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Scientific & Poster Abstracts ABSTRACT PRESENTATIONS THURSDAY CONCURRENT SESSION #1 adjusted for age, marital status, family income, race/ethnicity, education level, type of employment, physical activity, self-rated health, Selective Serotonin Reuptake Inhibitor (SSRI) use, depression, hysterectomy, chronic disease (hypertension, cardiovascular S-1. disease, rheumatoid arthritis, congestive heart failure, breast cancer, ovarian cancer, Influence of Reproductive Hormones and Nighttime Hot Flashes on Mood cervical cancer), menopausal hormone therapy, exercise, smoking, body mass index, in Depressed Perimenopausal Women reporting Stressful Life Events and alcohol use. Results: 48,396 (52%) participants reported sexual activity with a Hadine Joffe, MD, MSc2,1, Sybil Crawford, PhD3, Marlene P. Freeman, M.D.1, Geena partner within the last year and 52,250 (56%) reported being somewhat or very satisfied Athappilly, M.D.2, Wolfe David, MD, MPH2, Semmie Kim2, Thania Galvan2, Julia with their current sexual activity. Problematic insomnia was reported by 28,546 (30%). Camuso2, Freid Cathryn2, Lee S. Cohen, MD1, Janet Hall4. 1Psychiatry - Center for Participants with problematic insomnia were less sexually active than those not reporting Women’s Mental Health, Massachusetts General Hospital, Boston, MA; 2Psychiatry - problematic insomnia (49.7% vs. 53.3%, p-value <0.0001), and more were unsatisfied Women’s Hormones and Aging Research Program, Brigham and Women’s Hospital, with their sexual activity (35.9% vs 29.7%, p-value <0.0001). The odds of sexual activity Boston, MA; 3School of Medicine, University of Massachusetts, Worcester, MA; and sexual satisfaction were higher in women reporting no problematic insomnia vs. 4Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA problematic insomnia (OR 1.20, 95% CI 1.05 – 1.37 and OR 1.19, 95% CI 1.07 -1.33). Objective: The perimenopause is a period of increased risk for depression. Estradiol Conclusion: Our results indicate an association between problematic insomnia as defined variability, hot flashes, and stressful life events each increase the risk for depressive by the WHIIRS and self-reported partnered sexual activity and sexual satisfaction. symptoms during this time period. However, the relative contribution of these factors to Longitudinal investigation of sleep and its impact on sexual function during menopause depressive symptom severity in depressed perimenopausal women is not well understood. would help clarify this relationship further. We hypothesized that estradiol variability and nighttime hot flashes would independently predict worse mood in depressed perimenopausal women. Design: Perimenopausal women with mild depression (Montgomery-Åsberg Depression Rating Scale [MADRS] S-3. score 10–24) completed assessments of mood, serum estradiol and progesterone weekly The Prevalence of Insomnia in Perimenopausal Women Transitioning for 9 weeks, as well as a stressful life event survey and a daily hot flash diary. Repeated- to Menopause measure regression was used to examine independent associations of mood with the Colleen L. Ciano, PhD1, Tonya King, PhD3, Judith Hupcey, Ed.D2, Kristen Kjerulff, coefficient of variability in estradiol, the number of distinct progesterone elevations PhD3, Robin Redmon Wright, PhD4, Amy Sawyer, PhD2. 1School of Nursing, University exceeding 6 nl/dl, and hot flashes, while accounting for recent stressful life events. of Pennsylvania, Lancaster, PA; 2College of Nursing, The Pennsylvania State University, Results: Among 51 perimenopausal participants with a mean age of 48.2yrs, menopause State College, PA; 3Public Health Sciences, The Pennsylvania State University, Hershey, status was evenly divided between the early and late menopause transition. The mean PA; 4School of Behavioral Science and Education, The Pennsylvania State University, baseline MADRS score was 15.4 reflecting mild-to-moderate depressive symptom levels, Harrisburg, PA 84% of women reported experiencing hot flashes, and 88% reported recent stressful life Objective: Background/Significance: Insomnia in adults contributes to poor health events. During the study period, 90% had variable but detectable estradiol levels while outcomes such as myocardial infarction and obesity. Empiric evidence consistently 10% were persistently hypo-estrogenic; 61% never had a progesterone elevation, while suggests a predisposition to insomnia in women; yet, there is a paucity of research that the remaining 39% had at least one distinct elevation. Fewer progesterone elevations addresses the insomnia trajectory in a high-risk group of women – perimenopausal (p<0.001), greater variability in estradiol (p=0.049), and stressful life events (p=0.06) women transitioning to menopause. Perimenopause