49:28,440 --> 01:49:28,720 INVERSION. 2502 01:49:28,720 --> 01:49:29,800 WHAT DOES A CAUSE-EFFECT 2503 01:49:29,800 --> 01:49:31,840 INVERSION MEAN? 2504 01:49:31,840 --> 01:49:33,720 IT MEANS THAT WE ARE 2505 01:49:33,720 --> 01:49:36,480 INTERPRETING THE RESULTS AS 2506 01:49:36,480 --> 01:49:39,640 SUGGESTING THAT BILATERAL 2507 01:49:39,640 --> 01:49:41,160 OOPHORECTOMY OR THE SURGERY 2508 01:49:41,160 --> 01:49:42,360 CAUSED ACCELERATION OF AGING BUT 2509 01:49:42,360 --> 01:49:44,560 NEED TO MAKE SURE AND TO RULE 2510 01:49:44,560 --> 01:49:47,280 OUT THAT IT'S NOT THE OPPOSITE, 2511 01:49:47,280 --> 01:49:49,640 THAT THE WOMEN WERE ALREADY 2512 01:49:49,640 --> 01:49:51,920 HAVING UNDERGOING PROBLEMS WITH 2513 01:49:51,920 --> 01:49:57,040 AGING AND THEN THEY DEVELOPED 2514 01:49:57,040 --> 01:49:59,560 GYNECOLOGICAL SYMPTOMS WHICH 2515 01:49:59,560 --> 01:50:00,120 PROMPTED HYSTERECTOMY THAT 2516 01:50:00,120 --> 01:50:02,520 PROMPTED OOPHORECTOMY. 2517 01:50:02,520 --> 01:50:08,320 IN THIS CASE, SURGERY WOULD BE A 2518 01:50:08,320 --> 01:50:09,760 CONSEQUENCE OR EFFECT, INNOCENT 2519 01:50:09,760 --> 01:50:11,840 AS TO THE PROCESS. 2520 01:50:11,840 --> 01:50:13,040 WE HAVE SOME VERY INTERESTING 2521 01:50:13,040 --> 01:50:15,640 DATA TO ADDRESS THIS QUESTION, 2522 01:50:15,640 --> 01:50:17,520 THE MOST INTERESTING DATA 2523 01:50:17,520 --> 01:50:20,560 COMMENTS FROM ANALYSIS PUBLISHED 2524 01:50:20,560 --> 01:50:23,400 IN 2017, WHERE WE RESTRICTED OUR 2525 01:50:23,400 --> 01:50:27,240 ANALYSIS TO WOMEN WHO HAD ZERO 2526 01:50:27,240 --> 01:50:29,680 CONDITIONS AT BASELINE, SO THESE 2527 01:50:29,680 --> 01:50:32,040 WOMEN WERE ONLY THE ONES WHO THE 2528 01:50:32,040 --> 01:50:36,960 DAY BEFORE THE SURGERY HAD ZERO 2529 01:50:36,960 --> 01:50:38,560 DISEASES, NO HYPERTENSION OR 2530 01:50:38,560 --> 01:50:39,440 HYPERLIPIDEMIA, NO DEPRESSION, 2531 01:50:39,440 --> 01:50:39,720 NO DISEASES. 2532 01:50:39,720 --> 01:50:43,480 IF YOU TAKE THIS GROUP OF WOMEN 2533 01:50:43,480 --> 01:50:46,840 AND SEE THE ONE REFERENT, YOU 2534 01:50:46,840 --> 01:50:47,680 SEE ACCUMULATION OF 2535 01:50:47,680 --> 01:50:48,320 MULTI-MORBIDITY AND WHAT 2536 01:50:48,320 --> 01:50:52,320 HAPPENED TO THE WOMEN THAT 2537 01:50:52,320 --> 01:50:55,360 UNDERWENT SURGERY, OOPHORECTOMY. 2538 01:50:55,360 --> 01:50:56,600 THEY HAVE ACCELERATION OF 2539 01:50:56,600 --> 01:50:58,800 ACCUMULATION FOR FIRST FIVE, SIX 2540 01:50:58,800 --> 01:51:00,800 YEARS, REACH MORE PARALLEL 2541 01:51:00,800 --> 01:51:04,800 CONTINUING GROWTH OVER TIME WITH 2542 01:51:04,800 --> 01:51:06,040 SIGNIFICANT EFFECT. 2543 01:51:06,040 --> 01:51:09,560 SO, THIS IS A VERY IMPORTANT 2544 01:51:09,560 --> 01:51:11,680 PIECE OF EVIDENCE, SUGGESTING 2545 01:51:11,680 --> 01:51:14,440 THAT THE OOPHORECTOMY ITSELF IS 2546 01:51:14,440 --> 01:51:18,800 CAUSAL AND NOT SIMPLY A MARKER 2547 01:51:18,800 --> 01:51:20,560 OF AGING. 2548 01:51:20,560 --> 01:51:23,640 THERE ARE OTHER DATA THAT 2549 01:51:23,640 --> 01:51:27,360 SUPPORT A DIRECT CAUSALITY, ONE 2550 01:51:27,360 --> 01:51:30,960 SET OF ANALYSIS IS BY INDICATION 2551 01:51:30,960 --> 01:51:31,360 FOR OOPHORECTOMY. 2552 01:51:31,360 --> 01:51:33,720 WHEN WE DIVIDED OUR COHORT IN 2553 01:51:33,720 --> 01:51:41,080 WOMEN WHO HAD A BENIGN OVARIAN 2554 01:51:41,080 --> 01:51:41,920 CONDITION, PRIMARILY 2555 01:51:41,920 --> 01:51:44,600 ENDOMETRIOSIS, AND DID NOT HAVE 2556 01:51:44,600 --> 01:51:46,880 BENIGN INDICATION, RESULTS WERE 2557 01:51:46,880 --> 01:51:50,440 VERY SIMILAR AND THEY WERE BOTH 2558 01:51:50,440 --> 01:51:51,840 SIGNIFICANT SUGGESTING THAT THE 2559 01:51:51,840 --> 01:51:54,560 INDICATION WAS NOT EXPLAINING 2560 01:51:54,560 --> 01:51:56,120 THE OUTCOME. 2561 01:51:56,120 --> 01:51:59,520 BUT VERY IMPORTANTLY, WE ALSO 2562 01:51:59,520 --> 01:52:01,760 DID AN ANALYSIS, STRATIFYING 2563 01:52:01,760 --> 01:52:05,520 COHORT IN WOMEN WHO WERE TREATED 2564 01:52:05,520 --> 01:52:08,480 WITH ESTROGEN UP TO AGE 45, AND 2565 01:52:08,480 --> 01:52:10,120 WOMEN WHO WERE NOT TREATED. 2566 01:52:10,120 --> 01:52:14,480 AND YOU CAN SEE THE WOMEN WHO 2567 01:52:14,480 --> 01:52:16,880 ARE TREATED AT LITTLE INCREASED 2568 01:52:16,880 --> 01:52:19,880 RISK, WOMEN NOT TREATED WERE 2569 01:52:19,880 --> 01:52:23,120 CARRYING ALL OF THE RISK. 2570 01:52:23,120 --> 01:52:25,200 THIS MEANS THAT THIS IS AN 2571 01:52:25,200 --> 01:52:32,320 INDIRECT PROOF THAT IT IS THE 2572 01:52:32,320 --> 01:52:34,320 OOPHORECTOMY THAT CAUSES AGING 2573 01:52:34,320 --> 01:52:36,840 THROUGH DEPRIVATION OF ESTROGEN 2574 01:52:36,840 --> 01:52:39,120 AND IF YOU PUT IT BACK WITH 2575 01:52:39,120 --> 01:52:43,040 THERAPY YOU ELIMINATE AT LEAST 2576 01:52:43,040 --> 01:52:44,480 IN PART THE NEGATIVE EFFECT. 2577 01:52:44,480 --> 01:52:48,200 AGAIN, VERY IMPORTANT EVIDENCE. 2578 01:52:48,200 --> 01:52:50,600 WE ALSO STRATIFIED BY CALENDAR 2579 01:52:50,600 --> 01:52:54,520 YEAR DECADES AND FOUND NO 2580 01:52:54,520 --> 01:52:55,840 DIFFERENCE SUGGESTING THAT 2581 01:52:55,840 --> 01:52:58,360 EFFECT WE OBSERVED WERE NOT DUE 2582 01:52:58,360 --> 01:53:00,680 TO SURGICAL TECHNIQUE, THEY WERE 2583 01:53:00,680 --> 01:53:04,120 NOT DUE TO ANESTHESIA OR ANY 2584 01:53:04,120 --> 01:53:08,640 OTHER ISSUE RELATED TO THE 2585 01:53:08,640 --> 01:53:09,840 PERFORMANCE OF THE SURGERY. 2586 01:53:09,840 --> 01:53:13,200 LET US MOVE TO EVIDENCE FROM 2587 01:53:13,200 --> 01:53:14,000 BIOMARKER RESEARCH IN ANIMAL 2588 01:53:14,000 --> 01:53:24,440 MODEL MAL -- ANIMAL STUDIES. 2589 01:53:24,440 --> 01:53:29,120 A GROUP LOOKED AT EFFECT OF 2590 01:53:29,120 --> 01:53:31,080 BILATERAL HORMONE THERAPY ON 2591 01:53:31,080 --> 01:53:33,120 ACCELERATED AGING, DEFINED BY 2592 01:53:33,120 --> 01:53:36,040 COMPARING BIOLOGICAL AGE AT 2593 01:53:36,040 --> 01:53:41,200 CELLULAR AND TISSUE LEVEL 2594 01:53:41,200 --> 01:53:44,560 TO: CHRONOLOGICAL AGE. 2595 01:53:44,560 --> 01:53:49,200 IF A WOMAN HAS BIOLOGICAL AGE 2596 01:53:49,200 --> 01:53:50,200 THAT CORRESPONDS TO 2597 01:53:50,200 --> 01:53:52,600 CHRONOLOGICAL AGE IS AGING 2598 01:53:52,600 --> 01:53:52,920 NORMALLY. 2599 01:53:52,920 --> 01:54:01,560 IF HAS OLDER BIOLOGICAL AGE SHE 2600 01:54:01,560 --> 01:54:03,760 IS ON ACCELERATED TRACT, IF 2601 01:54:03,760 --> 01:54:05,200 BETTER SHE'S AGING SUCCESSFULLY. 2602 01:54:05,200 --> 01:54:07,120 THE PROBLEM IS YOU NEED TO 2603 01:54:07,120 --> 01:54:08,560 MEASURE BIOLOGICAL AGE AND THERE 2604 01:54:08,560 --> 01:54:12,920 ARE A NUMBER OF WAYS OF 2605 01:54:12,920 --> 01:54:15,360 MEASURING BIOLOGICAL AGE AT THE 2606 01:54:15,360 --> 01:54:18,040 CELLULAR, TISSUE, ORGAN LEVEL, 2607 01:54:18,040 --> 01:54:20,600 USING EPIGENETIC CLOCK, AND THIS 2608 01:54:20,600 --> 01:54:23,880 IS BASED ON DNA METHYLATION. 2609 01:54:23,880 --> 01:54:28,080 SIMPLE IDEA IS THAT THE OLDER IS 2610 01:54:28,080 --> 01:54:31,600 A CELL, THE MORE DNA METHYLATION 2611 01:54:31,600 --> 01:54:32,480 THERE WILL BE. 2612 01:54:32,480 --> 01:54:36,280 AND SO THAT'S A VERY SIMPLE 2613 01:54:36,280 --> 01:54:36,600 RELATIONSHIP. 2614 01:54:36,600 --> 01:54:43,840 NOW, THEY SHOWED THAT WOMEN WHO 2615 01:54:43,840 --> 01:54:48,320 UNDERWENT OOPHORECTOMY ARE 2616 01:54:48,320 --> 01:54:49,680 HIGHER LEVELS OF METHYLATION IN 2617 01:54:49,680 --> 01:54:53,360 BLOOD AND SALIVA, TWO DIFFERENT 2618 01:54:53,360 --> 01:54:55,120 TISSUES SHOWED ACCELERATION OF 2619 01:54:55,120 --> 01:54:57,480 AGING, THEY ALSO SHOWED IF THE 2620 01:54:57,480 --> 01:54:59,720 AGE AT MENOPAUSE WAS YOUNG BUT 2621 01:54:59,720 --> 01:55:02,920 NOT CAUSED BY THE SURGERY, BUT 2622 01:55:02,920 --> 01:55:07,480 CAME NATURALLY, IF A WOMAN HAD 2623 01:55:07,480 --> 01:55:09,000 PREMATURE OR EARLY SPONTANEOUS 2624 01:55:09,000 --> 01:55:13,200 OR NATURAL MENOPAUSE, THERE WAS 2625 01:55:13,200 --> 01:55:17,040 ACCELERATION OF THE AGING 2626 01:55:17,040 --> 01:55:20,560 PROCESS, IF THEY RECEIVED 2627 01:55:20,560 --> 01:55:24,360 ESTROGEN THERAPY THERE WAS 2628 01:55:24,360 --> 01:55:25,120 ACCELERATION, SHOWING 2629 01:55:25,120 --> 01:55:27,280 OOPHORECTOMY IS LEAVED TO 2630 01:55:27,280 --> 01:55:30,840 ACCELERATION OF AGING PROCESS 2631 01:55:30,840 --> 01:55:33,080 MEASURED BY BIOMARKERS RATHER 2632 01:55:33,080 --> 01:55:34,640 THAN CLINICAL OUTCOMES. 2633 01:55:34,640 --> 01:55:38,240 ALSO WE HAVE A LOT OF VERY 2634 01:55:38,240 --> 01:55:41,960 IMPORTANT STUDIES FROM ANIMALS, 2635 01:55:41,960 --> 01:55:50,400 AND IN MICE OOPHORECTOMY HAS 2636 01:55:50,400 --> 01:55:52,320 USED FOR DECADES, SO A LOT OF 2637 01:55:52,320 --> 01:55:55,000 WORK IS BEING DONE ON AGONIST 2638 01:55:55,000 --> 01:55:59,360 AND ANTAGONIST AND MODULATION OF 2639 01:55:59,360 --> 01:56:01,080 THE EFFECT OF ESTROGEN, USING 2640 01:56:01,080 --> 01:56:04,960 HORMONE THERAPY -- OOPHORECTOMY 2641 01:56:04,960 --> 01:56:06,520 IN THE ANIMALS. 2642 01:56:06,520 --> 01:56:09,680 WITH MONKEYS, REMOVAL OF OAF 2643 01:56:09,680 --> 01:56:18,000 RILLS CAN CAUSE AC -- OVARIES 2644 01:56:18,000 --> 01:56:20,560 CAN CAUSE ACCELERATION WITH 2645 01:56:20,560 --> 01:56:20,800 PLAQUES. 2646 01:56:20,800 --> 01:56:23,280 IN RODENTS AND MONKEY WE HAVE 2647 01:56:23,280 --> 01:56:26,440 EVIDENCE THAT REMOVING OVARIES 2648 01:56:26,440 --> 01:56:27,360 WILL ACCELERATE DEGENERATION OF 2649 01:56:27,360 --> 01:56:30,720 THE BRAIN, THIS IS VERY 2650 01:56:30,720 --> 01:56:33,160 IMPORTANT FOR BRAIN RESEARCH, IN 2651 01:56:33,160 --> 01:56:35,520 DOGS AND MICE WE HAVE EVIDENCE 2652 01:56:35,520 --> 01:56:37,560 SUGGESTING REMOVAL OF THE 2653 01:56:37,560 --> 01:56:40,160 OVARIES THAT IN ANIMAL IS CALLED 2654 01:56:40,160 --> 01:56:44,520 CASTRATION CAUSES REDUCTION IN 2655 01:56:44,520 --> 01:56:44,960 LIFESPAN. 2656 01:56:44,960 --> 01:56:47,680 BUT FASCINATING ARE EXPERIMENTS 2657 01:56:47,680 --> 01:56:49,880 THAT HAVE BEEN DONE IN MICE 2658 01:56:49,880 --> 01:56:52,880 WHERE IF YOU TRANSPLANT THE 2659 01:56:52,880 --> 01:56:57,200 OVARIES FROM YOUNG MICE TO OLD 2660 01:56:57,200 --> 01:56:59,840 MICE, YOU WILL OBSERVE THAT THE 2661 01:56:59,840 --> 01:57:02,800 OLD MICE WILL BEHAVE LIKE YOUNG 2662 01:57:02,800 --> 01:57:05,960 MICE, AND WILL HAVE INCREASED 2663 01:57:05,960 --> 01:57:08,920 LIFESPAN. 2664 01:57:08,920 --> 01:57:12,200 BASICALLY YOU CAN SAY THAT 2665 01:57:12,200 --> 01:57:14,400 SURVIVAL CAN BE TRANSPLANTED BY 2666 01:57:14,400 --> 01:57:16,720 THE TRANSPLANTATION OF OVARY AND 2667 01:57:16,720 --> 01:57:19,520 TISSUE, THIS IS A VERY DIRECT 2668 01:57:19,520 --> 01:57:22,040 FASCINATING DEMONSTRATION OF THE 2669 01:57:22,040 --> 01:57:24,360 ROLE OF OVARIAN FUNCTION ON 2670 01:57:24,360 --> 01:57:28,840 AGING AND LIFESPAN. 2671 01:57:28,840 --> 01:57:29,200 2672 01:57:29,200 --> 01:57:32,600 LET'S REACH CONCLUSIONS AND GIVE 2673 01:57:32,600 --> 01:57:33,920 SOME BRIEF CLINICAL 2674 01:57:33,920 --> 01:57:35,200 RECOMMENDATIONS, CONCLUSION 2675 01:57:35,200 --> 01:57:37,680 FIRST OF ALL, AN ATTEMPT OF 2676 01:57:37,680 --> 01:57:39,440 PUTTING TOGETHER A GENERAL 2677 01:57:39,440 --> 01:57:42,600 THEORY OF WHAT HAPPENS AFTER 2678 01:57:42,600 --> 01:57:43,080 OOPHORECTOMY. 2679 01:57:43,080 --> 01:57:47,200 AND THIS WAS PUBLISHED BY OUR 2680 01:57:47,200 --> 01:57:47,840 GROUP IN PHYSIOLOGY IN 2018. 2681 01:57:47,840 --> 01:57:52,120 SO IF YOU START FROM THE LEFT 2682 01:57:52,120 --> 01:57:53,880 YOU CAN SAY PREMATURE LOSS OF 2683 01:57:53,880 --> 01:57:56,840 ESTROGEN OR OTHER OVARIAN 2684 01:57:56,840 --> 01:58:00,320 HORMONES WILL CAUSE AN 2685 01:58:00,320 --> 01:58:02,600 ACCELERATION OF AGING PROCESS IN 2686 01:58:02,600 --> 01:58:05,720 GRAY BOX, AT THE CELLULAR TISSUE 2687 01:58:05,720 --> 01:58:07,680 ORGAN AND SYSTEM LEVEL. 2688 01:58:07,680 --> 01:58:10,960 THIS PROCESS CAN BE ACCUMULATION 2689 01:58:10,960 --> 01:58:11,600 MUCH SENESCENT CELL, 2690 01:58:11,600 --> 01:58:14,960 INFLAMMATION IN ABSENCE OF 2691 01:58:14,960 --> 01:58:20,640 INFECTION, PROTEIN AGGREGATION 2692 01:58:20,640 --> 01:58:21,240 AND MISFOLDING, MITOCHONDRIAL 2693 01:58:21,240 --> 01:58:22,200 DYSFUNCTION, EPIGENETIC 2694 01:58:22,200 --> 01:58:25,720 ALTERATION WE'VE SEEN THE 2695 01:58:25,720 --> 01:58:26,640 EXAMPLE OF METHYLATION, TELOMERE 2696 01:58:26,640 --> 01:58:31,000 INFILL RATION AND SO ON, WE HAVE 2697 01:58:31,000 --> 01:58:35,080 A SERIES OF AGING PROCESS -- 2698 01:58:35,080 --> 01:58:38,120 TELOMERE ATTRITION. 2699 01:58:38,120 --> 01:58:40,160 AND THESE CHANGES WILL MANIFEST 2700 01:58:40,160 --> 01:58:43,480 CLINICALLY AT THE CLINICAL 2701 01:58:43,480 --> 01:58:45,560 LEVEL, EITHER AS 2702 01:58:45,560 --> 01:58:46,360 MULTI-MORBIDITY, WE'VE SEEN 2703 01:58:46,360 --> 01:58:48,000 ACCELERATION OF MENTAL HEALTH 2704 01:58:48,000 --> 01:58:49,720 CONDITION, CARDIOVASCULAR AND 2705 01:58:49,720 --> 01:58:53,040 METABOLIC AND SOMATIC OR AS 2706 01:58:53,040 --> 01:58:55,360 FRAILTY WHICH IS DECLINE IN 2707 01:58:55,360 --> 01:58:59,600 PHYSICAL FUNCTION OR DECLINE IN 2708 01:58:59,600 --> 01:59:00,480 COGNITIVE FUNCTION. 2709 01:59:00,480 --> 01:59:03,080 NOW, MULTI-MORBIDITY AND FRAILTY 2710 01:59:03,080 --> 01:59:04,320 CAN BE INTERRELATED, 2711 01:59:04,320 --> 01:59:06,080 INTERDEPENDENT BUT CAN BE 2712 01:59:06,080 --> 01:59:07,720 CONSIDERED -- CONVENIENT TO 2713 01:59:07,720 --> 01:59:11,520 CONSIDER THEM IN PARALLEL. 2714 01:59:11,520 --> 01:59:13,200 NOW, MULTI-MORBIDITY AND FRAILLY 2715 01:59:13,200 --> 01:59:16,360 WILL LEAD TO REDUCED HEALTH SPAN 2716 01:59:16,360 --> 01:59:22,440 AND OF COURSE THE ACCELERATION 2717 01:59:22,440 --> 01:59:23,480 OF REACHING DEATH. 2718 01:59:23,480 --> 01:59:34,080 THIS IS THE MAIN CAUSAL AX IS BT 2719 01:59:36,880 --> 01:59:39,200 ESTROGEN REPLACEMENT THERAPY CAN 2720 01:59:39,200 --> 01:59:42,520 REDUCE OR ATTENUATE SOME OF THE 2721 01:59:42,520 --> 01:59:44,120 HARMFUL EFFECT OF OOPHORECTOMY. 2722 01:59:44,120 --> 01:59:47,280 ALSO, THERE ARE GENETIC VARIANTS 2723 01:59:47,280 --> 01:59:50,200 THAT CAN INFLUENCE EITHER 2724 01:59:50,200 --> 01:59:52,200 POSITIVELY OR NEGATIVELY EFFECT 2725 01:59:52,200 --> 01:59:55,200 OF OOPHORECTOMY, AND THERE ARE 2726 01:59:55,200 --> 01:59:56,720 OTHER VARIABLES THAT ARE 2727 01:59:56,720 --> 02:00:00,240 BEHAVIORAL AND ENVIRONMENTAL, 2728 02:00:00,240 --> 02:00:03,440 SUCH AS DIET, PHYSICAL ACTIVITY, 2729 02:00:03,440 --> 02:00:05,200 SMOKING, ADVERSE CHILDHOOD 2730 02:00:05,200 --> 02:00:07,320 EVENTS, ENVIRONMENTAL TOXINS. 2731 02:00:07,320 --> 02:00:09,920 THESE VARIABLES SHOWED IN THE 2732 02:00:09,920 --> 02:00:13,120 BLUE BOX CAN EITHER WORSEN THE 2733 02:00:13,120 --> 02:00:15,120 EFFECT OF OOPHORECTOMY OR 2734 02:00:15,120 --> 02:00:16,600 ATTENUATE THE EFFECT. 2735 02:00:16,600 --> 02:00:20,360 SO WE CAN SAY THAT NOT ALL WOMEN 2736 02:00:20,360 --> 02:00:21,960 WHO UNDERGO OOPHORECTOMY AT THE 2737 02:00:21,960 --> 02:00:26,360 SAME AGE WILL HAVE THE SAME 2738 02:00:26,360 --> 02:00:28,840 NEGATIVE EFFECT, THIS WILL BE 2739 02:00:28,840 --> 02:00:30,720 MODIFIED OR MODULATED BY 2740 02:00:30,720 --> 02:00:32,800 ESTROGEN REPLACEMENT THERAPY AND 2741 02:00:32,800 --> 02:00:36,200 BY OTHER VARIABLES THAT ARE 2742 02:00:36,200 --> 02:00:43,000 INTERACTING WITH ESTROGEN 2743 02:00:43,000 --> 02:00:44,200 DEPRIVATION. 2744 02:00:44,200 --> 02:00:45,960 THE CONCLUSION IS THAT 2745 02:00:45,960 --> 02:00:49,120 OOPHORECTOMY IN YOUNGER WOMEN 2746 02:00:49,120 --> 02:00:49,960 CONTRIBUTES TO ACCELERATED AGING 2747 02:00:49,960 --> 02:00:53,480 WHICH WILL LEAD TO INCREASED 2748 02:00:53,480 --> 02:00:55,040 MORBIDITY AND MORTALITY. 2749 02:00:55,040 --> 02:00:57,560 THE CLINICAL DATA, DATA COMING 2750 02:00:57,560 --> 02:00:58,960 FROM CLINICAL RESEARCH, ARE 2751 02:00:58,960 --> 02:01:02,680 CONSISTENT WITH DATA COMING FROM 2752 02:01:02,680 --> 02:01:04,320 STUDIES OF DNA METHYLATION, AND 2753 02:01:04,320 --> 02:01:06,280 THEY ARE CONSISTENT WITH THE 2754 02:01:06,280 --> 02:01:09,840 VERY LARGE BODY OF ANIMAL 2755 02:01:09,840 --> 02:01:11,360 STUDIES, INCLUDING PRIMATES. 2756 02:01:11,360 --> 02:01:13,400 SO WE CAN CONCLUDE OOPHORECTOMY 2757 02:01:13,400 --> 02:01:17,240 IS A DISRUPTOR OF THE ENDOCRINE 2758 02:01:17,240 --> 02:01:19,200 CONTROL OVER AGING, AND THE 2759 02:01:19,200 --> 02:01:21,480 WOMEN WHO HAVE UNDERGONE 2760 02:01:21,480 --> 02:01:24,680 BILATERAL OOPHORECTOMY IN THE 2761 02:01:24,680 --> 02:01:27,800 LAST 20, 30, 40 YEARS PROVIDE US 2762 02:01:27,800 --> 02:01:29,840 A UNIQUE NATURAL EXPERIMENT AND 2763 02:01:29,840 --> 02:01:31,640 THEY SHOULD BE STUDIED BECAUSE 2764 02:01:31,640 --> 02:01:33,680 BY STUDYING THESE WOMEN WE WILL 2765 02:01:33,680 --> 02:01:37,160 LEARN A LOT ABOUT THE AGING 2766 02:01:37,160 --> 02:01:37,920 PROCESS. 2767 02:01:37,920 --> 02:01:40,640 WE THINK THE EFFECT OF 2768 02:01:40,640 --> 02:01:43,000 OOPHORECTOMY IS MEDIATED BY 2769 02:01:43,000 --> 02:01:47,680 ESTROGEN, POSSIBLY BY OTHER 2770 02:01:47,680 --> 02:01:49,520 OVARIAN HORMONES AND MAY BE 2771 02:01:49,520 --> 02:01:52,760 MEDIATED BY CHANGES IN 2772 02:01:52,760 --> 02:01:56,960 HYPOTHALAMIC OVARIAN AXES. -- 2773 02:01:56,960 --> 02:01:57,800 AXIS. 2774 02:01:57,800 --> 02:02:00,760 THERE ARE GENETIC VARIANTS, 2775 02:02:00,760 --> 02:02:01,360 DEVELOPMENTAL FACTORS, EARLY 2776 02:02:01,360 --> 02:02:03,600 LIFE EVENTS. 2777 02:02:03,600 --> 02:02:05,160 THESE ARE EFFECT MODIFIERS OF 2778 02:02:05,160 --> 02:02:08,400 THE PRIMARY CHAIN OF CAUSALITY. 2779 02:02:08,400 --> 02:02:09,600 IN TERMS OF CLINICAL 2780 02:02:09,600 --> 02:02:10,400 RECOMMENDATION AND BRIEFLY 2781 02:02:10,400 --> 02:02:12,800 BECAUSE WE DO NOT HAVE TIME TO 2782 02:02:12,800 --> 02:02:14,640 GO INTO THE CLINICAL 2783 02:02:14,640 --> 02:02:17,640 RECOMMENDATION, WE WOULD SAY 2784 02:02:17,640 --> 02:02:21,480 THAT IN 2023, IT SHOULD BE ONLY 2785 02:02:21,480 --> 02:02:24,120 PERFORM WHEN THERE'S A CLEAR 2786 02:02:24,120 --> 02:02:26,080 INDICATION, BECAUSE THERE ARE 2787 02:02:26,080 --> 02:02:29,120 IMPORTANT HARMFUL SEQUELAE. 2788 02:02:29,120 --> 02:02:32,600 AND THE CLEAR INDICATION IS 2789 02:02:32,600 --> 02:02:37,360 RESTRICTED TO WOMEN WHO CARRY 2790 02:02:37,360 --> 02:02:45,800 HIGH RISK GENETIC VARIANT SUCH 2791 02:02:45,800 --> 02:02:47,440 AS BRCA1 OR BRCA2, FOR THESE IT 2792 02:02:47,440 --> 02:02:53,600 IS CORRECTLY BUT EVEN IF THEY 2793 02:02:53,600 --> 02:02:56,840 UNDERGO THE SURGERY SHOULD 2794 02:02:56,840 --> 02:02:58,480 RECEIVE ESTROGEN REPLACEMENT 2795 02:02:58,480 --> 02:03:03,600 THERAPY TO PREVENT HARMFUL 2796 02:03:03,600 --> 02:03:03,920 EFFECTS. 2797 02:03:03,920 --> 02:03:10,040 THANK YOU FOR YOUR ATTENTION. 2798 02:03:10,040 --> 02:03:14,600 >> THANK YOU. 2799 02:03:14,600 --> 02:03:17,680 I'M THRILLED TO INTRODUCE THE 2800 02:03:17,680 --> 02:03:21,680 '40s SPEAKER, DR. WENDY KOHRT, 2801 02:03:21,680 --> 02:03:22,680 PROFESSOR OF MEDICINE, 2802 02:03:22,680 --> 02:03:26,920 UNIVERSITY OF COLORADO ANSCHUTZ 2803 02:03:26,920 --> 02:03:30,880 MEDICAL CAM THUS, TO E OR -- 2804 02:03:30,880 --> 02:03:37,160 CAMPUS, TO E OR NOT TO E, 2805 02:03:37,160 --> 02:03:38,400 METABOLIC ACTIONS OF ESTROGENS. 2806 02:03:38,400 --> 02:03:41,160 >> THANK YOU FOR INVITING ME TO 2807 02:03:41,160 --> 02:03:44,440 BE PART OF THIS OUTSTANDING 2808 02:03:44,440 --> 02:03:47,400 SYMPOSIUM. 2809 02:03:47,400 --> 02:03:50,120 I HAVE NO FINANCIAL DISCLOSURES. 2810 02:03:50,120 --> 02:03:51,680 AND WHAT I'D LIKE TO TALK ABOUT 2811 02:03:51,680 --> 02:03:55,960 TODAY IS WORK THAT HAS COME FROM 2812 02:03:55,960 --> 02:03:57,680 OUR SPECIALIZED CENTER OF 2813 02:03:57,680 --> 02:04:00,720 RESEARCH EXCELLENCE ON SEX 2814 02:04:00,720 --> 02:04:04,360 DIFFERENCES WHICH IS FOCUSED ON 2815 02:04:04,360 --> 02:04:05,360 BIOENERGETIC AND METABOLIC 2816 02:04:05,360 --> 02:04:08,280 CONSEQUENCES OF THE LOSS OF 2817 02:04:08,280 --> 02:04:08,680 GONADAL FUNCTION. 2818 02:04:08,680 --> 02:04:10,720 THIS SLIDE SHOWS OUR WORKING 2819 02:04:10,720 --> 02:04:13,640 MODEL THAT GUIDES OUR THINKING 2820 02:04:13,640 --> 02:04:16,760 AND OUR RESEARCH THAT WE 2821 02:04:16,760 --> 02:04:17,520 DEVELOP. 2822 02:04:17,520 --> 02:04:23,440 SO, BECAUSE THE OVARIES AND 2823 02:04:23,440 --> 02:04:25,640 TESTES ARE ENDOCRINE ORGANS IF 2824 02:04:25,640 --> 02:04:27,160 THERE'S LOT OF GONADAL FUNCTION 2825 02:04:27,160 --> 02:04:29,200 IT HAS POTENTIAL TO IMPACT MANY 2826 02:04:29,200 --> 02:04:31,720 SYSTEMS. 2827 02:04:31,720 --> 02:04:32,840 WE BELIEVE THAT THIS COULD 2828 02:04:32,840 --> 02:04:36,560 MODIFY FACTORS IN A WAY THAT 2829 02:04:36,560 --> 02:04:38,160 WOULD INCREASE DISEASE RISK. 2830 02:04:38,160 --> 02:04:40,800 THIS IS PARTICULARLY IMPORTANT 2831 02:04:40,800 --> 02:04:42,640 FOR WOMEN BECAUSE GONADAL AGING 2832 02:04:42,640 --> 02:04:45,520 OCCURS DURING MID-LIFE, AVERAGE 2833 02:04:45,520 --> 02:04:47,400 AGE OF MENOPAUSE IS 51. 2834 02:04:47,400 --> 02:04:51,960 AND IF THERE IS A SIMILAR AGE 2835 02:04:51,960 --> 02:04:54,080 TRIGGERED LOSS OF GONADAL 2836 02:04:54,080 --> 02:04:57,200 FUNCTION IN MEN, IT HAPPENS MUCH 2837 02:04:57,200 --> 02:04:58,960 LATER IN LIFE POTENTIALLY 20 TO 2838 02:04:58,960 --> 02:05:00,560 30 YEARS LATER. 2839 02:05:00,560 --> 02:05:04,880 SO, WOMEN HAVE TO DEAL WITH THE 2840 02:05:04,880 --> 02:05:06,880 LOSS OF THIS, POTENTIAL IMPACT 2841 02:05:06,880 --> 02:05:08,520 ON HEALTH STATUS, ON FUNCTIONAL 2842 02:05:08,520 --> 02:05:12,800 STATUS, AND ON QUALITY OF LIFE. 2843 02:05:12,800 --> 02:05:14,320 AS DR. GREENDALE POINTED OUT 2844 02:05:14,320 --> 02:05:17,160 EARLIER THIS MORNING, WE HAVE AN 2845 02:05:17,160 --> 02:05:19,520 EXCEPTIONALLY WELL STUDIED 2846 02:05:19,520 --> 02:05:22,600 EXAMPLE OF THIS WHEREBY LOSS OF 2847 02:05:22,600 --> 02:05:23,800 OVARIAN FUNCTION ACCELERATES 2848 02:05:23,800 --> 02:05:27,080 BONE LOSS AND LEADS TO INCREASED 2849 02:05:27,080 --> 02:05:28,960 RISK OF OSTEOPOROSIS. 2850 02:05:28,960 --> 02:05:31,400 BUT IT'S NOT LIMITED TO EFFECT 2851 02:05:31,400 --> 02:05:32,520 ON BONE. 2852 02:05:32,520 --> 02:05:35,120 THE LOSS OF OVARIAN FUNCTION 2853 02:05:35,120 --> 02:05:37,880 COULD IMPACT OTHER TISSUES LIKE 2854 02:05:37,880 --> 02:05:39,360 THE BRAIN OR SKELETAL MUSCLE IN 2855 02:05:39,360 --> 02:05:43,560 A WAY THAT COULD INCREASE RISK 2856 02:05:43,560 --> 02:05:45,640 FOR DEMENTIAS OR SARCOPENIA. 2857 02:05:45,640 --> 02:05:48,480 IT COULD ALSO AFFECT REGULATORY 2858 02:05:48,480 --> 02:05:50,160 SYSTEMS, SOMETHING LIKE THE 2859 02:05:50,160 --> 02:05:52,360 REGULATION OF ENERGY BALANCE IN 2860 02:05:52,360 --> 02:05:56,000 A WAY THAT PROMOTES FAT GAIN AND 2861 02:05:56,000 --> 02:05:58,520 LEADS TO INCREASED RISK OF 2862 02:05:58,520 --> 02:06:01,200 CARDIOVASCULAR DISEASE, 2863 02:06:01,200 --> 02:06:04,520 DIABETES, AND OTHER 2864 02:06:04,520 --> 02:06:05,200 OBESITY-RELATED DISEASES. 2865 02:06:05,200 --> 02:06:06,840 IT'S THIS SIDE OF THE WORKING 2866 02:06:06,840 --> 02:06:10,880 MODEL OUR SCORE HAS BEEN HEAVILY 2867 02:06:10,880 --> 02:06:12,160 FOCUSED ON. 2868 02:06:12,160 --> 02:06:13,440 SOMETHING THAT I'LL TRY TO 2869 02:06:13,440 --> 02:06:17,360 IMPRESS UPON YOU DURING MY TALK 2870 02:06:17,360 --> 02:06:20,120 IS EXCESS FAT GAIN THAT OCCURS 2871 02:06:20,120 --> 02:06:23,000 DURING THE MENOPAUSAL TRANSITION 2872 02:06:23,000 --> 02:06:24,680 AND POTENTIALLY AFTER IS NOT 2873 02:06:24,680 --> 02:06:27,960 JUST MORE FAT IN THE SAME 2874 02:06:27,960 --> 02:06:28,200 PLACES. 2875 02:06:28,200 --> 02:06:30,360 THERE'S A CHANGE IN THE 2876 02:06:30,360 --> 02:06:31,480 DISTRIBUTION OF FAT, SO RATHER 2877 02:06:31,480 --> 02:06:36,600 THAN STORING IT IN THE HIPS AND 2878 02:06:36,600 --> 02:06:38,120 THIGHS WHERE PRE-MENOPAUSAL 2879 02:06:38,120 --> 02:06:41,080 WOMEN TEND TO GAIN FAT IT'S 2880 02:06:41,080 --> 02:06:46,640 SHIFTED TO ABDOMINAL, ASSOCIATED 2881 02:06:46,640 --> 02:06:49,280 WITH METABOLIC DYSFUNCTION, AND 2882 02:06:49,280 --> 02:06:50,320 CHANGE IN CELLULAR COMPOSITION 2883 02:06:50,320 --> 02:06:52,040 OF ADIPOSE TISSUE, I'M GOING TO 2884 02:06:52,040 --> 02:06:54,120 TOUCH BRIEFLY ON THAT AT THE END 2885 02:06:54,120 --> 02:06:55,440 OF MY TALK. 2886 02:06:55,440 --> 02:06:57,320 AND THEN ADDING ONE MORE 2887 02:06:57,320 --> 02:06:59,320 COMPONENT TO THIS MODEL IS 2888 02:06:59,320 --> 02:07:01,760 SOMETHING THAT IS I THINK VERY 2889 02:07:01,760 --> 02:07:04,720 WELL APPRECIATED IN THE BASIC 2890 02:07:04,720 --> 02:07:05,960 AND PRE-CLINICAL SCIENCE 2891 02:07:05,960 --> 02:07:08,320 COMMUNITY BUT LESS SO IN THE 2892 02:07:08,320 --> 02:07:13,200 CLINICAL SCIENCE COMMUNITY. 2893 02:07:13,200 --> 02:07:14,960 AND THAT'S THAT STEROID HORMONES 2894 02:07:14,960 --> 02:07:17,240 HAVE WHAT SEEMS TO BE A POTENT 2895 02:07:17,240 --> 02:07:19,680 REGULATORY EFFECT ON PHYSICAL 2896 02:07:19,680 --> 02:07:20,240 ACTIVITY. 2897 02:07:20,240 --> 02:07:21,960 SO WITH THE LOSS OF GONADAL 2898 02:07:21,960 --> 02:07:24,600 FUNCTION THERE'S A DECREASE IN 2899 02:07:24,600 --> 02:07:25,560 SPONTANEOUS PHYSICAL ACTIVITY, 2900 02:07:25,560 --> 02:07:27,640 AND BECAUSE WE KNOW PHYSICAL 2901 02:07:27,640 --> 02:07:30,800 ACTIVITY HAS MANY BENEFITS TO 2902 02:07:30,800 --> 02:07:31,920 HEALTH, THAT COULD EXACERBATE 2903 02:07:31,920 --> 02:07:35,760 ALL OF THESE OTHER FACTORS THAT 2904 02:07:35,760 --> 02:07:37,560 I'VE PUT WITHIN THIS 2905 02:07:37,560 --> 02:07:39,120 ENCAPSULATION ON THIS SLIDE. 2906 02:07:39,120 --> 02:07:40,880 WITH THAT AS THE WORKING MODEL, 2907 02:07:40,880 --> 02:07:43,520 I WANT TO FIRST POINT OUT SOME 2908 02:07:43,520 --> 02:07:46,760 PRE-CLINICAL DATA BEFORE I GET 2909 02:07:46,760 --> 02:07:48,520 TO THE CLINICAL DATA BECAUSE 2910 02:07:48,520 --> 02:07:50,400 THIS CAN BE CONTROLLED EASIER IN 2911 02:07:50,400 --> 02:07:52,600 ANIMALS THAN IN HUMANS. 2912 02:07:52,600 --> 02:07:54,160 SO THE OUTCOMES ARE MORE 2913 02:07:54,160 --> 02:07:56,480 CONSISTENT. 2914 02:07:56,480 --> 02:07:59,280 SO, THIS IS USING A MODEL, I 2915 02:07:59,280 --> 02:08:01,240 PICKED THIS BECAUSE IT INCLUDES 2916 02:08:01,240 --> 02:08:04,320 MICE AND RATS TO SHOW 2917 02:08:04,320 --> 02:08:06,360 CONSISTENCY ACROSS THESE TWO 2918 02:08:06,360 --> 02:08:07,960 SPECIES, HOW BODY WEIGHT CHANGES 2919 02:08:07,960 --> 02:08:10,600 IN RESPONSE TO THE REMOVAL OF 2920 02:08:10,600 --> 02:08:12,400 THE OVARIES. 2921 02:08:12,400 --> 02:08:15,360 SO YOU CAN SEE WHEN BOTH THE 2922 02:08:15,360 --> 02:08:19,200 MICE AND RATS RECOVER FROM THEIR 2923 02:08:19,200 --> 02:08:20,960 SURGERIES, THOSE THAT HAD 2924 02:08:20,960 --> 02:08:22,920 OVARIES REMOVED COMPARED TO 2925 02:08:22,920 --> 02:08:27,200 THOSE WHOSE OVARIES ARE LEFT 2926 02:08:27,200 --> 02:08:29,840 INTACT HAVE A VERY ACCELERATED 2927 02:08:29,840 --> 02:08:34,120 RATE OF WEIGHT GAIN, DISRUPTION 2928 02:08:34,120 --> 02:08:38,280 IN ENERGY BALANCE THAT PROMOTES 2929 02:08:38,280 --> 02:08:43,360 FAT, WEIGHT GAIN, PROBABLY FAT 2930 02:08:43,360 --> 02:08:43,640 GAIN. 2931 02:08:43,640 --> 02:08:44,600 THESE INVESTIGATORS FOUND THAT 2932 02:08:44,600 --> 02:08:46,760 THERE WAS INCREASE IN ENERGY 2933 02:08:46,760 --> 02:08:51,400 INTAKE, BUT LOOKING AT THE RATS 2934 02:08:51,400 --> 02:08:56,760 HERE, EVEN IF THEY PAIR FED OF 2935 02:08:56,760 --> 02:09:00,040 GROUP WITH THE SHAM OPERATED 2936 02:09:00,040 --> 02:09:05,240 RATS, EATING THE SAME AMOUNT OF 2937 02:09:05,240 --> 02:09:08,320 FOOD, OOPHORECTOMY RATS STILL 2938 02:09:08,320 --> 02:09:09,520 HAD ACCELERATED RATE OF WEIGHT 2939 02:09:09,520 --> 02:09:09,720 GAIN. 2940 02:09:09,720 --> 02:09:12,320 IF IT'S NOT ENERGY INTAKE SIDE 2941 02:09:12,320 --> 02:09:14,760 THAT'S AFFECTED IT MUST ALSO BE 2942 02:09:14,760 --> 02:09:17,080 THE ENERGY EXPENDITURE SIDE OF 2943 02:09:17,080 --> 02:09:17,400 THINGS. 2944 02:09:17,400 --> 02:09:20,680 IN FACT, WHEN THEY LOOKED AT 2945 02:09:20,680 --> 02:09:22,200 LOCOMOTOR ACTIVITY, HOW MUCH 2946 02:09:22,200 --> 02:09:24,200 ANIMALS WERE MOVING AROUND THEIR 2947 02:09:24,200 --> 02:09:26,840 CAGES, YOU CAN SEE THE SHAM 2948 02:09:26,840 --> 02:09:28,720 OPERATED ANIMALS ONCE THEY 2949 02:09:28,720 --> 02:09:30,360 RECOVERED FROM THEIR SURGERY 2950 02:09:30,360 --> 02:09:32,440 WERE ESSENTIALLY BACK TO THEIR 2951 02:09:32,440 --> 02:09:35,280 PRE-SURGERY LEVELS OF ACTIVITY. 2952 02:09:35,280 --> 02:09:39,240 SAME THING FOR THE RATS. 2953 02:09:39,240 --> 02:09:40,840 BUT THE OOPHORECTOMIZED ANIMALS 2954 02:09:40,840 --> 02:09:43,360 HAD DECREASE IN HOW MUCH THEY 2955 02:09:43,360 --> 02:09:48,280 WERE MOVING THAT WAS ABOUT 30%. 2956 02:09:48,280 --> 02:09:50,920 THIS STUDY FROM UNIVERSITY OF 2957 02:09:50,920 --> 02:09:54,600 MINNESOTA MAKES AN EVEN GREATER 2958 02:09:54,600 --> 02:09:57,720 VISUAL IMPACT ABOUT THE 2959 02:09:57,720 --> 02:09:58,640 CONSEQUENCE OF OOPHORECTOMY, 2960 02:09:58,640 --> 02:10:01,440 MICE HAD RUNNING WHEELS IN THEIR 2961 02:10:01,440 --> 02:10:04,320 CAGES, MICE ARE VERY ACTIVE. 2962 02:10:04,320 --> 02:10:05,480 THEY RUN ALMOST 10 KILOMETERS A 2963 02:10:05,480 --> 02:10:08,800 DAY, YOU CAN SEE THESE ARE THE 2964 02:10:08,800 --> 02:10:10,320 SHAM-OPERATED ANIMALS WHO 2965 02:10:10,320 --> 02:10:11,440 MAINTAINED THIS LEVEL OF 2966 02:10:11,440 --> 02:10:14,720 ACTIVITY WEEKS AFTER THEIR 2967 02:10:14,720 --> 02:10:15,560 SURGERIES. 2968 02:10:15,560 --> 02:10:23,880 THERE'S TWO GROUPS OF 2969 02:10:23,880 --> 02:10:25,960 OOPHORECTOMIZED, DECREASES OF 70 2970 02:10:25,960 --> 02:10:29,400 TO 90% IN RUNNING. 2971 02:10:29,400 --> 02:10:30,600 ANIMALS TREATED WITH PLACEBO 2972 02:10:30,600 --> 02:10:34,120 ADDBACK THERAPY THERE WAS NO 2973 02:10:34,120 --> 02:10:35,200 SPONTANEOUS RECOVERY OF THEIR 2974 02:10:35,200 --> 02:10:38,080 PHYSICAL ACTIVITY. 2975 02:10:38,080 --> 02:10:40,360 BUT IN ANIMALS GIVEN ESTRADIOL 2976 02:10:40,360 --> 02:10:42,520 IMPLANTS, THEY WERE RIGHT BACK 2977 02:10:42,520 --> 02:10:44,240 IN THEIR RUNNING WHEELS AND 2978 02:10:44,240 --> 02:10:45,640 ACHIEVING LEVELS OF ACTIVITY 2979 02:10:45,640 --> 02:10:48,560 THAT WERE NOT DIFFERENT FROM THE 2980 02:10:48,560 --> 02:10:49,360 SHAM CONTROLS. 2981 02:10:49,360 --> 02:10:51,080 SO, THIS SAYS THAT WHEN YOU 2982 02:10:51,080 --> 02:10:53,160 REMOVE THE OVARIES THERE ARE A 2983 02:10:53,160 --> 02:10:56,680 LOT OF THINGS SECRETED BY 2984 02:10:56,680 --> 02:10:58,440 OVARIES BUT IT SEEMS 2985 02:10:58,440 --> 02:11:01,440 SPECIFICALLY LOSS OF ESTRADIOL 2986 02:11:01,440 --> 02:11:05,080 THAT IS MODIFYING THIS 2987 02:11:05,080 --> 02:11:05,360 PHENOTYPE. 2988 02:11:05,360 --> 02:11:07,640 TO MAKE MORE OF AN IMPACT THAT 2989 02:11:07,640 --> 02:11:10,840 IT IS SPECIFICALLY LOSS OF 2990 02:11:10,840 --> 02:11:14,680 ESTRADIOL FROM OVARIES THAT 2991 02:11:14,680 --> 02:11:16,960 INFLUENCES MANY OUTCOMES, THIS 2992 02:11:16,960 --> 02:11:20,720 STUDY SHOWS CHANGES IN BODY MASS 2993 02:11:20,720 --> 02:11:22,000 WITH OOPHORECTOMY SHOWING THIS 2994 02:11:22,000 --> 02:11:26,760 INCREASED BODY WEIGHT AND IT IS 2995 02:11:26,760 --> 02:11:29,360 PREVENTED BY ESTRADIOL ADD-BACK. 2996 02:11:29,360 --> 02:11:30,760 THE IMPACT ON ADIPOSITY AS 2997 02:11:30,760 --> 02:11:33,960 PERCENT OF BODY WEIGHT IS 2998 02:11:33,960 --> 02:11:37,200 REMARKABLE, TWO TO THREE-FOLD 2999 02:11:37,200 --> 02:11:45,800 GREATER LEVELS OF ADIPOSITY IN 3000 02:11:45,800 --> 02:11:46,920 OOPHORECTOMIZED VERSUS SHAM, 3001 02:11:46,920 --> 02:11:48,280 PREVENTED BYES THAT DIOL 3002 02:11:48,280 --> 02:11:48,800 TREATMENT. 3003 02:11:48,800 --> 02:11:51,080 THIS IS AN INDICATOR OF RESTING 3004 02:11:51,080 --> 02:11:53,240 METABOLIC RATE IN MICE. 3005 02:11:53,240 --> 02:11:55,640 IF INCREASED ENERGY INTAKE AND 3006 02:11:55,640 --> 02:11:56,600 DECREASED PHYSICAL ACTIVITY 3007 02:11:56,600 --> 02:12:01,200 ISN'T ENOUGH OF A DISRUPTION TO 3008 02:12:01,200 --> 02:12:02,680 ENERGY BALANCE, HERE'S ANOTHER 3009 02:12:02,680 --> 02:12:04,440 FACTOR. 3010 02:12:04,440 --> 02:12:07,480 EVEN AT REST, THE LOSS OF 3011 02:12:07,480 --> 02:12:09,160 OVARIAN FUNCTION SEEMS TO 3012 02:12:09,160 --> 02:12:10,760 SOMEHOW MAKE ANIMALS MORE 3013 02:12:10,760 --> 02:12:13,240 EFFICIENT SO THEY HAVE TO EXPEND 3014 02:12:13,240 --> 02:12:17,840 LESS ENERGY AT REST TO MAINTAIN 3015 02:12:17,840 --> 02:12:18,320 FUNCTION. 3016 02:12:18,320 --> 02:12:23,880 THAT IS PREVENTED BYES THAT -- 3017 02:12:23,880 --> 02:12:26,640 BY ESTRADIOL TREATMENT. 3018 02:12:26,640 --> 02:12:28,920 THIS IS INSULIN SIMULATED 3019 02:12:28,920 --> 02:12:31,120 GLUCOSE DISPOSAL, INDICATOR OF 3020 02:12:31,120 --> 02:12:38,560 INSULIN RESISTANCE AND RISK FOR 3021 02:12:38,560 --> 02:12:41,200 DIABETES, DECREASE IS INDICATOR 3022 02:12:41,200 --> 02:12:43,440 OF INSULIN RESISTANCE PREVENTED 3023 02:12:43,440 --> 02:12:45,040 BY ESTROGEN TREATMENT. 3024 02:12:45,040 --> 02:12:46,560 THERE ARE MANY STUDIES IN THE 3025 02:12:46,560 --> 02:12:49,240 LITERATURE THAT ARE CONSISTENT 3026 02:12:49,240 --> 02:12:51,520 WITH THESE RESULTS. 3027 02:12:51,520 --> 02:12:54,440 OOPHORECTOMY IN RODENTS CAUSES 3028 02:12:54,440 --> 02:12:56,840 DECREASE IN PHYSICAL ACTIVITY, 3029 02:12:56,840 --> 02:12:58,080 DECREASED RESTING METABOLIC 3030 02:12:58,080 --> 02:13:00,560 RATE, THERE'S INCREASE IN ENERGY 3031 02:13:00,560 --> 02:13:04,360 INTAKE ALTHOUGH THIS IS NOT 3032 02:13:04,360 --> 02:13:05,360 CONSISTENT ACROSS SPECIES, ONE 3033 02:13:05,360 --> 02:13:08,320 OF THE CONSEQUENCES OF THIS IS 3034 02:13:08,320 --> 02:13:10,520 AN INCREASE IN ABDOMINAL FAT 3035 02:13:10,520 --> 02:13:13,200 GAIN IN ADDITION TO TOTAL BODY 3036 02:13:13,200 --> 02:13:18,720 FAT LEVELS, AND THE EXPECTED 3037 02:13:18,720 --> 02:13:19,720 METABOLIC DYSFUNCTION THAT WOULD 3038 02:13:19,720 --> 02:13:20,680 RESULT FROM THAT. 3039 02:13:20,680 --> 02:13:24,280 I HAVEN'T SHOWN ANY STUDIES 3040 02:13:24,280 --> 02:13:24,720 REGARDING EXERCISE. 3041 02:13:24,720 --> 02:13:26,880 I DID SHOW THAT ESTROGEN 3042 02:13:26,880 --> 02:13:28,200 PREVENTS THIS. 3043 02:13:28,200 --> 02:13:29,640 BUT TREADMILL EXERCISE IN 3044 02:13:29,640 --> 02:13:31,360 ANIMALS HAS ALSO BEEN SHOWN TO 3045 02:13:31,360 --> 02:13:33,680 BE EFFECTIVE AS PREVENTING MOST 3046 02:13:33,680 --> 02:13:35,240 OF THESE CHANGES. 3047 02:13:35,240 --> 02:13:37,200 AND THIS IS GREAT FOR MICE AND 3048 02:13:37,200 --> 02:13:37,960 RATS. 3049 02:13:37,960 --> 02:13:43,120 BUT WHAT'S THE RELEVANCE TO 3050 02:13:43,120 --> 02:13:43,320 WOMEN? 3051 02:13:43,320 --> 02:13:45,160 IN OUR STUDIES, BECAUSE THE 3052 02:13:45,160 --> 02:13:50,400 MENOPAUSE IS A PROCESS, NOT AN 3053 02:13:50,400 --> 02:13:51,960 EVENT, THAT HAPPENS OVER MANY 3054 02:13:51,960 --> 02:13:54,920 YEARS IT'S VERY DIFFICULT TO 3055 02:13:54,920 --> 02:13:55,880 ISOLATE THE EFFECTS OF MENOPAUSE 3056 02:13:55,880 --> 02:13:58,640 FROM THOSE OF AGING AND OTHER 3057 02:13:58,640 --> 02:14:01,240 FACTORS THAT CHANGE OVER MANY 3058 02:14:01,240 --> 02:14:01,680 YEARS. 3059 02:14:01,680 --> 02:14:05,440 SO, WE'VE GONE TO THE APPROACH 3060 02:14:05,440 --> 02:14:08,600 OF USING A PHARMACOLOGIC MODEL 3061 02:14:08,600 --> 02:14:17,200 OF MENOPAUSE, WHEREBY WE GIVE 3062 02:14:17,200 --> 02:14:21,200 GONAD OH TROPIN ANALOGS TO 3063 02:14:21,200 --> 02:14:22,800 PRE-MENOPAUSAL WOMEN, PUT THEM 3064 02:14:22,800 --> 02:14:26,360 IN A TEMPORARY POST MENOPAUSAL 3065 02:14:26,360 --> 02:14:29,760 STATE FOR 20 WEEKS, TO ISOLATE 3066 02:14:29,760 --> 02:14:32,680 EFFECTS OF ESTRADIOL 3067 02:14:32,680 --> 02:14:34,880 SPECIFICALLY, WE EITHER ADD BACK 3068 02:14:34,880 --> 02:14:39,080 A PLACEBO TRANSDERMAL PATCH OR 3069 02:14:39,080 --> 02:14:41,760 AN ESTRADIOL TRANSDERMAL PATCH. 3070 02:14:41,760 --> 02:14:43,320 IN THIS STUDY RANDOMIZED 70 3071 02:14:43,320 --> 02:14:44,600 WOMEN TO THESE TWO ARMS, I'M 3072 02:14:44,600 --> 02:14:46,520 GOING TO CALL YOUR ATTENTION TO 3073 02:14:46,520 --> 02:14:49,880 THE AVERAGE AGE. 3074 02:14:49,880 --> 02:14:53,120 THESE WERE ALL-COMEERS FOR 3075 02:14:53,120 --> 02:14:54,600 PRE-MENOPAUSAL REGARDLESS OF AGE 3076 02:14:54,600 --> 02:14:56,480 SO AVERAGE AGE WAS 35. 3077 02:14:56,480 --> 02:14:59,120 WE LOOK AT BODY COMPOSITION 3078 02:14:59,120 --> 02:15:00,000 CHANGES THAT OCCURRED. 3079 02:15:00,000 --> 02:15:01,840 THIS IS SOMETHING THAT WE'VE 3080 02:15:01,840 --> 02:15:04,280 SEEN REPEATEDLY IN OUR STUDIES 3081 02:15:04,280 --> 02:15:07,840 THAT WE KNOW THE LOSS OF 3082 02:15:07,840 --> 02:15:09,480 ESTROGEN CAUSES DECREASE -- 3083 02:15:09,480 --> 02:15:11,080 ACCELERATED RATE OF BONE LOSS 3084 02:15:11,080 --> 02:15:14,720 BUT ALSO SEEMS TO CAUSE 3085 02:15:14,720 --> 02:15:17,520 ACCELERATED LOSS OF LEAN MASS. 3086 02:15:17,520 --> 02:15:21,200 SO THIS IS .6 KILOGRAM DECREASE 3087 02:15:21,200 --> 02:15:24,600 IN TOTAL BODY LEAN PASS 3088 02:15:24,600 --> 02:15:28,080 PREVENTED IN ESTROGEN-TREATED 3089 02:15:28,080 --> 02:15:29,120 GROUP. 3090 02:15:29,120 --> 02:15:30,800 ESTROGEN IS A HYDRATING HORMONE, 3091 02:15:30,800 --> 02:15:32,440 SO WATER IS PART OF THE LEAN 3092 02:15:32,440 --> 02:15:33,520 COMPONENT OF THE BODY. 3093 02:15:33,520 --> 02:15:36,280 SO THIS COULD JUST BE A LOSS OF 3094 02:15:36,280 --> 02:15:36,680 WATER. 3095 02:15:36,680 --> 02:15:39,160 BUT TO LOOK AT THIS MORE 3096 02:15:39,160 --> 02:15:42,360 CAREFULLY, WE DID CTs OF THE 3097 02:15:42,360 --> 02:15:43,640 MID-THIGH AND MEASURED THE 3098 02:15:43,640 --> 02:15:44,800 MID-THIGH MUSCLE AREA, AND YOU 3099 02:15:44,800 --> 02:15:50,280 CAN SEE THAT THE PATTERNS OF 3100 02:15:50,280 --> 02:15:51,720 CHANGE REFLECT THE CHANGES AT 3101 02:15:51,720 --> 02:15:55,160 THE WHOLE BODY LEVEL SUGGESTING 3102 02:15:55,160 --> 02:15:58,320 THIS IS INDEED A DECREASE IN 3103 02:15:58,320 --> 02:16:00,840 MUSCLE MASS, NOT JUST A LOSS OF 3104 02:16:00,840 --> 02:16:01,600 BODY WATER. 3105 02:16:01,600 --> 02:16:04,800 WHEN WE LOOK AT CHANGES IN FAT 3106 02:16:04,800 --> 02:16:07,840 MASS IN THIS STUDY TOTAL BODY 3107 02:16:07,840 --> 02:16:10,720 FAT MASS THIS WAS A SURPRISING 3108 02:16:10,720 --> 02:16:11,240 OUTCOME. 3109 02:16:11,240 --> 02:16:12,440 WE EXPECTED A SIGNIFICANT 3110 02:16:12,440 --> 02:16:15,280 INCREASE IN FAT MASS WHICH WE 3111 02:16:15,280 --> 02:16:16,680 DID NOT SEE. 3112 02:16:16,680 --> 02:16:19,000 BUT DESPITE THE FACT THAT THERE 3113 02:16:19,000 --> 02:16:22,000 WAS NO INCREASE IN TOTAL BODY 3114 02:16:22,000 --> 02:16:26,080 FAT, THERE WERE SIGNIFICANT 3115 02:16:26,080 --> 02:16:27,800 INCREASES IN ABDOMINAL FAT AREAS 3116 02:16:27,800 --> 02:16:32,680 MEASURED BY CT, IN BOTH THE 3117 02:16:32,680 --> 02:16:34,440 SUBCUTANEOUS BUT MORE ROBUSTLY 3118 02:16:34,440 --> 02:16:37,400 IN ABDOMINAL VISCERAL 3119 02:16:37,400 --> 02:16:39,000 COMPARTMENT, INCREASE IN 3120 02:16:39,000 --> 02:16:41,440 VISCERAL FAT AREA OF 12% AND 3121 02:16:41,440 --> 02:16:44,720 THAT WAS PREVENTED BY ESTRADIOL 3122 02:16:44,720 --> 02:16:45,000 TREATMENT. 3123 02:16:45,000 --> 02:16:49,280 WE ALSO ASKED WOMEN IN THE STUDY 3124 02:16:49,280 --> 02:16:51,200 TO WEAR AN ACCELEROMETER ONE 3125 02:16:51,200 --> 02:16:55,120 WEEK OUT OF EVERY MONTH OF THE 3126 02:16:55,120 --> 02:16:56,200 STUDY, AND QUANTIFIED MODERATE 3127 02:16:56,200 --> 02:17:03,280 TO I VIGOROUS DATA. 3128 02:17:03,280 --> 02:17:06,640 IT'S THE WOMEN TREATED WITH 3129 02:17:06,640 --> 02:17:08,400 ESTRADIOL THAT MAINTAIN HIGHER 3130 02:17:08,400 --> 02:17:10,800 PHYSICAL ACTIVITY LEVELS THAN 3131 02:17:10,800 --> 02:17:15,200 THE WOMEN WHO HAVE THEIR OVARIAN 3132 02:17:15,200 --> 02:17:16,240 FUNCTION SUPPRESSED, ABOUT 20 TO 3133 02:17:16,240 --> 02:17:19,720 30 MINUTES PER DAY LESS PHYSICAL 3134 02:17:19,720 --> 02:17:20,040 ACTIVITY. 3135 02:17:20,040 --> 02:17:23,280 HERE IN COLORADO WE HAVE THE 3136 02:17:23,280 --> 02:17:28,880 GOOD FORTUNE OF HAVING A ROOM 3137 02:17:28,880 --> 02:17:30,640 CALORIMETE, MEASURING 24 HOUR 3138 02:17:30,640 --> 02:17:31,680 EXPENDITURE OR LONGER. 3139 02:17:31,680 --> 02:17:36,960 BASED ON THOSE STUDIES WE FOUND 3140 02:17:36,960 --> 02:17:38,560 THAT WOMEN WHO WE SUPPRESS 3141 02:17:38,560 --> 02:17:41,200 OVARIAN FUNCTION IN HAVE 3142 02:17:41,200 --> 02:17:43,080 DECREASE IN RESTING ENERGY 3143 02:17:43,080 --> 02:17:46,160 EXPENDITURE IN THE NEIGHBORHOOD 3144 02:17:46,160 --> 02:17:52,880 OF 50 TO 70 K CALS PER DAY, 3145 02:17:52,880 --> 02:17:55,200 DECREASE IN TOTAL ENERGY 3146 02:17:55,200 --> 02:17:57,880 EXPENDITURE, ESTRADIOL DID NOT 3147 02:17:57,880 --> 02:18:00,560 AFFECT THAT OUTCOME WHEREBY DID 3148 02:18:00,560 --> 02:18:02,120 PREVENTS DECREASE IN RESTING 3149 02:18:02,120 --> 02:18:02,720 ENERGY EXPENDITURE. 3150 02:18:02,720 --> 02:18:04,920 THIS IS THE SLIDE GOING BACK, I 3151 02:18:04,920 --> 02:18:07,040 TOLD YOU WE WERE SURPRISED WE 3152 02:18:07,040 --> 02:18:07,880 DIDN'T SEE INCREASE IN TOTAL 3153 02:18:07,880 --> 02:18:10,960 BODY FAT MASS IN THIS STUDY. 3154 02:18:10,960 --> 02:18:13,040 THAT'S BECAUSE THIS SLIDE SHOWS 3155 02:18:13,040 --> 02:18:15,760 IN ADDITION TO OUR STUDY ALL OF 3156 02:18:15,760 --> 02:18:18,920 THE OTHER STUDIES THAT HAD USED 3157 02:18:18,920 --> 02:18:20,400 GnRH ANALOGS IN WOMEN, LOOKING 3158 02:18:20,400 --> 02:18:22,640 AT CHANGES IN BODY COMPOSITION, 3159 02:18:22,640 --> 02:18:24,920 THESE WERE DIFFERENT DURATIONS 3160 02:18:24,920 --> 02:18:27,920 OF STUDIES FROM 12 TO 24 WEEKS, 3161 02:18:27,920 --> 02:18:31,280 YOU CAN SEE THIS GENERAL TREND 3162 02:18:31,280 --> 02:18:34,280 FOR FAT MASS TO INCREASE GIVEN 3163 02:18:34,280 --> 02:18:35,960 POSITIVELY RELATED TO THE 3164 02:18:35,960 --> 02:18:36,920 DURATION OF THERAPY. 3165 02:18:36,920 --> 02:18:40,640 SO WE WERE EXPECTING A 1 3166 02:18:40,640 --> 02:18:41,720 KILOGRAM INCREASE THAT DIDN'T 3167 02:18:41,720 --> 02:18:43,920 OCCUR BUT IN THE NEXT STUDY I'LL 3168 02:18:43,920 --> 02:18:46,400 SHOW YOU, MOST RECENT STUDY THAT 3169 02:18:46,400 --> 02:18:48,200 WE'VE COMPLETED UNDER OUR SCORE, 3170 02:18:48,200 --> 02:18:50,720 WE DID SEE THIS INCREASE IN FAT 3171 02:18:50,720 --> 02:18:53,640 MASS THAT WE HAD PREDICTED. 3172 02:18:53,640 --> 02:18:56,640 AND IN THIS STUDY WE DIDN'T HAVE 3173 02:18:56,640 --> 02:18:58,600 AN ESTRADIOL ADD-BACK GROUP BUT 3174 02:18:58,600 --> 02:19:00,680 HAVE ENDURANCE EXERCISE ARM IN 3175 02:19:00,680 --> 02:19:02,720 THIS STUDY, WE CARRIED THIS ONE 3176 02:19:02,720 --> 02:19:07,720 OUT FOR 24 WEEKS, SO WE HAVE 3177 02:19:07,720 --> 02:19:08,480 PLACEBO-TREATED WOMEN, WOMEN 3178 02:19:08,480 --> 02:19:10,680 SUPPRESSED, WOMEN WHO WERE 3179 02:19:10,680 --> 02:19:13,160 SUPPRESSED AND THEN ALSO ENGAGED 3180 02:19:13,160 --> 02:19:14,960 IN ENDURANCE EXERCISE PROGRAM. 3181 02:19:14,960 --> 02:19:17,560 SMALL NUMBERS OF WOMEN IN THIS 3182 02:19:17,560 --> 02:19:22,360 STUDY BUT IN THIS ONE UNIQUE 3183 02:19:22,360 --> 02:19:24,120 ASPECT WE ENROLLED WOMEN 3184 02:19:24,120 --> 02:19:25,000 APPROACHING THE MENOPAUSE 3185 02:19:25,000 --> 02:19:27,480 TRANSITION SO THEY WERE ALL AT 3186 02:19:27,480 --> 02:19:29,240 LEAST 40 YEARS OF AGE, SO 3187 02:19:29,240 --> 02:19:33,640 AVERAGE AGE IN THIS STUDY IS 3188 02:19:33,640 --> 02:19:35,280 ABOUT TEN YEARS MORE THAN THE 3189 02:19:35,280 --> 02:19:36,280 PREVIOUS STUDY. 3190 02:19:36,280 --> 02:19:41,000 AGAIN LOOKING AT CHANGES IN BODY 3191 02:19:41,000 --> 02:19:43,320 COMPOSITION WE SEE DECREASE IN 3192 02:19:43,320 --> 02:19:45,000 LEAN MASS WE'VE OBSERVED 3193 02:19:45,000 --> 02:19:46,120 REPEATEDLY AND ENDURANCE 3194 02:19:46,120 --> 02:19:49,160 EXERCISE DID NOT SEEM TO MODIFY 3195 02:19:49,160 --> 02:19:50,760 THAT AT ALL. 3196 02:19:50,760 --> 02:19:52,800 ENDURANCE EXERCISE IS NOT MUSCLE 3197 02:19:52,800 --> 02:19:54,240 BUILDING. 3198 02:19:54,240 --> 02:19:55,840 I WAS HOPING IT MIGHT BE 3199 02:19:55,840 --> 02:20:00,840 PRESERVE BUG 3200 02:20:00,840 --> 02:20:03,040 PRESERVING BUT DOES IN ESTRADIOL 3201 02:20:03,040 --> 02:20:04,840 DEFICIENCY DOES NOT SEEM TO BE 3202 02:20:04,840 --> 02:20:06,680 THE CASE. 3203 02:20:06,680 --> 02:20:08,880 WE SEE CRE DECREASE OF 1.6 3204 02:20:08,880 --> 02:20:10,560 KILOGRAMS OVER 26 WEEKS, A 3205 02:20:10,560 --> 02:20:12,680 DISRUPTION IN ENERGY BALANCE OF 3206 02:20:12,680 --> 02:20:15,120 MORE THAN 80 K-CALS A DAY, WHAT 3207 02:20:15,120 --> 02:20:21,920 WOULD ACCOUNT FOR THAT 3208 02:20:21,920 --> 02:20:22,880 MAGNITUDE, CONSISTENT WITH 3209 02:20:22,880 --> 02:20:30,680 MAGNITUDE OF DISRUPTION IN 3210 02:20:30,680 --> 02:20:31,200 VARIOUS ASPECTS. 3211 02:20:31,200 --> 02:20:32,720 WE SAW MOST INCREASE IN FAT MASS 3212 02:20:32,720 --> 02:20:34,720 WAS IN THE TRUNK REGION, THIS IS 3213 02:20:34,720 --> 02:20:36,240 MEASURED BY DEXA. 3214 02:20:36,240 --> 02:20:38,720 WE DON'T HAVE CT FROM THIS 3215 02:20:38,720 --> 02:20:39,600 STUDY. 3216 02:20:39,600 --> 02:20:44,720 AND IN THIS CASE EXERCISE SEEMED 3217 02:20:44,720 --> 02:20:50,120 TO PREVENT HALF. 3218 02:20:50,120 --> 02:20:53,640 THIS IS A WAY TO EVALUATE THIS 3219 02:20:53,640 --> 02:20:55,040 UNDER FREE LIVING CONDITIONS, 3220 02:20:55,040 --> 02:20:59,440 AND WE DO SEE THIS TREND FOR -- 3221 02:20:59,440 --> 02:21:00,960 SUPPRESSED GROUP TO HAVE 3222 02:21:00,960 --> 02:21:03,480 DECREASE OF ABOUT 100 K-CALLS 3223 02:21:03,480 --> 02:21:07,360 PER DAY IN TOTAL ENERGY 3224 02:21:07,360 --> 02:21:10,360 EXPENDITURE, ABOUT A THIRD WAS 3225 02:21:10,360 --> 02:21:15,600 ATTRIBUTABLE TO LESS ENERGY 3226 02:21:15,600 --> 02:21:16,680 EXPENDITURE FROM PHYSICAL 3227 02:21:16,680 --> 02:21:18,080 ACTIVITY BUT BULK ATTRIBUTED TO 3228 02:21:18,080 --> 02:21:20,760 DECREASE IN RESTING ENERGY 3229 02:21:20,760 --> 02:21:21,720 EXPENDITURE AND RESTING 3230 02:21:21,720 --> 02:21:23,520 METABOLIC RATE. 3231 02:21:23,520 --> 02:21:25,160 JUST TO SUMMARIZE HERE, WHAT WE 3232 02:21:25,160 --> 02:21:27,000 FOUND IN THESE AND OTHER 3233 02:21:27,000 --> 02:21:32,400 STUDIES, I DIDN'T SHOW ANY BASIC 3234 02:21:32,400 --> 02:21:34,360 RESEARCH, GENETIC MANIPULATIONS, 3235 02:21:34,360 --> 02:21:35,360 SUCH AS ESTROGEN RECEPTOR 3236 02:21:35,360 --> 02:21:38,200 KNOCKOUT MICE BUT ACROSS BASIC 3237 02:21:38,200 --> 02:21:39,280 PRE-CLINICAL AND CLINICAL 3238 02:21:39,280 --> 02:21:43,560 STUDIES THERE IS CONSISTENT 3239 02:21:43,560 --> 02:21:46,040 EVIDENCE THAT REGULATION OF 3240 02:21:46,040 --> 02:21:49,280 ENERGY BALANCE IS STRONGLY 3241 02:21:49,280 --> 02:21:51,440 INFLUENCED BY ESTRADIOL. 3242 02:21:51,440 --> 02:21:56,720 THE LOSS OF ESTROGENS OR 3243 02:21:56,720 --> 02:21:58,640 ESTROGEN SIGNALING PROMOTES FAT 3244 02:21:58,640 --> 02:22:00,960 GAIN THROUGH MULTIPLE SYSTEM 3245 02:22:00,960 --> 02:22:07,160 LEVEL MECHANISMS INCLUES 3246 02:22:07,160 --> 02:22:08,640 DECREASED METABOLIC RATE AND 3247 02:22:08,640 --> 02:22:10,320 THIS DISRUPTION OF ENERGY 3248 02:22:10,320 --> 02:22:12,000 BALANCE DOES NOT SIMPLY RESULT 3249 02:22:12,000 --> 02:22:14,480 IN THE SAME TYPE OF FAT GAIN, IN 3250 02:22:14,480 --> 02:22:16,000 THE SAME PLACES. 3251 02:22:16,000 --> 02:22:19,040 THERE'S A SHIFT IN ABDOMINAL FAT 3252 02:22:19,040 --> 02:22:20,240 ACCUMULATION, AND IN MICE 3253 02:22:20,240 --> 02:22:22,680 THERE'S A CHANGE IN THE CELLULAR 3254 02:22:22,680 --> 02:22:31,960 COMPOSITION OF IN THAT. 3255 02:22:31,960 --> 02:22:38,200 MY COLLEAGUE DISCOVERED THESE 3256 02:22:38,200 --> 02:22:40,480 UNIQUE WHITE ADIPOCYTES, 3257 02:22:40,480 --> 02:22:42,800 HEMATOPOIETIC STEM CELL DERIVED 3258 02:22:42,800 --> 02:22:45,200 WITH A UNIQUE SIGNATURE, HIGHLY 3259 02:22:45,200 --> 02:22:49,920 INFLAMMATORY WHEN COMPARED TO 3260 02:22:49,920 --> 02:22:50,800 CONVENTIONAL ADIPOCYTES BY GENE 3261 02:22:50,800 --> 02:22:54,040 EXPRESSION AND DO NOT PRODUCE 3262 02:22:54,040 --> 02:22:54,280 LEPTIN. 3263 02:22:54,280 --> 02:22:57,320 AND HE HAS DETERMINED THAT THE 3264 02:22:57,320 --> 02:22:59,840 PROLIFERATION OF THESE CELLS IN 3265 02:22:59,840 --> 02:23:04,160 FEMALE MICE ARE STRONGLY 3266 02:23:04,160 --> 02:23:06,520 INFLUENCED BY ESTRADIOL, SO IN 3267 02:23:06,520 --> 02:23:09,200 OOPHORECTOMIZED MICE THERE'S A 3268 02:23:09,200 --> 02:23:11,360 HUGE PROLIFERATION, ESPECIALLY 3269 02:23:11,360 --> 02:23:13,480 IN GONADAL VISCERAL REGION OF 3270 02:23:13,480 --> 02:23:15,800 FAT, THAT'S ENTIRELY PREVENTED 3271 02:23:15,800 --> 02:23:19,360 BY ESTRADIOL TREATMENT BUT NOT 3272 02:23:19,360 --> 02:23:21,760 BY PROGESTERONE TREATMENT, ALSO 3273 02:23:21,760 --> 02:23:24,960 IS OBSERVED IN ESTROGEN RECEPTOR 3274 02:23:24,960 --> 02:23:25,360 KNOCKOUT MICE. 3275 02:23:25,360 --> 02:23:27,920 WE THINK THERE ARE IMPORTANT 3276 02:23:27,920 --> 02:23:30,080 MOLECULAR SIGNALS THAT WE NEED 3277 02:23:30,080 --> 02:23:32,880 TO UNDERSTAND FOR HOW THE LOSS 3278 02:23:32,880 --> 02:23:34,920 OF ESTROGEN CONTRIBUTES BOTH TO 3279 02:23:34,920 --> 02:23:38,880 THE SHIFT IN FAT DISTRIBUTION 3280 02:23:38,880 --> 02:23:41,960 TOWARD ABDOMINAL ADIPOSITY AND 3281 02:23:41,960 --> 02:23:43,000 METABOLIC DYSFUNCTION. 3282 02:23:43,000 --> 02:23:45,200 I WOULD POINT THAT THIS REVIEW 3283 02:23:45,200 --> 02:23:46,640 ARTICLE WE PUBLISHED RECENTLY 3284 02:23:46,640 --> 02:23:48,200 THAT SUMMARIZES A LOT OF OUR 3285 02:23:48,200 --> 02:23:50,200 WORK IN THIS AREA. 3286 02:23:50,200 --> 02:23:53,000 AND THEN I WANT TO THANK ALL THE 3287 02:23:53,000 --> 02:23:55,040 PEOPLE IN MY GROUP AND SPONSORS 3288 02:23:55,040 --> 02:24:00,400 THAT CONTRIBUTED TO THIS 3289 02:24:00,400 --> 02:24:00,720 RESEARCH. 3290 02:24:00,720 --> 02:24:01,080 THANK YOU. 3291 02:24:01,080 --> 02:24:04,880 >> THANK YOU FOR THAT GREAT 3292 02:24:04,880 --> 02:24:05,200 PRESENTATION. 3293 02:24:05,200 --> 02:24:07,960 I THINK ONE HOUSEKEEPING THING, 3294 02:24:07,960 --> 02:24:10,040 WE'RE BEHIND TIME BUT WE WANTED 3295 02:24:10,040 --> 02:24:13,200 TO LET PEOPLE KNOW WE WILL BE 3296 02:24:13,200 --> 02:24:15,080 STARTING THE NEXT SESSION AT 3297 02:24:15,080 --> 02:24:20,240 1:05 BUT WE WILL EXTENDS THE Q&A 3298 02:24:20,240 --> 02:24:21,480 UNTIL 12:45. 3299 02:24:21,480 --> 02:24:24,600 IF THE SPEAKERS FROM THE FIRST 3300 02:24:24,600 --> 02:24:27,680 SESSION WANT TO TURN ON THEIR 3301 02:24:27,680 --> 02:24:29,640 CAMERAS THEN I'M GOING TO TURN 3302 02:24:29,640 --> 02:24:32,080 THIS OVER TO DR. JOFFE TO START 3303 02:24:32,080 --> 02:24:34,880 WITH THE FIRST QUESTION. 