Slim Down to Reduce Hot Flashes

Losing weight has been linked to numerous health benefits, but new research now shows another, added bonus: weight loss may also help to reduce the number of hot flashes in menopausal women.

A study recently published online in the journal of The North American Menopause Society, followed 40 overweight or obese women with hot flashes. The women represented in the study were both white and African-American. Hot flashes were assessed prior to and after the weight loss. The study confirmed that weight loss can hot flashes are associated, and a greater degree of weight loss is correlated with a degree of reduction in hot flashes.

A larger study with more data would help establish the degree of benefit, but for now the this new study confirms that healthy weight loss can remedy some hot flashes. If you are seeking help for your hot flashes, talk to your physician to discuss therapies and strongly consider incorporating a healthier lifestyle if needed. Visit Northwestern’s menopause website here for more answers on hot flashes, therapies, and ideas of health-promoting behavior.


Source: The above is based on recent press release from The North American Menopause Society.

Rebecca C. Thurston, Linda J. Ewing, Carissa A. Low, Aimee J. Christie, Michele D. Levine. Behavioral weight loss for the management of menopausal hot flashesMenopause, 2014; 1 DOI: 10.1097/GME.0000000000000274

Review: The Supreme Court Contraception Mandate Cases

On March 25, the Supreme Court heard arguments regarding challenges to the contraception mandate of the Affordable Care Act, with a decision expected to come down in late June. Here’s a rundown of the main aspects of this important case:

What is being challenged?

Under the contraception mandate in the Affordable Care Act, employers are required to provide employees with comprehensive health insurance, including a range of contraceptive methods for women. Organizations exempt from this mandate include small employers that are not required to provide any health insurance to employees, religious organizations and organizations with select insurance plans that were grandfathered in. Religiously-affiliated non-profit organizations may request exemptions as well. The main issue being decided is whether for-profit organizations can choose not to cover contraceptive care in health insurance plans based on religious objections. This comes down to the scope of the Religious Freedom Restoration Act of 1993 (RFRA), which currently does not apply to for-profit corporations.

Who is challenging the law?

The cases were brought by two for-profit corporations, that while not religious or religiously-affiliated, claim to operate based on religious principles. The corporations are Hobby Lobby, a craft store chain based in in Oklahoma City and owned by a Christian family, and Conestoga Wood Specialties, a Pennsylvania-based company that makes wood cabinets and is owned by a Mennonite family.

Why is the law being challenged?

The corporations challenging the contraception mandate believe that certain forms of birth control drugs and devices, including the morning after pill and IUDs, are equivalent to abortion because they may prevent embryos from implanting in the uterus. As such, they believe that covering the cost of these forms of contraception makes the them complicit with abortion. The corporations do not oppose all forms of birth control, including condoms, diaphragms, sponges, certain drugs and sterilization.

How is the administration defending the law?

Donald B. Verrilli, Jr., the current solicitor general who is representing the U.S. administration, has stated that the law offering comprehensive contraceptive care to women promotes public health and ensures equal access to healthcare for women. He also emphasized that it should be doctors, not employers, who should decide the best form of contraception for women. Additionally, a brief from the Guttmacher Institute points out that many women cannot afford highly effective forms of birth control, and so upholding the law will reduce unplanned pregnancy and abortions.

What are the potential outcomes and implications of the decision?

There are many ways the decision could go, each with varying repercussions. If the Supreme Court decides the RFRA does not cover for-profit organizations, it will end those organizations’ ability to challenge the contraception mandate based on religious beliefs. The Supreme Court could decide the RFRA does apply to for-profit organizations, but still rule on the side of the administration. This would be a less decisive win for the administration that would likely lead to more challenges. If the Supreme Court rules in favor of Hobby Lobby and Conestoga Wood Specialties, it will impact women’s access to affordable birth control, while opening the door to other religious objections raised by employers, such as hiring gay and lesbian individuals, or offering benefits to same sex spouses.

For more information, see the sources below:

Liptak, Adam. “Supreme Court Hears Cases on Contraception Rule.”  The New York Times. 25 March 2014.
Totenberg, Nina. “Supreme Court Justices Divide by Gender in Hobby Lobby Contraception Case.” NPR. 25 March 2014.

