The Study of Women's Health Across the Nation (SWAN): The Impact of Midlife and the Menopause Transition on Health and Functioning in Early Old Age

PROJECT SUMMARY
This U19 application, referred to as SWAN-Aging, is designed to determine the extent to which midlife health,
and specifically the menopause transition (MT), affects successful aging in women. This proposal capitalizes
on the rich resources of the Study of Women's Health Across the Nation (SWAN), a longitudinal cohort study
initiated in 1994 to characterize the physiological and psychosocial changes that occur during the MT. A total
of 3302 Black, Chinese, Japanese, Hispanic and White women were enrolled at seven sites, with 74% of still-
living women completing up to 16 visits spanning the pre-menopause to post-menopause. SWAN has
described the natural history of the MT -- its timing, patterns of hormonal changes, and symptoms – and their
relation to midlife health indicators. In SWAN-Aging, we will extend follow-up of the SWAN cohort into early old
age (66-75 years) and will prospectively link comprehensive longitudinal characterization of both the MT and
midlife health indicators to functioning and health across multiple domains in early old age, a pivotal time of
transition into old age when adverse changes in health and functioning begin to accumulate. The global
specific aims of this U19 application are to: 1) determine the impact of MT characteristics and trajectories of
midlife health indicators on the preservation of cognitive, physical, genitourinary, sexual, and psychosocial
function and sleep in early old age; 2) determine the impact of MT characteristics and trajectories of midlife
health indicators on risk of adverse health outcomes, including falls, osteoporosis and fractures, poor
cardiometabolic function, cardiovascular events and early mortality; 3) determine if racial/ethnic disparities in
health and functioning in early old age are attributable to midlife racial/ethnic differences in MT characteristics
and midlife health indicators; and 4) translate the SWAN and SWAN-Aging findings for women and their health
care providers. These aims will be achieved through three integrated scientific Projects that are organized
around key health domains (functioning, cardiometabolic health and musculoskeletal health) and linked by a
common focus on MT characteristics and midlife changes in health indicators as key exposures. The three
Projects will be supported by three Cores which will a) provide the necessary organizational infrastructure to
conduct this study and to disseminate results to the research and medical communities; b) conduct accurate,
high volume assays, adopting new methods as needed to provide state-of-the-art laboratory data, and c)
oversee the design and conduct of the core clinic visit, data collection and data management, and the creation
of the analytic datasets. SWAN-Aging will include one clinic visit and a National Death Index search to ensure
complete mortality ascertainment for the cohort. SWAN-Aging is uniquely positioned to fill important scientific
gaps in understanding of the impact of the MT and midlife indicators on women's health and functioning in
early old age and to facilitate the application of new knowledge to clinical practice. This study will provide
valuable insights into modifiable factors relevant to the design of future prevention and treatment programs.

Grant Number: 5U19AG063720-04
NIH Institute/Center: NIH
Principal Investigator: Maria Brooks