3304 02:24:34,880 --> 02:24:40,920 3305 02:24:40,920 --> 02:24:43,480 3306 02:24:43,480 --> 02:24:44,400 >> OUTSTANDING PRESENTATIONS. 3307 02:24:44,400 --> 02:24:46,280 I THANK THE SPEAKERS FOR 3308 02:24:46,280 --> 02:24:47,840 PRESENTING THOUGHTFUL AND 3309 02:24:47,840 --> 02:24:48,200 IMPORTANT WORK. 3310 02:24:48,200 --> 02:24:49,040 THERE ARE SO MANY QUESTIONS IN 3311 02:24:49,040 --> 02:24:49,920 THE Q&A. 3312 02:24:49,920 --> 02:24:51,760 WE WON'T BE ABLE TO GET TO ALL 3313 02:24:51,760 --> 02:24:55,800 BUT I WANT TO PUT SOME FORWARD. 3314 02:24:55,800 --> 02:24:57,760 I'LL DIRECT THEM TO EACH BUT 3315 02:24:57,760 --> 02:25:02,200 PLEASE ADD IN IF YOU HAVE OTHER 3316 02:25:02,200 --> 02:25:03,120 COMMENTS BEYOND THE FIRST. 3317 02:25:03,120 --> 02:25:05,240 I WANT TO MAKE SURE WE 3318 02:25:05,240 --> 02:25:13,200 DISTRIBUTE THEM SO EVERY TOPIC 3319 02:25:13,200 --> 02:25:14,720 IS COVERED. 3320 02:25:14,720 --> 02:25:19,120 DR. MANSON, A QUESTION HAS COME 3321 02:25:19,120 --> 02:25:21,400 UP WITH NEWLY POSTMENOPAUSAL 3322 02:25:21,400 --> 02:25:24,760 WOMEN, YOUNG WOMEN USING ORAL 3323 02:25:24,760 --> 02:25:26,760 CONTRACEPTIVES COMBINED ESTROGEN 3324 02:25:26,760 --> 02:25:27,560 AND PROGESTERONE AND 3325 02:25:27,560 --> 02:25:30,440 RISK/BENEFIT DECISION IN TERMS 3326 02:25:30,440 --> 02:25:34,000 OF USING THAT MEDICATION VERSUS 3327 02:25:34,000 --> 02:25:43,160 MENOPAUSE ESTROGEN AND PROGESTIN 3328 02:25:43,160 --> 02:25:45,520 COMBINATIONS.. 3329 02:25:45,520 --> 02:25:48,560 >> SOME ARE SIMILAR. 3330 02:25:48,560 --> 02:25:51,840 ORAL CEE PLUS MPA, THERE ARE 3331 02:25:51,840 --> 02:25:57,960 SOME INCREASED RISKS OF VENOUS 3332 02:25:57,960 --> 02:25:58,360 THROMBOSIS, VENOUS 3333 02:25:58,360 --> 02:26:00,160 THROMBOEMBOLISM AND STROKE, WITH 3334 02:26:00,160 --> 02:26:02,440 BOTH ORAL CONTRACEPTIVES AND 3335 02:26:02,440 --> 02:26:07,800 ORAL MENOPAUSAL HORMONE THERAPY. 3336 02:26:07,800 --> 02:26:12,880 AGAIN, TRANSDERMAL ESTRADIOL IS 3337 02:26:12,880 --> 02:26:13,640 INOBSERVATIONAL STUDIES SHOWING 3338 02:26:13,640 --> 02:26:16,400 LESS INCREASE IN STROKE BUT NOT 3339 02:26:16,400 --> 02:26:24,520 YET TESTED IN RANDOMIZED TRIAL. 3340 02:26:24,520 --> 02:26:25,120 WE'RE SEE WITH MENOPAUSAL 3341 02:26:25,120 --> 02:26:29,200 HORMONE TRIALS THERE'S A 3342 02:26:29,200 --> 02:26:36,480 REDUCTION IN TYPE 2 DIABETES, 3343 02:26:36,480 --> 02:26:42,960 WITH CEE PLUS MPA, PLUS MPA 3344 02:26:42,960 --> 02:26:43,160 ALONE. 3345 02:26:43,160 --> 02:26:44,600 THE BREAST CANCER FINDINGS THAT 3346 02:26:44,600 --> 02:26:49,240 WE SEE WITH CEE ALONE HASN'T 3347 02:26:49,240 --> 02:26:50,680 BEEN FOUND, THIS REDUCTION IN 3348 02:26:50,680 --> 02:26:52,800 BREAST CANCER RISK WITH CEE 3349 02:26:52,800 --> 02:27:01,120 ALONE, HAS NOT BEEN FOUND WITH 3350 02:27:01,120 --> 02:27:02,080 ORAL CONTRACEPTIVES, THERE'S 3351 02:27:02,080 --> 02:27:06,640 BEEN A SMALL INCREASE WHEN ORAL 3352 02:27:06,640 --> 02:27:08,200 CONTRACEPTIVES ARE LONG DURATION 3353 02:27:08,200 --> 02:27:11,640 OR STARTED BEFORE FIRST 3354 02:27:11,640 --> 02:27:16,760 PREGNANCY, MORE RESULT SIMILAR 3355 02:27:16,760 --> 02:27:17,480 TO CEE PLUS MPA. 3356 02:27:17,480 --> 02:27:21,640 WE WERE INTERESTED IN THE 3357 02:27:21,640 --> 02:27:22,600 INTERACTION WITH CIGARETTE 3358 02:27:22,600 --> 02:27:25,680 SMOKING ORAL CONTRACEPTIVES HAVE 3359 02:27:25,680 --> 02:27:28,080 A STRONG ADVERSE INTERACTION, IT 3360 02:27:28,080 --> 02:27:38,360 QUADRUPLES, RISK. 3361 02:27:45,960 --> 02:27:52,640 WE HAD FEW HEAVY SMOKERS, IN THE 3362 02:27:52,640 --> 02:27:53,960 WHI OR BECAUSE MENOPAUSAL 3363 02:27:53,960 --> 02:27:57,800 HORMONE THERAPY TENDS TO BE 3364 02:27:57,800 --> 02:28:01,360 WEAKER CEE, WEAKER ESTROGEN 3365 02:28:01,360 --> 02:28:03,840 THAN ESTRADIOL BUT DO NOT SEE 3366 02:28:03,840 --> 02:28:05,640 ADVERSE INTERACTIONS WITH 3367 02:28:05,640 --> 02:28:07,520 CIGARETTE SMOKING, I THINK 3368 02:28:07,520 --> 02:28:09,560 OVERALL IT'S A COMPLEX QUESTION, 3369 02:28:09,560 --> 02:28:13,200 AND WILL DEPEND ON THE 3370 02:28:13,200 --> 02:28:21,720 FORMULATION, DOSE OF THE HORMONE 3371 02:28:21,720 --> 02:28:23,800 THERAPY, DEPENDING ON DOSE THERE 3372 02:28:23,800 --> 02:28:24,720 MAY BE DIFFERENCE, UNDERLYING 3373 02:28:24,720 --> 02:28:26,440 HEALTH STATUS OF THE WOMAN BUT 3374 02:28:26,440 --> 02:28:29,240 MANY SIMILARITIES WITH RISK OF 3375 02:28:29,240 --> 02:28:30,000 ORAL CONTRACEPTIVES. 3376 02:28:30,000 --> 02:28:32,720 >> THANK YOU FOR THAT. 3377 02:28:32,720 --> 02:28:36,280 I'M GOING TO CHANGE AND ASK DR. 3378 02:28:36,280 --> 02:28:37,640 GREENDALE A QUESTION, SOME 3379 02:28:37,640 --> 02:28:39,920 COMMENTS AND QUESTIONS HAVE COME 3380 02:28:39,920 --> 02:28:42,720 UP ABOUT THRESHOLDS, GIVEN THE 3381 02:28:42,720 --> 02:28:45,720 CONCERN ABOUT BONE LOSS STARTING 3382 02:28:45,720 --> 02:28:49,320 IN THE YEAR BEFORE FINAL 3383 02:28:49,320 --> 02:28:52,800 MENSTRUAL PERIOD, WHAT IS KNOWN 3384 02:28:52,800 --> 02:28:55,440 IN TERMS OF PREDICTABILITY ON 3385 02:28:55,440 --> 02:28:58,280 NTX, AT WHAT POINT WOULD YOU 3386 02:28:58,280 --> 02:29:00,680 RECOMMEND BONE SCANS FOR 3387 02:29:00,680 --> 02:29:06,200 BASELINE GIVEN THAT WE'RE 3388 02:29:06,200 --> 02:29:09,040 STARTING TO SEE (INDISCERNIBLE) 3389 02:29:09,040 --> 02:29:09,480 BEFORE FMP? 3390 02:29:09,480 --> 02:29:11,320 >> IF I WON'T GOBBLE UP THE 3391 02:29:11,320 --> 02:29:14,200 ENTIRE TIME I'LL PICK ONE AND 3392 02:29:14,200 --> 02:29:14,560 ANSWER. 3393 02:29:14,560 --> 02:29:15,760 WHAT ABOUT THRESHOLDS? 3394 02:29:15,760 --> 02:29:19,120 A THRESHOLD IS AN ARBITRARILY 3395 02:29:19,120 --> 02:29:21,200 CHOSEN NUMBER, AND IT'S BASED IN 3396 02:29:21,200 --> 02:29:24,280 LARGE PART, ONE OF THE WAYS IS 3397 02:29:24,280 --> 02:29:27,200 WHAT NUMBER DO YOU THINK IS 3398 02:29:27,200 --> 02:29:28,400 CLINICAL RELEVANT? 3399 02:29:28,400 --> 02:29:32,160 THE AVERAGE LOSS RATE IS ABOUT 2 3400 02:29:32,160 --> 02:29:34,800 1/2% AT THE LUMBAR SPINE SO 50% 3401 02:29:34,800 --> 02:29:37,800 OF WOMEN WILL HAVE THAT RATE OF 3402 02:29:37,800 --> 02:29:40,840 LOSS OR GREATER, AND SO IF YOU 3403 02:29:40,840 --> 02:29:42,920 WANT TO TRY TO PREVENT 3404 02:29:42,920 --> 02:29:44,640 TRANSMENOPAUSAL BONE LOSS YOU 3405 02:29:44,640 --> 02:29:46,360 HAVE TO ASK YOURSELF IN WHOM DO 3406 02:29:46,360 --> 02:29:49,840 I WANT TO PREVENT IT, HOW MUCH 3407 02:29:49,840 --> 02:29:50,480 PEOPLE. 3408 02:29:50,480 --> 02:29:53,200 DO I WANT TO PREVENT IT IN 3409 02:29:53,200 --> 02:29:57,040 PEOPLE WHO ARE ABOVE AVERAGE? 3410 02:29:57,040 --> 02:29:59,600 YOU USE A THRESHOLD OF 2 1/2%. 3411 02:29:59,600 --> 02:30:01,120 DO I WANT TO PREVENT ANYTIME 3412 02:30:01,120 --> 02:30:05,280 PEOPLE WHO ARE AT THE MOST 3413 02:30:05,280 --> 02:30:08,800 EXTREME QUARTILE OF RISK? 3414 02:30:08,800 --> 02:30:11,840 USE A THRESHOLD MINUS 3.6% 3415 02:30:11,840 --> 02:30:13,880 BECAUSE THAT DEFINES LOWER BOUND 3416 02:30:13,880 --> 02:30:15,360 OF THE HIGHEST QUARTILE. 3417 02:30:15,360 --> 02:30:18,240 SO IT'S A VERY GOOD QUESTION, 3418 02:30:18,240 --> 02:30:20,720 THRESHOLD ONE WOULD USE WOULD 3419 02:30:20,720 --> 02:30:24,080 DEPEND ON WHO YOU WANT TO TARGET 3420 02:30:24,080 --> 02:30:26,080 FOR RISK PREVENTION, AND THOSE 3421 02:30:26,080 --> 02:30:29,640 ARE SOME OF THE BENEFIT-RISK 3422 02:30:29,640 --> 02:30:34,400 QUESTIONS WE ASK OURSELVES NOW. 3423 02:30:34,400 --> 02:30:36,960 >> A LOT OF PEOPLE WAITING FOR 3424 02:30:36,960 --> 02:30:40,200 RESULTS, SO MUCH MORE NEEDS TO 3425 02:30:40,200 --> 02:30:44,840 BE DONE. 3426 02:30:44,840 --> 02:30:46,920 DR. NEAL-PERRY, QUESTIONS ABOUT 3427 02:30:46,920 --> 02:30:53,080 OTHER ROLES OF THE KNDY NEURONS 3428 02:30:53,080 --> 02:30:55,440 BESIDES RESPONSIVITY TO ESTROGEN 3429 02:30:55,440 --> 02:30:57,360 IN TERMS OF THERMOREGULATION. 3430 02:30:57,360 --> 02:30:59,880 >> THANK FOR THE QUESTION. 3431 02:30:59,880 --> 02:31:01,920 KNDY NEURONS ARE IMPORTANT IN 3432 02:31:01,920 --> 02:31:06,320 PUBERTY, IMPORTANT IN TERMS OF 3433 02:31:06,320 --> 02:31:08,440 TIMING OF PUBERTY, THEY ALSO 3434 02:31:08,440 --> 02:31:10,320 PARTICIPATE, I DIDN'T SHOW THIS 3435 02:31:10,320 --> 02:31:14,960 IN MY PRESENTATION BECAUSE OF 3436 02:31:14,960 --> 02:31:17,120 TIME, BUT REGULATE GNH NEURONS 3437 02:31:17,120 --> 02:31:19,880 IN TERMS OF THEY HAVE IMPORTANCE 3438 02:31:19,880 --> 02:31:28,360 IN LIKE STRESS AND NUTRITIONAL 3439 02:31:28,360 --> 02:31:30,960 SURVEILLANCE AND SO PROVIDE 3440 02:31:30,960 --> 02:31:32,840 FEEDBACK IN TERMS OF ENVIRONMENT 3441 02:31:32,840 --> 02:31:34,360 TO NUTRITIONAL ENVIRONMENT AND 3442 02:31:34,360 --> 02:31:35,600 STRESS ENVIRONMENT. 3443 02:31:35,600 --> 02:31:37,600 SO THEY HAVE MULTIPLE ROLES, AND 3444 02:31:37,600 --> 02:31:42,720 IT SEEMS TO BE RELATED TO THE 3445 02:31:42,720 --> 02:31:47,320 NEUROPEPTIDE PREDOMINANT AT THAT 3446 02:31:47,320 --> 02:31:47,960 TIME. 3447 02:31:47,960 --> 02:31:48,400 >> THANK YOU. 3448 02:31:48,400 --> 02:31:53,560 LET ME MOVE TO DR. ROCCA. 3449 02:31:53,560 --> 02:31:57,240 AND QUESTION ABOUT WHY ESTROGEN 3450 02:31:57,240 --> 02:32:01,200 CONTRIBUTES TO OR LACK OF 3451 02:32:01,200 --> 02:32:08,720 ESTROGEN CONTRIBUTES TO 3452 02:32:08,720 --> 02:32:10,240 ACCELERATED AGING, BIOLOGICAL 3453 02:32:10,240 --> 02:32:11,080 EXPLANATIONS FOR THAT. 3454 02:32:11,080 --> 02:32:16,240 >> I DON'T THINK WE KNOW 3455 02:32:16,240 --> 02:32:17,040 EXACTLY WHICH MECHANISM. 3456 02:32:17,040 --> 02:32:25,280 I LIST THE A NUMBER OF POSSIBLE 3457 02:32:25,280 --> 02:32:29,200 MECHANISMS, THE CELLULAR TISSUE 3458 02:32:29,200 --> 02:32:31,560 ORGAN OR SYSTEM LEVEL THAT 3459 02:32:31,560 --> 02:32:34,440 CHARACTERIZES AGING SO THAT THE 3460 02:32:34,440 --> 02:32:38,760 THEORY IS ESTROGEN WOULD HAVE 3461 02:32:38,760 --> 02:32:44,280 EFFECT ON THESE MECHANISMS BUT 3462 02:32:44,280 --> 02:32:45,600 SPECIFIC LEVEL OF CHEMICAL LEVEL 3463 02:32:45,600 --> 02:32:46,960 WE DO NOT KNOW YET. 3464 02:32:46,960 --> 02:32:52,760 OF COURSE WE KNOW THERE'S 3465 02:32:52,760 --> 02:32:55,040 ACTIVITY DIRECTLY ON THE CELLS 3466 02:32:55,040 --> 02:32:57,000 BUT SPECIFIC STEPS ARE NOT YET 3467 02:32:57,000 --> 02:33:00,680 CLEAR SO IT'S MORE LIKE A SERIES 3468 02:33:00,680 --> 02:33:01,720 OF -- WE HAVE PIECES OF THE 3469 02:33:01,720 --> 02:33:03,680 PUZZLE THAT LINE UP BUT WE DON'T 3470 02:33:03,680 --> 02:33:12,200 KNOW ALL OF THE INTERMEDIATE, IF 3471 02:33:12,200 --> 02:33:12,680 THAT IS THE QUESTION. 3472 02:33:12,680 --> 02:33:19,360 >>A LOT OF WORK TO BE DONE AS 3473 02:33:19,360 --> 02:33:19,560 WELL. 3474 02:33:19,560 --> 02:33:20,600 DR. KOHRT, I'LL COME BACK TO 3475 02:33:20,600 --> 02:33:20,800 YOU. 3476 02:33:20,800 --> 02:33:22,400 THERE'S QUESTIONS FOR EVERYBODY 3477 02:33:22,400 --> 02:33:22,600 ELSE. 3478 02:33:22,600 --> 02:33:26,640 IF I COULD ASK YOU TO TAKE YOUR 3479 02:33:26,640 --> 02:33:29,680 WORK AND TRANSLATE TO THE 3480 02:33:29,680 --> 02:33:31,040 CLINICAL RECOMMENDATION FOR 3481 02:33:31,040 --> 02:33:32,720 ACTIVITY FOR WOMEN GIVEN THAT 3482 02:33:32,720 --> 02:33:36,160 YOU'RE SEEING SO MANY PROFOUND 3483 02:33:36,160 --> 02:33:38,520 CHANGES IN ANIMAL AND 3484 02:33:38,520 --> 02:33:40,320 NON-PRIMATE AND HUMANS WITH 3485 02:33:40,320 --> 02:33:43,360 REGARD TO ENERGY EXPENDITURE AND 3486 02:33:43,360 --> 02:33:45,720 PHYSICAL ACTIVITY WHAT WOULD YOU 3487 02:33:45,720 --> 02:33:51,120 RECOMMEND WOMEN THIS AGE TO BE 3488 02:33:51,120 --> 02:33:51,320 DOING? 3489 02:33:51,320 --> 02:33:52,040 >> THANKS. 3490 02:33:52,040 --> 02:33:54,520 YEAH, OUR WORK IS FOCUSED ON 3491 02:33:54,520 --> 02:33:56,280 TRYING TO UNDERSTAND EXACTLY 3492 02:33:56,280 --> 02:33:59,240 WHAT THE METABOLIC CONSEQUENCES 3493 02:33:59,240 --> 02:34:00,840 ARE OF THE LOSS OF OVARIAN 3494 02:34:00,840 --> 02:34:04,480 FUNCTION SO THAT WE CAN TRY TO 3495 02:34:04,480 --> 02:34:06,840 DESIGN LIFESTYLE OR OTHER TYPES 3496 02:34:06,840 --> 02:34:08,800 OF INTERVENTIONS TO HELP 3497 02:34:08,800 --> 02:34:10,320 MITIGATE SOME CHANGES. 3498 02:34:10,320 --> 02:34:12,600 WE'VE DONE SMALL STUDIES LOOKING 3499 02:34:12,600 --> 02:34:15,560 AT THE POTENTIAL BENEFITS OF 3500 02:34:15,560 --> 02:34:18,920 EITHER RESISTANCE TYPE EXERCISE 3501 02:34:18,920 --> 02:34:20,160 OR ENDURANCE EXERCISE, 3502 02:34:20,160 --> 02:34:21,360 RESISTANCE IS WEIGHT LIFTING 3503 02:34:21,360 --> 02:34:23,120 MUSCLE BUILDING, THAT DOES SEEM 3504 02:34:23,120 --> 02:34:26,720 TO BE EFFECTIVE AND 3505 02:34:26,720 --> 02:34:28,200 PREVENTING -- NOT PREVENTING, 3506 02:34:28,200 --> 02:34:30,440 SLOWING THE LOSS OF LEAN MASS, 3507 02:34:30,440 --> 02:34:33,240 BONE AND MUSCLE DURING THE 3508 02:34:33,240 --> 02:34:37,680 MENOPAUSE TRANSITION, IT DOESN'T 3509 02:34:37,680 --> 02:34:39,720 SEEM TO PREVENT INCREASE IN 3510 02:34:39,720 --> 02:34:41,480 ABDOMINAL ADIPOSITY OR EVEN 3511 02:34:41,480 --> 02:34:44,520 BEGIN TO TOUCH THAT. 3512 02:34:44,520 --> 02:34:48,000 ENDURANCE EXERCISE, CARDIO TYPE 3513 02:34:48,000 --> 02:34:50,040 OF EXERCISE, GENERALLY INCREASES 3514 02:34:50,040 --> 02:34:53,200 ENERGY EXPENDITURE MORE SO THAN 3515 02:34:53,200 --> 02:34:55,480 RESISTANCE EXERCISE SO DOES SEEM 3516 02:34:55,480 --> 02:34:59,040 TO HAVE A BENEFICIAL EFFECT TO 3517 02:34:59,040 --> 02:35:01,000 PREVENT SOME OF THE INCREASE IN 3518 02:35:01,000 --> 02:35:03,840 ADIPOSITY THAT OCCURS ACROSS THE 3519 02:35:03,840 --> 02:35:05,000 MENOPAUSE TRANSITION, BUT, 3520 02:35:05,000 --> 02:35:06,600 AGAIN, DOESN'T FULLY PREVENT IT 3521 02:35:06,600 --> 02:35:08,440 BUT WE DEFINITELY NEED MORE WORK 3522 02:35:08,440 --> 02:35:12,280 IN THIS AREA SO I THINK THE 3523 02:35:12,280 --> 02:35:17,120 TAKEHOME MESSAGE IS THAT THE 3524 02:35:17,120 --> 02:35:18,400 MENOPAUSE TRANSITION IS A 3525 02:35:18,400 --> 02:35:19,920 CRITICAL TIME WHERE EITHER 3526 02:35:19,920 --> 02:35:21,600 MAINTAINING OR INCREASING YOUR 3527 02:35:21,600 --> 02:35:24,120 PHYSICAL ACTIVITY LEVEL IS VERY 3528 02:35:24,120 --> 02:35:27,600 IMPORTANT FOR HAVING BENEFICIAL 3529 02:35:27,600 --> 02:35:29,200 EFFECTS ON HEALTH. 3530 02:35:29,200 --> 02:35:30,960 >> GOOD TO HAVE POSITIVE 3531 02:35:30,960 --> 02:35:32,000 MESSAGES LIKE THAT. 3532 02:35:32,000 --> 02:35:34,200 WINDOW OF OPPORTUNITY IN TERMS 3533 02:35:34,200 --> 02:35:37,360 OF PHYSICAL ACTIVITY AS YOU SAY. 3534 02:35:37,360 --> 02:35:39,920 SO, BACK TO DR. MANSON, A 3535 02:35:39,920 --> 02:35:43,880 QUESTION ABOUT STATINS, WHAT'S 3536 02:35:43,880 --> 02:35:49,640 KNOWN IN TERMS OF ANY IMPACT OF 3537 02:35:49,640 --> 02:35:56,440 REVERSING OR PREVENTING ADVERSE 3538 02:35:56,440 --> 02:35:57,040 EFFECTS OF ENP THERAPY. 3539 02:35:57,040 --> 02:36:00,600 >> THEY HAVE BEEN LOOKED AT IN 3540 02:36:00,600 --> 02:36:02,240 WHI AND RANDOMIZED TRIALS. 3541 02:36:02,240 --> 02:36:08,240 THEY HAVE NOT SHOWN A REALLY 3542 02:36:08,240 --> 02:36:09,920 STRONG INTERACTION WITH HORMONE 3543 02:36:09,920 --> 02:36:11,440 THERAPY IN TERMS DECREASING 3544 02:36:11,440 --> 02:36:14,160 RISK, I DON'T THINK ANY TRIALS 3545 02:36:14,160 --> 02:36:16,720 ARE WELL POWERED TO ADDRESS THAT 3546 02:36:16,720 --> 02:36:20,800 QUESTION BUT STATINS SHOULD BE 3547 02:36:20,800 --> 02:36:24,720 USED ACCORDING TO GUIDELINES, 3548 02:36:24,720 --> 02:36:26,160 GUIDELINE DIRECTED CARE, 3549 02:36:26,160 --> 02:36:27,920 STARTLING THEM IF A WOMAN IS 3550 02:36:27,920 --> 02:36:28,560 GOING ON HORMONE THERAPY, I 3551 02:36:28,560 --> 02:36:30,760 DON'T THINK THERE'S A STRONG 3552 02:36:30,760 --> 02:36:35,040 EVIDENCE BASE FOR THAT AT THIS 3553 02:36:35,040 --> 02:36:35,560 TIME. 3554 02:36:35,560 --> 02:36:38,080 AND ASPIRIN HAS ALSO BEEN LOOKED 3555 02:36:38,080 --> 02:36:41,960 AT BECAUSE THEY HAVE ALMOST THE 3556 02:36:41,960 --> 02:36:44,720 OPPOSITE EFFECTS, ORAL ESTROGEN 3557 02:36:44,720 --> 02:36:49,640 IS GOING TO INCREASE THROMBOSIS, 3558 02:36:49,640 --> 02:36:51,280 ASPIRIN DECREASE PLATELET 3559 02:36:51,280 --> 02:36:52,080 AGGREGATION, DECREASE 3560 02:36:52,080 --> 02:36:53,240 THROMBOSIS, COULD ASPIRIN 3561 02:36:53,240 --> 02:36:55,560 POSSIBLY COUNTERACT SOME OF THE 3562 02:36:55,560 --> 02:36:57,640 INCREASED THROMBOTIC RISK? 3563 02:36:57,640 --> 02:36:59,800 THERE'S BEEN A VERY, VERY SUBTLE 3564 02:36:59,800 --> 02:37:01,600 SIGNAL THAT IT MIGHT HAVE A ROLE 3565 02:37:01,600 --> 02:37:03,960 DOING THAT BUT IT'S NOT STRONG 3566 02:37:03,960 --> 02:37:05,720 ENOUGH TO ACTUALLY BECOME A 3567 02:37:05,720 --> 02:37:06,600 CLINICAL RECOMMENDATION, AND I 3568 02:37:06,600 --> 02:37:10,560 THINK NOW WITH THE TREND TOWARD 3569 02:37:10,560 --> 02:37:11,640 USING TRANSDERMAL RATHER THAN 3570 02:37:11,640 --> 02:37:15,680 ORAL, IN ORDER TO AVOID SOME OF 3571 02:37:15,680 --> 02:37:18,560 THE THROMBOTIC RISKS ESPECIALLY 3572 02:37:18,560 --> 02:37:19,400 VENOUS THROMBOSIS, EMBOLISM, 3573 02:37:19,400 --> 02:37:29,920 THAT MAY BE LESS OF AN ISSUE. 3574 02:37:36,760 --> 02:37:38,000 >>TO DR. GREENDALE, TRANSLATING 3575 02:37:38,000 --> 02:37:41,400 TO RECOMMENDATION OF BONE SCANS 3576 02:37:41,400 --> 02:37:42,040 AND MONITORING. 3577 02:37:42,040 --> 02:37:42,880 >> THEY DON'T. 3578 02:37:42,880 --> 02:37:46,600 IT WOULD BE CLINICAL VASTLY 3579 02:37:46,600 --> 02:37:47,880 PREMATURE TO RECOMMEND ANY 3580 02:37:47,880 --> 02:37:50,280 CHANGE TO CURRENT SCREENING 3581 02:37:50,280 --> 02:37:52,720 RECOMMENDATIONS BASED ON SWAN 3582 02:37:52,720 --> 02:37:53,040 DATA. 3583 02:37:53,040 --> 02:37:55,800 AS ENTHUSIASTIC AS I AM ABOUT 3584 02:37:55,800 --> 02:37:58,600 FINDING OUT THAT BONE LOSS 3585 02:37:58,600 --> 02:38:02,920 BEGINS BEFORE THE FMP COMES, I 3586 02:38:02,920 --> 02:38:03,960 AM APPROPRIATELY CONSERVATIVE 3587 02:38:03,960 --> 02:38:08,040 WITH SAYING THAT WE DON'T HAVE 3588 02:38:08,040 --> 02:38:09,440 ANY PROVEN EFFECTIVE THERAPY TO 3589 02:38:09,440 --> 02:38:10,760 INITIATE AT THAT POINT IN TIME 3590 02:38:10,760 --> 02:38:13,560 AND WE DON'T EVEN YET KNOW HOW 3591 02:38:13,560 --> 02:38:16,800 TO TARGET THE WOMEN WHO WILL 3592 02:38:16,800 --> 02:38:20,200 LOSE BONE IN AN AMOUNT THAT'S 3593 02:38:20,200 --> 02:38:23,000 RELEVANT NOR EVEN DO WE HAVE OUR 3594 02:38:23,000 --> 02:38:25,440 CLINICAL PREDICTION MODEL 3595 02:38:25,440 --> 02:38:26,640 COMPLETELY TOGETHER. 3596 02:38:26,640 --> 02:38:30,680 SO PERHAPS I GAVE AN OVERLY 3597 02:38:30,680 --> 02:38:31,720 ENTHUSIASTIC PICTURE WHICH I 3598 02:38:31,720 --> 02:38:33,520 WANTED TO DO TO SHOW HOW MUCH 3599 02:38:33,520 --> 02:38:34,960 PROGRESS WE MADE. 3600 02:38:34,960 --> 02:38:37,200 THAT'S VERY IMPORTANT. 3601 02:38:37,200 --> 02:38:39,720 BUT WE STILL NEED TO DO A LOT OF 3602 02:38:39,720 --> 02:38:42,800 HEAVY LIFTING BEFORE WE CAN GET 3603 02:38:42,800 --> 02:38:48,120 TO CLINICAL RECOMMENDATIONS 3604 02:38:48,120 --> 02:38:49,240 BASED ON SWAN DATA. 3605 02:38:49,240 --> 02:38:51,000 >> BALANCING WHERE WE ARE WITH 3606 02:38:51,000 --> 02:38:53,080 THE FINDINGS WE HAVE. 3607 02:38:53,080 --> 02:38:55,640 I APPRECIATE THAT. 3608 02:38:55,640 --> 02:38:57,480 SO DR. NEAL-PERRY ANOTHER 3609 02:38:57,480 --> 02:39:02,720 QUESTION ABOUT OTHER HYPO 3610 02:39:02,720 --> 02:39:06,480 ESTROGENIC STATES LIKE 3611 02:39:06,480 --> 02:39:08,640 AMENORREAH, POSTPARTUM, OTHER 3612 02:39:08,640 --> 02:39:11,520 CONDITIONS WHERE THERE'S 3613 02:39:11,520 --> 02:39:12,080 ESTROGEN WITHDRAWAL, LOW 3614 02:39:12,080 --> 02:39:14,680 ESTROGEN STATE, AND WHAT'S KNOWN 3615 02:39:14,680 --> 02:39:17,960 ABOUT THAT ACTIVITY IN TERMS OF 3616 02:39:17,960 --> 02:39:24,040 THE KNDY NEURONS AND ALSO 3617 02:39:24,040 --> 02:39:24,560 VASOMOTOR SYMPTOMS. 3618 02:39:24,560 --> 02:39:28,000 >> THERE ARE SOME WOMEN AND 3619 02:39:28,000 --> 02:39:28,880 PEOPLE WHO EXPERIENCE HOT 3620 02:39:28,880 --> 02:39:32,440 FLASHES AROUND THE TIME OF 3621 02:39:32,440 --> 02:39:34,840 ESTROGEN WITHDRAWAL AND 3622 02:39:34,840 --> 02:39:35,240 POSTPARTUM PERIOD. 3623 02:39:35,240 --> 02:39:38,080 THERE HAVEN'T BEEN STUDIES TO 3624 02:39:38,080 --> 02:39:40,120 SPECIFICALLY LOOK AT THE PERIOD, 3625 02:39:40,120 --> 02:39:42,960 I IMAGINE THE BIOLOGY IS 3626 02:39:42,960 --> 02:39:43,400 SIMILAR. 3627 02:39:43,400 --> 02:39:46,520 THERE IS ACTUALLY SOME DATA 3628 02:39:46,520 --> 02:39:49,240 LOOKING AT KNDY NEURONS IN PCOS, 3629 02:39:49,240 --> 02:39:53,200 THERE'S SOME DATA TO SUPPORT 3630 02:39:53,200 --> 02:39:55,800 THAT. 3631 02:39:55,800 --> 02:40:00,280 AND POSTPARTUM PERIOD, OH, 3632 02:40:00,280 --> 02:40:03,280 ACTUALLY TACHYKININ DEFICIENCY 3633 02:40:03,280 --> 02:40:05,320 ASSOCIATED WITH HYPO GONADISM, 3634 02:40:05,320 --> 02:40:07,840 THERE'S REAL BIOLOGY THERE THAT 3635 02:40:07,840 --> 02:40:09,480 I FEEL HAS REALLY JUST BEEN A 3636 02:40:09,480 --> 02:40:12,640 GAME CHANGER IN TERMS OF HOW WE 3637 02:40:12,640 --> 02:40:18,160 UNDERSTAND KIND OF THE BIOLOGY 3638 02:40:18,160 --> 02:40:18,360 THERE. 3639 02:40:18,360 --> 02:40:28,840 >> IS THERE ANYTHING KNOWN 3640 02:40:31,000 --> 02:40:31,440 HYPOTYLAMIC AMENORREAH? 3641 02:40:31,440 --> 02:40:35,560 >>DATA IN ANIMAL MODELS SUGGEST 3642 02:40:35,560 --> 02:40:41,720 KNDY NEURONS MAY REGULATE PRO 3643 02:40:41,720 --> 02:40:52,120 ACTIN, MORE SO AROUND 3644 02:41:00,160 --> 02:41:00,960 TACHYTACHYKININ RECEPTOR, 3645 02:41:00,960 --> 02:41:01,520 HYPOGONADISM. 3646 02:41:01,520 --> 02:41:08,520 >> QUESTIONS ABOUT THE 3647 02:41:08,520 --> 02:41:15,440 PREMATURE MENOPAUSE RELATED TO 3648 02:41:15,440 --> 02:41:18,080 BILATERAL, SINGLE REMOVAL OF 3649 02:41:18,080 --> 02:41:21,320 ONE, ONE OR MORE BUT NOT TWO, 3650 02:41:21,320 --> 02:41:26,680 AND HOW TO TRANSLATE AND HAVE 3651 02:41:26,680 --> 02:41:27,680 EQUIVALENCIES ACROSS TO NATURAL 3652 02:41:27,680 --> 02:41:27,960 MENOPAUSE. 3653 02:41:27,960 --> 02:41:28,880 >> WELL, THANK YOU. 3654 02:41:28,880 --> 02:41:32,200 THE QUESTION IS A VERY GOOD ONE. 3655 02:41:32,200 --> 02:41:34,560 AND TOUCHES ON OUR LACK OF 3656 02:41:34,560 --> 02:41:35,280 KNOWLEDGE. 3657 02:41:35,280 --> 02:41:38,040 OF COURSE IF YOU REMOVE TWO 3658 02:41:38,040 --> 02:41:40,720 OVARIES AT THE SAME TIME, OR THE 3659 02:41:40,720 --> 02:41:43,240 SECOND OF TWO, YOU GET INTO A 3660 02:41:43,240 --> 02:41:47,920 CLEAR PICTURE, IF YOU WANT, OF 3661 02:41:47,920 --> 02:41:49,600 COMPLETE ABSENCE OF OVARY 3662 02:41:49,600 --> 02:41:49,880 PRODUCTION. 3663 02:41:49,880 --> 02:41:55,520 IF YOU REMOVE ONE OVARY ONLY, 3664 02:41:55,520 --> 02:41:59,880 FOR EXAMPLE IN TERMS OF 3665 02:41:59,880 --> 02:42:02,960 FERTILITY, BUT IN TERMS OF 3666 02:42:02,960 --> 02:42:06,680 ENDOCRINE ACTIVITY WE ARE NOT 3667 02:42:06,680 --> 02:42:10,240 SURE THERE IS ADEQUATE FUNCTION 3668 02:42:10,240 --> 02:42:11,080 OF SINGLE OVARY. 3669 02:42:11,080 --> 02:42:13,000 AND SHOWN, FOR EXAMPLE, THE 3670 02:42:13,000 --> 02:42:21,240 SECOND OVARY SEEMS TO GO INTO A 3671 02:42:21,240 --> 02:42:23,880 PHASE OF ANTICIPATED 3672 02:42:23,880 --> 02:42:25,960 INSUFFICIENCY AND THAT MAY BE AS 3673 02:42:25,960 --> 02:42:29,200 A RESULT OF A SINGLE OVARY 3674 02:42:29,200 --> 02:42:33,440 HAVING TO PRODUCE A FULLY 3675 02:42:33,440 --> 02:42:36,120 (INDISCERNIBLE) EVERY CYCLE OR 3676 02:42:36,120 --> 02:42:38,160 CAN BE SOME SECONDARY SUFFERING 3677 02:42:38,160 --> 02:42:40,640 OF THE REMAINING OVARY. 3678 02:42:40,640 --> 02:42:43,200 SO I THINK WE KNOW VERY LITTLE 3679 02:42:43,200 --> 02:42:46,000 ABOUT THE SITUATION OF A SINGLE 3680 02:42:46,000 --> 02:42:47,400 OVARY REMOVAL COMPARED TO TWO. 3681 02:42:47,400 --> 02:42:49,840 ALSO THE QUESTION BECOMES EVEN 3682 02:42:49,840 --> 02:42:55,520 MORE COMPLICATED WHEN YOU TRY TO 3683 02:42:55,520 --> 02:42:58,960 SAY IS A PREMATURE BELOW 40 OR 3684 02:42:58,960 --> 02:43:00,960 EARLY BETWEEN 40 AND 45 3685 02:43:00,960 --> 02:43:04,440 MENOPAUSE EQUIVALENT IF IT IS 3686 02:43:04,440 --> 02:43:09,080 INDUCED BY THE SURGICALLY OR 3687 02:43:09,080 --> 02:43:12,080 CHEMOTHERAPY OR SOME OTHER WAY 3688 02:43:12,080 --> 02:43:12,720 VERSUS OCCURRING SPONTANEOUSLY, 3689 02:43:12,720 --> 02:43:13,560 WELL, WE DON'T KNOW. 3690 02:43:13,560 --> 02:43:18,640 CLEARLY IF YOU DO IT SURGICALLY 3691 02:43:18,640 --> 02:43:22,760 OR CHEMICAL IT'S MORE ABRUPT, 3692 02:43:22,760 --> 02:43:26,240 RAPID, INSANE THANOUS -- 3693 02:43:26,240 --> 02:43:30,200 INSTANTANEOUS, A WOMAN GOES FROM 3694 02:43:30,200 --> 02:43:32,080 FULL LEVEL TO ZERO, DAY OF 3695 02:43:32,080 --> 02:43:34,720 SURGERY, SO ONE WOULD GUESS THEY 3696 02:43:34,720 --> 02:43:36,160 ARE NOT EQUIVALENT BUT 3697 02:43:36,160 --> 02:43:37,600 UNFORTUNATELY WHAT WE KNOW UNTIL 3698 02:43:37,600 --> 02:43:39,560 TODAY IS PRIMARILY BASED ON WHAT 3699 02:43:39,560 --> 02:43:41,400 WE KNOW FROM OOPHORECTOMY SO 3700 02:43:41,400 --> 02:43:42,880 MANY OF THE CURRENT CONCEPTS 3701 02:43:42,880 --> 02:43:46,720 COME FROM WHAT WE HAVE LEARNED 3702 02:43:46,720 --> 02:43:49,240 USING COHORT OF WOMEN WITH 3703 02:43:49,240 --> 02:43:54,840 OOPHORECTOMY BUT IF IT'S 3704 02:43:54,840 --> 02:43:57,240 POSSIBLE WITH SPONTANEOUS 3705 02:43:57,240 --> 02:44:01,040 BECAUSE OF SLOWER DECLINE MAY BE 3706 02:44:01,040 --> 02:44:02,600 DIFFERENT, LESS DRAMATIC, MANY 3707 02:44:02,600 --> 02:44:06,920 OF THE CURRENT GUIDELINES FROM 3708 02:44:06,920 --> 02:44:07,800 SOCIETIES BASICALLY RECOMMEND 3709 02:44:07,800 --> 02:44:11,960 THE SAME APPROACH TO PREMATURE 3710 02:44:11,960 --> 02:44:12,920 OR EARLY MENOPAUSE REGARDLESS 3711 02:44:12,920 --> 02:44:18,520 WHERE IT CAME FROM BUT THIS BE 3712 02:44:18,520 --> 02:44:19,280 OVERSIMPLIFICATION, THE IDEA IS 3713 02:44:19,280 --> 02:44:23,800 TREAT THESE WOMEN AND MAKE SURE 3714 02:44:23,800 --> 02:44:27,720 THEY HAVE RECEIVING ESTROGEN ROW 3715 02:44:27,720 --> 02:44:28,920 PLACEMENT ADEQUATELY BECAUSE IF 3716 02:44:28,920 --> 02:44:31,400 THEY DON'T THEY WILL HAVE 3717 02:44:31,400 --> 02:44:34,040 SEQUELAE BUT IF DOSE IS 3718 02:44:34,040 --> 02:44:35,040 DIFFERENT WE DON'T KNOW. 3719 02:44:35,040 --> 02:44:37,920 WE HAVE NO CLINICAL TRIALS, NO 3720 02:44:37,920 --> 02:44:40,600 EXPERIMENTAL EVIDENCE, THE 3721 02:44:40,600 --> 02:44:41,480 EVIDENCE IS OBSERVATIONAL, WHICH 3722 02:44:41,480 --> 02:44:43,120 IS THE BEST WE HAVE. 3723 02:44:43,120 --> 02:44:45,760 AND I THINK THERE'S A TREMENDOUS 3724 02:44:45,760 --> 02:44:49,520 NEED FOR RESEARCH IN THIS AREA, 3725 02:44:49,520 --> 02:44:50,760 PREMATURE AND EARLY MENOPAUSE 3726 02:44:50,760 --> 02:44:55,920 SHOULD BE A FOCUS OF HIGH 3727 02:44:55,920 --> 02:44:57,600 PRIORITY BECAUSE IT'S NOT 3728 02:44:57,600 --> 02:45:01,000 UNCOMMON AND IT'S A BIG UNKNOWN 3729 02:45:01,000 --> 02:45:01,960 AREA OF TREATMENT. 3730 02:45:01,960 --> 02:45:02,880 >> THANK YOU. 3731 02:45:02,880 --> 02:45:06,160 WE'RE REALLY AT TIME. 3732 02:45:06,160 --> 02:45:12,280 I HOPE TO ASK DR. K OHRT A QUICK 3733 02:45:12,280 --> 02:45:12,880 QUESTION. 3734 02:45:12,880 --> 02:45:14,720 IN THE HUMAN CONDITION MOST 3735 02:45:14,720 --> 02:45:15,320 WOMEN WHO AFTER MENOPAUSE IF 3736 02:45:15,320 --> 02:45:18,520 THEY ARE GOING TO GO ON ESTROGEN 3737 02:45:18,520 --> 02:45:20,240 WILL BE ON PROGESTIN AS WELL, IS 3738 02:45:20,240 --> 02:45:25,880 THERE ANYTHING KNOWN FROM MODELS 3739 02:45:25,880 --> 02:45:34,080 WHERE YOU ARE HAVE E E ADD-BACK 3740 02:45:34,080 --> 02:45:36,240 HAS THE SAME OR E ALONE? 3741 02:45:36,240 --> 02:45:38,720 >> WE'RE STARTING TO DO THOSE 3742 02:45:38,720 --> 02:45:42,480 IN ANIMAL WORK BUT THESE DNRH 3743 02:45:42,480 --> 02:45:43,160 ANALOG STUDIES ARE CHALLENGING 3744 02:45:43,160 --> 02:45:44,600 SO WE HAVEN'T -- IT WOULD 3745 02:45:44,600 --> 02:45:46,400 REQUIRE ADDING ANOTHER ARM AND 3746 02:45:46,400 --> 02:45:49,800 WE JUST HAVEN'T GONE THERE. 3747 02:45:49,800 --> 02:45:53,000 >> THANK YOU ALL FOR YOUR 3748 02:45:53,000 --> 02:45:54,760 THOUGHTFUL ANSWERS TO SO MANY 3749 02:45:54,760 --> 02:45:55,760 IMPORTANT QUESTIONS, AND THERE'S 3750 02:45:55,760 --> 02:45:58,160 STILL MORE IN THE Q&A, IF PEOPLE 3751 02:45:58,160 --> 02:46:01,640 HAVE TIME TO ANSWER THEM. 3752 02:46:01,640 --> 02:46:03,320 >> THANK YOU, EVERYONE. 3753 02:46:03,320 --> 02:46:05,160 WE WILL RETURN AT 1:05 FOR THE 3754 02:46:05,160 --> 02:51:04,040 AFTERNOON SESSIONS. 3755 02:51:04,040 --> 02:51:06,800 >>WELCOME BACK. 3756 02:51:06,800 --> 02:51:08,560 I THANK EVERYONE WHO HAS SPOKEN 3757 02:51:08,560 --> 02:51:12,400 SO FAR. 3758 02:51:12,400 --> 02:51:20,120 IT'S MY PLEASURE TO WELCOME DR. 3759 02:51:20,120 --> 02:51:21,640 REBECCA THURSTON, PITTSBURGH 3760 02:51:21,640 --> 02:51:23,000 FOUNDATION CHAIR IN WOMEN'S 3761 02:51:23,000 --> 02:51:33,480 HEALTH AND DEMENTIA UNIVERSITY 3762 02:51:40,560 --> 02:51:41,240 OF PITTSBURGH. 3763 02:51:41,240 --> 02:51:48,000 >> I'M THRILLED TO BE HERE. 3764 02:51:48,000 --> 02:51:48,880 >> WE CAN'T HEAR YOU. 3765 02:51:48,880 --> 02:51:53,040 >> I CAN HEAR YOU. 3766 02:51:53,040 --> 02:51:55,480 I'LL BE PRESENTING DR. BARBARA 3767 02:51:55,480 --> 02:51:56,120 NORQUIST, ASSOCIATE PROFESSOR, 3768 02:51:56,120 --> 02:52:06,560 DEPARTMENT OF OBSTETRICS, 3769 02:52:09,280 --> 02:52:09,720 UNIVERSITY OF WASHINGTON. 3770 02:52:09,720 --> 02:52:15,160 >> CAN EVERYBODY HEAR ME OKAY? 3771 02:52:15,160 --> 02:52:16,200 >> THANK YOU. 3772 02:52:16,200 --> 02:52:20,800 I'M SO HONORED TO BE HERE. 3773 02:52:20,800 --> 02:52:21,600 I'M A GYNECOLOGIC ONCOLOGIST, 3774 02:52:21,600 --> 02:52:24,240 UNIVERSITY OF WASHINGTON, WHILE 3775 02:52:24,240 --> 02:52:28,520 I DO RESEARCH IN THESE AREAS, 3776 02:52:28,520 --> 02:52:30,560 IT'S INFORMED BY MY CLINICAL 3777 02:52:30,560 --> 02:52:33,200 CARE OF PATIENTS WHO ARE THE 3778 02:52:33,200 --> 02:52:35,880 RISK FOR OVARIAN CANCER, A LARGE 3779 02:52:35,880 --> 02:52:39,720 PART OF MY CLINICAL PRACTICE. 3780 02:52:39,720 --> 02:52:45,680 I HAVE NO FINANCIAL DISCLOSURES. 3781 02:52:45,680 --> 02:52:47,880 I'M GOING TO SPEAK ABOUT WHO IS 3782 02:52:47,880 --> 02:52:49,160 AT RISK FOR OVARIAN CANCER. 3783 02:52:49,160 --> 02:52:51,880 I'LL GO THROUGH WHAT OPTIONS 3784 02:52:51,880 --> 02:52:55,600 PATIENTS HAVE TO PREVENT 3785 02:52:55,600 --> 02:52:55,920 CANCERS. 3786 02:52:55,920 --> 02:52:57,160 WHAT ARE POTENTIAL HARMS OF 3787 02:52:57,160 --> 02:52:58,560 INTERVENTIONS WE HAVE TO OFFER 3788 02:52:58,560 --> 02:53:00,840 THEM AND FINALLY WHAT ARE SOME 3789 02:53:00,840 --> 02:53:02,160 UNANSWERED QUESTIONS ABOUT 3790 02:53:02,160 --> 02:53:04,680 HORMONE REPLACEMENT THERAPY OR 3791 02:53:04,680 --> 02:53:06,320 HRT IN THESE PATIENTS AT RISK 3792 02:53:06,320 --> 02:53:13,280 FOR BOTH OVARIAN AND BREAST 3793 02:53:13,280 --> 02:53:13,840 CANCER. 3794 02:53:13,840 --> 02:53:18,120 FIRST PATIENTS AT RISK OF 3795 02:53:18,120 --> 02:53:19,440 OVARIAN CANCER, SPRINKLED IN 3796 02:53:19,440 --> 02:53:22,960 SOME RANDOM PHOTOS OF PACIFIC 3797 02:53:22,960 --> 02:53:26,880 NORTHWEST HIKING, JUST TO 3798 02:53:26,880 --> 02:53:34,800 INDICATE TOPIC CHANGES. 3799 02:53:34,800 --> 02:53:37,760 SO WE KNOW WITH MUTATIONS IS 3800 02:53:37,760 --> 02:53:40,640 HIGH FOR OVARIAN AND BREAST 3801 02:53:40,640 --> 02:53:47,560 CANCER. 3802 02:53:47,560 --> 02:53:51,320 THIS PAPER IN JAMA, UPDATED RISK 3803 02:53:51,320 --> 02:53:53,080 INFORMATION, OVARIAN ON THE 3804 02:53:53,080 --> 02:53:58,920 RIGHT SIDE OF THE FIGURE. 3805 02:53:58,920 --> 02:54:02,560 BRCA1 CARRIERS HAVING HIGHEST 3806 02:54:02,560 --> 02:54:04,360 RISK, AND BRCA2 HAVING ELEVATED 3807 02:54:04,360 --> 02:54:11,200 RISK BUT NOT AS HIGH AS BRCA1. 3808 02:54:11,200 --> 02:54:13,600 THESE LOOKED HIGH TO ME, I DON'T 3809 02:54:13,600 --> 02:54:16,400 KNOW IF THEY LOOK HIGH TO 3810 02:54:16,400 --> 02:54:17,160 EVERYONE WATCHING, BUT OVARIAN 3811 02:54:17,160 --> 02:54:19,840 CANCER IS SUCH A SERIOUS CANCER 3812 02:54:19,840 --> 02:54:22,080 AND MOST PATIENTS WHO ARE 3813 02:54:22,080 --> 02:54:22,880 DIAGNOSED WITH OVARIAN CANCER 3814 02:54:22,880 --> 02:54:29,240 WILL DIE FROM THEIR CANCERS. 3815 02:54:29,240 --> 02:54:30,800 THERE ARE MANY OTHER PATIENTS 3816 02:54:30,800 --> 02:54:33,720 WHO ARE ALSO AT RISK FOR OVARIAN 3817 02:54:33,720 --> 02:54:34,120 CANCER. 3818 02:54:34,120 --> 02:54:37,960 MUCH OF THE TALK ABOUT FOCUS ON 3819 02:54:37,960 --> 02:54:39,760 THE BRCA1 AND 2 CARRIERS, THE 3820 02:54:39,760 --> 02:54:41,160 LARGEST GROUP, AND THE GROUP WE 3821 02:54:41,160 --> 02:54:43,240 HAVE THE MOST INFORMATION ON BUT 3822 02:54:43,240 --> 02:54:46,560 I DIDN'T WANT TO LEAVE OUT THESE 3823 02:54:46,560 --> 02:54:51,600 OTHER POPULATIONS SUCH AS 3824 02:54:51,600 --> 02:54:53,040 MUTATIONS IN HOMOLOGOUS 3825 02:54:53,040 --> 02:54:54,760 RECOMBINATION GENES AND 3826 02:54:54,760 --> 02:54:57,680 MUTATIONS IN GENES LEADING TO 3827 02:54:57,680 --> 02:54:59,520 LYNCH SYNDROME WITH RISKS OF 3828 02:54:59,520 --> 02:55:07,240 OVARIAN AND END MEDIAL CANCER. 3829 02:55:07,240 --> 02:55:09,840 WHY DON'T THESE PATIENTS GET 3830 02:55:09,840 --> 02:55:13,800 MORE SCREENING? 3831 02:55:13,800 --> 02:55:18,040 MANY ON THIS SYMPOSIUM 3832 02:55:18,040 --> 02:55:19,720 UNDERSTAND SCREENING HAS BEEN 3833 02:55:19,720 --> 02:55:28,720 NOT EFFECTIVE FOR THESE 3834 02:55:28,720 --> 02:55:29,000 PATIENTS. 3835 02:55:29,000 --> 02:55:30,640 PART IS THE NATURE, IDENTIFYING 3836 02:55:30,640 --> 02:55:34,040 A PRECURSOR TO A CANCER THAT CAN 3837 02:55:34,040 --> 02:55:35,000 BE SUCCESSFULLY TREATED. 3838 02:55:35,000 --> 02:55:37,320 AND THE BEST WE CAN HOPE FOR 3839 02:55:37,320 --> 02:55:39,120 WITH OVARIAN CANCER IS FOR 3840 02:55:39,120 --> 02:55:40,240 EARLIER DISEASE DETECTION THAT 3841 02:55:40,240 --> 02:55:46,720 MIGHT BE EASIER TO TREAT. 3842 02:55:46,720 --> 02:55:50,800 BUT WE'VE NOT AFTER ABLE TO 3843 02:55:50,800 --> 02:55:52,480 IMPROVE EARLY DETECTION IMPROVES 3844 02:55:52,480 --> 02:55:55,640 MORTALITY OR HELPS PATIENTS LIVE 3845 02:55:55,640 --> 02:55:56,160 LONGER. 3846 02:55:56,160 --> 02:56:02,560 AND PART IS THIS PHOTO HERE OF 3847 02:56:02,560 --> 02:56:03,360 THESE CANCERS MICROSCOPICALLY 3848 02:56:03,360 --> 02:56:08,760 STARTING IN THE FALLOPIAN TUBE, 3849 02:56:08,760 --> 02:56:10,360 EVEN THE SMALLEST CLINICAL 3850 02:56:10,360 --> 02:56:11,520 RECOMMENDATION IS LARGE SURGERY, 3851 02:56:11,520 --> 02:56:14,240 SIX CYCLES OF CHEMOTHERAPY WITH 3852 02:56:14,240 --> 02:56:17,960 HIGH RECURRENCE RATES EVEN WHEN 3853 02:56:17,960 --> 02:56:18,880 DETECTED EARLY. 3854 02:56:18,880 --> 02:56:22,040 FOR MOST PATIENTS THEY WOULD 3855 02:56:22,040 --> 02:56:25,920 AGREE THAT IS NOT AN ACCEPTABLE 3856 02:56:25,920 --> 02:56:27,760 SUBSTITUTE FOR OUTRIGHT 3857 02:56:27,760 --> 02:56:28,040 PREVENTION. 3858 02:56:28,040 --> 02:56:30,280 SO THE CURRENTLY AVAILABLE 3859 02:56:30,280 --> 02:56:31,280 OVARIAN CANCER SCREENINGS 3860 02:56:31,280 --> 02:56:33,840 METHODS ARE JUST NOT SENSITIVE 3861 02:56:33,840 --> 02:56:36,560 ENOUGH TO FIND THOSE SMALL 3862 02:56:36,560 --> 02:56:36,880 LESIONS. 3863 02:56:36,880 --> 02:56:43,120 WE HAVE BLOOD TEST MONITORING 3864 02:56:43,120 --> 02:56:44,720 AND TRANSVAGINAL ULTRASOUND TO 3865 02:56:44,720 --> 02:56:47,160 LOOK AT OVARIES, THESE HAVE BEEN 3866 02:56:47,160 --> 02:56:51,320 STUDIED EXTENSIVELY IN THE 3867 02:56:51,320 --> 02:56:53,760 LANDMARK PLCO TRIAL AND UKCTOCS 3868 02:56:53,760 --> 02:56:57,800 TRIALS, NEITHER HAS BEEN ABLE TO 3869 02:56:57,800 --> 02:57:00,080 SHOW IMPROVED MORTALITY FROM 3870 02:57:00,080 --> 02:57:00,880 OVARIAN CANCER. 3871 02:57:00,880 --> 02:57:05,520 THIS IS NOT TO SAY PELVIC 3872 02:57:05,520 --> 02:57:07,840 ULTRASOUND IS NOT THE TEST OF 3873 02:57:07,840 --> 02:57:13,640 CHOICE TO ALLEVIATE SYMPTOMS BT 3874 02:57:13,640 --> 02:57:17,440 NOT A GREAT ASYMPTOMATIC 3875 02:57:17,440 --> 02:57:19,520 SCREENING TEST. 3876 02:57:19,520 --> 02:57:22,040 IN PATIENTS WITH HIGH RISK, U.K. 3877 02:57:22,040 --> 02:57:23,200 FOX TRIAL DID A TREMENDOUS 3878 02:57:23,200 --> 02:57:25,600 EFFORT WITH 4,000 PATIENTS WITH 3879 02:57:25,600 --> 02:57:27,960 GREATER THAN 10% LIFETIME RISK 3880 02:57:27,960 --> 02:57:32,000 OF OVARIAN CANCER. 3881 02:57:32,000 --> 02:57:39,800 THEY HAD A CA-125 EVERY 4 MONTHS 3882 02:57:39,800 --> 02:57:46,400 USING ROCAA ALGORITHM. 3883 02:57:46,400 --> 02:57:50,840 18 INCIDENT CANCERS DETECTED, 12 3884 02:57:50,840 --> 02:57:51,960 SCREENING, 6 OCCULT CANCERS, 3885 02:57:51,960 --> 02:57:56,120 UNRELATED TO SCREENING THEY HAD. 3886 02:57:56,120 --> 02:57:59,560 OF THOSE 12 SCREEN DETECTED HALF 3887 02:57:59,560 --> 02:58:01,800 WERE STILL ADVANCED STAGE 3888 02:58:01,800 --> 02:58:02,880 DESPITE BEING SCREEN DETECTED. 3889 02:58:02,880 --> 02:58:05,360 THEY WERE EASIER TO OPERATE ON 3890 02:58:05,360 --> 02:58:07,120 WITH GREATER RATES OF COMPLETE 3891 02:58:07,120 --> 02:58:09,840 GROSS RESECTION WHICH CAN BE 3892 02:58:09,840 --> 02:58:11,000 IMPORTANT PROGNOSTICALLY BUT WE 3893 02:58:11,000 --> 02:58:14,320 HAVEN'T BEEN ABLE TO PROVE THIS 3894 02:58:14,320 --> 02:58:16,600 HELPED PEOPLE LIVE LONGER. 3895 02:58:16,600 --> 02:58:21,160 SO, WHAT ACTUALLY WORKS FOR 3896 02:58:21,160 --> 02:58:22,160 THESE PATIENTS? 3897 02:58:22,160 --> 02:58:23,080 THE INTERVENTION THAT'S 3898 02:58:23,080 --> 02:58:26,960 EFFECTIVE IS WHAT I SOMETIMES 3899 02:58:26,960 --> 02:58:31,080 REFER TO AS NUCLEAR OPTION, THE 3900 02:58:31,080 --> 02:58:33,920 ONLY WAY WE HAVE TO EFFECTIVELY 3901 02:58:33,920 --> 02:58:36,400 REDUCE RISK AS MUCH AS POSSIBLE 3902 02:58:36,400 --> 02:58:41,800 IS SURGICALLY REMOVE THE AT RISK 3903 02:58:41,800 --> 02:58:43,160 ORGANS, RECOMMENDED IN NCCN 3904 02:58:43,160 --> 02:58:45,000 GUIDELINES WITH REMOVAL OF TUBES 3905 02:58:45,000 --> 02:58:47,440 AND OVARIES WITH INCREASED RISK 3906 02:58:47,440 --> 02:58:51,080 OF OVARIAN CANCER. 3907 02:58:51,080 --> 02:58:52,320 RISK REDUCING 3908 02:58:52,320 --> 02:58:52,920 SALPINGO-OOPHORECTOMY IS 3909 02:58:52,920 --> 02:58:56,840 RECOMMENDED BETWEEN 35 TO 40 FOR 3910 02:58:56,840 --> 02:59:01,720 BRCA1, AND 40 TO 45 FOR BRCA2. 3911 02:59:01,720 --> 02:59:03,760 YOU'LL NOTICE AGES ARE DIFFERENT 3912 02:59:03,760 --> 02:59:06,320 FOR THE TWO GENES BECAUSE RISK 3913 02:59:06,320 --> 02:59:07,640 PROFILE IS DIFFERENT. 3914 02:59:07,640 --> 02:59:11,560 THE RISK IS HIGHER AND EARLIER 3915 02:59:11,560 --> 02:59:15,120 ONSET FOR BRCA1, THIS TABLE JUST 3916 02:59:15,120 --> 02:59:16,840 SHOWS OBSERVATIONAL DATA IN A 3917 02:59:16,840 --> 02:59:19,160 LARGE COHORT OF PATIENTS WITH 3918 02:59:19,160 --> 02:59:24,240 BRCA1 AND 2 MUTATIONS AND 3919 02:59:24,240 --> 02:59:25,800 LEFT-HAND SIDE LOOKS AT BRCA1 3920 02:59:25,800 --> 02:59:27,160 CARRIERS SHOWING SOME OVARIAN 3921 02:59:27,160 --> 02:59:29,760 CANCERS IN PATIENTS BELOW AGE OF 3922 02:59:29,760 --> 02:59:30,000 40. 3923 02:59:30,000 --> 02:59:32,000 AND THIS PAPER WAS ABLE TO 3924 02:59:32,000 --> 02:59:36,240 ESTIMATE A RISK OF AROUND 4% OF 3925 02:59:36,240 --> 02:59:39,160 DEVELOPING OVARIAN OR FALLOPIAN 3926 02:59:39,160 --> 02:59:42,000 TUBE CANCER BETWEEN 35 TO 40 FOR 3927 02:59:42,000 --> 02:59:45,200 BRCA1 CARRIERS, AND BRCA2 3928 02:59:45,200 --> 02:59:49,640 CARRIERS VERY FEW MALIGNANCIES 3929 02:59:49,640 --> 02:59:51,840 PRIOR TO AGE 40. 3930 02:59:51,840 --> 02:59:59,440 THERE ARE GUIDELINES FOR OTHER 3931 02:59:59,440 --> 03:00:00,640 GENES I MENTIONED, FOR PURPOSES 3932 03:00:00,640 --> 03:00:04,320 OF TIME I WON'T GO INTO THIS, 3933 03:00:04,320 --> 03:00:07,080 THERE ARE AN EXPANDED NUMBER OF 3934 03:00:07,080 --> 03:00:11,400 PATIENTS WITH GUIDELINES FOR 3935 03:00:11,400 --> 03:00:12,760 OVARIAN CANCER PREVENTION. 3936 03:00:12,760 --> 03:00:13,640 IS THIS EFFECTIVE? 3937 03:00:13,640 --> 03:00:17,120 WE HAVE QUITE A BIT OF 3938 03:00:17,120 --> 03:00:25,040 ACCUMULATED DATA FOR BRCA1 AND 2 3939 03:00:25,040 --> 03:00:26,000 MUTATION CARRIERS, RISK 3940 03:00:26,000 --> 03:00:30,160 REDUCING, REASSURING IN LIGHT OF 3941 03:00:30,160 --> 03:00:32,600 THE DATA SHOWN EARLIER BY DR. 3942 03:00:32,600 --> 03:00:35,560 ROCCA AND DR. MANSON LOOKING AT 3943 03:00:35,560 --> 03:00:38,600 MORTALITY CHANGES WITH 3944 03:00:38,600 --> 03:00:39,440 MENOPAUSE. 3945 03:00:39,440 --> 03:00:42,560 WE KNOW SCREENING IS NOT 3946 03:00:42,560 --> 03:00:44,960 EFFECTIVE, AND SURGERY IS THE 3947 03:00:44,960 --> 03:00:46,240 INTERVENTION THAT IS LIFE 3948 03:00:46,240 --> 03:00:47,320 SAVING. 3949 03:00:47,320 --> 03:00:49,040 AND THERE ARE GUIDELINES THAT 3950 03:00:49,040 --> 03:00:50,400 SHOULD MAKE THIS RELATIVELY 3951 03:00:50,400 --> 03:00:51,920 SIMPLE WHEN TAKING CARE OF 3952 03:00:51,920 --> 03:00:53,560 PATIENTS BUT WHAT ARE PEOPLE 3953 03:00:53,560 --> 03:00:57,640 ACTUALLY DOING LIKE WHAT IS 3954 03:00:57,640 --> 03:00:59,000 ACTUALLY HAPPENING? 3955 03:00:59,000 --> 03:01:01,840 AT THESE INSTITUTIONS, WE LOOKED 3956 03:01:01,840 --> 03:01:04,960 AT OUR EXPERIENCE OVER THE PAST 3957 03:01:04,960 --> 03:01:09,160 20 YEARS OR SO, AND OUT OF 371 3958 03:01:09,160 --> 03:01:12,520 BRCA1 AND 2 CARRIERS, OVER HALF, 3959 03:01:12,520 --> 03:01:15,320 57%, HAVE RISK REDUCTION 3960 03:01:15,320 --> 03:01:16,240 SURGERIES AFTER GUIDELINE 3961 03:01:16,240 --> 03:01:18,440 RECOMMENDED AGES, WHICH WOULD BE 3962 03:01:18,440 --> 03:01:21,360 GREATER THAN 40, FOR BRCA1 3963 03:01:21,360 --> 03:01:27,000 CARRIERS, OVER 45 FOR BRCA2. 3964 03:01:27,000 --> 03:01:32,840 WE FOUND 16 OCCULT NEOPLASMS IN 3965 03:01:32,840 --> 03:01:37,240 THIS COHORT, WITH EIGHT BEING 3966 03:01:37,240 --> 03:01:40,840 PRE-CANCEROUS LESIONS, AND EIGHT 3967 03:01:40,840 --> 03:01:44,000 BEING INVASIVE CANCERS, 81% WERE 3968 03:01:44,000 --> 03:01:44,920 OVER THE GUIDELINE-RECOMMENDED 3969 03:01:44,920 --> 03:01:48,320 AGES, OR IF YOU LOOK ANOTHER 3970 03:01:48,320 --> 03:01:50,160 WAY, IF YOU WERE PAST GUIDELINE 3971 03:01:50,160 --> 03:01:52,800 RECOMMENDED AGES THERE WAS 6% 3972 03:01:52,800 --> 03:01:55,400 RISK OF FINDING OCCULT NEOPLASIA 3973 03:01:55,400 --> 03:01:58,040 VERSUS 2% RISK IF SURGERY WAS 3974 03:01:58,040 --> 03:02:00,600 DONE WITHIN THE 3975 03:02:00,600 --> 03:02:01,680 GUIDELINE-RECOMMENDED AGES. 3976 03:02:01,680 --> 03:02:03,240 NOW IN THIS STUDY WE WERE NOT 3977 03:02:03,240 --> 03:02:06,440 ABLE TO TELL WHY PEOPLE WERE 3978 03:02:06,440 --> 03:02:08,040 WAITING FOR SURGERY, AND THERE'S 3979 03:02:08,040 --> 03:02:09,320 A NUMBER OF THINGS THAT COULD BE 3980 03:02:09,320 --> 03:02:10,040 CONTRIBUTING TO THAT. 3981 03:02:10,040 --> 03:02:12,360 ONE IS THAT MANY OF THESE 3982 03:02:12,360 --> 03:02:13,480 PATIENTS FIND OUT THEY HAVE THE 3983 03:02:13,480 --> 03:02:14,560 RISK BECAUSE THEY HAVE DEVELOPED 3984 03:02:14,560 --> 03:02:17,320 A CANCER AND HAD TESTING, SO 3985 03:02:17,320 --> 03:02:21,120 THOSE POPULATIONS MAY BE OLDER. 3986 03:02:21,120 --> 03:02:24,200 AND BUT AT LEAST SOME COULD BE 3987 03:02:24,200 --> 03:02:25,320 FROM PATIENTS WAITING TO HAVE 3988 03:02:25,320 --> 03:02:29,840 SURGERY FOR A VARIETY OF 3989 03:02:29,840 --> 03:02:31,440 REASONS. 3990 03:02:31,440 --> 03:02:33,800 SO IS HORMONE REPLACEMENT 3991 03:02:33,800 --> 03:02:41,320 THERAPY RECOMMENDED FOR PRE-MEN 3992 03:02:41,320 --> 03:02:44,200 PAUSAL CHARACTERS AFTER RISK 3993 03:02:44,200 --> 03:02:44,680 REDUCING OOPHORECTOMY? 3994 03:02:44,680 --> 03:02:48,800 THERE ARE NO SPECIFIC 3995 03:02:48,800 --> 03:02:49,400 GUIDELINES. 3996 03:02:49,400 --> 03:02:51,320 THE NORTH AMERICAN MENOPAUSE 3997 03:02:51,320 --> 03:02:53,480 SOCIETY HAS THIS STATEMENT ON 3998 03:02:53,480 --> 03:02:56,120 BASIS OF LIMITED STUDIES, 3999 03:02:56,120 --> 03:02:56,880 CONSIDERING OFFERING SYSTEMIC 4000 03:02:56,880 --> 03:03:00,680 HORMONE THERAPY UNTIL MEDIAN AGE 4001 03:03:00,680 --> 03:03:01,640 OF MENOPAUSE, AND AMERICAN 4002 03:03:01,640 --> 03:03:05,560 COLLEGE OF OBSTETRICS AND 4003 03:03:05,560 --> 03:03:06,800 GYNECOLOGY SAYS WOMEN UNAFFECTED 4004 03:03:06,800 --> 03:03:10,320 SHOULD BE OFFERED HORMONE 4005 03:03:10,320 --> 03:03:13,320 REPLACEMENT THERAPY TO MITIGATE 4006 03:03:13,320 --> 03:03:14,400 EARLY EFFECTS OF MENOPAUSE. 4007 03:03:14,400 --> 03:03:16,520 NOT A LOT OF SPECIFICS THERE. 4008 03:03:16,520 --> 03:03:19,520 ONE OF THE PRIMARY CONCERNS IN 4009 03:03:19,520 --> 03:03:20,800 THIS POPULATION, SPECIFICALLY 4010 03:03:20,800 --> 03:03:23,480 RISK OF DEVELOPING BREAST 4011 03:03:23,480 --> 03:03:24,880 CANCER, WHILE TAKING HORMONE 4012 03:03:24,880 --> 03:03:25,880 REPLACEMENT THERAPY, AS THESE 4013 03:03:25,880 --> 03:03:29,840 ARE PATIENTS WHO ARE AT RISK FOR 4014 03:03:29,840 --> 03:03:34,160 BOTH OVARIAN AND BREAST CANCER, 4015 03:03:34,160 --> 03:03:36,920 AND THERE'S NOT A TON OF DATA IN 4016 03:03:36,920 --> 03:03:40,760 THIS SETTING BUT WE DO HAVE SOME 4017 03:03:40,760 --> 03:03:42,880 GOOD PROSPECTIVE COHORT STUDIES 4018 03:03:42,880 --> 03:03:44,760 THAT HAVE BEEN QUITE REASSURING 4019 03:03:44,760 --> 03:03:47,040 IN TERMS OF BREAST CANCER RISK 4020 03:03:47,040 --> 03:03:49,920 WITH HORMONE REPLACEMENT THERAPY 4021 03:03:49,920 --> 03:03:50,880 AFTER PRE-MENOPAUSAL 4022 03:03:50,880 --> 03:03:55,320 OOPHORECTOMY WITH THE PRO STUDY 4023 03:03:55,320 --> 03:03:58,840 SHOWN HERE AND THEN THIS MORE 4024 03:03:58,840 --> 03:04:00,200 RECENT PAPER SHOWING 4025 03:04:00,200 --> 03:04:05,800 PARTICULARLY IN BRCA1 CARRIERS 4026 03:04:05,800 --> 03:04:08,360 THERE WAS NO INCREASED RISK 4027 03:04:08,360 --> 03:04:11,520 AFTER OOPHORECTOMY. 4028 03:04:11,520 --> 03:04:14,920 EACH STUDY WAS TOO SMALL TO SEE 4029 03:04:14,920 --> 03:04:18,640 IF DIFFERENT TIMES OF HRT WERE 4030 03:04:18,640 --> 03:04:22,880 ASSOCIATED WITH RISK. 4031 03:04:22,880 --> 03:04:25,920 WE KNOW FROM WHI DESCRIBED BY 4032 03:04:25,920 --> 03:04:28,480 DR. MANSON THAT THE ESTROGEN 4033 03:04:28,480 --> 03:04:30,280 ALONE ARM OF THE TRIAL DID NOT 4034 03:04:30,280 --> 03:04:36,240 HAVE AN INCREASED RISK OF BREAST 4035 03:04:36,240 --> 03:04:38,360 CANCER COMPARED TO THE GROUP 4036 03:04:38,360 --> 03:04:43,760 GETTING ORAL E PLUS P. 4037 03:04:43,760 --> 03:04:47,120 WE HAVE PATIENTS WHO WILL DECIDE 4038 03:04:47,120 --> 03:04:49,320 TO HAVE RISKIER SURGERY WITH 4039 03:04:49,320 --> 03:04:51,120 HYSTERECTOMY TO FIT THIS 4040 03:04:51,120 --> 03:04:53,840 PARADIGM WHEN THEY TAKE HRT 4041 03:04:53,840 --> 03:04:56,400 AFTER SURGERY. 4042 03:04:56,400 --> 03:04:59,520 WHAT DO WE KNOW GOOD QUALITY OF 4043 03:04:59,520 --> 03:05:02,720 LIFE AFTER RISK REDUCING 4044 03:05:02,720 --> 03:05:06,360 OOPHORECTOMY? 4045 03:05:06,360 --> 03:05:07,600 WE'RE ACCUMULATING STUDIES. 4046 03:05:07,600 --> 03:05:09,320 MARTHA HICKEY LED THE WHAM 4047 03:05:09,320 --> 03:05:10,400 STUDY, AS A CHILD OF THE '80s 4048 03:05:10,400 --> 03:05:12,520 THAT WAS ONE OF THE BEST-NAMED 4049 03:05:12,520 --> 03:05:18,800 STUDIES THAT I'VE COME ACROSS. 4050 03:05:18,800 --> 03:05:20,520 LOOKING AT WHAT HAPPENS TO 4051 03:05:20,520 --> 03:05:22,640 PEOPLE AFTER MENOPAUSE. 4052 03:05:22,640 --> 03:05:25,800 AND THE TWO PUNCHLINES FROM THE 4053 03:05:25,800 --> 03:05:28,480 PUBLICATION, MORE DATA TO COME, 4054 03:05:28,480 --> 03:05:33,880 HRT REDUCES BUT DOES NOT RESOLVE 4055 03:05:33,880 --> 03:05:36,720 VASOMOTOR SYMPTOMS AFTER 4056 03:05:36,720 --> 03:05:37,400 OOPHORECTOMY AND HRT IMPROVES 4057 03:05:37,400 --> 03:05:39,480 MENOPAUSE RELATED QUALITY OF 4058 03:05:39,480 --> 03:05:42,200 LIFE BUT NOT TO PRE-SET LEVELS, 4059 03:05:42,200 --> 03:05:52,640 A RECURRING THEME IN THESE 4060 03:05:55,640 --> 03:05:57,280 STUDIES. 4061 03:05:57,280 --> 03:05:59,360 I SEE THEY ROUTINELY. 4062 03:05:59,360 --> 03:06:01,560 34-YEAR-OLD PRESENTING WITH A 4063 03:06:01,560 --> 03:06:02,720 BRCA1 MUTATION. 4064 03:06:02,720 --> 03:06:06,480 LIFETIME RISK OF OVARIAN CANCER 4065 03:06:06,480 --> 03:06:07,640 IS QUITE SUBSTANTIAL. 4066 03:06:07,640 --> 03:06:09,760 BASED ON THAT I COUNSEL HER 4067 03:06:09,760 --> 03:06:12,000 ABOUT THE GUIDELINES INDICATING 4068 03:06:12,000 --> 03:06:13,520 THAT RISK-REDUCING REMOVAL OF 4069 03:06:13,520 --> 03:06:17,600 TUBES AND OVARIES IS RECOMMENDED 4070 03:06:17,600 --> 03:06:18,840 BETWEEN 35 TO 40. 4071 03:06:18,840 --> 03:06:20,840 THE WHOLE REASON SHE KNOWS SHE 4072 03:06:20,840 --> 03:06:22,800 HAS THIS BRCA1 MUTATION IS 4073 03:06:22,800 --> 03:06:25,880 BECAUSE SHE WAS DIAGNOSED WITH A 4074 03:06:25,880 --> 03:06:27,280 HORMONE RECEPTOR NEGATIVE BREAST 4075 03:06:27,280 --> 03:06:30,720 CANCER, WHICH WAS TREATED WITH 4076 03:06:30,720 --> 03:06:32,440 CHEMOTHERAPY AND BILATERAL 4077 03:06:32,440 --> 03:06:32,760 MASTECTOMY. 4078 03:06:32,760 --> 03:06:36,840 SO HOW SHOULD WE MANAGE THIS 4079 03:06:36,840 --> 03:06:37,080 PATIENT? 4080 03:06:37,080 --> 03:06:39,720 SHE'S NOT ON HORMONE 4081 03:06:39,720 --> 03:06:43,400 SUPPRESSION, AND ONE MEDICAL 4082 03:06:43,400 --> 03:06:46,480 ONCOLOGIST SHE SPOKE WITH TOLD 4083 03:06:46,480 --> 03:06:49,360 HER IT WAS OKAY, ANOTHER TOLD 4084 03:06:49,360 --> 03:06:54,720 THEY ARE ABSOLUTELY NOT, NO WAY 4085 03:06:54,720 --> 03:06:59,600 THEY WOULD CONSIDER GIVING IT, 4086 03:06:59,600 --> 03:07:01,240 AND WE ARE CAUGHT IN THE MIDDLE, 4087 03:07:01,240 --> 03:07:05,680 THERE'S NOT A LOT OF DATA TO 4088 03:07:05,680 --> 03:07:06,880 GUIDE THIS SCENARIO BUT PEOPLE 4089 03:07:06,880 --> 03:07:14,520 HAVE A LOT OF FEELINGS ABOUT IT. 4090 03:07:14,520 --> 03:07:16,440 THE TRIAL SHOWING HORMONE 4091 03:07:16,440 --> 03:07:17,600 REPLACEMENT THERAPY INCREASED 4092 03:07:17,600 --> 03:07:21,960 RISK OF BREAST CANCER RECURRENCE 4093 03:07:21,960 --> 03:07:24,200 WAS UNDERPOWERED TO LOOK AT 4094 03:07:24,200 --> 03:07:26,440 SUBGROUP WITH HORMONE RECEPTOR 4095 03:07:26,440 --> 03:07:28,720 NEGATIVE CANCERS, AND ALSO 4096 03:07:28,720 --> 03:07:31,280 INCREASED RISK WITH LOCAL OR 4097 03:07:31,280 --> 03:07:32,520 CONTRALATERAL RECURRENCE, AND 4098 03:07:32,520 --> 03:07:35,520 MANY OF THESE PATIENTS HAD 4099 03:07:35,520 --> 03:07:36,840 BILATERAL MASTECTOMIES, WE DON'T 4100 03:07:36,840 --> 03:07:38,600 KNOW HOW THAT CHANGES OUR 4101 03:07:38,600 --> 03:07:40,120 RECOMMENDATIONS FOR THESE 4102 03:07:40,120 --> 03:07:41,320 PATIENTS BUT THIS IS A TIGHT 4103 03:07:41,320 --> 03:07:49,720 SPOT TO BE IN FOR THESE WOMEN. 