Fuller, Jaime.  “Here’s What You Need to Know About the Hobby Lobby Case.” The Washington Post. 24 March 2014.
“Health Care Law’s ‘Contraception Mandate’ Reaches the Supreme Court.”  Pew Research: Religion and Public Life Forum. 20 March 2014.

The Link between Mental Health and Aging: Keeping the Brain Young

By: Christie Hunter

It is becoming a concern in many sectors that the population is aging as the baby boomers are one of the largest segments of the population. One of the parts of this is looking at cognitive ability and mental health in this demographic.  Helping people in their later years to maintain both physical and mental health is a public health issue. Older people are prone to depression and dementia, and research is showing that there are steps that can be taken to help alleviate the symptoms of both of these. This article will highlight some of the research and what this research points to in regard to preventing cognitive decline.

Zanjani, Kruger, and Murray (2012), discuss the organization Mental Healthiness Aging Initiatives.  This organization promotes education, awareness and action in regard to mental health in elderly rural adults. They have found that mental health problems and drug use can be problems found in this population.  In addition, 50% of this demographic may suffer from depression which has been found to decrease life expectancy by as many as 25 years.  Because of these findings, it becomes prudent that focusing on these problems and the problems of aging in general would be well advised.

Research is beginning to also focus more on healthy aging as more of the population is getting older (Bryant, et al., 2012). Successful aging is defined with a number of components.  These include a lack of disability, good general health and mental health, social function, and a lack of dementia.  These authors see attitudes toward aging as being an important factor in these components. Negative attitudes toward aging can lead to depression. On the other hand, positive and optimistic attitudes to aging meant better life satisfaction and better physical health. Health care professionals can increase more positive outlooks on aging by educating patients about activities that can help keep mind and body young.

In the same vein, Carlson, el al. (2012) discusses activities and memory.  Some of the listed activities for better cognitive functioning include reading books, doing crosswords, and taking classes that are often offered through local colleges.  Seniors should also think about volunteer activity, joining into activities at community centers that are geared toward the aging population, and other social connections.  The authors state that more than frequency, intensity, and duration of an activity that the most important component is to engage in a diverse routine of many of these activities for more positive cognitive outcomes.  They suggest that activities like this may be even more important for women than for men, given their longer life expectancies and increased likelihood of decline in cognitive functions.  The authors note that one barrier to this can be that women are more likely to be caretakers which can impede their abilities to find the time to devote to developing healthy brain routines.

From a physical and brain functioning aspect, Deslandes, et al. (2009), suggest that exercise is also an important undertaking in aging. Exercise has been shown to be correlated with better brain function. It should be noted that any type of physical activity is preferable to no activity at all. There are specific approaches to helping people become more active.    In addition, water exercises are usually a good alternative for those with arthritis and joint pain and programs specifically for seniors are often found at the local YMCA. Short walks, stretches, even owning a pet can increase physical activity in seniors.

Cook (2007) suggests that any and all of these approaches are a good idea for all ages of people. Routines are easier to adhere to when they have been in place for a longer period of time. Starting at a younger age can benefit the mental health of most age groups. According to Cook (2007) exercises that improve logic, processing, memory, and intellectual development should be the aim. Games focusing on analytical thinking are a good place to start. These include word games like Scrabble, chess and checkers, and even the children’s game Memory. Many times a google search can lead to online computer games and software available to develop these skills.

Aging is an inevitable part of the life cycle. Learning to navigate it can be challenging. Health care professionals should be advised to do what they can to encourage some of the activities outlined above. It is much easier to prevent physical and mental health problems than it is to treat them once they have taken over. The population is aging due to the baby boomers and this fact should not be ignored. Many of these people have lived long successful lives, and helping them to maintain a good quality of life should be a priority.

By Christie Hunter



Bryant, C., Bei, B., Gilson, K., Komiti, A., Jackson, H., & Judd, F. (2012). The relationship between attitudes to aging and physical and mental health in older adults. International Psychogeriatrics, 24(10), 1674-83.

Carlson, M. C., Parisi, J. M., Xia, J., Xue, Q., Rebok, G. W., Bandeen-Roche, K., & Fried, L. P. (2012). Lifestyle activities and memory: Variety may be the spice of life. The women’s health and aging study II. Journal of the International Neuropsychological Society: JINS, 18(2), 286-94.

