The Study of Women's Health Across the Nation (SWAN) is a multicenter, multiethnic, community based longitudinal study designed to characterize the biological, symptomatic and psychosocial changes that occur during the menopausal transition and the effects of these changes on women's health during and after the transition. Current and prior funding (SWAN I and II) has supported seven years of follow-up, at the end of which 60%of observable transitions to postmenopause will have occured. This competitve renewal application (SWAN III) requests funding to complete 10 cohort follow-up visits. This will allow us to capture 91% of observable transitions to postmenopause and obtain a more representative sample. The additional data will a focus on the late perimenopausal and early postmenopausal periods that have not been well studied. As women reach the end of early postmenopause (two years following the final menstrual period), we will shift from an annual to a bi-annual follow-up schedule with mail and telphone contact in the alternating years. This will set the stage for cost-effective and less intensive follow-up beyond SWAN III. We will continue our current observations and undertake new science in each of the four scientific project areas (ovarian aging; symptoms, risk factors, functioning and aging; cardiovascular risk factors; and determinants and outcomes of bone mass). New science includes measurement of vascular stiffness to assess early cardiovascular disease, vertebral morphometry using newly developed DEXA technology bone and body composition and circulating androgens as markers androgen biosynthesis. The latter will use an assay system developed by SWAN investigators. In addition, we will focus on linking the menopause and midlife experiences to age-related outcomes and chronic diseases, including physical and cognitive function. The additional follow-up will contribute to and expand the SWAN biological specimen repository (annual blood and urine samples as well as DNA and immortalized cells), a separately funded component that provides opportunities to address future hypotheses about health, disease, and aging. SWAN III will allow us to bring to fruition many of the original goals of SWAN. By building upon the rich foundation developed during SWAN I and II, and ultimately linking these data to age-related health outcomes, we will achieve unparalleled new insights into the role of the menopause on the health of American women.
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