4104 03:07:49,720 --> 03:07:54,240 A FEW MORE SCENARIOS IN MY OWN 4105 03:07:54,240 --> 03:07:56,960 PRACTICE, SO A 40-YEAR-OLD BRCA2 4106 03:07:56,960 --> 03:07:59,760 CARRIER COMES IN WHO ALREADY HAD 4107 03:07:59,760 --> 03:08:01,160 TUBES AND OVARY REMOVED IN 4108 03:08:01,160 --> 03:08:03,520 GUIDELINE RECOMMENDED AGES FOR 4109 03:08:03,520 --> 03:08:06,200 RISK OF OVARIAN CANCER BUT HAS 4110 03:08:06,200 --> 03:08:07,560 BEEN TOLD HORMONE REPLACEMENT 4111 03:08:07,560 --> 03:08:09,520 THERAPY ISN'T SAFE BECAUSE SHE'S 4112 03:08:09,520 --> 03:08:12,800 AT INCREASED RISK OF BREAST 4113 03:08:12,800 --> 03:08:15,480 CANCER, DESPITE THE DATA AND 4114 03:08:15,480 --> 03:08:16,360 OTHER FINDINGS. 4115 03:08:16,360 --> 03:08:18,080 AND SO SHE IS HAVING VERY POOR 4116 03:08:18,080 --> 03:08:20,040 QUALITY OF LIFE AND FEELS 4117 03:08:20,040 --> 03:08:20,880 CONFLICT AND GUILTY AND DOESN'T 4118 03:08:20,880 --> 03:08:25,600 KNOW WHAT TO DO. 4119 03:08:25,600 --> 03:08:27,560 ANOTHER SCENARIO I SEE, A 4120 03:08:27,560 --> 03:08:30,960 35-YEAR-OLD BRCA1 CARRIER WITH 4121 03:08:30,960 --> 03:08:33,080 HISTORY OF ESTROGEN RECEPTOR 4122 03:08:33,080 --> 03:08:36,000 POSITIVE BREAST CANCER, 4123 03:08:36,000 --> 03:08:39,760 PRESCRIBED VAGINAL ESTROGEN FOR 4124 03:08:39,760 --> 03:08:40,720 DYSPAREUNIA, THE PHARMACIST SAID 4125 03:08:40,720 --> 03:08:41,720 IT WAS CONTRAINDICATED BECAUSE 4126 03:08:41,720 --> 03:08:44,280 OF HISTORY OF BREAST CANCER AND 4127 03:08:44,280 --> 03:08:46,840 REFUSED TO FILL THE 4128 03:08:46,840 --> 03:08:49,560 PRESCRIPTION. 4129 03:08:49,560 --> 03:08:50,880 ANOTHER SCENARIO 42-YEAR-OLD 4130 03:08:50,880 --> 03:08:54,680 BRCA1 CARRIER WITH HISTORY OF 4131 03:08:54,680 --> 03:08:58,120 NON-INVASIVE DCIS OF THE BREAST, 4132 03:08:58,120 --> 03:09:02,040 HAD A BILATERAL MASTECTOMY, 4133 03:09:02,040 --> 03:09:03,040 PLANNING RISK REDUCING 4134 03:09:03,040 --> 03:09:09,280 SALPINGO-OOPHORECTOMY WANTS TO 4135 03:09:09,280 --> 03:09:12,800 GO ON HORMONE REPLACEMENT 4136 03:09:12,800 --> 03:09:13,960 THERAPY BUT DOCTORS CANNOT AGREE 4137 03:09:13,960 --> 03:09:16,320 THIS IS SAFE. 4138 03:09:16,320 --> 03:09:19,640 AND THE FINAL, 45-YEAR-OLD BRCA2 4139 03:09:19,640 --> 03:09:22,040 CARRIER, HAVING BOTHERSOME HOT 4140 03:09:22,040 --> 03:09:23,840 FLASHES AND NIGHT SWEATS, UNABLE 4141 03:09:23,840 --> 03:09:25,680 TO FIND A PHYSICIAN TO ADDRESS 4142 03:09:25,680 --> 03:09:28,240 HER CONCERNS, COMES TO ME PRIOR 4143 03:09:28,240 --> 03:09:31,120 TO SURGERY, ALREADY ON A REGIMEN 4144 03:09:31,120 --> 03:09:32,560 OF COMPOUNDED HORMONES WHICH SHE 4145 03:09:32,560 --> 03:09:34,720 IS PAYING A LARGE SUM OF MONEY 4146 03:09:34,720 --> 03:09:37,400 FOR EACH MONTH, BECAUSE SHE 4147 03:09:37,400 --> 03:09:40,360 COULDN'T FIND A PHYSICIAN WHO 4148 03:09:40,360 --> 03:09:47,120 WOULD PRESCRIBE HER FDA-APPROVED 4149 03:09:47,120 --> 03:09:50,440 THERAPYIES IN THE HIGH RISK 4150 03:09:50,440 --> 03:09:50,720 SCENARIO. 4151 03:09:50,720 --> 03:09:52,040 I EXPECT THIS TO GET WORSE IN 4152 03:09:52,040 --> 03:09:54,640 LIGHT OF THE DOBBS DECISION AND 4153 03:09:54,640 --> 03:09:57,880 OB/GYNS LEAVING STATES IN WHICH 4154 03:09:57,880 --> 03:10:03,280 THEY FIND IT UNSAFE TO PRACTICE 4155 03:10:03,280 --> 03:10:03,960 THEIR FIELD. 4156 03:10:03,960 --> 03:10:07,320 SO WHAT ABOUT THE FALLOPIAN 4157 03:10:07,320 --> 03:10:09,000 TUBES? 4158 03:10:09,000 --> 03:10:11,520 IT WILL BE ADDRESSED LATER BY 4159 03:10:11,520 --> 03:10:13,600 SUE FRIEDMAN BUT THE MAJORITY OF 4160 03:10:13,600 --> 03:10:15,920 OVARIAN CANCERS WE THINK MAY 4161 03:10:15,920 --> 03:10:20,480 COME FROM THE FALLOPIAN TUBE, 4162 03:10:20,480 --> 03:10:24,240 THIS HAS LED TO INTEREST IN 4163 03:10:24,240 --> 03:10:25,640 REMOVING THE FALLOPIAN TUBES 4164 03:10:25,640 --> 03:10:27,520 FIRST RATHER THAN OVARIES WHICH 4165 03:10:27,520 --> 03:10:32,000 LEADS TO STERILIZATION WITH 4166 03:10:32,000 --> 03:10:34,240 UNCERTAIN DEGREE OF RISK 4167 03:10:34,240 --> 03:10:38,640 REDUCTION, PATIENTS NEED TWO 4168 03:10:38,640 --> 03:10:39,640 SURGERIES. 4169 03:10:39,640 --> 03:10:41,400 BUT THERE ARE A NUMBER OF 4170 03:10:41,400 --> 03:10:43,560 REASONS TO WAIT ON OOPHORECTOMY. 4171 03:10:43,560 --> 03:10:45,600 I SEE DR. TEMKIN AND I'M CLOSE 4172 03:10:45,600 --> 03:10:46,800 TO TIME. 4173 03:10:46,800 --> 03:10:51,680 A COUPLE MORE SLIDES. 4174 03:10:51,680 --> 03:10:57,240 WE CAN MITIGATE CONSEQUENCES CAN 4175 03:10:57,240 --> 03:10:58,840 HORMONE REPLACEMENT THERAPY, 4176 03:10:58,840 --> 03:11:00,080 PATIENTS HAVE REAL CONCERNS, 4177 03:11:00,080 --> 03:11:01,880 SUBSTANTIAL ENOUGH TO DRIVE 4178 03:11:01,880 --> 03:11:03,840 MULTIPLE CLINICAL TRIALS OF 4179 03:11:03,840 --> 03:11:06,640 PATIENTS CONSIDERING HAVING SAL 4180 03:11:06,640 --> 03:11:09,320 PINGECTOMY FOLLOWED BY 4181 03:11:09,320 --> 03:11:11,360 OOPHORECTOMY COMPARED WITH 4182 03:11:11,360 --> 03:11:13,120 BILATERAL SALPINGO-OOPHORECTOMY, 4183 03:11:13,120 --> 03:11:13,920 PATIENTS ARE CHOOSING WHAT TYPE 4184 03:11:13,920 --> 03:11:15,960 OF SURGERY THEY WILL HAVE, THESE 4185 03:11:15,960 --> 03:11:18,680 ARE NOT RANDOMIZED. 4186 03:11:18,680 --> 03:11:22,480 I WAS INVOLVED WITH THE WISP 4187 03:11:22,480 --> 03:11:24,160 STUDY IN THE UNITED STATES 4188 03:11:24,160 --> 03:11:25,800 LOOKING AT HOW PEOPLE DID AFTER 4189 03:11:25,800 --> 03:11:27,640 THESE OPERATIONS IN TERMS OF 4190 03:11:27,640 --> 03:11:29,120 SEXUAL FUNCTION AND MENOPAUSAL 4191 03:11:29,120 --> 03:11:31,600 SYMPTOMS. 4192 03:11:31,600 --> 03:11:34,240 HERE ARE SOME OF THE FINDINGS. 4193 03:11:34,240 --> 03:11:36,680 THE STUDY HAS NOT BEEN PUBLISHED 4194 03:11:36,680 --> 03:11:38,200 BUT SHOULD BE COMING OUT 4195 03:11:38,200 --> 03:11:38,760 HOPEFULLY SOON. 4196 03:11:38,760 --> 03:11:42,600 WHICH I THINK WILL ADD TO THESE 4197 03:11:42,600 --> 03:11:42,920 DATA. 4198 03:11:42,920 --> 03:11:45,000 THE TUBA STUDY IN THE 4199 03:11:45,000 --> 03:11:46,880 NETHERLANDS CONFIRMED WHAT WHAM 4200 03:11:46,880 --> 03:11:48,240 SHOWED, MENOPAUSE-RELATED 4201 03:11:48,240 --> 03:11:52,680 QUALITY OF LIFE WAS WORSE AFTER 4202 03:11:52,680 --> 03:11:53,520 RISK REDUCING 4203 03:11:53,520 --> 03:11:54,920 SALPINGO-OOPHORECTOMY EVEN WITH 4204 03:11:54,920 --> 03:11:56,280 HORMONE REPLACEMENT THERAPY AND 4205 03:11:56,280 --> 03:12:02,840 SEXUAL FUNCTIONING WAS BETTER 4206 03:12:02,840 --> 03:12:04,240 WITH HRT BUT NOT BACK TO 4207 03:12:04,240 --> 03:12:04,920 BASELINE. 4208 03:12:04,920 --> 03:12:07,040 THERE ARE PENDING STUDIES 4209 03:12:07,040 --> 03:12:09,240 LOOKING AT CANCER OUTCOMES. 4210 03:12:09,240 --> 03:12:11,080 OVARIAN CANCER IS A 4211 03:12:11,080 --> 03:12:11,720 LIFE-THREATENING DISEASE, 4212 03:12:11,720 --> 03:12:14,800 SCREENING IS NOT EFFECTIVE. 4213 03:12:14,800 --> 03:12:16,520 SURGERY IS THE LIFE SAVING 4214 03:12:16,520 --> 03:12:18,200 INTERVENTION BUT LEADS TO 4215 03:12:18,200 --> 03:12:19,920 SURGICAL MENOPAUSE. 4216 03:12:19,920 --> 03:12:21,480 AND DESPITE HRT QUALITY OF LIFE 4217 03:12:21,480 --> 03:12:26,480 AND SEXUAL FUNCTIONING ARE NOT 4218 03:12:26,480 --> 03:12:29,440 THE SAME AFTER PRE-MENOPAUSAL 4219 03:12:29,440 --> 03:12:31,520 RISK REDUCING 4220 03:12:31,520 --> 03:12:32,800 SALPINGO-OOPHORECTOMY, MORE DATA 4221 03:12:32,800 --> 03:12:34,560 IS NEEDED TO MITIGATE SIDE 4222 03:12:34,560 --> 03:12:34,800 EFFECTS. 4223 03:12:34,800 --> 03:12:45,240 THANK YOU FOR YOUR TIME. 4224 03:12:46,080 --> 03:12:53,320 >> THANKS YOU FOR INFORMATIVE 4225 03:12:53,320 --> 03:12:55,320 PRESENTATION. 4226 03:12:55,320 --> 03:12:57,960 THE NEXT SPEAKER, DR. SARA 4227 03:12:57,960 --> 03:12:59,120 LOOBY, HARVARD MEDICAL SCHOOL, 4228 03:12:59,120 --> 03:13:01,920 WILL BE TALKING TO US ABOUT 4229 03:13:01,920 --> 03:13:07,120 MENOPAUSE IN WOMEN WITH HIV. 4230 03:13:07,120 --> 03:13:07,680 >> THANK YOU. 4231 03:13:07,680 --> 03:13:13,040 IF YOU COULD START MY SLIDES. 4232 03:13:13,040 --> 03:13:15,560 CAN EVERYBODY HEAR ME OKAY? 4233 03:13:15,560 --> 03:13:15,960 GOOD AFTERNOON. 4234 03:13:15,960 --> 03:13:18,080 THANK YOU VERY MUCH FOR THE 4235 03:13:18,080 --> 03:13:23,160 OPPORTUNITY TO PRESENT AT THIS 4236 03:13:23,160 --> 03:13:24,560 PRESTIGIOUS SYMPOSIUM. 4237 03:13:24,560 --> 03:13:26,240 I'M SARA LOOBY, WITH THE 4238 03:13:26,240 --> 03:13:30,440 PRIVILEGE OF SHARING RESEARCH, 4239 03:13:30,440 --> 03:13:31,080 RICH PERSPECTIVES, EXPERIENTIAL 4240 03:13:31,080 --> 03:13:32,320 CLINICAL DATA FROM MY WORK, THAT 4241 03:13:32,320 --> 03:13:34,760 OF MY COLLEAGUES FROM AROUND THE 4242 03:13:34,760 --> 03:13:37,360 WORLD, AND FROM THE EXPERTS, 4243 03:13:37,360 --> 03:13:40,000 WOMEN LIVING WITH HIV. 4244 03:13:40,000 --> 03:13:43,280 ON THE TOPIC OF MENOPAUSE, 4245 03:13:43,280 --> 03:13:45,480 EMERGING KNOWLEDGE, SPECIAL 4246 03:13:45,480 --> 03:13:46,920 CONSIDERATIONS. 4247 03:13:46,920 --> 03:13:47,280 NO DISCLOSURES. 4248 03:13:47,280 --> 03:13:48,080 NEXT SLIDE PLEASE. 4249 03:13:48,080 --> 03:13:49,480 THIS SHARES AN OVERVIEW OF 4250 03:13:49,480 --> 03:13:51,280 SELECT TOPICS I WILL PRESENT IN 4251 03:13:51,280 --> 03:13:53,520 THE NEXT 20 MINUTES, BUILDING ON 4252 03:13:53,520 --> 03:13:54,360 THE INCREDIBLE PRESENTATIONS 4253 03:13:54,360 --> 03:13:56,600 WE'VE HEARD FROM THE EXPERTS 4254 03:13:56,600 --> 03:13:58,880 TODAY, IT'S MY GOAL TO PROVIDE A 4255 03:13:58,880 --> 03:14:02,680 MINI STATE OF THE SCIENCE, 4256 03:14:02,680 --> 03:14:03,760 RESEARCH, VOICES OF WOMEN, 4257 03:14:03,760 --> 03:14:04,960 CLINICAL CONSIDERATION FOR THIS 4258 03:14:04,960 --> 03:14:06,080 GROWING POPULATION OF WOMEN 4259 03:14:06,080 --> 03:14:10,600 EXPERIENCING MENOPAUSE. 4260 03:14:10,600 --> 03:14:12,560 ONE OF THE MOST IMPORTANT THINGS 4261 03:14:12,560 --> 03:14:15,200 I'VE LEARN IN TWO DECADES OF 4262 03:14:15,200 --> 03:14:16,160 CLINICAL RESEARCH, IS THAT 4263 03:14:16,160 --> 03:14:18,920 FINDINGS FROM THE MOST RIGOROUS 4264 03:14:18,920 --> 03:14:21,320 SCIENCE AND MOST SEMINAL 4265 03:14:21,320 --> 03:14:23,440 PUBLICATIONS AND MOST REPUTABLE 4266 03:14:23,440 --> 03:14:26,560 JOURNALS ARE ONLY AS EFFECTIVE 4267 03:14:26,560 --> 03:14:29,720 AS THE PATIENT'S ABILITY TO 4268 03:14:29,720 --> 03:14:31,520 UNDERSTAND, TRUST, AND OPT TO 4269 03:14:31,520 --> 03:14:32,400 USE THESE FINDINGS TO HELP 4270 03:14:32,400 --> 03:14:36,920 ENHANCE THEIR OWN HEALTH. 4271 03:14:36,920 --> 03:14:38,160 AS PROVIDERS, RESEARCHERS, 4272 03:14:38,160 --> 03:14:39,960 EDUCATORS AND PEERS, A CRITICAL 4273 03:14:39,960 --> 03:14:42,120 FIRST STEP IN FACILITATING 4274 03:14:42,120 --> 03:14:43,160 UPTAKE OF EVIDENCE-BASED 4275 03:14:43,160 --> 03:14:45,880 TREATMENT IS NOT ASSESSING AND 4276 03:14:45,880 --> 03:14:47,400 TREATING A PARTICULAR CONDITION 4277 03:14:47,400 --> 03:14:49,680 BASED ON EVIDENCE ALONE, IT'S 4278 03:14:49,680 --> 03:14:51,720 UNDERSTANDING THE PATIENT AS A 4279 03:14:51,720 --> 03:14:54,480 WHOLE, INCLUDING FACTORS SUCH AS 4280 03:14:54,480 --> 03:15:03,720 SOCIAL DETERMINANTS OF HEALTH, 4281 03:15:03,720 --> 03:15:05,120 PSYCHOLOGICAL HEALTH, COMORBID 4282 03:15:05,120 --> 03:15:07,080 CONDITIONS, HOW A PATIENT MAY 4283 03:15:07,080 --> 03:15:08,480 EXPERIENCE A MEDICAL CONDITION 4284 03:15:08,480 --> 03:15:11,040 OR SYMPTOM OR HOW PROVIDERS MAY 4285 03:15:11,040 --> 03:15:12,720 ASSESS AND TREAT THE SAME 4286 03:15:12,720 --> 03:15:17,160 SYMPTOM OR CONDITION IS STRONGLY 4287 03:15:17,160 --> 03:15:19,520 INFLUENCED BY SOCIODEMOGRAPHIC 4288 03:15:19,520 --> 03:15:20,000 AND BIOPSYCHOSOCIAL 4289 03:15:20,000 --> 03:15:22,520 CHARACTERISTICS AND DIFFER 4290 03:15:22,520 --> 03:15:23,320 ACROSS PATIENT POPULATIONS. 4291 03:15:23,320 --> 03:15:25,120 LET'S LOOK IN THE CONTEXT OF 4292 03:15:25,120 --> 03:15:29,800 MENOPAUSE AND WOMEN WITH HIV. 4293 03:15:29,800 --> 03:15:31,520 13 YEARS AGO I WAS ASKED BY A 4294 03:15:31,520 --> 03:15:33,480 WOMAN WITH HIV IN HER MID-40s 4295 03:15:33,480 --> 03:15:36,640 HOW SHE COULD TELL IF THE NIGHT 4296 03:15:36,640 --> 03:15:38,800 SWEATS SHE STARTED EXPERIENCING 4297 03:15:38,800 --> 03:15:40,840 WERE RELATED TO A LOW CD4 COUNT, 4298 03:15:40,840 --> 03:15:43,960 HIGH HIV VIRAL LOAD VERSUS 4299 03:15:43,960 --> 03:15:44,360 MENOPAUSE? 4300 03:15:44,360 --> 03:15:46,960 THIS NEW ONSET OF NIGHT SWEATS 4301 03:15:46,960 --> 03:15:48,640 ABSOLUTELY TERRIFIED HER. 4302 03:15:48,640 --> 03:15:50,800 HAVING LIVED 15 YEARS WITH 4303 03:15:50,800 --> 03:15:53,560 STABLE HIV ON MEDICATION, SHE 4304 03:15:53,560 --> 03:15:55,280 WAS CONCERNED HER HIV 4305 03:15:55,280 --> 03:15:56,200 MEDICATIONS WERE NO LONGER 4306 03:15:56,200 --> 03:16:00,400 WORKING AND NOW HAD AIDS OR 4307 03:16:00,400 --> 03:16:01,400 ANOTHER HIV-ASSOCIATED 4308 03:16:01,400 --> 03:16:01,680 CONDITION. 4309 03:16:01,680 --> 03:16:04,320 NEXT SLIDE PLEASE. 4310 03:16:04,320 --> 03:16:08,080 HER STORY IS NOT ISOLATED. 4311 03:16:08,080 --> 03:16:09,880 IN HIV PATIENT PUBLICATION, HELL 4312 03:16:09,880 --> 03:16:12,640 IN A HOT FLASH, SHARED SIMILAR 4313 03:16:12,640 --> 03:16:13,520 ACCOUNTS ABOUT HOT FLASHES 4314 03:16:13,520 --> 03:16:15,520 EXPERIENCED BY WOMEN WITH HIV. 4315 03:16:15,520 --> 03:16:17,480 AND PERHAPS THE MOST INSIGHTFUL 4316 03:16:17,480 --> 03:16:18,600 QUOTE FROM THE ARTICLE, WAS 4317 03:16:18,600 --> 03:16:20,360 AFTER A WEEK OF WAKING UP IN THE 4318 03:16:20,360 --> 03:16:22,080 MIDDLE OF THE NIGHT WERE 4319 03:16:22,080 --> 03:16:23,400 DRENCHING NIGHT SWEATS, I RAN TO 4320 03:16:23,400 --> 03:16:27,840 MY DOCTOR IN AEN PAIC, REMINISCE 4321 03:16:27,840 --> 03:16:30,080 OF OF DAYS T CELL COUNT WAS 8, I 4322 03:16:30,080 --> 03:16:32,040 KNEW SOMETHING MAJOR WAS WRONG 4323 03:16:32,040 --> 03:16:33,120 WITH ME. 4324 03:16:33,120 --> 03:16:36,000 THESE QUOTES REVEAL SOME WOMEN 4325 03:16:36,000 --> 03:16:37,080 WITH HIV PERCEIVE MENOPAUSE 4326 03:16:37,080 --> 03:16:38,520 SYMPTOMS TO BE HIV SYMPTOMS, AND 4327 03:16:38,520 --> 03:16:40,920 THIS MAY BE DUE TO LACK OF 4328 03:16:40,920 --> 03:16:42,440 KNOWLEDGE REGARDING MENOPAUSE 4329 03:16:42,440 --> 03:16:44,560 AND ITS ASSOCIATED SYMPTOMS OR 4330 03:16:44,560 --> 03:16:46,000 OVERLAP BETWEEN SYMPTOMS OF HIV 4331 03:16:46,000 --> 03:16:48,920 AND SYMPTOMS OF MENOPAUSE. 4332 03:16:48,920 --> 03:16:50,960 4333 03:16:50,960 --> 03:16:53,160 4334 03:16:53,160 --> 03:16:54,640 THIS CLEARLY CAUSES 4335 03:16:54,640 --> 03:16:56,440 PSYCHOLOGICAL DISTRESS AMONG 4336 03:16:56,440 --> 03:16:57,360 MID-LIFE WOMEN WITH HIV, 4337 03:16:57,360 --> 03:16:59,240 HIGHLIGHTING THE NEED FOR 4338 03:16:59,240 --> 03:17:08,160 PATIENT AND PROVIDER EDUCATION. 4339 03:17:08,160 --> 03:17:11,680 NEXT SLIDE PLEASE. 4340 03:17:11,680 --> 03:17:13,640 WOMEN EXPERIENCE TRAUMA. 4341 03:17:13,640 --> 03:17:15,960 SEXUAL ASSAULT, RAPE, TEEN 4342 03:17:15,960 --> 03:17:16,840 PREGNANCY, DOMESTIC VIOLENCE, 4343 03:17:16,840 --> 03:17:18,720 PERHAPS HAVING A FIRST MENSTRUAL 4344 03:17:18,720 --> 03:17:22,120 PERIOD IN THE ABSENCE OF AN 4345 03:17:22,120 --> 03:17:23,760 ADULT CARETAKER. 4346 03:17:23,760 --> 03:17:24,960 IN MANY CULTURE AND FAMILIES 4347 03:17:24,960 --> 03:17:31,520 DISCUSSION OF WOMEN'S HEALTH AND 4348 03:17:31,520 --> 03:17:34,600 MENOPAUSE CAN CONTRIBUTE TO 4349 03:17:34,600 --> 03:17:36,800 KNOWLEDGE GAP TRAUMA, STIGMA, 4350 03:17:36,800 --> 03:17:44,320 ISOLATION, THUS EDUCATING WOMEN 4351 03:17:44,320 --> 03:17:46,880 WITH HIV, A TRAUMA INDUCED 4352 03:17:46,880 --> 03:17:49,840 APPROACH CONSIDERATE IN A MANNER 4353 03:17:49,840 --> 03:17:53,040 WITH CULTURAL BACKGROUND, AGE, 4354 03:17:53,040 --> 03:17:54,360 HEALTH LITERACY AND CLINICAL 4355 03:17:54,360 --> 03:17:54,640 FACTORS. 4356 03:17:54,640 --> 03:17:58,520 NEXT SLIDE. 4357 03:17:58,520 --> 03:17:59,640 OF GREAT CONCERN IS 4358 03:17:59,640 --> 03:18:00,600 PSYCHOLOGICAL WELL BEING AND 4359 03:18:00,600 --> 03:18:02,520 QUALITY OF LIFE OF WOMEN WITH 4360 03:18:02,520 --> 03:18:07,600 HIV IN THE TRANSITION MAY BE 4361 03:18:07,600 --> 03:18:08,920 FURTHER COMPOUNDED WITH SOCIAL 4362 03:18:08,920 --> 03:18:10,320 CONCERNS EXPERIENCED BY MANY 4363 03:18:10,320 --> 03:18:11,320 WOMEN WITH HIV THAT ARE SHARED 4364 03:18:11,320 --> 03:18:14,760 ON THIS SLIDE. 4365 03:18:14,760 --> 03:18:16,240 WHETHER MENOPAUSE WILL OFFSET 4366 03:18:16,240 --> 03:18:18,160 THIS PRECARIOUS HEALTH STATE IN 4367 03:18:18,160 --> 03:18:19,680 THIS POPULATION IS NOT FULLY 4368 03:18:19,680 --> 03:18:22,000 UNDERSTOOD. 4369 03:18:22,000 --> 03:18:24,240 4370 03:18:24,240 --> 03:18:26,160 A LARGE PORTION OF THE 4371 03:18:26,160 --> 03:18:29,280 LITERATURE ON HIV AND MENOPAUSE 4372 03:18:29,280 --> 03:18:30,960 TO DATE FOCUSED ON DETERMINING 4373 03:18:30,960 --> 03:18:33,160 AGE OF ONSET AND WHETHER IT IS 4374 03:18:33,160 --> 03:18:37,800 EARLIER IN WOMEN WITH HIV. 4375 03:18:37,800 --> 03:18:39,000 NEXT SLIDE. 4376 03:18:39,000 --> 03:18:40,800 CRITERIA TO HELD GUIDE 4377 03:18:40,800 --> 03:18:42,440 CLINICIANS WITH ASSESSMENT OF 4378 03:18:42,440 --> 03:18:44,920 REPRODUCTIVE AGING AND ONSET IN 4379 03:18:44,920 --> 03:18:46,720 WOMEN DO EXIST, AS WE'VE LEARNED 4380 03:18:46,720 --> 03:18:49,040 FROM PRESENTERS THIS MORNING. 4381 03:18:49,040 --> 03:18:50,520 HOWEVER, THEY ARE NOT 4382 03:18:50,520 --> 03:18:51,720 ONE-SIZE-FITS-ALL AND EXISTING 4383 03:18:51,720 --> 03:18:53,240 GAP IN LITERATURE TO DATE 4384 03:18:53,240 --> 03:18:57,000 IDENTIFIED AT THE STAGES OF 4385 03:18:57,000 --> 03:18:57,920 REPRODUCTIONING AGE WORKSHOP IN 4386 03:18:57,920 --> 03:18:59,520 2012 IS EVALUATING STAGING OF 4387 03:18:59,520 --> 03:19:02,680 REPRODUCTIVE AGING IN WOMEN WITH 4388 03:19:02,680 --> 03:19:04,960 CHRONIC ILLNESSES INCLUDING HIV 4389 03:19:04,960 --> 03:19:06,520 NEEDED. 4390 03:19:06,520 --> 03:19:08,520 PRIOR STUDIES SUGGEST WOMEN WITH 4391 03:19:08,520 --> 03:19:10,400 HIV EXPERIENCE EARLIER ONSET OF 4392 03:19:10,400 --> 03:19:11,840 MENOPAUSE OCCURRING BETWEEN AGES 4393 03:19:11,840 --> 03:19:16,360 OF 46 AND 50, VERSUS 51 OR 52, 4394 03:19:16,360 --> 03:19:17,840 MEDIAN AGE OF ONSET COMMONLY 4395 03:19:17,840 --> 03:19:21,760 OBSERVED IN WOMEN WITHOUT HIV. 4396 03:19:21,760 --> 03:19:22,960 HOWEVER, SOME FINDINGS IN 4397 03:19:22,960 --> 03:19:25,960 STUDIES HAVE BEEN LIMITED DUE TO 4398 03:19:25,960 --> 03:19:27,640 ASSESSMENT IN METHODOLOGICAL 4399 03:19:27,640 --> 03:19:28,440 CONCERNS WITH CLASSIFYING 4400 03:19:28,440 --> 03:19:30,240 MENOPAUSE STAGE OR STATUS IN 4401 03:19:30,240 --> 03:19:30,880 RESEARCH STUDIES. 4402 03:19:30,880 --> 03:19:33,600 NEXT SLIDE. 4403 03:19:33,600 --> 03:19:36,480 IT CAN BE CHALLENGING TO 4404 03:19:36,480 --> 03:19:39,000 DECIPHER IF CESSATION OF MENSES 4405 03:19:39,000 --> 03:19:49,400 IS RELATED TO TRUE MENOPAUSE DUE 4406 03:19:49,400 --> 03:19:52,760 TO AMENORREAH DUE TO SUBSTANCE 4407 03:19:52,760 --> 03:19:54,040 USE DISORDER, LOW WEIGHT, AND 4408 03:19:54,040 --> 03:19:56,880 MIGHT BE RELATED TO HIV-SPECIFIC 4409 03:19:56,880 --> 03:19:57,560 CHARACTERISTICS AS SHOWN ON THIS 4410 03:19:57,560 --> 03:20:01,600 SLIDE. 4411 03:20:01,600 --> 03:20:02,800 NEXT SLIDE PLEASE. 4412 03:20:02,800 --> 03:20:04,720 THERE HAVE BEEN STUDIES AMONG 4413 03:20:04,720 --> 03:20:11,360 WOMEN WITH HIV THAT HAVE 4414 03:20:11,360 --> 03:20:16,520 DESCRIBED HYPOTHALAMIC 4415 03:20:16,520 --> 03:20:17,800 AMENORREAH, AND INVESTIGATORS 4416 03:20:17,800 --> 03:20:20,400 FOUND THAT AMONG EVALUATED 4417 03:20:20,400 --> 03:20:21,360 STUDIES A SIGNIFICANT 4418 03:20:21,360 --> 03:20:23,520 ASSOCIATION BETWEEN HIV STATUS 4419 03:20:23,520 --> 03:20:25,440 AND AMENORREAH EXISTED THAT MAY 4420 03:20:25,440 --> 03:20:27,360 BE INDEPENDENT OF SUBSTANCE USE 4421 03:20:27,360 --> 03:20:29,680 AND COMMONLY RELATED TO LOW 4422 03:20:29,680 --> 03:20:31,000 WEIGHT IN THIS POPULATION. 4423 03:20:31,000 --> 03:20:34,320 THUS IT IS GREAT VALUE TO 4424 03:20:34,320 --> 03:20:37,640 CONDUCT COMPREHENSIVE EVALUATION 4425 03:20:37,640 --> 03:20:39,480 OF PSYCHOSOCIAL LIFESTYLE, 4426 03:20:39,480 --> 03:20:40,640 CLINICAL, HIV FACTORS, 4427 03:20:40,640 --> 03:20:42,080 MEDICATION WHEN DETERMINING THE 4428 03:20:42,080 --> 03:20:47,160 ORIGIN OF AMENORREAH IN THIS 4429 03:20:47,160 --> 03:20:48,120 POPULATION. 4430 03:20:48,120 --> 03:20:50,080 TAKEN TOGETHER SOME LITERATURE 4431 03:20:50,080 --> 03:20:52,520 CONFLICTS REGARDING AGE AND 4432 03:20:52,520 --> 03:20:56,800 ONSET AND ITS RELATIONSHIP TO 4433 03:20:56,800 --> 03:21:00,120 HIV IF IT MAY ENTER MENOPAUSE 4434 03:21:00,120 --> 03:21:02,360 EARLY, THERE IS GREAT POTENTIAL 4435 03:21:02,360 --> 03:21:03,520 TO DETRIMENTAL IMPACT ON 4436 03:21:03,520 --> 03:21:04,480 CONDITIONS AND SYMPTOMS 4437 03:21:04,480 --> 03:21:07,080 ASSOCIATED WITH MENOPAUSE AS 4438 03:21:07,080 --> 03:21:09,760 WELL AS HIV-SPECIFIC FACTORS 4439 03:21:09,760 --> 03:21:13,520 INCLUDING IMMUNE HEALTH, 4440 03:21:13,520 --> 03:21:16,920 ADHERENCE TO RETROVIRAL THERAPY, 4441 03:21:16,920 --> 03:21:18,120 OVERALL SYMPTOM BURDEN. 4442 03:21:18,120 --> 03:21:20,320 NEXT SLIDE PLEASE. 4443 03:21:20,320 --> 03:21:22,120 BODY OF RESEARCH EXPLORING 4444 03:21:22,120 --> 03:21:23,000 MENOPAUSE SYMPTOMS AND 4445 03:21:23,000 --> 03:21:24,480 ASSOCIATED CLINICAL CONDITIONS 4446 03:21:24,480 --> 03:21:27,680 IN WOMEN WITH HIV IS GROWING 4447 03:21:27,680 --> 03:21:28,240 THINKS HYPOTHESIS-GENERATING 4448 03:21:28,240 --> 03:21:31,120 STUDIES AND LARGE COHORT STUDIES 4449 03:21:31,120 --> 03:21:33,120 INCLUDING WOMEN'S INTERAGENCY 4450 03:21:33,120 --> 03:21:36,480 HIV STUDY, POSITIVE TRANSITION 4451 03:21:36,480 --> 03:21:41,640 THROUGH MENOPAUSE PRIME STUDY, 4452 03:21:41,640 --> 03:21:43,400 CANADIAN HIV WOMEN'S COHORT 4453 03:21:43,400 --> 03:21:45,040 STUDY AND VASCULAR EVENTS IN HIV 4454 03:21:45,040 --> 03:21:46,360 OR REPRIEVE TRIAL. 4455 03:21:46,360 --> 03:21:50,120 MORE RESEARCH IS NEEDED. 4456 03:21:50,120 --> 03:21:52,520 NEXT SLIDE. 4457 03:21:52,520 --> 03:21:54,240 GIVEN OUR COLLECTIVE 4458 03:21:54,240 --> 03:21:56,120 UNDERSTANDING OF THE INTERPLAY 4459 03:21:56,120 --> 03:21:58,480 AND RISK FOR COMORBID CONDITIONS 4460 03:21:58,480 --> 03:22:01,080 THERE'S CONCERN REGARDING 4461 03:22:01,080 --> 03:22:03,000 ADDITIONAL BURDEN OF ESTROGEN 4462 03:22:03,000 --> 03:22:06,400 LOSS AND DEVELOPMENT OF SIMILAR 4463 03:22:06,400 --> 03:22:08,840 CHRONIC DISEASES, HIGHLIGHTED ON 4464 03:22:08,840 --> 03:22:12,320 THE RIGHT, THAT MAY POTENTIATE 4465 03:22:12,320 --> 03:22:13,400 EXISTING DISEASE PROCESSES. 4466 03:22:13,400 --> 03:22:16,200 IN OTHER WORDS, MANY 4467 03:22:16,200 --> 03:22:18,240 PRE-MENOPAUSAL WOMEN WITH HIV 4468 03:22:18,240 --> 03:22:18,920 EXPERIENCE THESE CONDITIONS 4469 03:22:18,920 --> 03:22:20,360 ALREADY, AND WHAT WILL HAPPEN 4470 03:22:20,360 --> 03:22:24,760 WHEN THEY LOSE PROTECTIVE 4471 03:22:24,760 --> 03:22:26,040 EFFECTS OF ESTROGEN? 4472 03:22:26,040 --> 03:22:29,560 THIS SLIDE SHARES FOUR FACTS OR 4473 03:22:29,560 --> 03:22:30,560 SUMMARIES GLEANED ON MENOPAUSE 4474 03:22:30,560 --> 03:22:36,160 SYMPTOMS IN WOMEN WITH HIV. 4475 03:22:36,160 --> 03:22:37,520 FIRST, WOMEN WITH HIV 4476 03:22:37,520 --> 03:22:38,480 PERIMENOPAUSAL IN PARTICULAR 4477 03:22:38,480 --> 03:22:40,720 APPEAR TO HAVE MORE SEVERE 4478 03:22:40,720 --> 03:22:42,880 DEPRESSIVE SYMPTOMS AND ANXIETY 4479 03:22:42,880 --> 03:22:45,360 COMPARED TO WOMEN WITHOUT HIV 4480 03:22:45,360 --> 03:22:46,360 DURING PERIMENOPAUSE. 4481 03:22:46,360 --> 03:22:49,600 INDEED MOOD SYMPTOMS MAY VARY BY 4482 03:22:49,600 --> 03:22:51,760 MENOPAUSE TRANSITION STATUS, AND 4483 03:22:51,760 --> 03:22:54,560 CAN FLUCTUATE AMONG ALL WOMEN, 4484 03:22:54,560 --> 03:22:56,400 WOMEN WITH HIV TEND TO HAVE 4485 03:22:56,400 --> 03:22:59,080 HIGHER PREVALENCE OF DEPRESSION 4486 03:22:59,080 --> 03:23:01,000 AND ANXIETY DURING PRE-MENOPAUSE 4487 03:23:01,000 --> 03:23:02,800 COMPARED TO WITHOUT HIV. 4488 03:23:02,800 --> 03:23:05,400 WOMEN WITH HIV MAY REPORT OR 4489 03:23:05,400 --> 03:23:06,520 EXPERIENCE WORSE DEPRESSIVE 4490 03:23:06,520 --> 03:23:09,120 SYMPTOMS AND ANXIETY DURING THE 4491 03:23:09,120 --> 03:23:10,560 MENOPAUSE TRANSITION, COMPARED 4492 03:23:10,560 --> 03:23:14,280 TO AGE, RATE, MENSTRUAL STATUS 4493 03:23:14,280 --> 03:23:17,680 MATCHED WOMEN WITHOUT HIV. 4494 03:23:17,680 --> 03:23:19,480 IN ONE STUDY THEY REMAIN 4495 03:23:19,480 --> 03:23:22,160 SIGNIFICANT WHEN EVALUATED AT 4496 03:23:22,160 --> 03:23:24,160 BASE LINE AT 12 MONTHS LATER, 4497 03:23:24,160 --> 03:23:25,320 ONE YEAR. 4498 03:23:25,320 --> 03:23:27,160 SECOND, PRIOR STUDIES REPORTED 4499 03:23:27,160 --> 03:23:29,960 THAT WOMEN WITH HIV EXPERIENCE 4500 03:23:29,960 --> 03:23:31,680 INCREASED HOT FLASH PREVALENCE 4501 03:23:31,680 --> 03:23:33,760 AND SEVERITY. 4502 03:23:33,760 --> 03:23:38,200 THERE IS CONFLICTING DATA, 4503 03:23:38,200 --> 03:23:40,680 POSSIBLY DUE TO METHODOLOGICAL 4504 03:23:40,680 --> 03:23:41,000 CHALLENGES. 4505 03:23:41,000 --> 03:23:48,440 REGARDLESS, WOMEN WITH HIV 4506 03:23:48,440 --> 03:23:50,560 EXPERIENCE THINGS I WILL SHARE 4507 03:23:50,560 --> 03:23:54,280 IN A SUBSEQUENT SLIDE. 4508 03:23:54,280 --> 03:23:55,920 SYMPTOMS IN WOMAN ACROSS 4509 03:23:55,920 --> 03:24:02,880 TRANSITION OCCUR, INCLUDING 4510 03:24:02,880 --> 03:24:06,760 VAGINAL DRYNESS, SEXUAL 4511 03:24:06,760 --> 03:24:08,720 DYSFUNCTION, DYSPAREUNIA, 4512 03:24:08,720 --> 03:24:10,240 UNCLEAR IF WORSE IN WOMEN 4513 03:24:10,240 --> 03:24:13,880 WITHOUT HIV. 4514 03:24:13,880 --> 03:24:16,400 AND VERY FEW STUDIES EVALUATED 4515 03:24:16,400 --> 03:24:18,240 HORMONE THERAPY USE IN THE 4516 03:24:18,240 --> 03:24:19,480 CONTEXT OF MENOPAUSE. 4517 03:24:19,480 --> 03:24:21,200 CURRENT STUDIES HAVE BEEN 4518 03:24:21,200 --> 03:24:21,440 HELPFUL. 4519 03:24:21,440 --> 03:24:23,680 HOWEVER THEY HAVE BEEN 4520 03:24:23,680 --> 03:24:25,160 RETROSPECTIVE CHART REVIEWS AND 4521 03:24:25,160 --> 03:24:27,320 QUALITATIVE INQUIRY. 4522 03:24:27,320 --> 03:24:28,880 BECAUSE OF THIS UPTAKE OF 4523 03:24:28,880 --> 03:24:30,720 HORMONE THERAPY IS LOW IN THIS 4524 03:24:30,720 --> 03:24:33,240 POPULATION, DUE TO THIS LACK OF 4525 03:24:33,240 --> 03:24:33,440 DATA. 4526 03:24:33,440 --> 03:24:36,520 WOMEN WITH HIV HAVE A DIFFICULT 4527 03:24:36,520 --> 03:24:37,840 TIME DISTINGUISHES SYMPTOMS OF 4528 03:24:37,840 --> 03:24:39,760 MENOPAUSE FROM SYMPTOMS OF HIV, 4529 03:24:39,760 --> 03:24:42,240 DUE TO POTENTIAL FOR OVERLAP AND 4530 03:24:42,240 --> 03:24:43,920 THIS IS AN IMPORTANT 4531 03:24:43,920 --> 03:24:44,400 CONSIDERATION FOR BOTH 4532 03:24:44,400 --> 03:24:47,800 ASSESSMENT AND TREATMENT OF THIS 4533 03:24:47,800 --> 03:24:48,400 POPULATION. 4534 03:24:48,400 --> 03:24:50,640 THERE IS A GREAT ARTICLE IN THE 4535 03:24:50,640 --> 03:24:52,080 JOURNAL OF MENOPAUSE ON THIS 4536 03:24:52,080 --> 03:24:53,400 DISTINCTION WHICH IS DEFINITELY 4537 03:24:53,400 --> 03:24:54,920 WORTH READING WHEN YOU HAVE 4538 03:24:54,920 --> 03:24:56,880 TIME. 4539 03:24:56,880 --> 03:24:58,640 NEXT SLIDE PLEASE. 4540 03:24:58,640 --> 03:25:04,000 IN CONTEXT OF HOT FLASHES, GRET 4541 03:25:04,000 --> 03:25:05,480 PAPERS HAVE BEEN PUBLISHED 4542 03:25:05,480 --> 03:25:06,400 LOOKING AT CHARACTERISTICS 4543 03:25:06,400 --> 03:25:08,000 ASSOCIATED WITH HOT FLASHES IN 4544 03:25:08,000 --> 03:25:09,640 WOMEN WITH HIV. 4545 03:25:09,640 --> 03:25:11,040 SPECIFICALLY, HOT FLASHES HAVE 4546 03:25:11,040 --> 03:25:14,000 BEEN SHOWN TO NEGATIVELY IMPACT 4547 03:25:14,000 --> 03:25:20,280 ADHERENCE TO LIFE-SAVING 4548 03:25:20,280 --> 03:25:21,840 MEDICATION, OR ANTIRETROVIRAL 4549 03:25:21,840 --> 03:25:22,080 THERAPY. 4550 03:25:22,080 --> 03:25:24,680 IMPAIRED DOMAINS OF FUNCTION AND 4551 03:25:24,680 --> 03:25:25,440 ELEVATED DEPRESSIVE SYMPTOMS, 4552 03:25:25,440 --> 03:25:32,880 ALL IMPORTANT CONSIDERATIONS. 4553 03:25:32,880 --> 03:25:33,320 NEXT SLIDE. 4554 03:25:33,320 --> 03:25:35,200 THERE'S BEEN RESEARCH EXPLORING 4555 03:25:35,200 --> 03:25:36,720 RELATIONSHIP BETWEEN MENOPAUSAL 4556 03:25:36,720 --> 03:25:38,800 HOT FLASHES AND CARDIOVASCULAR 4557 03:25:38,800 --> 03:25:43,440 DISEASE RISK AMONG WOMEN WITHOUT 4558 03:25:43,440 --> 03:25:48,200 HIV LED BY DR. REBECCA THURSTON. 4559 03:25:48,200 --> 03:25:50,240 A RECENT SAMPLE DETERMINED AN 4560 03:25:50,240 --> 03:25:52,000 ASSOCIATION WITH HOT FLASH 4561 03:25:52,000 --> 03:25:54,680 FREQUENCY AND HIGHER LEVELS OF A 4562 03:25:54,680 --> 03:25:55,800 DISTINCT BIOMARKER OF 4563 03:25:55,800 --> 03:25:57,400 INFLAMMATION THAT'S BEEN 4564 03:25:57,400 --> 03:25:58,440 ASSOCIATED WITH CARDIOVASCULAR 4565 03:25:58,440 --> 03:26:00,080 DISEASE AND OTHER CONDITIONS IN 4566 03:26:00,080 --> 03:26:03,000 PEOPLE WITH HIV. 4567 03:26:03,000 --> 03:26:05,600 AND AMONG WOMEN WITH HIV YEARS 4568 03:26:05,600 --> 03:26:15,440 SINCE ONSET OF HOT FLASHES 4569 03:26:15,440 --> 03:26:18,000 RELATED TO DECREASE THE DIE A 4570 03:26:18,000 --> 03:26:22,920 STOLIC FUNCTION. 4571 03:26:22,920 --> 03:26:26,040 IN TERMS OF BONE HEALTH, THERE 4572 03:26:26,040 --> 03:26:28,240 HAVE BEEN SEMINAL STUDIES 4573 03:26:28,240 --> 03:26:28,920 EXPLORING CARDIOVASCULAR INDICES 4574 03:26:28,920 --> 03:26:37,000 IN WOMEN WITH HIV DURING THE 4575 03:26:37,000 --> 03:26:38,280 MENOPAUSE TRANSITION. 4576 03:26:38,280 --> 03:26:39,880 RELEVANT FINDINGS SUGGEST IN 4577 03:26:39,880 --> 03:26:43,040 WOMEN WITH HIV INCREASED WAIST 4578 03:26:43,040 --> 03:26:45,600 CIRCUMFERENCE IS ASSOCIATED WITH 4579 03:26:45,600 --> 03:26:52,520 ADVANCED OVARIAN AGING AND MAY 4580 03:26:52,520 --> 03:26:54,040 ASSOCIATE WITH CLINICAL CVD AND 4581 03:26:54,040 --> 03:26:59,640 INCREASED MARKERS OF IMMUNE 4582 03:26:59,640 --> 03:27:02,000 ACTIVATION. 4583 03:27:02,000 --> 03:27:05,240 WOMEN WITH HIV ARE AT INCREASED 4584 03:27:05,240 --> 03:27:06,360 RISK FOR OSTEOPENIA AND 4585 03:27:06,360 --> 03:27:09,560 OSTEOPOROSIS RELATED TO 4586 03:27:09,560 --> 03:27:10,960 HIV-RELATED FACTORS AND HAVE 4587 03:27:10,960 --> 03:27:12,440 HIGHER PREVALENCE OF THESE 4588 03:27:12,440 --> 03:27:17,320 INDICES IN THE MENOPAUSE 4589 03:27:17,320 --> 03:27:18,840 TRANSITION, AND HIV FACTORS THAT 4590 03:27:18,840 --> 03:27:20,360 RELATE AND ASSOCIATE WITH 4591 03:27:20,360 --> 03:27:24,120 REDUCED BONE MINERAL DENSITY IN 4592 03:27:24,120 --> 03:27:26,720 THIS POPULATION INCLUDE A LOW CD 4593 03:27:26,720 --> 03:27:32,600 4 COUNT, HISTORY OF LOW WEIGHT, 4594 03:27:32,600 --> 03:27:34,480 CERTAIN ANTIRETROVIRAL 4595 03:27:34,480 --> 03:27:36,840 MEDICATION THAT MAY IMPACT BONE 4596 03:27:36,840 --> 03:27:39,280 TURNOVER AND VITAMIN D 4597 03:27:39,280 --> 03:27:39,600 ABSORPTION. 4598 03:27:39,600 --> 03:27:43,880 BOTH ARE ASSOCIATED WITH HIV AND 4599 03:27:43,880 --> 03:27:44,960 MENOPAUSE PARTICULAR ATTENTION 4600 03:27:44,960 --> 03:27:46,600 ON RISK REDUCING BEHAVIOR AND 4601 03:27:46,600 --> 03:27:47,520 ASSESSMENT AND TREATMENT AMONG 4602 03:27:47,520 --> 03:27:50,760 THE GROWING NUMBER OF WOMEN WITH 4603 03:27:50,760 --> 03:27:52,200 HIV APPROACHING OR EXPERIENCING 4604 03:27:52,200 --> 03:27:55,920 MENOPAUSE IS WARRANTED. 4605 03:27:55,920 --> 03:27:57,760 NEXT SLIDE. 4606 03:27:57,760 --> 03:28:01,600 SO, I PROVIDED A SURFACE LEVEL 4607 03:28:01,600 --> 03:28:02,320 UNDERSTANDING. 4608 03:28:02,320 --> 03:28:04,480 WHAT ARE THE NEXT STEPS? 4609 03:28:04,480 --> 03:28:07,560 INDEED MORE RESEARCH IS NEEDED 4610 03:28:07,560 --> 03:28:10,000 TO EXPLORE ALL ASPECTS OF THE 4611 03:28:10,000 --> 03:28:11,640 TRANSITION IN THIS SPECIAL 4612 03:28:11,640 --> 03:28:13,440 POPULATION, ESPECIALLY RESEARCH 4613 03:28:13,440 --> 03:28:15,520 LOOKING AT TREATMENT MODALITIES 4614 03:28:15,520 --> 03:28:17,120 SUCH AS HORMONE REPLACEMENT 4615 03:28:17,120 --> 03:28:19,360 THERAPY USE, OTHER THERAPIES TO 4616 03:28:19,360 --> 03:28:20,560 ENHANCE THE WELLNESS OF WOMEN 4617 03:28:20,560 --> 03:28:24,240 WITH HIV DURING THE MENOPAUSE 4618 03:28:24,240 --> 03:28:25,840 TRANSITION, IMPROVING CONDITIONS 4619 03:28:25,840 --> 03:28:27,600 ASSOCIATED WITH ESTROGEN LOSS 4620 03:28:27,600 --> 03:28:29,720 AND SYMPTOM BURDEN. 4621 03:28:29,720 --> 03:28:31,160 ALSO, INNOVATIVE EDUCATION 4622 03:28:31,160 --> 03:28:35,720 STRATEGIES ARE NEEDED FOR BOTH 4623 03:28:35,720 --> 03:28:36,840 PATIENTS AND PROVIDERS. 4624 03:28:36,840 --> 03:28:39,440 ESPECIALLY DUE TO THE MYRIAD 4625 03:28:39,440 --> 03:28:41,160 SOCIAL CONCERNS THAT THIS 4626 03:28:41,160 --> 03:28:42,400 POPULATION EXPERIENCES AS I 4627 03:28:42,400 --> 03:28:45,480 OUTLINED IN THE BEGINNING OF 4628 03:28:45,480 --> 03:28:48,080 THIS PRESENTATION. 4629 03:28:48,080 --> 03:28:53,680 PROVIDERS MUST PAY ATTENTION TO 4630 03:28:53,680 --> 03:28:56,160 SOCIAL CONCERNS INCLUDING 4631 03:28:56,160 --> 03:28:57,600 SUBSTANCE USE DISORDER, DOMESTIC 4632 03:28:57,600 --> 03:29:01,520 VIOLENCE, WHICH MAY VARY, TO 4633 03:29:01,520 --> 03:29:01,920 PROVIDE CARE. 4634 03:29:01,920 --> 03:29:04,600 DRAWING FROM THE STORY I SHARED 4635 03:29:04,600 --> 03:29:05,840 AT THE BEGINNING, IT'S IMPORTANT 4636 03:29:05,840 --> 03:29:08,800 TO ASK PATIENTS IF THEY 4637 03:29:08,800 --> 03:29:10,840 UNDERSTAND WHAT MENOPAUSE IS, 4638 03:29:10,840 --> 03:29:12,800 COMMON SYMPTOMS, ESPECIALLY MOOD 4639 03:29:12,800 --> 03:29:15,080 FLUCTUATION AND DISTURBANCE, HOT 4640 03:29:15,080 --> 03:29:17,480 FLASHES, WHY THEY OCCUR, HAVE AN 4641 03:29:17,480 --> 03:29:19,600 OPEN DISCUSSION WITH WOMEN WITH 4642 03:29:19,600 --> 03:29:22,760 HIV ABOUT TRADITIONAL AND 4643 03:29:22,760 --> 03:29:23,320 ALTERNATIVE INTERVENTION FOR 4644 03:29:23,320 --> 03:29:24,320 SYMPTOM MANAGEMENT. 4645 03:29:24,320 --> 03:29:25,760 FOR MOOD SYMPTOMS IF A PATIENT 4646 03:29:25,760 --> 03:29:28,640 IS ALREADY RECEIVING TREATMENT 4647 03:29:28,640 --> 03:29:30,560 FOR DEPRESSION, ANXIETY, SLEEP, 4648 03:29:30,560 --> 03:29:32,000 RECOGNIZING THAT IN THIS 4649 03:29:32,000 --> 03:29:33,680 POPULATION TREATMENT MAY NEED TO 4650 03:29:33,680 --> 03:29:36,000 BE MODIFIED OR ENHANCED DURING 4651 03:29:36,000 --> 03:29:38,160 THE MENOPAUSE TRANSITION WHEN 4652 03:29:38,160 --> 03:29:40,600 SYMPTOMS MAY INTENSIFY. 4653 03:29:40,600 --> 03:29:43,240 PROVIDER EDUCATION IS NEEDED TO 4654 03:29:43,240 --> 03:29:44,080 ENHANCE KNOWLEDGE AND IMPROVE 4655 03:29:44,080 --> 03:29:45,400 DELIVERY OF CARE AND EDUCATION 4656 03:29:45,400 --> 03:29:47,000 FOR WOMEN WITH HIV. 4657 03:29:47,000 --> 03:29:49,560 THERE IS AN EVOLVING NEED TO 4658 03:29:49,560 --> 03:29:50,440 EDUCATE INFECTIOUS DISEASE 4659 03:29:50,440 --> 03:29:53,440 PROVIDERS REGARDING CARE OF 4660 03:29:53,440 --> 03:29:54,960 MID-LIFE WOMEN, PARTICULARLY 4661 03:29:54,960 --> 03:29:58,640 ASSESSMENT OF MENOPAUSE SYMPTOMS 4662 03:29:58,640 --> 03:30:02,320 AND COMORBID CONDITIONS DURING 4663 03:30:02,320 --> 03:30:04,960 MENOPAUSE AND SUPPORT EDUCATION 4664 03:30:04,960 --> 03:30:07,600 FOR WOMEN WITH HIV. 4665 03:30:07,600 --> 03:30:09,560 WOMEN'S HEALTH PROVIDERS MAY 4666 03:30:09,560 --> 03:30:11,320 NEED SUPPORT AND EDUCATION ON 4667 03:30:11,320 --> 03:30:12,760 HIV SPECIFIC FACTORS IMPORTANT 4668 03:30:12,760 --> 03:30:15,600 TO CONSIDER AND UNIQUE TO 4669 03:30:15,600 --> 03:30:17,840 NON-HIV INFECTED WOMEN AT 4670 03:30:17,840 --> 03:30:18,640 MID-LIFE, OCCURRING THROUGH 4671 03:30:18,640 --> 03:30:21,080 SYMPOSIA LIKE THIS AND CREATION 4672 03:30:21,080 --> 03:30:22,560 OF INNOVATIVE EDUCATION 4673 03:30:22,560 --> 03:30:23,360 OPPORTUNITIES TO BRING 4674 03:30:23,360 --> 03:30:24,920 CLINICIANS TOGETHER WITH WOMEN 4675 03:30:24,920 --> 03:30:28,160 WITH HIV TO ENHANCE LEARNING. 4676 03:30:28,160 --> 03:30:30,280 MORE WORK NEEDS TO BE DONE. 4677 03:30:30,280 --> 03:30:32,080 IT'S ALREADY STARTED TODAY 4678 03:30:32,080 --> 03:30:33,800 THROUGH THIS AMAZING SYMPOSIUM 4679 03:30:33,800 --> 03:30:34,800 BRINGING US TOGETHER TO SHARE 4680 03:30:34,800 --> 03:30:36,200 KNOWLEDGE TO IMPROVE HEALTH OF 4681 03:30:36,200 --> 03:30:39,320 ALL WOMEN. 4682 03:30:39,320 --> 03:30:39,720 NEXT SLIDE PLEASE. 4683 03:30:39,720 --> 03:30:41,640 I'D LIKE TO THANK YOU FOR YOUR 4684 03:30:41,640 --> 03:30:42,560 TIME AND ATTENTION. 4685 03:30:42,560 --> 03:30:44,360 I SHARED MY PERSONAL E-MAIL AND 4686 03:30:44,360 --> 03:30:45,640 WOULD BE HAPPY TO HEAR FROM 4687 03:30:45,640 --> 03:30:47,480 ANYONE AT THE END OF THE PANEL 4688 03:30:47,480 --> 03:30:48,960 DISCUSSION AND OFFLINE WHEN THIS 4689 03:30:48,960 --> 03:30:49,760 IS COMPLETED. 4690 03:30:49,760 --> 03:30:55,800 THANK YOU VERY MUCH. 4691 03:30:55,800 --> 03:31:06,360 >> THANK YOU FOR THE EXCELLENT 4692 03:31:10,640 --> 03:31:10,880 PRESENTATION. 4693 03:31:10,880 --> 03:31:16,320 DR. HARLOW FROM UNIVERSITY OF 4694 03:31:16,320 --> 03:31:20,960 MICHIGAN. 4695 03:31:20,960 --> 03:31:22,360 >> THANK YOU. 4696 03:31:22,360 --> 03:31:25,000 TODAY I'LL TALK ABOUT THE SOCIAL 4697 03:31:25,000 --> 03:31:27,440 DETERMINANTS OF DISPARITIES IN 4698 03:31:27,440 --> 03:31:28,400 MENOPAUSE AND MID-LIFE HEALTH, 4699 03:31:28,400 --> 03:31:29,800 GROWING INSIGHT FROM STUDY OF 4700 03:31:29,800 --> 03:31:35,440 WOMEN'S HEALTH ACROSS THE NATION 4701 03:31:35,440 --> 03:31:37,880 IN RELATIONSHIP TO BLACK/WHITE 4702 03:31:37,880 --> 03:31:43,720 HEALTH DISPARITIES. 4703 03:31:43,720 --> 03:31:49,840 IT'S NOT MOVING DOWN. 4704 03:31:49,840 --> 03:31:50,960 INITIALLY I WOULD LIKE TO BEGIN 4705 03:31:50,960 --> 03:31:53,720 WITH DISCUSSION OF THE SOCIAL 4706 03:31:53,720 --> 03:31:55,520 HISTORICAL CONTEXT OF SWAN AND 4707 03:31:55,520 --> 03:31:58,720 LIFE CONTEXT OF BLACK AND WHITE 4708 03:31:58,720 --> 03:32:01,120 SWAN PARTICIPANTS BECAUSE 4709 03:32:01,120 --> 03:32:04,400 ALTHOUGH STUDIES ARE CONDUCTED 4710 03:32:04,400 --> 03:32:05,680 IN SPECIFIC GEOGRAPHIES, 4711 03:32:05,680 --> 03:32:07,840 SPECIFIC CONTEXTS, THEY OFTEN 4712 03:32:07,840 --> 03:32:11,280 FAIL TO PROPERLY SITUATE AND 4713 03:32:11,280 --> 03:32:12,920 CONSIDER IMPLICATIONS OF LIFE 4714 03:32:12,920 --> 03:32:15,000 CONTACTS FOR THOUGHTS AND 4715 03:32:15,000 --> 03:32:16,080 RESEARCH FINDINGS. 4716 03:32:16,080 --> 03:32:19,640 I WILL NEXT PRESENT SOME OF THE 4717 03:32:19,640 --> 03:32:21,640 DATA ON BLACK-WHITE DISPARITIES 4718 03:32:21,640 --> 03:32:24,360 FROM SOMEONE RELATED TO 4719 03:32:24,360 --> 03:32:25,800 MENOPAUSE AND MID-LIFE HEALTH 4720 03:32:25,800 --> 03:32:28,520 AND SUGGEST THREE CRITICAL GAPS 4721 03:32:28,520 --> 03:32:29,160 IN SCIENTIFIC UNDERSTANDING OF 4722 03:32:29,160 --> 03:32:32,680 MENOPAUSE THAT SHOULD INFORM OUR 4723 03:32:32,680 --> 03:32:39,840 FUTURE RESEARCH AGENDA. 4724 03:32:39,840 --> 03:32:42,560 AS PREVIOUSLY STATED, WOMEN IN 4725 03:32:42,560 --> 03:32:44,880 SWAN WERE 42 TO 52 WHEN ENROLLED 4726 03:32:44,880 --> 03:32:45,960 IN THE COHORT. 4727 03:32:45,960 --> 03:32:48,640 THEREFORE THEY WERE BORN BETWEEN 4728 03:32:48,640 --> 03:32:49,480 1944 AND 1954. 4729 03:32:49,480 --> 03:32:53,800 AT THAT TIME IN THE UNITED 4730 03:32:53,800 --> 03:32:57,360 STATES JIM CROWE LAWS SANCTIONED 4731 03:32:57,360 --> 03:33:00,360 RACIAL DISCRIMINATION LEADING TO 4732 03:33:00,360 --> 03:33:01,560 SEGREGATION IN HOUSING, HEALTH 4733 03:33:01,560 --> 03:33:02,160 CARE. 4734 03:33:02,160 --> 03:33:05,040 WHICH ALSO LED TO DIFFERENTIAL 4735 03:33:05,040 --> 03:33:10,200 ACCESS TO QUALITY HOUSING, FEWER 4736 03:33:10,200 --> 03:33:11,480 EMPLOYMENT OPPORTUNITIES, POOR 4737 03:33:11,480 --> 03:33:14,120 QUALITY EDUCATION, AND BARRIERS 4738 03:33:14,120 --> 03:33:16,840 TO HEALTH CARE FOR BLACK 4739 03:33:16,840 --> 03:33:19,480 CITIZENS, ALSO CREATING A 4740 03:33:19,480 --> 03:33:23,760 CLIMATE OF TERROR. 4741 03:33:23,760 --> 03:33:32,440 IN 1964 THE CIVIL RIGHTS LAW 4742 03:33:32,440 --> 03:33:35,200 OUTLAWED THIS. 4743 03:33:35,200 --> 03:33:36,760 DISPARITIES IN EDUCATION WERE 4744 03:33:36,760 --> 03:33:38,240 OPPORTUNITIES AND ACCESS TO 4745 03:33:38,240 --> 03:33:41,760 HEALTH CARE CONTINUED, CONTINUED 4746 03:33:41,760 --> 03:33:42,680 TO EXIST. 4747 03:33:42,680 --> 03:33:43,720 TO PERSIST. 4748 03:33:43,720 --> 03:33:45,640 WE DID KNOT DIRECTLY MEASURE 4749 03:33:45,640 --> 03:33:52,240 STRUCTURAL RACISM IN SWAN WE CAN 4750 03:33:52,240 --> 03:33:54,040 EXAMINE BLACK-WHITE DIFFERENCES 4751 03:33:54,040 --> 03:33:56,360 THAT REFLECT PERVASIVE AND 4752 03:33:56,360 --> 03:33:57,040 PERSISTENT INEQUITIES STEMMING 4753 03:33:57,040 --> 03:34:00,320 FROM SYSTEMIC RACISM IN THE 4754 03:34:00,320 --> 03:34:01,880 UNITED STATES. 4755 03:34:01,880 --> 03:34:08,360 SO IN THIS SLIDE, DOCUMENTING 4756 03:34:08,360 --> 03:34:11,200 SOCIOECONOMIC DISADVANTAGE OF 4757 03:34:11,200 --> 03:34:12,560 BLACK WOMEN AT BASELINE, LESS 4758 03:34:12,560 --> 03:34:17,160 LIKELY TO HAVE A COLLEGE DEGREE, 4759 03:34:17,160 --> 03:34:19,240 MORE LIKELY TO REPORT FINANCIAL 4760 03:34:19,240 --> 03:34:20,600 STRAIN, LESS LIKELY TO BE 4761 03:34:20,600 --> 03:34:23,520 EMPLOYED, MORE LIKELY TO REPORT 4762 03:34:23,520 --> 03:34:24,720 CHILDHOOD DISADVANTAGE 4763 03:34:24,720 --> 03:34:26,080 CHARACTERIZED BY GREATER 4764 03:34:26,080 --> 03:34:30,000 PREVALENCE OF LOW PARENTAL 4765 03:34:30,000 --> 03:34:32,520 EDUCATION, HAVING RECEIVED 4766 03:34:32,520 --> 03:34:33,840 PUBLIC ASSISTANCE, HAD 4767 03:34:33,840 --> 03:34:35,520 DIFFICULTIES PAYING FOR FOOD OR 4768 03:34:35,520 --> 03:34:36,080 RENT. 4769 03:34:36,080 --> 03:34:37,360 BLACK WOMEN WERE LESS LIKELY TO 4770 03:34:37,360 --> 03:34:44,720 BE MARRIED, MORE LIKELY TO HAVE 4771 03:34:44,720 --> 03:34:45,800 CHILDREN. 4772 03:34:45,800 --> 03:34:49,400 MORE CURRENT SMOKERS. 4773 03:34:49,400 --> 03:34:50,360 WE ASSESSED ENVIRONMENTAL 4774 03:34:50,360 --> 03:34:55,080 ESTROGENS IN A SUBSET OF SWAN 4775 03:34:55,080 --> 03:34:57,280 PARTICIPANTS AND EXPOSURE 4776 03:34:57,280 --> 03:34:58,800 DIFFERS BY GEOGRAPHY AND 4777 03:34:58,800 --> 03:34:59,160 RACE/ETHNICITY. 4778 03:34:59,160 --> 03:35:02,240 IN SWAN, BLACK WOMEN IN THE 4779 03:35:02,240 --> 03:35:03,080 SOUTHEAST MICHIGAN, PITTSBURGH 4780 03:35:03,080 --> 03:35:06,080 AND BOSTON SIDES HAD HIGHEST 4781 03:35:06,080 --> 03:35:08,440 PFOS CONCENTRATIONS, AND THIS 4782 03:35:08,440 --> 03:35:09,520 GRAPH SHOWS SPECIFICALLY BLACK 4783 03:35:09,520 --> 03:35:12,160 WOMEN REPRESENTED BY THE ORANGE 4784 03:35:12,160 --> 03:35:15,280 BARS HAD HIGHER BLOOD 4785 03:35:15,280 --> 03:35:16,560 CONCENTRATIONS OF THE PFOS THAN 4786 03:35:16,560 --> 03:35:27,040 WHITE WOMEN IN THE GREEN BARS. 4787 03:35:39,560 --> 03:35:46,360 AS WELL AS TROUBLE WITH THE 4788 03:35:46,360 --> 03:35:47,080 EXPERIENCE, EXPERIENCE OF 4789 03:35:47,080 --> 03:35:48,800 VIOLENCE, SWAN WAS AN EARLY 4790 03:35:48,800 --> 03:35:51,400 ADOPTER OF MEASURES OF 4791 03:35:51,400 --> 03:35:53,200 DISCRIMINATION, WE USE THE 4792 03:35:53,200 --> 03:35:54,840 10-ITEM EVERYDAY DISCRIMINATION 4793 03:35:54,840 --> 03:35:56,200 SCALE THAT FRAMES EXPERIENCE 4794 03:35:56,200 --> 03:35:58,880 WITHOUT REFERENCE TO RACE, WITH 4795 03:35:58,880 --> 03:36:05,920 EACH ITEM ON THE 4-POINT SCALE. 4796 03:36:05,920 --> 03:36:08,680 AVERAGE IS HIGHER FOR BLACK 4797 03:36:08,680 --> 03:36:11,400 WOMEN AT EACH ITEM, TOTAL SCORE 4798 03:36:11,400 --> 03:36:14,400 HIGHER IN BLACK THAN WHITE 4799 03:36:14,400 --> 03:36:14,920 WOMEN. 4800 03:36:14,920 --> 03:36:16,720 WHEN ASKED THE REASON THE MOST 4801 03:36:16,720 --> 03:36:20,520 COMMON REPORTED BY BLACKS WAS 4802 03:36:20,520 --> 03:36:21,960 RACE, 57%. 4803 03:36:21,960 --> 03:36:26,800 FOR WHITE IT WAS GENDER, 23% OF 4804 03:36:26,800 --> 03:36:27,920 WHITE WOMEN. 4805 03:36:27,920 --> 03:36:34,040 MOVING ON TO DISCUSS DISPARITIES 4806 03:36:34,040 --> 03:36:35,640 WE'VE SEEN, ONE QUESTION SWAN 4807 03:36:35,640 --> 03:36:38,680 ADDRESSED IS WHETHER 4808 03:36:38,680 --> 03:36:47,680 RACE/ETHNICITY IMPACTS AGE AT 4809 03:36:47,680 --> 03:36:49,200 FINAL MENSTRUAL PERIOD. 4810 03:36:49,200 --> 03:36:55,000 THIS INDICATES WHEN 50% OF GROUP 4811 03:36:55,000 --> 03:36:56,720 APPEARED FINAL PERIOD. 4812 03:36:56,720 --> 03:36:57,760 HISPANICS AND AFRICAN AMERICANS 4813 03:36:57,760 --> 03:37:00,400 REACHED FINAL MENSTRUAL PERIOD 4814 03:37:00,400 --> 03:37:06,040 AT EARLIER AGE THAN WOMEN IN 4815 03:37:06,040 --> 03:37:07,520 OTHER GROUPS. 4816 03:37:07,520 --> 03:37:08,960 IMPORTANTLY COMPARED TO WHITE 4817 03:37:08,960 --> 03:37:10,640 PARTICIPANTS BLACK PARTICIPANTS 4818 03:37:10,640 --> 03:37:12,480 HAVE LESS EDUCATION, GREATER 4819 03:37:12,480 --> 03:37:15,600 FINANCIAL STRAIN, GREATER 4820 03:37:15,600 --> 03:37:18,760 CIGARETTE USE, MORE 4821 03:37:18,760 --> 03:37:20,080 UNEMPLOYMENT, HIGHER EXPOSURE TO 4822 03:37:20,080 --> 03:37:21,720 PFOS ASSOCIATED WITH EARLIER AGE 4823 03:37:21,720 --> 03:37:24,000 OF MENOPAUSE AS WELL AS DIABETES 4824 03:37:24,000 --> 03:37:33,400 WHICH I'LL SHOW DATA ON SHORTLY. 4825 03:37:33,400 --> 03:37:35,440 AFTER ADJUSTMENTS FOR THE 4826 03:37:35,440 --> 03:37:37,360 LIFESTYLE AND SES, ETHNICITY WAS 4827 03:37:37,360 --> 03:37:39,040 NOT INDEPENDENTLY ASSOCIATED 4828 03:37:39,040 --> 03:37:42,840 WITH AGE AT MENOPAUSE BUT THESE 4829 03:37:42,840 --> 03:37:45,640 DO CLUSTER IN THE AFRICAN 4830 03:37:45,640 --> 03:37:46,280 AMERICAN POPULATION. 4831 03:37:46,280 --> 03:37:50,320 WHEN WE LOOK AT MEDIAN AGE AT 4832 03:37:50,320 --> 03:37:52,920 MENOPAUSE WE HAVE TO UNDERSTAND 4833 03:37:52,920 --> 03:38:03,400 BLEAK WOMEN EXPERIENCE EARLIER 4834 03:38:06,800 --> 03:38:08,440 MENOPAUSE, 52.2 VERSUS 52.9, 4835 03:38:08,440 --> 03:38:10,640 REDUCED IF ONE TAKES INTO 4836 03:38:10,640 --> 03:38:13,520 ACCOUNT LIFE AND SOCIAL CONTEXT, 4837 03:38:13,520 --> 03:38:16,320 LIFE CONTEXT AND SOCIAL 4838 03:38:16,320 --> 03:38:18,280 DISADVANTAGE AND OBESITY 4839 03:38:18,280 --> 03:38:21,720 EXPERIENCED BY BLACK AND WHITE 4840 03:38:21,720 --> 03:38:22,280 WOMEN. 4841 03:38:22,280 --> 03:38:25,160 BLACK WOMEN TWICE AS LIKELY TO 4842 03:38:25,160 --> 03:38:27,160 HAVE SURGICAL MENOPAUSE, AN 4843 03:38:27,160 --> 03:38:28,800 IMPORTANT CAUSE FOR SELECTION 4844 03:38:28,800 --> 03:38:33,560 BIAS INTO THE SWAN COHORT. 4845 03:38:33,560 --> 03:38:38,240 A RECENT ANALYSIS BY ALEXIS 4846 03:38:38,240 --> 03:38:40,240 REEVES, IN ADDITION TO LIFE 4847 03:38:40,240 --> 03:38:45,560 CONTEXT AND SOCIAL DISADVANTAGE 4848 03:38:45,560 --> 03:38:47,480 VARIABLES, DOCUMENTED ACCOUNTING 4849 03:38:47,480 --> 03:38:49,960 FOR THESE VARIABLES, BLACK WOMEN 4850 03:38:49,960 --> 03:38:53,960 HAVE A SEVEN-MONTH EARLIER AGE 4851 03:38:53,960 --> 03:38:55,480 OF MENOPAUSE. 4852 03:38:55,480 --> 03:38:59,920 MOVING ON TO LOOK AT HOT 4853 03:38:59,920 --> 03:39:01,400 FLASHES, THE SWAN MENSTRUAL 4854 03:39:01,400 --> 03:39:03,520 CALENDAR COLLECTED REPORTS 4855 03:39:03,520 --> 03:39:05,240 MONTHLY WHETHER WOMEN 4856 03:39:05,240 --> 03:39:07,160 EXPERIENCED HOT FLASHES FOR TEN 4857 03:39:07,160 --> 03:39:07,360 YEARS. 4858 03:39:07,360 --> 03:39:10,000 THIS GRAPH SHOWS PERCENT OF 4859 03:39:10,000 --> 03:39:13,320 WOMEN REPORTING HOT FLASH INDEX 4860 03:39:13,320 --> 03:39:15,640 ON FMP TIME WITH RED BAR BEING 4861 03:39:15,640 --> 03:39:18,480 TIME OF FMP. 4862 03:39:18,480 --> 03:39:19,920 RED VERTICAL BAR. 4863 03:39:19,920 --> 03:39:24,280 AS YOU CAN SEE, ABOUT 10 TO 20% 4864 03:39:24,280 --> 03:39:29,080 OF WOMEN REPORT HOT FLASHES LONG 4865 03:39:29,080 --> 03:39:30,520 BEFORE ONSET OF MENOPAUSAL 4866 03:39:30,520 --> 03:39:32,920 TRANSITION, 8 YEARS BEFORE, 4867 03:39:32,920 --> 03:39:41,080 REPORTING INCREASE AS WOMEN MOVE 4868 03:39:41,080 --> 03:39:42,280 ACROSS MENOPAUSAL TRANSITION, 4869 03:39:42,280 --> 03:39:49,400 JUMPS AFTER FMP, WOMEN WERE 4870 03:39:49,400 --> 03:39:49,640 UNAWARE. 4871 03:39:49,640 --> 03:39:51,080 THE SAME GRAPH SORTED BY RACE 4872 03:39:51,080 --> 03:39:51,960 AND ETHNICITY. 4873 03:39:51,960 --> 03:39:55,560 BLACK WOMEN IN GREEN REPORTED 4874 03:39:55,560 --> 03:39:58,720 HIGHER PROBABILITIES ACROSS 4875 03:39:58,720 --> 03:40:00,840 TIME, PRE-MENOPAUSEALLY, DURING 4876 03:40:00,840 --> 03:40:03,720 TRANSITION, AND 4877 03:40:03,720 --> 03:40:04,160 POST-MENOPAUSEALLY. 4878 03:40:04,160 --> 03:40:06,480 WITH EVEN PRE-MENOPAUSAL, 20 TO 4879 03:40:06,480 --> 03:40:09,640 30% PROBABILITY OF REPORTING HOT 4880 03:40:09,640 --> 03:40:10,520 FLASH. 4881 03:40:10,520 --> 03:40:14,160 SWAN HAS LOOKED AT THIS QUESTION 4882 03:40:14,160 --> 03:40:15,560 EXTENSIVELY AND DOCUMENTED 4883 03:40:15,560 --> 03:40:18,240 SEVERAL WAYS WHICH BLACK WOMEN 4884 03:40:18,240 --> 03:40:25,640 SEE BURDEN EXCEEDING THAT OF 4885 03:40:25,640 --> 03:40:30,040 WHITE WOMEN. 4886 03:40:30,040 --> 03:40:31,800 INCIDENTS OF VASOMOTOR SYMPTOMS 4887 03:40:31,800 --> 03:40:36,040 GREATER IN BLACK WOMEN, GREEN 4888 03:40:36,040 --> 03:40:38,160 LINE, THAN WHITE PARTICIPANTS IN 4889 03:40:38,160 --> 03:40:42,320 THE BLACK LINE OR OTHER WOMEN AT 4890 03:40:42,320 --> 03:40:49,680 ANY STAGE OF THE TRANSITION. 4891 03:40:49,680 --> 03:40:51,600 WE'VE LEARNED FROM SWAN HOT 4892 03:40:51,600 --> 03:40:54,480 FLASHES LAST MUCH LONGER THAN 4893 03:40:54,480 --> 03:40:55,600 PREVIOUSLY BELIEVED. 4894 03:40:55,600 --> 03:40:57,120 BLACK WOMEN EXPERIENCE ON 4895 03:40:57,120 --> 03:40:59,240 AVERAGE 10 YEARS, COMPARED TO 4896 03:40:59,240 --> 03:41:01,800 6.5 IN WHITE WOMEN. 4897 03:41:01,800 --> 03:41:03,000 LOWER EDUCATIONAL ATTAINMENT, 4898 03:41:03,000 --> 03:41:04,840 GREATER PERCEIVED STRESS WERE 4899 03:41:04,840 --> 03:41:08,400 RELATED TO LONGER DURATION OF 4900 03:41:08,400 --> 03:41:09,760 VMS, DESPITE SYMPTOM BURDEN 4901 03:41:09,760 --> 03:41:14,800 BLACK WOMEN, HALF AS LIKELY AS 4902 03:41:14,800 --> 03:41:17,400 WHITE WOMEN TO USE HT. 4903 03:41:17,400 --> 03:41:19,080 IN THIS LONGITUDINAL TRAJECTORY 4904 03:41:19,080 --> 03:41:22,360 ANALYSIS WOMEN ARE GROUPED BY 4905 03:41:22,360 --> 03:41:25,800 PATTERNS THEY REPORT. 4906 03:41:25,800 --> 03:41:32,600 AGAIN, INDEXED ON FMP TIME, TWO 4907 03:41:32,600 --> 03:41:32,960 GROUPS. 4908 03:41:32,960 --> 03:41:36,240 SYMPTOMS INCREASE AS WOMEN REACH 4909 03:41:36,240 --> 03:41:38,480 FMP, AND DECLINE, ONE WITH 4910 03:41:38,480 --> 03:41:43,880 LOWER, ONE WITH HIGHER LEVEL OF 4911 03:41:43,880 --> 03:41:44,520 SYMPTOMS. 