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Consistent ovulation may not be enough to make women healthy when approaching menopause: an update from the Study of Women’s Health Across the Nation

Allshouse, Amanda A. MS1; Polotsky, Alex MD, MS2; Crawford, Sybil PhD3; Chen, Hsiang-Yu MS4; El Khoudary, Samar R. PhD, MPH4; Santoro, Nanette MD2

doi: 10.1097/GME.0000000000000314
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Objective This study aims to test the hypothesis that consistently ovulatory premenopausal/perimenopausal women have a more favorable cardiometabolic profile than anovulatory women.

Methods The first four collections from the Study of Women’s Health Across the Nation Daily Hormone Study (DHS) were used. DHS enrollees annually completed a daily collection of first morning voided urine for an entire menstrual cycle or up to 50 days (whichever comes first). A woman was categorized as consistently ovulatory annually (COA) if four ovulatory cycles or two to three ovulatory cycles followed by the final menstrual period (FMP) were observed. A woman was categorized as not consistently ovulatory annually (nCOA) if at least one anovulatory year was observed. Cross-sectional and longitudinal differences were compared between COA and nCOA women. Data were centered at FMP and adjusted for age and body mass index (BMI).

Results Six hundred thirty-six DHS participants (mean [SD] age, 47.3 [2.5] y; mean [SD] BMI, 27.4 [7.1] kg/m2) were included. Thirty-six percent of the DHS participants were COA women. On the fourth follow-up collection, COA women had lower high-density lipoprotein than nCOA women (mean [95% CI], 55.7 [54.0-57.4] vs 59.5 [57.9-61.0] mg/dL, P = 0.002, respectively), which persisted after adjustment. Among 460 women with FMP, 39% were COA women. COA women were slightly older (52.9 vs 52.0 y, P = 0.002) and had lower BMI (geometric mean, 26.1 vs 27.5 kg/m2, P = 0.06) than nCOA women at FMP. Other cardiometabolic factors did not significantly differ by COA status through FMP.

Conclusions Consistent ovulation across the menopausal transition does not seem to reflect superior cardiometabolic health.

From the 1Department of Biostatistics and Informatics, School of Public Health, and 2Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO; 3Department of Epidemiology, Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA; and 4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.

Received May 14, 2014; revised and accepted July 1, 2014.

The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, National Institute of Nursing Research, Office of Research on Women’s Health, or NIH.

Funding/support: The Study of Women’s Health Across the Nation received grant support from the National Institutes of Health (NIH), Department of Health and Human Services, through the National Institute on Aging, National Institute of Nursing Research, and NIH Office of Research on Women’s Health (grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, and U01AG012495).

Financial disclosure/conflicts of interest: A.A.A., H.-Y.C., S.C., S.R.E.K., and A.P. have no conflicts of interest to disclose. N.S. has stock options in Menogenixand has received investigator-initiated grant support from Bayer Inc.

Address correspondence to: Amanda A. Allshouse, MS, Department of Biostatistics and Informatics, School of Public Health, University of Colorado Denver, Campus Box B119-406, 12477 E 19th Avenue, Aurora, CO 80045. E-mail: Amanda.Allshouse@UCdenver.edu

© 2015 by The North American Menopause Society.