Cook, Linda J. (2007). Exercises for mental wellness: Couldn’t we all benefit? Journal of Psychosocial Nursing & Mental Health Services, 45(5), 8-9.

Deslandes, A., Moraes, H., Ferreira, C., Veiga, H., Silveira, H., Mouta, R., Laks, J. (2009). Exercise and mental health: Many reasons to move. Neuropsychobiology, 59(4), 191-8.

Zanjani, F., Kruger, T., & Murray, D. (2012). Evaluation of the mental healthiness aging initiative: Community program to promote awareness about mental health and aging issues. Community Mental Health Journal, 48(2), 193-201.

The Importance of Promoting Mental Health in Universities

By: Christie Hunter

Recent shootings and homicides on college campuses have been dramatically represented by the media as a sign of failure to treat students. When such a tragedy occurs, it is common to see mental health issues on the forefront. However, such events are relatively rare even though severe, when compared to the general mental health needs of many college students around the world. Although we are beginning to see an increase in the awareness of mental health issues, there remain more opportunities for universities to improve on dissemination of this information through the right channels and to the correct people. In the following article, an examination of the research will highlight the population in need, who can help, and how to obtain mental health for both groups.

Mental health counseling centers and awareness services exist on many campuses. However, if students and staff do not know about these services, do not have the tools to help themselves, and do not have the tools to help someone else in distress, these resources go unused. Hunt and Eisenberg (2010) indicate that while many college students are seen as being more privileged than their non-student peers, there is very little difference in the occurrence of mental health problems between the two groups. According to the authors, college attendance in high school graduates is at 65%. Among people age 18-24, half of all health concerns are related to mental illness. Also, onset generally occurs by the age of 24. This is a prime time for college administrators to recognize and intervene with mental health issues. Untreated mental health affects academic success, productivity, substance abuse, and relationships. Because students are often immersed in campus life including their involvement in academics, recreational activities, social interactions, and work, they are well known by their peers and by staff, who can serve as allies when needed (Wagner and Rhee, 2013).

Hunt and Eisenberg (2010) report that one in three college students have reported that they have experienced depression symptoms that have resulted in a significant life impact. Of those students, 4% admitted to having seriously considered suicide. Anxiety is another common challenge on college campuses. Academics are becoming more competitive as the prospects for employment following college are decreasing. Stress is increasing as a result. While the effects of stress are often minor and  common among college students (go here for further reading),  there is nevertheless a lurking danger, and in severe cases,  treatment is necessary.  Many students are dealing with critical levels of stress on college campuses, and this is a concerning reality.

Many campus administrators and counselors are of the opinion that they are providing appropriate information on mental health to promote awareness and prevention. However, the study by Wagner and Rhee (2013) does not bear this out. Students are likely to report that they do not find the information helpful in self-identification or in recognizing problems in others. This is a mistake given the close relationships that tend to occur on campuses. Students are interested in information on depression and anxiety, grief, stress, sleep, and relationship difficulties in addition to information on how to help others. This is a fertile population to educate as they spend considerable education and social time together.

In a study on school based mental health which is more focused on primary education, there are trends that translate to similar issues at the college level (Weist, 2005). The findings of this study indicate that mental health services were not a focus and were not well funded.  Assessment of needs and linking to services are not done effectively. Educators can certainly be promoters of mental health awareness but time and resources are limited. At the college level, these effects may be amplified. However there is great opportunity to catch mental health concerns early and before they become more severe.

Dogan (2012) points out that many mental health problems emerge in the first year of college because it is a difficult time of transition in the lifespan. There is more freedom, different types of support systems, and increased stress. College students are often struggling to find a good balance between education and social interactions. The authors also found that students are increasingly presenting with more intense problems, and that as time goes on toward graduation, stress levels and mental health issues increase dramatically. Self-referral continues to be the main avenue to first contact, but that parents, staff, and friends are also making referrals.

Given all of the above, there has been a focus on campaigns to increase awareness and to decrease the stigma of diagnosis and treatment (Livingston, et al., 2012). This was shown to make individuals more aware of problems, but did not necessarily decrease stigma which can lower the likelihood that an individual will seek treatment. Perhaps it is important for universities to change the way that they approach promotion of mental health awareness. Asking students and staff what they need for themselves and in order to help others seems to be a significant step. While this may work now, it may need to be fluid and change over the years. It also makes sense for information to be disseminated in such a way that all staff and students know where to turn if experiencing a mental health problem, or when they recognize a problem in another individual. Finally, universities can hope to succeed in the promotion of mental health if they provide the staff the necessary training and resources for that success.