4912 03:41:44,520 --> 03:41:46,080 HOWEVER, 26% OF WOMEN HAVE 4913 03:41:46,080 --> 03:41:47,680 CONSISTENTLY HIGH PROBABILITY OF 4914 03:41:47,680 --> 03:41:49,400 SYMPTOMS FROM LONG BEFORE TO 4915 03:41:49,400 --> 03:41:51,400 LONG AFTER THE FINAL MENSTRUAL 4916 03:41:51,400 --> 03:41:53,480 PERIOD WITH FOURTH GROUP HAVING 4917 03:41:53,480 --> 03:41:57,160 SYMPTOMS HIGH BEFORE, RAPID 4918 03:41:57,160 --> 03:42:03,360 DECLINE POST. 4919 03:42:03,360 --> 03:42:05,280 BLACK WOMEN THREE-FOLD HIGHER 4920 03:42:05,280 --> 03:42:07,120 ODDS THAN WHITE WOMEN. 4921 03:42:07,120 --> 03:42:13,280 WE LOOKED AT CHRONIC 4922 03:42:13,280 --> 03:42:13,760 DISCRIMINATION, AVERAGE 4923 03:42:13,760 --> 03:42:17,080 DISCRIMINATION ACROSS THE SWAN 4924 03:42:17,080 --> 03:42:17,320 VISITS. 4925 03:42:17,320 --> 03:42:23,120 THIS SHOWS INCREASED RISK OR 4926 03:42:23,120 --> 03:42:26,600 ODDS OF VMS, TRAJECTORIES AFTER 4927 03:42:26,600 --> 03:42:32,000 ADJUSTMENT FOR AGE, RACE, 4928 03:42:32,000 --> 03:42:33,880 ETHNICITY, BMI, SMOKING. 4929 03:42:33,880 --> 03:42:36,480 COMPARED TO WOMEN WHO HAD LOW 4930 03:42:36,480 --> 03:42:41,240 LEVEL WITH FMP ONSET, WOMEN WITH 4931 03:42:41,240 --> 03:42:43,040 CONTINUOUSLY HIGH AND DECLINE 4932 03:42:43,040 --> 03:42:47,800 POST FMP HIGH FMP ON SET WERE 4933 03:42:47,800 --> 03:42:49,840 MORE LIKELY TO REPORT BEING IN 4934 03:42:49,840 --> 03:42:52,000 THOSE CATEGORIES WHEN THEY 4935 03:42:52,000 --> 03:42:55,640 REPORTED HIGHER LEVELS OF 4936 03:42:55,640 --> 03:42:58,360 CHRONIC DISCRIMINATION. 4937 03:42:58,360 --> 03:43:01,880 ANOTHER EXAMPLE, SLEEP. 4938 03:43:01,880 --> 03:43:09,640 WHEN WE ASSESS SLEEP USING 4939 03:43:09,640 --> 03:43:10,800 ACTIGRAPHY, WE OBSERVED 4940 03:43:10,800 --> 03:43:14,440 DISPARITIES IN SLEEP QUALITY. 4941 03:43:14,440 --> 03:43:17,040 BLACK WOMEN HAD SHORTER SLEEP, 4942 03:43:17,040 --> 03:43:19,680 40% VERSUS 19% OF WHITE WOMEN. 4943 03:43:19,680 --> 03:43:23,800 BLACK WOMEN HAVE MORE 4944 03:43:23,800 --> 03:43:26,600 INTERRUPTED SLEEP AND TOOK 4945 03:43:26,600 --> 03:43:28,000 LONGER TO FALL ASLEEP. 4946 03:43:28,000 --> 03:43:29,440 WITH EVERYDAY DISCRIMINATION 4947 03:43:29,440 --> 03:43:30,880 ASSOCIATED WITH INCREASED WAKE 4948 03:43:30,880 --> 03:43:33,480 AFTER SLEEP ONSET. 4949 03:43:33,480 --> 03:43:34,960 AND THESE DIFFERENCES PERSIST 4950 03:43:34,960 --> 03:43:37,440 AFTER ADJUSTMENT FOR AGE, USE OF 4951 03:43:37,440 --> 03:43:39,480 SLEEP MEDICATIONS, MEASURES OF 4952 03:43:39,480 --> 03:43:41,920 SOCIAL DISADVANTAGE, INCLUDING 4953 03:43:41,920 --> 03:43:43,360 EDUCATION AND EMPLOYMENT, AND 4954 03:43:43,360 --> 03:43:46,800 WERE MEDIATED BY FINANCIAL 4955 03:43:46,800 --> 03:43:50,680 HARDSHIP, STRESSFUL LIFE EVENTS, 4956 03:43:50,680 --> 03:43:52,200 ACTIVITY, VMS. 4957 03:43:52,200 --> 03:43:53,480 BLACK WHIM ENTERED THE 4958 03:43:53,480 --> 03:43:58,920 TRANSITION WITH A MORE ADVERSE 4959 03:43:58,920 --> 03:44:00,120 CARDIOVASCULAR -- 4960 03:44:00,120 --> 03:44:02,160 CARDIOMETABOLIC HEALTH BURDEN. 4961 03:44:02,160 --> 03:44:05,000 AT ENROLLMENT BLACK WOMEN WERE 4962 03:44:05,000 --> 03:44:07,680 MORE LIKELY TO REPORT POOR 4963 03:44:07,680 --> 03:44:08,720 SELF-REPORTED HEALTH, MORE 4964 03:44:08,720 --> 03:44:11,400 LIKELY TO BE OBESE, MORE LIKELY 4965 03:44:11,400 --> 03:44:13,720 TO HAVE DIABETES, METABOLIC 4966 03:44:13,720 --> 03:44:18,280 SYNDROME, HYPERTENSION, HIGHER 4967 03:44:18,280 --> 03:44:19,840 ALLOSTATIC LOAD, HIGHER 4968 03:44:19,840 --> 03:44:28,720 INCIDENCE AND EARLIER ONSET OF 4969 03:44:28,720 --> 03:44:29,720 CARDIOMETABOLIC DISEASE. 4970 03:44:29,720 --> 03:44:32,120 WE FOUND EVIDENCE OF RISK 4971 03:44:32,120 --> 03:44:34,320 FACTORS BY RACE/ETHNICITY. 4972 03:44:34,320 --> 03:44:36,320 WITH DEPRESSION INCREASED, LOADS 4973 03:44:36,320 --> 03:44:39,760 OF DIABETES IN BLACK BUT NOT 4974 03:44:39,760 --> 03:44:41,160 WHITE WOMEN, DISCRIMINATION 4975 03:44:41,160 --> 03:44:43,760 INCREASED ODDS OF CORONARY 4976 03:44:43,760 --> 03:44:46,640 ARTERY DISEASE IN BLACK WOMEN. 4977 03:44:46,640 --> 03:44:49,040 BLACK WOMEN ONLY DEATHS OF 4978 03:44:49,040 --> 03:44:51,440 FAMILY AND FRIENDS RELATED TO 4979 03:44:51,440 --> 03:44:54,240 CRUET IT IMT. 4980 03:44:54,240 --> 03:44:56,560 WE'VE DOCUMENTED DISPARITIES IN 4981 03:44:56,560 --> 03:44:59,080 TIMING OF REPRODUCTIVE AGING, 4982 03:44:59,080 --> 03:45:00,280 BURDEN OF VMS, OTHER SYMPTOMS, 4983 03:45:00,280 --> 03:45:02,680 AND TIMING AND BURDEN OF 4984 03:45:02,680 --> 03:45:04,240 CARDIOMETABOLIC DISEASE. 4985 03:45:04,240 --> 03:45:07,720 IN SOME INSTANCES THESE 4986 03:45:07,720 --> 03:45:10,960 DISPARITIES COULD BE ACCOUNTED 4987 03:45:10,960 --> 03:45:12,160 FOR BLACK-WHITE DIFFERENCE, 4988 03:45:12,160 --> 03:45:15,240 CLUSTERING OF RISK FACTORS WITH 4989 03:45:15,240 --> 03:45:17,560 SOCIAL DISADVANTAGE, AMONG BLACK 4990 03:45:17,560 --> 03:45:17,920 PARTICIPANTS. 4991 03:45:17,920 --> 03:45:19,520 IN OTHERS, BLACK WOMEN WERE 4992 03:45:19,520 --> 03:45:20,880 DIFFERENTIALLY VULNERABLE TO 4993 03:45:20,880 --> 03:45:23,800 IMPACTS OF DEPRESSION AND 4994 03:45:23,800 --> 03:45:26,280 PSYCHOSOCIAL RISK FACTORS ON 4995 03:45:26,280 --> 03:45:28,840 CARDIOMETABOLIC DISEASE, TO SOME 4996 03:45:28,840 --> 03:45:31,240 EXTENT REFLECTING DIFFERENCE IN 4997 03:45:31,240 --> 03:45:33,400 EXPOSURE PROFILES, AS WELL AS 4998 03:45:33,400 --> 03:45:36,280 SUGGESTING A NEED FOR WITHIN 4999 03:45:36,280 --> 03:45:40,440 RACE ANALYSES TO BE CONDUCTED. 5000 03:45:40,440 --> 03:45:44,680 I'D LIKE TO ADDRESS SOME 5001 03:45:44,680 --> 03:45:46,400 CRITICAL GAPS IN SCIENTIFIC 5002 03:45:46,400 --> 03:45:46,680 KNOWLEDGE. 5003 03:45:46,680 --> 03:45:50,000 FOLLOWING UP ON DR. GREENDALE'S 5004 03:45:50,000 --> 03:45:51,920 COMMENTS, KNOWING YOUR FMP AGE 5005 03:45:51,920 --> 03:45:54,640 DOES MATTER. 5006 03:45:54,640 --> 03:45:59,240 AND WE HAVE UNFINISHED BUSINESS. 5007 03:45:59,240 --> 03:46:00,560 TO UPDATE THE CRITERIA, 5008 03:46:00,560 --> 03:46:02,080 INCORPORATE THE LARGE BODY OF 5009 03:46:02,080 --> 03:46:04,760 INFORMATION WE NOW HAVE ABOUT 5010 03:46:04,760 --> 03:46:07,160 AMH AS CRITICAL MARKER OF THE 5011 03:46:07,160 --> 03:46:10,920 APPROACH OF MENOPAUSE IN THE 5012 03:46:10,920 --> 03:46:12,920 STAGING SYSTEM FOR REPRODUCTIVE 5013 03:46:12,920 --> 03:46:16,160 AGING IN WOMEN. 5014 03:46:16,160 --> 03:46:20,920 CRITICAL FOR UNDERSTANDING WOMEN 5015 03:46:20,920 --> 03:46:22,640 WITH HYSTERECTOMY, AND COULD BE 5016 03:46:22,640 --> 03:46:24,400 QUITE CRITICAL FOR WOMEN WITH 5017 03:46:24,400 --> 03:46:32,160 CHRONIC DISEASE AND HIV. 5018 03:46:32,160 --> 03:46:35,640 AND IN ADDITION, WE DO NEED TO 5019 03:46:35,640 --> 03:46:37,600 DEVELOP A VALIDATED 5020 03:46:37,600 --> 03:46:40,400 QUESTIONNAIRE THAT CAN IDENTIFY 5021 03:46:40,400 --> 03:46:44,320 ONSET OF EARLY AND LATE 5022 03:46:44,320 --> 03:46:44,720 TRANSITION. 5023 03:46:44,720 --> 03:46:47,760 SECOND, WE NEED TO HAVE MORE 5024 03:46:47,760 --> 03:46:49,640 DISCUSSION AND INVESTIGATION 5025 03:46:49,640 --> 03:46:52,240 INTO WHETHER HOT FLASHES WOMEN 5026 03:46:52,240 --> 03:47:01,920 ARE REPORTING ARE INDEED 5027 03:47:01,920 --> 03:47:02,880 MENOPAUSAL. 5028 03:47:02,880 --> 03:47:08,040 WE NEED TO ASK ARE THESE WOMEN 5029 03:47:08,040 --> 03:47:11,000 WITH SUSTAINED HIGH HOT FLASHES 5030 03:47:11,000 --> 03:47:12,520 EXPERIENCING MENOPAUSAL HOT 5031 03:47:12,520 --> 03:47:14,200 FLASHES OR DO THEY BEGIN BEFORE 5032 03:47:14,200 --> 03:47:18,800 AND CONTINUE AFTER HAVE A 5033 03:47:18,800 --> 03:47:19,240 DIFFERENT ETIOLOGY? 5034 03:47:19,240 --> 03:47:24,840 WE SEE THE SAME GRAPH OF 5035 03:47:24,840 --> 03:47:26,560 MULTI-REPORTS OF HOT FLASHES, IN 5036 03:47:26,560 --> 03:47:30,160 RED, NO USE IN BLUE. 5037 03:47:30,160 --> 03:47:32,640 NOTABLY HT USERS ARE LESS LIKELY 5038 03:47:32,640 --> 03:47:35,680 TO REPORT HOT FLASHES AFTER FMP, 5039 03:47:35,680 --> 03:47:39,240 HT HAD MUCH LESS OR LITTLE 5040 03:47:39,240 --> 03:47:44,040 EFFECT ON REPORT OF HOT FLASHES 5041 03:47:44,040 --> 03:47:45,680 PRIOR TO FMP. 5042 03:47:45,680 --> 03:47:47,760 THAT RAISES THE QUESTION WERE 5043 03:47:47,760 --> 03:47:49,800 HOT FLASHES IN EARLY TRANSITION 5044 03:47:49,800 --> 03:47:52,760 STAGE ARE MENOPAUSAL OR DO THEY 5045 03:47:52,760 --> 03:47:53,720 HAVE DIFFERENT ETIOLOGY? 5046 03:47:53,720 --> 03:47:58,160 IT RAISES THE QUESTION TO WHAT 5047 03:47:58,160 --> 03:48:00,560 EXTENT IS HORMONE THERAPY 5048 03:48:00,560 --> 03:48:03,360 EFFECTIVE TREATMENT FOR 5049 03:48:03,360 --> 03:48:06,960 PRE-MENOPAUSAL VMS, IF NOT DO 5050 03:48:06,960 --> 03:48:08,000 RISKS OUTWEIGH THE BENEFITS. 5051 03:48:08,000 --> 03:48:10,720 I WOULD LIKE TO ADDRESS THE 5052 03:48:10,720 --> 03:48:12,560 QUESTION, WHERE IS THE SCIENCE 5053 03:48:12,560 --> 03:48:19,480 ON BLEEDING AND MENOPAUSE IN OUR 5054 03:48:19,480 --> 03:48:19,760 STUDIES? 5055 03:48:19,760 --> 03:48:22,680 IT WAS INTERESTING TO ME IN THE 5056 03:48:22,680 --> 03:48:23,960 MANY, MANY JOURNALISTS I'VE 5057 03:48:23,960 --> 03:48:25,320 SPOKEN TO SINCE THE PUBLICATION 5058 03:48:25,320 --> 03:48:30,160 OF OUR ARTICLE ON THE 5059 03:48:30,160 --> 03:48:31,400 BLACK-WHITE DISPARITIES, NOT ONE 5060 03:48:31,400 --> 03:48:32,960 HAS ASKED ABOUT OR EXPRESSED 5061 03:48:32,960 --> 03:48:36,160 INTEREST IN WHEN I MENTIONED THE 5062 03:48:36,160 --> 03:48:37,360 PROBLEM OF EXCESSIVE BLEEDING OR 5063 03:48:37,360 --> 03:48:40,360 ISSUE OF THE IMPACT OF BLEEDING 5064 03:48:40,360 --> 03:48:41,600 CHANGES IN THE MENOPAUSAL 5065 03:48:41,600 --> 03:48:44,400 TRANSITION, ON WOMEN'S QUALITY 5066 03:48:44,400 --> 03:48:45,920 OF LIFE OR HEALTH. 5067 03:48:45,920 --> 03:48:53,280 WE'VE KNOWN SINCE THE 196 4 5068 03:48:53,280 --> 03:48:54,360 WOMEN APPROACHING MENOPAUSE ARE 5069 03:48:54,360 --> 03:48:56,200 LIKELY TO EXPERIENCE HEAVY 5070 03:48:56,200 --> 03:48:57,480 BLEEDING, AND WE'VE DOCUMENTED 5071 03:48:57,480 --> 03:48:59,400 INCREASE IN THE EPISODES OF 5072 03:48:59,400 --> 03:49:01,080 PROLONGED GREATER THAN 10 DAYS 5073 03:49:01,080 --> 03:49:04,320 OR VERY HEAVY BLEEDING FOR THREE 5074 03:49:04,320 --> 03:49:08,160 OR MORE DAYS IN SWAN IN THE 5075 03:49:08,160 --> 03:49:08,960 MENOPAUSAL TRANSITION. 5076 03:49:08,960 --> 03:49:10,840 THREE OR MORE EPISODES OF 5077 03:49:10,840 --> 03:49:12,600 PROLONGED BLEEDING WERE REPORTED 5078 03:49:12,600 --> 03:49:14,880 BY THREE IN FOUR WOMEN, ONE IN 5079 03:49:14,880 --> 03:49:17,600 FIVE REPORTED THOSE THREE 5080 03:49:17,600 --> 03:49:21,640 EPISODES WITHIN A SIX-MONTH 5081 03:49:21,640 --> 03:49:23,280 PERIOD CONSISTENT WITH 5082 03:49:23,280 --> 03:49:23,600 DEFINITIONS. 5083 03:49:23,600 --> 03:49:25,920 THREE OR MORE OF VERY HEAVY 5084 03:49:25,920 --> 03:49:27,880 BLEEDING REPORTED BY ONE IN 5085 03:49:27,880 --> 03:49:30,000 THREE, DESPITE EXCLUSION OF MANY 5086 03:49:30,000 --> 03:49:33,080 WOMEN WHO HAVE A HYSTERECTOMY 5087 03:49:33,080 --> 03:49:34,800 BEING INELIGIBLE. 5088 03:49:34,800 --> 03:49:38,000 ONE IN SEVEN HAD THREE-PLUS 5089 03:49:38,000 --> 03:49:39,920 EPISODES IN A SIX-MONTH PERIOD. 5090 03:49:39,920 --> 03:49:41,880 ABNORMAL BLEEDING IS ASSOCIATED 5091 03:49:41,880 --> 03:49:43,760 WITH HIGHER RISK OF HYSTERECTOMY 5092 03:49:43,760 --> 03:49:47,040 AND CONSEQUENCES BUT WHY ARE WE 5093 03:49:47,040 --> 03:49:50,520 NOT CONNECTING IMPACT OF HEAVY 5094 03:49:50,520 --> 03:50:01,080 BLEEDING TO RISKS OF ANEMIA AND 5095 03:50:01,920 --> 03:50:03,640 ITS CONSEQUENCES, COGNITIVE FOG. 5096 03:50:03,640 --> 03:50:08,400 I RAN THESE IN PREPARATION FOR 5097 03:50:08,400 --> 03:50:09,600 TODAY'S TALK, ADJUSTMENT OF 5098 03:50:09,600 --> 03:50:12,600 FATIGUE AND HEAVY BLEEDING IN 5099 03:50:12,600 --> 03:50:13,760 SIX MONTHS. 5100 03:50:13,760 --> 03:50:20,600 WOMEN WITH THREE OR MORE DAYS OR 5101 03:50:20,600 --> 03:50:22,360 THREE PLUS TIMES IN SIX MONTHS 5102 03:50:22,360 --> 03:50:27,520 MORE LIKELY TO REPORT BEING 5103 03:50:27,520 --> 03:50:35,600 TIRED OR WORN OUT, EDUCATIONAL 5104 03:50:35,600 --> 03:50:38,880 EFFORTS ARE NEEDED TO 5105 03:50:38,880 --> 03:50:41,160 INCORPORATE INFORMATION ON RISK 5106 03:50:41,160 --> 03:50:42,320 OF EXCESSIVE BLEEDING DURING 5107 03:50:42,320 --> 03:50:44,680 THIS LIFE STAGE, AND WOMEN NEED 5108 03:50:44,680 --> 03:50:47,480 THIS INFORMATION TO KNOW WHAT TO 5109 03:50:47,480 --> 03:50:50,160 EXPECT AS WELL AS TO SEEK 5110 03:50:50,160 --> 03:50:52,400 APPROPRIATE CARE FOR BLEEDING 5111 03:50:52,400 --> 03:50:57,280 AND ITS MYRIAD CONSEQUENCES. 5112 03:50:57,280 --> 03:50:58,640 I WOULD URGE RESEARCHERS TO 5113 03:50:58,640 --> 03:51:00,160 FOCUS ON BLEEDING AND 5114 03:51:00,160 --> 03:51:05,000 RELATIONSHIP TO SYMPTOMS AND 5115 03:51:05,000 --> 03:51:06,960 HEALTH CARE OUTCOMES. 5116 03:51:06,960 --> 03:51:15,400 I'D LIKE TO ACKNOWLEDGE GRANT 5117 03:51:15,400 --> 03:51:15,880 SUPPORT. 5118 03:51:15,880 --> 03:51:18,320 I DO NOT HAVE FINANCIAL 5119 03:51:18,320 --> 03:51:18,600 DISCLOSURES. 5120 03:51:18,600 --> 03:51:21,560 AND THANK YOU VERY MUCH. 5121 03:51:21,560 --> 03:51:27,240 5122 03:51:27,240 --> 03:51:29,760 >> THANK YOU FOR THE 5123 03:51:29,760 --> 03:51:30,600 PRESENTATION. 5124 03:51:30,600 --> 03:51:33,960 I HAVE THE PLEASURE OF 5125 03:51:33,960 --> 03:51:40,720 INTRODUCING OUR NEXT SPEAKER, 5126 03:51:40,720 --> 03:51:41,240 YAMNIA CORTES, ASSISTANT 5127 03:51:41,240 --> 03:51:42,200 PROFESSOR UNIVERSITY OF NORTH 5128 03:51:42,200 --> 03:51:43,680 CAROLINA AT CHAPEL HILL SCHOOL 5129 03:51:43,680 --> 03:51:47,400 OF NURSING SHARE HER WORK AROUND 5130 03:51:47,400 --> 03:51:48,920 EXPERIENCES IN SOCIAL 5131 03:51:48,920 --> 03:51:54,760 DETERMINANTS OF MENOPAUSE AMONG 5132 03:51:54,760 --> 03:52:03,240 LATINAS. 5133 03:52:03,240 --> 03:52:04,160 >> GOOD AFTERNOON. 5134 03:52:04,160 --> 03:52:05,680 THANK YOU. 5135 03:52:05,680 --> 03:52:09,360 IT'S A PLEASURE TO JOIN YOU AND 5136 03:52:09,360 --> 03:52:11,480 DISCUSS EXPERIENCES AND SOCIAL 5137 03:52:11,480 --> 03:52:16,840 DETERMINANTS OF MENOPAUSE AMONG 5138 03:52:16,840 --> 03:52:17,480 LATINAS. 5139 03:52:17,480 --> 03:52:20,320 AN OVERVIEW OF MY PRESENTATION, 5140 03:52:20,320 --> 03:52:22,800 BEGINNING WITH DEFINITIONS OF 5141 03:52:22,800 --> 03:52:26,960 KEY TERMS AND BACKGROUND, THEN 5142 03:52:26,960 --> 03:52:31,040 MOVE TO DISCUSSING EXPERIENCES, 5143 03:52:31,040 --> 03:52:34,760 DISPARITIES WE'VE NOTED, AND KEY 5144 03:52:34,760 --> 03:52:37,280 FACTORS OF SOCIAL DETERMINANTS 5145 03:52:37,280 --> 03:52:41,480 OF HEALTH AND MENOPAUSE, 5146 03:52:41,480 --> 03:52:42,800 CONCLUDING WITH FUTURE 5147 03:52:42,800 --> 03:52:43,040 DIRECTION. 5148 03:52:43,040 --> 03:52:46,080 I WILL USE THE TERM HISPANIC AND 5149 03:52:46,080 --> 03:52:48,400 LATINA INTERCHANGEABLY TO REFER 5150 03:52:48,400 --> 03:52:49,800 TO PERSONS LIVING IN THE UNITED 5151 03:52:49,800 --> 03:52:52,560 STATES AND HAVING ROOTS 5152 03:52:52,560 --> 03:52:54,240 PRIMARILY IN SPANISH-SPEAKING 5153 03:52:54,240 --> 03:52:56,360 PARTS OF LATIN AMERICA AND THE 5154 03:52:56,360 --> 03:52:57,760 CARIBBEAN, BUT WE ALSO KNOW 5155 03:52:57,760 --> 03:53:00,800 PEOPLE WITH ROOTS IN SPAIN AND 5156 03:53:00,800 --> 03:53:02,120 NON-SPANISH-SPEAKING PARTS OF 5157 03:53:02,120 --> 03:53:04,440 LATIN AMERICA AND CARIBBEAN MAY 5158 03:53:04,440 --> 03:53:09,640 ALSO IDENTIFY AS HISPANIC AND 5159 03:53:09,640 --> 03:53:10,080 LATINO. 5160 03:53:10,080 --> 03:53:11,400 TERMINOLOGY IS IMPORTANT. 5161 03:53:11,400 --> 03:53:14,560 AS YOU CAN SEE BY RESEARCH IN 5162 03:53:14,560 --> 03:53:16,520 THE PEW RESEARCH CENTER 5163 03:53:16,520 --> 03:53:18,640 HISPANICS HAVE A MIXED VIEW HOW 5164 03:53:18,640 --> 03:53:24,640 THEY DESCRIBE THEIR IDENTITY, 5165 03:53:24,640 --> 03:53:27,520 WITH A PREFERENCE, OR NO 5166 03:53:27,520 --> 03:53:28,760 PREFERENCE BETWEEN HISPANIC OR 5167 03:53:28,760 --> 03:53:30,640 LATINO, SO IT'S ALWAYS IMPORTANT 5168 03:53:30,640 --> 03:53:33,640 TO GET AN IDEA HOW PEOPLE PREFER 5169 03:53:33,640 --> 03:53:35,800 TO IDENTIFY. 5170 03:53:35,800 --> 03:53:37,240 IT'S IMPORTANT TO THINK ABOUT 5171 03:53:37,240 --> 03:53:39,800 THE FACT LATINOS ARE NOT A 5172 03:53:39,800 --> 03:53:44,720 HOMOGENOUS GROUP. 5173 03:53:44,720 --> 03:53:46,680 THE HETEROGENEOUS GROUP WITH 5174 03:53:46,680 --> 03:53:48,160 DIFFERENT NATIONALITY, LANGUAGE, 5175 03:53:48,160 --> 03:53:50,800 SOCIAL AND HISTORIC CONTEXT, AND 5176 03:53:50,800 --> 03:53:54,680 IMMIGRATION AND -- SORRY, 5177 03:53:54,680 --> 03:53:55,800 MIGRATION POLICIES THAT IMPACT 5178 03:53:55,800 --> 03:54:03,080 MENOPAUSE EXPERIENCE AND HEALTH. 5179 03:54:03,080 --> 03:54:07,160 LATINAS REMAINED 5180 03:54:07,160 --> 03:54:09,000 UNDERREPRESENTED IN MENOPAUSE 5181 03:54:09,000 --> 03:54:09,280 RESEARCH. 5182 03:54:09,280 --> 03:54:10,040 THEY CONSTITUTE 20% OF MID-LIFE 5183 03:54:10,040 --> 03:54:12,600 PEOPLE IN THE U.S., MAKE UP LESS 5184 03:54:12,600 --> 03:54:15,800 THAN 10% OF PARTICIPANTS IN MOST 5185 03:54:15,800 --> 03:54:17,400 STUDIES, WITH THE EXCEPTION 5186 03:54:17,400 --> 03:54:20,360 BEING THE SAN FRANCISCO MID-LIFE 5187 03:54:20,360 --> 03:54:23,240 WOMEN'S HEALTH STUDY. 5188 03:54:23,240 --> 03:54:27,480 IT'S IMPORTANT TO NOTE HISPANIC 5189 03:54:27,480 --> 03:54:35,720 COMMUNITY HEALTH STUDY IS NHLBI 5190 03:54:35,720 --> 03:54:42,640 BUT NOT A MENOPAUSE STUDY. 5191 03:54:42,640 --> 03:54:45,360 IN ORDER TO PROVIDE CULTURALLY 5192 03:54:45,360 --> 03:54:46,320 RELEVANT EDUCATION AND CLINICAL 5193 03:54:46,320 --> 03:54:49,480 CARE IT'S NECESSARY TO 5194 03:54:49,480 --> 03:54:50,840 UNDERSTAND THEIR EXPERIENCE, 5195 03:54:50,840 --> 03:54:52,800 THEIR DEFINITION, SO HERE I 5196 03:54:52,800 --> 03:54:58,720 PROVIDE EXAMPLES FROM SEVERAL 5197 03:54:58,720 --> 03:55:00,040 QUALITATIVE STUDIES, THREE, EACH 5198 03:55:00,040 --> 03:55:02,000 REPRESENT THREE THEMES THAT WE 5199 03:55:02,000 --> 03:55:05,160 SEE IN THE LITERATURE. 5200 03:55:05,160 --> 03:55:07,320 ONE IS CAMBIO DE VIDA, 5201 03:55:07,320 --> 03:55:10,960 DESCRIBING MEN TAUS AS -- 5202 03:55:10,960 --> 03:55:13,840 MENOPAUSE AS A CHANGE OF LIFE. 5203 03:55:13,840 --> 03:55:17,640 IT'S LIKE ENTERING A NEW PHASE 5204 03:55:17,640 --> 03:55:21,840 IN YOUR LIFE, YOUR BODY IS GOING 5205 03:55:21,840 --> 03:55:31,040 TO CHANGE, IRREGULARITY, SOME 5206 03:55:31,040 --> 03:55:32,800 SUBTHEMES THAT ALSO COME ALONG 5207 03:55:32,800 --> 03:55:39,520 WITH IT, NOT ONLY IS IT THAT 5208 03:55:39,520 --> 03:55:42,120 LATINOS VIEWS IT AS A NORMAL 5209 03:55:42,120 --> 03:55:45,400 STAGE OF LIFE BUT WE KNOW FOR 5210 03:55:45,400 --> 03:55:47,160 THIS REASON MENOPAUSE AND 5211 03:55:47,160 --> 03:55:48,520 THINKING ABOUT MENOPAUSE 5212 03:55:48,520 --> 03:55:49,480 SYMPTOMS AND SEEKING MENOPAUSE 5213 03:55:49,480 --> 03:55:53,560 CARE IS NOT REALLY A PRIORITY. 5214 03:55:53,560 --> 03:55:55,400 AND YOU'RE TOLD TO BEAR IT 5215 03:55:55,400 --> 03:55:56,760 BECAUSE THAT'S LIFE, AND YOU 5216 03:55:56,760 --> 03:56:00,520 JUST HAVE TO MOVE ON. 5217 03:56:00,520 --> 03:56:03,000 AND ANOTHER IMPORTANT THING THAT 5218 03:56:03,000 --> 03:56:06,680 WE ACTUALLY SEE IS EMERGENCE OF 5219 03:56:06,680 --> 03:56:08,800 ISSUES, HEALTH ISSUES DURING 5220 03:56:08,800 --> 03:56:10,000 MENOPAUSE TRANSITION. 5221 03:56:10,000 --> 03:56:12,560 AND ONE OF THE QUOTES IS I WENT 5222 03:56:12,560 --> 03:56:21,480 THROUGH THIS, MEN MENOPAUSE, TD 5223 03:56:21,480 --> 03:56:22,200 50, EVERYTHING CHANGED. 5224 03:56:22,200 --> 03:56:23,760 BEGINNING TO NOTE THERE ARE 5225 03:56:23,760 --> 03:56:25,320 CHANGES BEING ASSOCIATED WITH 5226 03:56:25,320 --> 03:56:26,800 MENOPAUSE BUT NOT TRULY 5227 03:56:26,800 --> 03:56:31,200 UNDERSTANDING WHAT IS AND IS NOT 5228 03:56:31,200 --> 03:56:32,040 MENOPAUSE SYMPTOM. 5229 03:56:32,040 --> 03:56:35,040 OR HOW TO MANAGE THESE SYMPTOMS. 5230 03:56:35,040 --> 03:56:36,880 AND MOST RECENTLY IN FOCUS 5231 03:56:36,880 --> 03:56:38,560 GROUPS WE CONDUCTED IN NORTH 5232 03:56:38,560 --> 03:56:42,720 CAROLINA, WE ALSO NOTED 5233 03:56:42,720 --> 03:56:43,960 PARTICIPANTS WANTED MORE 5234 03:56:43,960 --> 03:56:45,120 INFORMATION ABOUT MENOPAUSE 5235 03:56:45,120 --> 03:56:46,680 ESPECIALLY FROM HEALTH PROVIDERS 5236 03:56:46,680 --> 03:56:51,040 BECAUSE INFORMATION IS POWER. 5237 03:56:51,040 --> 03:56:53,160 NOW I'M ASKING QUESTIONS ABOUT 5238 03:56:53,160 --> 03:56:55,120 MENOPAUSE PERHAPS BECAUSE WE'VE 5239 03:56:55,120 --> 03:56:58,760 COME TO THIS COUNTRY, IN HOME 5240 03:56:58,760 --> 03:57:06,760 COUNTRY PEOPLE ARE RESERVED, 5241 03:57:06,760 --> 03:57:08,720 WOMEN MOVE TO THE U.S. AND IT 5242 03:57:08,720 --> 03:57:10,520 CHANGES THEIR THOUGHT PROCESS. 5243 03:57:10,520 --> 03:57:14,000 THEY FEEL IN THE UNITED STATES 5244 03:57:14,000 --> 03:57:14,880 CONVERSATION IS MORE OPEN. 5245 03:57:14,880 --> 03:57:18,680 OF COURSE IT'S IMPORTANT TO NOTE 5246 03:57:18,680 --> 03:57:21,120 THESE EXPERIENCES DIFFER BY 5247 03:57:21,120 --> 03:57:22,960 GEOGRAPHIC SETTING, LATINO 5248 03:57:22,960 --> 03:57:23,960 SUBGROUP, ACCULTURATION, 5249 03:57:23,960 --> 03:57:26,560 EDUCATION LEVEL, AND MENOPAUSE 5250 03:57:26,560 --> 03:57:27,480 KNOWLEDGE. 5251 03:57:27,480 --> 03:57:29,840 OUR FOCUS GROUPS IN NORTH 5252 03:57:29,840 --> 03:57:32,640 CAROLINA, THEY WERE CONDUCTED 5253 03:57:32,640 --> 03:57:35,800 AMONG WOMEN WHO WERE BETWEEN 35 5254 03:57:35,800 --> 03:57:40,320 AND 60, WHO HAD EXPERIENCED 5255 03:57:40,320 --> 03:57:41,520 MENOPAUSE OR THOSE THAT WERE 5256 03:57:41,520 --> 03:57:44,320 THINKING THROUGH WHAT WOULD BE 5257 03:57:44,320 --> 03:57:45,760 QUESTIONS OR EXPECTATIONS. 5258 03:57:45,760 --> 03:57:50,200 WE CONDUCTED A SURVEY AND FOUND 5259 03:57:50,200 --> 03:57:53,120 THAT 79% OF PARTICIPANTS VIEWED 5260 03:57:53,120 --> 03:57:55,320 MENOPAUSE POSITIVELY, IT MEANS 5261 03:57:55,320 --> 03:57:58,960 NO MORE PERIODS, NO MORE WORRY 5262 03:57:58,960 --> 03:58:02,240 ABOUT CONTRACEPTION, 60% VIEW 5263 03:58:02,240 --> 03:58:03,120 HORMONE THERAPY NEGATIVELY. 5264 03:58:03,120 --> 03:58:06,200 55% REPORT LITTLE KNOWLEDGE 5265 03:58:06,200 --> 03:58:07,200 ABOUT MENOPAUSE AND ONLY 24% 5266 03:58:07,200 --> 03:58:09,160 SAID THEY GET INFORMATION FROM A 5267 03:58:09,160 --> 03:58:10,640 HEALTH PROVIDER. 5268 03:58:10,640 --> 03:58:14,000 WHICH IS AN IMPORTANT GAP I'LL 5269 03:58:14,000 --> 03:58:18,200 DISCUSS LATER. 5270 03:58:18,200 --> 03:58:22,400 FOLLOWING UP ON DR. HARLOW, WE 5271 03:58:22,400 --> 03:58:25,360 FIND LATINAS DO EXPERIENCE 5272 03:58:25,360 --> 03:58:31,360 MENOPAUSE AT YOUNGER AGE, 50.9 5273 03:58:31,360 --> 03:58:34,360 VERSUS 52.9 AND 53.1, AND A 5274 03:58:34,360 --> 03:58:37,360 LONGER DURATION OF VASOMOTOR 5275 03:58:37,360 --> 03:58:37,600 SYMPTOMS. 5276 03:58:37,600 --> 03:58:43,200 SO 8.9 YEARS VERSUS 6.5, AND 4.8 5277 03:58:43,200 --> 03:58:45,160 IN JAPANESE WOMEN. 5278 03:58:45,160 --> 03:58:47,680 HOWEVER DR. HARLOW MENTIONED 5279 03:58:47,680 --> 03:58:51,480 THESE APPLIED ONCE WE ADJUST FOR 5280 03:58:51,480 --> 03:58:54,600 LIFESTYLE AND SOCIOECONOMIC 5281 03:58:54,600 --> 03:58:57,480 SUGGESTING IMPORTANCE IN 5282 03:58:57,480 --> 03:59:02,080 MID-LIFE HEALTH. 5283 03:59:02,080 --> 03:59:05,520 IN TERMS OF SYMPTOMS, A SURVEY 5284 03:59:05,520 --> 03:59:10,360 FOUND 50% OR MORE LATINAS REPORT 5285 03:59:10,360 --> 03:59:20,480 WEIGHT GAIN, FEELING 5286 03:59:20,480 --> 03:59:25,040 HOT-CONTROLLED, FATIGUE, SLEEP 5287 03:59:25,040 --> 03:59:27,120 DIFFICULTY SLEEPING. 5288 03:59:27,120 --> 03:59:31,280 NOW, THIS COULD BE BECAUSE THIS 5289 03:59:31,280 --> 03:59:33,200 IS A CROSS-SECTIONAL SURVEY, 5290 03:59:33,200 --> 03:59:34,320 MORE DIFFERENCE NOTED WHEN 5291 03:59:34,320 --> 03:59:37,640 LOOKING AT SEVERITY OF SYMPTOM, 5292 03:59:37,640 --> 03:59:39,320 OR INDIVIDUALS SUGGEST THIS IS 5293 03:59:39,320 --> 03:59:43,120 EVIDENCE OF THE LATINO HEALTH 5294 03:59:43,120 --> 03:59:43,440 PARADOX. 5295 03:59:43,440 --> 03:59:50,200 LATINO HEALTH PARADOX SUGGESTS 5296 03:59:50,200 --> 03:59:51,920 DESPITE SOCIOECONOMIC 5297 03:59:51,920 --> 03:59:57,680 DISADVANTAGES LATINOS DISPLAYED 5298 03:59:57,680 --> 04:00:00,200 HEALTH OUTCOMES COMPARABLE TO 5299 04:00:00,200 --> 04:00:01,160 NON-LATINO WHITE PERSONS. 5300 04:00:01,160 --> 04:00:04,000 IF YOU THEN BEGIN TO LOOK AT 5301 04:00:04,000 --> 04:00:07,640 LATINOS INSTEAD OF AS A GROUP, 5302 04:00:07,640 --> 04:00:08,680 AND DISAGGREGATE THAT 5303 04:00:08,680 --> 04:00:11,920 INFORMATION, THE PICTURE BECOMES 5304 04:00:11,920 --> 04:00:13,080 CLEARER. 5305 04:00:13,080 --> 04:00:15,160 THIS IS EVIDENCE WHEN WE LOOK AT 5306 04:00:15,160 --> 04:00:17,560 DATA FROM SWAN NEW JERSEY, THE 5307 04:00:17,560 --> 04:00:19,360 STUDY SITE THAT RECRUITED 5308 04:00:19,360 --> 04:00:19,720 LATINAS. 5309 04:00:19,720 --> 04:00:22,000 THE GRAPH ON THE LEFT COMPARED 5310 04:00:22,000 --> 04:00:23,960 SYMPTOMS BETWEEN LATINAS AS A 5311 04:00:23,960 --> 04:00:26,000 GROUP TO NON-LATINA WHITE WOMEN. 5312 04:00:26,000 --> 04:00:36,440 GRAPH ON THE RIGHT LOOK AT 5313 04:00:38,640 --> 04:00:39,400 LATINA DISAGGREGATED. 5314 04:00:39,400 --> 04:00:47,120 ON LEFT SMALL OR NO DIFFERENCE 5315 04:00:47,120 --> 04:00:48,160 ESPECIALLY SLEEP DISTURBANCE. 5316 04:00:48,160 --> 04:00:51,760 ON THE RIGHT THOUGH WE BEGIN TO 5317 04:00:51,760 --> 04:00:57,640 SEE DIFFERENCES IN TERMS OF 5318 04:00:57,640 --> 04:00:59,840 VAGINAL DRYNESS, VASOMOTOR 5319 04:00:59,840 --> 04:01:01,920 SYMPTOMS, AND THEN FOR SLEEP 5320 04:01:01,920 --> 04:01:08,240 DISTURBANCES, WHEN YOU LOOK AT 5321 04:01:08,240 --> 04:01:12,400 LATINO AS A WHOLE, 50%, 5322 04:01:12,400 --> 04:01:13,920 DISAGGREGATE AMONG DOMINICANS 5323 04:01:13,920 --> 04:01:19,000 AND PUERTO RICAN 66.1, 64% 5324 04:01:19,000 --> 04:01:22,640 COMPARED TO 49.7. 5325 04:01:22,640 --> 04:01:26,320 AND SO THIS IS SUGGESTING 5326 04:01:26,320 --> 04:01:29,680 IMPORTANCE OF LOOKING, COMPARING 5327 04:01:29,680 --> 04:01:32,240 ACROSS SUBGROUPS, BUT THEN ALSO 5328 04:01:32,240 --> 04:01:35,040 THINKING THROUGH THE DIFFERENT 5329 04:01:35,040 --> 04:01:37,240 FACTORS THAT MIGHT IMPACT THESE 5330 04:01:37,240 --> 04:01:37,560 DIFFERENCES. 5331 04:01:37,560 --> 04:01:41,560 IN A RECENT REVIEW WE DEVELOPED 5332 04:01:41,560 --> 04:01:43,480 CONCEPTUAL FRAMEWORK, BASED ON 5333 04:01:43,480 --> 04:01:46,120 THE NIMHD MINORITY HEALTH AND 5334 04:01:46,120 --> 04:01:48,520 HEALTH DISPARITIES RESEARCH 5335 04:01:48,520 --> 04:01:49,560 FRAMEWORK, HIGHLIGHTING DRIVERS 5336 04:01:49,560 --> 04:01:51,920 HEALTH INEQUITIES, SOME HAVE 5337 04:01:51,920 --> 04:01:54,320 BEEN DISCUSSED IN PRESENTATIONS 5338 04:01:54,320 --> 04:01:54,520 TODAY. 5339 04:01:54,520 --> 04:01:55,880 AND THE FOLLOWING SLIDE I'M 5340 04:01:55,880 --> 04:01:58,800 GOING TO FOCUS ON THE 5341 04:01:58,800 --> 04:01:59,480 SOCIOCULTURAL ENVIRONMENT AND 5342 04:01:59,480 --> 04:02:02,720 HEALTH CARE SYSTEM DUE TO TIME. 5343 04:02:02,720 --> 04:02:05,560 AND SO ONE FACTOR MOST STUDIES 5344 04:02:05,560 --> 04:02:10,040 HAVE EVALUATED TO EXPLAIN 5345 04:02:10,040 --> 04:02:14,160 DIFFERENCES BETWEEN LATINAS IS 5346 04:02:14,160 --> 04:02:14,720 ACCULTURATION. 5347 04:02:14,720 --> 04:02:15,680 ACCULTURATION IS PROCESS BY 5348 04:02:15,680 --> 04:02:17,800 WHICH INDIVIDUALS ADAPT TO A NEW 5349 04:02:17,800 --> 04:02:19,640 LIVING ENVIRONMENT AND ADAPT 5350 04:02:19,640 --> 04:02:26,680 VALUES, BELIEFS, NORMS OF THAT 5351 04:02:26,680 --> 04:02:27,000 SOCIETY. 5352 04:02:27,000 --> 04:02:34,280 ACCULTURATION HAS BEEN RELATED 5353 04:02:34,280 --> 04:02:35,280 TO MENOPAUSE, LOWER 5354 04:02:35,280 --> 04:02:37,000 ACCULTURATION RELATED TO MORE 5355 04:02:37,000 --> 04:02:38,200 POSITIVE OUTCOMES, LONGER TIME 5356 04:02:38,200 --> 04:02:41,160 IN THE U.S. IT'S BEEN RELATED TO 5357 04:02:41,160 --> 04:02:42,200 MORE SLEEP DISTURBANCE BUT AT 5358 04:02:42,200 --> 04:02:44,720 THE SAME TIME BEING BORN OUTSIDE 5359 04:02:44,720 --> 04:02:46,560 THE UNITED STATES HAS BEEN 5360 04:02:46,560 --> 04:02:49,960 ASSOCIATED WITH MORE SLEEP 5361 04:02:49,960 --> 04:02:50,480 DISTURBANCES. 5362 04:02:50,480 --> 04:02:53,480 ONE REASON WE MIGHT SEE THESE 5363 04:02:53,480 --> 04:02:54,720 INCONSISTENCIES IS BECAUSE A LOT 5364 04:02:54,720 --> 04:02:59,960 OF THE STUDIES ARE USING LINEAR 5365 04:02:59,960 --> 04:03:02,560 OR UNIDIMENSIONAL MEASURES OF 5366 04:03:02,560 --> 04:03:03,080 ACCULTURATION. 5367 04:03:03,080 --> 04:03:06,760 AND SO THE ASSUMPTION IS THAT IF 5368 04:03:06,760 --> 04:03:10,680 WE JUST USE LENGTH OF TIME IN 5369 04:03:10,680 --> 04:03:14,040 THE UNITED STATES, IT'S LINEAR, 5370 04:03:14,040 --> 04:03:16,240 EVERYONE ACCULTURATES THE SAME 5371 04:03:16,240 --> 04:03:17,080 WITH EACH YEAR, AMOUNT OF 5372 04:03:17,080 --> 04:03:20,280 DURATION IN THE UNITED STATES, 5373 04:03:20,280 --> 04:03:23,080 THAT DOESN'T TAKE INTO ACCOUNT 5374 04:03:23,080 --> 04:03:24,920 GEOGRAPHIC SETTING, WHETHER OR 5375 04:03:24,920 --> 04:03:27,400 NOT YOU HAVE RESOURCES IN 5376 04:03:27,400 --> 04:03:29,440 SPANISH OR YOU'RE ONE OF A FEW 5377 04:03:29,440 --> 04:03:31,320 LATINOS IN A COMMUNITY VERSUS 5378 04:03:31,320 --> 04:03:32,200 LIVING IN A COMMUNITY WHERE 5379 04:03:32,200 --> 04:03:35,160 THERE ARE A LOT OF RESOURCES AND 5380 04:03:35,160 --> 04:03:39,200 OTHER PEOPLE THAT ARE ALSO 5381 04:03:39,200 --> 04:03:40,800 LATINO, SPEAK SPANISH, SO YOU 5382 04:03:40,800 --> 04:03:45,840 MIGHT HAVE A DIFFERENT 5383 04:03:45,840 --> 04:03:46,560 ACCULTURATION EXPERIENCE. 5384 04:03:46,560 --> 04:03:48,000 THE OTHER THING I WANTED TO 5385 04:03:48,000 --> 04:03:51,280 MENTION ABOUT THIS AS WELL IS 5386 04:03:51,280 --> 04:03:53,120 THAT ACCULTURATION SOMETIMES IS 5387 04:03:53,120 --> 04:03:57,320 ALSO RELATED TO, IN OUR STUDIES, 5388 04:03:57,320 --> 04:03:58,560 WITH BEHAVIOR. 5389 04:03:58,560 --> 04:04:00,520 AND IT CAN SHIFT AWAY -- IT'S 5390 04:04:00,520 --> 04:04:01,800 IMPORTANT TO LOOK AT BUT CAN 5391 04:04:01,800 --> 04:04:03,720 SHIFT AWAY THE FOCUS FROM SOME 5392 04:04:03,720 --> 04:04:07,280 OF THE SOCIAL AND STRUCTURAL 5393 04:04:07,280 --> 04:04:08,800 FACULTIORS ALSO RELATED TO 5394 04:04:08,800 --> 04:04:11,560 MENOPAUSE SYMPTOMS AND FOR 5395 04:04:11,560 --> 04:04:13,520 EXAMPLE AS I MENTIONED 5396 04:04:13,520 --> 04:04:15,680 IMMIGRATION STATUS IS SOMETIMES 5397 04:04:15,680 --> 04:04:17,720 USED AS A PROXY FOR 5398 04:04:17,720 --> 04:04:18,600 ACCULTURATION BUT IMMIGRATION 5399 04:04:18,600 --> 04:04:23,040 WITHIN ITSELF IS A SOCIAL 5400 04:04:23,040 --> 04:04:25,720 DETERMINANT OF HEALTH, 5401 04:04:25,720 --> 04:04:27,040 EXISTING -- BEING -- 5402 04:04:27,040 --> 04:04:28,040 IMPLICATIONS OF IMMIGRATION 5403 04:04:28,040 --> 04:04:29,480 STATUS ARE THAT IT DETERMINES 5404 04:04:29,480 --> 04:04:32,560 WHAT KIND OF EMPLOYMENT YOU GET, 5405 04:04:32,560 --> 04:04:35,120 WHAT KIND OF HOUSING, ACCESS TO 5406 04:04:35,120 --> 04:04:42,280 CARE AND HEALTH CARE, FEAR OF 5407 04:04:42,280 --> 04:04:45,280 DEPORTATION, TENSION, FEELING 5408 04:04:45,280 --> 04:04:47,120 SOCIAL ISOLATION AND 5409 04:04:47,120 --> 04:04:49,000 IMPORTANTLY, IN TERMS OF ACCESS 5410 04:04:49,000 --> 04:04:51,280 ISSUE WE'VE SEEN LATINOS HAVE 5411 04:04:51,280 --> 04:04:54,040 HIGHEST RATE OF UNINSURANCE IN 5412 04:04:54,040 --> 04:04:57,120 THE U.S., ABOUT 18%. 5413 04:04:57,120 --> 04:04:59,480 IN NORTH CAROLINA, IT'S 40%, 5414 04:04:59,480 --> 04:05:01,840 AMONG WOMEN IN THE STUDY I 5415 04:05:01,840 --> 04:05:04,040 CONDUCTED IT'S 60%. 5416 04:05:04,040 --> 04:05:05,360 THESE ARE NOT INDIVIDUALS THAT 5417 04:05:05,360 --> 04:05:08,280 WE'RE ALSO SEEING IN OUR HEALTH 5418 04:05:08,280 --> 04:05:10,520 CARE PRACTICES, OR IN OUR 5419 04:05:10,520 --> 04:05:11,880 RESEARCH STUDIES, WHICH IS ONE 5420 04:05:11,880 --> 04:05:16,560 OF THE GAPS THAT I WANTED TO 5421 04:05:16,560 --> 04:05:17,160 HIGHLIGHT. 5422 04:05:17,160 --> 04:05:24,080 AS WE KNOW, UNINSURED WOMEN HAVE 5423 04:05:24,080 --> 04:05:25,280 LESS ACCESS TO SCREENING, 5424 04:05:25,280 --> 04:05:28,240 COMPARED TO WOMEN WITH HEALTH 5425 04:05:28,240 --> 04:05:35,800 INSURANCE UNINSURED WOMEN REPORT 5426 04:05:35,800 --> 04:05:39,000 MORE BOTHERSOME MENOPAUSE 5427 04:05:39,000 --> 04:05:39,320 SYMPTOMS. 5428 04:05:39,320 --> 04:05:41,720 SOME ARE ANXIETY AND DEPRESSION, 5429 04:05:41,720 --> 04:05:45,280 TRANSITIONING TO THE NEXT SLIDE, 5430 04:05:45,280 --> 04:05:46,560 IN SWAN, YOU'RE ALL FAMILIAR 5431 04:05:46,560 --> 04:05:49,960 WITH THIS STUDY BY NOW, BASELINE 5432 04:05:49,960 --> 04:05:54,320 SWAN SHOWED 43% OF LATINAS HAD 5433 04:05:54,320 --> 04:05:54,960 DEPRESSIVE SYMPTOMS COMPARED TO 5434 04:05:54,960 --> 04:05:59,000 14 TO 27 OF WOMEN IN OTHER 5435 04:05:59,000 --> 04:06:01,560 GROUPS. 5436 04:06:01,560 --> 04:06:06,480 WHEN EVALUATING DEPRESSION 5437 04:06:06,480 --> 04:06:09,480 SYMPTOMS ACROSS 50 YEARS LATINAS 5438 04:06:09,480 --> 04:06:14,040 FOLLOWED A HIGH TRAJECTORY OF 5439 04:06:14,040 --> 04:06:17,280 SYMPTOMS, AND FACTORS WERE 5440 04:06:17,280 --> 04:06:19,720 HAVING MORE FINANCIAL HARDSHIP, 5441 04:06:19,720 --> 04:06:20,720 MORE FREQUENT VASOMOTOR 5442 04:06:20,720 --> 04:06:23,440 SYMPTOMS, MORE STRESSFUL LIFE 5443 04:06:23,440 --> 04:06:27,280 EVENTS, SLEEP DISTURBANCE, LOWER 5444 04:06:27,280 --> 04:06:27,640 SOCIAL SUPPORT. 5445 04:06:27,640 --> 04:06:31,240 ALL OF THESE WE ACTUALLY KNOW 5446 04:06:31,240 --> 04:06:32,840 ARE RELATED TO ADDITIONAL 5447 04:06:32,840 --> 04:06:34,120 CONDITIONS SUCH AS 5448 04:06:34,120 --> 04:06:39,680 CARDIOVASCULAR DISEASE. 5449 04:06:39,680 --> 04:06:43,360 IN OUR PILOT WORK DURING THE 5450 04:06:43,360 --> 04:06:52,920 MENOPAUSE TRANSITION, 5451 04:06:52,920 --> 04:06:55,440 PERIMENOPAUSAL, EXPERIENCED 5452 04:06:55,440 --> 04:06:57,840 HIGHER EVERYDAY DISCRIMINATION, 5453 04:06:57,840 --> 04:07:03,200 MORE SLEEP DISTURBANCE, HIGHER 5454 04:07:03,200 --> 04:07:08,320 SYSTOLIC BLOOD PRESSURE, HIGHER 5455 04:07:08,320 --> 04:07:11,400 BLOOD PLY COAST, HIGHER 5456 04:07:11,400 --> 04:07:14,280 EDUCATION, CONSISTENT WITH OTHER 5457 04:07:14,280 --> 04:07:14,680 STUDIES. 5458 04:07:14,680 --> 04:07:16,280 THE EDUCATION WAS SURPRISING, 5459 04:07:16,280 --> 04:07:18,920 BUT WE ALSO FOUND WOMEN WITH 5460 04:07:18,920 --> 04:07:21,320 HIGHER EDUCATION WERE ALSO 5461 04:07:21,320 --> 04:07:24,200 INDIVIDUALS WHO REPORTED MORE 5462 04:07:24,200 --> 04:07:26,400 EVERYDAY DISCRIMINATION. 5463 04:07:26,400 --> 04:07:28,040 THESE ARE FINDINGS THAT 5464 04:07:28,040 --> 04:07:30,880 UNDERSTORE NEED TO REEVALUATE 5465 04:07:30,880 --> 04:07:32,920 ROLE OF THE SOCIAL ENVIRONMENT 5466 04:07:32,920 --> 04:07:33,240 IN MENOPAUSE. 5467 04:07:33,240 --> 04:07:36,080 IN THE BEGINNING OF THE 5468 04:07:36,080 --> 04:07:37,360 PRESENTATION I PRESENTED 5469 04:07:37,360 --> 04:07:39,560 FINDINGS FROM OUR FOCUS GROUPS 5470 04:07:39,560 --> 04:07:44,040 WHICH INDICATED 24% OF LATINAS 5471 04:07:44,040 --> 04:07:44,840 SOUGHT INFORMATION ABOUT 5472 04:07:44,840 --> 04:07:47,120 MENOPAUSE FROM HEALTH CARE 5473 04:07:47,120 --> 04:07:47,400 PROVIDER. 5474 04:07:47,400 --> 04:07:50,160 AND I'VE DISCUSSED ACCESS MAY BE 5475 04:07:50,160 --> 04:07:51,240 ONE REASON. 5476 04:07:51,240 --> 04:07:52,640 EVEN AMONG INDIVIDUALS WITH 5477 04:07:52,640 --> 04:07:54,680 ACCESS WE SEE THE EXPECTATIONS 5478 04:07:54,680 --> 04:07:58,440 ARE NOT BEING MET, OR THERE'S 5479 04:07:58,440 --> 04:08:00,400 THIS DISCORDANCE. 5480 04:08:00,400 --> 04:08:01,880 ONE QUOTE IS, FOR ME, IT WOULD 5481 04:08:01,880 --> 04:08:03,760 HAVE BEEN BETTER IF THE DOCTOR 5482 04:08:03,760 --> 04:08:05,760 TOLD ME ABOUT ALL THIS, 5483 04:08:05,760 --> 04:08:12,960 MENOPAUSE, BEFORE I WENT TO ASK 5484 04:08:12,960 --> 04:08:14,640 ABOUT MY SYMPTOMS. 5485 04:08:14,640 --> 04:08:17,320 PROVIDER EXPECT PATIENTS WILL 5486 04:08:17,320 --> 04:08:19,960 ASK QUESTIONS, COMMENT, ASK 5487 04:08:19,960 --> 04:08:20,600 ABOUT MENOPAUSE, DISCUSS 5488 04:08:20,600 --> 04:08:23,800 SYMPTOMS THEY ARE HAVING AND 5489 04:08:23,800 --> 04:08:25,120 PATIENTS, ACCORDING TO SOME 5490 04:08:25,120 --> 04:08:27,040 FOCUS GROUPSR EXPECTING THE 5491 04:08:27,040 --> 04:08:29,960 PROVIDER WILL BE THE ONES TO 5492 04:08:29,960 --> 04:08:39,560 BRING UP THE TOPIC BUT ONLY 6.8% 5493 04:08:39,560 --> 04:08:41,600 OF RESIDENTS FEEL PREPARED. 5494 04:08:41,600 --> 04:08:46,000 AND HEALTH CARE PROVIDERS ARE 5495 04:08:46,000 --> 04:08:47,240 RELUCTANT TO PROVIDE INFORMATION 5496 04:08:47,240 --> 04:08:48,440 TO IMMIGRANT WOMEN DUE TO LACK 5497 04:08:48,440 --> 04:08:51,440 OF TIME, LACK OF KNOWLEDGE, LACK 5498 04:08:51,440 --> 04:08:56,200 OF CONFIDENCE IN CULTURALLY 5499 04:08:56,200 --> 04:08:56,680 COMPETENT COMMUNICATION. 5500 04:08:56,680 --> 04:09:01,760 WE HAVE LACK OF ACCESS TO 5501 04:09:01,760 --> 04:09:03,920 PROVIDERS, CULTURALLY 5502 04:09:03,920 --> 04:09:05,560 APPROPRIATE CARE, AND THIS 5503 04:09:05,560 --> 04:09:07,160 CONTRIBUTES TO THIS CONFUSION 5504 04:09:07,160 --> 04:09:11,840 ABOUT MENOPAUSE, WHAT TO EXPECT, 5505 04:09:11,840 --> 04:09:14,680 AND WHAT ARE MANAGEMENT 5506 04:09:14,680 --> 04:09:16,520 STRATEGIES, WHETHER THIS 5507 04:09:16,520 --> 04:09:22,200 MISTRUST IS APPROPRIATE FOR AN 5508 04:09:22,200 --> 04:09:23,080 INDIVIDUAL. 5509 04:09:23,080 --> 04:09:24,880 LATINAS ARE UNDERREPRESENTED IN 5510 04:09:24,880 --> 04:09:26,760 MENOPAUSE RESEARCH. 5511 04:09:26,760 --> 04:09:33,320 WE KNOW DISPARITIES EXIST 5512 04:09:33,320 --> 04:09:35,520 BETWEEN LATINAS AND WHITE WOMEN 5513 04:09:35,520 --> 04:09:37,440 AND WITHIN THE SUBGROUPS. 5514 04:09:37,440 --> 04:09:39,720 ACCULTURATION IS ONE IMPORTANT 5515 04:09:39,720 --> 04:09:43,000 FACTOR BUT IT ONLY SCRATCHES THE 5516 04:09:43,000 --> 04:09:43,680 SURFACE. 5517 04:09:43,680 --> 04:09:46,000 WE NEED MORE ADDITIONAL MEASURES 5518 04:09:46,000 --> 04:09:49,600 OF ACCULTURATION BUT ALSO NEED 5519 04:09:49,600 --> 04:09:51,840 TO GO BENEATH THAT TO LOOK 5520 04:09:51,840 --> 04:09:58,160 CLOSER AT THE CONTEXT, 5521 04:09:58,160 --> 04:10:00,920 GEOGRAPHIC SETTING, IMMIGRATION, 5522 04:10:00,920 --> 04:10:01,680 EDUCATION, EMPLOYMENT. 5523 04:10:01,680 --> 04:10:06,120 THERE'S A NEED FOR GREATER 5524 04:10:06,120 --> 04:10:07,120 ACCESS TO CULTURALLY RELEVANT 5525 04:10:07,120 --> 04:10:08,920 HEALTH CARE INFORMATION FOR 5526 04:10:08,920 --> 04:10:10,760 LATINAS AND TO FURTHER EVALUATE 5527 04:10:10,760 --> 04:10:15,560 SOCIAL AND COMMUNITY CONTEXT, 5528 04:10:15,560 --> 04:10:17,880 HOW THAT IMPACTS MENOPAUSE 5529 04:10:17,880 --> 04:10:20,400 EXPERIENCE, SO SOCIAL SUPPORT, 5530 04:10:20,400 --> 04:10:28,840 SOCIAL ISOLATION, HOW DOES YOUR 5531 04:10:28,840 --> 04:10:30,440 FAMILY VIEW MENOPAUSE? 5532 04:10:30,440 --> 04:10:36,640 FUTURE DIRECTIONS, WE NEED 5533 04:10:36,640 --> 04:10:38,120 RECRUITMENT IN RESEARCH, MOVING 5534 04:10:38,120 --> 04:10:42,080 BEYOND INDIVIDUAL LEVEL FACTORS 5535 04:10:42,080 --> 04:10:45,200 AND BEHAVIORS, TO GET AT SOME 5536 04:10:45,200 --> 04:10:46,920 MECHANISMS IN TERMS OF SOCIAL 5537 04:10:46,920 --> 04:10:47,880 DETERMINANTS OF HEALTH, 5538 04:10:47,880 --> 04:10:51,120 INCREASING ACCESS TO HEALTH 5539 04:10:51,120 --> 04:10:54,160 CARE, INCREASING AVAILABILITY OF 5540 04:10:54,160 --> 04:10:55,440 CULTURALLY RELEVANT EDUCATION 5541 04:10:55,440 --> 04:10:58,080 FOR PATIENTS AND PROVIDERS, AND 5542 04:10:58,080 --> 04:11:02,520 THINKING THROUGH HOW WE'RE 5543 04:11:02,520 --> 04:11:05,760 DISSEMINATING AND IMPLEMENTING 5544 04:11:05,760 --> 04:11:06,160 KNOWLEDGE. 5545 04:11:06,160 --> 04:11:07,480 ARE WE DISSEMINATE NATURING OUR 5546 04:11:07,480 --> 04:11:08,080 RESEARCH INFORMATION IN 5547 04:11:08,080 --> 04:11:10,680 LOCATIONS WHERE THE PUBLIC WILL 5548 04:11:10,680 --> 04:11:13,160 HAVE ACCESS IN A FORMAT THAT'S 5549 04:11:13,160 --> 04:11:14,840 AVAILABLE AND EASY TO 5550 04:11:14,840 --> 04:11:16,280 UNDERSTAND, LANGUAGE THAT IS 5551 04:11:16,280 --> 04:11:22,160 PREFERRED BY INDIVIDUALS WHO WE 5552 04:11:22,160 --> 04:11:23,960 WANT TO IMPACT? 5553 04:11:23,960 --> 04:11:26,880 THANK YOU TO EVERYONE AND ALSO 5554 04:11:26,880 --> 04:11:29,520 JUST SHOW A FEW PICTURES OF MY 5555 04:11:29,520 --> 04:11:30,960 RESEARCH TEAM AND ALL THE WORK 5556 04:11:30,960 --> 04:11:31,560 THEY ARE DOING. 5557 04:11:31,560 --> 04:11:38,240 SO THANK YOU. 5558 04:11:38,240 --> 04:11:40,000 >> THANK YOU, DR. CORTES, FOR 5559 04:11:40,000 --> 04:11:41,680 THAT IMPORTANT WORK. 5560 04:11:41,680 --> 04:11:43,600 WE APPRECIATE IT. 5561 04:11:43,600 --> 04:11:48,520 I HAVE THE PLEASURE OF 5562 04:11:48,520 --> 04:11:50,120 INTRODUCING DR. SUSAN FRIEDMAN, 5563 04:11:50,120 --> 04:11:51,960 FACING OUR RISK OF CANCER 5564 04:11:51,960 --> 04:11:58,680 EMPOWERED, AND SHE WILL BE 5565 04:11:58,680 --> 04:12:02,760 GIVING US A PATIENT PERSPECTIVE. 5566 04:12:02,760 --> 04:12:04,800 >> TOUGH ACTS TO FOLLOW. 5567 04:12:04,800 --> 04:12:07,320 I'M GOING TO SWITCH GEARS AND 5568 04:12:07,320 --> 04:12:09,680 TALKING MORE ABOUT MY OWN 5569 04:12:09,680 --> 04:12:12,440 EXPERIENCE WITH EARLY ONSET 5570 04:12:12,440 --> 04:12:15,200 MENOPAUSE, SURGICAL MENOPAUSE, 5571 04:12:15,200 --> 04:12:17,520 SO THE POPULATION THAT DR. 5572 04:12:17,520 --> 04:12:20,720 NORQUIST WAS TALKING ABOUT 5573 04:12:20,720 --> 04:12:23,880 EARLIER AND EXPERIENCE AT FORCE, 5574 04:12:23,880 --> 04:12:25,680 A NATIONAL NON-PROFIT 5575 04:12:25,680 --> 04:12:26,000 ORGANIZATION. 5576 04:12:26,000 --> 04:12:26,960 HERE IS OUR QR CODE. 5577 04:12:26,960 --> 04:12:29,200 IT'S AN ORGANIZATION FOR PEOPLE 5578 04:12:29,200 --> 04:12:31,080 AT RISK OF HEREDITARY CANCER. 5579 04:12:31,080 --> 04:12:33,000 MANY PEOPLE IN OUR COMMUNITY 5580 04:12:33,000 --> 04:12:36,920 THAT WE SERVE ARE PEOPLE WHO ARE 5581 04:12:36,920 --> 04:12:40,960 LOOKING AT RISK FOR OVARIAN AND 5582 04:12:40,960 --> 04:12:44,000 GYNECOLOGIC CANCER AND MAKING 5583 04:12:44,000 --> 04:12:45,040 THESE DECISIONS. 5584 04:12:45,040 --> 04:12:46,120 MY PERSONAL EXPERIENCE, THIS WAS 5585 04:12:46,120 --> 04:12:48,080 ME BEFORE CANCER. 5586 04:12:48,080 --> 04:12:50,720 I WAS A VETERINARIAN, EARLY IN 5587 04:12:50,720 --> 04:12:56,120 MY CAREER I WAS A NEW MOM, JUST 5588 04:12:56,120 --> 04:12:56,920 STARTING OUT. 5589 04:12:56,920 --> 04:12:59,400 I DIDN'T HAVE A FAMILY HISTORY 5590 04:12:59,400 --> 04:13:03,120 OF CANCER, DIDN'T EXPECT IT. 5591 04:13:03,120 --> 04:13:06,640 IT HIT ME OUT OF THE BLUE I 5592 04:13:06,640 --> 04:13:08,640 DIDN'T HAVE RESOURCES EARLY IN 5593 04:13:08,640 --> 04:13:10,440 MY CAREER, FOCUSING ON MY 5594 04:13:10,440 --> 04:13:11,760 FAMILY, AND NOT THINKING ABOUT 5595 04:13:11,760 --> 04:13:13,560 CANCER, NONE OF MY PEERS WERE 5596 04:13:13,560 --> 04:13:14,640 EXPERIENCING IT. 5597 04:13:14,640 --> 04:13:17,400 I WAS GETTING READY TO HAVE A 5598 04:13:17,400 --> 04:13:18,960 SECOND CHILD WHEN I WENT DOWN 5599 04:13:18,960 --> 04:13:20,560 THE LIST OF THINGS TO DO WITH 5600 04:13:20,560 --> 04:13:22,000 YOUR HEALTH AND BECAUSE OF A 5601 04:13:22,000 --> 04:13:26,280 PRIOR LUMP I FELT I WAS HAVING 5602 04:13:26,280 --> 04:13:29,640 MAMMOGRAMS AND SO A MAMMOGRAM 5603 04:13:29,640 --> 04:13:33,560 RIGHT BEFORE I GOT PREGNANT 5604 04:13:33,560 --> 04:13:35,680 SHOWED ABNORMALITIES THAT LED TO 5605 04:13:35,680 --> 04:13:37,720 DIAGNOSIS OF CANCER. 5606 04:13:37,720 --> 04:13:41,200 I ENDED UP WITH A QUESTIONING 5607 04:13:41,200 --> 04:13:41,840 RECURRENCE, COMPREHENSIVE CANCER 5608 04:13:41,840 --> 04:13:43,800 CENTER, A FEW OTHER THINGS 5609 04:13:43,800 --> 04:13:44,800 HAPPENED WHERE I DIDN'T 5610 04:13:44,800 --> 04:13:47,760 NECESSARILY GET THE TYPE OF CARE 5611 04:13:47,760 --> 04:13:48,840 THAT I NEEDED. 5612 04:13:48,840 --> 04:13:50,840 AND EVEN THOUGH I WAS PRIVILEGED 5613 04:13:50,840 --> 04:13:53,160 TO HAVE MEDICAL KNOWLEDGE AND 5614 04:13:53,160 --> 04:13:53,720 MEDICAL BACKGROUND THERE WAS 5615 04:13:53,720 --> 04:13:56,280 STILL A LOT I DIDN'T KNOW. 5616 04:13:56,280 --> 04:13:57,280 THIS WAS PRETTY HARD TO 5617 04:13:57,280 --> 04:13:58,080 NAVIGATE. 5618 04:13:58,080 --> 04:14:01,080 I LEARNED FROM A MAGAZINE 5619 04:14:01,080 --> 04:14:02,720 ARTICLE ABOUT HEREDITARY 5620 04:14:02,720 --> 04:14:08,720 CANCERS, BACK IN 1997 WHEN I WAS 5621 04:14:08,720 --> 04:14:10,040 FIRST DIAGNOSED, TESTING FOR 5622 04:14:10,040 --> 04:14:12,760 BRCA WAS EARLY BUT I FOUND OUT I 5623 04:14:12,760 --> 04:14:15,880 HAD MANY OF THE RED FLAGS FOR A 5624 04:14:15,880 --> 04:14:17,680 HEREDITARY CANCER SYNDROME. 5625 04:14:17,680 --> 04:14:19,400 SO AFTER MY RECURRENCE, AFTER 5626 04:14:19,400 --> 04:14:22,160 LEARNING ABOUT HEREDITARY CANCER 5627 04:14:22,160 --> 04:14:25,640 RISK, I ENDED UP AT A CANCER 5628 04:14:25,640 --> 04:14:27,280 CENTER. 5629 04:14:27,280 --> 04:14:28,080 HALF WHICH THROUGH CHEMOTHERAPY 5630 04:14:28,080 --> 04:14:33,800 I FOUND I HAD A BRCA2 MUTATION. 5631 04:14:33,800 --> 04:14:36,400 SO, AFTER I FINISHED TREATMENT, 5632 04:14:36,400 --> 04:14:37,520 AFTER CHEMOTHERAPY AND 5633 04:14:37,520 --> 04:14:43,520 RADIATION, I HAD A UNILATERAL 5634 04:14:43,520 --> 04:14:45,760 MASTECTOMY, MY THOUGHTS TURNED 5635 04:14:45,760 --> 04:14:48,400 TOWARD MY REMAINING RISK FOR 5636 04:14:48,400 --> 04:14:49,360 OVARIAN CANCER, FOR BREAST 5637 04:14:49,360 --> 04:14:53,640 CANCER, AT THE TIME THAT I 5638 04:14:53,640 --> 04:14:55,400 FINISHED TREATMENT I WAS 35. 5639 04:14:55,400 --> 04:14:56,960 I DIDN'T WANT TO BE DIAGNOSED 5640 04:14:56,960 --> 04:14:58,640 WITH BREAST CANCER OR ANY CANCER 5641 04:14:58,640 --> 04:14:59,000 AGAIN. 5642 04:14:59,000 --> 04:15:02,440 IN TALKING TO MY DOCTORS IT WAS 5643 04:15:02,440 --> 04:15:04,080 REALLY AGAIN PRETTY EARLY IN 5644 04:15:04,080 --> 04:15:07,520 GENETIC TESTING, WHAT WE KNEW, 5645 04:15:07,520 --> 04:15:09,320 THE KNOWLEDGE DR. NORQUIST WAS 5646 04:15:09,320 --> 04:15:11,440 TALKING ABOUT WITH LONG-TERM 5647 04:15:11,440 --> 04:15:13,120 OUTCOMES, IMPROVED SURVIVAL, 5648 04:15:13,120 --> 04:15:15,440 EVEN THINGS LIKE THAT WOMEN WITH 5649 04:15:15,440 --> 04:15:18,960 BRCA2 MUTATIONS MIGHT BE ABLE TO 5650 04:15:18,960 --> 04:15:19,800 DELAY OOPHORECTOMY, WE DIDN'T 5651 04:15:19,800 --> 04:15:20,600 KNOW THAT. 5652 04:15:20,600 --> 04:15:24,880 I HAD TO MAKE DECISIONS IN A 5653 04:15:24,880 --> 04:15:25,120 VACUUM. 5654 04:15:25,120 --> 04:15:29,160 IN A DATA-FREE ZONE. 5655 04:15:29,160 --> 04:15:30,800 I FELT FAIRLY UNPREPARED TO MAKE 5656 04:15:30,800 --> 04:15:31,320 THAT DECISION. 5657 04:15:31,320 --> 04:15:34,240 I KNEW THAT I WOULD BE ENDING MY 5658 04:15:34,240 --> 04:15:37,280 FERTILITY BUT NOBODY HAD OFFERED 5659 04:15:37,280 --> 04:15:41,440 ME ANY FERTILITY PRESERVATION 5660 04:15:41,440 --> 04:15:41,840 OPTIONS. 5661 04:15:41,840 --> 04:15:47,600 I KNEW I WOULD GO THROUGH 5662 04:15:47,600 --> 04:15:49,480 MENOPAUSE AT 35 IF I WENT 5663 04:15:49,480 --> 04:15:51,120 THROUGH WITH SURGERY. 5664 04:15:51,120 --> 04:15:55,520 I WAS TOLD I COULD NEVER HAVE 5665 04:15:55,520 --> 04:15:56,800 HORMONES BECAUSE OF BREAST 5666 04:15:56,800 --> 04:16:01,400 CANCER, IT ENDED UP BEING AN 5667 04:16:01,400 --> 04:16:03,200 ER+, WE DIDN'T KNOW THAT AT THE 5668 04:16:03,200 --> 04:16:06,840 TIME, THERE WAS NO LONG-TERM 5669 04:16:06,840 --> 04:16:07,120 DATA. 5670 04:16:07,120 --> 04:16:09,760 AS AN ASIDE, THIS PHOTO WAS 5671 04:16:09,760 --> 04:16:11,120 TAKEN FROM THE CHAPEL AT THE 5672 04:16:11,120 --> 04:16:14,160 HOSPITAL WHERE I HAD MY SURGERY. 5673 04:16:14,160 --> 04:16:16,760 I REMEMBER THE NIGHT BEFORE 5674 04:16:16,760 --> 04:16:19,120 SURGERY, ADMITTED EARLY, THE 5675 04:16:19,120 --> 04:16:20,520 NIGHT BEFORE, NOT PARTICULARLY A 5676 04:16:20,520 --> 04:16:22,720 RELIGIOUS PERSON BUT I REMEMBER 5677 04:16:22,720 --> 04:16:25,440 GOING TO THE CHAPEL AND PRAYING 5678 04:16:25,440 --> 04:16:27,800 BECAUSE I WAS TERRIFIED ABOUT 5679 04:16:27,800 --> 04:16:31,800 WHAT THIS SURGERY WOULD MEAN FOR 5680 04:16:31,800 --> 04:16:32,400 ME. 5681 04:16:32,400 --> 04:16:36,160 AS I SAID, MY DOCTOR DIDN'T 5682 04:16:36,160 --> 04:16:36,440 PREPARE ME. 5683 04:16:36,440 --> 04:16:38,240 THIS WAS EARLY IN THE DAYS OF 5684 04:16:38,240 --> 04:16:39,040 INTERNET, DIDN'T HAVE A 5685 04:16:39,040 --> 04:16:39,280 COMPUTER. 5686 04:16:39,280 --> 04:16:43,520 I WENT TO THE BOOK STORE, FOUND 5687 04:16:43,520 --> 04:16:46,840 THIS BOOK, LIGHT-HEARTED 5688 04:16:46,840 --> 04:16:47,720 APPROACH TO MENOPAUSE, WRITTEN 5689 04:16:47,720 --> 04:16:51,920 BY AN AUTHOR WHO WAS GOING 5690 04:16:51,920 --> 04:16:54,760 THROUGH REALLY MENOPAUSE AT AN 5691 04:16:54,760 --> 04:16:56,920 AVERAGE AGE, AND SHE WAS TALKING 5692 04:16:56,920 --> 04:16:58,560 ABOUT HER EXPERIENCE. 5693 04:16:58,560 --> 04:17:00,160 I QUOTE FROM THE BOOK, JUST TO 5694 04:17:00,160 --> 04:17:02,360 POINT OUT HOW SHE WAS TRYING TO 5695 04:17:02,360 --> 04:17:04,800 MAKE IT LIGHT HARDED BUT IT WAS 5696 04:17:04,800 --> 04:17:06,160 REALLY HARD TO HEAR. 5697 04:17:06,160 --> 04:17:08,640 SAYING NOW SEX HAS ALL THE 5698 04:17:08,640 --> 04:17:14,080 EROTICISM AND PLEASURE OF A FULL 5699 04:17:14,080 --> 04:17:15,080 BODY WAX. 5700 04:17:15,080 --> 04:17:18,840 PARENTS ARE THE GHOSTS OF 5701 04:17:18,840 --> 04:17:20,320 CHRISTMAS FUTURE, FROM WHAT I'VE 5702 04:17:20,320 --> 04:17:22,760 SEEN MY FUTURE LOOKS SHORT AND 5703 04:17:22,760 --> 04:17:23,840 POROUS, TALKING ABOUT BONE 5704 04:17:23,840 --> 04:17:24,080 HEALTH. 5705 04:17:24,080 --> 04:17:26,520 I REMEMBER THROWING THIS BOOK 5706 04:17:26,520 --> 04:17:27,480 ACROSS THE ROOM. 5707 04:17:27,480 --> 04:17:29,600 AT THE END THE CONCLUSION WAS 5708 04:17:29,600 --> 04:17:31,280 SHE EXPERIENCED A LOT OF 5709 04:17:31,280 --> 04:17:32,800 NEGATIVE SIDE EFFECTS OF 5710 04:17:32,800 --> 04:17:34,600 MENOPAUSE, AND DECIDED TO GO ON 5711 04:17:34,600 --> 04:17:36,000 HORMONE REPLACEMENT AND HER LIFE 5712 04:17:36,000 --> 04:17:37,000 WAS WONDERFUL. 5713 04:17:37,000 --> 04:17:38,680 AND THAT WAS NOT GOING TO BE ME. 5714 04:17:38,680 --> 04:17:40,440 AT THE END OF THE DAY THE BOOK 5715 04:17:40,440 --> 04:17:41,400 WASN'T VERY HELPFUL. 5716 04:17:41,400 --> 04:17:43,920 I DIDN'T HAVE MUCH IN THE WAY OF 5717 04:17:43,920 --> 04:17:45,440 GUIDANCE OR ANY PEERS THAT I 5718 04:17:45,440 --> 04:17:48,080 KNEW GOING THROUGH THIS 5719 04:17:48,080 --> 04:17:48,400 EXPERIENCE. 