will affect 500 million women were associated with higher depression scores in univariate models. In adjusted models, within the next decade. Quantitative studies related to perimenopause and individual MADRS scores were lower in women who had episodic elevations of progesterone sleep symptoms are abundant yet scientists have yet to frame the insomnia trajectory (p<0.001), while greater variability in estradiol increased MADRS scores in the in perimenopausal women transitioning to menopause. The study purpose was to absence (p<0.001), but not the presence (p=0.80), of episodic progesterone elevation. describe the prevalence of insomnia in all perimenopausal women progressing naturally Nighttime (but not daytime) hot flashes were associated with higher MADRS scores to menopause. Design: Theoretical Framework: An adaptation of the Spielman 3 in women with persistent hypo-estrogenism (p=0.001), but were not associated with P Model of Insomnia and the Symptom Management Theory were used to guide this depressive symptom severity in those with detectable estradiol levels (p=0.22). Stressful study. The SMT and 3 P Model of Insomnia, when combined, address the essence of life events were not associated with depression symptom severity in adjusted models. the subjective and objective experience of sleep complaints among perimenopausal Conclusion: In perimenopausal depressed women, increasing dysregulation of ovarian women. Methods: A secondary analysis of publically-available data from the Study hormones with greater estradiol variability and loss of ovulation indicated by absence of Women’s Health Across the Nation (SWAN), a multisite, longitudinal study of the of progesterone production is associated with worse mood. In addition, nighttime hot natural history of menopause (n=3302) was conducted. Baseline and 13 annual data flashes are associated with higher depression scores among those who are persistently collection points inclusive of survey and biophysical data were completed. Survey data hypo-estrogenic. These menopause-specific correlates of depression are strongly linked from perimenopausal women, including perimenopausal stages and sleep symptoms, with worse mood after accounting for stressful life events. were used to examine the insomnia trajectory, defined by American Academy of Sleep Medicine (AASM) insomnia criteria. The primary outcome variables were four sleep complaints: difficulty falling asleep, sleep latency [SL], awakenings from sleep [A], S-2. wake after sleep onset [WASO], and sleep quality [SQ]. Descriptive analysis of all Association of Sleep and Sexual Function in Postmenopausal Women variables for each study interval was completed. Repeated measures logistic regression Juliana M. Kling, MD, MPH10, JoAnn E. Manson, MD, DrPh8, Michelle J. Naughton, was used to identify if insomnia symptoms (SL, WASO, A, SQ) change over time by Ph.D., MPH1, M’hamed Temkit, Ph.D.2, Shannon D. Sullivan, MD, PhD3, Emily W. perimenopausal stage (Table 1). Multivariable logistic regression models were used Gower, Ph.D.4, Lauren Hale, Ph.D.5, Julie C. Weitlauf, Ph.D.6, Sara Nowakowski, Ph.D.9, to identify predictors of influence on chronic insomnia. Results: Results: The sample Carolyn J. Crandall, MD, MS7. 1Department of Internal Medicine, Ohio State University, (n=3302) were middle aged (45.9 + 2.69) women at baseline survey. Insomnia was Columbus, OH; 2Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ; present in a third or more of perimenopausal women at any point in the transition period 3Division of Endocrinology, Medstar Washington Hospital Center and Georgetown (31%-42%). Awakenings (A) were the most frequently reported insomnia symptom University, District of Columbia, DC; 4Department of Epidemiology and Opthalmology, (31%); SL was least frequently reported (14%); and WASO (15%) was reported half as Wake Forest School of Medicine, Winston-Salem, NC; 5Program in Public Health, Stony often as A. SQ (restless or very restless sleep) did not significantly worsen by self-report Brook University, Stony Brook, NY; 6Department of Medicine, Stanford University over the ten year study period. Insomnia symptoms were worse and more prevalent in School of Medicine, Palo Alto, CA; 7Department of Medicine, David Geffen School the late stage of perimenopause. The odds of having any one symptom of insomnia were of Medicine at University of California, Los Angeles, Los Angeles, CA; 8Department 1.3 times greater for those in late stage versus early stage of perimenopause (95% CI of Medicine, Brigham and Women’s Hospital, Harvard, Boston, MA; 9Department (1.2, 1.5); p<0.001). The odds of developing chronic insomnia were 1.5 times greater for of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX; those in
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