By Christie Hunter



Dogan, T. (2012). A long-term study of the counseling needs of Turkish university students. Journal of Counseling and Development : JCD, 90(1), 91-96.

Hunt, J., Eisenburg, D. (2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46(1), 3-10.

Livingston, J. D., Tugwell, A., Korf-uzan, K., Cianfrone, M., & Coniglio, C. (2013). Evaluation of a campaign to improve awareness and attitudes of young people towards mental health issues. Social Psychiatry and Psychiatric Epidemiology,48(6), 965-73.

Wagner, M., & Rhee (2013). Stress, sleep, grief: Are college students receiving information that interests them? College Student Journal, 47(1), 24-33.

Weist, M. D. (2005). Fulfilling the promise of school-based mental health: Moving toward a public mental health promotion approach. Journal of Abnormal Child Psychology, 33(6), 735-41.

Understanding and Reducing the Stigma of Mental Illness in Women

By: Christie Hunter

The study of the stigma of mental illness has been in the literature for decades. There remain various different theories regarding how this type of stigma affects individuals and numerous approaches for decreasing it. These theories and approaches have changed over the years. Positive progress has been made since discrimination and stigma toward mental illness was first identified. This article will address some of the recent thoughts and research on the subject, especially as it relates to mental illness stigma in the female population.

Lange, et al. (2003), studied the correlation between stigma and mental health treatment seeking in Black and Latina women as compared to White women born in the U.S. and some interesting findings were the result. There are cultural differences in stigma that make it less likely that minority females will seek treatment even when they know that they could benefit from services. Some of this is due to distrust of those in helping roles where practitioners who have nothing in common with them are unable to relate to their experiences. The authors also identified that insurance coverage and transportation issues were factors.  However, overwhelmingly the minority women in the study cited that they did not seek treatment because of how they would be seen in their communities.  Cultural differences were also reported in immigrant women. Stigma affects all women with mental illness, but it needs to be noted that it is especially prevalent in the minority population.

The authors of another study add to these findings in their examination of the way that professionals, politicians, and activists frame the stigma relating to mental illness (Corrigan, et al., 2005).  There has, in the past two decades, been a focus on reducing stigma from a public health perspective. Corrigan, Watson, Byrne, and Davis (2003), note that a Surgeon General’s report in 1999 identified stigma as being a significant barrier to individuals seeking mental health treatment.  As a result, focus has been placed on emphasizing the biological reasons behind mental illness as a genetic or brain illness. Education programs have been implemented to raise awareness of mental health issues in the general population. While this has helped to decrease some of the stigma, there is concern that this approach can lead to pity or otherness that can be just as damaging (Corrigan, et al., 2005).

From a social justice lens on the other hand, consumers of mental health services may be seen in a better light, as being humans who are worthy of dignity and respect (Corrigan, et al., 2005). They argue that one of the best ways to accomplish this is to encourage and empower those same consumers to advocate for, to treat, and to work toward helping others with mental illness. The authors also stress the need to recognize the intersections among race, socioeconomic status, and gender that is exacerbated by mental illness. This is especially important to remember as it relates to women in all marginalized groups who also seek mental health treatment.  These researchers are quick to note that both approaches are valid, and that neither approach is effective without the other.

The Americans with Disabilities Act (1992) prohibits discrimination based on qualified disabilities in state and local governments. Mental Illness is classified as one of these protected disabilities. However, it is also important to keep in mind the findings of Feldman and Crandall (2007), that outright discrimination is not the main problem with stigma. Women especially may be more prone to internalized or self-stigma in which the way that others see them becomes the way that they see themselves. This can lead to lower self-esteem and avoidance of a label or treatment.

What then does it all mean, and how can a reduction in stigma occur? One important takeaway from the research is the importance of a diversity of approaches taking into account the unique circumstances of women, from different demographic groups. Additionally, approaching the problem of stigma from both a public health/education perspective and from a social justice perspective seems to be most effective.    For further reading and an easy-to-remember method of reducing stigma using the acronym U.N.I.T.E, visit here:

Reducing mental health stigma for all women is important, because treatment is important, and stigma has been shown repeatedly to stifle the willingness to seek treatment. The thing that ends up happening is that women internalize the perceptions of society, and the avoidance that is often a result.  This can deepen the effects of the symptomatology of mental illness that already exists.