5720 04:17:48,400 --> 04:17:50,680 SO I WENT THROUGH THIS 5721 04:17:50,680 --> 04:17:53,640 THREE-YEAR EXPERIMENT OF NO 5722 04:17:53,640 --> 04:17:55,760 HORMONES, AND I WENT TO A LOT OF 5723 04:17:55,760 --> 04:17:57,520 HEALTH CARE PROFESSIONALS. 5724 04:17:57,520 --> 04:18:04,360 THE BIGGEST SYMPTOMS WERE 5725 04:18:04,360 --> 04:18:07,840 FATIGUE, NO LIBIDO, JOINT PAIN, 5726 04:18:07,840 --> 04:18:10,160 DEPRESSION, HOT FLASHES, BONE 5727 04:18:10,160 --> 04:18:12,200 LOSS, BUT THE FATIGUE WAS SUCH A 5728 04:18:12,200 --> 04:18:13,560 QUALITY OF LIFE CONCERN. 5729 04:18:13,560 --> 04:18:15,400 I REMEMBER TALKING TO WHATEVER 5730 04:18:15,400 --> 04:18:17,840 EXPERTS, WHOEVER WOULD TALK TO 5731 04:18:17,840 --> 04:18:18,440 ME. 5732 04:18:18,440 --> 04:18:20,560 I WAS A CONFERENCE, I ASKED A 5733 04:18:20,560 --> 04:18:22,960 QUESTION OF A SPEAKER TALKING 5734 04:18:22,960 --> 04:18:24,440 ABOUT SEXUALITY, SPECIFICALLY 5735 04:18:24,440 --> 04:18:30,520 FOR WOMEN WITH BRCA MUTATION WHO 5736 04:18:30,520 --> 04:18:33,760 HAD OOPHORECTOMY, HAVE YOU SEEN 5737 04:18:33,760 --> 04:18:36,440 A CONNECTION BETWEEN SURGICAL 5738 04:18:36,440 --> 04:18:37,840 MENOPAUSE AND LACK OF LIBIDO, 5739 04:18:37,840 --> 04:18:39,960 NO, SHE HAD NOT SEEN THAT. 5740 04:18:39,960 --> 04:18:43,520 I WAS FATIGUED BECAUSE I WAS 5741 04:18:43,520 --> 04:18:45,080 DEPRESSED, I KNEW THIS WAS 5742 04:18:45,080 --> 04:18:47,440 DIFFERENT, HAVING EXPERIENCED 5743 04:18:47,440 --> 04:18:47,760 DEPRESSION. 5744 04:18:47,760 --> 04:18:51,440 NO, I'M DEPRESSED BECAUSE I'M 5745 04:18:51,440 --> 04:18:53,560 FATIGUED BUT I HAD MY 5746 04:18:53,560 --> 04:18:54,200 EXPERIENCES INVALIDATED BY THE 5747 04:18:54,200 --> 04:18:55,600 HEALTH CARE COMMUNITY. 5748 04:18:55,600 --> 04:18:56,640 AROUND THIS THREE-YEAR MARK I 5749 04:18:56,640 --> 04:18:59,600 HAD AN APPOINTMENT AT A 5750 04:18:59,600 --> 04:19:02,320 DEDICATED FATIGUE CLINIC, CANCER 5751 04:19:02,320 --> 04:19:03,480 CENTER WHERE AFTER EXAMINING ME 5752 04:19:03,480 --> 04:19:05,560 AND HEARING MY HISTORY THEY SAID 5753 04:19:05,560 --> 04:19:07,200 YOU HAVE CANCER FATIGUE. 5754 04:19:07,200 --> 04:19:10,040 I'M THREE YEARS OUT OF 5755 04:19:10,040 --> 04:19:10,320 TREATMENT! 5756 04:19:10,320 --> 04:19:12,560 THE EXPERT SAID WE SEE IT. 5757 04:19:12,560 --> 04:19:15,720 I ASKED, COULD THIS BE MENOPAUSE 5758 04:19:15,720 --> 04:19:16,160 RELATED? 5759 04:19:16,160 --> 04:19:18,000 THEY SAID NO. 5760 04:19:18,000 --> 04:19:20,680 I WAS FRUSTRATED BUT ALSO I WAS 5761 04:19:20,680 --> 04:19:29,840 CONVINCED MY SYMPTOMS WERE 5762 04:19:29,840 --> 04:19:31,320 MENOPAUSAL. 5763 04:19:31,320 --> 04:19:33,280 AN ENDOCRINOLOGIST AGREED, BUT 5764 04:19:33,280 --> 04:19:35,120 NO HORMONES, BREAST CANCER THAT 5765 04:19:35,120 --> 04:19:36,960 WAS ER+. 5766 04:19:36,960 --> 04:19:39,240 AROUND THE THREE-YEAR MARK, AGE 5767 04:19:39,240 --> 04:19:41,680 38, I REACHED MY LIMIT, WENT 5768 04:19:41,680 --> 04:19:44,360 THROUGH ALL THESE SURGERIES AND 5769 04:19:44,360 --> 04:19:46,840 GENETIC TESTING, CHEMO, 5770 04:19:46,840 --> 04:19:53,640 RADIATION, TREATMENT, TO TRY AND 5771 04:19:53,640 --> 04:19:55,520 NOT JUST LIVE LONGER BUT IMPROVE 5772 04:19:55,520 --> 04:19:57,680 QUALITY OF LIFE. 5773 04:19:57,680 --> 04:20:00,120 I TOLD A LOCAL DOCTOR IF HE DID 5774 04:20:00,120 --> 04:20:02,280 NOT PRESCRIBE HORMONES, NOT 5775 04:20:02,280 --> 04:20:05,000 BEING FACETIOUS, THAT I WOULD 5776 04:20:05,000 --> 04:20:06,680 PERSONALLY HOLD HIM ACCOUNTABLE 5777 04:20:06,680 --> 04:20:08,000 WHEN I FLUNG MYSELF OFF THE TOP 5778 04:20:08,000 --> 04:20:09,680 OF MY OFFICE BUILDING. 5779 04:20:09,680 --> 04:20:11,320 I LITERALLY SAID THAT, I 5780 04:20:11,320 --> 04:20:12,840 LITERALLY MEANT IT. 5781 04:20:12,840 --> 04:20:15,120 HE PRESCRIBED ME HORMONES THAT 5782 04:20:15,120 --> 04:20:15,640 DAY. 5783 04:20:15,640 --> 04:20:17,040 I HAVE OTHER ONCOLOGISTS TELLING 5784 04:20:17,040 --> 04:20:20,160 ME I WAS CRAZY, TO GO ON 5785 04:20:20,160 --> 04:20:21,600 HORMONES WITH EVERYTHING ELSE I 5786 04:20:21,600 --> 04:20:21,880 HAD DONE. 5787 04:20:21,880 --> 04:20:23,840 FOR ME IT WAS QUALITY OF LIFE 5788 04:20:23,840 --> 04:20:24,120 DECISION. 5789 04:20:24,120 --> 04:20:26,400 I DON'T ENDORSE THIS FOR OTHER 5790 04:20:26,400 --> 04:20:26,840 PEOPLE. 5791 04:20:26,840 --> 04:20:29,600 I WENT INTO THIS WITH FULL 5792 04:20:29,600 --> 04:20:32,640 KNOWLEDGE I TRIED EVERYTHING 5793 04:20:32,640 --> 04:20:32,960 ELSE. 5794 04:20:32,960 --> 04:20:36,240 INCLUDING I HAD BEEN PUT ON THIS 5795 04:20:36,240 --> 04:20:39,760 MEDICATION USED FOR PEOPLE WITH 5796 04:20:39,760 --> 04:20:44,560 NARCOLEPSY AND THAT DID NOT 5797 04:20:44,560 --> 04:20:44,760 HELP. 5798 04:20:44,760 --> 04:20:47,160 AFTER STARTING HORMONES, I WAS 5799 04:20:47,160 --> 04:20:49,960 AT A CONFERENCE, RUNNING FULL 5800 04:20:49,960 --> 04:20:56,640 TIME, I WAS AT A CONFERENCE, A 5801 04:20:56,640 --> 04:20:57,520 FOR 5802 04:20:57,520 --> 04:20:58,600 YOUNG WOMEN WITH BREAST CANCER, 5803 04:20:58,600 --> 04:21:00,760 RUNNING ON A TREADMILL AND 5804 04:21:00,760 --> 04:21:01,840 FEELING GOOD FOR THE FIRST TIME 5805 04:21:01,840 --> 04:21:12,240 IN THE LAST THREE YEARS. 5806 04:21:13,680 --> 04:21:15,600 ENERGY AND LIBIDO RESTORED, I 5807 04:21:15,600 --> 04:21:16,600 RECOGNIZED MYSELF FOR THE FIRST 5808 04:21:16,600 --> 04:21:18,320 TIME IN THREE YEARS. 5809 04:21:18,320 --> 04:21:20,600 NOT AN ENDORSEMENT BUT I'M STILL 5810 04:21:20,600 --> 04:21:28,200 ON ESTROGEN TO THIS DAY, AT AGE 5811 04:21:28,200 --> 04:21:29,040 60. 5812 04:21:29,040 --> 04:21:31,760 THIS IS THE EXPERIENCE OF THE 5813 04:21:31,760 --> 04:21:37,840 FORCE COMMUNITY. 5814 04:21:37,840 --> 04:21:40,800 WE'VE DONE SURVEYS AND 5815 04:21:40,800 --> 04:21:41,680 DOCUMENTED, EARLY SURGICAL 5816 04:21:41,680 --> 04:21:42,040 MENOPAUSE. 5817 04:21:42,040 --> 04:21:44,200 I HAD MEMBERS COME TO ME, I HATE 5818 04:21:44,200 --> 04:21:45,480 TO MAKE THIS DECISION WHETHER OR 5819 04:21:45,480 --> 04:21:47,840 NOT TO REMOVE MY OVARIES, MORE 5820 04:21:47,840 --> 04:21:50,160 WORRIED ABOUT MY DAUGHTER. 5821 04:21:50,160 --> 04:21:51,920 I REMEMBER WITH NAIVE CONFIDENCE 5822 04:21:51,920 --> 04:21:58,400 BACK THEN, I STARTED FORCE IN 5823 04:21:58,400 --> 04:22:04,040 2000, THIS IS OUR 25th YEAR, 5824 04:22:04,040 --> 04:22:05,880 WE'VE COME SO FAR THERE WILL BE 5825 04:22:05,880 --> 04:22:06,760 BETTER DECISIONS WHEN YOUR 5826 04:22:06,760 --> 04:22:08,400 DAUGHTER HAS TO MAKE THIS 5827 04:22:08,400 --> 04:22:09,760 DECISIONS WHICH THERE AREN'T. 5828 04:22:09,760 --> 04:22:13,440 WE'RE JUST NOT THERE YET. 5829 04:22:13,440 --> 04:22:15,040 THIS QUOTE ENCAPSULATES THE 5830 04:22:15,040 --> 04:22:20,000 WOMAN WHO IS 38 WITH BRCA1 5831 04:22:20,000 --> 04:22:21,720 MUTATION, THERE ARE INCREASED 5832 04:22:21,720 --> 04:22:24,920 RISK FOR OSTEOPOROSIS, HEART 5833 04:22:24,920 --> 04:22:25,960 DISEASE FROM PREMATURE REMOVAL, 5834 04:22:25,960 --> 04:22:29,320 AT LEAST THIS ACKNOWLEDGE THIS, 5835 04:22:29,320 --> 04:22:32,120 THIS WOMAN SAYING THIS IS A 5836 04:22:32,120 --> 04:22:33,520 HORRIBLE HARD THING BECAUSE NO 5837 04:22:33,520 --> 04:22:40,720 MATTER WHAT I DO THERE SEEMS TO 5838 04:22:40,720 --> 04:22:42,640 BE SUBSTANTIAL RISK. 5839 04:22:42,640 --> 04:22:44,440 SO DR. NORQUIST TALKED ABOUT THE 5840 04:22:44,440 --> 04:22:47,160 IDEA OF THE FALLOPIAN TUBES, 5841 04:22:47,160 --> 04:22:49,080 EXCITING RESEARCH, THE FIRST 5842 04:22:49,080 --> 04:22:51,840 PUBLICATION I SAW WAS IN 2007, 5843 04:22:51,840 --> 04:22:54,280 LED TO THIS IDEA PERHAPS MOST OF 5844 04:22:54,280 --> 04:22:57,560 THESE CANCERS ARE STARTING IN 5845 04:22:57,560 --> 04:22:59,520 THE FALLOPIAN TUBES COULD WE 5846 04:22:59,520 --> 04:23:01,040 REMOVE THOSE BEFORE MENOPAUSE 5847 04:23:01,040 --> 04:23:03,480 AND WAIT TILL PEOPLE ARE CLOSER 5848 04:23:03,480 --> 04:23:06,440 TO MENOPAUSE BEFORE REMOVING THE 5849 04:23:06,440 --> 04:23:07,280 OVARIES. 5850 04:23:07,280 --> 04:23:12,680 AND WE DID A SURVEY IN 2011, 5851 04:23:12,680 --> 04:23:14,440 ASKED WOMEN WHO WERE HIGH RISK 5852 04:23:14,440 --> 04:23:16,640 AND HAD NOT REMOVED THEIR 5853 04:23:16,640 --> 04:23:19,240 OVARIES YET, HOW THEY FELT ABOUT 5854 04:23:19,240 --> 04:23:21,280 POTENTIALLY PARTICIPATING IN A 5855 04:23:21,280 --> 04:23:25,880 STUDY WHERE WE HADN'T PROVEN SAL 5856 04:23:25,880 --> 04:23:27,120 PINGECTOMY WOULD LOWER RISK, 5857 04:23:27,120 --> 04:23:28,600 WOULD THEY PARTICIPATE KNOWING 5858 04:23:28,600 --> 04:23:30,120 THEY WOULD NEED ANOTHER SURGERY 5859 04:23:30,120 --> 04:23:33,400 LATER, A THIRD SAID YES, A THIRD 5860 04:23:33,400 --> 04:23:36,160 UNSURE, A THIRD SAID NO. 5861 04:23:36,160 --> 04:23:38,400 THIS WAS A STUDY THAT OUR 5862 04:23:38,400 --> 04:23:39,720 COMMUNITY WOULD BE VERY 5863 04:23:39,720 --> 04:23:41,120 INTERESTED IN. 5864 04:23:41,120 --> 04:23:45,080 AND SOME OF THE QUOTES, WILL YOU 5865 04:23:45,080 --> 04:23:48,680 HAVE COPIES, THESE HAD SOMETHING 5866 04:23:48,680 --> 04:23:51,640 LIKE 107 WRITE-IN COMMENTS, 5867 04:23:51,640 --> 04:23:56,480 PEOPLE HAD STRONG OPINIONS. 5868 04:23:56,480 --> 04:24:01,680 WE'VE-CHAMPIONS OF THE SOROCK 5869 04:24:01,680 --> 04:24:03,720 STUDY. 5870 04:24:03,720 --> 04:24:06,160 THIS IS PROSPECTIVE STUDY 5871 04:24:06,160 --> 04:24:09,560 LOOKING AT CANCER OUTCOMES FOR 5872 04:24:09,560 --> 04:24:10,880 SALPINGECTOMY, REMOVAL OF 5873 04:24:10,880 --> 04:24:12,760 FALLOPIAN TUBES FOLLOWED BY 5874 04:24:12,760 --> 04:24:13,760 OOPHORECTOMY CLOSER TO 5875 04:24:13,760 --> 04:24:16,520 MENOPAUSE, WE WILL NOT -- THIS 5876 04:24:16,520 --> 04:24:17,680 WILL NOT CLOSE UNTIL 2037 SO WE 5877 04:24:17,680 --> 04:24:21,200 HAVE A LONG HAUL BEFORE WE HAVE 5878 04:24:21,200 --> 04:24:22,960 THESE ANSWERS. 5879 04:24:22,960 --> 04:24:24,280 IT COULD BE ANOTHER 25 YEARS IF 5880 04:24:24,280 --> 04:24:26,600 WE DON'T DO THE STUDY AND STILL 5881 04:24:26,600 --> 04:24:30,120 MAY BE TELLING PEOPLE WE DON'T 5882 04:24:30,120 --> 04:24:30,320 KNOW. 5883 04:24:30,320 --> 04:24:34,120 YOUR DAUGHTERS HAVE TO MAKE THE 5884 04:24:34,120 --> 04:24:36,520 SAME DECISIONS SO WE'RE VERY 5885 04:24:36,520 --> 04:24:37,120 INVESTED. 5886 04:24:37,120 --> 04:24:39,920 THERE ARE CHALLENGES TO SOROCK, 5887 04:24:39,920 --> 04:24:44,000 IT'S UNPROVEN AS PREVENTION IN 5888 04:24:44,000 --> 04:24:46,440 HIGH RISK WOMEN, SALPINGECTOMY 5889 04:24:46,440 --> 04:24:47,200 IS AVAILABLE OUTSIDE 5890 04:24:47,200 --> 04:24:48,280 CONTRACEPTION, PEOPLE WITH GOING 5891 04:24:48,280 --> 04:24:51,200 TO OB/GYNs BECAUSE THEY DIDN'T 5892 04:24:51,200 --> 04:24:53,840 KNOW SOROCK, AND HAVING SURGERY. 5893 04:24:53,840 --> 04:24:57,640 WE DON'T HAVE PROOF THIS IS 5894 04:24:57,640 --> 04:25:01,240 GOING TO BE COMPARABLE TO 5895 04:25:01,240 --> 04:25:02,800 OOPHORECTOMY, AND SO IF WE CAN 5896 04:25:02,800 --> 04:25:05,560 GET EVERYBODY ON BOARD, ANYONE 5897 04:25:05,560 --> 04:25:10,320 WHO WOULD QUALIFY FOR SURGERY, 5898 04:25:10,320 --> 04:25:12,760 WE CAN FINISH ENROLLMENT AND GET 5899 04:25:12,760 --> 04:25:13,480 LONG-TERM OUTCOMES. 5900 04:25:13,480 --> 04:25:17,800 WE'RE ASKING PEOPLE TO COMMIT, A 5901 04:25:17,800 --> 04:25:20,560 LONG TIME, A LOT OF PEOPLE TO 5902 04:25:20,560 --> 04:25:21,560 COMPLETE THIS. 5903 04:25:21,560 --> 04:25:23,520 THAT THREATENS OUR CHANCE TO GET 5904 04:25:23,520 --> 04:25:26,200 ENOUGH PEOPLE ENROLLED TO GET 5905 04:25:26,200 --> 04:25:26,880 ANSWERS. 5906 04:25:26,880 --> 04:25:29,040 THAT'S ALL I'M GOING TO SAY. 5907 04:25:29,040 --> 04:25:31,840 HAPPY TO ANSWER QUESTIONS AFTER. 5908 04:25:31,840 --> 04:25:33,320 FINAL THOUGHTS THAT PEOPLE AT 5909 04:25:33,320 --> 04:25:38,840 HIGH RISK FOR GYNECOLOGIC 5910 04:25:38,840 --> 04:25:41,000 CANCERS NEED BETTER OPTIONS, 5911 04:25:41,000 --> 04:25:42,880 THEY ARE MOTIVATED TO 5912 04:25:42,880 --> 04:25:43,960 PARTICIPATE IN RESEARCH. 5913 04:25:43,960 --> 04:25:46,520 BETTER OPTIONS ARE NEEDED FOR 5914 04:25:46,520 --> 04:25:49,400 MANAGING SIDE EFFECTS OF EARLY 5915 04:25:49,400 --> 04:25:50,960 MENOPAUSE ESPECIALLY FOR THOSE 5916 04:25:50,960 --> 04:25:52,720 FOR WHOM HORMONE REPLACEMENT IS 5917 04:25:52,720 --> 04:25:55,160 NOT CONSIDERED SAFE, THAT 5918 04:25:55,160 --> 04:25:56,440 INCLUDES ME. 5919 04:25:56,440 --> 04:25:58,440 I'M ON HORMONE REPLACEMENT BUT 5920 04:25:58,440 --> 04:26:00,280 IT'S NOT CONSIDERED SAFETY. 5921 04:26:00,280 --> 04:26:02,000 QUALITY OF LIFE DECISIONS. 5922 04:26:02,000 --> 04:26:05,120 HEALTH CARE PROFESSIONALS SHOULD 5923 04:26:05,120 --> 04:26:07,480 HAVE HONEST CONVERSATIONS. 5924 04:26:07,480 --> 04:26:11,920 WE HEAR THIS FROM OUR COMMUNITY, 5925 04:26:11,920 --> 04:26:13,600 MEDICAL GAS LIGHTING WE 5926 04:26:13,600 --> 04:26:15,240 SOMETIMES HEAR, CONCERNS ARE 5927 04:26:15,240 --> 04:26:16,920 REAL BECAUSE THEY ARE HEALTH 5928 04:26:16,920 --> 04:26:19,320 CARE PROFESSIONALS DON'T HAVE 5929 04:26:19,320 --> 04:26:21,560 ANYTHING TO OFFER THEM. 5930 04:26:21,560 --> 04:26:27,400 IT'S CRITICAL TO INVEST IN 5931 04:26:27,400 --> 04:26:31,160 STUDIES LIKE SOROCK AND 5932 04:26:31,160 --> 04:26:33,400 TUBA/WISPII SEE WE HAVE BETTER 5933 04:26:33,400 --> 04:26:35,920 OPTIONS FOR HIGH RISK WOMEN 5934 04:26:35,920 --> 04:26:36,360 TOMORROW. 5935 04:26:36,360 --> 04:26:37,360 THANK YOU VERY MUCH. 5936 04:26:37,360 --> 04:26:43,400 I'LL STOP SHARING. 5937 04:26:43,400 --> 04:26:46,200 >> THANK YOU SO MUCH FOR THAT 5938 04:26:46,200 --> 04:26:46,880 WONDERFUL PERSPECTIVE. 5939 04:26:46,880 --> 04:26:48,320 WE APPRECIATE IT. 5940 04:26:48,320 --> 04:26:58,800 NOW WE HAVE OUR FINAL SPEAKER, 5941 04:26:58,800 --> 04:27:00,760 DORCAS BAKER, THE CO-FOUNDER OF 5942 04:27:00,760 --> 04:27:04,800 OLDER WOMEN EMBRACING LIFE. 5943 04:27:04,800 --> 04:27:06,200 >> THANK YOU. 5944 04:27:06,200 --> 04:27:13,760 I WANT TO THANK DR. TEMKIN AND 5945 04:27:13,760 --> 04:27:16,280 THE ORGANIZING MEAT FOR THE 5946 04:27:16,280 --> 04:27:17,080 OPPORTUNITY TO PRESENT. 5947 04:27:17,080 --> 04:27:19,600 THANK YOU FOR THE AMAZING 5948 04:27:19,600 --> 04:27:21,600 SYMPOSIUM, AN HONOR TO SHARE 5949 04:27:21,600 --> 04:27:23,960 WITH YOU TODAY ABOUT AN AMAZING 5950 04:27:23,960 --> 04:27:27,360 GROUP OF WOMEN WHO HAVE THE 5951 04:27:27,360 --> 04:27:29,760 LIVED EXPERIENCE, LIFE WITH HIV, 5952 04:27:29,760 --> 04:27:32,720 MANY WERE DIAGNOSED MORE THAN 25 5953 04:27:32,720 --> 04:27:36,400 YEARS AGO, YOU SEE SOME LADIES 5954 04:27:36,400 --> 04:27:40,640 ON THE SCREEN, SOME 38 YEARS 5955 04:27:40,640 --> 04:27:43,040 PLUS IN THEIR QUOTE/UNQUOTE 5956 04:27:43,040 --> 04:27:43,600 GOLDEN YEARS. 5957 04:27:43,600 --> 04:27:46,880 ONE NOT ON THE HOME PAGE OF OUR 5958 04:27:46,880 --> 04:27:48,640 WEBSITE, SHE IS ONE OF THE 5959 04:27:48,640 --> 04:27:51,160 FOUNDERS, THE MAIN FOUNDER NOT 5960 04:27:51,160 --> 04:27:54,280 ON THAT PAGE, SHE WILL BE 80 IN 5961 04:27:54,280 --> 04:27:56,080 JULY. 5962 04:27:56,080 --> 04:27:57,960 AND DOING VERY WELL. 5963 04:27:57,960 --> 04:28:00,080 THIS IS A VERY IMPORTANT GROUP. 5964 04:28:00,080 --> 04:28:02,880 I'M GLAD WE WERE ABLE TO SHARE 5965 04:28:02,880 --> 04:28:06,920 ABOUT OLDER WOMEN EMBRACING 5966 04:28:06,920 --> 04:28:08,800 LIFE. 5967 04:28:08,800 --> 04:28:15,480 FOUNDED IN 2004, THE ACRONYM IS 5968 04:28:15,480 --> 04:28:19,440 PRONOUNCED "OH WELL," OLDER 5969 04:28:19,440 --> 04:28:20,600 WOMEN THAT PROVIDE FOR WOMEN 5970 04:28:20,600 --> 04:28:21,280 WITH HIV. 5971 04:28:21,280 --> 04:28:22,960 OUR VISION IS TO HAVE A 5972 04:28:22,960 --> 04:28:25,480 COMMUNITY OF WOMEN WHO ARE 5973 04:28:25,480 --> 04:28:26,240 LIVING FULL PRODUCTIVE LEVELS IN 5974 04:28:26,240 --> 04:28:31,600 SPITE OF THE CHALLENGE OF HIV. 5975 04:28:31,600 --> 04:28:33,840 OUR MISSION PLAN, DEVELOP THE 5976 04:28:33,840 --> 04:28:35,480 IMPLEMENT PROGRAM, PROJECTS, NOT 5977 04:28:35,480 --> 04:28:38,920 ONLY THAT AFFECT PHYSICAL HEALTH 5978 04:28:38,920 --> 04:28:41,840 BUT MEDICAL, SPIRITUAL, 5979 04:28:41,840 --> 04:28:43,480 EMOTIONAL HEALTH, BUILD STRONG 5980 04:28:43,480 --> 04:28:47,640 CONNECTIONS WITH ONE ANOTHER AND 5981 04:28:47,640 --> 04:28:48,720 ADVOCATES, WITH SERVICE 5982 04:28:48,720 --> 04:28:51,840 AGENCIES, HEALTH CARE PROVIDERS, 5983 04:28:51,840 --> 04:28:54,640 AND THEY BUILD FOUNDATION OF 5984 04:28:54,640 --> 04:28:55,800 SUPPORTING AND MAKING 5985 04:28:55,800 --> 04:28:58,480 CONFIDENCE, MAKING WOMEN FEEL 5986 04:28:58,480 --> 04:29:00,320 CONFIDENT AND BEING PRO-ACTIVE 5987 04:29:00,320 --> 04:29:03,160 IN THEIR CARE AND PARTICIPATION. 5988 04:29:03,160 --> 04:29:07,120 AS YOU SEE ON THIS SCREEN, THESE 5989 04:29:07,120 --> 04:29:08,840 WOMEN JUST TO POINT OUT THE 5990 04:29:08,840 --> 04:29:13,360 CURRENT FOUNDER IN RED AND BLACK 5991 04:29:13,360 --> 04:29:16,320 DRESS, MELANIE, THE CURRENT 5992 04:29:16,320 --> 04:29:17,480 EXECUTIVE DIRECTOR, NOT FOUNDER. 5993 04:29:17,480 --> 04:29:19,480 THE WOMEN WITH GLASSES ON HER 5994 04:29:19,480 --> 04:29:26,440 HEAD IS 77 YEARS OLD, WITH THE 5995 04:29:26,440 --> 04:29:28,680 YELLOW VEST, SHE'S 70, AND THE 5996 04:29:28,680 --> 04:29:31,920 ONE TO THE OTHER SIDE OF MELANIE 5997 04:29:31,920 --> 04:29:37,120 REESE WITH THE RED DRESS IS ONE 5998 04:29:37,120 --> 04:29:39,400 OF OUR LADIES, LIVING WITH HIV A 5999 04:29:39,400 --> 04:29:41,520 LONG TIME, AND THE LAST WOMAN IS 6000 04:29:41,520 --> 04:29:44,440 NOT LIVING WITH HIV BUT SHE'S 6001 04:29:44,440 --> 04:29:46,000 ONE OF OUR CO-FOUNDERS ALONG 6002 04:29:46,000 --> 04:29:47,320 WITH US. 6003 04:29:47,320 --> 04:29:50,840 THIS GROUP OF WOMEN, THEY ARE 6004 04:29:50,840 --> 04:29:53,400 ADVOCATES, EDUCATORS, MENTORS, 6005 04:29:53,400 --> 04:29:54,880 GRANDMOTHERS, CAREGIVERS, 6006 04:29:54,880 --> 04:29:56,440 COMMUNITY BOARD ADVISORS, 6007 04:29:56,440 --> 04:30:01,040 MEMBERS, PARTICIPANTS IN CENTERS 6008 04:30:01,040 --> 04:30:03,520 FOR AIDS RESEARCH, CFARs, FOR 6009 04:30:03,520 --> 04:30:06,560 FOUR YEARS WE'VE BEEN DOING A 6010 04:30:06,560 --> 04:30:09,920 BREAKOUT SESSION FOR THE JOHNS 6011 04:30:09,920 --> 04:30:11,320 HOPKINS GERIATRIC CONFERENCE AND 6012 04:30:11,320 --> 04:30:12,760 THEY INSERT THEMSELVES WITH SUCH 6013 04:30:12,760 --> 04:30:13,880 GRACE, IF YOU'RE NOT INCLUDING 6014 04:30:13,880 --> 04:30:16,360 THEM AND THEY SHOULD BE PART OF 6015 04:30:16,360 --> 04:30:18,040 THE CONVERSATION, WHETHER A NEW 6016 04:30:18,040 --> 04:30:21,000 COMMITTEE OR HIV PLANNING GROUP 6017 04:30:21,000 --> 04:30:26,400 OR WHATEVER, THEY ARE INVOLVED 6018 04:30:26,400 --> 04:30:27,520 AND HAVE BEEN SINCE 2004. 6019 04:30:27,520 --> 04:30:29,520 THEY ARE PRECEPTORS FOR STUDENTS 6020 04:30:29,520 --> 04:30:32,800 TO LEARN ABOUT HIV AND AGING AND 6021 04:30:32,800 --> 04:30:35,480 ESPECIALLY IN WOMEN SO THEY 6022 04:30:35,480 --> 04:30:37,520 MENTORED QUITE A FEW WOMEN, AND 6023 04:30:37,520 --> 04:30:39,720 FROM WALDEN INSTITUTE AND OTHER 6024 04:30:39,720 --> 04:30:41,000 PLACES. 6025 04:30:41,000 --> 04:30:43,520 THEY SHARE THEIR STORIES, 6026 04:30:43,520 --> 04:30:44,640 STRENGTHEN SO MANY INDIVIDUALS, 6027 04:30:44,640 --> 04:30:48,160 WHETHER THEY ARE YOUNG WOMEN, 6028 04:30:48,160 --> 04:30:50,760 EVEN YOUNG MEN, OLDER, DOESN'T 6029 04:30:50,760 --> 04:30:51,000 MATTER. 6030 04:30:51,000 --> 04:30:54,600 WHEN THEY TALK ABOUT THE JOURNEY 6031 04:30:54,600 --> 04:30:56,080 WITH LIVING WITH HIV DOESN'T 6032 04:30:56,080 --> 04:30:59,480 MATTER WHO THEY ARE ADDRESSING 6033 04:30:59,480 --> 04:31:00,320 BUT EVERYONE LISTENS AND THEY 6034 04:31:00,320 --> 04:31:03,240 HAVE THAT GRACE TO SHARE THEIR 6035 04:31:03,240 --> 04:31:04,520 STORY GOING THROUGH MENOPAUSE, 6036 04:31:04,520 --> 04:31:07,200 SOME ARE NOW 10 TO 20 YEARS PAST 6037 04:31:07,200 --> 04:31:08,920 WHEN THEY FIRST WENT THROUGH 6038 04:31:08,920 --> 04:31:11,800 MENOPAUSE AND QUITE A FEW STILL 6039 04:31:11,800 --> 04:31:13,720 DEALING WITH HOT FLASHES. 6040 04:31:13,720 --> 04:31:16,520 THEY ADDRESS ISOLATION AND 6041 04:31:16,520 --> 04:31:18,760 DEPRESSION, ESPECIALLY DURING 6042 04:31:18,760 --> 04:31:18,960 COVID. 6043 04:31:18,960 --> 04:31:20,120 WE MEET MONTHLY. 6044 04:31:20,120 --> 04:31:22,720 THEY HAVE A RESILIENCE THAT YOU 6045 04:31:22,720 --> 04:31:24,120 CAN'T SEE IT ON A SCREEN. 6046 04:31:24,120 --> 04:31:26,360 YOU WOULD HAVE TO HEAR THEM 6047 04:31:26,360 --> 04:31:28,400 SHARE THEIR STORIES AND THEIR 6048 04:31:28,400 --> 04:31:30,160 STRONG CONNECTIONS. 6049 04:31:30,160 --> 04:31:35,600 THE AVERAGE AGE MOSTLY IS IN 6050 04:31:35,600 --> 04:31:37,840 THEIR 60s NOW, LIVING FOR MORE 6051 04:31:37,840 --> 04:31:42,800 THAN, AS I SAID, UP TO 38, 39 6052 04:31:42,800 --> 04:31:45,880 YEARS, ENGAGED COMPLETELY IN 6053 04:31:45,880 --> 04:31:47,040 UNDERSTANDING MULTI-MORBIDITIES 6054 04:31:47,040 --> 04:31:48,200 AS ALREADY ROCCA TALKED ABOUT 6055 04:31:48,200 --> 04:31:52,240 AND HAS COME ACROSS IN THIS 6056 04:31:52,240 --> 04:31:53,720 AWESOME SYMPOSIUM WITH MENOPAUSE 6057 04:31:53,720 --> 04:31:57,160 AND HIV WHICH IS NOW A CHRONIC 6058 04:31:57,160 --> 04:31:58,200 DISEASE, DECLARED SO IN 2012, 6059 04:31:58,200 --> 04:32:04,520 EVEN THOUGH WE KNEW IT SOONER. 6060 04:32:04,520 --> 04:32:07,080 DOUBLE WHAMMY, MORE PRONE TO 6061 04:32:07,080 --> 04:32:11,440 HAVE AND HAVE MULTI-MORBIDITIES, 6062 04:32:11,440 --> 04:32:12,240 DIABETES, CARDIOVASCULAR 6063 04:32:12,240 --> 04:32:15,080 DISEASE, COGNITIVE CHANGES, 6064 04:32:15,080 --> 04:32:16,160 COPD, KIDNEY DISEASE, FRAILTY 6065 04:32:16,160 --> 04:32:17,080 AND POLYPHARMACY. 6066 04:32:17,080 --> 04:32:19,680 SOME HAVE BEEN EXPOSED TO 6067 04:32:19,680 --> 04:32:22,560 EARLIER YEARS OF HIV TREATMENT, 6068 04:32:22,560 --> 04:32:24,520 ANT RETROVIRAL THERAPY THAT 6069 04:32:24,520 --> 04:32:26,840 IMPACTED BONES AND SO FORTH. 6070 04:32:26,840 --> 04:32:29,400 NOW THERAPY IS WAY BETTER. 6071 04:32:29,400 --> 04:32:30,880 THESE WOMEN ARE EPITOME OF 6072 04:32:30,880 --> 04:32:33,160 ADHERENCE AND WE DO KNOW THAT 6073 04:32:33,160 --> 04:32:35,800 ADHERENCE IS ONE OF THE 6074 04:32:35,800 --> 04:32:38,400 QUALITIES OF AGING POPULATION OF 6075 04:32:38,400 --> 04:32:40,600 INDIVIDUALS, AGING REGARDLESS OF 6076 04:32:40,600 --> 04:32:41,800 GENDER WITH HIV. 6077 04:32:41,800 --> 04:32:44,480 IT'S NOT THE HIV BUT IT'S 6078 04:32:44,480 --> 04:32:45,880 EVERYTHING ELSE, THEY SAY THAT 6079 04:32:45,880 --> 04:32:48,080 IS A SHORT VISIT BUT AGING 6080 04:32:48,080 --> 04:32:50,480 ISSUES AND AGING ISSUES THAT 6081 04:32:50,480 --> 04:32:54,120 CONCERN THE WOMEN, SOME HAD HIP 6082 04:32:54,120 --> 04:32:55,640 REPLACEMENTS, KNEE REPLACEMENTS, 6083 04:32:55,640 --> 04:32:56,720 SHOULDER REPLACEMENTS. 6084 04:32:56,720 --> 04:33:04,240 AND ARE DOING WELL, EXTREMELY 6085 04:33:04,240 --> 04:33:05,160 RESILIENT. 6086 04:33:05,160 --> 04:33:07,600 OWEL EMBRACES COMMUNITY 6087 04:33:07,600 --> 04:33:08,360 ENGAGEMENT, INITIATING, IN 6088 04:33:08,360 --> 04:33:10,080 EARLIER YEARS GOING TO SENIOR 6089 04:33:10,080 --> 04:33:12,160 CENTERS OR SENIOR ACTIVITIES 6090 04:33:12,160 --> 04:33:14,840 WHERE WE COULD ASK CAN WE BE 6091 04:33:14,840 --> 04:33:18,040 INVITED SO WOMEN CAN TALK ABOUT 6092 04:33:18,040 --> 04:33:23,080 SEXUAL HEALTH AS OLDER WOMEN, 6093 04:33:23,080 --> 04:33:25,680 REMARKABLE BECAUSE THEY ALSO ARE 6094 04:33:25,680 --> 04:33:26,080 INTO PREVENTION. 6095 04:33:26,080 --> 04:33:28,320 A FEW WERE DIAGNOSED IN 50s, 6096 04:33:28,320 --> 04:33:34,920 NOW IN THEIR 70'S BUT WERE 6097 04:33:34,920 --> 04:33:36,360 SEXUALLY ACTIVE, NOT ALL, SOME 6098 04:33:36,360 --> 04:33:38,920 HAVE CHOSEN NOT TO, IT'S THE 6099 04:33:38,920 --> 04:33:40,360 LEAST OF THEIR CONCERNS AND THEY 6100 04:33:40,360 --> 04:33:41,600 DEAL WITH IT IN OTHER WAYS. 6101 04:33:41,600 --> 04:33:44,120 IF YOU WANT TO TALK ABOUT SEXUAL 6102 04:33:44,120 --> 04:33:46,040 ACTIVITY, THAT DOES NOT STOP AS 6103 04:33:46,040 --> 04:33:49,240 THEY AGE, THAT'S ANOTHER 6104 04:33:49,240 --> 04:33:49,640 CONVERSATION. 6105 04:33:49,640 --> 04:33:51,600 THEY PARTICIPATE WITH SISTER 6106 04:33:51,600 --> 04:33:54,320 ORGANIZATIONS ACROSS THE UNITED 6107 04:33:54,320 --> 04:33:56,080 STATES, EXECUTIVE DIRECTOR IS 6108 04:33:56,080 --> 04:33:57,880 INVOLVED INTERNATIONALLY AS 6109 04:33:57,880 --> 04:33:58,880 WELL. 6110 04:33:58,880 --> 04:34:01,000 AND LOCALLY WE WERE INVOLVED 6111 04:34:01,000 --> 04:34:03,240 WITH DOING OUR COVID VACCINE 6112 04:34:03,240 --> 04:34:05,720 CLINICS, SO IN SPITE OF WHAT 6113 04:34:05,720 --> 04:34:09,080 THEY HAVE GOING ON, THEY ARE 6114 04:34:09,080 --> 04:34:11,600 RESILIENT WITH COMMUNITY 6115 04:34:11,600 --> 04:34:11,960 PARTICIPATION. 6116 04:34:11,960 --> 04:34:16,240 WE DO THE ANNUAL SIGNATURE 6117 04:34:16,240 --> 04:34:18,280 CONFERENCE, LEGENDS FOR 18 6118 04:34:18,280 --> 04:34:20,640 YEARS, IT BROUGHT TOGETHER WOMEN 6119 04:34:20,640 --> 04:34:23,160 REGIONALLY, THOSE THAT CANNOT 6120 04:34:23,160 --> 04:34:26,080 ATTEND INTERNATIONALLY WE PAY 6121 04:34:26,080 --> 04:34:27,760 GREETINGS, AS FAR AS AFRICA AND 6122 04:34:27,760 --> 04:34:30,560 KENYA, AND THERE'S A GROUP THERE 6123 04:34:30,560 --> 04:34:33,200 THAT DEALS WITH HIV IN OLDER 6124 04:34:33,200 --> 04:34:33,520 WOMEN. 6125 04:34:33,520 --> 04:34:36,280 THEY ARE ACTIVE PARTICIPANTS IN 6126 04:34:36,280 --> 04:34:37,640 RESEARCH AND ADVOCATE FOR 6127 04:34:37,640 --> 04:34:39,240 RESEARCH TO BE DONE THAT 6128 04:34:39,240 --> 04:34:42,720 INCLUDES OLDER WOMEN AS WELL. 6129 04:34:42,720 --> 04:34:45,480 WE'VE BEEN RECOGNIZED. 6130 04:34:45,480 --> 04:34:47,600 WE RECEIVED HENRIETTA LACKS 6131 04:34:47,600 --> 04:34:50,200 AWARD IN 2018 FOR ONGOING 6132 04:34:50,200 --> 04:34:52,040 PARTICIPATION IN THE CHECKUP 6133 04:34:52,040 --> 04:34:58,840 STUDY, A STUDY THAT TALKED ABOUT 6134 04:34:58,840 --> 04:34:59,840 EDUCATING WOMEN, THE NEED TO 6135 04:34:59,840 --> 04:35:02,400 MAKE SURE THEY ARE GETTING THEIR 6136 04:35:02,400 --> 04:35:03,920 PAP SMEARS AND UNDERSTAND 6137 04:35:03,920 --> 04:35:05,880 CERVICAL CANCER AND HOW TO 6138 04:35:05,880 --> 04:35:07,720 PREVENT THAT BECAUSE, AGAIN, 6139 04:35:07,720 --> 04:35:10,520 WITH HIV, WHICH IS A CHRONIC 6140 04:35:10,520 --> 04:35:11,560 DISEASE, ALSO INFLAMMATION, BUT 6141 04:35:11,560 --> 04:35:15,560 WOMEN ARE MORE PRONE TO HAVE 6142 04:35:15,560 --> 04:35:17,080 OTHER ISSUES WITH CERVICAL 6143 04:35:17,080 --> 04:35:20,160 CANCER AND SO FORTH BUT THEY 6144 04:35:20,160 --> 04:35:21,000 WERE RECOGNIZED. 6145 04:35:21,000 --> 04:35:24,600 WE APPLIED FOR THREE YEARS, AND 6146 04:35:24,600 --> 04:35:27,320 IN THE THIRD YEAR WE DID GET IT 6147 04:35:27,320 --> 04:35:28,520 BECAUSE WE COLLABORATED WITH A 6148 04:35:28,520 --> 04:35:30,600 FACULTY AT THE SCHOOL OF NURSING 6149 04:35:30,600 --> 04:35:32,720 THAT WAS DOING THE CERVICAL 6150 04:35:32,720 --> 04:35:33,680 CANCER STUDY. 6151 04:35:33,680 --> 04:35:35,080 I COULD GO ON AND ON. 6152 04:35:35,080 --> 04:35:36,920 THERE'S SO MANY OTHER THINGS 6153 04:35:36,920 --> 04:35:40,000 THAT THIS UNIQUE GROUP OF WOMEN 6154 04:35:40,000 --> 04:35:41,480 HAVE DONE. 6155 04:35:41,480 --> 04:35:44,920 WE MAY BE ABOUT 100 STRONG WHEN 6156 04:35:44,920 --> 04:35:46,400 IT COMES TO PARTICIPANTS, WE 6157 04:35:46,400 --> 04:35:47,640 DON'T SAY MEMBERSHIP. 6158 04:35:47,640 --> 04:35:49,360 YOU DON'T HAVE TO JOIN BUT YOU 6159 04:35:49,360 --> 04:35:51,560 CAN JUST ATTEND AND YOU WILL SEE 6160 04:35:51,560 --> 04:35:54,000 YOU'LL BECOME PART OF IT. 6161 04:35:54,000 --> 04:35:56,080 WE PARTICIPATED IN THE FOLLOW 6162 04:35:56,080 --> 04:35:59,320 YOUR HEART STUDY WITH DR. LOOBY 6163 04:35:59,320 --> 04:36:00,560 IN 2017. 6164 04:36:00,560 --> 04:36:02,440 THEY PARTICIPATED IN COGNITIVE 6165 04:36:02,440 --> 04:36:05,040 CHANGES IN WOMEN STUDY, IN ONE 6166 04:36:05,040 --> 04:36:08,640 OF THE LADIES, WITH GLASSES ON 6167 04:36:08,640 --> 04:36:11,840 HER HEAD, IN 1985, IN 1989, 6168 04:36:11,840 --> 04:36:13,480 PARTICIPATED IN NEW THERAPIES 6169 04:36:13,480 --> 04:36:17,240 FOR HIV TREATMENT, WAY BACK 6170 04:36:17,240 --> 04:36:17,600 THEN. 6171 04:36:17,600 --> 04:36:18,960 AND EVEN NOW A PARTICIPANT IN 6172 04:36:18,960 --> 04:36:21,960 THE CLINICAL TRIALS FOR 6173 04:36:21,960 --> 04:36:23,840 TREATMENT USING INJECTABLE ANT 6174 04:36:23,840 --> 04:36:24,160 RETROVIRAL. 6175 04:36:24,160 --> 04:36:26,200 WE'VE COME SO FAR WITH HIV 6176 04:36:26,200 --> 04:36:28,160 TREATMENT THAT IT'S WAY 6177 04:36:28,160 --> 04:36:31,520 TOLERABLE, ADHERENCE IS NOT A 6178 04:36:31,520 --> 04:36:31,840 PROBLEM. 6179 04:36:31,840 --> 04:36:32,840 BUT AGING IS. 6180 04:36:32,840 --> 04:36:34,760 MENOPAUSE IS AN ISSUE. 6181 04:36:34,760 --> 04:36:36,120 BUT I WANTED YOU TO SEE THAT 6182 04:36:36,120 --> 04:36:39,520 THERE IS A GROUP OF OLDER WOMEN 6183 04:36:39,520 --> 04:36:42,240 WHICH WAS NOT A GROUP BEFORE 6184 04:36:42,240 --> 04:36:42,480 2004. 6185 04:36:42,480 --> 04:36:45,200 I COULD NOT FIND A GROUP FOR 6186 04:36:45,200 --> 04:36:47,480 OLDER WOMEN. 6187 04:36:47,480 --> 04:36:49,320 AND THIS WAS FORMED, THE 6188 04:36:49,320 --> 04:36:51,320 ATTITUDE WAS, OH WELL, WE HAVE 6189 04:36:51,320 --> 04:36:53,080 HIV BUT WE'RE GOING TO EMBRACE 6190 04:36:53,080 --> 04:36:55,480 LIFE, MAKE THE MOST OF IT, WE'RE 6191 04:36:55,480 --> 04:36:58,040 GOING TO MAKE SURE WHOEVER WE 6192 04:36:58,040 --> 04:36:59,840 COME IN CONTACT WITH, THEY WILL 6193 04:36:59,840 --> 04:37:02,400 NOT FORGET THAT THEY HAVE BEEN 6194 04:37:02,400 --> 04:37:05,600 TALKING TO AN OLDER WOMAN WITH 6195 04:37:05,600 --> 04:37:07,800 HIV THAT'S SURVIVING. 6196 04:37:07,800 --> 04:37:09,240 THEY ARE MOTIVATED EVEN MEN AND 6197 04:37:09,240 --> 04:37:11,280 LIKE I SAID YOUNG MEN, 6198 04:37:11,280 --> 04:37:12,440 REGARDLESS OF GENDER. 6199 04:37:12,440 --> 04:37:14,000 YOU TAKE YOUR THERAPY. 6200 04:37:14,000 --> 04:37:15,520 AND SEE HOW LONG YOU LIVE. 6201 04:37:15,520 --> 04:37:16,920 LOOK AT ME. 6202 04:37:16,920 --> 04:37:17,720 I'M AN EXAMPLE. 6203 04:37:17,720 --> 04:37:19,280 AND THE LAST THING I WOULD LIKE 6204 04:37:19,280 --> 04:37:23,760 TO SAY IS WE DID NOT KNOW THAT 6205 04:37:23,760 --> 04:37:25,840 FOLKS WOULD BE LIVING LONG WITH 6206 04:37:25,840 --> 04:37:28,480 HIV IN THE EARLIER YEARS, AND 6207 04:37:28,480 --> 04:37:30,360 NOW THIS IS THE FIRST COHORT, 6208 04:37:30,360 --> 04:37:34,760 MEN AND WOMEN, THAT ARE LIVING 6209 04:37:34,760 --> 04:37:35,840 LONGER RESILIENT, BASICALLY 6210 04:37:35,840 --> 04:37:37,880 DOING WELL BUT THERE ARE 6211 04:37:37,880 --> 04:37:38,400 CHALLENGES. 6212 04:37:38,400 --> 04:37:39,880 IT'S AGING THAT'S THE CHALLENGE, 6213 04:37:39,880 --> 04:37:41,840 ALL THAT GOES WITH IT. 6214 04:37:41,840 --> 04:37:46,760 IF YOU WANT TO HEAR FROM WOMEN 6215 04:37:46,760 --> 04:37:47,480 THAT HAD MENOPAUSE 10 OR 20 6216 04:37:47,480 --> 04:37:50,280 YEARS AGO THIS IS A GREAT GROUP 6217 04:37:50,280 --> 04:37:50,640 TO TALK TO. 6218 04:37:50,640 --> 04:37:51,560 I THANK YOU. 6219 04:37:51,560 --> 04:37:55,520 I DON'T WANT TO DETAIN THE TIME 6220 04:37:55,520 --> 04:37:56,720 ANY LONGER BECAUSE WE WANT 6221 04:37:56,720 --> 04:37:57,000 QUESTIONS. 6222 04:37:57,000 --> 04:38:03,160 THANK YOU SO MUCH. 6223 04:38:03,160 --> 04:38:07,520 >> THANK YOU FOR THAT VALUABLE 6224 04:38:07,520 --> 04:38:07,800 PERSPECTIVE. 6225 04:38:07,800 --> 04:38:13,600 NOW, WE ARE ENTERING INTO THE 6226 04:38:13,600 --> 04:38:15,040 QUESTION-AND-ANSWER PERIOD. 6227 04:38:15,040 --> 04:38:17,800 SO I ENCOURAGE PEOPLE TO -- 6228 04:38:17,800 --> 04:38:21,080 ATTENDEES TO PUT THEIR QUESTIONS 6229 04:38:21,080 --> 04:38:22,720 INTO THE QUESTION AND ANSWER 6230 04:38:22,720 --> 04:38:25,400 AREA AND WE WILL HAVE THE 6231 04:38:25,400 --> 04:38:27,960 PANELISTS AND SPEAKERS ANSWER 6232 04:38:27,960 --> 04:38:32,920 THEM. 6233 04:38:32,920 --> 04:38:35,960 WE HAVE SOME THAT CAME IN DURING 6234 04:38:35,960 --> 04:38:38,080 THE TALKS. 6235 04:38:38,080 --> 04:38:42,040 ONE IS, ANECDOTALLY WOMEN I KNOW 6236 04:38:42,040 --> 04:38:44,640 IN PERIMENOPAUSE AND MENOPAUSE 6237 04:38:44,640 --> 04:38:45,360 DISCUSS DIETARY APPROACHES TO 6238 04:38:45,360 --> 04:38:47,080 MITIGATE SYMPTOMS. 6239 04:38:47,080 --> 04:38:51,440 I.E. EAT MORE PROTEIN, 6240 04:38:51,440 --> 04:38:52,280 INCORPORATE FLAX SEED, TAKE 6241 04:38:52,280 --> 04:38:54,680 MATCHA POWDER, ET CETERA. 6242 04:38:54,680 --> 04:38:56,080 ARE THERE SIGNIFICANT MEDICAL 6243 04:38:56,080 --> 04:38:56,960 RECOMMENDATIONS ABOUT DIET FOR 6244 04:38:56,960 --> 04:39:02,000 PEOPLE IN THESE STAGES OF LIFE? 6245 04:39:02,000 --> 04:39:05,320 DO ANY SPEAKERS WANT TO ADDRESS 6246 04:39:05,320 --> 04:39:10,600 THE DIET QUESTION? 6247 04:39:10,600 --> 04:39:12,760 >> MAYBE ONE OF THE PHYSICIANS 6248 04:39:12,760 --> 04:39:18,120 FROM THE PRIOR SESSION MIGHT 6249 04:39:18,120 --> 04:39:18,800 GIVE THE MEDICAL 6250 04:39:18,800 --> 04:39:21,040 RECOMMENDATIONS. 6251 04:39:21,040 --> 04:39:26,320 6252 04:39:26,320 --> 04:39:29,080 >> I CAN PROBABLY ADDRESS A 6253 04:39:29,080 --> 04:39:33,480 LITTLE OF THE DATA. 6254 04:39:33,480 --> 04:39:35,400 TYPICALLY DIETARY APPROACHES 6255 04:39:35,400 --> 04:39:39,120 HAVE NOT BEEN HELPFUL TREATING 6256 04:39:39,120 --> 04:39:40,960 VASOMOTOR SYMPTOMS, ONE 6257 04:39:40,960 --> 04:39:46,040 EXCEPTION HAD A STRICT VEGAN LOW 6258 04:39:46,040 --> 04:39:53,840 FAT AND I BELIEVE HIGH SOY DIE 6259 04:39:53,840 --> 04:39:56,320 THAT -- DIET THAT SHOWED COME 6260 04:39:56,320 --> 04:40:06,160 EFFICACY BUT NOT THE BULK OF THE 6261 04:40:06,160 --> 04:40:06,480 LITERATURE. 6262 04:40:06,480 --> 04:40:07,720 >> DR. CORTES? 6263 04:40:07,720 --> 04:40:09,120 DR. LOOBY? 6264 04:40:09,120 --> 04:40:09,400 >> SORRY. 6265 04:40:09,400 --> 04:40:12,920 YES, I CAN ONLY SPEAK IN THE 6266 04:40:12,920 --> 04:40:15,760 CONTEXT OF MID-LIFE WOMEN'S 6267 04:40:15,760 --> 04:40:16,640 HEALTH, NUTRITION, SPECIFICALLY 6268 04:40:16,640 --> 04:40:19,320 CARDIOVASCULAR HEALTH AND BONE 6269 04:40:19,320 --> 04:40:19,880 LOSS. 6270 04:40:19,880 --> 04:40:20,840 CHARACTER FOR WOMEN AT THIS 6271 04:40:20,840 --> 04:40:22,200 PHASE OF LIFE IT'S VERY 6272 04:40:22,200 --> 04:40:23,960 IMPORTANT FOR WOMEN TO RECONNECT 6273 04:40:23,960 --> 04:40:29,240 WITH THEIR DIET AND MAKE SURE IT 6274 04:40:29,240 --> 04:40:30,760 IS HEART HEALTHY, OBVIOUSLY, 6275 04:40:30,760 --> 04:40:32,720 ALSO NUTRIENT RICH PARTICULARLY 6276 04:40:32,720 --> 04:40:36,400 WITH REGARD TO VITAMIN D AND 6277 04:40:36,400 --> 04:40:37,640 CALCIUM, AND RAISE THE QUESTION 6278 04:40:37,640 --> 04:40:39,280 BECAUSE IT DOESN'T HAPPEN TO 6279 04:40:39,280 --> 04:40:41,240 FALL ON THE LIST OF THINGS. 6280 04:40:41,240 --> 04:40:43,440 SO CHECKING IN WITH YOUR HEALTH 6281 04:40:43,440 --> 04:40:44,440 CARE PROVIDERS OR PROVIDERS 6282 04:40:44,440 --> 04:40:46,880 BEING SENSITIVE TO RAISE 6283 04:40:46,880 --> 04:40:49,720 AWARENESS TO ASKING SPECIFICALLY 6284 04:40:49,720 --> 04:40:50,880 ABOUT CARDIOVASCULAR HEALTH, 6285 04:40:50,880 --> 04:40:56,160 DIET, EXERCISE, AND ALSO BONE 6286 04:40:56,160 --> 04:40:58,200 HEALTH IN THAT REGARD. 6287 04:40:58,200 --> 04:41:01,760 WHAT COMES HAND IN HAND IS 6288 04:41:01,760 --> 04:41:02,040 EXERCISE. 6289 04:41:02,040 --> 04:41:05,240 MAKING SURE THAT FOLKS ARE AWARE 6290 04:41:05,240 --> 04:41:06,560 OF RISK REDUCTION BEHAVIORS IN 6291 04:41:06,560 --> 04:41:08,960 THE CONTEXT OF NUTRITION BUT 6292 04:41:08,960 --> 04:41:09,760 ALSO INCREASING PHYSICAL 6293 04:41:09,760 --> 04:41:12,720 ACTIVITY AS ABLE. 6294 04:41:12,720 --> 04:41:15,920 AND THEN I ALSO WOULD REALLY BE 6295 04:41:15,920 --> 04:41:19,920 CAREFUL ABOUT ADVISING OR 6296 04:41:19,920 --> 04:41:21,600 PARTICIPATING IN ANY FAD BASED 6297 04:41:21,600 --> 04:41:24,880 DIETS THAT GET HYPE NATIONWIDE 6298 04:41:24,880 --> 04:41:25,920 AND INTERNATIONALLY. 6299 04:41:25,920 --> 04:41:27,520 THERE'S A NEW ONE EVERY WEEK. 6300 04:41:27,520 --> 04:41:32,400 SOME MAY BE VERY EFFECTIVE FOR 6301 04:41:32,400 --> 04:41:33,360 CERTAIN POPULATIONS BUT I THINK 6302 04:41:33,360 --> 04:41:35,240 IT'S A GREAT THING TO CHECK IN 6303 04:41:35,240 --> 04:41:36,920 WITH YOUR HEALTH CARE PROVIDER 6304 04:41:36,920 --> 04:41:41,760 TO MAKE SURE THAT DIET, ANY 6305 04:41:41,760 --> 04:41:43,160 SUPPLEMENTS, HERBAL REMEDIES OR 6306 04:41:43,160 --> 04:41:44,760 DRASTIC CHANGES ATED MY LIVE 6307 04:41:44,760 --> 04:41:50,440 WHERE SO MUCH IS CHANGE -- AT 6308 04:41:50,440 --> 04:41:51,520 MID-LIFE, IT'S A GREAT 6309 04:41:51,520 --> 04:41:55,920 OPPORTUNITIES TO MAKE SURE IT'S 6310 04:41:55,920 --> 04:41:58,640 SAFE FOR YOU. 6311 04:41:58,640 --> 04:42:03,000 >> I WOULD SAY, FOLLOWING UP 6312 04:42:03,000 --> 04:42:05,840 THAT WE'RE NOT FOCUSING ENOUGH 6313 04:42:05,840 --> 04:42:07,840 ON IMPACT OF BLEEDING, WOMEN ARE 6314 04:42:07,840 --> 04:42:12,640 LOSING A LOT OF IRON. 6315 04:42:12,640 --> 04:42:16,840 DIETS THAT -- DIETS OR 6316 04:42:16,840 --> 04:42:18,000 SUPPLEMENTS THAT ADDRESS GETTING 6317 04:42:18,000 --> 04:42:19,440 ADEQUATE IRON MIGHT BE SOMETHING 6318 04:42:19,440 --> 04:42:26,320 THAT WOULD WANT TO BE MONITORING 6319 04:42:26,320 --> 04:42:28,800 WITH THEIR HEALTH PROFESSIONALS. 6320 04:42:28,800 --> 04:42:30,360 >> THANK YOU. 6321 04:42:30,360 --> 04:42:31,720 THANKS FOR THE ANSWERS. 6322 04:42:31,720 --> 04:42:34,320 WE ALSO HAVE ANOTHER QUESTION 6323 04:42:34,320 --> 04:42:36,200 HERE FROM OUR ATTENDEES, ARE 6324 04:42:36,200 --> 04:42:37,600 THERE UNIQUE MENOPAUSAL SYMPTOMS 6325 04:42:37,600 --> 04:42:44,840 OF WOMEN LIVING WITH HIV? 6326 04:42:44,840 --> 04:42:47,360 >> I WOULD SAY THAT ONE OF THE 6327 04:42:47,360 --> 04:42:49,080 THINGS THAT CAN BE DIFFICULT IS 6328 04:42:49,080 --> 04:42:50,480 DIFFERENTIATING BETWEEN WHAT IS 6329 04:42:50,480 --> 04:42:53,280 A SYMPTOM OF HIV AS WE MENTIONED 6330 04:42:53,280 --> 04:42:54,960 IN MY PRESENTATION, AND WHAT IS 6331 04:42:54,960 --> 04:42:56,200 A SYMPTOM OF MENOPAUSE BECAUSE 6332 04:42:56,200 --> 04:42:59,160 THERE IS A LOT OF OVERLAP. 6333 04:42:59,160 --> 04:43:00,680 IN MY EXPERIENCE, BASED ON 6334 04:43:00,680 --> 04:43:02,960 RESEARCH THAT I HAVE READ IN 6335 04:43:02,960 --> 04:43:05,840 THIS AREA, THEY SEEM TO BE 6336 04:43:05,840 --> 04:43:06,920 GENERALLY SIMILAR, ALTHOUGH 6337 04:43:06,920 --> 04:43:13,040 WOMEN WITH HIV PARTICULARLY IN 6338 04:43:13,040 --> 04:43:16,280 THAT LATE PERIMENOPAUSE PHASE 6339 04:43:16,280 --> 04:43:18,440 APPEAR TO EXPERIENCE MORE SEVERE 6340 04:43:18,440 --> 04:43:23,720 SYMPTOMS OR REPORT MORE SEVERE 6341 04:43:23,720 --> 04:43:25,680 SYMPTOMS WITH HOT FLASH, MOOD, 6342 04:43:25,680 --> 04:43:28,520 ANXIETY, HAS TO DO WITH 6343 04:43:28,520 --> 04:43:30,400 INTERPLAY BETWEEN HAVING THESE 6344 04:43:30,400 --> 04:43:31,120 CONDITIONS PRE-MENOPAUSEALLY. 6345 04:43:31,120 --> 04:43:32,920 I WILL SHARE ONE OF THE THINGS 6346 04:43:32,920 --> 04:43:36,360 THAT I ENCOUNTERED IN WOMEN WITH 6347 04:43:36,360 --> 04:43:38,120 HIV, TO MY KNOWLEDGE THERE'S 6348 04:43:38,120 --> 04:43:42,200 BEEN NOTHING WRITTEN UP ABOUT 6349 04:43:42,200 --> 04:43:44,480 THIS, IS THAT THE DISTRESS THAT 6350 04:43:44,480 --> 04:43:46,880 MID-LIFE SYMPTOMS CAUSE AS I 6351 04:43:46,880 --> 04:43:48,240 SHARED IN MY PRESENTATION 6352 04:43:48,240 --> 04:43:49,400 PARTICULARLY HOT FLASHES AND 6353 04:43:49,400 --> 04:43:51,120 MOOD SWINGS, THAT HAPPEN DURING 6354 04:43:51,120 --> 04:43:53,840 THIS TIME, WITH THE LACK OF 6355 04:43:53,840 --> 04:43:56,600 KNOWLEDGE AND UNDERSTANDING THAT 6356 04:43:56,600 --> 04:43:59,680 THIS IS ACTUALLY A PHYSIOLOGIC 6357 04:43:59,680 --> 04:44:03,320 PROCESS CAN TRIGGER SUCH MOOD 6358 04:44:03,320 --> 04:44:06,320 AND PTSD CHANGES THAT I HAVE 6359 04:44:06,320 --> 04:44:08,960 SEEN WOMEN WHO CONTRACTED HIV 6360 04:44:08,960 --> 04:44:12,200 THROUGH INTRAVENOUS DRUG USE 6361 04:44:12,200 --> 04:44:14,360 RELAPSE BECAUSE THEY ARE SO 6362 04:44:14,360 --> 04:44:15,680 SCARED ABOUT WHAT'S HAPPENING TO 6363 04:44:15,680 --> 04:44:18,440 THEM OR FEELING A LACK OF 6364 04:44:18,440 --> 04:44:20,200 CONTROL OR HAVING SOME PTSD OR 6365 04:44:20,200 --> 04:44:21,640 FORM OF TRAUMA. 6366 04:44:21,640 --> 04:44:24,920 SO I WOULD SAY THAT THAT IS NOT 6367 04:44:24,920 --> 04:44:25,720 NECESSARILY A UNIQUE SYMPTOM BUT 6368 04:44:25,720 --> 04:44:28,840 IF THERE IS A PATIENT UNDER YOUR 6369 04:44:28,840 --> 04:44:29,840 CARE WHO EXPERIENCES SUBSTANCE 6370 04:44:29,840 --> 04:44:33,880 USE DISORDER, WHO IS IN 6371 04:44:33,880 --> 04:44:34,440 RECOVERY, PARTICULARLY AT 6372 04:44:34,440 --> 04:44:35,880 MID-LIFE, IN ADDITION TO 6373 04:44:35,880 --> 04:44:37,040 CHECKING IN ON MOOD AND MENTAL 6374 04:44:37,040 --> 04:44:39,320 HEALTH STATUS IF THEY HAVE THAT 6375 04:44:39,320 --> 04:44:40,560 HISTORY, I THINK IT'S A 6376 04:44:40,560 --> 04:44:41,560 TREMENDOUS IDEA TO MAKE SURE 6377 04:44:41,560 --> 04:44:51,160 THEY ARE OKAY IN THEIR RECOVERY. 6378 04:44:51,160 --> 04:44:52,400 >> FOR DR. FRIEDMAN, WHAT DO 6379 04:44:52,400 --> 04:44:53,520 YOU THINK HEALTH CARE 6380 04:44:53,520 --> 04:44:57,280 PROFESSIONALS CAN DO TO RAISE 6381 04:44:57,280 --> 04:44:59,480 AWARENESS AND ACCELERATE OVARIAN 6382 04:44:59,480 --> 04:45:00,680 CANCER PREVENTION INDIVIDUALS 6383 04:45:00,680 --> 04:45:01,680 FOR HIGH RISK INDIVIDUALS? 6384 04:45:01,680 --> 04:45:02,240 >> GREAT QUESTION. 6385 04:45:02,240 --> 04:45:04,960 THANK YOU FOR THAT. 6386 04:45:04,960 --> 04:45:06,800 IT GIVES ME THE OPPORTUNITY TO 6387 04:45:06,800 --> 04:45:10,040 PROMOTE TWO STUDIES, I PUT THEM 6388 04:45:10,040 --> 04:45:11,200 IN THE CHAT. 6389 04:45:11,200 --> 04:45:14,720 IF SOMEONE CAN SHARE WITH 6390 04:45:14,720 --> 04:45:15,720 EVERYONE. 6391 04:45:15,720 --> 04:45:17,360 I THINK A LOT OF TIMES PATIENTS 6392 04:45:17,360 --> 04:45:20,160 ARE NOT TOLD ABOUT STUDIES THEY 6393 04:45:20,160 --> 04:45:21,840 MAY QUALIFY FOR, ESPECIALLY 6394 04:45:21,840 --> 04:45:23,880 PREVENTION STUDIES, WE THINK OF 6395 04:45:23,880 --> 04:45:26,560 CLINICAL TRIALS OFTEN AS 6396 04:45:26,560 --> 04:45:29,080 TREATMENT BASED, AND SO 6397 04:45:29,080 --> 04:45:30,680 OFTENTIMES IF THE STUDY IS 6398 04:45:30,680 --> 04:45:32,880 HAPPENING AT AN INSTITUTION 6399 04:45:32,880 --> 04:45:34,600 OUTSIDE OF YOUR OWN, THAT 6400 04:45:34,600 --> 04:45:36,920 THERE'S BARRIERS TO LETTING 6401 04:45:36,920 --> 04:45:37,920 PATIENTS KNOW ABOUT IT. 6402 04:45:37,920 --> 04:45:41,880 BE AWARE OF THE STUDIES THAT ARE 6403 04:45:41,880 --> 04:45:45,720 AVAILABLE OUT THERE, 6404 04:45:45,720 --> 04:45:46,240 PARTICULARLY SOROCK, AND 6405 04:45:46,240 --> 04:45:49,240 TUBA-II, BUT THERE ARE STUDIES, 6406 04:45:49,240 --> 04:45:51,120 THE FORCE WEBSITE HAS A LOT OF 6407 04:45:51,120 --> 04:45:53,280 THOSE BUT ALSO 6408 04:45:53,280 --> 04:45:53,960 clinicaltrials.gov. 6409 04:45:53,960 --> 04:45:56,080 AND SHARE IN PLAIN LANGUAGE ALL 6410 04:45:56,080 --> 04:45:59,520 STUDIES WITH PATIENTS SO THEY 6411 04:45:59,520 --> 04:46:00,800 KNOW THEIR OPTIONS. 6412 04:46:00,800 --> 04:46:02,680 >> THANK YOU. 6413 04:46:02,680 --> 04:46:04,280 ANOTHER QUESTION, WE'VE TALKED 6414 04:46:04,280 --> 04:46:05,840 ABOUT SOCIAL DETERMINANTS OF 6415 04:46:05,840 --> 04:46:07,520 HEALTH, AND DIFFERENCES IN 6416 04:46:07,520 --> 04:46:09,080 ACCESS TO TREATMENT FOR 6417 04:46:09,080 --> 04:46:10,680 VASOMOTOR SYMPTOMS, BLEEDING, ET 6418 04:46:10,680 --> 04:46:10,920 CETERA. 6419 04:46:10,920 --> 04:46:11,920 DO ANY PANELISTS HAVE THOUGHTS 6420 04:46:11,920 --> 04:46:14,040 ABOUT HOW WE CAN START TO BEGIN 6421 04:46:14,040 --> 04:46:16,680 TO TACKLE SOME OF THE BARRIERS 6422 04:46:16,680 --> 04:46:19,400 TO TREATMENT THAT WOMEN MAY 6423 04:46:19,400 --> 04:46:20,720 FACE, AND THIS PIGGYBACKS ON A 6424 04:46:20,720 --> 04:46:23,280 QUESTION IN THE CHAT ABOUT 6425 04:46:23,280 --> 04:46:25,640 HELPING TO ALERT WOMEN EARLY, 6426 04:46:25,640 --> 04:46:27,080 BEFORE THEY ENTER MENOPAUSE 6427 04:46:27,080 --> 04:46:29,800 TRANSITION ABOUT WHAT TO EXPECT. 6428 04:46:29,800 --> 04:46:32,280 IT'S A TWO-PRONGED QUESTION, HAS 6429 04:46:32,280 --> 04:46:34,600 TO DO WITH ACCESS TO TREATMENT 6430 04:46:34,600 --> 04:46:40,840 AND HOW WE'RE STRUCTURAL OUR 6431 04:46:40,840 --> 04:46:41,200 MENOPAUSE CARE. 6432 04:46:41,200 --> 04:46:45,040 >> I THINK IT'S LIKE A TWO-PART 6433 04:46:45,040 --> 04:46:46,960 ISSUE, ONE BEING -- PROVIDING 6434 04:46:46,960 --> 04:46:50,480 MORE PUBLIC INFORMATION THAT'S 6435 04:46:50,480 --> 04:46:52,040 READILY AVAILABLE SO THAT 6436 04:46:52,040 --> 04:46:54,480 INDIVIDUALS FEEL EMPOWERED TO 6437 04:46:54,480 --> 04:46:56,600 ASK QUESTIONS, DURING CLINICAL 6438 04:46:56,600 --> 04:46:57,120 ENCOUNTERS, HAVE THAT 6439 04:46:57,120 --> 04:46:58,360 INFORMATION AVAILABLE. 6440 04:46:58,360 --> 04:47:00,640 BUT THEN EVEN THROUGH OUR FOCUS 6441 04:47:00,640 --> 04:47:01,640 GROUPS AND EVERYTHING, 6442 04:47:01,640 --> 04:47:04,520 PARTICIPANTS WANT TO KNOW 6443 04:47:04,520 --> 04:47:04,960 EARLIER. 6444 04:47:04,960 --> 04:47:06,440 AGE 35, BEFORE AGE 40. 6445 04:47:06,440 --> 04:47:09,080 THEY WANT TO JUST KNOW WHAT TO 6446 04:47:09,080 --> 04:47:11,920 EXPECT, WHAT AGE, AROUND WHAT 6447 04:47:11,920 --> 04:47:13,800 AGE WILL I EXPECT CHANGES, WHAT 6448 04:47:13,800 --> 04:47:15,040 KINDS OF CHANGES. 6449 04:47:15,040 --> 04:47:19,520 I WAS TOLD WHAT TO EXPECT DURING 6450 04:47:19,520 --> 04:47:21,720 PUBERTY WHEN I ENTERED MENARCHE, 6451 04:47:21,720 --> 04:47:24,760 DURING PREGNANCY, WHY AM I NOT 6452 04:47:24,760 --> 04:47:28,320 TOLD WHAT TO EXPECT IN THE 6453 04:47:28,320 --> 04:47:28,840 MENOPAUSE TRANSITION? 6454 04:47:28,840 --> 04:47:31,080 DURING ANNUAL VISITS OR CLINICAL 6455 04:47:31,080 --> 04:47:32,560 ENCOUNTERS BRINGING IT UP AS WE 6456 04:47:32,560 --> 04:47:35,040 DO FOR OTHER STAGES OF LIFE. 6457 04:47:35,040 --> 04:47:39,000 >> I WANT TO ADD TO THAT, 6458 04:47:39,000 --> 04:47:41,440 EMPOWERING YOUNGER WOMEN OR 6459 04:47:41,440 --> 04:47:43,120 THOSE MID-LIFE WITH GROUPS SUCH 6460 04:47:43,120 --> 04:47:47,320 AS OH WELL, THEY DO TALK ABOUT 6461 04:47:47,320 --> 04:47:47,520 THAT. 6462 04:47:47,520 --> 04:47:49,080 DON'T DO LIKE I DID. 6463 04:47:49,080 --> 04:47:50,880 YOU NEED TO KNOW THESE ARE THE 6464 04:47:50,880 --> 04:47:58,120 WEST YOU WANT TO THINK ABOUT 6465 04:47:58,120 --> 04:48:00,160 ASKING AT YOUR NEXT VISIT, VERY 6466 04:48:00,160 --> 04:48:01,680 EMPOWERING, THAT'S WHY I 6467 04:48:01,680 --> 04:48:04,200 APPRECIATE OWEL SO MUCH BUT THEY 6468 04:48:04,200 --> 04:48:07,040 DO HAVE CONVERSATIONS TO HELP 6469 04:48:07,040 --> 04:48:10,960 EMPOWER WOMEN THAT MAY NOT BE 6470 04:48:10,960 --> 04:48:12,880 ASKED BUT KNOW, YOU GO IN 6471 04:48:12,880 --> 04:48:13,960 PREPARED TO ASK QUESTIONS. 6472 04:48:13,960 --> 04:48:16,640 IT MEANS A LOT, ESPECIALLY FOR 6473 04:48:16,640 --> 04:48:17,960 BLACK WOMEN, AND THEY REALLY GO 6474 04:48:17,960 --> 04:48:18,360 INTO THAT. 6475 04:48:18,360 --> 04:48:22,920 THANK YOU. 6476 04:48:22,920 --> 04:48:26,000 >> I'M CONSCIOUS OF TIME. 6477 04:48:26,000 --> 04:48:29,560 I SEE YOU'RE READY TO MOVE US 6478 04:48:29,560 --> 04:48:29,960 ALONG. 6479 04:48:29,960 --> 04:48:31,800 >> I WAS GOING TO SAY IF ANYONE 6480 04:48:31,800 --> 04:48:32,800 HAS A LAST ANSWER, WE'RE STILL 6481 04:48:32,800 --> 04:48:35,200 GOING TO START THE NEXT SESSION 6482 04:48:35,200 --> 04:48:42,560 AT 3:10. 6483 04:48:42,560 --> 04:48:44,600 I'LL OPEN IT IF ANYONE ELSE HAS 6484 04:48:44,600 --> 04:48:47,960 ANYTHING TO SAY OR WE'LL TAKE A 6485 04:48:47,960 --> 04:48:48,240 SHORT BREAK. 6486 04:48:48,240 --> 04:48:49,640 >> I'LL JUST ADD THAT'S 6487 04:48:49,640 --> 04:48:52,560 SOMETHING THAT FORCE PROVIDES, 6488 04:48:52,560 --> 04:48:53,960 THAT PEER EXPERIENCE. 6489 04:48:53,960 --> 04:48:56,560 SO THAT EVEN IF YOUR HEALTH CARE 6490 04:48:56,560 --> 04:48:57,720 PROFESSIONALS DOES PREPARE YOU 6491 04:48:57,720 --> 04:48:59,920 THERE'S NOTHING LIKE TALKING TO 6492 04:48:59,920 --> 04:49:03,240 SOMEONE ELSE WHO HAS BEEN 6493 04:49:03,240 --> 04:49:05,920 THROUGH THE EXPERIENCE. 6494 04:49:05,920 --> 04:49:07,560 >> THANK YOU. 6495 04:49:07,560 --> 04:49:11,560 >> IN TERMS OF DISPARITIES 6496 04:49:11,560 --> 04:49:13,800 QUESTION, ONE OF THE ISSUES, NOT 6497 04:49:13,800 --> 04:49:15,320 BEING A HEALTH CARE PROVIDER 6498 04:49:15,320 --> 04:49:18,240 MYSELF, THAT THERE IS A CONCERN 6499 04:49:18,240 --> 04:49:20,840 ABOUT THE LEVEL OF KNOWLEDGE AT 6500 04:49:20,840 --> 04:49:24,840 THE PRIMARY CARE LEVEL, NOT 6501 04:49:24,840 --> 04:49:28,240 EVERYONE HAS ACCESS TO 6502 04:49:28,240 --> 04:49:32,320 GYNECOLOGICAL CARE OR SPECIALTY 6503 04:49:32,320 --> 04:49:35,160 WOMEN'S HEALTH CENTERS NEAR 6504 04:49:35,160 --> 04:49:35,560 RESEARCH CENTERS. 6505 04:49:35,560 --> 04:49:38,720 I THINK ONE BIG ISSUE HAS TO DO 6506 04:49:38,720 --> 04:49:40,200 WITH IMPROVING THE LEVEL OF 6507 04:49:40,200 --> 04:49:42,880 KNOWLEDGE AT THE PRIMARY CARE 6508 04:49:42,880 --> 04:49:47,000 LEVEL ABOUT CRITICAL ISSUES IN 6509 04:49:47,000 --> 04:49:47,720 MENOPAUSE CARE. 6510 04:49:47,720 --> 04:49:52,960 AND WE NEED TO HAVE A LOT MORE 6511 04:49:52,960 --> 04:49:53,680 INFORMATION IN MULTIPLE 6512 04:49:53,680 --> 04:49:55,960 LANGUAGES, SO THERE'S VERY GOOD 6513 04:49:55,960 --> 04:50:00,000 WEBSITES BEING DEVELOPED, NEED 6514 04:50:00,000 --> 04:50:04,800 TO MAKE SURE THEY ARE AVAILABLE 6515 04:50:04,800 --> 04:50:06,080 IN MULTI-LANGUAGES FOR VARIOUS 6516 04:50:06,080 --> 04:50:11,280 COUNTRIES THAT WE NEED HAVE. 6517 04:50:11,280 --> 04:50:15,080 >> ONE COMMENT AS A GYN 6518 04:50:15,080 --> 04:50:17,360 ONCOLOGIST, THIS HAS TO BE A 6519 04:50:17,360 --> 04:50:20,320 MULTI-PRONGED APPROACH TO GET 6520 04:50:20,320 --> 04:50:22,760 THIS INFORMATION OUT THERE, AND 6521 04:50:22,760 --> 04:50:25,040 THERE'S A LACK OF KNOWLEDGE AT 6522 04:50:25,040 --> 04:50:27,120 EVERY LEVEL ON HOW TO TAKE CARE 6523 04:50:27,120 --> 04:50:35,600 OF THIS PROBLEM, AND IT HAS BEEN 6524 04:50:35,600 --> 04:50:39,680 SYSTEMATICALLY IGNORED AND 6525 04:50:39,680 --> 04:50:40,880 UNDEREMPHASIZED, WOMEN ARE OKAY 6526 04:50:40,880 --> 04:50:42,040 WITH SUFFERING, IT'S SOMETHING 6527 04:50:42,040 --> 04:50:43,960 THAT'S EXPECTED OF THEM, AND 6528 04:50:43,960 --> 04:50:48,120 THIS MENTALITY BLEEDS INTO EVERY 6529 04:50:48,120 --> 04:50:51,680 ASPECT OF HEALTH CARE AND WITH 6530 04:50:51,680 --> 04:50:54,920 OB/GYNs BEING LESS AVAILABLE 6531 04:50:54,920 --> 04:50:55,800 IN DIFFERENT AREAS, OTHER 6532 04:50:55,800 --> 04:50:58,880 SPECIALTIES ARE GOING TO NEED TO 6533 04:50:58,880 --> 04:51:00,000 LEARN SOME GYNECOLOGY, AND WE 6534 04:51:00,000 --> 04:51:01,960 ALL HAVE TO WORK TOGETHER TO 6535 04:51:01,960 --> 04:51:03,160 HELP TAKE CARE OF THESE 6536 04:51:03,160 --> 04:51:08,200 PATIENTS. 