This CDA will provide the candidate the opportunity to enact a comprehensive training plan that will enable her to become an independent, interdisciplinary research investigator with specific expertise in the area of female reproductive aging, a topic of enormous public health concern in light of the rapidly increasing number of American women entering menopause each year. Menopause marks a time of significant change not only in a woman's reproductive status but also in her health more generally. Women entering menopause are at increased risk for several chronic diseases which account for a significant morbidity and mortality burden. In this regard, elucidating factors that explain variance in the timing of menopause onset is of critical importance. Emerging evidence shows that psychosocial factors, including lower socioeconomic status (SES) and depression history, are related prospectively to earlier onset menopause. The relation of these factors to the reproductive aging process underlying menopause onset, however, is not known. Here, psychosocial factors will be examined in relation to ovarian aging, indexed by antral follicle count (AFC), in a sample of healthy, reproductive age women (N = 850). Specifically, the candidate will utilize her CDA training experiences in the areas of the epidemiology of women's health, reproductive endocrinology, and psycho-neuroendocrinology to conduct 2 studies that stem from an ongoing funded research study at the University of California San Francisco. Study 1 aims (1) to examine SES over the life course (periods of childhood, adolescence, adulthood) in relation to ovarian aging, (2) to examine the potential behavioral/psychosocial mediators of SES effects on ovarian aging, and (3) to determine whether SES effects on ovarian aging differ across women of various ethnic backgrounds. Study 2 aims to determine (1) whether women with Major Depressive Disorder (N = 50) exhibit accelerated ovarian aging compared to never-depressed women (N = 50) and (2) whether disruptions in the regulation of the female reproductive system by the hypothalamic-pituitary-gonadal (HPG) axis and its interaction with the hypothalamic-pituitary-adrenal (HPA) axis may explain this difference. Life course SES and psychiatric diagnoses will be assessed by structured interviews, psychosocial factors by standardized self-report questionnaires, AFC by transvaginal ultrasound, and HPG and HPA function by salivary measures of estradiol and cortisol, respectively. Results will elucidate possible modifiable risk factors for accelerated ovarian aging underlying earlier onset menopause.
The proposed studies are the first to examine psychosocial factors in relation to variability in ovarian aging. This work will make an important contribution to the identification of women who are at increased risk for accelerated reproductive aging and will illuminate potential areas for intervention to delay menopause onset. This contribution is underscored by the significant health burden conferred by earlier onset menopause.
|Bleil, Maria E; Gregorich, Steven E; Adler, Nancy E et al. (2014) Race/ethnic disparities in reproductive age: an examination of ovarian reserve estimates across four race/ethnic groups of healthy, regularly cycling women. Fertil Steril 101:199-207|
|Bleil, Maria E; Gregorich, Steven E; McConnell, Daniel et al. (2013) Does accelerated reproductive aging underlie premenopausal risk for cardiovascular disease? Menopause 20:1139-46|
|Bleil, Maria E; Adler, Nancy E; Pasch, Lauri A et al. (2011) Adverse childhood experiences and repeat induced abortion. Am J Obstet Gynecol 204:122.e1-6|