Women comprise approximately half of the population, the nature of their mental health issues sometimes mean more stigma than what is present for males. Women are seen as being more emotional, dramatic, even attention seeking, and so often legitimate symptoms of mental illness go ignored and untreated. A multi-faceted approach to the problem is the best option. Additionally, using mental health consumers to help other people is well-advised. This provides information directly from the people experiencing the illness, and there is something to be said for knowing an illness from the inside in order to identify what others may need.

By Christie Hunter


Americans With Disabilities Act (1990).  The Americans with Disabilities Act of 1990
and Revised ADA Regulations Implementing Title II and Title III. Retrieved from

Corrigan, P., Markowitz, F. E., Watson, A., Rowan, D., & Kubiak, M. A. (2003). An attribution model of public discrimination towards persons with mental illness*. Journal of Health and Social Behavior, 44(2), 162-79.

Corrigan, P. W., Watson, A. C., Byrne, P., & Davis, K. E. (2005). Mental illness stigma: Problem of public health or social justice? Social Work, 50(4), 363-8

Feldman, D. B., & Crandall, C. S. (2007). Dimensions of mental illness stigma: What About Mental Illness Causes Social Rejection? Journal of Social and Clinical Psychology, 26(2), 137-154

Nadeem, E., PhD., Lange, J. M., M.S., Edge, D., PhD., Fongwa, M., PhD., Belin, T., PhD., & Miranda, J., PhD. (2007). Does stigma keep poor young immigrant and U.S.-born black and Latina women from seeking mental health care? Psychiatric Services, 58(12), 1547-54.

Congresswoman Schakowsky cites WHRI in testimony

On July 12, Janet Woodcock, MD, Director, Center for Drug Evaluation & Research at the FDA appeared before the Subcommittee on Health of the Congressional Energy and Commerce Committee.  Congresswoman Jan Schakowsky (pictured) questioned the Director about the inclusion of equal number of women in drug studies that are often male biased.   The  Women’s Health Research Institute at Northwestern provided background information for the Congresswoman on the topic which she acknowledged.

To view her remarks , forward to the 1 hour, 5 minute section of the U-Tube TAPE.

National Action Plan on Infertility Released

The Centers for Disease Control and Prevention released the final version of its National Public Health Action Plan for the Detection, Prevention and Management of Infertility.  The National Action Plan developed over the course of seven years and began with an ad hoc working group that included members of the Oncofertility Consortium that started at Northwestern.    A draft National Action Plan was released in May 2012. ASRM provided input at each step of process under which the National Action Plan was developed and will continue to be involved as the National Action Plan is implemented.

The goals of the National Action Plan are to:

• Promote healthy behaviors to maintain and preserve fertility;

• Promote prevention and early detection and treatment of medical conditions that can threaten fertility; and

• Reduce exposures to environmental, occupational, infectious and iatrogenic agents that can threaten fertility.

The National Action Plan is available at

The CDC will host a Public Health Grand Rounds on August 19, 2014 on infertility.
For more information please see

Microchip contraceptive with on/off switch?

Women may soon bid farewell to birth control pills and welcome a new type of contraception in the form of microchip implants. An MIT startup backed by the Bill Gates Foundation plans to start pre-clinical testing for the birth control chip next year and pave the way for a possible market debut in 2018.

The fingernail-size microchip implant holds enough 30-microgram daily doses of levonorgestrel—a hormone already used in several contraceptives—to last for 16 years. Women who received the implant under the skin of buttocks, upper arm or abdomen would also get a remote control that allows them to halt or restart the implant whenever they like, according to MIT Technology Review.

MicroCHIPS, the MIT startup behind the birth control implant, developed a clever design for a titanium and platinum seal that temporarily melts when an internal battery sends an electric charge running through the seal. That lasts just long enough for the melted seal to release the daily dose of levonorgestrel from the microchip reservoirs.