6537 04:51:08,200 --> 04:51:10,480 >> I COULDN'T AGREE MORE. 6538 04:51:10,480 --> 04:51:12,040 EVERY PANELIST HAS ECHOED ALL 6539 04:51:12,040 --> 04:51:13,400 THE THOUGHTS THAT CROSSED MY 6540 04:51:13,400 --> 04:51:13,680 MIND. 6541 04:51:13,680 --> 04:51:14,920 NOTHING MORE TO ADD. 6542 04:51:14,920 --> 04:51:15,240 THANK YOU. 6543 04:51:15,240 --> 04:51:17,120 >> I WANT TO THANK EVERYONE. 6544 04:51:17,120 --> 04:51:19,800 WE'RE GOING TO TAKE A VERY SHORT 6545 04:51:19,800 --> 04:51:21,920 BREAK AND WE'RE GOING TO SEE 6546 04:51:21,920 --> 04:51:25,200 SOME GRAPHIC REPORTING THAT HAS 6547 04:51:25,200 --> 04:51:30,000 BEEN BEING DONE DURING THIS 6548 04:51:30,000 --> 04:51:30,680 SESSION. 6549 04:51:30,680 --> 04:51:32,160 WE'LL RECONVENE IN FIVE 6550 04:51:32,160 --> 04:51:33,000 SHORT 6551 04:51:33,000 --> 04:51:34,240 MINUTES. 6552 04:51:34,240 --> 04:51:34,640 THANK YOU. 6553 04:51:34,640 --> 04:51:36,840 >> I WANT TO THANK EVERYONE FOR 6554 04:51:36,840 --> 04:51:38,400 JOINING US TODAY. 6555 04:51:38,400 --> 04:51:45,160 AS WE ENTER THE END OF THE DAY, 6556 04:51:45,160 --> 04:51:48,640 7th ANNUAL SYMPOSIUM, I WANT 6557 04:51:48,640 --> 04:51:50,400 TO THANK ANGELIQUE FOR HER 6558 04:51:50,400 --> 04:51:58,200 DRAWINGS AND GRAPHIC REPORTING 6559 04:51:58,200 --> 04:52:00,880 DURING THE DAY. 6560 04:52:00,880 --> 04:52:11,600 IT'S MY PLEASURE TO INTRODUCE 6561 04:52:11,600 --> 04:52:13,720 DR. NANETTE SANTORUM, TAILOR 6562 04:52:13,720 --> 04:52:17,520 CHAIR IN DEPARTMENT OF 6563 04:52:17,520 --> 04:52:23,560 OBSTETRICS, UNIVERSITY OF 6564 04:52:23,560 --> 04:52:29,000 COLORADO SCHOOL OF MEDICINE. 6565 04:52:29,000 --> 04:52:34,200 >> IT'S PLEASURE TO BE HERE. 6566 04:52:34,200 --> 04:52:38,040 WE'RE GOING TO BEGIN WITH THE 6567 04:52:38,040 --> 04:52:46,600 WHO, WHEN, WHAT OF THERAPY WITH 6568 04:52:46,600 --> 04:52:49,920 DR. VIRGINIA MILLER, SHE'S 6569 04:52:49,920 --> 04:52:54,440 PROFESSOR EMERITA OF SURGERY 6570 04:52:54,440 --> 04:52:57,720 MAYO CLINIC, HAD GREAT IMPACT ON 6571 04:52:57,720 --> 04:52:58,880 THE FIELD. 6572 04:52:58,880 --> 04:53:03,760 I'M GOING TO KEEP US ON STRICT 6573 04:53:03,760 --> 04:53:05,640 TIME LIMIT, I'LL THE LOW YOU 6574 04:53:05,640 --> 04:53:08,080 KNOW WHEN YOU HAVE THREE MINUTES 6575 04:53:08,080 --> 04:53:08,280 LEFT. 6576 04:53:08,280 --> 04:53:08,840 >> PERFECT. 6577 04:53:08,840 --> 04:53:19,400 I DON'T HAVE TO START MY TIMER. 6578 04:53:20,680 --> 04:53:24,720 THANKS TO THE ORGANIZERS. 6579 04:53:24,720 --> 04:53:32,640 WE'VE HEARD A LOT ABOUT 6580 04:53:32,640 --> 04:53:33,160 INDIVIDUALIZING HORMONE 6581 04:53:33,160 --> 04:53:35,080 TREATMENT TODAY. 6582 04:53:35,080 --> 04:53:38,160 MY FUNDING SOURCES ARE HERE, I'M 6583 04:53:38,160 --> 04:53:40,400 GRATEFUL TO THE GRANTS FROM NIH 6584 04:53:40,400 --> 04:53:42,040 THAT SUPPORTED US OVER THE YEARS 6585 04:53:42,040 --> 04:53:47,120 AS WELL AS FROM THE KRONOS 6586 04:53:47,120 --> 04:53:48,840 INSTITUTE FROM THE AURORA 6587 04:53:48,840 --> 04:53:50,520 FOUNDATION WHICH SUPPORTED THE 6588 04:53:50,520 --> 04:53:51,120 KEEPS TRIAL. 6589 04:53:51,120 --> 04:54:01,680 I HAVE NO CONFLICTS OF INTEREST. 6590 04:54:02,320 --> 04:54:04,880 FIRST OBJECTIVE TO RENEW 6591 04:54:04,880 --> 04:54:07,600 MECHANISM OF ACTION, WITHOUT 6592 04:54:07,600 --> 04:54:10,240 UNDERSTANDING OR REFRESHER WE 6593 04:54:10,240 --> 04:54:11,160 WON'T UNDERSTAND SOME 6594 04:54:11,160 --> 04:54:13,280 IMPLICATIONS OF THE 6595 04:54:13,280 --> 04:54:14,280 RISK/BENEFITS OF HORMONE 6596 04:54:14,280 --> 04:54:14,560 TREATMENT. 6597 04:54:14,560 --> 04:54:18,120 I'M GOING TO LEVEL INTO THE 6598 04:54:18,120 --> 04:54:19,680 PHARMACOGENETICKIC APPROACHES 6599 04:54:19,680 --> 04:54:21,920 USED TO UNDERSTAND EFFICACY OF 6600 04:54:21,920 --> 04:54:23,560 HORMONE TREATMENTS, ESPECIALLY 6601 04:54:23,560 --> 04:54:26,520 AS THEY RELATE TO 6602 04:54:26,520 --> 04:54:27,920 INDIVIDUALIZING TREATMENTS BASED 6603 04:54:27,920 --> 04:54:31,440 ON PERHAPS GENOTYPE OR 6604 04:54:31,440 --> 04:54:35,760 METABOLISM OF ESTROGEN AND LEAVE 6605 04:54:35,760 --> 04:54:38,320 YOU WITH CHALLENGES SCIENCE 6606 04:54:38,320 --> 04:54:39,640 FACES PERSONALIZING HORMONE 6607 04:54:39,640 --> 04:54:43,320 TREATMENTS AND LOOKS TO THE 6608 04:54:43,320 --> 04:54:53,240 FUTURE OF WHAT NEEDS TO BE DONE. 6609 04:54:53,240 --> 04:55:00,560 MOST OF THE ONES TODAY HAVE BEEN 6610 04:55:00,560 --> 04:55:03,040 ESTRADIOL, AND ORAL CONJUGATED 6611 04:55:03,040 --> 04:55:03,920 EQUINE ESTROGEN. 6612 04:55:03,920 --> 04:55:11,960 YOU CAN SEE FROM THE SLIDE, ORAL 6613 04:55:11,960 --> 04:55:18,960 EQUINE CONJUGATED CONTAINS 6614 04:55:18,960 --> 04:55:20,360 ESTRADIOL IT CONTAINS OTHER 6615 04:55:20,360 --> 04:55:20,920 PRODUCTS. 6616 04:55:20,920 --> 04:55:25,040 WHAT ARE THESE EFFECTS IN THE 6617 04:55:25,040 --> 04:55:25,240 CELL? 6618 04:55:25,240 --> 04:55:27,840 COMPOUNDS CAN ENTER AND BIND TO 6619 04:55:27,840 --> 04:55:33,120 HORMONE RECEPTORS, IN THIS CASE 6620 04:55:33,120 --> 04:55:34,440 ESTROGEN RECEPTOR, GO INTO 6621 04:55:34,440 --> 04:55:36,320 NUCLEUS, AFFECT GENE 6622 04:55:36,320 --> 04:55:38,320 TRANSCRIPTION AND TRANSLATION. 6623 04:55:38,320 --> 04:55:40,360 THESE ARE CALLED GENOMIC 6624 04:55:40,360 --> 04:55:43,560 REGULATION OF HORMONE 6625 04:55:43,560 --> 04:55:46,800 TREATMENTS, AND THROUGH THE 6626 04:55:46,800 --> 04:55:53,520 REGULATION OF THE GENOME CAN 6627 04:55:53,520 --> 04:55:57,360 AFFECT PROTEIN SYNTHESIS, MANY 6628 04:55:57,360 --> 04:55:59,320 CELL FUNCTIONS, LONG TERM, AND 6629 04:55:59,320 --> 04:55:59,960 LONG LASTING. 6630 04:55:59,960 --> 04:56:10,520 AND TAKE A WHILE TO ACTUALLY BE 6631 04:56:17,160 --> 04:56:17,360 OBSERVED. 6632 04:56:17,360 --> 04:56:23,000 ON THE OTHER HAND THEY BIND TO 6633 04:56:23,000 --> 04:56:26,280 RECEPTORS IN THE CELL MEMBRANE, 6634 04:56:26,280 --> 04:56:30,000 AND ALSO CAUSE SEVERAL VERY 6635 04:56:30,000 --> 04:56:32,120 RAPID CHANGES IN ION REGULATION, 6636 04:56:32,120 --> 04:56:35,120 SIGNAL PATHWAYS, RELEASE OF 6637 04:56:35,120 --> 04:56:37,280 NITRIC OXIDE WHICH YOU HEARD 6638 04:56:37,280 --> 04:56:40,080 FROM DR. MANSON'S TALK EARLIER 6639 04:56:40,080 --> 04:56:41,760 THIS MORNING, AND AGAIN THESE 6640 04:56:41,760 --> 04:56:52,160 PATHWAYS CAN AFFECT CELL 6641 04:56:57,720 --> 04:56:58,280 FUNCTION. 6642 04:56:58,280 --> 04:57:00,120 THESE RESPONSES ARE PRESENT WHEN 6643 04:57:00,120 --> 04:57:02,440 HORMONES ARE THERE, GONE WHEN 6644 04:57:02,440 --> 04:57:05,120 THE HORMONES ARE REMOVED. 6645 04:57:05,120 --> 04:57:07,000 REVERSIBLE EFFECTS OF TREATMENT. 6646 04:57:07,000 --> 04:57:09,520 YOU HAVE KEEP IN MIND LOOKING AT 6647 04:57:09,520 --> 04:57:16,120 BENEFITS AND RISKS, LONG TERM 6648 04:57:16,120 --> 04:57:17,400 CONSEQUENCES. 6649 04:57:17,400 --> 04:57:21,760 AS MODE OF DELIVERY AFFECT THEIR 6650 04:57:21,760 --> 04:57:26,640 EFFICACY, ORAL COMPOUNDS MUST GO 6651 04:57:26,640 --> 04:57:29,800 THROUGH OR BE TAKEN INTO THE 6652 04:57:29,800 --> 04:57:32,000 LIVER AND METABOLIZED. 6653 04:57:32,000 --> 04:57:34,480 I SHOWED ESTROGEN AND 6654 04:57:34,480 --> 04:57:37,240 METABOLITES, THOSE OCCUR IN THE 6655 04:57:37,240 --> 04:57:38,440 LIVER AND AFFECT INFLAMMATORY 6656 04:57:38,440 --> 04:57:40,320 FACTORS AND COAGULATION FACTORS 6657 04:57:40,320 --> 04:57:42,080 WHICH GIVES US SOME BIOLOGICAL 6658 04:57:42,080 --> 04:57:46,880 BASIS FOR THE FACT THAT ORAL 6659 04:57:46,880 --> 04:57:51,640 COMPOUNDS MAY BE THROMBOGENIC 6660 04:57:51,640 --> 04:57:56,920 THAN THOSE USE TRANSDERMALLY 6661 04:57:56,920 --> 04:57:57,960 THAN THOSE WITHOUT BEING 6662 04:57:57,960 --> 04:57:59,120 METABOLIZED BEFORE ENTERING THE 6663 04:57:59,120 --> 04:58:01,960 LIVER AND BROKEN DOWN AND 6664 04:58:01,960 --> 04:58:02,600 ELIMINATED. 6665 04:58:02,600 --> 04:58:04,760 WHEN WE'RE TALKING ABOUT EFFECTS 6666 04:58:04,760 --> 04:58:06,080 OF HORMONES AND INDIVIDUALIZING 6667 04:58:06,080 --> 04:58:07,400 TREATMENT, YOU HAVE TO KEEP IN 6668 04:58:07,400 --> 04:58:14,480 MIND THESE TWO IMPORTANT 6669 04:58:14,480 --> 04:58:15,000 FACTORS. 6670 04:58:15,000 --> 04:58:17,840 WHAT IS THE FORMULATION AND HOW 6671 04:58:17,840 --> 04:58:26,640 ARE THEY DELIVERED, AFFECTING 6672 04:58:26,640 --> 04:58:28,440 OUTCOMES OF CHOICE. 6673 04:58:28,440 --> 04:58:34,000 HOW CAN WE LOOK AT GENETICS 6674 04:58:34,000 --> 04:58:34,560 AFFECTING OUTCOME. 6675 04:58:34,560 --> 04:58:38,320 I'M GOING TO TALK ABOUT THE 6676 04:58:38,320 --> 04:58:42,360 KEEPS STUDY. 6677 04:58:42,360 --> 04:58:44,960 WHICH WAS BEGUN AS A 6678 04:58:44,960 --> 04:58:49,240 MULTI-CENTER STUDY, NINE SITES 6679 04:58:49,240 --> 04:58:59,800 ACROSS THE UNITED STATES IN 20, 6680 04:59:02,240 --> 04:59:07,280 FIRST OF ALL THE AGE OF THE 6681 04:59:07,280 --> 04:59:11,480 PARTICIPANTS WERE WITHIN AVERAGE 6682 04:59:11,480 --> 04:59:13,680 AGE OF MENOPAUSE. 6683 04:59:13,680 --> 04:59:17,520 WE WERE KEEN TO ASSURE THE WOMEN 6684 04:59:17,520 --> 04:59:19,040 WERE WITHIN CLOSE RANGE, THREE 6685 04:59:19,040 --> 04:59:22,160 YEARS, OF THEIR LAST MENSTRUAL 6686 04:59:22,160 --> 04:59:23,880 PERIOD. 6687 04:59:23,880 --> 04:59:27,360 YOU REMEMBER SOME WOMEN WHY TEN 6688 04:59:27,360 --> 04:59:29,280 YEARS PAST FINAL MENOPAUSE SO 6689 04:59:29,280 --> 04:59:31,680 MENOPAUSAL AGE IS ONE OF THE 6690 04:59:31,680 --> 04:59:38,000 QUESTIONS CAME FROM THE 6691 04:59:38,000 --> 04:59:39,320 AUDIENCE, AND WE WERE KEEN TO 6692 04:59:39,320 --> 04:59:41,000 ASSURE WE WERE WITHIN A 6693 04:59:41,000 --> 04:59:44,320 REASONABLE RANGE CLOSE TO THE 6694 04:59:44,320 --> 04:59:46,600 FINAL MENOPAUSE. 6695 04:59:46,600 --> 04:59:48,160 WOMEN WERE METABOLICALLY 6696 04:59:48,160 --> 04:59:50,560 HEALTHY. 6697 04:59:50,560 --> 04:59:52,680 HERE IS THEIR BMI, BLOOD 6698 04:59:52,680 --> 04:59:54,480 PRESSURE, SCREENED FOR CORONARY 6699 04:59:54,480 --> 04:59:58,680 CALCIFICATION, BLOOD PRESSURE 6700 04:59:58,680 --> 05:00:01,840 UNDER CONTROL, AIRED YO 6701 05:00:01,840 --> 05:00:04,280 METABOLIC PARAMETERS WITHIN THE 6702 05:00:04,280 --> 05:00:05,120 NORMATIVE RANGE. 6703 05:00:05,120 --> 05:00:11,040 WHAT DID WE USE TO TREAT? 6704 05:00:11,040 --> 05:00:12,160 TWO FORMULATIONS, FIRST 6705 05:00:12,160 --> 05:00:13,640 TRANSDERMAL 17 BETA ESTRADIOL 6706 05:00:13,640 --> 05:00:19,160 AND HERE IS DOSAGE AND ORAL 6707 05:00:19,160 --> 05:00:20,720 CONJUGATED EQUINE ESTROGEN, 0.4 6708 05:00:20,720 --> 05:00:22,400 MILLIGRAMS PER DAY, A LOWER 6709 05:00:22,400 --> 05:00:26,320 CONCENTRATION THAT WAS USED IN 6710 05:00:26,320 --> 05:00:28,320 THE WHI, BECAUSE WE WERE BASED 6711 05:00:28,320 --> 05:00:34,080 ON OUTCOMES OF THE WHI CHOSE TO 6712 05:00:34,080 --> 05:00:35,720 USE LOWER DOSE. 6713 05:00:35,720 --> 05:00:40,680 IN CONTRAST TO WHI USED NATURAL 6714 05:00:40,680 --> 05:00:42,560 PROGESTERONE, GIVEN NOT 6715 05:00:42,560 --> 05:00:44,240 CONTINUOUSLY BUT FOR FIRST 12 6716 05:00:44,240 --> 05:00:45,360 DAYS OF THE MONTH. 6717 05:00:45,360 --> 05:00:48,080 SO WHEN WE THINK ABOUT THE 6718 05:00:48,080 --> 05:00:49,600 METABOLISM OF THESE TWO 6719 05:00:49,600 --> 05:00:54,200 COMPOUNDS, WE NEED KEEP IN MIND 6720 05:00:54,200 --> 05:01:00,960 ESTROGEN METABOLISM IS COMPLEX. 6721 05:01:00,960 --> 05:01:11,520 IT'S HIGH DOCKS LATE -- HYDROXY 6722 05:01:16,240 --> 05:01:22,160 LATED. 6723 05:01:22,160 --> 05:01:23,400 THERE ARE GENETIC VARIANTS IN 6724 05:01:23,400 --> 05:01:25,880 THE GENES THAT ENCODE THIS 6725 05:01:25,880 --> 05:01:28,120 ENZYME, WE WERE CURIOUS TO SEE 6726 05:01:28,120 --> 05:01:38,640 IF THIS THAT ANY EFFECT ON ANY 6727 05:01:40,400 --> 05:01:40,920 OUTCOMES. 6728 05:01:40,920 --> 05:01:43,240 YOU CAN SEE THIS IS A COMPLEX 6729 05:01:43,240 --> 05:01:44,200 GENETIC VARIATION. 6730 05:01:44,200 --> 05:01:46,120 YOU CAN HAVE ONE COPY OF THE 6731 05:01:46,120 --> 05:01:53,000 VARIATION, TWO OF THE VARIATION, 6732 05:01:53,000 --> 05:01:53,840 THREE OR FOUR. 6733 05:01:53,840 --> 05:01:58,720 THE MORE COPIES THE FASTER YOU 6734 05:01:58,720 --> 05:02:07,520 METABOLIZE TO THE SULFYNATED 6735 05:02:07,520 --> 05:02:07,840 FORM. 6736 05:02:07,840 --> 05:02:08,560 DOES THIS A SUBSEQUENT 6737 05:02:08,560 --> 05:02:11,240 CONSEQUENCE IF A WOMAN CARRIES A 6738 05:02:11,240 --> 05:02:12,040 LARGE NUMBER? 6739 05:02:12,040 --> 05:02:13,240 WE FOUND IT DID. 6740 05:02:13,240 --> 05:02:15,280 IF WE LOOK AT WOMEN WHEN THEY 6741 05:02:15,280 --> 05:02:18,160 ENROLLED IN THE TRIAL, AND THE 6742 05:02:18,160 --> 05:02:20,560 AGE WHICH THEY EXPERIENCED THEIR 6743 05:02:20,560 --> 05:02:23,240 FINAL MENSTRUAL PERIOD, WE FOUND 6744 05:02:23,240 --> 05:02:26,480 THE WOMEN THAT HAD NUMBER OF 6745 05:02:26,480 --> 05:02:29,600 ALLELES WITH THIS VARIANT, THE 6746 05:02:29,600 --> 05:02:31,800 MORE COPIES OF THE VARIANT THEY 6747 05:02:31,800 --> 05:02:34,840 HAD, THE EARLIER WAS THEIR ONSET 6748 05:02:34,840 --> 05:02:35,160 OF MENOPAUSE. 6749 05:02:35,160 --> 05:02:38,440 IN OTHER WORDS, THE NUMBER OF 6750 05:02:38,440 --> 05:02:40,440 THESE PARTICULAR VARIANT ALLELES 6751 05:02:40,440 --> 05:02:42,800 INCREASED THE ACTIVITY WHICH 6752 05:02:42,800 --> 05:02:48,800 WOULD REMOVE THE ACTIVE FORM OF 6753 05:02:48,800 --> 05:02:50,120 ESTROGEN FROM CIRCULATING POOL 6754 05:02:50,120 --> 05:02:51,440 REDUCING THE AMOUNT OF HORMONE 6755 05:02:51,440 --> 05:02:56,240 THAT WAS AVAILABLE TO BIND TO 6756 05:02:56,240 --> 05:03:05,800 THE RECEPTORS FOR ITS CELLULAR 6757 05:03:05,800 --> 05:03:06,840 EFFECTS. 6758 05:03:06,840 --> 05:03:07,840 WHAT ABOUT VARIABILITY AND 6759 05:03:07,840 --> 05:03:08,120 RESPONSE? 6760 05:03:08,120 --> 05:03:09,560 THIS WAS BASED ON WOMEN WHEN 6761 05:03:09,560 --> 05:03:12,600 THEY CAME INTO THE TRIAL, PRIOR 6762 05:03:12,600 --> 05:03:14,760 TO HAVING -- RECEIVING THEIR 6763 05:03:14,760 --> 05:03:15,760 DRUG, PRIOR TO RANDOMIZATION, 6764 05:03:15,760 --> 05:03:18,760 WAS THERE ANY RELATIONSHIP TO 6765 05:03:18,760 --> 05:03:20,920 ESTROGEN METABOLISM AND AGE OF 6766 05:03:20,920 --> 05:03:23,480 MENOPAUSE, YES, THERE WAS. 6767 05:03:23,480 --> 05:03:27,320 KNOWING THERE'S VARIATIONS IN 6768 05:03:27,320 --> 05:03:29,320 THESE ENZYMES THAT AFFECT 6769 05:03:29,320 --> 05:03:30,480 ESTROGEN METABOLISM WOULD THAT 6770 05:03:30,480 --> 05:03:32,560 AFFECT RESPONSE TO THE HORMONE 6771 05:03:32,560 --> 05:03:34,640 TREATMENTS? 6772 05:03:34,640 --> 05:03:35,960 LET'S SEE WHAT HAPPENED. 6773 05:03:35,960 --> 05:03:38,960 FIRST WE NEED TO ESTABLISH THAT 6774 05:03:38,960 --> 05:03:42,440 THESE HORMONE TREATMENTS DID 6775 05:03:42,440 --> 05:03:45,200 RAISE THE LEVEL, CIRCULATING 6776 05:03:45,200 --> 05:03:48,600 LEVELS OF HORMONES IN THE BLOOD. 6777 05:03:48,600 --> 05:03:51,000 WOMEN RANDOMIZE TO TRANSDERMAL 6778 05:03:51,000 --> 05:03:52,600 17 BETA ESTRADIOL, THEIR HORMONE 6779 05:03:52,600 --> 05:03:55,720 LEVELS WERE INCREASED AND THEY 6780 05:03:55,720 --> 05:03:56,920 STAYED PRETTY SUBSTANTIALLY THE 6781 05:03:56,920 --> 05:03:59,200 SAME THROUGHOUT THE FOUR YEARS 6782 05:03:59,200 --> 05:04:00,960 OF THE TRIAL. 6783 05:04:00,960 --> 05:04:06,520 THE WOMEN THAT RECEIVED THE 6784 05:04:06,520 --> 05:04:08,400 CONJUGATED ESTROGEN LEVELS WERE 6785 05:04:08,400 --> 05:04:10,080 NOT HIGH BUT GIVEN THE NATURE OF 6786 05:04:10,080 --> 05:04:13,480 THE COMPOUND THEY WERE GIVEN, 6787 05:04:13,480 --> 05:04:17,840 AND HOW THIS METABOLIZED IN THE 6788 05:04:17,840 --> 05:04:20,640 LIVER WE SEE INDEED ESTRONE WAS 6789 05:04:20,640 --> 05:04:22,720 HIGHER THAN THOSE THAT RECEIVED 6790 05:04:22,720 --> 05:04:24,440 ESTRADIOL PATCH. 6791 05:04:24,440 --> 05:04:27,280 EACH OF THESE ACTIVE TREATMENTS 6792 05:04:27,280 --> 05:04:30,360 DID INDEED INCREATES CIRCULATING 6793 05:04:30,360 --> 05:04:33,840 LEVEL OF A PHARMACO EFFECTIVE 6794 05:04:33,840 --> 05:04:35,120 TREATMENT STEROID BUT WHAT CAN 6795 05:04:35,120 --> 05:04:37,480 WE SAY ABOUT THESE DIFFERENCES 6796 05:04:37,480 --> 05:04:38,640 IN HORMONE LEVELS ON THE 6797 05:04:38,640 --> 05:04:40,560 SYMPTOMS OF MENOPAUSE AND OTHER 6798 05:04:40,560 --> 05:04:45,480 PARAMETERS OF THE KEEPS TRIAL? 6799 05:04:45,480 --> 05:04:47,160 LET'S LOOK. 6800 05:04:47,160 --> 05:04:48,720 WE'VE HEARD ABOUT VASOMOTOR 6801 05:04:48,720 --> 05:04:51,320 SYMPTOMS, HOT FLASHES, NOT THE 6802 05:04:51,320 --> 05:04:53,640 ONLY SYMPTOMS WHICH WOMEN ARE 6803 05:04:53,640 --> 05:04:54,040 CONCERNED ABOUT. 6804 05:04:54,040 --> 05:05:03,440 THEY ARE CONCERNED ABOUT 6805 05:05:03,440 --> 05:05:08,200 IRRITABILITY, INSOMNIA, I CAN'T 6806 05:05:08,200 --> 05:05:12,400 READ BECAUSE THERE'S A THING ON 6807 05:05:12,400 --> 05:05:12,800 TOP. 6808 05:05:12,800 --> 05:05:13,200 >> NIGHT SWEATS. 6809 05:05:13,200 --> 05:05:18,880 >> THANK YOU VERY MUCH. 6810 05:05:18,880 --> 05:05:20,400 SO THESE ARE TERRIBLE. 6811 05:05:20,400 --> 05:05:23,240 WE TALKED ABOUT THE WOMAN WHO 6812 05:05:23,240 --> 05:05:25,480 THOUGHT SHE WAS IN A SAUNA IN 6813 05:05:25,480 --> 05:05:26,520 THE NIGHT, OKAY? 6814 05:05:26,520 --> 05:05:31,880 THE IMPORTANT THING IS TO LOOK 6815 05:05:31,880 --> 05:05:34,520 AT THESE SCALE OF THESE 6816 05:05:34,520 --> 05:05:35,720 SYMPTOMS, WOMEN IN PLACEBO, 6817 05:05:35,720 --> 05:05:39,080 COMPARED TO THOSE ON THE ACTIVE 6818 05:05:39,080 --> 05:05:41,440 TREATMENT, INDEED FOR HOT 6819 05:05:41,440 --> 05:05:43,000 FLASHES, NIGHT SWEATS, INSOMNIA 6820 05:05:43,000 --> 05:05:47,200 THE TREATMENTS BOTH OF THEM EVEN 6821 05:05:47,200 --> 05:05:48,520 THOUGH CONTAIN DIFFERENT 6822 05:05:48,520 --> 05:05:50,800 CONCENTRATIONS OF ACTIVE 6823 05:05:50,800 --> 05:05:51,800 HORMONES THEY SIGNIFICANTLY 6824 05:05:51,800 --> 05:05:53,200 REDUCED THESE SYMPTOMS AS 6825 05:05:53,200 --> 05:05:57,000 REPORTED BY THE WOMEN IN THE 6826 05:05:57,000 --> 05:05:57,320 STUDY. 6827 05:05:57,320 --> 05:06:00,520 IRRITABILITY, NOT MUCH RESPONSE 6828 05:06:00,520 --> 05:06:00,720 THERE. 6829 05:06:00,720 --> 05:06:02,480 THERE WAS NOT MUCH DIFFERENCE 6830 05:06:02,480 --> 05:06:05,040 BETWEEN THE GROUP AND NUMBER OF 6831 05:06:05,040 --> 05:06:07,080 WOMEN THAT REPORTED IRRITABILITY 6832 05:06:07,080 --> 05:06:09,040 WAS ALSO QUITE SMALL. 6833 05:06:09,040 --> 05:06:12,920 IN SPITE OF DIFFERENCES IN 6834 05:06:12,920 --> 05:06:14,760 CIRCULATING LEVELS OF HORMONES 6835 05:06:14,760 --> 05:06:17,360 AND TYPE, THE ABILITY TO REDUCE 6836 05:06:17,360 --> 05:06:19,640 THESE SYMPTOMS OF MENOPAUSE WERE 6837 05:06:19,640 --> 05:06:20,160 COMPARABLE. 6838 05:06:20,160 --> 05:06:24,240 THESE ARE THE COLLECTIVE DATA. 6839 05:06:24,240 --> 05:06:26,240 IS THERE ANY INFORMATION THAT 6840 05:06:26,240 --> 05:06:29,040 CAN BE RELATED TO THIS OF 6841 05:06:29,040 --> 05:06:31,440 INDIVIDUAL VARIATION AND 6842 05:06:31,440 --> 05:06:32,960 RESPONSE TO THESE SYMPTOMS? 6843 05:06:32,960 --> 05:06:39,400 AGAIN, WE TRIED TO LOOK AT THE 6844 05:06:39,400 --> 05:06:41,480 GENETIC COMPOSITION OF THE 6845 05:06:41,480 --> 05:06:43,000 METABOLITES, AND GENETIC 6846 05:06:43,000 --> 05:06:46,680 VARIATION OF THE ENZYMES. 6847 05:06:46,680 --> 05:06:47,640 THESE ARE PHARMACOGENOMIC 6848 05:06:47,640 --> 05:06:50,840 EFFECTS, THAT IS GENETIC VARIANT 6849 05:06:50,840 --> 05:06:52,960 OR SNP INFLUENCES THE EFFECT OF 6850 05:06:52,960 --> 05:06:54,880 THE TREATMENT ON THE OUTCOME. 6851 05:06:54,880 --> 05:06:58,320 SO IF WE HAVE A GENETIC 6852 05:06:58,320 --> 05:06:59,320 VARIATION OF SOMETHING, WHICH IN 6853 05:06:59,320 --> 05:07:06,040 THIS CASE WE WERE LOOKING AT 6854 05:07:06,040 --> 05:07:07,240 ENZYMES THAT METABOLIZE, DOES IT 6855 05:07:07,240 --> 05:07:09,200 HAVE EFFECT OF THE TREATMENT ON 6856 05:07:09,200 --> 05:07:11,320 THE OUTCOME WHICH WOULD BE HOT 6857 05:07:11,320 --> 05:07:12,880 FLASHES, NIGHT SWEATS, SO ON. 6858 05:07:12,880 --> 05:07:15,680 SO LET'S LOOK AT THIS. 6859 05:07:15,680 --> 05:07:19,960 AGAIN, KEEP IN MIND THAT THIS IS 6860 05:07:19,960 --> 05:07:24,080 A CELL, METABOLISM OF ESTROGEN 6861 05:07:24,080 --> 05:07:28,800 IS COMPLEX. 6862 05:07:28,800 --> 05:07:29,800 WE HAVE SHULFINATION, 6863 05:07:29,800 --> 05:07:31,440 HYDROXYLATION AND METHYLATION 6864 05:07:31,440 --> 05:07:33,280 FOR ELIMINATION BUT THERE'S A 6865 05:07:33,280 --> 05:07:35,320 TRANSPORTER WHICH IS INVOLVED 6866 05:07:35,320 --> 05:07:39,240 WHICH TAKES ESTROGEN OR ESTRONE 6867 05:07:39,240 --> 05:07:40,920 INTO THE CELL, WHERE IT BEGINS 6868 05:07:40,920 --> 05:07:43,280 THIS JOURNEY THROUGH THE 6869 05:07:43,280 --> 05:07:44,160 METABOLIC PATHWAYS. 6870 05:07:44,160 --> 05:07:47,120 SO, WE DECIDED TO LOOK AT THIS 6871 05:07:47,120 --> 05:07:48,920 TRANSPORTER, IS THERE ANY 6872 05:07:48,920 --> 05:07:55,200 GENETIC VARIATION IN THIS 6873 05:07:55,200 --> 05:07:56,080 TRANSPORTER RELATED TO 6874 05:07:56,080 --> 05:07:57,760 INDIVIDUAL WOMAN TO HORMONE 6875 05:07:57,760 --> 05:08:01,720 TREATMENTS AS RELATED TO 6876 05:08:01,720 --> 05:08:02,400 MENOPAUSAL SYMPTOMS? 6877 05:08:02,400 --> 05:08:04,800 THIS IS NOT THE SLIDE I'M MOST 6878 05:08:04,800 --> 05:08:05,400 PROUD OF. 6879 05:08:05,400 --> 05:08:07,600 HOW CAN WE FOLLOW IT? 6880 05:08:07,600 --> 05:08:10,160 BEAR WITH ME. 6881 05:08:10,160 --> 05:08:11,440 THE VISUALS, YOU'LL SEE, PROVE 6882 05:08:11,440 --> 05:08:16,440 TO BE EASY TO SEE. 6883 05:08:16,440 --> 05:08:21,080 THESE ARE THE CONCENTRATIONS OF 6884 05:08:21,080 --> 05:08:22,480 ESTRONE MEASURED, 17 BETA 6885 05:08:22,480 --> 05:08:24,000 ESTRADIOL, THIS IS THE -- THESE 6886 05:08:24,000 --> 05:08:28,000 ARE THE SAME THROUGH ALL THE 6887 05:08:28,000 --> 05:08:30,560 PANELS, PLACEBO GROUP, 6888 05:08:30,560 --> 05:08:32,440 TRANSDERMAL, ORAL CONJUGATED 6889 05:08:32,440 --> 05:08:32,800 GROUP. 6890 05:08:32,800 --> 05:08:37,400 AT THE BOTTOM ARE THE GENOTYPES. 6891 05:08:37,400 --> 05:08:40,840 THIS WOULD BE HOMOZYGOUS FOR CC 6892 05:08:40,840 --> 05:08:43,040 ALLELE, HETEROZYGOUS FOR CT 6893 05:08:43,040 --> 05:08:51,120 ALLELE, AND HOMOZYGOUS FOR TT 6894 05:08:51,120 --> 05:08:51,360 ALLELE. 6895 05:08:51,360 --> 05:08:52,640 IN PLACEBO GROUP THESE VARIANTS 6896 05:08:52,640 --> 05:08:55,480 DIDN'T HAVE MUCH OF A RESPONSE 6897 05:08:55,480 --> 05:08:56,160 ON HORMONE CONCENTRATIONS 6898 05:08:56,160 --> 05:08:59,600 BECAUSE THERE WAS NO HORMONE 6899 05:08:59,600 --> 05:09:01,840 THERE, RIGHT? 6900 05:09:01,840 --> 05:09:09,240 WHEN YOU LOOK AT THOSE 6901 05:09:09,240 --> 05:09:11,160 RANDOMIZED TO THE TRANSDERMAL 17 6902 05:09:11,160 --> 05:09:15,240 BETA ESTRADIOL COMPARED TO 6903 05:09:15,240 --> 05:09:16,080 CONJUGATED ESTROGEN, YOU SEE 6904 05:09:16,080 --> 05:09:18,040 DIFFERENCES IN THE SIZE OF THE 6905 05:09:18,040 --> 05:09:19,400 BARS AND DIRECTION THEY GO. 6906 05:09:19,400 --> 05:09:22,480 LET'S LOOK AT THIS. 6907 05:09:22,480 --> 05:09:24,800 THERE'S A BIGGER RESPONSE WHEN 6908 05:09:24,800 --> 05:09:35,360 THEY ARE ON ORAL -- TRANSDERMAL 6909 05:09:35,760 --> 05:09:40,600 ESTROGEN COMPARED TO CONJUGATED 6910 05:09:40,600 --> 05:09:44,760 ESTRONE COMPARED TO ESTRADIOL. 6911 05:09:44,760 --> 05:09:46,480 HETEROZYGOUS RESPONSE IS LARGER 6912 05:09:46,480 --> 05:09:49,640 FOR THE CONCENTRATIONS OF THE 6913 05:09:49,640 --> 05:09:53,400 HORMONES THAN THE HOMOZYGOUS IN 6914 05:09:53,400 --> 05:09:56,800 ORAL CONJUGATED -- TRANSDERMAL 6915 05:09:56,800 --> 05:09:59,600 AND ORAL CONJUGATED ESTROGEN IN 6916 05:09:59,600 --> 05:10:08,080 TERMS OF LEVEL OF HORMONES. 6917 05:10:08,080 --> 05:10:09,080 >> THREE MINUTE WARNING. 6918 05:10:09,080 --> 05:10:11,160 >> OKAY. 6919 05:10:11,160 --> 05:10:11,760 WE'RE GOOD. 6920 05:10:11,760 --> 05:10:14,160 IN OTHER WORDS, WHAT WE HAVE IS 6921 05:10:14,160 --> 05:10:19,440 IF YOU HAVE MORE OF THE T 6922 05:10:19,440 --> 05:10:20,920 ALLELES, HOMOZYGOUS, LOWER 6923 05:10:20,920 --> 05:10:21,880 CONCENTRATIONS OF THESE 6924 05:10:21,880 --> 05:10:23,440 EFFECTIVE HORMONES. 6925 05:10:23,440 --> 05:10:27,840 WHAT DOES THAT TRANSLATE OUT TO 6926 05:10:27,840 --> 05:10:29,240 IN TERMS OF SYMPTOMS? 6927 05:10:29,240 --> 05:10:33,040 WITH TREATMENT THE WOMEN WITH CT 6928 05:10:33,040 --> 05:10:35,280 ALLELE, THAT IS THE 6929 05:10:35,280 --> 05:10:36,920 HETEROZYGOUS, HAD GREATER 6930 05:10:36,920 --> 05:10:40,320 DECREASES IN NIGHT SWEATS THAN 6931 05:10:40,320 --> 05:10:42,040 WOMEN WITH HOMOZYGOUS TT ALLELE. 6932 05:10:42,040 --> 05:10:44,200 THE MORE ESTROGEN IN THE BLOOD, 6933 05:10:44,200 --> 05:10:46,320 THE BETTER YOUR TREATMENT OF 6934 05:10:46,320 --> 05:10:48,400 SYMPTOMS, IN OTHER WORDS NOT 6935 05:10:48,400 --> 05:10:50,120 TRANSPORTED INTO THE CELL FOR 6936 05:10:50,120 --> 05:10:51,920 METABOLISM. 6937 05:10:51,920 --> 05:10:53,960 WE LOOKED AT ANOTHER 6938 05:10:53,960 --> 05:11:01,080 CHARACTERISTIC, THIS IS THE 6939 05:11:01,080 --> 05:11:05,200 DEPOSITION OF AMYLOID IN THE 6940 05:11:05,200 --> 05:11:08,000 BRAIN, CARRIERS FOR APOE4 MORE 6941 05:11:08,000 --> 05:11:11,400 LIKELY TO HAVE AMYLOID LAID 6942 05:11:11,400 --> 05:11:15,400 DOWN, A CHARACTERISTIC OF 6943 05:11:15,400 --> 05:11:17,040 ALZHEIMER'S DISEASE, WITH 6944 05:11:17,040 --> 05:11:18,320 ESTROGEN TREATMENT AMOUNT OF 6945 05:11:18,320 --> 05:11:19,320 AMYLOID WAS DETECTED IN BRAINS 6946 05:11:19,320 --> 05:11:25,080 OF THESE WOMEN LOWER THAN THOSE 6947 05:11:25,080 --> 05:11:26,560 IN EITHER CONJUGATED EQUINE OR 6948 05:11:26,560 --> 05:11:30,000 COMPARED TO PLACEBO, AGAIN THESE 6949 05:11:30,000 --> 05:11:30,840 ALLELES FOR ANOTHER 6950 05:11:30,840 --> 05:11:32,360 CHARACTERISTIC EXPRESSION OF IT, 6951 05:11:32,360 --> 05:11:34,200 LAYING DOWN OF AMYLOID WAS BEING 6952 05:11:34,200 --> 05:11:37,760 INFLUENCED BY THE PRESENCE OF 6953 05:11:37,760 --> 05:11:39,120 THE HORMONES. 6954 05:11:39,120 --> 05:11:47,400 WHAT ARE THE CHALLENGES GOING 6955 05:11:47,400 --> 05:11:47,840 FORWARD? 6956 05:11:47,840 --> 05:11:50,440 WE HAVE SIMILAR STUDY 6957 05:11:50,440 --> 05:11:51,280 POPULATIONS, WE TALKED 6958 05:11:51,280 --> 05:11:53,960 THROUGHOUT THIS TALK, WE HAVE 6959 05:11:53,960 --> 05:11:55,920 DISSIMILAR STUDY POPULATIONS, 6960 05:11:55,920 --> 05:11:57,360 KEEPS TRIAL, DISSIMILAR STUDY 6961 05:11:57,360 --> 05:11:57,640 POPULATIONS. 6962 05:11:57,640 --> 05:12:02,120 THERE'S NOT THE SAME TYPE OF 6963 05:12:02,120 --> 05:12:03,280 TREATMENT REGIME. 6964 05:12:03,280 --> 05:12:06,040 THE DOSE IS DIFFERENT, DURATION 6965 05:12:06,040 --> 05:12:07,040 IS DIFFERENT. 6966 05:12:07,040 --> 05:12:09,040 ONE OF THE PARTICIPANTS ASKED 6967 05:12:09,040 --> 05:12:10,840 CAN'T WE HAVE REGISTRIES WHERE 6968 05:12:10,840 --> 05:12:11,480 EVERYBODY REGISTRIES? 6969 05:12:11,480 --> 05:12:12,600 THESE ARE KIND OF QUESTIONS AND 6970 05:12:12,600 --> 05:12:16,800 TYPES OF INFORMATION THAT NEED 6971 05:12:16,800 --> 05:12:18,720 TO BE COLLECTED, AND UNLESS 6972 05:12:18,720 --> 05:12:21,360 COLLECTED ACCURATELY YOU WON'T 6973 05:12:21,360 --> 05:12:24,400 BE ABLE TO MAKE SOUND 6974 05:12:24,400 --> 05:12:24,720 CONCLUSIONS. 6975 05:12:24,720 --> 05:12:26,560 THERE'S ALSO DIFFERENCES IN THE 6976 05:12:26,560 --> 05:12:27,480 ASSESSMENTS AND CLASSIFICATION 6977 05:12:27,480 --> 05:12:29,600 OF SYMPTOMS AND OUTCOMES. 6978 05:12:29,600 --> 05:12:32,080 EVERYBODY USES NOT THE SAME 6979 05:12:32,080 --> 05:12:33,560 SCALE, SOME IS REALLY 6980 05:12:33,560 --> 05:12:34,200 QUALITATIVE RATHER THAN 6981 05:12:34,200 --> 05:12:37,720 QUANTITATIVE AND HOW DO YOU 6982 05:12:37,720 --> 05:12:39,120 ASSESS SEVERITY OF SYMPTOMS? 6983 05:12:39,120 --> 05:12:40,800 AND IT'S EASIER WHEN YOU MEASURE 6984 05:12:40,800 --> 05:12:43,280 SOMETHING LIKE BONE MINERAL 6985 05:12:43,280 --> 05:12:47,280 DENSITY OR CORONARY CALLS IF 6986 05:12:47,280 --> 05:12:49,720 CALCIFICATION BECAUSE YOU HAVE A 6987 05:12:49,720 --> 05:12:51,840 STAND ART QUALITATIVE OR 6988 05:12:51,840 --> 05:12:52,440 QUANTITATIVE MEASURE. 6989 05:12:52,440 --> 05:12:54,920 AND THEN YOU HAVE TO KEEP IN 6990 05:12:54,920 --> 05:12:58,080 MIND THERE'S INTERACTIONS AMONG 6991 05:12:58,080 --> 05:12:59,160 DIFFERENT GENETIC VARIANTS. 6992 05:12:59,160 --> 05:13:00,920 AND SO WE WOULD LIKE TO SAY HERE 6993 05:13:00,920 --> 05:13:02,600 IS OUR SEQUENCE AND GIVE ME THE 6994 05:13:02,600 --> 05:13:06,000 DRUG THAT'S RIGHT FOR ME, IT 6995 05:13:06,000 --> 05:13:09,440 DEPENDS ON THE GENETIC 6996 05:13:09,440 --> 05:13:12,120 COMPOSITION OF MULTIPLE ENZYMES 6997 05:13:12,120 --> 05:13:13,760 INVOLVED IN ESTROGEN METABOLISM 6998 05:13:13,760 --> 05:13:18,120 LET ALONE RECEPTORS AND OTHER 6999 05:13:18,120 --> 05:13:19,480 GENETIC VARIANTS AND THE 7000 05:13:19,480 --> 05:13:22,880 OUTCOMES THAT WE'RE LOOKING AT. 7001 05:13:22,880 --> 05:13:25,240 WE SAY MEDICINE IS A SCIENCE OF 7002 05:13:25,240 --> 05:13:27,360 UNCERTAINTY, IT IS AN ART, AN 7003 05:13:27,360 --> 05:13:29,600 ART OF PROBABILITY, AND MANY OF 7004 05:13:29,600 --> 05:13:31,840 THE PHYSICIANS IN THE AUDIENCE 7005 05:13:31,840 --> 05:13:35,800 I'M SURE SAY THAT THEY USE THOSE 7006 05:13:35,800 --> 05:13:38,040 IN TERMS OF ADJUSTING HORMONE 7007 05:13:38,040 --> 05:13:40,360 TREATMENTS FOR INDIVIDUAL 7008 05:13:40,360 --> 05:13:40,600 PATIENTS. 7009 05:13:40,600 --> 05:13:43,440 THAT'S PRETTY MUCH WHERE WE ARE 7010 05:13:43,440 --> 05:13:44,720 IN TERMS OF PHARMACOGENOMICS, 7011 05:13:44,720 --> 05:13:46,360 THE PRICE OF DOING GENETIC 7012 05:13:46,360 --> 05:13:49,480 TESTING ON EVERYONE IS NOT 7013 05:13:49,480 --> 05:13:51,320 REASONABLE, LET ALONE THE 7014 05:13:51,320 --> 05:13:52,040 INTERPRETATION IS NOT 7015 05:13:52,040 --> 05:13:53,640 STRAIGHTFORWARD FOR THOSE WHO 7016 05:13:53,640 --> 05:13:56,880 AREN'T USED TO LOOKING AT 7017 05:13:56,880 --> 05:13:57,320 COMPLICATED ANALYSIS. 7018 05:13:57,320 --> 05:13:58,200 >> THANKS, DR. MILLER. 7019 05:13:58,200 --> 05:14:00,360 WE'RE OUT OF TIME. 7020 05:14:00,360 --> 05:14:02,640 >> I WOULD LIKE TO SAY NONE 7021 05:14:02,640 --> 05:14:04,480 WOULD HAPPEN WITHOUT VIVIAN 7022 05:14:04,480 --> 05:14:07,120 PINN, THIS TAKEN IN 2016 WHEN 7023 05:14:07,120 --> 05:14:08,920 SHE WAS GUEST SPEAKER AT MAYO 7024 05:14:08,920 --> 05:14:10,120 AND WITHOUT HER WE WOULDN'T KNOW 7025 05:14:10,120 --> 05:14:15,840 ANY OF THIS INFORMATION TODAY. 7026 05:14:15,840 --> 05:14:16,520 THANK YOU VERY MUCH. 7027 05:14:16,520 --> 05:14:18,000 >> THANK YOU GREAT START TO THE 7028 05:14:18,000 --> 05:14:18,320 SESSION. 7029 05:14:18,320 --> 05:14:25,280 WE'RE GOING TO MOVE TO OUR NEXT 7030 05:14:25,280 --> 05:14:28,720 SPEAKER DR. ANDREW KAUNITZ, HE'S 7031 05:14:28,720 --> 05:14:29,760 PROFESSOR AND ASSOCIATE CHAIR, 7032 05:14:29,760 --> 05:14:32,120 UNIVERSITY OF FLORIDA, TALKING 7033 05:14:32,120 --> 05:14:36,760 ABOUT NOT SYSTEMATIC BUT I 7034 05:14:36,760 --> 05:14:39,760 IMAGINE SYSTEMIC HORMONE 7035 05:14:39,760 --> 05:14:40,680 THERAPY. 7036 05:14:40,680 --> 05:14:44,560 BALANCING EVIDENCE WITH CLINICAL 7037 05:14:44,560 --> 05:14:49,520 JUDGMENT. 7038 05:14:49,520 --> 05:14:50,160 I'M SETTING MY TIMER. 7039 05:14:50,160 --> 05:14:55,120 >> ANDY, I DON'T KNOW IF YOU'RE 7040 05:14:55,120 --> 05:15:05,280 MUTED. 7041 05:15:06,320 --> 05:15:08,600 >> I NEED TO GO TO PRESENTATION 7042 05:15:08,600 --> 05:15:08,800 MODE. 7043 05:15:08,800 --> 05:15:10,120 >> YOU'RE ALMOST THERE. 7044 05:15:10,120 --> 05:15:11,280 WE WOULD LOVE TO SEE YOUR FACE 7045 05:15:11,280 --> 05:15:13,120 IF YOU WANT TO TURN YOUR VIDEO 7046 05:15:13,120 --> 05:15:13,360 ON. 7047 05:15:13,360 --> 05:15:17,000 I CAN DO THAT FOR YOU ACTUALLY. 7048 05:15:17,000 --> 05:15:23,520 >> THANKS, DR. TEMKIN. 7049 05:15:23,520 --> 05:15:25,240 >> YOU'RE NOT IN PRESENTATION 7050 05:15:25,240 --> 05:15:25,640 MODE. 7051 05:15:25,640 --> 05:15:32,560 >> LET ME TRY AGAIN. 7052 05:15:32,560 --> 05:15:33,840 >> PERFECT. 7053 05:15:33,840 --> 05:15:37,000 >> GREAT. 7054 05:15:37,000 --> 05:15:39,280 HERE ARE MY DISCLOSURES. 7055 05:15:39,280 --> 05:15:41,240 AS YOU HEARD FROM DR. MANSON 7056 05:15:41,240 --> 05:15:45,080 FIRST THING IN THE MORNING, 7057 05:15:45,080 --> 05:15:47,040 SINCE PUBLICATION OF INITIAL WHI 7058 05:15:47,040 --> 05:15:50,000 FINDINGS OVER 20 YEARS AGO 7059 05:15:50,000 --> 05:15:53,040 THERE'S BEEN A TREMENDOUS DROP 7060 05:15:53,040 --> 05:15:54,080 IN PRESCRIPTION OF SYSTEMIC 7061 05:15:54,080 --> 05:15:55,840 HORMONE THERAPY BY U.S. 7062 05:15:55,840 --> 05:15:56,160 CLINICIANS. 7063 05:15:56,160 --> 05:15:59,000 THAT'S TRUE BOTH FOR PRIMARY 7064 05:15:59,000 --> 05:16:01,920 CARE PHYSICIANS, CLINICIANS, BUT 7065 05:16:01,920 --> 05:16:06,680 ALSO FOR OB/GYNs, PARTICULARLY 7066 05:16:06,680 --> 05:16:09,400 YOUNGER OB/GYNs. 7067 05:16:09,400 --> 05:16:12,000 DESPITE THAT HEALTHY WOMEN WITH 7068 05:16:12,000 --> 05:16:13,320 BOTHERSOME SYMPTOMS WITHIN 10 7069 05:16:13,320 --> 05:16:17,160 YEARS OF ONSET OF MENOPAUSE THAT 7070 05:16:17,160 --> 05:16:18,760 HORMONE THERAPY IS SAFE, MOST 7071 05:16:18,760 --> 05:16:20,520 CLINICIANS IN THE U.S. REMAIN 7072 05:16:20,520 --> 05:16:21,280 RELUCTANT TO PRESCRIBE IT 7073 05:16:21,280 --> 05:16:23,600 BECAUSE THEY ARE CONCERNED ABOUT 7074 05:16:23,600 --> 05:16:25,040 THE SAFETY OF HORMONE THERAPY. 7075 05:16:25,040 --> 05:16:27,720 WHAT WE'VE SEEN IS THAT THE 7076 05:16:27,720 --> 05:16:29,760 PENDULUM HAS SWUNG IN THE 7077 05:16:29,760 --> 05:16:32,640 DIRECTION OF AWAY FROM EVIDENCE 7078 05:16:32,640 --> 05:16:35,280 BASE AND TOWARDS FEAR-BASED 7079 05:16:35,280 --> 05:16:38,080 DECISION-MAKING ABOUT HORMONE 7080 05:16:38,080 --> 05:16:41,640 THERAPY LEAVING MANY WOMEN WHO 7081 05:16:41,640 --> 05:16:42,520 MIGHT OTHERWISE BE GOOD 7082 05:16:42,520 --> 05:16:48,840 CANDIDATES -- 7083 05:16:48,840 --> 05:16:59,080 [ NO AUDIO ] 7084 05:17:03,000 --> 05:17:04,520 I'LL SPEND A FEW MINUTES 7085 05:17:04,520 --> 05:17:13,040 DEMAILING MY WISH LIST IN TERMS 7086 05:17:13,040 --> 05:17:15,880 OF FUTURE TRIALS THEY MIGHT 7087 05:17:15,880 --> 05:17:18,440 CONSIDER SPONSORING. 7088 05:17:18,440 --> 05:17:20,240 WE'VE HEARD FROM DR. MANSON, 7089 05:17:20,240 --> 05:17:22,480 ALSO FROM DR. MILLER ABOUT THE 7090 05:17:22,480 --> 05:17:26,480 DIFFERENCES BETWEEN ORAL AND 7091 05:17:26,480 --> 05:17:28,160 TRANSDERMAL ESTROGEN. 7092 05:17:28,160 --> 05:17:29,040 THERE'S NO RANDOMIZED DATA 7093 05:17:29,040 --> 05:17:35,720 COMPARING ONE WITH THE OTHER, 7094 05:17:35,720 --> 05:17:36,200 WE 7095 05:17:36,200 --> 05:17:38,600 HAVE A WEALTH OF OBSERVATIONAL 7096 05:17:38,600 --> 05:17:44,880 DATA, IF YOU ONLY WANT TO LOOK 7097 05:17:44,880 --> 05:17:47,320 AT ONE SUCH STUDY, THE BRITISH 7098 05:17:47,320 --> 05:17:49,560 EPIDEMIOLOGIST, HER WAS A 7099 05:17:49,560 --> 05:17:50,560 PARTICULARLY LARGE AND WELL 7100 05:17:50,560 --> 05:17:52,880 CONTROLLED STUDY BUT ALL OF THE 7101 05:17:52,880 --> 05:17:59,840 OBSERVATIONAL LITERATURE SHOWS 7102 05:17:59,840 --> 05:18:04,520 THAT IN CONTRAST TO ORAL 7103 05:18:04,520 --> 05:18:05,320 ESTROGEN, SHOWING RISK, 7104 05:18:05,320 --> 05:18:07,640 TRANSDERMAL ESTROGEN SEEMS NOT 7105 05:18:07,640 --> 05:18:15,520 TO HAVE ANY IMPACT ON RISK OF 7106 05:18:15,520 --> 05:18:15,680 VTE. 7107 05:18:15,680 --> 05:18:26,200 (INAUDIBLE) WHEN YOUR PATIENTS 7108 05:18:35,040 --> 05:18:37,240 HAD HIGH BMI OR OTHER RISK 7109 05:18:37,240 --> 05:18:40,800 FACTORS FOR VTE ARE PRESENT, 7110 05:18:40,800 --> 05:18:45,160 APPROPRIATE FOR WOMEN WITH 7111 05:18:45,160 --> 05:18:46,600 BASELINE HYPER TRIGLYCERIDEEMIA, 7112 05:18:46,600 --> 05:18:51,160 WE KNOW ORAL ESTROGEN IN 7113 05:18:51,160 --> 05:18:55,440 CONTRAST TO PATCH, CAN CAUSE 7114 05:18:55,440 --> 05:18:56,520 TRIGLYCERIDE LEVELS TO SKYROCKET 7115 05:18:56,520 --> 05:19:06,760 IN PATIENTS WITH ELEVATED 7116 05:19:06,760 --> 05:19:09,600 BASELINE LEVELS. 7117 05:19:09,600 --> 05:19:14,800 WE HAVE NO RANDOMIZED TRIALS 7118 05:19:14,800 --> 05:19:17,600 COMPARING BREAST SAFETY, THERE 7119 05:19:17,600 --> 05:19:28,120 IS ONE LARGER RECENTLY PUBLISHED 7120 05:19:32,400 --> 05:19:34,520 STUDY AND A SMALLER ONE, WITH 7121 05:19:34,520 --> 05:19:37,880 THE PROGESTIN USED IN WOMEN'S 7122 05:19:37,880 --> 05:19:41,560 HEALTH INITIATIVE, IN THE 16,000 7123 05:19:41,560 --> 05:19:46,800 WOMEN WITH INTACT UTERUS, AND 7124 05:19:46,800 --> 05:19:49,200 ANOTHER SYNTHETIC PROGESTIN USED 7125 05:19:49,200 --> 05:19:53,080 IN THE U.S., THE LARGE UK-BASED 7126 05:19:53,080 --> 05:20:03,280 STUDY WITH 40,000 CASES OF 7127 05:20:03,280 --> 05:20:05,960 BREAST CANCER, USING MPA IN THE 7128 05:20:05,960 --> 05:20:08,600 U.K. RELATIVE RISK OF BREAST 7129 05:20:08,600 --> 05:20:11,160 CANCER WAS 1.28, REMARKABLY 7130 05:20:11,160 --> 05:20:15,600 SIMILAR TO WHAT WE FOUND WITH 7131 05:20:15,600 --> 05:20:21,640 WOMEN'S HEALTH INITIATIVE WITH 7132 05:20:21,640 --> 05:20:23,840 EQUINE ESTROGEN. 7133 05:20:23,840 --> 05:20:29,160 WOMEN WHO USED ESTROGEN WITH 7134 05:20:29,160 --> 05:20:31,600 MICRONIZED PROGESTERONE, THERE 7135 05:20:31,600 --> 05:20:34,760 WAS NO DIFFERENCE BETWEEN 7136 05:20:34,760 --> 05:20:36,480 HORMONE USERS AND NON-HORMONE 7137 05:20:36,480 --> 05:20:40,640 USERS, RISK ESSENTIALLY 7138 05:20:40,640 --> 05:20:40,960 IDENTICAL. 7139 05:20:40,960 --> 05:20:43,360 OLDER FRENCH COHORT STUDY 7140 05:20:43,360 --> 05:20:44,480 LOOKING AT FRENCH TEACHERS, MUCH 7141 05:20:44,480 --> 05:20:47,560 SMALLER THAN THE U.K. STUDY, 7142 05:20:47,560 --> 05:20:49,480 FOUND ESSENTIALLY IDENTICAL 7143 05:20:49,480 --> 05:20:49,880 FINDINGS. 7144 05:20:49,880 --> 05:20:51,680 BREAST CANCER SAFETY WITH 7145 05:20:51,680 --> 05:20:55,760 RESPECT TO PROGESTERONE WITH 7146 05:20:55,760 --> 05:21:00,240 ESTROGEN, SMALL ELEVATED RISK 7147 05:21:00,240 --> 05:21:08,400 WITH ESTROGEN PLUS MPA. 7148 05:21:08,400 --> 05:21:14,320 LET'S MOVE ON TO SOME MORE 7149 05:21:14,320 --> 05:21:17,840 PRACTICAL ISSUES WHEN WOMEN ARE 7150 05:21:17,840 --> 05:21:19,320 INITIATING OR CONTINUING. 7151 05:21:19,320 --> 05:21:21,920 I THINK HELPING PROVIDE A SCRIPT 7152 05:21:21,920 --> 05:21:23,920 TO CLINICIANS WHO FEEL 7153 05:21:23,920 --> 05:21:25,920 UNCOMFORTABLE DISCUSSING SOME OF 7154 05:21:25,920 --> 05:21:30,920 THESE ISSUES CAN HELP IN SOME 7155 05:21:30,920 --> 05:21:31,120 CASES. 7156 05:21:31,120 --> 05:21:35,120 SO, IN A PATIENT WHO HAS 7157 05:21:35,120 --> 05:21:36,760 BOTHERSOME SYMPTOMS, CONSIDERING 7158 05:21:36,760 --> 05:21:39,080 INITIATING SYSTEMIC HT, I'LL SAY 7159 05:21:39,080 --> 05:21:41,040 SOMETHING LIKE HT IS HIGHLY 7160 05:21:41,040 --> 05:21:43,800 EFFECTIVE IN TREATING SYMPTOMS, 7161 05:21:43,800 --> 05:21:46,240 ALSO PREVENTING OSTEOPOROSIS AND 7162 05:21:46,240 --> 05:21:47,000 FRACTURES. 7163 05:21:47,000 --> 05:21:50,160 IF YOU CAN SEE THE SUGGESTED 7164 05:21:50,160 --> 05:21:52,840 SCRIPT, IF UTERUS IS ABSENT, IF 7165 05:21:52,840 --> 05:22:00,960 UTERUS IS PRESENT AND ESTROGEN 7166 05:22:00,960 --> 05:22:02,000 AND PROGESTERONE IS BEING 7167 05:22:02,000 --> 05:22:07,520 CONSIDERED OR REFILLED YOU CAN 7168 05:22:07,520 --> 05:22:11,160 SEE POTENTIAL SCRIPT, ALSO FOR 7169 05:22:11,160 --> 05:22:14,600 ORAL ESTROGEN RATHER THAN 7170 05:22:14,600 --> 05:22:17,280 TRANSDERMAL, WITH POINTING OUT 7171 05:22:17,280 --> 05:22:19,360 ORAL ESTROGEN AS WE HEARD TODAY 7172 05:22:19,360 --> 05:22:21,720 INCREASES RISK OF BLOOD CLOTS 7173 05:22:21,720 --> 05:22:26,200 SIMILAR TO YOUNGER WOMEN USING 7174 05:22:26,200 --> 05:22:27,960 ORAL CONTRACEPTIVES. 7175 05:22:27,960 --> 05:22:30,160 LET'S TALK ABOUT NUTS AND BOLTS 7176 05:22:30,160 --> 05:22:32,840 OF STARTING WOMEN ON SYSTEMIC 7177 05:22:32,840 --> 05:22:36,280 HORMONE THERAPY. 7178 05:22:36,280 --> 05:22:37,680 INCLUDING FORMULATIONS AND DOSE. 7179 05:22:37,680 --> 05:22:40,040 MANY CLINICIANS WILL START WITH 7180 05:22:40,040 --> 05:22:44,160 LOWER THAN STANDARD DOSES, MY 7181 05:22:44,160 --> 05:22:52,640 PREFER ENCE, THEY EVER BEEN 7182 05:22:52,640 --> 05:22:53,920 DEALING WITH SYMPTOMS AND MAJOR 7183 05:22:53,920 --> 05:22:55,040 SLEEP DISRUPTION FOR MONTHS OR 7184 05:22:55,040 --> 05:22:56,800 YEARS BEFORE THEY GET INTO MY 7185 05:22:56,800 --> 05:22:57,040 OFFICE. 7186 05:22:57,040 --> 05:23:03,920 SO I'LL START WITH THE STANDARD 7187 05:23:03,920 --> 05:23:10,120 DOSE, IT'S NOT UNUSUAL OR SIX 7188 05:23:10,120 --> 05:23:13,520 WEEKS, CONSIDER INCREASING THE 7189 05:23:13,520 --> 05:23:21,360 DOSE. 7190 05:23:21,360 --> 05:23:31,880 STANDARD IS 1 MILLIGRAM, .625, 7191 05:23:33,360 --> 05:23:37,720 FOR CONJUGATED EQUINE, USED IN 7192 05:23:37,720 --> 05:23:40,240 WOMEN'S HEALTH INITIATIVE. 7193 05:23:40,240 --> 05:23:42,320 EQUIVALENT STANDARD DOSES OF 7194 05:23:42,320 --> 05:23:45,040 PATCH, THERE'S TREMENDOUS 7195 05:23:45,040 --> 05:23:49,240 CONFUSION AMONG OUR COLLEAGUES 7196 05:23:49,240 --> 05:23:52,360 COMPARING DOSES OF TRANSDERMAL 7197 05:23:52,360 --> 05:23:56,640 ESTRADIOL OR PATCH WITH ORAL 7198 05:23:56,640 --> 05:23:56,960 ESTRADIOL. 7199 05:23:56,960 --> 05:23:58,760 1 MILLIGRAM TABLET REFERS TO 7200 05:23:58,760 --> 05:24:03,160 MILLIGRAM QUANTITY OF ESTROGEN 7201 05:24:03,160 --> 05:24:07,080 IN THAT TABLET, IN CONTRAST .05 7202 05:24:07,080 --> 05:24:12,600 PATCH RELEASES 24 -- RELEASES 7203 05:24:12,600 --> 05:24:14,440 .05 MILLIGRAMS OF ESTRADIOL PER 7204 05:24:14,440 --> 05:24:15,480 24 HOURS. 7205 05:24:15,480 --> 05:24:21,240 THE WATCH DOSE REFERS TO RELEASE 7206 05:24:21,240 --> 05:24:22,720 RATE, ORAL MILLIGRAM REFERS TO 7207 05:24:22,720 --> 05:24:27,800 QUANTITY OF STEROIDS IN THE 7208 05:24:27,800 --> 05:24:28,800 INDIVIDUAL TABLET. 7209 05:24:28,800 --> 05:24:33,440 IN WOMEN AT ELEVATED BASELINE 7210 05:24:33,440 --> 05:24:35,120 RISK FOR VTE, HIGH BMI PATIENTS, 7211 05:24:35,120 --> 05:24:44,680 OTHER WOMEN AT ELEVATED RISK FOR 7212 05:24:44,680 --> 05:24:47,160 ARTERIAL EVENTS I RECOMMEND 7213 05:24:47,160 --> 05:24:50,440 TRANSDERMAL VERSUS ORAL BECAUSE 7214 05:24:50,440 --> 05:24:54,040 OF SAFETY DIFFERENTIAL. 7215 05:24:54,040 --> 05:24:56,440 IN A PATIENT STARTED AFTER 7216 05:24:56,440 --> 05:24:57,880 SYMPTOMS REVOLVED ON THE INITIAL 7217 05:24:57,880 --> 05:25:01,040 DOSE, I'LL ENCOURAGE THE PATIENT 7218 05:25:01,040 --> 05:25:11,560 TO TRY LOWERING THE DOSE, AND IF 7219 05:25:14,680 --> 05:25:19,800 SYMPTOMS RETURN WITH A PHONE 7220 05:25:19,800 --> 05:25:21,280 CALL OR PATIENT PORTAL. 7221 05:25:21,280 --> 05:25:22,840 ONCE A PATIENT, NOW THE PATIENT 7222 05:25:22,840 --> 05:25:30,840 MIGHT BE IN HER LATE 50s OR 7223 05:25:30,840 --> 05:25:34,640 EARLY 60s, HAS BEEN USING 7224 05:25:34,640 --> 05:25:36,080 LOWER DOSE, MENTIONED HERE, FOR 7225 05:25:36,080 --> 05:25:38,320 SOME YEARS REPORTING NO 7226 05:25:38,320 --> 05:25:40,680 SYMPTOMS, IF HER UNDERLYING RISK 7227 05:25:40,680 --> 05:25:42,920 FOR OSTEOPOROSIS IS NOT 7228 05:25:42,920 --> 05:25:45,360 ELEVATED, I'LL ENCOURAGE HER TO 7229 05:25:45,360 --> 05:25:47,680 TRY DISCONTINUING SYSTEMIC 7230 05:25:47,680 --> 05:25:49,840 HORMONE THERAPY. 7231 05:25:49,840 --> 05:25:52,080 IF BOTHERSOME SYMPTOMS OR SENSE 7232 05:25:52,080 --> 05:25:54,960 OF WELL-BEING ARE LOST WITHOUT 7233 05:25:54,960 --> 05:25:56,680 USE OF SYSTEMIC THERAPY THE 7234 05:25:56,680 --> 05:25:57,600 PATIENT CAN RESTART. 7235 05:25:57,600 --> 05:26:02,400 ALSO KEEP IN MIND WHEN WOMEN 7236 05:26:02,400 --> 05:26:06,240 STOP SYSTEMIC HORMONE THERAPY OR 7237 05:26:06,240 --> 05:26:10,960 LOWER THEIR DOSE, VAGINAL 7238 05:26:10,960 --> 05:26:13,520 SYMPTOMS OF GSM MAY OCCUR, AND 7239 05:26:13,520 --> 05:26:16,360 USE OF VAGINAL ESTROGEN WOULD BE 7240 05:26:16,360 --> 05:26:18,800 APPROPRIATE IN THIS SETTING. 7241 05:26:18,800 --> 05:26:21,040 HOWEVER, IF THE WOMAN -- IF THE 7242 05:26:21,040 --> 05:26:23,320 PATIENT IS ON LOWER DOSE OF 7243 05:26:23,320 --> 05:26:25,000 SYSTEMIC HORMONE THERAPY FOR 7244 05:26:25,000 --> 05:26:28,880 SOME YEARS, IS AT ELEVATED 7245 05:26:28,880 --> 05:26:30,000 UNDERLYING RISK FOR OSTEOPOROSIS 7246 05:26:30,000 --> 05:26:32,000 AND FRACTURE, THAT MIGHT BE A 7247 05:26:32,000 --> 05:26:35,160 VERY SLENDER WOMAN, WITH A 7248 05:26:35,160 --> 05:26:39,480 POSITIVE FAMILY HISTORY, 7249 05:26:39,480 --> 05:26:44,000 CIGARETTE SMOKER, WHO USES 7250 05:26:44,000 --> 05:26:45,680 CORTICOSTEROIDS CONSIDER PROS 7251 05:26:45,680 --> 05:26:49,760 AND CONS OF LOW DOSE OR 7252 05:26:49,760 --> 05:26:51,400 ENDEFINITE USE. 7253 05:26:51,400 --> 05:26:53,960 WITH LOW DOSES OF ESTROGEN, THIS 7254 05:26:53,960 --> 05:26:55,200 IS WITHOUT ANY STRONG DATA TO 7255 05:26:55,200 --> 05:27:02,200 BACK IT UP, I WILL SOMETIMES USE 7256 05:27:02,200 --> 05:27:03,280 INTERMITTENT PRO GESTATIONAL 7257 05:27:03,280 --> 05:27:07,160 SUPPRESSION IN PATIENTS IS THAT 7258 05:27:07,160 --> 05:27:10,040 EXPERIENCE DYSPHORIA WITH 7259 05:27:10,040 --> 05:27:13,160 PROGESTINS, WHEN WE'RE USING 7260 05:27:13,160 --> 05:27:14,840 ESTROGEN LONG TERM, INDEFINITE 7261 05:27:14,840 --> 05:27:16,760 BASIS IN OLDER MENOPAUSAL 7262 05:27:16,760 --> 05:27:19,520 PATIENTS, I WOULD STRONGLY 7263 05:27:19,520 --> 05:27:20,600 PREFER TO USE TRANSDERMAL RATHER 7264 05:27:20,600 --> 05:27:22,600 THAN ORAL, AND I WOULD ALSO 7265 05:27:22,600 --> 05:27:24,160 BECAUSE OF THE BREAST HEALTH 7266 05:27:24,160 --> 05:27:28,080 SAFETY, I GUESS MENTION I WOULD 7267 05:27:28,080 --> 05:27:30,200 PREFER PROGESTERONE OVER 7268 05:27:30,200 --> 05:27:32,360 SYNTHETIC PROGESTINS. 7269 05:27:32,360 --> 05:27:37,440 IF WE ARE USING CYCLICAL OR 7270 05:27:37,440 --> 05:27:38,440 INTERMITTENT PROGESTATIONAL END 7271 05:27:38,440 --> 05:27:41,840 MEDIAL PROTECTION WITH 7272 05:27:41,840 --> 05:27:42,960 CONTINUOUS ESTROGEN USE, SINCE 7273 05:27:42,960 --> 05:27:45,280 WE DON'T HAVE DATA IN THIS 7274 05:27:45,280 --> 05:27:47,480 SETTING ABOUT END MEDIAL SAFETY 7275 05:27:47,480 --> 05:27:51,240 I WOULD MONITOR END MEDIAL 7276 05:27:51,240 --> 05:27:51,960 THICKNESS WITH VAGINAL 7277 05:27:51,960 --> 05:27:54,160 ULTRASOUND EVERY YEAR OR TWO. 7278 05:27:54,160 --> 05:27:56,440 OF COURSE, IN ANY WOMAN USING 7279 05:27:56,440 --> 05:27:58,400 HORMONE THERAPY REGARDLESS OF 7280 05:27:58,400 --> 05:28:00,280 DOSE, JUST AS TRUE FOR ANY 7281 05:28:00,280 --> 05:28:01,640 MENOPAUSAL PATIENT IN GENERAL, 7282 05:28:01,640 --> 05:28:04,840 WHETHER SHE'S USING HORMONES OR 7283 05:28:04,840 --> 05:28:07,600 NOT, IF THERE'S ANY REPORT OF 7284 05:28:07,600 --> 05:28:11,000 SPOTTING OR BLEEDING PROMPT END 7285 05:28:11,000 --> 05:28:12,720 MEDIAL ASSESSMENT IS 7286 05:28:12,720 --> 05:28:13,040 APPROPRIATE. 7287 05:28:13,040 --> 05:28:15,160 WHEN THINGS SEEM TO BE GOING 7288 05:28:15,160 --> 05:28:16,560 WELL WITH YOUR 72-YEAR-OLD 7289 05:28:16,560 --> 05:28:19,080 PATIENT AT ELEVATED BASELINE 7290 05:28:19,080 --> 05:28:20,520 RISK FOR OSTEOPOROSIS DOING 7291 05:28:20,520 --> 05:28:25,800 WELL, LOW DOSE, YOU GET A NOTE 7292 05:28:25,800 --> 05:28:32,960 FROM THE INSURANCE COMPANY, 7293 05:28:32,960 --> 05:28:35,320 REFERRING TO THE CRITERIA, THE 7294 05:28:35,320 --> 05:28:38,360 COMMITTEE RESPONSE FOR THE LIST 7295 05:28:38,360 --> 05:28:42,000 HAS NO MENOPAUSE EXPERTS ON THAT 7296 05:28:42,000 --> 05:28:43,040 COMMITTEE. 7297 05:28:43,040 --> 05:28:45,120 AND THE GOOD NEWS IS THAT BOTH 7298 05:28:45,120 --> 05:28:47,680 AMERICAN COLLEGE OF OB/GYNs 7299 05:28:47,680 --> 05:28:52,640 AND ALSO NORTH AMERICAN 7300 05:28:52,640 --> 05:28:54,800 MENOPAUSE SOCIETY, NEITHER 7301 05:28:54,800 --> 05:28:56,720 PROFESSIONAL GROUP ENDORSES 7302 05:28:56,720 --> 05:28:58,000 STOPPING SYSTEMIC HORMONE 7303 05:28:58,000 --> 05:29:01,120 THERAPY BASED ON ARBITRARY AGE 7304 05:29:01,120 --> 05:29:05,840 BUT RATHER INDIVIDUALIZING EACH 7305 05:29:05,840 --> 05:29:07,480 PATIENT'S CARE. 7306 05:29:07,480 --> 05:29:10,000 WE'VE TALKED ABOUT THE SAFETY OF 7307 05:29:10,000 --> 05:29:11,000 TRANSDERMAL ESTROGEN WITH 7308 05:29:11,000 --> 05:29:13,160 RESPECT TO BLOOD CLOT. 7309 05:29:13,160 --> 05:29:18,840 WE'VE TALKED ABOUT SAFETY OF 7310 05:29:18,840 --> 05:29:20,040 PROGESTERONE VERSUS SYNTHETIC IN 7311 05:29:20,040 --> 05:29:21,960 TERMS OF BREAST HEALTH. 7312 05:29:21,960 --> 05:29:25,480 I HOPE YOU CAN FEEL THAT THE 7313 05:29:25,480 --> 05:29:27,800 PENDULUM IS SWINGING BACK IN THE 7314 05:29:27,800 --> 05:29:31,800 DIRECTION AWAY FROM FEAR, MORE 7315 05:29:31,800 --> 05:29:32,720 TOWARD EVIDENCE BASED 7316 05:29:32,720 --> 05:29:35,120 DECISION-MAKING BETWEEN PATIENT 7317 05:29:35,120 --> 05:29:39,760 AND CLINICIAN REGARDING USE OR 7318 05:29:39,760 --> 05:29:42,360 NON-USE OF SYSTEMIC HORMONE 7319 05:29:42,360 --> 05:29:43,320 THERAPY. 7320 05:29:43,320 --> 05:29:46,280 DR. MANSON CLARIFIED FOR MOST 7321 05:29:46,280 --> 05:29:46,960 GENERALLY HEALTHY WOMEN WITHIN 7322 05:29:46,960 --> 05:29:50,120 TEN YEARS OR LESS OF THE ONSET 7323 05:29:50,120 --> 05:29:52,080 OF MENOPAUSE, WITH BOTHERSOME 7324 05:29:52,080 --> 05:29:54,680 SYMPTOMS, SYSTEMIC HORMONE 7325 05:29:54,680 --> 05:29:55,400 THERAPY IS SAFE. 7326 05:29:55,400 --> 05:29:59,840 I THINK THAT'S A MESSAGE WE 7327 05:29:59,840 --> 05:30:02,280 SHOULD TAKE TO HEART AND FOCUS 7328 05:30:02,280 --> 05:30:04,800 ON EVIDENCE BASE RATHER THAN 7329 05:30:04,800 --> 05:30:06,160 FEAR-BASED DECISION MAKING FOR 7330 05:30:06,160 --> 05:30:10,240 OUR PATIENTS AND SELVES IN TERMS 7331 05:30:10,240 --> 05:30:11,840 OF PRESCRIBING HORMONE THERAPY. 7332 05:30:11,840 --> 05:30:14,360 DR. TEMKIN ASKED ME FOR THE LAST 7333 05:30:14,360 --> 05:30:16,960 PART OF MY TALK TO COME UP WITH 7334 05:30:16,960 --> 05:30:18,920 A WISH LIST FOR THE OFFICE OF 7335 05:30:18,920 --> 05:30:22,840 RESEARCH ON WOMEN'S HEALTH, WHAT 7336 05:30:22,840 --> 05:30:24,960 CLINICAL TRIALS WOULD I LIKE TO 7337 05:30:24,960 --> 05:30:26,880 SEE THE OFFICE SPONSOR? 7338 05:30:26,880 --> 05:30:27,880 HERE GOES. 7339 05:30:27,880 --> 05:30:38,360 WE TALKED ABOUT THE LACK OF 7340 05:30:41,920 --> 05:30:44,200 RANDOMIZED DATA, IT WOULD BE 7341 05:30:44,200 --> 05:30:47,880 USEFUL TO SPONSOR SUCH A TRIAL. 