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 a baseline and six annual follow-up examinations during which 895 (48%) women will have transitioned to postmenopause. This application requests funding to complete four additional follow-up visits (SWAN III) to allow an adequate evaluation of the late perimenopause and early postmenopause, a period that has not been well studied, particularly among non-white women. We will continue our current tracking of changes in reproductive hormones, bleeding patterns, symptoms, bone loss, cardiovascular (CV) risk factors blood pressure, body size, and other related characteristics and will undertake new scientific endeavors in targeted areas. These include measurement of vascular stiffness to assess early CV disease, assessment of vertebral morphometry at four sites using DEXA technology, and the addition of one cognitive function test. In addition, we will focus on linking the midlife experience to age-related outcomes (e.g. cognitive function, urinary incontinence) and chronic diseases (e.g. fractures, diabetes and hypertension). Specimens from the additional follow-up visits will continue to contribute to the SWAN biological specimen repository (annual blood and urine samples as well as DNA and immortalized cells). This is a separately funded component that broadens the opportunities to address future hypotheses about health and disease in aging women. 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 examination schedule with mail and telephone contact in the alternating years. This will permit cost-effective and less intensive follow-up. SWAN's organization and operations have been modified to enhance productivity and we are poised to publish important biological, symptom and behavioral results pertaining to the menopause transition. With SWAN III, many of the original goals of SWAN will be brought to fruition. We will build upon the rich foundation developed during SWAN I and II and link these data to important menopause-related and health outcomes in SWAN III.
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