The microchip technology’s latest mission first came about when Bill Gates visited the MIT lab of Robert Langer and challenged researchers to come up with a birth control method that women could control themselves and would also last for many years. Langer, an MIT professor who already holds 1,050 patents worldwide, thought of using the controlled release microchip technology that he and his colleagues had developed in the 1990s.

MicroCHIPS had previously demonstrated how the microchip technology could release daily doses of an osteoporosis drug during human clinical trials detailed in the 16 Feb 2012 online edition of the journal Science Translational Medicine. The new application for the microchips—each measuring 20 x 20 x 7 millimeters—could potentially revolutionize the level of control women have over their birth control technologies.

The biggest difference that the MicroCHIPS technology brings comes from giving women control over starting and stopping birth control regimens that can otherwise work for years without requiring regular attention. By comparison, existing contraceptive implants require a trip to the local clinic or hospital for removal if a woman wants to stop using the implant.

Any device offering wireless control for its users also runs the risk of being hacked. But Robert Farra, president and CEO of MicroCHIPS, told BBC News that their technology included secure encryption to prevent outsiders from blocking or reprogramming the implants wirelessly. As an added precaution, the remote control can only communicate with the microchip implant across a distance equivalent to skin contact.

Source:  IEEE Spectrum  By Jeremy Hsu



Inclusion of women in medical device studies critical!

Most people know that human clinical trials are critical to prove safety and efficacy in new medications.   This is also true for medical devices yet a recent study indicated that only 14% of device studies included sex as a key outcome measure, and only 4% included a subgroup analysis for female participants.    The differences in anatomy and physiology, as well as other factors in men and women,  can lead to devices working less effectively and safely.

The FDA’s Office of Women’s Health  recently supported a study of clinical trials conducted on cardiac resynchronization therapy (CRT), a pacemaker therapy for patients with heart failure.  Only 22% of the clinical trial participants were women.   By combining multiple studies and mining the multi-study data, the FDA Center for Devices and Radiological Health (CDRH) found that women benefited more than men from CRT.

This particular study demonstrates that we need adequate samples of men and women in studies early in the research process.   The good news is the FDA is taking two steps to insure more sex inclusion is built int0 future studies:

  • The FDA will finalized a guidance document that provides a clear framework for the inclusion of women in device studies
  • Mandated by Congress, the FDA will release an Action Plan, that will further address the analysis of data on women and product and safety data in labeling for drugs and devices.

How can you help??  Ask you doctor if there are clinical studies looking for subjects or contact your local medical school.    If you live in Illinois, you can join the Illinois Women’s Health Registry  a gateway to clinical trials in Illinois.

Source:  FDA VOICE, June 23, 2014

Having babies later may extend life

Women who had their last child at age 33 years or older were more likely to reach extremes of longevity, according to an analysis published online June 23 in Menopause.
Women who had their last child when they were aged 33 to 37 years were twice as likely to reach the extreme fifth percentile of longevity compared with women who had their last child before that age.

“Prolonged fertility may be a marker of slower aging,” write the authors, led by Fangui Sun, PhD, from the Department of Biostatistics at Boston University in Massachusetts. Previous studies, including some on historical data in the 17th, 18th, and 19th centuries, had found that women who had their last children late in life tended to live longer and to have siblings who lived longer.

Dr. Sun and colleagues analyzed data from the Long Life Family Study, whose participants have multiple family members who have reached extremes of longevity. The population includes sets of siblings selected because of their collective longevity scores, along with their spouses and children. The families were recruited between 2006 and 2009 in Boston; Pittsburgh, Pennsylvania; New York City; and Denmark.

One hypothesis to account for the association between maternal age and longevity, write Dr. Sun and colleagues, is that women whose bodies use energy more efficiently are able to both avoid age-related diseases and have increased fertility. The authors suspect these women would also be more likely to have more children, but in this study, they found a nonsignificant association in the opposite direction: having 3 or more children decreased the likelihood of extreme longevity.

The authors note that twin studies have suggested that genetics only explain about 20% of variation in longevity but that the influence of genetics increases at older ages. In other words, environmental and behavioral factors may influence a person’s likelihood of living to their mid-80s, but in the extremes of old age, genetics play more of a role. They suggest that studying the genetics of fertility may reveal genes that influence longevity.

The Long Life Family Study was funded by the National Institute on Aging/National Institutes of Health.
Menopause. Published online June 23, 2014.