7342 05:30:47,880 --> 05:30:49,960 LIKEWISE, WE TALKED ABOUT WHAT 7343 05:30:49,960 --> 05:30:54,160 SEEMS TO BE BASED ON 7344 05:30:54,160 --> 05:30:55,400 OBSERVATIONAL DATA, THE BETTER 7345 05:30:55,400 --> 05:31:01,520 BREAST HEALTH SAFETY WITH 7346 05:31:01,520 --> 05:31:08,320 RESPECT TO NATURAL , OUR PATIENS 7347 05:31:08,320 --> 05:31:09,400 COULD BENEFIT FROM RANDOMIZED 7348 05:31:09,400 --> 05:31:10,440 TRIAL DATA HERE. 7349 05:31:10,440 --> 05:31:12,280 I WOULD LOVE TO SEE THE OFFICE 7350 05:31:12,280 --> 05:31:17,240 OF RESEARCH ON WOMEN'S HEALTH 7351 05:31:17,240 --> 05:31:19,960 SPONSOR SUCH A TRIAL. 7352 05:31:19,960 --> 05:31:25,120 LET'S TALK ABOUT BREAST CANCER 7353 05:31:25,120 --> 05:31:25,520 CHEMOPROPHYLAXIS. 7354 05:31:25,520 --> 05:31:27,640 WE KNOW THAT DR. MANSON 7355 05:31:27,640 --> 05:31:31,000 MENTIONED IT THIS MORNING THAT 7356 05:31:31,000 --> 05:31:32,760 CONJUGATED EQUINE ESTROGEN WITH 7357 05:31:32,760 --> 05:31:37,480 20 YEARS OF FOLLOW-UP IN 10,000 7358 05:31:37,480 --> 05:31:44,000 WOMEN STUDY IN WHI, WOMEN POST 7359 05:31:44,000 --> 05:31:45,120 HYSTERECTOMY, CEE LOWERED BREAST 7360 05:31:45,120 --> 05:31:46,520 CANCER INCIDENCE AND MORTALITY 7361 05:31:46,520 --> 05:31:48,520 WITH 20 YEARS FOLLOW-UP, THERE 7362 05:31:48,520 --> 05:31:53,440 WAS A 40% REDUCTION IN BREAST 7363 05:31:53,440 --> 05:32:00,200 CANCER SPECIFIC MORTALITY. 7364 05:32:00,200 --> 05:32:04,680 THE TWO ARE AGENTS RECOMMENDED 7365 05:32:04,680 --> 05:32:09,560 IN HIGH RISK WOMEN, THESE HAVE 7366 05:32:09,560 --> 05:32:10,520 DEMONSTRATED REDUCING INCIDENCE, 7367 05:32:10,520 --> 05:32:13,680 NEITHER ONE HAVE BEEN DOCUMENTED 7368 05:32:13,680 --> 05:32:17,720 TO REDUCE BREAST CANCER 7369 05:32:17,720 --> 05:32:18,120 MORTALITY. 7370 05:32:18,120 --> 05:32:19,360 SO LEAVING THE OBSERVATION THAT 7371 05:32:19,360 --> 05:32:21,240 THE ONLY AGENT THAT HAS BEEN 7372 05:32:21,240 --> 05:32:23,760 DOCUMENTED TO REDUCE BREAST 7373 05:32:23,760 --> 05:32:26,600 CANCER MORTALITY IS CEE, AS 7374 05:32:26,600 --> 05:32:32,200 DEMONSTRATED IN THE 20-YEAR 7375 05:32:32,200 --> 05:32:42,600 FOLLOW-UP OF THE POST 7376 05:32:43,360 --> 05:32:43,680 HYSTERECTOMIZED. 7377 05:32:43,680 --> 05:32:44,920 >> THREE MINUTE WORK. 7378 05:32:44,920 --> 05:32:46,600 >> PROPHYLAXIS HASN'T CHANGED 7379 05:32:46,600 --> 05:32:48,320 IN TWO DECADES. 7380 05:32:48,320 --> 05:32:52,000 AND YOU CAN SEE OBSERVATIONS 7381 05:32:52,000 --> 05:32:57,000 MADE, THAT HE MAKES IN HIS 2021 7382 05:32:57,000 --> 05:32:58,800 REVIEW ARTICLE. 7383 05:32:58,800 --> 05:33:02,760 ESTROGEN RECEPTOR POSITIVE AND 7384 05:33:02,760 --> 05:33:03,960 PROGESTERONE RECEPTOR POSITIVE 7385 05:33:03,960 --> 05:33:10,440 CANSERS IS HAVE LOW MORTALITY, 7386 05:33:10,440 --> 05:33:18,920 ER PUSS/PR NEGATIVE HAVE HIGHER 7387 05:33:18,920 --> 05:33:19,200 MORTALITY. 7388 05:33:19,200 --> 05:33:21,880 THIS MAY BE WHY MORTALITY 7389 05:33:21,880 --> 05:33:26,120 REDUCTION HAS NOT BEEN OBSERVED 7390 05:33:26,120 --> 05:33:29,000 WITH SERMs OR AROMATASE 7391 05:33:29,000 --> 05:33:29,440 INHIBITORS. 7392 05:33:29,440 --> 05:33:31,560 MY HOPE IS THAT OFFICE OF 7393 05:33:31,560 --> 05:33:35,040 RESEARCH ON WOMEN'S HEALTH WOULD 7394 05:33:35,040 --> 05:33:38,680 CONSIDER A TRIAL OF CONJUGATED 7395 05:33:38,680 --> 05:33:41,200 ESTROGEN AS POSSIBLE BREAST 7396 05:33:41,200 --> 05:33:44,280 CANCER CHEMOPROPHYLAXIS IN HIGH 7397 05:33:44,280 --> 05:33:48,520 RISK WOMEN POST HYSTERECTOMY. 7398 05:33:48,520 --> 05:33:50,880 DO WE HAVE ONE MINUTE FOR 7399 05:33:50,880 --> 05:33:52,680 COGNITIVE DECLINE OR NOT? 7400 05:33:52,680 --> 05:33:53,760 >>YOU HAVE ONE MINUTE. 7401 05:33:53,760 --> 05:33:54,760 >> GREAT. 7402 05:33:54,760 --> 05:33:55,600 >> EXACTLY ONE MINUTE. 7403 05:33:55,600 --> 05:33:58,760 >> WE KNOW A.D. IS MORE 7404 05:33:58,760 --> 05:34:00,240 PREVALENT IN WOMEN. 7405 05:34:00,240 --> 05:34:03,200 AND WE KNOW THREE NIH-FUNDED 7406 05:34:03,200 --> 05:34:09,040 TRIALS, TWO OF WHICH YOU HEARD 7407 05:34:09,040 --> 05:34:10,520 ABOUT, THREE ALREADY TODAY, 7408 05:34:10,520 --> 05:34:12,000 FOUND WITH SHORTER TERM USE OF 7409 05:34:12,000 --> 05:34:15,600 HORMONE THERAPY NO IMPACT ON 7410 05:34:15,600 --> 05:34:18,440 COGNITIVE FUNCTION. 7411 05:34:18,440 --> 05:34:20,600 HOWEVER, LARGE WELL-CONDUCTED 7412 05:34:20,600 --> 05:34:21,920 NATIONAL INSTITUTES OF AGING 7413 05:34:21,920 --> 05:34:24,080 STUDY INITIALLY PUBLISHED SOME 7414 05:34:24,080 --> 05:34:25,880 YEARS AGO FOUND IN CONTRAST TO 7415 05:34:25,880 --> 05:34:27,960 OVERALL USE OF HORMONE THERAPY 7416 05:34:27,960 --> 05:34:30,480 WITH NO IMPACT, WOMEN WHO 7417 05:34:30,480 --> 05:34:32,520 STARTED HORMONE THERAPY AS 7418 05:34:32,520 --> 05:34:34,000 RECENTLY AS MENOPAUSAL WOMEN OR 7419 05:34:34,000 --> 05:34:35,520 CONTINUED HORMONE THERAPY FOR 7420 05:34:35,520 --> 05:34:39,160 MORE THAN A DECADE, THERE WAS 7421 05:34:39,160 --> 05:34:40,680 REDUCED INCIDENCE OF ALZHEIMER'S 7422 05:34:40,680 --> 05:34:40,960 DISEASE. 7423 05:34:40,960 --> 05:34:45,880 VERY SIMILAR FINDING IN A LARGE 7424 05:34:45,880 --> 05:34:47,920 NATIONWIDE FINNISH STUDY, NO 7425 05:34:47,920 --> 05:34:51,600 IMPACT OVERALL BUT WHEN USED FOR 7426 05:34:51,600 --> 05:34:56,520 MORE THAN A DECADE, A VERY 7427 05:34:56,520 --> 05:34:57,640 SUBSTANTIAL REDUCTION IN 7428 05:34:57,640 --> 05:34:58,960 ALZHEIMER'S DISEASE. 7429 05:34:58,960 --> 05:35:01,920 I WOULD LOVE TO SEE THE OFFICE 7430 05:35:01,920 --> 05:35:04,520 OF RESEARCH AND WOMEN'S HEALTH 7431 05:35:04,520 --> 05:35:09,280 SPONSOR A LONG-TERM TRIAL OF 7432 05:35:09,280 --> 05:35:10,040 HORMONE THERAPY, STARTING SOON 7433 05:35:10,040 --> 05:35:12,640 AFTER MENOPAUSE EXTENDING FOR A 7434 05:35:12,640 --> 05:35:14,800 DECADE. 7435 05:35:14,800 --> 05:35:17,920 I'D LIKE TO THANK THE NIH FOR 7436 05:35:17,920 --> 05:35:21,520 THIS OPPORTUNITY TO DISCUSS 7437 05:35:21,520 --> 05:35:22,720 SYSTEMIC HORMONE THERAPY. 7438 05:35:22,720 --> 05:35:24,600 >> I'M NOT SURE THAT 7439 05:35:24,600 --> 05:35:26,640 CONVERSATION WENT EXACTLY LIKE 7440 05:35:26,640 --> 05:35:27,160 THAT. 7441 05:35:27,160 --> 05:35:29,000 BUT I AM GLAD FOR YOU TO SHARE 7442 05:35:29,000 --> 05:35:33,120 YOUR THOUGHTS ABOUT FUTURE 7443 05:35:33,120 --> 05:35:33,400 RESEARCH. 7444 05:35:33,400 --> 05:35:34,000 THANK YOU. 7445 05:35:34,000 --> 05:35:34,920 >> THANKS VERY MUCH. 7446 05:35:34,920 --> 05:35:38,760 I WANT TO THANK THE SPEAKERS FOR 7447 05:35:38,760 --> 05:35:39,720 STAYING ON TIME. 7448 05:35:39,720 --> 05:35:41,200 WE'LL MOVE TO THE NEXT ONE 7449 05:35:41,200 --> 05:35:42,880 BECAUSE A LOT OF PEOPLE HAVE A 7450 05:35:42,880 --> 05:35:44,840 LOT TO SAY THAT'S IMPORTANT. 7451 05:35:44,840 --> 05:35:49,400 IT'S MY PLEASURE NEXT TO 7452 05:35:49,400 --> 05:35:53,360 INTRODUCE ANDREA LACROIX, 7453 05:35:53,360 --> 05:35:54,240 PROFESSOR OF EPIDEMIOLOGY, 7454 05:35:54,240 --> 05:35:54,840 UNIVERSITY OF CALIFORNIA SAN 7455 05:35:54,840 --> 05:35:55,200 DIEGO. 7456 05:35:55,200 --> 05:35:57,480 AND SHE WILL BE SPEAKING ABOUT 7457 05:35:57,480 --> 05:36:02,640 KEY INGREDIENTS FOR TRAVERSING A 7458 05:36:02,640 --> 05:36:03,080 HEALTHY MENOPAUSE. 7459 05:36:03,080 --> 05:36:05,040 >> I WANT TO MAKE SURE YOU CAN 7460 05:36:05,040 --> 05:36:06,280 HEAR ME. 7461 05:36:06,280 --> 05:36:07,960 >> WE CAN HEAR YOU. 7462 05:36:07,960 --> 05:36:09,360 >> NO SMALL MIRACLE TODAY. 7463 05:36:09,360 --> 05:36:14,840 THANK YOU FOR HAVING ME WITH 7464 05:36:14,840 --> 05:36:15,200 YOU. 7465 05:36:15,200 --> 05:36:20,080 I'M GRATEFUL TO TALK ABOUT KEY 7466 05:36:20,080 --> 05:36:23,160 INGREDIENTS FOR TRAVERSING 7467 05:36:23,160 --> 05:36:29,680 HEALTHY MENOPAUSE. 7468 05:36:29,680 --> 05:36:31,760 I JUST WANTED TO START WITH 7469 05:36:31,760 --> 05:36:32,440 QUARANTINE MENOPAUSE. 7470 05:36:32,440 --> 05:36:36,320 THIS IS A SLIDE THAT SHOWS NEWS 7471 05:36:36,320 --> 05:36:39,920 STORIES THAT CAME OUT OVER THE 7472 05:36:39,920 --> 05:36:40,920 COVID PANDEMIC FROM MARCH 2020 7473 05:36:40,920 --> 05:36:46,800 ON, AND I DON'T KNOW WHETHER IT 7474 05:36:46,800 --> 05:36:48,280 WAS CLOSE QUARTERS OR EXTRA TIME 7475 05:36:48,280 --> 05:36:51,000 TO THINK ABOUT OUR BODIES, ALL 7476 05:36:51,000 --> 05:36:52,200 THE EXTRA RESPONSIBILITIES THAT 7477 05:36:52,200 --> 05:36:57,160 WOMEN HAD DURING THIS PERIOD, OR 7478 05:36:57,160 --> 05:37:02,040 JUST GEN X AND YOUNGER WOMEN 7479 05:37:02,040 --> 05:37:03,480 COMING INTO PERIMENOPAUSE DURING 7480 05:37:03,480 --> 05:37:04,960 THIS EXPERIENCE, LESS ACCESS TO 7481 05:37:04,960 --> 05:37:06,840 THEIR HEALTH CARE SYSTEMS DURING 7482 05:37:06,840 --> 05:37:12,840 THE PANDEMIC, BUT IT GENERATED A 7483 05:37:12,840 --> 05:37:13,800 BUZZ ABOUT MENOPAUSE AND HOW 7484 05:37:13,800 --> 05:37:15,440 CONCERNS WERE RAISED ABOUT HOW 7485 05:37:15,440 --> 05:37:18,360 THEY DIDN'T KNOW WHAT WAS 7486 05:37:18,360 --> 05:37:19,200 HAPPENING IN THEIR BODIES, 7487 05:37:19,200 --> 05:37:21,920 RESEARCH HADN'T BEEN DONE IN 7488 05:37:21,920 --> 05:37:23,360 CERTAIN GROUPS OF WOMEN, THEY 7489 05:37:23,360 --> 05:37:26,000 HAD BEEN NOT PREPARED WELL BY 7490 05:37:26,000 --> 05:37:28,080 THEIR MOTHERS, NOT ADVISED WELL 7491 05:37:28,080 --> 05:37:30,480 BY THEIR CLINICIANS. 7492 05:37:30,480 --> 05:37:34,480 SO THESE WERE NEWS STORIES THAT 7493 05:37:34,480 --> 05:37:36,080 KEPT MOUNTING DURING THE 7494 05:37:36,080 --> 05:37:41,480 PANDEMIC, AND IF YOU FAST 7495 05:37:41,480 --> 05:37:43,880 FORWARD TO 2023, MAYBE THIS WAS 7496 05:37:43,880 --> 05:37:47,000 A CULMINATION OR MAYBE ANOTHER 7497 05:37:47,000 --> 05:37:48,480 STEP IN THE CURRENT EXPERIENCE 7498 05:37:48,480 --> 05:37:50,720 THAT WE'RE HAVING BUT THERE WAS 7499 05:37:50,720 --> 05:37:55,960 JUST A "NEW YORK TIMES" 7500 05:37:55,960 --> 05:37:57,840 EDITORIAL IN WHICH INVESTIGATORS 7501 05:37:57,840 --> 05:37:59,800 EXPRESSED DISMAY AT NOT BEING 7502 05:37:59,800 --> 05:38:00,880 COUNSELED WELL ABOUT HER 7503 05:38:00,880 --> 05:38:01,960 MENOPAUSE SYMPTOMS, NOT KNOWING 7504 05:38:01,960 --> 05:38:06,000 WHAT TO EXPECT IN THE 7505 05:38:06,000 --> 05:38:06,600 PERIMENOPAUSE, ARGUING 7506 05:38:06,600 --> 05:38:08,320 STRENUOUSLY I WOULD SAY AGAINST 7507 05:38:08,320 --> 05:38:10,520 IGNORANCE ABOUT THE SPACE OF 7508 05:38:10,520 --> 05:38:12,840 LIFE AND ALSO ASKING THE 7509 05:38:12,840 --> 05:38:14,560 QUESTION, WHAT IF YOU KNEW ABOUT 7510 05:38:14,560 --> 05:38:16,680 A PILL THAT COULD HELP YOU WITH 7511 05:38:16,680 --> 05:38:17,320 THESE SYMPTOMS? 7512 05:38:17,320 --> 05:38:19,480 AND WHY DON'T WE KNOW ABOUT 7513 05:38:19,480 --> 05:38:20,040 THAT? 7514 05:38:20,040 --> 05:38:22,880 AND SO WE'RE GOING TO ADDRESS 7515 05:38:22,880 --> 05:38:26,440 THIS BROADLY IN THIS TALK TODAY. 7516 05:38:26,440 --> 05:38:31,680 OPRAH WINFREY JUST HAD I THINK A 7517 05:38:31,680 --> 05:38:33,120 WEEK'S WORTH OF MENOPAUSE 7518 05:38:33,120 --> 05:38:36,720 SYMPOSIA FOR WOMEN WITH VARIOUS 7519 05:38:36,720 --> 05:38:37,800 GUEST SPEAKERS TALKING, 7520 05:38:37,800 --> 05:38:40,360 ACTRESSES, DOCTORS TALKING ABOUT 7521 05:38:40,360 --> 05:38:42,960 THEIR EXPERIENCE IN MENOPAUSE. 7522 05:38:42,960 --> 05:38:46,800 AS YOU'VE SEEN TODAY, MUCH OF 7523 05:38:46,800 --> 05:38:50,120 THE DIALOGUE ABOUT ESTROGEN 7524 05:38:50,120 --> 05:38:51,280 HORMONE THERAPY HAS SINCE 2002 7525 05:38:51,280 --> 05:38:53,240 BEEN THROUGH THE LENS OF THE 7526 05:38:53,240 --> 05:39:02,800 RESULTS OF THE WOMEN'S HEALTH 7527 05:39:02,800 --> 05:39:04,200 INITIATIVE, I'M A WHI 7528 05:39:04,200 --> 05:39:05,560 INVESTIGATORS FOR 30 YEARS, I 7529 05:39:05,560 --> 05:39:07,080 WANT TO ACKNOWLEDGE AS DR. 7530 05:39:07,080 --> 05:39:09,920 MANSON DID AND OTHER SPEAKERS 7531 05:39:09,920 --> 05:39:12,200 THIS TRIAL WAS MEANT ONLY TO 7532 05:39:12,200 --> 05:39:14,040 TEST WHETHER HORMONE THERAPY WAS 7533 05:39:14,040 --> 05:39:19,040 USEFUL FOR PREVENTION OF CHRONIC 7534 05:39:19,040 --> 05:39:20,680 DISEASES, THE RESULTS ESPECIALLY 7535 05:39:20,680 --> 05:39:29,280 OVER THE LONG TERM FOLLOW-UP ARE 7536 05:39:29,280 --> 05:39:30,280 NUANCED, ESTROGEN IF TAKEN MORE 7537 05:39:30,280 --> 05:39:32,200 A NUMBER OF YEARS HAS SERIOUS 7538 05:39:32,200 --> 05:39:34,600 RISKS AND BENEFITS. 7539 05:39:34,600 --> 05:39:37,080 COMPLETELY SEPARATE FROM THE 7540 05:39:37,080 --> 05:39:38,920 DISCUSSION ABOUT TREATMENT OF 7541 05:39:38,920 --> 05:39:39,520 VASOMOTOR SYMPTOMS. 7542 05:39:39,520 --> 05:39:42,280 SO PART OF WHAT WE'RE DOING 7543 05:39:42,280 --> 05:39:47,000 TODAY IS TRYING TO SEE HORMONE 7544 05:39:47,000 --> 05:39:48,800 THERAPY THROUGH VASOMOTOR RELIEF 7545 05:39:48,800 --> 05:39:52,480 AND I'D LIKE TO ADDRESS THE KEY 7546 05:39:52,480 --> 05:39:54,560 INGREDIENTS FOR MAKING DECISIONS 7547 05:39:54,560 --> 05:39:59,120 ABOUT TRAVERSING A HEALTHY 7548 05:39:59,120 --> 05:40:00,760 MENOPAUSE, AND DR. PINN HERSELF 7549 05:40:00,760 --> 05:40:06,560 SHORTLY AFTER THE MAIN WHI 7550 05:40:06,560 --> 05:40:08,520 RESULTS WERE PUBLISHED WROTE 7551 05:40:08,520 --> 05:40:09,880 THIS QUOTE. 7552 05:40:09,880 --> 05:40:11,880 GOOD DECISIONS INVOLVE GATHERING 7553 05:40:11,880 --> 05:40:13,320 AND EVALUATING INFORMATION, 7554 05:40:13,320 --> 05:40:15,760 WEIGHING WHAT IS IMPORTANT AT A 7555 05:40:15,760 --> 05:40:17,360 PERSONAL LEVEL, FINDING THE 7556 05:40:17,360 --> 05:40:18,720 NECESSARY RESOURCES FOR THE TYPE 7557 05:40:18,720 --> 05:40:21,280 AND QUALITY OF CARE REQUIRED, 7558 05:40:21,280 --> 05:40:24,320 AND MANAGING THE ASSOCIATED 7559 05:40:24,320 --> 05:40:24,760 COSTS. 7560 05:40:24,760 --> 05:40:27,360 ONE MIGHT ARGUE I THINK WISELY 7561 05:40:27,360 --> 05:40:30,680 THESE ARE THE KEY INGREDIENTS 7562 05:40:30,680 --> 05:40:31,960 FOR TRAVERSING A HEALTHY 7563 05:40:31,960 --> 05:40:32,440 MENOPAUSE. 7564 05:40:32,440 --> 05:40:35,240 I'M GOING TO FOCUS ON THIS FIRST 7565 05:40:35,240 --> 05:40:39,000 ONE INVOLVING GATHERING AND 7566 05:40:39,000 --> 05:40:40,200 EVALUATING INFORMATION. 7567 05:40:40,200 --> 05:40:46,680 NUMBER ONE INGREDIENT IN MY VIEW 7568 05:40:46,680 --> 05:40:48,240 IS HAVING KNOWLEDGE ABOUT WHAT'S 7569 05:40:48,240 --> 05:40:51,960 HAPPENING IN OUR BODIES, AND 7570 05:40:51,960 --> 05:40:53,400 KNOWLEDGE ABOUT WHAT IS 7571 05:40:53,400 --> 05:40:55,360 AVAILABLE TO US, TO TREAT 7572 05:40:55,360 --> 05:40:56,840 SYMPTOMS, AND WHAT OUR OWN 7573 05:40:56,840 --> 05:40:59,200 VALUES ARE RELATIVE TO THOSE 7574 05:40:59,200 --> 05:41:00,680 DIFFERENT KINDS OF THERAPIES. 7575 05:41:00,680 --> 05:41:05,800 SO, AFTER THE WOMEN'S HEALTH 7576 05:41:05,800 --> 05:41:07,600 INITIATIVE WAS DONE, THIS 7577 05:41:07,600 --> 05:41:10,120 COLLABORATION OF NIH INSTITUTES 7578 05:41:10,120 --> 05:41:13,680 INCLUDING THE ORWH CAME TOGETHER 7579 05:41:13,680 --> 05:41:17,360 TO HELP WOMEN GET MORE KNOWLEDGE 7580 05:41:17,360 --> 05:41:19,880 ABOUT ALTERNATIVE TREATMENTS FOR 7581 05:41:19,880 --> 05:41:21,280 RELIEVING MENOPAUSE SYMPTOMS 7582 05:41:21,280 --> 05:41:22,280 INCLUDING HORMONE THERAPY, BUT 7583 05:41:22,280 --> 05:41:25,120 INCLUSIVE OF A GREAT MANY OTHER 7584 05:41:25,120 --> 05:41:26,720 THERAPIES, AND MY COLLEAGUES AND 7585 05:41:26,720 --> 05:41:30,640 I WERE LUCKY ENOUGH TO COMPETE 7586 05:41:30,640 --> 05:41:34,640 FOR WHAT BECAME THE MS. FLASH 7587 05:41:34,640 --> 05:41:37,240 MET WORK BRINGING TOGETHER FOUR 7588 05:41:37,240 --> 05:41:40,560 CLINICAL CENTERS AND 20 TO 30 7589 05:41:40,560 --> 05:41:41,320 INVESTIGATORS SPECIALIZING IN 7590 05:41:41,320 --> 05:41:43,840 THIS AREA TO FIND NEW WAYS TO 7591 05:41:43,840 --> 05:41:45,720 ALLEVIATE THE MOST COMMON 7592 05:41:45,720 --> 05:41:46,920 BOTHERSOME SYMPTOMS OF THE 7593 05:41:46,920 --> 05:41:49,120 MENOPAUSE TRANSITION BY 7594 05:41:49,120 --> 05:41:50,840 DESIGNING AND CONDUCTING 7595 05:41:50,840 --> 05:41:52,920 MULTIPLE CONCURRENT CLINICAL 7596 05:41:52,920 --> 05:41:53,360 INTERVENTION STUDIES, 7597 05:41:53,360 --> 05:41:57,160 ACCOMMODATING A WIDE SCOPE OF 7598 05:41:57,160 --> 05:41:58,200 POPULATIONS AND INTERVENTION 7599 05:41:58,200 --> 05:41:58,480 STRATEGIES. 7600 05:41:58,480 --> 05:42:02,280 I READ THOSE BECAUSE WE REALLY 7601 05:42:02,280 --> 05:42:04,840 TRULY DEVOTED OURSELVES TO 7602 05:42:04,840 --> 05:42:06,200 INTERVENTION TRIALS THAT 7603 05:42:06,200 --> 05:42:08,880 EMBODIED THAT PURPOSE. 7604 05:42:08,880 --> 05:42:10,880 WE ESTABLISHED COMMON 7605 05:42:10,880 --> 05:42:12,960 ELIGIBILITY CRITERIA, AND MY 7606 05:42:12,960 --> 05:42:14,880 DEAR COLLEAGUE NOW DEPARTED, 7607 05:42:14,880 --> 05:42:17,800 KATHERINE NEWTON, WROTE A 7608 05:42:17,800 --> 05:42:21,040 METHODS PAPER ON COMMON 7609 05:42:21,040 --> 05:42:22,520 MS. FLASH CRITERIA TRANSLATING 7610 05:42:22,520 --> 05:42:24,600 WELL IN CURRENT NEW TRIALS FOR 7611 05:42:24,600 --> 05:42:25,160 VASOMOTOR SYMPTOMS. 7612 05:42:25,160 --> 05:42:27,680 WE SET THE AGE RANGE TO 40 TO 7613 05:42:27,680 --> 05:42:34,480 62, WOMEN HAD TO BE IN THE 7614 05:42:34,480 --> 05:42:36,600 MENOPAUSE TRANSITION OR 7615 05:42:36,600 --> 05:42:38,200 POSTMENOPAUSAL, AT LEAST 14 7616 05:42:38,200 --> 05:42:39,200 FLASHES PER WEEK, SOME 7617 05:42:39,200 --> 05:42:40,960 BOTHERSOME OR SEVERE. 7618 05:42:40,960 --> 05:42:44,400 THIS WE'LL COME BACK TO, BUT WE 7619 05:42:44,400 --> 05:42:46,880 DID NOT REQUIRE IN THE TRIALS 7620 05:42:46,880 --> 05:42:49,480 THAT WOMEN HAVE 7 OR MORE 7621 05:42:49,480 --> 05:42:50,760 MODERATE OR SEVERE HOT FLASHES 7622 05:42:50,760 --> 05:42:51,200 PER DAY. 7623 05:42:51,200 --> 05:42:54,920 THAT WAS BECAUSE WE WANTED TO 7624 05:42:54,920 --> 05:42:56,040 TARGET THIS BROADER POPULATION 7625 05:42:56,040 --> 05:42:57,680 OF WOMEN THAT ARE BOTHERED BY 7626 05:42:57,680 --> 05:42:59,080 HOT FLASHES BUT NOT AT THAT 7627 05:42:59,080 --> 05:43:00,320 LEVEL. 7628 05:43:00,320 --> 05:43:06,000 THEY HAD TO HAVE GOOD GENERAL 7629 05:43:06,000 --> 05:43:07,040 HEALTH AND SIGN INFORMED 7630 05:43:07,040 --> 05:43:08,000 CONSENT. 7631 05:43:08,000 --> 05:43:09,600 WHY IS IT IMPORTANT TO DO TRIALS 7632 05:43:09,600 --> 05:43:11,880 THAT ARE MORE INCLUSIVE OF THE 7633 05:43:11,880 --> 05:43:13,560 WOMEN WHO EXPERIENCED VASOMOTOR 7634 05:43:13,560 --> 05:43:13,840 SYMPTOMS? 7635 05:43:13,840 --> 05:43:15,160 THE REASON IS THAT IT'S 7636 05:43:15,160 --> 05:43:19,080 EXTREMELY RARE FOR WOMEN TO HAVE 7637 05:43:19,080 --> 05:43:22,440 7 OR MORE MODERATE OR SEVERE 7638 05:43:22,440 --> 05:43:23,720 VASOMOTOR SYMPTOMS A DAY. 7639 05:43:23,720 --> 05:43:25,600 U.S. REPRESENTATIVE DATA FROM A 7640 05:43:25,600 --> 05:43:29,160 WHILE AGO, BUT THE MOST CURRENT 7641 05:43:29,160 --> 05:43:32,720 I COULD FIND AT THE MOMENT WE 7642 05:43:32,720 --> 05:43:34,360 NEED TO DO MORE SURVEILLANCE OF 7643 05:43:34,360 --> 05:43:35,880 THIS REALLY. 7644 05:43:35,880 --> 05:43:37,960 BUT ANYWAYS, WHAT THIS SHOWS IS 7645 05:43:37,960 --> 05:43:41,680 AS A PERCENT OF THE WOMEN WHO 7646 05:43:41,680 --> 05:43:42,840 EXPERIENCE VMS, NOT EVEN 7647 05:43:42,840 --> 05:43:43,960 PREVALENCE IN THE WHOLE 7648 05:43:43,960 --> 05:43:45,520 POPULATION, JUST THE WOMEN IN 7649 05:43:45,520 --> 05:43:47,880 THIS AGE RANGE WHO EXPERIENCE 7650 05:43:47,880 --> 05:43:50,280 HOT FLASHES, NIGHT SWEATS, THE 7651 05:43:50,280 --> 05:43:52,360 PURPLE BARS ARE THE ONES HAVING 7652 05:43:52,360 --> 05:43:54,000 THE MOST HOT FLASHES, AND YOU 7653 05:43:54,000 --> 05:43:57,320 CAN SEE IT'S A SMALL PERCENTAGE 7654 05:43:57,320 --> 05:43:59,600 OF THE POPULATION, PROBABLY 2 TO 7655 05:43:59,600 --> 05:44:02,000 5% OF THE WHOLE POPULATION THAT 7656 05:44:02,000 --> 05:44:04,960 FIT INTO THIS CATEGORY OF 7 OR 7657 05:44:04,960 --> 05:44:06,400 MORE MODERATE OR SEVERE HOT 7658 05:44:06,400 --> 05:44:08,200 FLASHES A DAY. 7659 05:44:08,200 --> 05:44:10,640 WE TARGETED A BROADER AUDIENCE 7660 05:44:10,640 --> 05:44:11,960 OF WOMEN. 7661 05:44:11,960 --> 05:44:19,320 AND WE TESTED IN THE FIRST THREE 7662 05:44:19,320 --> 05:44:22,400 MSFLASH TRIALS SSRI VERSUS 7663 05:44:22,400 --> 05:44:25,560 PLACEBO, IN A 3 X 2 FACTORIAL 7664 05:44:25,560 --> 05:44:28,360 DESIGN TRIAL TESTED EXERCISE AND 7665 05:44:28,360 --> 05:44:30,720 YOGA VERSUS BEHAVIORAL CONTROL, 7666 05:44:30,720 --> 05:44:32,040 AND OMEGA 3 SUPPLEMENTATION 7667 05:44:32,040 --> 05:44:38,800 WHICH AT THE TIME WAS THOUGHT TO 7668 05:44:38,800 --> 05:44:41,160 HAVE SALUTARY EFFECTS ON HOT 7669 05:44:41,160 --> 05:44:43,080 FLASHES AND NIGHT SWEATS. 7670 05:44:43,080 --> 05:44:52,080 AND WE STUDIED LOW DOSES TRAY 7671 05:44:52,080 --> 05:44:55,840 DIOL AND VENLAFAXINE COMPARED TO 7672 05:44:55,840 --> 05:44:57,000 PLACEBO AND COMPARED SIDE BY 7673 05:44:57,000 --> 05:44:57,680 SIDE. 7674 05:44:57,680 --> 05:45:00,040 I WOULD NOT SAY HEAD TO HEAD BUT 7675 05:45:00,040 --> 05:45:02,080 WE HIDE BEHIND THE DESIRE FOR 7676 05:45:02,080 --> 05:45:05,080 HEAD TO HEAD TRIALS THAT ARE 7677 05:45:05,080 --> 05:45:06,760 ALMOST NEVER DONE, AS A WAY OF 7678 05:45:06,760 --> 05:45:08,720 NOT TELLING WOMEN HOW THESE 7679 05:45:08,720 --> 05:45:09,920 DIFFERENT THERAPIES COMPARE. 7680 05:45:09,920 --> 05:45:14,040 AND WE WANTED TO GET PAST THAT. 7681 05:45:14,040 --> 05:45:19,200 LET'S LOOK AT THE COMPARATIVE 7682 05:45:19,200 --> 05:45:24,040 EFFECTS ON VASOMOTOR SYMPTOM 7683 05:45:24,040 --> 05:45:24,800 FREQUENCY. 7684 05:45:24,800 --> 05:45:27,000 WE DO POOLED ANALYSIS, ALL 7685 05:45:27,000 --> 05:45:28,120 PUBLISHED, IT SAYS UNDER REVIEW, 7686 05:45:28,120 --> 05:45:32,800 THIS IS VERY MUCH PUBLISHED. 7687 05:45:32,800 --> 05:45:37,160 WE'RE COMPARING THE CHANGES FROM 7688 05:45:37,160 --> 05:45:39,120 BASELINE HERE, VMS FREQUENCY IN 7689 05:45:39,120 --> 05:45:42,680 INTERVENTION GROUP RELATIVE TO 7690 05:45:42,680 --> 05:45:48,760 COME BIBBED GROUP -- COMBINED 7691 05:45:48,760 --> 05:45:48,960 GROUP. 7692 05:45:48,960 --> 05:45:54,720 FOR FREQUENCY, LOW DOSE 7693 05:45:54,720 --> 05:46:03,600 ESTRADIOL RESULTED IN MOST 7694 05:46:03,600 --> 05:46:14,040 REDUCTION IN HOT FLASHES. 7695 05:46:16,440 --> 05:46:21,760 TWO OTHERS REDUCED HOT FLASHES. 7696 05:46:21,760 --> 05:46:23,520 THE DIFFERENCE BETWEEN THE THREE 7697 05:46:23,520 --> 05:46:27,680 MEDICINES IS HALF A HOT FLASH A 7698 05:46:27,680 --> 05:46:28,680 DAY COMPARED TO PLACEBO. 7699 05:46:28,680 --> 05:46:30,840 I WOULD ARGUE THAT MESSAGE IS 7700 05:46:30,840 --> 05:46:34,400 NOT GETTING ACROSS TO VIRTUALLY 7701 05:46:34,400 --> 05:46:35,920 ANYONE. 7702 05:46:35,920 --> 05:46:39,640 YOGA DIDN'T DO MUCH. 7703 05:46:39,640 --> 05:46:42,280 OMEGA 3 ACTUALLY DIDN'T DO MUCH. 7704 05:46:42,280 --> 05:46:43,720 THE OPPOSITE DIRECTION. 7705 05:46:43,720 --> 05:46:44,880 AND EXERCISE DIDN'T HELP WITH 7706 05:46:44,880 --> 05:46:49,120 FREQUENCY OF HOT FLASHES. 7707 05:46:49,120 --> 05:46:49,920 ALSO IMPORTANT INFORMATION. 7708 05:46:49,920 --> 05:46:54,760 WHEN WE LOOK AT VMS BOTHER, THIS 7709 05:46:54,760 --> 05:46:58,600 IS NOT SEVERITY BUT BOTHER, WE 7710 05:46:58,600 --> 05:47:03,760 SEE SIMILAR RESULTS, THREE-PILL 7711 05:47:03,760 --> 05:47:10,000 TRIALS REDUCED, MOST BY 7712 05:47:10,000 --> 05:47:10,520 ESCITALOPRAM AND ESTRADIOL 7713 05:47:10,520 --> 05:47:11,640 ALMOST EQUIVALENTLY. 7714 05:47:11,640 --> 05:47:16,880 GOING A RE-- YOGA REDUCED A 7715 05:47:16,880 --> 05:47:20,040 LITTLE BIT, NOT AS MUCH AS PILL 7716 05:47:20,040 --> 05:47:20,840 INTERVENTIONS. 7717 05:47:20,840 --> 05:47:25,200 IF WE LOOK AT CLINICAL 7718 05:47:25,200 --> 05:47:27,720 IMPROVEMENT, DEFINED AS AT LEAST 7719 05:47:27,720 --> 05:47:31,680 50% IMPROVEMENT FROM BASELINE 7720 05:47:31,680 --> 05:47:36,480 AND VMS FREQUENCY, YOU CAN SEE 7721 05:47:36,480 --> 05:47:37,760 THESE MEDICINES, THREE-PILL 7722 05:47:37,760 --> 05:47:40,080 INTERVENTIONS WERE VERY 7723 05:47:40,080 --> 05:47:40,480 COMPARABLE. 7724 05:47:40,480 --> 05:47:42,600 I THINK THAT THESE KIND OF 7725 05:47:42,600 --> 05:47:45,280 COMPARISONS ARE SUPER IMPORTANT 7726 05:47:45,280 --> 05:47:47,440 TO GET ACROSS IN CLINICAL 7727 05:47:47,440 --> 05:47:48,240 PRACTICE. 7728 05:47:48,240 --> 05:47:49,920 WOMEN HAVE CHOICE OF MEDICINES. 7729 05:47:49,920 --> 05:47:54,120 I DON'T THINK THEY REALIZE THAT. 7730 05:47:54,120 --> 05:47:57,200 SO, WE ALSO LOOKED AT INSOMNIA, 7731 05:47:57,200 --> 05:48:00,560 THE SECOND MOST BOTHERSOME 7732 05:48:00,560 --> 05:48:06,000 MID-LIFE SYMPTOM ACCORDING TO 7733 05:48:06,000 --> 05:48:08,360 WORK IN MSFLASH, VASOMOTOR 7734 05:48:08,360 --> 05:48:12,200 SYMPTOMS AND TROUBLE SLEEPING. 7735 05:48:12,200 --> 05:48:14,800 FOR THE NEXT COMPARISONS 7736 05:48:14,800 --> 05:48:18,440 RESTRICTING ARE THOSE WITH INDEX 7737 05:48:18,440 --> 05:48:28,720 OF 12, THE CUT POINT ON THE IS. 7738 05:48:28,720 --> 05:48:31,400 WE DID A FOURTH TRIAL TARGETING 7739 05:48:31,400 --> 05:48:35,160 SLEEP PROBLEMS THAT TESTED 7740 05:48:35,160 --> 05:48:36,400 COGNITIVE BEHAVIORAL THERAPY, AS 7741 05:48:36,400 --> 05:48:37,800 WELL AS MEASURING SLEEP OUTCOMES 7742 05:48:37,800 --> 05:48:39,600 IN ALL THE PREVIOUS TRIALS THAT 7743 05:48:39,600 --> 05:48:43,640 I SHOWED YOU. 7744 05:48:43,640 --> 05:48:50,280 THIS WAS PUBLISHED BY SUMMA 7745 05:48:50,280 --> 05:48:54,800 CURRY, CBT INTERVENTION INVOLVED 7746 05:48:54,800 --> 05:48:55,960 CBTI, TARGETING MENOPAUSAL AND 7747 05:48:55,960 --> 05:48:58,520 AGE-RELATED CHANGES IN SLEEP, 7748 05:48:58,520 --> 05:49:00,880 SOME KNOWLEDGE, SLEEP HYGIENE 7749 05:49:00,880 --> 05:49:02,480 EDUCATION, SLEEP RESTRICTION, 7750 05:49:02,480 --> 05:49:05,000 STIMULUS CONTROL PROCEDURES 7751 05:49:05,000 --> 05:49:07,520 REALLY IMPORTANT PART OF CBT-I, 7752 05:49:07,520 --> 05:49:09,520 AND I CAN ANSWER MORE QUESTIONS 7753 05:49:09,520 --> 05:49:12,520 ABOUT THAT LATER, IF PEOPLE HAVE 7754 05:49:12,520 --> 05:49:12,800 THEM. 7755 05:49:12,800 --> 05:49:15,000 COGNITIVE STRATEGIES TO DISRUPT 7756 05:49:15,000 --> 05:49:16,880 SLEEP-RELATED DYSFUNCTIONAL 7757 05:49:16,880 --> 05:49:18,320 BELIEFS AND ATTITUDES. 7758 05:49:18,320 --> 05:49:21,000 BOTH GROUPS GOT THE SAME AMOUNT 7759 05:49:21,000 --> 05:49:22,840 OF CONTACT WITH TELEPHONE 7760 05:49:22,840 --> 05:49:24,040 INTERVENTIONISTS, WE DID THIS ON 7761 05:49:24,040 --> 05:49:26,000 THE TELEPHONE SO IT WOULD BE 7762 05:49:26,000 --> 05:49:29,520 PRAGMATIC AND ABLE TO SCALE UP, 7763 05:49:29,520 --> 05:49:32,040 AND MENOPAUSE EDUCATION WAS THE 7764 05:49:32,040 --> 05:49:32,280 CONTROL. 7765 05:49:32,280 --> 05:49:35,800 AND SO NOW WE ADD THE CBT-I 7766 05:49:35,800 --> 05:49:37,640 INTERVENTION INTO THE MECHANICS, 7767 05:49:37,640 --> 05:49:40,360 IN WOMEN WITH INSOMNIA, AND WE 7768 05:49:40,360 --> 05:49:45,520 SEE THAT CBT-I FAR AND AWAY 7769 05:49:45,520 --> 05:49:48,400 SURPASSED ANY INTERVENTION FOR 7770 05:49:48,400 --> 05:49:51,080 IMPROVING SLEEP ON THE ISI IN 7771 05:49:51,080 --> 05:49:54,760 THESE WOMEN. 7772 05:49:54,760 --> 05:50:03,280 THE NEXT MOST EFFICACIOUS TWO 7773 05:50:03,280 --> 05:50:06,400 DRUGS, ESTROGEN LESS EFFECTIVE 7774 05:50:06,400 --> 05:50:08,240 THAN THOSE, YOU'LL SEE 7775 05:50:08,240 --> 05:50:09,520 CONFIDENCE INTERVALS 7776 05:50:09,520 --> 05:50:10,960 OVERLAPPING. 7777 05:50:10,960 --> 05:50:13,080 INTERESTINGLY EXERCISE AND YOGA 7778 05:50:13,080 --> 05:50:16,880 WERE AS EFFECTIVE AS SSRI AND 7779 05:50:16,880 --> 05:50:18,880 SNRI AT 12 WEEKS, A LONGER 7780 05:50:18,880 --> 05:50:19,600 TRIAL. 7781 05:50:19,600 --> 05:50:23,200 THESE HELP A LITTLE BIT WITH 7782 05:50:23,200 --> 05:50:26,960 SLEEP, CBT-I HELPS A LOT. 7783 05:50:26,960 --> 05:50:28,840 WHEN WE LOOK AT PITTSBURGH SLEEP 7784 05:50:28,840 --> 05:50:30,440 QUALITY INDEX WE GET THE VERY 7785 05:50:30,440 --> 05:50:32,640 SAME PICTURE. 7786 05:50:32,640 --> 05:50:36,720 DIFFERENT MEASURE OF SLEEP 7787 05:50:36,720 --> 05:50:38,520 OUTCOME AND SAME RESULTS. 7788 05:50:38,520 --> 05:50:40,920 A SUMMARY OF INTERVENTION 7789 05:50:40,920 --> 05:50:42,320 EFFECTS RELATED TO SLEEP WOULD 7790 05:50:42,320 --> 05:50:45,960 BE CBTI IS THE MOST EFFECTIVE 7791 05:50:45,960 --> 05:50:47,000 INTERVENTION FOR IMPROVING 7792 05:50:47,000 --> 05:50:48,160 INSOMNIA IN SLEEP QUALITY, WE 7793 05:50:48,160 --> 05:50:50,000 HEAR SO MUCH ABOUT THE 7794 05:50:50,000 --> 05:50:52,960 IMPORTANCE OF SLEEPING WELL IN 7795 05:50:52,960 --> 05:50:54,280 RELATION TO HEALTHY AGING, AND 7796 05:50:54,280 --> 05:50:56,800 THERE'S A TREMENDOUS AMOUNT OF 7797 05:50:56,800 --> 05:51:00,520 RESEARCH IN THIS AREA. 7798 05:51:00,520 --> 05:51:02,680 I THINK THAT HELPING WOMEN WITH 7799 05:51:02,680 --> 05:51:04,520 THEIR SLEEP PROBLEMS IN MID-LIFE 7800 05:51:04,520 --> 05:51:06,800 COULD SET US UP FOR HEALTHY 7801 05:51:06,800 --> 05:51:08,680 AGING IN A WAY WE'RE NOT 7802 05:51:08,680 --> 05:51:12,000 ATTENDING TO NOW. 7803 05:51:12,000 --> 05:51:15,320 I THINK IT'S IMPORTANT FOR IT TO 7804 05:51:15,320 --> 05:51:21,200 BE AVAILABLE, CBT-I, AND THIS 7805 05:51:21,200 --> 05:51:22,400 TELEPHONE INTERVENTION, IT'S 7806 05:51:22,400 --> 05:51:25,000 SOMETHING I REALLY HOPE COULD 7807 05:51:25,000 --> 05:51:26,960 MAKE HAPPEN TO ENCOURAGE 7808 05:51:26,960 --> 05:51:28,680 HAPPENING, BECAUSE IT'S SO MUCH 7809 05:51:28,680 --> 05:51:34,440 MORE EFFECTIVE THAN ANY PILL. 7810 05:51:34,440 --> 05:51:36,080 THE DRUGS WERE MODESTLY 7811 05:51:36,080 --> 05:51:38,880 EFFECTIVE AT IMPROVING SLEEP 7812 05:51:38,880 --> 05:51:40,280 QUALITY, YOGA AND EXERCISE WERE 7813 05:51:40,280 --> 05:51:43,680 ABOUT AS EFFECTIVE AS THE TWO 7814 05:51:43,680 --> 05:51:50,200 PILLS, AND ESTRADIOL WAS ABOUT 7815 05:51:50,200 --> 05:51:52,360 AS EFFECTIVE AS WELL. 7816 05:51:52,360 --> 05:51:54,360 LET'S TALK ABOUT 7817 05:51:54,360 --> 05:52:02,040 MENOPAUSE-RELATED QUALITY OF 7818 05:52:02,040 --> 05:52:04,120 LIFE. 7819 05:52:04,120 --> 05:52:06,080 A VERY SALUTORY OUTCOME BASED ON 7820 05:52:06,080 --> 05:52:11,200 AN INSTRUMENT DEVELOPED BY LUCE 7821 05:52:11,200 --> 05:52:17,640 IS, 29 QUESTIONS, THERE ARE FOUR 7822 05:52:17,640 --> 05:52:19,520 DOMAIN SCORES, VASOMOTOR, 7823 05:52:19,520 --> 05:52:20,240 PSYCHOSOCIAL, PHYSICAL, SEXUAL, 7824 05:52:20,240 --> 05:52:22,520 RANGING FROM 1 TO 8, HIGHER 7825 05:52:22,520 --> 05:52:25,600 SCORES INDICATE MORE OR MORE 7826 05:52:25,600 --> 05:52:26,560 BOTHERSOME SYMPTOMS. 7827 05:52:26,560 --> 05:52:28,000 HIGHER SCORES MEANS WORSE 7828 05:52:28,000 --> 05:52:29,560 QUALITY OF LIFE. 7829 05:52:29,560 --> 05:52:31,840 IN THAT DOMAIN. 7830 05:52:31,840 --> 05:52:34,040 YOU CAN SEE THERE ARE SOME -- 7831 05:52:34,040 --> 05:52:35,200 THESE ARE THE QUESTION CONTENT 7832 05:52:35,200 --> 05:52:43,040 AREAS FOR EACH OF THE DOMAINS. 7833 05:52:43,040 --> 05:52:47,920 PHYSICAL DOMAIN IS, YOU KNOW, 7834 05:52:47,920 --> 05:52:50,320 BASKET OF IRRITATING SYMPTOMS OF 7835 05:52:50,320 --> 05:52:52,000 A PHYSICAL NATURE. 7836 05:52:52,000 --> 05:52:55,600 THE OTHERS ARE MUCH MORE 7837 05:52:55,600 --> 05:52:56,240 TARGETED. 7838 05:52:56,240 --> 05:52:58,640 PSYCHOSOCIAL DOMAIN INCLUDES 7839 05:52:58,640 --> 05:52:59,640 ANXIETY, DEPRESSION, VASOMOTOR 7840 05:52:59,640 --> 05:53:02,000 INCLUDES HOT FLASHES AND NIGHT 7841 05:53:02,000 --> 05:53:04,680 SWEATS, SEXUAL DOMAIN INCLUDES 7842 05:53:04,680 --> 05:53:05,480 DESIRE, VAGINAL DRYNESS, 7843 05:53:05,480 --> 05:53:07,080 INTIMACY. 7844 05:53:07,080 --> 05:53:14,040 SO WHEN WE LOOK AT TOTAL MENQOL 7845 05:53:14,040 --> 05:53:17,440 CHANGE FROM BASELINE WE SEE 7846 05:53:17,440 --> 05:53:20,240 IMPROVEMENTS IN QUALITY OF LIFE 7847 05:53:20,240 --> 05:53:20,360 -- 7848 05:53:20,360 --> 05:53:21,360 >>THREE-MINUTE WARNING. 7849 05:53:21,360 --> 05:53:22,640 >> HOW MANY? 7850 05:53:22,640 --> 05:53:26,240 >> THREE MINUTES. 7851 05:53:26,240 --> 05:53:29,760 >> WE SEE THAT HALF A POINT 7852 05:53:29,760 --> 05:53:32,760 HERE IS WHAT YOU GET FOR 7853 05:53:32,760 --> 05:53:41,800 ESTRADIOL, ALMOST QUIFF LEAPT 7854 05:53:41,800 --> 05:53:43,760 FOR ECCITALOPRAM. 7855 05:53:43,760 --> 05:53:47,000 EFFECTS ON MANQOL ARE MODEST. 7856 05:53:47,000 --> 05:53:50,600 A NEW DRUG GOT APPROVED BY THE 7857 05:53:50,600 --> 05:53:53,880 FDA, AVAILABLE TO WOMEN IN THREE 7858 05:53:53,880 --> 05:54:02,280 WEEKS PURPORTEDLY. 7859 05:54:02,280 --> 05:54:04,000 THIS IS CALLED VESOLINITAN, THE 7860 05:54:04,000 --> 05:54:06,320 ICER PUT OUT A REPORT THAT MAKES 7861 05:54:06,320 --> 05:54:10,160 IT EASY TO COMPARE THE EFFICACY 7862 05:54:10,160 --> 05:54:12,960 OF THIS NEW MEDICINE TO OTHER 7863 05:54:12,960 --> 05:54:14,360 TRIALS THAT HAVE TESTED. 7864 05:54:14,360 --> 05:54:24,840 I PUT IN THIS SLIDE HERE LOW 7865 05:54:26,440 --> 05:54:29,280 DOSE ESTRADIOL AND ECCITALOPRAM. 7866 05:54:29,280 --> 05:54:33,040 HOW SEVERITY DOESN'T DIFFER THAT 7867 05:54:33,040 --> 05:54:40,280 MUCH BY TREATMENT OPTION AND 7868 05:54:40,280 --> 05:54:41,600 MENQOL SCORES ARE MODESTERLY 7869 05:54:41,600 --> 05:54:43,120 IMPROVED. 7870 05:54:43,120 --> 05:54:48,800 I WON'T SAY MUCH ABOUT 7871 05:54:48,800 --> 05:54:49,560 MYMENOPLN. 7872 05:54:49,560 --> 05:54:51,520 OUR GOAL WAS TO DISSEMINATE THIS 7873 05:54:51,520 --> 05:54:52,840 INFORMATION TO LEARN ABOUT 7874 05:54:52,840 --> 05:54:53,680 DIFFERENT TREATMENTS FOR 7875 05:54:53,680 --> 05:54:55,440 MENOPAUSE, WHAT'S HAPPENING IN 7876 05:54:55,440 --> 05:54:56,840 THEIR BODY, HOW OTHER WOMEN 7877 05:54:56,840 --> 05:55:01,600 EXPERIENCE THIS, HOW THEY MIGHT 7878 05:55:01,600 --> 05:55:03,640 TALK TO THEIR CLINICIANS. 7879 05:55:03,640 --> 05:55:05,040 THAT'S AVAILABLE TO EXPLORE. 7880 05:55:05,040 --> 05:55:09,680 WE DID A RANDOMIZED TRIAL 7881 05:55:09,680 --> 05:55:12,640 AGAINST REPUTABLE WEBSITES LIKE 7882 05:55:12,640 --> 05:55:15,160 THE NAMs WEBSITE AND OFFICE OF 7883 05:55:15,160 --> 05:55:22,480 WOMEN'S HEALTH WEBSITE ON 7884 05:55:22,480 --> 05:55:26,280 MENOPAUSE, AND MYMENOPLN WEBSITE 7885 05:55:26,280 --> 05:55:27,000 INCREASED KNOWLEDGE, WOMEN LIKED 7886 05:55:27,000 --> 05:55:31,800 IT MORE THAN OTHER REPUTABLE 7887 05:55:31,800 --> 05:55:33,000 WEBSITES, BUT, YOU KNOW, I THINK 7888 05:55:33,000 --> 05:55:35,000 THEY ARE ALL GOOD. 7889 05:55:35,000 --> 05:55:36,840 WE CERTAINLY WANT PEOPLE TO JUST 7890 05:55:36,840 --> 05:55:40,000 HAVE THE INFORMATION THAT THEY 7891 05:55:40,000 --> 05:55:40,200 NEED. 7892 05:55:40,200 --> 05:55:41,440 FINAL THOUGHTS, MID-LIFE WOMEN 7893 05:55:41,440 --> 05:55:43,400 ARE A MAJOR MARKET FOR PRODUCTS 7894 05:55:43,400 --> 05:55:44,400 AND SERVICES. 7895 05:55:44,400 --> 05:55:47,400 IT'S ESTIMATED THAT THAT MARKET 7896 05:55:47,400 --> 05:55:57,960 IS WORTH $24.4 BILLION BY 2030. 7897 05:55:58,680 --> 05:56:01,800 WOMEN ARE A TARGET FOR NEW 7898 05:56:01,800 --> 05:56:09,280 BUSINESS MODELS FOR BUSINESS 7899 05:56:09,280 --> 05:56:18,440 SERVICES BY FEM TECH AND 7900 05:56:18,440 --> 05:56:22,480 COMPANIES SUCH AS GWYNETH 7901 05:56:22,480 --> 05:56:23,200 PALTROW'S COMPANY. 7902 05:56:23,200 --> 05:56:27,640 WOMEN SHOULD NOT HAVE TO PAY 7903 05:56:27,640 --> 05:56:28,720 EXTRA TO MANAGE MENOPAUSE AND 7904 05:56:28,720 --> 05:56:31,840 ONCE TRIALS ARE IN THE PUBLIC 7905 05:56:31,840 --> 05:56:35,360 DOMAIN, PARTICULARLY THOSE PAID 7906 05:56:35,360 --> 05:56:37,160 FOR BY NIH, IT'S IMPORTANT THAT 7907 05:56:37,160 --> 05:56:41,040 A WOMAN NOT HAVE TO GIVE UP 7908 05:56:41,040 --> 05:56:44,720 NIAGARA HAVE THIS INFORMATION -- 7909 05:56:44,720 --> 05:56:45,560 INFORMATION THAT OUR TAXPAYER 7910 05:56:45,560 --> 05:56:46,840 DOLLARS PAID FOR. 7911 05:56:46,840 --> 05:56:48,200 AND CURRENT TREATMENTS WITH 7912 05:56:48,200 --> 05:56:53,440 ADEQUATE EVIDENCE HAVE MODEST 7913 05:56:53,440 --> 05:56:55,960 AND SIMILAR EFFECTS ON VASOMOTOR 7914 05:56:55,960 --> 05:56:57,280 SYMPTOMS AND I ENCOURAGE ALL OF 7915 05:56:57,280 --> 05:57:00,440 YOU COUNSELING WOMEN TO MANGE 7916 05:57:00,440 --> 05:57:00,760 -- 7917 05:57:00,760 --> 05:57:02,560 MAKE SURE THEY GET THE CHOICE 7918 05:57:02,560 --> 05:57:04,040 ABOUT WHICH MEDICINE AND NOT 7919 05:57:04,040 --> 05:57:07,360 ONLY THINK ONE WORKS, BECAUSE 7920 05:57:07,360 --> 05:57:09,240 THEY ALL WORK SIMILARLY WELL. 7921 05:57:09,240 --> 05:57:13,400 DR. PINN SAYS WOMEN AND HEALTH 7922 05:57:13,400 --> 05:57:15,880 CARE PROVIDERS NEED TRUSTWORTHY 7923 05:57:15,880 --> 05:57:18,000 INFORMATION TO MAKE RESPONSIBLE 7924 05:57:18,000 --> 05:57:18,600 INFORMED DECISIONS REGARDING 7925 05:57:18,600 --> 05:57:19,920 HEALTH AND WELL-BEING. 7926 05:57:19,920 --> 05:57:25,360 I COULD NOT AGREE MORE. 7927 05:57:25,360 --> 05:57:27,120 AND FOR THOSE TRYING TO IMPACT 7928 05:57:27,120 --> 05:57:28,560 POSITIVELY THE HEALTH OF WOMEN I 7929 05:57:28,560 --> 05:57:29,800 THINK WE ALL NEED TO JOIN 7930 05:57:29,800 --> 05:57:32,360 TOGETHER TO MAKE THIS HAPPEN. 7931 05:57:32,360 --> 05:57:33,120 I WILL STOP THERE. 7932 05:57:33,120 --> 05:57:34,800 >> THANK YOU VERY MUCH. 7933 05:57:34,800 --> 05:57:37,240 WE WILL MOVE TO THE FINAL 7934 05:57:37,240 --> 05:57:38,840 PRESENTATION OF THE SESSION. 7935 05:57:38,840 --> 05:57:41,840 AND WE'VE GOT NICE QUESTIONS 7936 05:57:41,840 --> 05:57:44,040 PILING UP IN THE Q&A. 7937 05:57:44,040 --> 05:57:47,120 LET ME INTRODUCE DR. ROBERT 7938 05:57:47,120 --> 05:57:49,440 WILD, PROFESSOR OF OB/GYN, 7939 05:57:49,440 --> 05:57:51,200 UNIVERSITY OF OKLAHOMA HEALTH 7940 05:57:51,200 --> 05:57:59,120 SCIENCES CENTER, HE IS GOING TO 7941 05:57:59,120 --> 05:58:09,680 ADDRESS THE ORWH RESEARCH 7942 05:58:09,680 --> 05:58:10,040 AGENDA. 7943 05:58:10,040 --> 05:58:11,120 >> GOOD AFTERNOON. 7944 05:58:11,120 --> 05:58:12,760 I BRING GREETINGS FROM OKLAHOMA, 7945 05:58:12,760 --> 05:58:15,200 IT'S MY PLEASURE TO PRESENT THE 7946 05:58:15,200 --> 05:58:18,680 LAST PRESENTATION OF A FABULOUS 7947 05:58:18,680 --> 05:58:20,080 SESSION. 7948 05:58:20,080 --> 05:58:21,880 I EXPRESS MY THANKS TO THE 7949 05:58:21,880 --> 05:58:23,800 ORGANIZERS FOR INCLUDING ME BUT 7950 05:58:23,800 --> 05:58:25,120 WHAT A GREAT SYMPOSIUM. 7951 05:58:25,120 --> 05:58:31,680 I THOUGHT IT WON IMPORTANT -- E 7952 05:58:31,680 --> 05:58:32,680 IMPORTANT TO CHANGE PACE. 7953 05:58:32,680 --> 05:58:35,040 WE'VE COME SO FAR BUT WE HAVE SO 7954 05:58:35,040 --> 05:58:37,360 FAR TO GO. 7955 05:58:37,360 --> 05:58:42,160 I'D LIKE TO BRING PERSPECTIVE. 7956 05:58:42,160 --> 05:58:43,080 NEXT SLIDE PLEASE. 7957 05:58:43,080 --> 05:58:45,760 I'LL TALK ABOUT WHERE WE WERE, 7958 05:58:45,760 --> 05:58:47,840 YOU'VE HEARD ABOUT WHERE WE ARE 7959 05:58:47,840 --> 05:58:48,880 ALL DAY. 7960 05:58:48,880 --> 05:58:51,400 I'M GOING TO SAY WORDS ABOUT 7961 05:58:51,400 --> 05:58:56,120 WHERE WE NEED TO BE. 7962 05:58:56,120 --> 05:58:58,120 NO CONFLICTS. 7963 05:58:58,120 --> 05:58:58,960 NEXT SLIDE PLEASE. 7964 05:58:58,960 --> 05:59:01,160 IN THE BEGINNING, IT'S IMPORTANT 7965 05:59:01,160 --> 05:59:04,680 TO RECOGNIZE THE ROLE OF DR. ED 7966 05:59:04,680 --> 05:59:06,160 BRANT, U.S. ASSISTANT SECRETARY 7967 05:59:06,160 --> 05:59:08,040 FOR U.S. HEALTH, LIVED ON NIH 7968 05:59:08,040 --> 05:59:10,960 CAMPUS WITH HIS WIFE PAT, HE WAS 7969 05:59:10,960 --> 05:59:15,280 NEVER AT THE NIH, AS THE NIH 7970 05:59:15,280 --> 05:59:16,920 DIRECTOR ACTUALLY NIH REPORTED 7971 05:59:16,920 --> 05:59:20,680 TO HIM AS DID ALL OF PUBLIC 7972 05:59:20,680 --> 05:59:26,800 HEALTH, AND HE APPOINTED C 7973 05:59:26,800 --> 05:59:28,480 EVERETT KOOP, HE PICKED A 7974 05:59:28,480 --> 05:59:31,320 WINNER, HE WAS IN THAT ROLE TWO 7975 05:59:31,320 --> 05:59:32,200 YEARS MYSELF. 7976 05:59:32,200 --> 05:59:37,120 HE WAS MY TEACHER AND MENTOR, 7977 05:59:37,120 --> 05:59:42,560 AND I WAS FUNDED BY THE NHLBI IN 7978 05:59:42,560 --> 05:59:51,000 PREVENTED CARD GEORGE. 7979 05:59:51,000 --> 05:59:51,320 CARDIOLOGY. 7980 05:59:51,320 --> 05:59:53,920 HIS RIGHT HAND WOMAN WAS VALERIE 7981 05:59:53,920 --> 05:59:56,440 WILLIAMS, SHE WAS THE STAFF 7982 05:59:56,440 --> 05:59:58,320 PERSON FOR NIH AND INDIAN HEALTH 7983 05:59:58,320 --> 06:00:01,160 SERVICE, IMPORTANT FOR OKLAHOMA 7984 06:00:01,160 --> 06:00:01,400 HEALTH. 7985 06:00:01,400 --> 06:00:03,080 SHE BECAME EXECUTIVE SECRETARY 7986 06:00:03,080 --> 06:00:04,800 FOR COORDINATING COMMITTEE ON 7987 06:00:04,800 --> 06:00:10,360 WOMEN'S HEALTH, IN A TIME LED BY 7988 06:00:10,360 --> 06:00:12,800 RUTH KIRSCHSTEIN AND DORIS 7989 06:00:12,800 --> 06:00:13,760 MERITT. 7990 06:00:13,760 --> 06:00:16,840 I WAS AN ADVISER BETWEEN 1999 7991 06:00:16,840 --> 06:00:18,640 AND 2003, VIVIAN ASKED ME TO BE 7992 06:00:18,640 --> 06:00:23,000 LIAISON TO THE WHI FOR THE ORWH. 7993 06:00:23,000 --> 06:00:26,040 I WAS NO STRANGER TO THE WHI, ON 7994 06:00:26,040 --> 06:00:27,600 THE REVIEW COMMITTEE FOR EASTERN 7995 06:00:27,600 --> 06:00:28,640 SEABOARD, HAD SOME OPPORTUNITY 7996 06:00:28,640 --> 06:00:31,200 TO HAVE INPUT IN TERMS OF WHO 7997 06:00:31,200 --> 06:00:32,120 GOT FUNDED. 7998 06:00:32,120 --> 06:00:36,240 I GOT TO PUT IN MY TWO CENTS 7999 06:00:36,240 --> 06:00:40,360 ABOUT DESIGN AT THE NCI, I 8000 06:00:40,360 --> 06:00:42,520 WARNED ABOUT ROUTE PREPARATION, 8001 06:00:42,520 --> 06:00:43,120 DOSAGE, MESSAGES TO CLINICIANS 8002 06:00:43,120 --> 06:00:51,160 AT THE TIME, I CAN TELL IT DID 8003 06:00:51,160 --> 06:00:52,880 COME TRUE, I'M HAPPY TO SEE THAT 8004 06:00:52,880 --> 06:00:54,200 HAPPENED IN THE PROCESS. 8005 06:00:54,200 --> 06:01:00,600 I CAME FROM THE PERSPECTIVE OF 8006 06:01:00,600 --> 06:01:01,440 REPRODUCTIVE ENDOCRINOLOGIST, 8007 06:01:01,440 --> 06:01:02,440 GYNECOLOGY'SI LATER 8008 06:01:02,440 --> 06:01:03,400 EPIDEMIOLOGY, A MENOPAUSE 8009 06:01:03,400 --> 06:01:04,840 PRACTITIONER NOW, I AM NOW. 8010 06:01:04,840 --> 06:01:08,240 I WOULD LIKE TO POINT OUT 8011 06:01:08,240 --> 06:01:09,240 SOMETIMES I WAS VIVIAN'S 8012 06:01:09,240 --> 06:01:14,600 MEMORIAL SIS. 8013 06:01:14,600 --> 06:01:15,680 8014 06:01:15,680 --> 06:01:18,400 NEMESIS, SHE TOLD ME DON'T TRY 8015 06:01:18,400 --> 06:01:19,600 SAVE MONEY GOING FROM CON 8016 06:01:19,600 --> 06:01:22,080 MEETING TO THE NEXT. 8017 06:01:22,080 --> 06:01:23,400 THERE ARE A LOT OF COURAGEOUS 8018 06:01:23,400 --> 06:01:25,800 PEOPLE WERE INVOLVED. 8019 06:01:25,800 --> 06:01:32,000 IT'S A MONUMENTAL TASK TO FOCUS 8020 06:01:32,000 --> 06:01:32,840 ON WOMEN. 8021 06:01:32,840 --> 06:01:34,280 A LOT OF COURAGEOUS PEOPLE 8022 06:01:34,280 --> 06:01:35,640 PUSHING UP AGAINST THE CURVE. 8023 06:01:35,640 --> 06:01:40,760 I TALKED ON THE FAR RIGHT RUTH 8024 06:01:40,760 --> 06:01:41,720 KIRSCHSTEIN MENTIONED WITH 8025 06:01:41,720 --> 06:01:43,200 BERNADINE HEALEY KNEW ABOUT 8026 06:01:43,200 --> 06:01:45,080 GENDER BIAS AND STUDIES, CAME AS 8027 06:01:45,080 --> 06:01:47,160 A CARDIOLOGIST FROM OHIO STATE 8028 06:01:47,160 --> 06:01:50,560 BEFORE SHE TOOK ON THAT TASK, 8029 06:01:50,560 --> 06:01:54,240 WHERE GENDER BIAS IS MORE ACUTE 8030 06:01:54,240 --> 06:01:58,720 THAN CARDIOLOGY, VIVIAN PINN, A 8031 06:01:58,720 --> 06:02:01,920 NICE PICTURE OF ED BRANT. 8032 06:02:01,920 --> 06:02:06,480 HIS TOLD ME HE ENJOYED THE ORWH 8033 06:02:06,480 --> 06:02:07,240 THE MOST. 8034 06:02:07,240 --> 06:02:08,800 HE TAUGHT IT'S MORE IMPORTANT TO 8035 06:02:08,800 --> 06:02:10,520 DEVELOP CAREERS OF OTHERS THAN 8036 06:02:10,520 --> 06:02:11,200 YOUR OWN. 8037 06:02:11,200 --> 06:02:13,480 HE ALSO TAUGHT ME THE BEST JOB 8038 06:02:13,480 --> 06:02:17,120 HE'S EVER ABOUT BY FAR WAS 8039 06:02:17,120 --> 06:02:18,440 BAGGING GROCERIES IN OKLAHOMA 8040 06:02:18,440 --> 06:02:20,080 CITY WHERE HE LEARNED A LOT. 8041 06:02:20,080 --> 06:02:23,920 IT TURNS OUT ED INVITED VIVIAN 8042 06:02:23,920 --> 06:02:26,240 TO OKLAHOMA TO SEE SITES, AND 8043 06:02:26,240 --> 06:02:27,800 BOUGHT HIMSELF A RED TRUCK FOR 8044 06:02:27,800 --> 06:02:28,440 THAT EVENT. 8045 06:02:28,440 --> 06:02:31,800 I GOT TO GO AROUND IN THE RED 8046 06:02:31,800 --> 06:02:34,200 TRUCK TO ENJOY THAT CAMERADERIE 8047 06:02:34,200 --> 06:02:34,960 AND INVOLVEMENT. 8048 06:02:34,960 --> 06:02:37,600 IT'S STILL AN ISSUE OF LACK OF 8049 06:02:37,600 --> 06:02:39,360 INCLUSION OF WOMEN, EVEN GREATER 8050 06:02:39,360 --> 06:02:41,880 ISSUE NOW UNDERSTANDING HOW TO 8051 06:02:41,880 --> 06:02:47,160 PROMOTE HEALTHY AGING FOR WHAT'S 8052 06:02:47,160 --> 06:02:50,120 A GENDER BIASED POPULATION 8053 06:02:50,120 --> 06:02:52,560 UNDERSTUDIED MAJORITY. 8054 06:02:52,560 --> 06:02:54,280 NEXT SLIDE PLEASE. 8055 06:02:54,280 --> 06:02:55,920 WELL, THAT GENDER GAP. 8056 06:02:55,920 --> 06:02:58,760 I THINK IT'S USEFUL TO POINT OUT 8057 06:02:58,760 --> 06:03:07,600 IN 2019 HEALTHY LIFE EXPECTANCY 8058 06:03:07,600 --> 06:03:11,440 FOR WOMEN 76, FOR MEN 71 YEARS. 8059 06:03:11,440 --> 06:03:14,160 NOTICE THE DIFFERENCE. 8060 06:03:14,160 --> 06:03:16,280 FOR WOMEN OVER 60, FROM 2015 TO 8061 06:03:16,280 --> 06:03:18,920 2050 THAT WILL GROW FROM 12% TO 8062 06:03:18,920 --> 06:03:19,280 22%. 8063 06:03:19,280 --> 06:03:21,640 THINK OF THE MAGNITUDE OF THAT 8064 06:03:21,640 --> 06:03:22,040 WORLDWIDE. 8065 06:03:22,040 --> 06:03:24,080 WE'VE HEARD ABOUT THE LACK OF 8066 06:03:24,080 --> 06:03:26,280 PEOPLE BEING ABLE TO ADDRESS IT, 8067 06:03:26,280 --> 06:03:28,320 ONE OF THE PROBLEMS WITH THE 8068 06:03:28,320 --> 06:03:29,840 ORGANIZATION WE DON'T HAVE 8069 06:03:29,840 --> 06:03:33,800 ENOUGH MENOPAUSE PRACTITIONERS 8070 06:03:33,800 --> 06:03:36,440 TO HANDLE THE CLINICAL 8071 06:03:36,440 --> 06:03:36,720 CHALLENGE. 8072 06:03:36,720 --> 06:03:39,600 MAJORITY OF STUDIES OF 8073 06:03:39,600 --> 06:03:41,280 SUCCESSFUL AGEERS, CONCEPT IS 8074 06:03:41,280 --> 06:03:43,160 OLDER ADULT WITH HEALTH STATUS 8075 06:03:43,160 --> 06:03:45,840 SIMILAR TO YOUNG PEOPLE, REFER 8076 06:03:45,840 --> 06:03:48,040 TO AS FUNCTIONAL IDEAL AGING, NO 8077 06:03:48,040 --> 06:03:48,880 DISABILITY OR PHYSICAL ILLNESS, 8078 06:03:48,880 --> 06:03:52,080 IS THAT REALLY OUR GOAL, OUR 8079 06:03:52,080 --> 06:03:52,440 BEST GOAL? 8080 06:03:52,440 --> 06:03:53,320 GREATER PHENOTYPE AND GREATER 8081 06:03:53,320 --> 06:03:56,280 NUMBER OF PEOPLE THAT HAVE A 8082 06:03:56,280 --> 06:03:57,600 DISABILITY OR CHRONIC ILLNESS, 8083 06:03:57,600 --> 06:03:59,000 THEY HAVE GOOD COGNITIVE 8084 06:03:59,000 --> 06:04:00,120 FUNCTION, CAN HAVE LIFE 8085 06:04:00,120 --> 06:04:02,080 SATISFACTION AND GOOD SOCIAL 8086 06:04:02,080 --> 06:04:02,640 ENGAGEMENT. 8087 06:04:02,640 --> 06:04:03,280 MY OPINION, THE GOAL SHOULD BE 8088 06:04:03,280 --> 06:04:10,160 TO HELP ALL. 8089 06:04:10,160 --> 06:04:14,480 NEXT SLIDE PLEASE. 8090 06:04:14,480 --> 06:04:18,840 THIS IS A FAMOUS CARDIOVASCULAR 8091 06:04:18,840 --> 06:04:21,360 CARTOON. 8092 06:04:21,360 --> 06:04:25,160 FOR ATHEROSCLEROSIS IT BEGINS IN 8093 06:04:25,160 --> 06:04:26,280 UTERO, INTO REPRODUCTIVE YEARS, 8094 06:04:26,280 --> 06:04:32,080 AND WE THINK ABOUT EVENTS AT THE 8095 06:04:32,080 --> 06:04:34,160 TIME OF MENOPAUSE. 8096 06:04:34,160 --> 06:04:37,320 RISK ESTIMATORS START AT 40. 8097 06:04:37,320 --> 06:04:38,000 THAT'S THE HORIZON. 8098 06:04:38,000 --> 06:04:40,160 TO BEGIN TO THINK ABOUT WHAT'S 8099 06:04:40,160 --> 06:04:42,800 HAPPENING, IT'S IMPORTANT TO 8100 06:04:42,800 --> 06:04:44,640 LOOK AS A CONTINUUM, THAT SHOULD 8101 06:04:44,640 --> 06:04:45,800 ENTER INTO DECISION MAKING, IN 8102 06:04:45,800 --> 06:04:47,200 MY OPINION. 8103 06:04:47,200 --> 06:04:48,520 FOR WOMEN THE MENOPAUSE 8104 06:04:48,520 --> 06:04:49,200 TRANSITION IS PARTICULARLY 8105 06:04:49,200 --> 06:04:52,560 IMPORTANT BECAUSE IT'S A CALL TO 8106 06:04:52,560 --> 06:04:53,120 ACTION. 8107 06:04:53,120 --> 06:04:55,120 IT'S BECAUSE OF ACCELERATION OF 8108 06:04:55,120 --> 06:04:56,760 CARDIOVASCULAR DISEASE, BONE 8109 06:04:56,760 --> 06:04:59,480 LOSS, PREVALENCE OF DIABETES, 8110 06:04:59,480 --> 06:05:00,160 OBESITY, PSYCHOLOGICAL DISTRESS, 8111 06:05:00,160 --> 06:05:02,440 YOU HEARD THAT TALKED ABOUT 8112 06:05:02,440 --> 06:05:03,160 TODAY. 8113 06:05:03,160 --> 06:05:06,360 FOCUS ON ROLE OF HORMONES IN 8114 06:05:06,360 --> 06:05:07,240 ORGAN SYSTEMS. 8115 06:05:07,240 --> 06:05:08,120 UNDERLYING CONDITIONS ARE 8116 06:05:08,120 --> 06:05:13,680 TREATED WITH VARIETY OF CLASSES 8117 06:05:13,680 --> 06:05:16,640 OF MEDICATIONS, I WOULD ARGUE WE 8118 06:05:16,640 --> 06:05:20,720 KNOW LITTLE ABOUT GENDER 8119 06:05:20,720 --> 06:05:22,280 DIFFERENCES, AND HEALTHY AGING 8120 06:05:22,280 --> 06:05:28,640 IN GENERAL. 8121 06:05:28,640 --> 06:05:34,640 VASCULAR INTEGRITY, BONE 8122 06:05:34,640 --> 06:05:37,480 DYNAMICS, BEYOND MENOPAUSE. 8123 06:05:37,480 --> 06:05:38,680 EFFECTS OF GENDER DIFFERENCE 8124 06:05:38,680 --> 06:05:40,520 GOING INTO MENOPAUSE AND BEYOND 8125 06:05:40,520 --> 06:05:43,080 ARE CHALLENGING, WE KNOW LESS 8126 06:05:43,080 --> 06:05:44,160 ABOUT PRIMARY, SECONDARY, 8127 06:05:44,160 --> 06:05:45,280 TERTIARY PREVENTION. 8128 06:05:45,280 --> 06:05:47,160 AND IN RELATIVE TERMS COMPARED 8129 06:05:47,160 --> 06:05:50,120 TO A LOT OF THINGS WE STUDY 8130 06:05:50,120 --> 06:05:53,480 THERE ARE FEWER LONGITUDINAL 8131 06:05:53,480 --> 06:05:55,920 STUDIES, NOT MINED WELL TO TAKE 8132 06:05:55,920 --> 06:05:58,520 INTO ACCOUNT NEWER RESEARCH 8133 06:05:58,520 --> 06:05:59,240 TECHNIQUES. 8134 06:05:59,240 --> 06:06:03,360 MANY ARE CROSS-SECTIONAL 8135 06:06:03,360 --> 06:06:05,560 HYPOTHESIS GENERATING WHICH CAN 8136 06:06:05,560 --> 06:06:08,040 ONLY SET UP HYPOTHESES. 8137 06:06:08,040 --> 06:06:08,840 NEXT SLIDE PLEASE. 8138 06:06:08,840 --> 06:06:11,280 BECAUSE OF THE RAPID CHANGES IN 8139 06:06:11,280 --> 06:06:13,560 DISEASE RISK, ASSOCIATED WITH 8140 06:06:13,560 --> 06:06:18,400 THIS DECLINE, THERE'S REASON TO 8141 06:06:18,400 --> 06:06:20,040 EXPECT MAINTAINING ESTROGEN 8142 06:06:20,040 --> 06:06:22,760 SHOULD ATTENUATE. 8143 06:06:22,760 --> 06:06:25,400 A FOCUS IS CLEARLY NEEDED. 8144 06:06:25,400 --> 06:06:30,400 I WON'T SPEND A LOT OF TIME ON 8145 06:06:30,400 --> 06:06:33,400 CURRENT INDICATIONS BUT AN 8146 06:06:33,400 --> 06:06:35,240 OVERFOCUS ON ESTROGEN PLUS 8147 06:06:35,240 --> 06:06:37,080 PROGESTERONE ALONE MISSES THE 8148 06:06:37,080 --> 06:06:39,440 BOAT AS JOANNE SAID SO OFTEN, 8149 06:06:39,440 --> 06:06:46,520 THE WHI GIVES, AND THAT'S TRUE. 8150 06:06:46,520 --> 06:06:48,760 NEXT SLIDE PLEASE. 8151 06:06:48,760 --> 06:06:52,440 LET'S LOOK AT DISEASE BURDEN. 