The Study of Women's Health Across the Nation (SWAN) is a 7-center multi-ethnic longitudinal study designed to characterize the physiological and psychosocial changes that occur during the menopausal transition. SWAN has amassed ten years of data about endocrinology of the transition and other factors relevant to midlife health and aging. As SWAN requests its fourth competing renewal, the study itself proposes to transition from a study of the menopause to a study of aging in women. The average age of participants at the beginning of the SWAN IV project will be 59 years (54 to 65) and SWAN IV will follow these women through the age range of 59 to 70. SWAN has the unprecedented capability to link the expansive biological, medical, social, behavioral, and demographic data it has collected during mid-life and the menopausal transition to the development of both positive and adverse health states in early oldage. The primary objectives of SWAN IV are to: 1) Characterize the endocrinology and symptomotology of the post-menopause (2 to 12 years after final menses);2) Ascertain additional health outcomes (such as measured physical performance) that are relevant to the early old age range and that may be affected by the factors that we have studied in mid-life and 3) Understand the relations between the mid-life and menopausal transition experience of women and subsequent positive and negative health outcomes. To accomplish this, the investigators propose annual phone contact to closely track menopausal status, menopausal symptoms and selected health events. In addition, two in-person clinic visits are proposed to accomplish detailed physical measures of early disease. The major thematic areas of SWAN IV include 1) Physical Functioning;2) Bone/Osteoporosis;3) Cognitive Function/ Symptoms/ Mental Health and 4) Cardiovascular. New areas for SWAN include physical performance and osteoarthritis, history of major depression, and carotid wall thickness. SWAN will continue to monitor symptoms, cognition, cardiovascular risk factors, endocrinology, bone density and fractures. SWAN IV will advance our understanding of how modifiable risk factors related to the menopause transition are linked to sub-clinical disease measures and hard outcomes. This may lead to improved strategies for the primary prevention of disease in women.

Public Health Relevance

SWAN has compiled the most comprehensive characterization to date of the health and the physiologic and psychosocial changes of women from pre- to postmenopause in community based samples. Of particular public health importance is that the continuation of SWAN will permit the study to increase understanding of the effects of these menopause-related changes on subsequent health and risk factors for age-related diseases.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project--Cooperative Agreements (U01)
Project #
Application #
Study Section
Special Emphasis Panel (ZAG1-ZIJ-8 (J3))
Program Officer
Rossi, Winifred K
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
Zheng, Huiyong; Harlow, Siobán D; Kravitz, Howard M et al. (2015) Actigraphy-defined measures of sleep and movement across the menstrual cycle in midlife menstruating women: Study of Women's Health Across the Nation Sleep Study. Menopause 22:66-74
Greendale, Gail A; Tseng, Chi-Hong; Han, Weijuan et al. (2015) Dietary isoflavones and bone mineral density during midlife and the menopausal transition: cross-sectional and longitudinal results from the Study of Women's Health Across the Nation Phytoestrogen Study. Menopause 22:279-88
Matthews, Karen A; Chang, Yuefang; Kravitz, Howard M et al. (2014) Sleep and risk for high blood pressure and hypertension in midlife women: the SWAN (Study of Women's Health Across the Nation) Sleep Study. Sleep Med 15:203-8
Crandall, C J; Han, W; Greendale, G A et al. (2014) Socioeconomic status in relation to incident fracture risk in the Study of Women's Health Across the Nation. Osteoporos Int 25:1379-88
Khan, Unab I; Wang, Dan; Karvonen-Gutierrez, Carrie A et al. (2014) Progression from metabolically benign to at-risk obesity in perimenopausal women: a longitudinal analysis of study of women across the nation (SWAN). J Clin Endocrinol Metab 99:2516-25
Hale, Lauren; Troxel, Wendy M; Kravitz, Howard M et al. (2014) Acculturation and sleep among a multiethnic sample of women: the Study of Women's Health Across the Nation (SWAN). Sleep 37:309-17
Brown, Charlotte; Bromberger, Joyce T; Schott, Laura L et al. (2014) Persistence of depression in African American and Caucasian women at midlife: findings from the Study of Women Across the Nation (SWAN). Arch Womens Ment Health 17:549-57
Mori, T; Ishii, S; Greendale, G A et al. (2014) Physical activity as determinant of femoral neck strength relative to load in adult women: findings from the hip strength across the menopause transition study. Osteoporos Int 25:265-72
Karvonen-Gutierrez, Carrie A; Harlow, Sioban D; Jacobson, Jon et al. (2014) The relationship between longitudinal serum leptin measures and measures of magnetic resonance imaging-assessed knee joint damage in a population of mid-life women. Ann Rheum Dis 73:883-9
Gibson, Carolyn; Matthews, Karen; Thurston, Rebecca (2014) Daily physical activity and hot flashes in the Study of Women's Health Across the Nation (SWAN) Flashes Study. Fertil Steril 101:1110-6

Showing the most recent 10 out of 261 publications