8152 06:06:52,440 --> 06:06:53,680 LOOK AT RED, PERCENTAGES. 8153 06:06:53,680 --> 06:06:55,320 NOT THAT THE OTHER CONDITIONS 8154 06:06:55,320 --> 06:06:57,280 AREN'T IMPORTANT BECAUSE THE 8155 06:06:57,280 --> 06:06:58,800 VASCULAR INTEGRITY GOES TO ALL 8156 06:06:58,800 --> 06:07:01,440 THOSE ORGAN SYSTEMS. 8157 06:07:01,440 --> 06:07:01,840 THAT'S IMPORTANT. 8158 06:07:01,840 --> 06:07:03,560 IN TERMS OF BANG FOR THE BUCK, 8159 06:07:03,560 --> 06:07:06,080 HOW WE DESIGN OUR STUDIES, I 8160 06:07:06,080 --> 06:07:07,000 THINK UNDERSTANDING AND LOOKING 8161 06:07:07,000 --> 06:07:08,680 AT THAT WE NEED TO UNDERSTAND 8162 06:07:08,680 --> 06:07:10,640 THE PUBLIC HEALTH BURDEN. 8163 06:07:10,640 --> 06:07:20,960 NEXT SLIDE PLEASE. 8164 06:07:20,960 --> 06:07:26,320 PROMINENT MEDS ARE STATINS, 8165 06:07:26,320 --> 06:07:27,360 BISPHOSPHONATES, STATINS, SOME 8166 06:07:27,360 --> 06:07:29,920 HAVE ADVERSE EFFECTS ON OTHER 8167 06:07:29,920 --> 06:07:31,360 SYSTEMS COMMON TO POSTMENOPAUSAL 8168 06:07:31,360 --> 06:07:33,040 WOMEN NEEDS. 8169 06:07:33,040 --> 06:07:34,720 I WOULD SUGGEST POLYPHARMACY AT 8170 06:07:34,720 --> 06:07:36,720 ADVANCE AGED IS MOST OFTEN 8171 06:07:36,720 --> 06:07:39,000 IGNORED, A CHALLENGING PROBLEM 8172 06:07:39,000 --> 06:07:44,160 FOR PATIENTS AND FRAGMENTED 8173 06:07:44,160 --> 06:07:46,120 HEALTH SYSTEM. 8174 06:07:46,120 --> 06:07:47,880 ISCHEMIC HEART DISEASE ACCOUNTS 8175 06:07:47,880 --> 06:07:50,400 FOR MORE DEATHS THAN ALL CANCERS 8176 06:07:50,400 --> 06:07:53,520 COMBINED, NOT THAT EACH SYSTEM 8177 06:07:53,520 --> 06:07:55,080 IS NOT IMPORTANT ONE-THIRD OF 8178 06:07:55,080 --> 06:07:57,640 LIVING DISEASE IN WOMEN 50 OR 8179 06:07:57,640 --> 06:07:59,600 OLDER WORLDWIDE, MOST OF THE 8180 06:07:59,600 --> 06:08:01,560 STUDIES LEAVE OUT WOMEN WITH 8181 06:08:01,560 --> 06:08:03,160 THEIR UNIQUE RISKS. 8182 06:08:03,160 --> 06:08:05,400 WE'RE IMPROVING, BEGINNING TO 8183 06:08:05,400 --> 06:08:08,400 SEE WITH A LOT OF VOCIFEROUS 8184 06:08:08,400 --> 06:08:09,800 WORKS IMPORTANCE OF PREGNANCY 8185 06:08:09,800 --> 06:08:11,320 COMPLICATIONS TO VASCULAR RISK 8186 06:08:11,320 --> 06:08:15,200 LATER, BEGINNING TO SEE 8187 06:08:15,200 --> 06:08:16,200 POLYCYSTIC OVARY SYNDROME AND 8188 06:08:16,200 --> 06:08:18,160 THE WAY IT GOES INTO MENOPAUSE 8189 06:08:18,160 --> 06:08:19,360 MAY BE DIFFERENT, THAT'S 8190 06:08:19,360 --> 06:08:22,880 BEGINNING TO BE PUBLICIZED. 8191 06:08:22,880 --> 06:08:25,920 NEXT SLIDE PLEASE. 8192 06:08:25,920 --> 06:08:30,200 SO, THERE ARE GAPS, MEDICAL 8193 06:08:30,200 --> 06:08:30,720 INVASIVE TREATMENT, 8194 06:08:30,720 --> 06:08:32,520 UNDERUTILIZED IN WOMEN. 8195 06:08:32,520 --> 06:08:35,560 A LATER PRESENTATION, EVEN IF 8196 06:08:35,560 --> 06:08:38,840 TROPONIN IS ABNORMAL, GREATER 8197 06:08:38,840 --> 06:08:42,360 ODDS OF MORTALITY FROM 8198 06:08:42,360 --> 06:08:46,080 INFARCTION WITH MI LESS THAN 45, 8199 06:08:46,080 --> 06:08:48,040 MORE ANGINA, LESS OBSTRUCTIVE 8200 06:08:48,040 --> 06:08:50,840 DISEASE, WHY IS THAT? 8201 06:08:50,840 --> 06:08:52,640 THEY PRESENT WITH ATYPICAL 8202 06:08:52,640 --> 06:08:54,080 SYMPTOMS, WHY IS IT ATYPICAL? 8203 06:08:54,080 --> 06:08:55,080 THOSE ARE THE SYMPTOMS. 8204 06:08:55,080 --> 06:08:57,240 THEY ARE BROAD. 8205 06:08:57,240 --> 06:08:58,040 IT'S IMPORTANT. 8206 06:08:58,040 --> 06:08:59,320 SCIENTIFICALLY, EXCITING TO TRY 8207 06:08:59,320 --> 06:09:02,600 TO FIGURE OUT WHY THAT HAPPENS. 8208 06:09:02,600 --> 06:09:03,760 NEXT SLIDE PLEASE. 8209 06:09:03,760 --> 06:09:06,200 SO, A FEW WORDS ABOUT RISK 8210 06:09:06,200 --> 06:09:06,440 SCORING. 8211 06:09:06,440 --> 06:09:08,160 I WOULD SUGGEST MENOPAUSE IS A 8212 06:09:08,160 --> 06:09:10,360 PERFECT WINDOW TO SCREEN USING 8213 06:09:10,360 --> 06:09:11,880 RISK SCORE, I WILL WARN THERE'S 8214 06:09:11,880 --> 06:09:15,200 NO GOOD RISK SCORE THAT EXISTS 8215 06:09:15,200 --> 06:09:16,320 POST CARDIOVASCULAR EVENT. 8216 06:09:16,320 --> 06:09:20,160 I'VE STUDIED RISK SCORE SYSTEMS, 8217 06:09:20,160 --> 06:09:23,440 NONE ARE PERFECT BUT ACC/AHA 8218 06:09:23,440 --> 06:09:25,960 COHORT IS SURFACING BECAUSE IT'S 8219 06:09:25,960 --> 06:09:27,880 READILY AVAILABLE IN EMR 8220 06:09:27,880 --> 06:09:28,360 SYSTEMS. 8221 06:09:28,360 --> 06:09:29,040 NEXT SLIDE PLEASE. 8222 06:09:29,040 --> 06:09:31,760 I WANT TO POINT OUT THE 8223 06:09:31,760 --> 06:09:34,080 IMPORTANCE OF UNDERSTANDING WHAT 8224 06:09:34,080 --> 06:09:35,760 ARE PROPER RESIDUAL TARGETS, 8225 06:09:35,760 --> 06:09:37,840 WHEN WE MANAGE PREVENTION WE 8226 06:09:37,840 --> 06:09:39,560 HAVE TO UNDERSTAND TARGETS. 8227 06:09:39,560 --> 06:09:42,640 WE KNOW TARGETS BETTER FOR 8228 06:09:42,640 --> 06:09:43,840 CHOLESTEROL AND TRIGLYCERIDES, 8229 06:09:43,840 --> 06:09:45,760 BEGINNING TO SEE FOR BOTH LOWER 8230 06:09:45,760 --> 06:09:47,600 IS ALWAYS BETTER, EVEN LOWER 8231 06:09:47,600 --> 06:09:50,800 THAN WE'RE SHOWING HERE. 8232 06:09:50,800 --> 06:09:56,160 CERTAINLY FOR SECONDARY 8233 06:09:56,160 --> 06:09:56,440 PREVENTION. 8234 06:09:56,440 --> 06:09:59,240 THROMBOTIC ISSUE IS IMPORTANT TO 8235 06:09:59,240 --> 06:10:00,840 MEASURE ONCE AT LEAST. 8236 06:10:00,840 --> 06:10:10,680 YOU HEARD ABOUT HORMONES AND 8237 06:10:10,680 --> 06:10:11,520 THROMBOTIC RISKS, DIABETES, 8238 06:10:11,520 --> 06:10:13,120 PRESERVED EJECTION FRACTION, HOW 8239 06:10:13,120 --> 06:10:15,160 WE STUDY THAT EXCITING BUT I 8240 06:10:15,160 --> 06:10:18,200 DON'T WANT TO PUT SLIDES ON THE 8241 06:10:18,200 --> 06:10:21,760 IMPORTANCE OF BLOOD PRESSURE, SO 8242 06:10:21,760 --> 06:10:22,360 IMPORTANT TO CARDIOVASCULAR 8243 06:10:22,360 --> 06:10:22,800 OUTCOMES. 8244 06:10:22,800 --> 06:10:25,520 NEXT SLIDE PLEASE. 8245 06:10:25,520 --> 06:10:30,120 I WON'T SAY MUCH ABOUT ORAL 8246 06:10:30,120 --> 06:10:32,600 VERSUS TRANSDERMAL, BUT THE ROLE 8247 06:10:32,600 --> 06:10:37,080 OF INFLAMMATION, CRITICAL. 8248 06:10:37,080 --> 06:10:39,160 THIS IS REPETITIVE BUT SOME 8249 06:10:39,160 --> 06:10:40,480 BELIEVE INFLAMMATION IS THE ROOT 8250 06:10:40,480 --> 06:10:48,160 OF ALL EVIL. 8251 06:10:48,160 --> 06:10:49,640 MORE TO COME. 8252 06:10:49,640 --> 06:10:51,600 THAT ARROW SHOWS AVERAGE AGE OF 8253 06:10:51,600 --> 06:10:54,480 MENOPAUSE BUT YOU GOT TO 8254 06:10:54,480 --> 06:10:55,520 UNDERSTAND PRE AND POST, 8255 06:10:55,520 --> 06:10:57,560 LAUNCHED INTO LATER YEARS. 8256 06:10:57,560 --> 06:11:00,040 IT'S IMPORTANT TO POINT OUT M.I. 8257 06:11:00,040 --> 06:11:01,720 BEFORE 55 INCREASED OVERALL IN 8258 06:11:01,720 --> 06:11:03,800 THE PAST TWO DECADES, BUT FOR 8259 06:11:03,800 --> 06:11:06,000 WOMEN THEY HAVE GONE FROM A 8260 06:11:06,000 --> 06:11:09,000 FIFTH TO A THIRD, AND FOR WOMEN, 8261 06:11:09,000 --> 06:11:11,440 A LOT OF MORE COMORBIDITIES 8262 06:11:11,440 --> 06:11:14,000 ASSOCIATED WITH THAT. 8263 06:11:14,000 --> 06:11:16,120 NEXT SLIDE PLEASE. 8264 06:11:16,120 --> 06:11:18,880 THE THING TO REMEMBER, 8265 06:11:18,880 --> 06:11:25,040 SPONTANEOUS CORE ANOTHER 8266 06:11:25,040 --> 06:11:30,200 DISSECTION IS NON-TRAUMATIC, 8267 06:11:30,200 --> 06:11:30,600 NON-IATROGENIC. 8268 06:11:30,600 --> 06:11:34,160 LOOK GENDER BIAS FOR WOMEN, 24 8269 06:11:34,160 --> 06:11:41,440 TO 35% OF MI IN WOMEN LESS THAN 8270 06:11:41,440 --> 06:11:41,960 60. 8271 06:11:41,960 --> 06:11:43,280 HORMONE THERAPY IS 8272 06:11:43,280 --> 06:11:43,720 CONTRAINDICATED. 8273 06:11:43,720 --> 06:11:47,480 I PUT THIS CARTOON UP SHOWING 8274 06:11:47,480 --> 06:11:49,760 DIFFERENCE BETWEEN ATHEROGENESIS 8275 06:11:49,760 --> 06:11:52,600 OR PRECIPITATION EVENTS AND 8276 06:11:52,600 --> 06:11:54,040 PATHOPHYSIOLOGY, CONTRASTING 8277 06:11:54,040 --> 06:11:56,960 WOMEN VERSUS MEN AT EVERY LEVEL 8278 06:11:56,960 --> 06:11:57,640 IT'S DIFFERENT. 8279 06:11:57,640 --> 06:11:58,640 I WOULD LIKE TO DRAW YOUR 8280 06:11:58,640 --> 06:12:02,120 ATTENTION TO THE WORK OF DR. 8281 06:12:02,120 --> 06:12:03,040 HUCKSY, UNIVERSITY OF MISSOURI, 8282 06:12:03,040 --> 06:12:06,560 20 YEARS LOOKING AT PHYSIOLOGY 8283 06:12:06,560 --> 06:12:08,240 OF DIFFERENCE AT EVERY LEVEL, 8284 06:12:08,240 --> 06:12:10,080 ORGAN SYSTEMS, CELL SYSTEMS, 8285 06:12:10,080 --> 06:12:11,080 NEED TO ENCOURAGE BASIC 8286 06:12:11,080 --> 06:12:11,680 UNDERSTANDING TO FIGURE OUT 8287 06:12:11,680 --> 06:12:15,120 WHERE WE NEED TO GO. 8288 06:12:15,120 --> 06:12:18,360 NEXT SLIDE PLEASE. 8289 06:12:18,360 --> 06:12:19,360 AGAIN, HYPERTENSION, LET'S NOT 8290 06:12:19,360 --> 06:12:21,120 FORGET THE STATE OF THE ART IS 8291 06:12:21,120 --> 06:12:23,000 LIKE THAT ELEPHANT IN THE RIGHT 8292 06:12:23,000 --> 06:12:23,920 WITH HYPERTENSION. 8293 06:12:23,920 --> 06:12:28,800 WE ARE NOT PUTTING OUR ACT 8294 06:12:28,800 --> 06:12:29,480 TOGETHER. 8295 06:12:29,480 --> 06:12:33,600 SEX STEROIDS AFFECTING THE 8296 06:12:33,600 --> 06:12:34,400 SYMPATHETIC SYSTEM, 8297 06:12:34,400 --> 06:12:35,520 PARASYMPATHETIC SYSTEM WE NEED 8298 06:12:35,520 --> 06:12:36,200 IMPROVEMENT, NO DOUBT. 8299 06:12:36,200 --> 06:12:41,080 THERE ARE A LOT OF QUESTIONS 8300 06:12:41,080 --> 06:12:42,360 ABOUT DIET, PHYTOESTROGENS AS 8301 06:12:42,360 --> 06:12:44,160 HOW THEY INTERACT WHICH AFTER 8302 06:12:44,160 --> 06:12:47,360 ALL IS A CHALLENGING CLINICAL 8303 06:12:47,360 --> 06:12:49,200 ISSUE BECAUSE NOT ALL OFFICE PAY 8304 06:12:49,200 --> 06:12:52,120 ATTENTION AND MEASURE, RUN THE 8305 06:12:52,120 --> 06:12:55,760 ROOM QUICK, GO OUT, HAVE TO MOVE 8306 06:12:55,760 --> 06:12:57,440 THE PATIENT AHEAD, BUT IT'S OUR 8307 06:12:57,440 --> 06:13:02,000 RESPONSIBILITY TO KEEP PEOPLE ON 8308 06:13:02,000 --> 06:13:04,200 TARGET TO PREVENT EVENTS. 8309 06:13:04,200 --> 06:13:06,640 I DON'T WANT TO DIMINISH 8310 06:13:06,640 --> 06:13:08,560 IMPORTANCE OF NEUROGENERATIVE 8311 06:13:08,560 --> 06:13:08,800 DISEASE. 8312 06:13:08,800 --> 06:13:10,560 EFFECTS OF AGING ARE 8313 06:13:10,560 --> 06:13:12,560 UNDERSTUDIED AND UNCLEAR. 8314 06:13:12,560 --> 06:13:14,360 THE SAME FOR EXOGENOUS, THE 8315 06:13:14,360 --> 06:13:15,440 SECOND BULLET POINT. 8316 06:13:15,440 --> 06:13:18,880 THE REASON I BRING IT UP, WE 8317 06:13:18,880 --> 06:13:22,120 THINK ABOUT HORMONES AS 8318 06:13:22,120 --> 06:13:23,240 MENSTRUAL CYCLE, PREGNANCY, MEN 8319 06:13:23,240 --> 06:13:23,440 TAUS. 8320 06:13:23,440 --> 06:13:24,200 IT'S MORE. 8321 06:13:24,200 --> 06:13:28,200 IT'S A CONTINUUM THAT GOES INTO 8322 06:13:28,200 --> 06:13:36,040 THE OLDER YEARS. 8323 06:13:36,040 --> 06:13:46,440 WE KNOW IT PASSES THE 8324 06:13:47,720 --> 06:13:48,520 BLOOD-BRAIN BARRIER, IMPORTANT 8325 06:13:48,520 --> 06:13:50,480 TALK THIS MORNING ABOUT 8326 06:13:50,480 --> 06:13:52,480 CONNECTION TO AXIS LEARNING 8327 06:13:52,480 --> 06:13:53,480 ABOUT MENOPAUSE. 8328 06:13:53,480 --> 06:13:55,240 BE CAREFUL ABOUT ANIMAL VERSUS 8329 06:13:55,240 --> 06:13:57,600 HUMANS IN UNDERSTANDING OF 8330 06:13:57,600 --> 06:13:59,600 ESTROGEN AS MORE ADVANCED THAN 8331 06:13:59,600 --> 06:14:03,120 IN PROGESTERONE, LESS IS KNOWN, 8332 06:14:03,120 --> 06:14:05,960 WE'RE LEARNING MORE ABOUT 8333 06:14:05,960 --> 06:14:07,480 METABOLIC IMPLICATIONS OF 8334 06:14:07,480 --> 06:14:09,960 METABOLISM PROGESTERONE, HOW IT 8335 06:14:09,960 --> 06:14:15,760 AFFECTS THE BRAIN. 8336 06:14:15,760 --> 06:14:18,600 AREA UNDERSTUDIED WHAT AROMATASE 8337 06:14:18,600 --> 06:14:25,880 INHIBITORS DO TO BRAIN FUNCTION. 8338 06:14:25,880 --> 06:14:27,160 ESTRADIOL REGULATES GLYCOLYSIS, 8339 06:14:27,160 --> 06:14:29,240 PHOSPHORYLATION, IT'S 8340 06:14:29,240 --> 06:14:32,080 UNDERSTUDIED WITH AGING. 8341 06:14:32,080 --> 06:14:36,480 WE'VE GOT SEVERAL MANUSCRIPTING 8342 06:14:36,480 --> 06:14:40,360 ABOUT APOE 4, THOUGHTS WITH 8343 06:14:40,360 --> 06:14:41,720 HORMONES AND AGING, DEMENTIA, 8344 06:14:41,720 --> 06:14:52,040 MORE STUDY THERE. 8345 06:14:55,680 --> 06:14:57,160 ESTRADIOL AND PROGESTERONE HAVE 8346 06:14:57,160 --> 06:14:59,360 EFFECTS. 8347 06:14:59,360 --> 06:15:01,880 I PUT THIS CARTOON UP, 8348 06:15:01,880 --> 06:15:02,880 ILLUSTRATING ORGAN SYSTEMS. 8349 06:15:02,880 --> 06:15:10,760 LOOK AT THEM ALL. 8350 06:15:10,760 --> 06:15:12,760 I HIGHLIGHTED POLYCYSTIC OVARY 8351 06:15:12,760 --> 06:15:13,560 SYSTEM, PAYING ATTENTION TO 8352 06:15:13,560 --> 06:15:17,120 INFERTILITY AND THIS DISO. 8353 06:15:17,120 --> 06:15:17,840 CARDIOVASCULAR DISEASE AND 8354 06:15:17,840 --> 06:15:25,560 DIABETES ACCOUNT FOR HALF OF THE 8355 06:15:25,560 --> 06:15:27,560 MORTALITY, A THIRD IN WOMEN. 8356 06:15:27,560 --> 06:15:33,600 THEY SHARE RISK FACTORS THAT 8357 06:15:33,600 --> 06:15:35,800 COMPRISE METABOLIC SYSTEMS. 8358 06:15:35,800 --> 06:15:37,320 MEDICATIONS FOR DEMENTIA ARE 8359 06:15:37,320 --> 06:15:39,040 WANTING, A LOT OF LEADS ABOUT 8360 06:15:39,040 --> 06:15:40,760 HORMONE THERAPY AND MOOD. 8361 06:15:40,760 --> 06:15:42,120 HOW ARE THESE CONNECTED 8362 06:15:42,120 --> 06:15:44,960 METABOLICALLY TO THE ISSUE OF 8363 06:15:44,960 --> 06:15:47,360 OBSTRUCTIVE SLEEP APNEA OR 8364 06:15:47,360 --> 06:15:48,520 CONGESTIVE FAILURE IS EXCITING 8365 06:15:48,520 --> 06:15:49,360 TO LOOK AT. 8366 06:15:49,360 --> 06:15:50,160 NEXT SLIDE PLEASE. 8367 06:15:50,160 --> 06:15:53,240 WHERE WE NEED TO BE? 8368 06:15:53,240 --> 06:15:55,280 WE KNOW LITTLE ABOUT ENDOGENOUS 8369 06:15:55,280 --> 06:15:56,800 SYSTEMS AND ORGAN SYSTEMS IN 8370 06:15:56,800 --> 06:15:59,080 GENERAL BUT I WOULD SUGGEST 8371 06:15:59,080 --> 06:16:01,760 LEARNING ABOUT NORMAL TRANSITION 8372 06:16:01,760 --> 06:16:05,840 VERSUS ABNORMAL ONE, LONG-TERM 8373 06:16:05,840 --> 06:16:07,160 EFFECTS, DIFFERENCE IN GENE 8374 06:16:07,160 --> 06:16:08,800 MUTATION NEEDS TO COME TO THE 8375 06:16:08,800 --> 06:16:09,320 FOREFRONT. 8376 06:16:09,320 --> 06:16:12,520 YOU HEARD ABOUT GENETICS OF WHO, 8377 06:16:12,520 --> 06:16:14,920 WHEN, WHY SHOULD WE TEST. 8378 06:16:14,920 --> 06:16:18,000 NEXT SLIDE PLEASE. 8379 06:16:18,000 --> 06:16:21,360 PREVENTION OF DISEASE AND GENDER 8380 06:16:21,360 --> 06:16:23,200 DIFFERENCE IS IMPORTANT. 8381 06:16:23,200 --> 06:16:24,760 PHENOTYPES IN OLDER AGE, 8382 06:16:24,760 --> 06:16:27,400 IGNORANCE ABOUT WHAT MENOPAUSE 8383 06:16:27,400 --> 06:16:29,680 DOES TO ORGAN SYSTEMS LATER. 8384 06:16:29,680 --> 06:16:31,440 EFFECTS OF LIFESTYLE ARE 8385 06:16:31,440 --> 06:16:32,560 IMPORTANT, TARGET TISSUE EFFECTS 8386 06:16:32,560 --> 06:16:34,080 OF HORMONE OPTIONS WITH BREAST 8387 06:16:34,080 --> 06:16:35,720 CANCER RISK. 8388 06:16:35,720 --> 06:16:37,400 YOU'VE HEARD ABOUT OSTEOPOROSIS, 8389 06:16:37,400 --> 06:16:39,160 I'LL MOVE BEYOND THAT. 8390 06:16:39,160 --> 06:16:41,480 A PLUG WE NEED TO KNOW 8391 06:16:41,480 --> 06:16:45,480 DETERMINANTS OF MENTAL HEALTH 8392 06:16:45,480 --> 06:16:48,680 DISORDER, WE KNOW HORMONES ARE 8393 06:16:48,680 --> 06:16:53,520 PSYCHOACTIVE, SOME PEOPLE FEEL 8394 06:16:53,520 --> 06:16:55,040 WEEPY ON ESTROGEN, CONVERT AND 8395 06:16:55,040 --> 06:16:56,560 IT GOES AWAY. 8396 06:16:56,560 --> 06:16:58,560 COLORECTAL CANCER AND KIDNEY 8397 06:16:58,560 --> 06:16:58,800 DISEASE. 8398 06:16:58,800 --> 06:16:59,880 NEXT SLIDE PLEASE. 8399 06:16:59,880 --> 06:17:03,800 I WOULD PUT IN A PLUG AS WE 8400 06:17:03,800 --> 06:17:06,600 DESIGN MOVING AHEAD RANDOMIZED 8401 06:17:06,600 --> 06:17:07,240 TRIALS, OBSERVATIONAL STUDIES, A 8402 06:17:07,240 --> 06:17:09,120 LOT OF NEAT TECHNIQUES TO 8403 06:17:09,120 --> 06:17:10,440 OPTIMIZE THAT WEREN'T USED OVER 8404 06:17:10,440 --> 06:17:12,320 THE PAST TWO DECADES, NEED TO BE 8405 06:17:12,320 --> 06:17:12,600 INCLUDED. 8406 06:17:12,600 --> 06:17:14,920 I WANT TO PUT IN A PLUG WHILE WE 8407 06:17:14,920 --> 06:17:18,600 DO THAT WE WANT TO ADAPT SOME 8408 06:17:18,600 --> 06:17:19,720 BETTER METHODS OF ANALYSIS, 8409 06:17:19,720 --> 06:17:22,200 THERE'S A LOT OF 8410 06:17:22,200 --> 06:17:25,080 INDIVIDUALIZATION THAT'S NEEDED, 8411 06:17:25,080 --> 06:17:25,960 GAPS IN ASSESSMENT 8412 06:17:25,960 --> 06:17:29,560 POST-MENOPAUSE, DOESN'T APPLY TO 8413 06:17:29,560 --> 06:17:34,040 EVERY PERSON. 8414 06:17:34,040 --> 06:17:35,240 TRANSDERMAL DELIVERY, WE HAVE A 8415 06:17:35,240 --> 06:17:38,960 LONG WAY TO GO. 8416 06:17:38,960 --> 06:17:42,200 NEXT SLIDE PLEASE. 8417 06:17:42,200 --> 06:17:45,000 MY FORMULA TO FOCUS ON AGING, 8418 06:17:45,000 --> 06:17:47,840 LET'S PAY ATTENTION TO PHYSICAL 8419 06:17:47,840 --> 06:17:49,720 ACTIVITY, DIMINISHES OBESITY, 8420 06:17:49,720 --> 06:17:51,680 CUTS DOWN ON INFLAMMATION, 8421 06:17:51,680 --> 06:17:52,720 IMPROVES SLEEP. 8422 06:17:52,720 --> 06:17:54,640 POSITIVE ATTITUDE IS IMPORTANT, 8423 06:17:54,640 --> 06:17:56,600 HAPPINESS, LOVE, HOW DO WE TAKE 8424 06:17:56,600 --> 06:17:58,720 THAT INTO ACCOUNT IN PROPER 8425 06:17:58,720 --> 06:18:00,440 MENTAL HEALTH, RELATIONSHIPS ARE 8426 06:18:00,440 --> 06:18:04,080 CLEARLY IMPORTANT FOR SURVIVAL. 8427 06:18:04,080 --> 06:18:05,360 WE'RE SOCIAL BEINGS. 8428 06:18:05,360 --> 06:18:08,560 WE HEARD GREAT THINGS ABOUT 8429 06:18:08,560 --> 06:18:09,560 HISPANICS AND AFRICAN AMERICANEN 8430 06:18:09,560 --> 06:18:10,760 BUT A PLUG FOR AMERICAN INDIANS. 8431 06:18:10,760 --> 06:18:15,800 IF WE'RE GOING TO GET ANY 8432 06:18:15,800 --> 06:18:16,600 ATTRACTION IN THE AMERICAN 8433 06:18:16,600 --> 06:18:18,000 INDIAN COMMUNITY WE NEED TO 8434 06:18:18,000 --> 06:18:19,440 INVOLVE TRIBAL LEADERSHIP. 8435 06:18:19,440 --> 06:18:21,120 THERE ARE UNIQUE DIFFERENCES, 8436 06:18:21,120 --> 06:18:23,120 HIGHEST COUNTY FOR CANCER IN THE 8437 06:18:23,120 --> 06:18:24,280 UNITED STATES -- 8438 06:18:24,280 --> 06:18:24,680 >>THAT'S TIME. 8439 06:18:24,680 --> 06:18:26,400 >> IS IN OKLAHOMA. 8440 06:18:26,400 --> 06:18:29,560 WE HAVE A LOT TO LEARN, BREAK 8441 06:18:29,560 --> 06:18:31,000 DOWN SILOS, CROSS-TALK AMONG 8442 06:18:31,000 --> 06:18:33,080 THEM AND I'LL FINISH MY QUOTE. 8443 06:18:33,080 --> 06:18:35,640 THE ONLY THROUGH WISDOM IS 8444 06:18:35,640 --> 06:18:36,840 KNOWING YOU KNOW NOTHING, TAUGHT 8445 06:18:36,840 --> 06:18:41,400 YEARS AGO, STILL TRUE. 8446 06:18:41,400 --> 06:18:42,240 THANK YOU VERY MUCH. 8447 06:18:42,240 --> 06:18:45,120 >> THANKS FOR THE FANTASTIC 8448 06:18:45,120 --> 06:18:46,320 PRESENTATIONS, SORRY FOR BEING 8449 06:18:46,320 --> 06:18:54,680 STRICT ON TIME BUT WE'VE GOT SO 8450 06:18:54,680 --> 06:18:55,960 MANY GOOD QUESTIONS. 8451 06:18:55,960 --> 06:18:58,680 THERE'S A GENERATION OF 8452 06:18:58,680 --> 06:19:00,480 CLINICIANS AFRAID OF MENOPAUSAL 8453 06:19:00,480 --> 06:19:01,560 HORMONE THERAPY, AND I THINK -- 8454 06:19:01,560 --> 06:19:07,240 I DON'T THINK ANYONE DISAGREES 8455 06:19:07,240 --> 06:19:08,200 WITH THAT. 8456 06:19:08,200 --> 06:19:12,160 CAN YOU TELL US ABOUT ACCESSING 8457 06:19:12,160 --> 06:19:16,480 CBT-I FOR SLEEP, THAT WOULD BE 8458 06:19:16,480 --> 06:19:19,160 FOR DR. LACROIX. 8459 06:19:19,160 --> 06:19:29,560 >> I WOULD LOOK IN YOUR 8460 06:19:29,880 --> 06:19:30,920 COMMUNITY FOR CBT-I PROVIDERS, 8461 06:19:30,920 --> 06:19:33,040 AND WE NEED TO HAVE THIS BUILT 8462 06:19:33,040 --> 06:19:35,400 INTO HEALTH CARE SYSTEMS. 8463 06:19:35,400 --> 06:19:38,040 FOR EXAMPLE, I ASKED ABOUT THIS 8464 06:19:38,040 --> 06:19:40,000 AT UCSD, I WAS TOLD BY SLEEP 8465 06:19:40,000 --> 06:19:42,040 MEDICINE COLLEAGUE A WOMAN 8466 06:19:42,040 --> 06:19:43,160 SHOULD CALL UP UCSD AND GET 8467 06:19:43,160 --> 06:19:45,160 WORKED UP FOR SLEEP PROBLEM. 8468 06:19:45,160 --> 06:19:46,360 THAT'S NOT THE ANSWER I WANTED. 8469 06:19:46,360 --> 06:19:50,400 I WANT TO KNOW WHERE YOU CAN GO 8470 06:19:50,400 --> 06:19:52,240 GET CBT-I BY TELEPHONE. 8471 06:19:52,240 --> 06:19:55,160 I DON'T HAVE A PLACE TO SEND 8472 06:19:55,160 --> 06:19:58,280 YOU, BUT I THINK WE NEED TO 8473 06:19:58,280 --> 06:19:59,880 DEMAND THAT THESE SERVICES BE 8474 06:19:59,880 --> 06:20:02,280 MADE AVAILABLE TO WOMEN IN EACH 8475 06:20:02,280 --> 06:20:03,120 OF OUR COMMUNITIES. 8476 06:20:03,120 --> 06:20:07,080 >> I CAN SAY THERE IS AN APP, 8477 06:20:07,080 --> 06:20:10,760 CBT-I, IT'S BLUE WITH A CRESCENT 8478 06:20:10,760 --> 06:20:11,200 MOON. 8479 06:20:11,200 --> 06:20:14,160 IT'S MADE BY THE VETERANS 8480 06:20:14,160 --> 06:20:14,640 ADMINISTRATION, FREELY 8481 06:20:14,640 --> 06:20:14,920 AVAILABLE. 8482 06:20:14,920 --> 06:20:25,400 IT'S NOT A BAD PLACE TO START, 8483 06:20:26,840 --> 06:20:29,240 IF NEED INSOMNIA THERAPY. 8484 06:20:29,240 --> 06:20:31,640 >>THE PEOPLE WHO DEVELOPED 8485 06:20:31,640 --> 06:20:35,080 CBT-I, HAVING THE COACH INTERACT 8486 06:20:35,080 --> 06:20:35,680 IS SO IMPORTANT. 8487 06:20:35,680 --> 06:20:38,480 IF YOU TRY AN APP, IT DOESN'T 8488 06:20:38,480 --> 06:20:39,800 WORK, KNOW THAT A COACH CAN 8489 06:20:39,800 --> 06:20:42,240 REALLY HELP YOU DO THIS. 8490 06:20:42,240 --> 06:20:44,640 IT'S NOT EASY TO DO SLEEP 8491 06:20:44,640 --> 06:20:47,160 RESTRICTION WITHOUT THAT SUPPORT 8492 06:20:47,160 --> 06:20:48,160 OF A COACH. 8493 06:20:48,160 --> 06:20:52,440 SO, THAT'S ONE THING I WOULD SAY 8494 06:20:52,440 --> 06:20:54,320 ABOUT TRYING AN APP. 8495 06:20:54,320 --> 06:20:57,000 >> AND ONE OF THE OTHER 8496 06:20:57,000 --> 06:20:58,920 QUESTIONS THAT YOU'RE TALKING 8497 06:20:58,920 --> 06:21:00,800 ABOUT AS WELL, NEW TECHNOLOGY 8498 06:21:00,800 --> 06:21:02,320 USAGE, SOCIAL MEDIA STREAMING 8499 06:21:02,320 --> 06:21:05,280 TAKEN INTO ACCOUNT WHEN LOOKING 8500 06:21:05,280 --> 06:21:06,960 INTO INSOMNIA AND SLEEP QUALITY. 8501 06:21:06,960 --> 06:21:09,960 >> I THINK IT IS TAKEN INTO 8502 06:21:09,960 --> 06:21:13,480 ACCOUNT. 8503 06:21:13,480 --> 06:21:14,240 WITH RESPECT TO SLEEP HYGIENE, 8504 06:21:14,240 --> 06:21:15,920 TURNING OFF THE BLUE LIGHT, 8505 06:21:15,920 --> 06:21:17,080 STUFF LIKE THAT. 8506 06:21:17,080 --> 06:21:21,000 THAT'S PART OF THE COUNSELING. 8507 06:21:21,000 --> 06:21:22,200 BUT IT'S SOMETHING TO 8508 06:21:22,200 --> 06:21:23,640 INVESTIGATE WITH RESPECT TO THE 8509 06:21:23,640 --> 06:21:28,840 SLEEP DISTURBANCE TO BEGIN WITH. 8510 06:21:28,840 --> 06:21:30,560 >> ANOTHER QUESTION I'M GOING 8511 06:21:30,560 --> 06:21:33,080 TO FIELD TO YOU, DR. WILD, HOW 8512 06:21:33,080 --> 06:21:36,120 IS WEIGHT GAIN NOT CONSIDERED A 8513 06:21:36,120 --> 06:21:36,800 BOTHERSOME SYMPTOM BEING 8514 06:21:36,800 --> 06:21:39,640 ADDRESSED? 8515 06:21:39,640 --> 06:21:41,120 >> ARE YOU TALKING TO ME? 8516 06:21:41,120 --> 06:21:46,720 >>YES, SINCE THAT BEARS ON 8517 06:21:46,720 --> 06:21:47,120 CARDIOVASCULAR. 8518 06:21:47,120 --> 06:21:49,360 >> YEAH, GREAT TALK ABOUT 8519 06:21:49,360 --> 06:21:51,120 PHYSICAL ACTIVITY, WHAT CAN IT 8520 06:21:51,120 --> 06:21:53,120 DO, CAN'T DO. 8521 06:21:53,120 --> 06:21:57,160 CHRONIC EXERCISE VERSUS ACUTE. 8522 06:21:57,160 --> 06:21:58,040 HOW HORMONE THERAPY MODULATION 8523 06:21:58,040 --> 06:21:59,440 CAN BE AFFECTED. 8524 06:21:59,440 --> 06:22:03,160 IT'S AN IMPORTANT PART OF 8525 06:22:03,160 --> 06:22:05,440 EXACTLY WHAT WE DO, I THINK TO 8526 06:22:05,440 --> 06:22:07,680 OVERFOCUS ON BODY IMAGE CAN BE 8527 06:22:07,680 --> 06:22:09,760 CHALLENGING, AND I THINK AS WE 8528 06:22:09,760 --> 06:22:10,960 INCORPORATE OUR APPROPRIATE 8529 06:22:10,960 --> 06:22:13,760 MESSAGES INTO TOTAL HEALTHY 8530 06:22:13,760 --> 06:22:14,280 LIFESTYLE, UNDERSTANDING 8531 06:22:14,280 --> 06:22:15,400 NUTRITION IS PART OF THAT. 8532 06:22:15,400 --> 06:22:17,600 THAT'S THE MESSAGE AND THE WAY 8533 06:22:17,600 --> 06:22:18,840 TO GO. 8534 06:22:18,840 --> 06:22:21,480 AND AS WE GET BETTER WAYS TO 8535 06:22:21,480 --> 06:22:23,200 UNDERSTAND HEALTHY EXERCISE, 8536 06:22:23,200 --> 06:22:26,720 GREAT TALK TODAY ABOUT WEIGHT 8537 06:22:26,720 --> 06:22:28,160 BEARING VERSUS AEROBIC VERSUS 8538 06:22:28,160 --> 06:22:32,160 CHRONIC, AND ALL THOSE 8539 06:22:32,160 --> 06:22:32,480 COMPONENTS. 8540 06:22:32,480 --> 06:22:35,360 WE NEED ON WRAP OUR MESSAGES 8541 06:22:35,360 --> 06:22:36,400 AROUND THEM, A MULTI-SPECIALTY 8542 06:22:36,400 --> 06:22:36,920 APPROACH. 8543 06:22:36,920 --> 06:22:42,840 HAROLD TO DO ALONE FOR A GIVEN 8544 06:22:42,840 --> 06:22:43,400 INDIVIDUAL. 8545 06:22:43,400 --> 06:22:45,040 MANAGEMENT IS SUCCESSFUL IN MANY 8546 06:22:45,040 --> 06:22:46,000 CIRCUMSTANCES, IT HAS A LOT TO 8547 06:22:46,000 --> 06:22:47,480 DO WITH WHAT'S AVAILABLE TO A 8548 06:22:47,480 --> 06:22:49,480 GIVEN PERSON AND HOW THEY CAN 8549 06:22:49,480 --> 06:22:50,680 EFFECTIVELY AND COST EFFECTIVELY 8550 06:22:50,680 --> 06:22:52,400 TAKE ADVANTAGE OF WHAT RESOURCES 8551 06:22:52,400 --> 06:22:58,360 ARE AROUND. 8552 06:22:58,360 --> 06:23:01,360 >> I'LL ADD ONE OF THE AREAS 8553 06:23:01,360 --> 06:23:02,880 WE'RE INVESTIGATING IN WHI 8554 06:23:02,880 --> 06:23:04,160 ACTUALLY BUT OTHER COHORTS AS 8555 06:23:04,160 --> 06:23:05,760 WELL IS WHETHER OR NOT WEIGHT 8556 06:23:05,760 --> 06:23:07,320 LOSS IS GOOD FOR YOU WHEN YOU'RE 8557 06:23:07,320 --> 06:23:09,400 OLDER THAN A CERTAIN AGE. 8558 06:23:09,400 --> 06:23:12,160 AND IT REALLY LOOKS AS AN 8559 06:23:12,160 --> 06:23:15,680 EPIDEMIOLOGIST, I WOULD SAY ONE 8560 06:23:15,680 --> 06:23:21,480 OF THE PUBLIC HEALTH MYTHS, GOOD 8561 06:23:21,480 --> 06:23:25,400 EVIDENCE IT'S NOT GOOD FOR YOU, 8562 06:23:25,400 --> 06:23:26,440 WEIGHT STABILITY IS WHAT SHOULD 8563 06:23:26,440 --> 06:23:28,640 BE VALUING AS IN TERMS OF 8564 06:23:28,640 --> 06:23:31,120 HEALTHY AGING. 8565 06:23:31,120 --> 06:23:32,560 I HATE GAINING WEIGHT, AS MUCH 8566 06:23:32,560 --> 06:23:34,720 AS ANY OTHER WOMAN. 8567 06:23:34,720 --> 06:23:35,160 IT SUCKS. 8568 06:23:35,160 --> 06:23:37,560 AND I WANT TO BE AS SKINNY AS I 8569 06:23:37,560 --> 06:23:39,880 WAS AT THE SKINNIEST PART OF MY 8570 06:23:39,880 --> 06:23:42,440 LIFE, BUT I KNOW IT'S NOT GOOD 8571 06:23:42,440 --> 06:23:42,800 FOR ME. 8572 06:23:42,800 --> 06:23:45,440 >> ONE OF THE THINGS I DO IN MY 8573 06:23:45,440 --> 06:23:50,840 OFFICE, SHOW A PICTURE OF IDEAL 8574 06:23:50,840 --> 06:23:52,840 WEIGHT AND GET PEOPLE TO CIRCLE 8575 06:23:52,840 --> 06:23:53,080 IT. 8576 06:23:53,080 --> 06:23:55,680 WHAT'S HEALTHY AND WHAT ISN'T. 8577 06:23:55,680 --> 06:23:57,080 THE UNDERSTANDING IS ENORMOUS. 8578 06:23:57,080 --> 06:23:58,840 IT TAKES 10% OF YOUR WEIGHT 8579 06:23:58,840 --> 06:24:04,200 DOWN, IF YOU'RE WAY OVER, TO GET 8580 06:24:04,200 --> 06:24:05,640 METABOLICALLY NORMALLY, I USE 8581 06:24:05,640 --> 06:24:08,280 METABOLIC INDICATORS RATHER THAN 8582 06:24:08,280 --> 06:24:08,520 WEIGHT. 8583 06:24:08,520 --> 06:24:10,440 >> I SEE DR. PINN AND DR. 8584 06:24:10,440 --> 06:24:11,440 CLAYTON'S CAMERAS ON. 8585 06:24:11,440 --> 06:24:14,080 I'M GOING TO ALLOW FOR LAST 8586 06:24:14,080 --> 06:24:22,400 COMMENTS FROM THE SPEAKERS AND 8587 06:24:22,400 --> 06:24:22,680 DR. SANTORO. 8588 06:24:22,680 --> 06:24:25,200 >> I WANT TO SAY, ON THE WEIGHT 8589 06:24:25,200 --> 06:24:27,080 QUESTION, IN CLINICAL PRACTICE I 8590 06:24:27,080 --> 06:24:28,440 SEE MANY PATIENTS WHO ARE VERY 8591 06:24:28,440 --> 06:24:30,280 BENT OUT OF SHAPE WITH LARGE 8592 06:24:30,280 --> 06:24:32,280 AMOUNTS OF WEIGHT GAIN, YOU DO 8593 06:24:32,280 --> 06:24:34,280 NOT SEE THAT IN LARGER 8594 06:24:34,280 --> 06:24:35,600 POPULATION STUDIES. 8595 06:24:35,600 --> 06:24:41,240 YOU SEE MODEST AMOUNT OF WAIST 8596 06:24:41,240 --> 06:24:42,720 WEIGHT GAIN THAT DRIVES EVERYONE 8597 06:24:42,720 --> 06:24:44,360 NUTS, YOU CAN'T CLOSE THE 8598 06:24:44,360 --> 06:24:45,640 WAISTBAND, BUT THAT'S WHAT 8599 06:24:45,640 --> 06:24:47,400 HAPPENS ACROSS THE TRANSITION. 8600 06:24:47,400 --> 06:24:49,040 SO IF YOU LOOK AT THE WHOLE 8601 06:24:49,040 --> 06:24:50,400 POPULATION YOU'RE MISSING THIS 8602 06:24:50,400 --> 06:24:51,120 ONE GROUP. 8603 06:24:51,120 --> 06:24:52,720 BUT THIS MULTIPLE A GROUP WE 8604 06:24:52,720 --> 06:24:55,760 WANT TO BREAK OUT AND STUDY 8605 06:24:55,760 --> 06:24:57,440 SEPARATELY BECAUSE THEY PROBABLY 8606 06:24:57,440 --> 06:25:00,440 ARE AT SOME EXCESS RISK OR HAVE 8607 06:25:00,440 --> 06:25:05,560 SOME UNIQUE COMBINATION OF 8608 06:25:05,560 --> 06:25:05,800 FACTORS. 8609 06:25:05,800 --> 06:25:10,320 >> OR ALREADY ENTER WITH 8610 06:25:10,320 --> 06:25:10,680 COMORBIDITIES. 8611 06:25:10,680 --> 06:25:10,920 >> YES. 8612 06:25:10,920 --> 06:25:13,040 >> I WANT TO THANK EVERYBODY SO 8613 06:25:13,040 --> 06:25:16,360 MUCH FOR COMING HERE TODAY, FOR 8614 06:25:16,360 --> 06:25:18,040 SPEAKING, FOR ALL OF EVERYBODY'S 8615 06:25:18,040 --> 06:25:19,360 SHARING OF THOUGHTS. 8616 06:25:19,360 --> 06:25:23,320 IT'S BEEN A PLEASURE TO HOST 8617 06:25:23,320 --> 06:25:25,920 THIS SYMPOSIUM TODAY, FOCUS ON 8618 06:25:25,920 --> 06:25:26,200 MENOPAUSE. 8619 06:25:26,200 --> 06:25:31,400 TO CONCLUDE THIS I WOULD LIKE TO 8620 06:25:31,400 --> 06:25:33,920 WELCOME DR. VIVIAN PINN, THE 8621 06:25:33,920 --> 06:25:34,560 INAUGURAL FULL-TIME DIRECTOR OF 8622 06:25:34,560 --> 06:25:36,840 THE OFFICE OF RESEARCH ON 8623 06:25:36,840 --> 06:25:39,600 WOMEN'S HEALTH FROM 1991 UNTIL 8624 06:25:39,600 --> 06:25:42,760 HER RETIREMENT IN 2011. 8625 06:25:42,760 --> 06:25:45,560 AND NIH'S ASSOCIATE DIRECTOR 8626 06:25:45,560 --> 06:25:50,360 FROM 1994 UNTIL 2011 FOR WOMEN 8627 06:25:50,360 --> 06:25:50,600 HEALTH. 8628 06:25:50,600 --> 06:25:52,640 THE OFFICE LED IMPLEMENTATION OF 8629 06:25:52,640 --> 06:25:55,120 INCLUSION POLICIES FOR WOMEN AND 8630 06:25:55,120 --> 06:25:57,000 MINORITIES IN CLINICAL RESEARCH, 8631 06:25:57,000 --> 06:25:59,560 DEVELOPED THE FIRST AND SEVERAL 8632 06:25:59,560 --> 06:26:00,200 SUBSEQUENT NATIONAL STRATEGIC 8633 06:26:00,200 --> 06:26:02,600 PLANS FOR WOMEN'S HEALTH 8634 06:26:02,600 --> 06:26:04,360 RESEARCH, AND ESTABLISHED MANY 8635 06:26:04,360 --> 06:26:05,680 NEW FUNDING INITIATIVES. 8636 06:26:05,680 --> 06:26:07,520 WE'RE SO DELIGHTED TO HAVE YOU 8637 06:26:07,520 --> 06:26:10,560 HERE TODAY. 8638 06:26:10,560 --> 06:26:12,600 WELCOME, DR. PINN. 8639 06:26:12,600 --> 06:26:13,920 >> THANK YOU. 8640 06:26:13,920 --> 06:26:15,640 AGAIN, I'M REALLY HONORED THAT 8641 06:26:15,640 --> 06:26:17,880 THE OFFICE HAS THIS SYMPOSIUM IN 8642 06:26:17,880 --> 06:26:19,040 MY NAME. 8643 06:26:19,040 --> 06:26:19,440 THANK YOU, JANINE. 8644 06:26:19,440 --> 06:26:21,160 THANK YOU TO THE STAFF AND 8645 06:26:21,160 --> 06:26:22,560 COORDINATING COMMITTEE FOR DOING 8646 06:26:22,560 --> 06:26:22,760 THIS. 8647 06:26:22,760 --> 06:26:24,480 IT'S QUITE AN HONOR FOR ME 8648 06:26:24,480 --> 06:26:26,200 ESPECIALLY SINCE I CAN SIT BACK 8649 06:26:26,200 --> 06:26:26,760 AND LEARN. 8650 06:26:26,760 --> 06:26:30,040 I DON'T HAVE TO TRY TO PRESENT 8651 06:26:30,040 --> 06:26:32,800 BUT REALLY TO LEARN FROM THE 8652 06:26:32,800 --> 06:26:33,960 PRESENTATIONS EACH YEAR. 8653 06:26:33,960 --> 06:26:36,600 I MUST SAY THIS YEAR WAS 8654 06:26:36,600 --> 06:26:39,160 ESPECIALLY OF INTEREST TO ME 8655 06:26:39,160 --> 06:26:41,800 BECAUSE OF DEALING WITH YOUR 8656 06:26:41,800 --> 06:26:44,880 PRIORITIES, DEAL WITH LOOKING AT 8657 06:26:44,880 --> 06:26:47,280 THE MENOPAUSE AND MID-LIFE 8658 06:26:47,280 --> 06:26:48,200 CHANGES FOR WOMEN, VERY 8659 06:26:48,200 --> 06:26:48,520 IMPORTANT. 8660 06:26:48,520 --> 06:26:50,200 I'M PLEASED YOU STARTED WITH THE 8661 06:26:50,200 --> 06:26:51,520 WOMEN'S HEALTH INITIATIVE. 8662 06:26:51,520 --> 06:26:52,960 I WAS THE CO-DIRECTOR OF THAT 8663 06:26:52,960 --> 06:26:55,640 STUDY IN THE EARLY YEARS, ALONG 8664 06:26:55,640 --> 06:26:57,320 WITH BILL HARLAN, AND I STILL 8665 06:26:57,320 --> 06:27:00,200 THINK I HAVE A LOT OF SCARS ON 8666 06:27:00,200 --> 06:27:01,600 MY BACK FROM REACTIONS TO THE 8667 06:27:01,600 --> 06:27:02,560 FINDINGS OF THE WOMEN'S HEALTH 8668 06:27:02,560 --> 06:27:06,000 INITIATIVE WHEN THEY WERE NOT 8669 06:27:06,000 --> 06:27:09,280 WHAT WE EXPECTED. 8670 06:27:09,280 --> 06:27:12,120 AND RECENTLY I'VE BEEN DISTURBED 8671 06:27:12,120 --> 06:27:16,800 SEEING SO MUCH REACTION, OP-ED, 8672 06:27:16,800 --> 06:27:18,920 PEOPLE ON TV TALKING ABOUT USE 8673 06:27:18,920 --> 06:27:21,480 OF HORMONES AS THOUGH HORMONAL 8674 06:27:21,480 --> 06:27:23,200 THERAPY, AS THOUGH WE NEVER HAD 8675 06:27:23,200 --> 06:27:25,680 THE WOMEN'S HEALTH INITIATIVE 8676 06:27:25,680 --> 06:27:28,040 AND ADVOCATING FOR ITS USE 8677 06:27:28,040 --> 06:27:29,600 WITHOUT RECOGNIZING THAT THERE 8678 06:27:29,600 --> 06:27:31,160 ARE SOME RISKS INVOLVED, AT 8679 06:27:31,160 --> 06:27:33,600 LEAST FOR SOME WOMEN. 8680 06:27:33,600 --> 06:27:36,640 AND OPPOSED TO WHAT I HEARD 8681 06:27:36,640 --> 06:27:38,480 REITERATED AGAIN THAT MANY 8682 06:27:38,480 --> 06:27:40,560 PHYSICIANS ARE AFRAID OF HORMONE 8683 06:27:40,560 --> 06:27:40,800 THERAPY. 8684 06:27:40,800 --> 06:27:43,080 I THINK BACK TO THE NON-USE WHEN 8685 06:27:43,080 --> 06:27:44,840 RESULTS OF THE WOMEN'S HEALTH 8686 06:27:44,840 --> 06:27:48,040 INITIATIVE, THE FIRST STUDY WAS 8687 06:27:48,040 --> 06:27:50,200 STOPPED, WE PRESENTED THAT RISKS 8688 06:27:50,200 --> 06:27:51,680 SEEMED TO OUTWEIGH THE BENEFITS, 8689 06:27:51,680 --> 06:27:54,280 THAT OUR CHARGE WAS REALLY TO 8690 06:27:54,280 --> 06:27:56,520 GET PHYSICIANS TO MOVE AWAY 8691 06:27:56,520 --> 06:27:57,800 THINKING ALWAYS ABOUT HORMONE 8692 06:27:57,800 --> 06:28:00,040 THERAPY AS THE FIRST THING AND 8693 06:28:00,040 --> 06:28:01,040 THAT EVERY WOMAN REACHING 8694 06:28:01,040 --> 06:28:03,480 MENOPAUSE SHOULD BE GOING ON 8695 06:28:03,480 --> 06:28:04,160 HORMONE THERAPY. 8696 06:28:04,160 --> 06:28:06,000 AND IT'S SORT OF COME FULL 8697 06:28:06,000 --> 06:28:07,160 CIRCLE BECAUSE WHAT I WAS 8698 06:28:07,160 --> 06:28:09,640 HEARING IN A LOT OF 8699 06:28:09,640 --> 06:28:12,520 PRESENTATIONS TODAY WERE 8700 06:28:12,520 --> 06:28:13,880 JUSTIFICATION FOR WHY WE NEED TO 8701 06:28:13,880 --> 06:28:16,040 GO BACK TO ADVOCATE FOR USE OF 8702 06:28:16,040 --> 06:28:16,960 HORMONES. 8703 06:28:16,960 --> 06:28:18,760 I HOPE WE DON'T FORGET LESSONS 8704 06:28:18,760 --> 06:28:20,240 OF THE WOMEN'S HEALTH INITIATIVE 8705 06:28:20,240 --> 06:28:22,280 BUT THAT A SET DOSE USING 8706 06:28:22,280 --> 06:28:24,920 DOSAGES THAT WERE THE USUAL 8707 06:28:24,920 --> 06:28:26,720 DOSAGES, AND WAS A BIG STUDY BUT 8708 06:28:26,720 --> 06:28:28,520 LEFT A LOT OF QUESTIONS. 8709 06:28:28,520 --> 06:28:30,520 AND I'M JUST PLEASED WITH ALL OF 8710 06:28:30,520 --> 06:28:31,720 THE PRESENTATIONS THAT DEALT 8711 06:28:31,720 --> 06:28:34,360 WITH SO MANY OTHER ISSUES GOING 8712 06:28:34,360 --> 06:28:35,400 BEYOND JUST HORMONE THERAPY BUT 8713 06:28:35,400 --> 06:28:38,160 OTHER ISSUES THAT ARE IMPORTANT 8714 06:28:38,160 --> 06:28:39,840 TO WOMEN IN MID-LIFE. 8715 06:28:39,840 --> 06:28:43,120 I THOUGHT DEALING WITH THE 8716 06:28:43,120 --> 06:28:46,080 QUESTIONS ABOUT BRCA1 AND BRCA2 8717 06:28:46,080 --> 06:28:48,480 AND DECISIONS TO BE MADE ABOUT 8718 06:28:48,480 --> 06:28:49,720 POSSIBILITY OF DEVELOPING 8719 06:28:49,720 --> 06:28:51,520 OVARIAN CANCER AND LOOKING AT 8720 06:28:51,520 --> 06:28:52,800 THE FALLOPIAN TUBES, THESE ARE 8721 06:28:52,800 --> 06:28:55,080 THINGS THAT WE THOUGHT ABOUT 8722 06:28:55,080 --> 06:28:57,040 YEARS AGO BUT OBVIOUSLY HAVEN'T 8723 06:28:57,040 --> 06:28:57,840 BEEN PURSUED, STILL ARE 8724 06:28:57,840 --> 06:29:01,600 IMPORTANT FOR WOMEN AS THEY 8725 06:29:01,600 --> 06:29:02,840 APPROACH MID-LIFE, LOOKING 8726 06:29:02,840 --> 06:29:06,160 PARTICULARLY IMPRESSED WITH THE 8727 06:29:06,160 --> 06:29:08,160 PATIENT ADVOCACY PERSPECTIVES, 8728 06:29:08,160 --> 06:29:10,480 DR. FRIEDMAN AND HEARING ABOUT 8729 06:29:10,480 --> 06:29:18,800 WOMEN WITH HIV AND THEN THE 8730 06:29:18,800 --> 06:29:19,760 MENOPAUSAL SYMPTOMS INTERACTING 8731 06:29:19,760 --> 06:29:21,800 WITH SYMPTOMS OF HIV AND DILEMMA 8732 06:29:21,800 --> 06:29:22,920 WOMEN AND PHYSICIANS HAVE TRYING 8733 06:29:22,920 --> 06:29:27,680 TO DIED -- DECIDE WHERE TO GO. 8734 06:29:27,680 --> 06:29:29,240 DR. WILD, I NEVER THOUGHT OF YOU 8735 06:29:29,240 --> 06:29:29,960 AS MY NEMESIS. 8736 06:29:29,960 --> 06:29:33,800 I THOUGHT OF YOU AS MY SUPPORT, 8737 06:29:33,800 --> 06:29:35,160 AS MY ADVISER. 8738 06:29:35,160 --> 06:29:36,240 ESPECIALLY WHEN YOU WERE ON THE 8739 06:29:36,240 --> 06:29:37,880 ADVISORY COMMITTEE AND WORKING 8740 06:29:37,880 --> 06:29:39,000 WITH THE WOMEN'S HEALTH 8741 06:29:39,000 --> 06:29:39,320 INITIATIVE. 8742 06:29:39,320 --> 06:29:41,920 BUT I DO REMEMBER THAT TRIP TO 8743 06:29:41,920 --> 06:29:43,160 OKLAHOMA, AND ACTUALLY WE 8744 06:29:43,160 --> 06:29:45,080 LABELED DR. ED BRANT THE 8745 06:29:45,080 --> 06:29:46,400 GODFATHER OF WOMEN'S HEALTH 8746 06:29:46,400 --> 06:29:47,840 BECAUSE HE REALLY WAS THE ONE 8747 06:29:47,840 --> 06:29:51,400 WHO GOT THE WHOLE IDEA OF 8748 06:29:51,400 --> 06:29:53,080 WOMEN'S HEALTH IN THE DEPARTMENT 8749 06:29:53,080 --> 06:29:55,600 OF HHS, AND REALLY STARTED THAT 8750 06:29:55,600 --> 06:29:56,320 COORDINATING COMMITTEE AND 8751 06:29:56,320 --> 06:29:57,440 CERTAINLY ADVISED AND WORKED 8752 06:29:57,440 --> 06:30:00,720 WITH US AT ORWH ON JUST ABOUT 8753 06:30:00,720 --> 06:30:01,640 EVERYTHING WE DID, LOSING HIM 8754 06:30:01,640 --> 06:30:03,920 WAS A BIG LOSS FOR US BUT HE WAS 8755 06:30:03,920 --> 06:30:05,880 SUCH A GREAT SUPPORT FOR US AND 8756 06:30:05,880 --> 06:30:08,440 DEALING WITH NOT JUST SCIENCE 8757 06:30:08,440 --> 06:30:10,080 BUT THE POLITICS AND DIPLOMACY 8758 06:30:10,080 --> 06:30:12,040 AND HOW TO MOVE FORWARD. 8759 06:30:12,040 --> 06:30:14,560 HE WAS REALLY A GENIUS, TO MY 8760 06:30:14,560 --> 06:30:15,960 MIND, SUCH A WONDERFUL SUPPORT. 8761 06:30:15,960 --> 06:30:18,800 BUT I DIDN'T REALIZE YOU WERE A 8762 06:30:18,800 --> 06:30:19,040 NEMESIS. 8763 06:30:19,040 --> 06:30:20,680 I'M GOING TO REMEMBER THIS. 8764 06:30:20,680 --> 06:30:23,600 I WANT TO JUST EXPRESS MY 8765 06:30:23,600 --> 06:30:25,000 APPRECIATION TO THE OFFICE FOR 8766 06:30:25,000 --> 06:30:27,560 ALL THE NEW INITIATIVES YOU HAVE 8767 06:30:27,560 --> 06:30:29,280 BECAUSE WE CAN'T FORGET YOU 8768 06:30:29,280 --> 06:30:31,680 MOVED ON FAR FROM WHEN I 8769 06:30:31,680 --> 06:30:33,760 RETIRED, WHICH IS NOW IN AUGUST 8770 06:30:33,760 --> 06:30:34,480 OF 2011. 8771 06:30:34,480 --> 06:30:36,480 AND SEEING THE NEW INITIATIVES 8772 06:30:36,480 --> 06:30:38,920 AND NEW PROGRAMS, AND THE NEW 8773 06:30:38,920 --> 06:30:40,120 INVESTIGATORS YOU BROUGHT 8774 06:30:40,120 --> 06:30:42,920 FORWARD AND HAVE IDENTIFIED, AND 8775 06:30:42,920 --> 06:30:43,800 NEW OPPORTUNITIES FOR FUNDING, 8776 06:30:43,800 --> 06:30:46,360 IT'S VERY EXCITING TO ME. 8777 06:30:46,360 --> 06:30:49,560 AGAIN, I DO WHATEVER I CAN TO 8778 06:30:49,560 --> 06:30:50,480 SUPPORT YOUR EFFORTS, AND OF 8779 06:30:50,480 --> 06:30:52,200 COURSE SINCE I'M NO LONGER 8780 06:30:52,200 --> 06:30:53,920 EMPLOYED BY THE GOVERNMENT I CAN 8781 06:30:53,920 --> 06:30:56,240 MAKE A PLEA FOR INCREASED 8782 06:30:56,240 --> 06:30:58,320 FUNDING FOR THE ORWH WHICH I 8783 06:30:58,320 --> 06:30:59,600 COULDN'T DO WHEN I WAS REALLY 8784 06:30:59,600 --> 06:31:02,240 WORKING THERE BUT I CAN DO. 8785 06:31:02,240 --> 06:31:05,000 AND I HOPE THAT THOSE WHO ARE 8786 06:31:05,000 --> 06:31:07,440 YOUR SUPPORTERS AND ADVISORS 8787 06:31:07,440 --> 06:31:08,960 WILL DO THAT. 8788 06:31:08,960 --> 06:31:10,480 THERE WERE SUGGESTIONS ABOUT 8789 06:31:10,480 --> 06:31:11,680 RESEARCH, NEW RESEARCH 8790 06:31:11,680 --> 06:31:13,200 INITIATIVES. 8791 06:31:13,200 --> 06:31:15,080 SOME OF THOSE WE THOUGHT ABOUT 8792 06:31:15,080 --> 06:31:16,760 WHEN THE WOMEN'S HEALTH 8793 06:31:16,760 --> 06:31:18,600 INITIATIVE WAS FIRST -- RESULTS 8794 06:31:18,600 --> 06:31:19,600 WERE FIRST COMING OUT, KNOWING 8795 06:31:19,600 --> 06:31:21,840 WE NEEDED TO DO MANY OTHER 8796 06:31:21,840 --> 06:31:23,960 STUDIES TO GO BEYOND ESPECIALLY 8797 06:31:23,960 --> 06:31:26,920 LOOKING AT DIFFERENT 8798 06:31:26,920 --> 06:31:33,840 PREPARATIONS AND DIFFERENT 8799 06:31:33,840 --> 06:31:35,040 MANNERS OF ADMINISTERING 8800 06:31:35,040 --> 06:31:35,280 THERAPIES. 8801 06:31:35,280 --> 06:31:36,880 I REMEMBER WHEN THERE WERE NO 8802 06:31:36,880 --> 06:31:37,960 STUDIES ON MENOPAUSE. 8803 06:31:37,960 --> 06:31:40,080 DR. HEALEY CAME UP WITH THE IDEA 8804 06:31:40,080 --> 06:31:40,880 FOR THE WOMEN'S HEALTH 8805 06:31:40,880 --> 06:31:50,240 INITIATIVE AND GOT IT GOING. 8806 06:31:50,240 --> 06:31:51,400 450 STUDIES ON MENOPAUSE, THIS 8807 06:31:51,400 --> 06:31:53,640 WAS BACK IN THE EARLY '90s, 8808 06:31:53,640 --> 06:31:55,000 I'M SURE KNOLL THERE ARE MANY 8809 06:31:55,000 --> 06:31:56,480 MORE BUT WE CAN'T GET AWAY FROM 8810 06:31:56,480 --> 06:31:59,440 THAT AND WE SHOULD NOT GET AWAY 8811 06:31:59,440 --> 06:32:00,360 FROM THE FINDINGS, MONUMENTAL 8812 06:32:00,360 --> 06:32:02,240 FINDINGS OF THE WOMEN'S HEALTH 8813 06:32:02,240 --> 06:32:05,640 INITIATIVE BUT LOOKING BEYOND 8814 06:32:05,640 --> 06:32:08,560 THAT AS WE EXPAND, AS YOU EXPAND 8815 06:32:08,560 --> 06:32:08,840 RESEARCH. 8816 06:32:08,840 --> 06:32:10,880 I JUST AM VERY IMPRESSED AND 8817 06:32:10,880 --> 06:32:14,720 THRILLED WITH WHAT I HEARD 8818 06:32:14,720 --> 06:32:15,080 TOGETHER. 8819 06:32:15,080 --> 06:32:17,680 THE DIFFERENT VIEWPOINTS WERE 8820 06:32:17,680 --> 06:32:18,000 INFORMATIVE. 8821 06:32:18,000 --> 06:32:18,680 REALLY STIMULATING. 8822 06:32:18,680 --> 06:32:20,960 AND IF YOU'RE GOING TO CARRY OUT 8823 06:32:20,960 --> 06:32:22,600 THOSE NEW INITIATIVES AND THOSE 8824 06:32:22,600 --> 06:32:24,800 NEW RESEARCH AREAS THAT WERE 8825 06:32:24,800 --> 06:32:26,360 IDENTIFIED, THE OFFICE IS GOING 8826 06:32:26,360 --> 06:32:29,240 TO NEED ADDITIONAL FUNDING, WE 8827 06:32:29,240 --> 06:32:31,680 NEED TO DO WHAT WE CAN TO HELP 8828 06:32:31,680 --> 06:32:32,840 BRING ADDITIONAL SUPPORT TO THE 8829 06:32:32,840 --> 06:32:33,080 OFFICE. 8830 06:32:33,080 --> 06:32:36,000 SO THAT YOU CAN BE THE LEAD ON 8831 06:32:36,000 --> 06:32:40,440 THESE ISSUES AND LOOK AT SEX AND 8832 06:32:40,440 --> 06:32:41,400 GENDER FACTORS AFFECTING 8833 06:32:41,400 --> 06:32:43,480 MID-LIFE AREAS OF WOMEN AS WE 8834 06:32:43,480 --> 06:32:45,600 KNOW THAT HELPS PROJECT WHAT THE 8835 06:32:45,600 --> 06:32:47,800 LATER YEARS WILL BE. 8836 06:32:47,800 --> 06:32:49,760 I WAS DISAPPOINTED RECENTLY AS 8837 06:32:49,760 --> 06:32:52,880 I'M SURE MANY OF YOU HEARD WHEN 8838 06:32:52,880 --> 06:32:54,080 A NEWS ANCHOR SAID WOMEN WERE 8839 06:32:54,080 --> 06:32:56,280 ONLY IN THEIR PRIME IN THEIR 8840 06:32:56,280 --> 06:32:57,680 20s, 30s, 40s. 8841 06:32:57,680 --> 06:33:00,760 I'M THINKING, OH MY GOSH, THIS 8842 06:33:00,760 --> 06:33:02,200 GUY NEEDS TO BE ASSOCIATED WITH 8843 06:33:02,200 --> 06:33:03,840 ORWH SO WE CAN EXPLAIN TO HIM 8844 06:33:03,840 --> 06:33:05,240 THAT THAT WAS THE WHOLE PURPOSE 8845 06:33:05,240 --> 06:33:09,480 OF THE OFFICE TO LOOK BEYOND THE 8846 06:33:09,480 --> 06:33:10,080 REPRODUCTIVE YEARS AND 8847 06:33:10,080 --> 06:33:11,160 REPRODUCTIVE LIVES OF WOMEN AND 8848 06:33:11,160 --> 06:33:18,040 TO THINK HOW WOMEN IN THEIR 8849 06:33:18,040 --> 06:33:24,080 POST-MENOPAUSAL YEARS ARE 8850 06:33:24,080 --> 06:33:25,000 ACTIVE, LEADERS, CEOS, NOT 8851 06:33:25,000 --> 06:33:27,280 SITTING IN A ROCKING CHAIR ON 8852 06:33:27,280 --> 06:33:28,480 THE PORCH SO SOMETIMES I WISH 8853 06:33:28,480 --> 06:33:30,120 THAT'S WHAT I WAS DOING. 8854 06:33:30,120 --> 06:33:31,440 IT'S IMPORTANT TO IDENTIFY 8855 06:33:31,440 --> 06:33:33,560 HEALTH ISSUES AND WELLNESS FOR 8856 06:33:33,560 --> 06:33:36,160 WOMEN ACROSS THE LIFESPAN 8857 06:33:36,160 --> 06:33:36,800 ESPECIALLY POSTMENOPAUSAL YEARS. 8858 06:33:36,800 --> 06:33:38,560 JANINE, WE'LL DO WHAT WE CAN TO 8859 06:33:38,560 --> 06:33:39,640 BRING SUPPORT. 8860 06:33:39,640 --> 06:33:42,400 I CONGRATULATE YOU ON PUTTING 8861 06:33:42,400 --> 06:33:43,160 TOGETHER ANOTHER WONDERFUL 8862 06:33:43,160 --> 06:33:44,440 SYMPOSIUM AND I KNOW MEMBERS OF 8863 06:33:44,440 --> 06:33:46,440 THE OFFICE HAVE TO WORK TO PULL 8864 06:33:46,440 --> 06:33:47,080 IT TOGETHER. 8865 06:33:47,080 --> 06:33:49,480 I'M JUST THRILLED WITH IT. 8866 06:33:49,480 --> 06:33:50,680 THANK YOU FOR ATTACHING MY NAME 8867 06:33:50,680 --> 06:33:52,040 TO SUCH A WONDERFUL EVENT. 8868 06:33:52,040 --> 06:33:55,680 THANK YOU. 8869 06:33:55,680 --> 06:33:57,720 >> OF COURSE, IT IS OUR 8870 06:33:57,720 --> 06:34:00,280 PLEASURE TO RECOGNIZE ALL OF 8871 06:34:00,280 --> 06:34:01,040 YOUR AMAZING EFFORTS. 8872 06:34:01,040 --> 06:34:02,440 NONE OF US WOULD BE HERE WITHOUT 8873 06:34:02,440 --> 06:34:04,160 THE EFFORTS THAT YOU PUT IN 8874 06:34:04,160 --> 06:34:04,960 PLACE. 8875 06:34:04,960 --> 06:34:07,160 AND MANY OTHERS WHO WERE -- I 8876 06:34:07,160 --> 06:34:08,920 SAW ONE SLIDE, I THINK IT WAS 8877 06:34:08,920 --> 06:34:11,800 DR. WILD, THERE WERE MANY BRAVE 8878 06:34:11,800 --> 06:34:14,360 FOLKS OUT FRONT MAKING CHANGE 8879 06:34:14,360 --> 06:34:18,560 WHEN THIS WAS VERY DIFFICULT AND 8880 06:34:18,560 --> 06:34:20,200 WE'RE IN SOME SIMILAR CHALLENGES 8881 06:34:20,200 --> 06:34:22,480 THESE DAYS, THAT WE MIGHT NOT 8882 06:34:22,480 --> 06:34:24,440 HAVE ANTICIPATED, BUT WE DO ALL 8883 06:34:24,440 --> 06:34:25,280 BELIEVE PUTTING SCIENCE TO WORK 8884 06:34:25,280 --> 06:34:27,280 FOR THE HEALTH OF WOMEN IS WHERE 8885 06:34:27,280 --> 06:34:29,040 WE NEED TO PUT OUR EFFORTS. 8886 06:34:29,040 --> 06:34:33,000 AND THAT INCLUDES THE HELP OF 8887 06:34:33,000 --> 06:34:34,720 ALL WOMEN, AND OUR INTENTION 8888 06:34:34,720 --> 06:34:40,120 TODAY WAS BRING FOCUS ON 8889 06:34:40,120 --> 06:34:42,520 MENOPAUSE RESEARCH, MID-LIFE 8890 06:34:42,520 --> 06:34:44,880 WOMEN, OPTIMIZING HEALTH, HOW 8891 06:34:44,880 --> 06:34:45,360 HOW 8892 06:34:45,360 --> 06:34:46,640 MANY QUESTIONS AWAY HAVE. 8893 06:34:46,640 --> 06:34:50,200 NO ONE CAN DISAGREE THE WOMEN'S 8894 06:34:50,200 --> 06:34:53,400 HEALTH INITIATIVE REPRESENTED 8895 06:34:53,400 --> 06:34:54,240 AMAZING EXAMPLE OF ADDRESSING 8896 06:34:54,240 --> 06:34:56,640 NEEDS OF WOMEN THROUGH SCIENCE 8897 06:34:56,640 --> 06:34:58,640 AND RESEARCH AND INVESTMENTS. 8898 06:34:58,640 --> 06:35:00,080 THAT LANDMARK INVESTMENT 8899 06:35:00,080 --> 06:35:01,160 CONTINUES TO PAY OFF. 8900 06:35:01,160 --> 06:35:03,000 WE HAVE MORE QUESTIONS WE STILL 8901 06:35:03,000 --> 06:35:06,240 NEED TO ASK AND ANSWER. 8902 06:35:06,240 --> 06:35:07,440 WHY WOMEN EXPERIENCE DIFFERENT 8903 06:35:07,440 --> 06:35:11,120 SEVERITIES OF HOT FLASHES, HOW 8904 06:35:11,120 --> 06:35:13,880 THE MENOPAUSAL TRANSITION AND 8905 06:35:13,880 --> 06:35:15,320 CHRONOLOGICAL AGING SEPARATELY 8906 06:35:15,320 --> 06:35:18,800 AND TOGETHER INFLUENCE MID-LIFE 8907 06:35:18,800 --> 06:35:19,160 HEALTH. 8908 06:35:19,160 --> 06:35:21,160 SO MANY QUESTIONS WE HAVE, WE 8909 06:35:21,160 --> 06:35:22,640 WANT TO SEE THOSE ADDRESSED. 8910 06:35:22,640 --> 06:35:24,880 THE TAG LINE PUTTING SCIENCE TO 8911 06:35:24,880 --> 06:35:26,520 WORK FOR THE HEALTH OF WOMEN, 8912 06:35:26,520 --> 06:35:28,480 THAT'S WHAT WE NEED TO DO ACROSS 8913 06:35:28,480 --> 06:35:29,640 THE BOARD. 8914 06:35:29,640 --> 06:35:33,200 I THANK DR. SARAH TEMKIN AT ORWH 8915 06:35:33,200 --> 06:35:36,280 FOR LEADING THE PLANNING OF THIS 8916 06:35:36,280 --> 06:35:36,520 SESSION. 8917 06:35:36,520 --> 06:35:37,600 WITH THE CLINICAL RESEARCH 8918 06:35:37,600 --> 06:35:39,880 SECTION AT ORWH AND PLANNING 8919 06:35:39,880 --> 06:35:41,120 COMMITTEE WHICH REPRESENTED 8920 06:35:41,120 --> 06:35:42,520 INDIVIDUALS FROM VARIOUS 8921 06:35:42,520 --> 06:35:44,120 INSTITUTES AND CENTERS AND 8922 06:35:44,120 --> 06:35:44,320 OFFICES. 8923 06:35:44,320 --> 06:35:46,160 I ACKNOWLEDGE ALL OF THE 8924 06:35:46,160 --> 06:35:50,160 SPEAKERS FOR SHARING YOUR 8925 06:35:50,160 --> 06:35:55,200 PERSPECTIVES, DR. WILD AND DR. 8926 06:35:55,200 --> 06:35:57,160 MANSON, INCREDIBLE BOOK ENDS, 8927 06:35:57,160 --> 06:35:58,520 WITH THE KEYNOTE AND BRINGING IT 8928 06:35:58,520 --> 06:36:00,000 ALL TOGETHER AT THE END. 8929 06:36:00,000 --> 06:36:03,640 I WANT TO ACKNOWLEDGE OUR 8930 06:36:03,640 --> 06:36:04,840 COMMUNICATIONS CONTRACTORS AND 8931 06:36:04,840 --> 06:36:06,520 COLLEAGUES FOR MANAGING AND 8932 06:36:06,520 --> 06:36:09,040 LOGISTICAL SUPPORT, FOLKS BEHIND 8933 06:36:09,040 --> 06:36:12,520 THE SCENES WHO DON'T GET 8934 06:36:12,520 --> 06:36:13,280 ACKNOWLEDGED. 8935 06:36:13,280 --> 06:36:14,120 EVERYONE ATTENDING, THANK YOU 8936 06:36:14,120 --> 06:36:15,720 FOR JOINING AND STAYING ON ALL 8937 06:36:15,720 --> 06:36:15,960 DAY. 8938 06:36:15,960 --> 06:36:19,320 THERE'S SO MUCH YET TO LEARN BUT 8939 06:36:19,320 --> 06:36:20,760 THERE'S INCREDIBLE ADVANCES MADE 8940 06:36:20,760 --> 06:36:22,280 BECAUSE WE HAVE INVESTED IN 8941 06:36:22,280 --> 06:36:23,400 HEALTH OF WOMEN AND RESEARCH ON 8942 06:36:23,400 --> 06:36:24,480 THE HEALTH OF WOMEN. 8943 06:36:24,480 --> 06:36:27,760 I WILL END BY THANKING YOU, 8944 06:36:27,760 --> 06:36:29,520 VIVIAN, FOR BEING THE GODMOTHER 8945 06:36:29,520 --> 06:36:31,560 OF WOMEN'S HEALTH RESEARCH AND 8946 06:36:31,560 --> 06:36:33,840 MAKING IT POSSIBLE FOR ALL OF US 8947 06:36:33,840 --> 06:36:35,920 TO BE HERE. 8948 06:36:35,920 --> 06:36:40,280 WE NEED TO CONTINUE THIS FIGHT. 8949 06:36:40,280 --> 06:36:41,680 SCIENCE, WE BELIEVE SCIENCE WILL 8950 06:36:41,680 --> 06:36:42,640 SOLVE SOCIETY'S PROBLEMS, WE 8951 06:36:42,640 --> 06:36:44,200 HAVE TO HAVE SCIENCE IN PLACE TO 8952 06:36:44,200 --> 06:36:45,720 DO THAT. 8953 06:36:45,720 --> 06:36:48,000 THANK YOU ALL, SPEAKERS. 8954 06:36:48,000 --> 06:36:50,280 THANK YOU, DR. PINN, FOR PAVING 8955 06:36:50,280 --> 06:36:53,440 THE WAY FOR THE ROAD. 8956 06:36:53,440 --> 06:36:54,360 FIRST IS HARD. 8957 06:36:54,360 --> 06:36:56,400 AND WE APPRECIATE IT GREATLY. 8958 06:36:56,400 --> 06:36:58,400 THANKS, EVERYONE, FOR JOINING 8959 06:36:58,400 --> 06:36:59,560 US. 8960 06:36:59,560 --> 06:37:06,200 DR. 8961 06:37:06,200 --> 06:37:08,760 DR. TEMKIN, ANY LAST WORDS? 8962 06:37:08,760 --> 06:37:12,080 >> I WANT TO REITERATE THANKS, 8963 06:37:12,080 --> 06:37:13,880 AND THANKS ALL THE SPEAKERS AND 8964 06:37:13,880 --> 06:37:15,520 THE AUDIENCE FOR JOINING US. 8965 06:37:15,520 --> 00:00:00,000 >> THANK YOU, EVERYONE.