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  F E A T U R E S  
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FEATURES
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MENOPAUSE MEDICINE RESEARCHER CHALLENGES CONVENTIONAL WISDOM

 "" PHOTO — Julie Schweitzer, associate professor of psychiatry and behavioral sciences and researcher at the UC Davis M.I.N.D. Instituter
 
Urogynecologist L. Elaine Waetjen, foreground, and her clinical team, Tracy Seward, left, case manager for Urogynecology, and Deborah Deatheragehand, middle, case manager for the Women's Midlife Program, address women's complaints about menopausal symptoms.
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For years, it was a familiar story line. As women aged and began experiencing incontinence, they were told the bothersome condition was simply a fact of menopausal life.

But science is producing new answers, and one investigator at the forefront of menopause research is L. Elaine Waetjen, a Department of Obstetrics and Gynecology associate professor. Waetjen has not only challenged the long-held belief that the menopausal transition causes incontinence, but also has added her voice to a growing chorus dismissing estrogen as a treatment for the condition.

"There was a time when estrogen was seen as a cure for all of middle-aged women's woes," Waetjen says. "But now we are learning its limitations."

A urogynecologist by training, Waetjen primarily is interested in menopausal medicine – an increasingly essential area given the nation's aging population. In addition to her research and teaching duties, she sees patients with peri- and postmenopausal health and gynecological problems as part of the department's Women's Midlife Program.

Absence of research

Despite its ability to seriously diminish a woman's quality of life as she ages beyond her childbearing years, menopause and its symptoms have been lesser studied topics in the research community, says Waetjen.

"It's partly because after their reproductive years, women have been generally undervalued as a priority in research."

Gynecologic oncologist Lloyd Smith discovered that women with early stage ovarian cancer do have symptoms despite the cancer being called a "silent killer." Symptoms often include abdominal swelling and pain and by listening carefully for patient reports of these symptoms, physicians can help identify cancer early, when treatments are most beneficial. Smith, who is chair of the UC Davis Department of Obstetrics and Gynecology also conducted one of the first studies to examine maternal and newborn health risks and colorectal cancer. In his study, he found that women diagnosed with the disease during or shortly after their pregnancies have the same survival as women who have the disease and are not pregnant.

Menopause is also a difficult topic to study because symptoms vary dramatically among women, with some barely noticing physiological changes and others finding their lives turned upside down.

Incontinence – loss of bladder control – has long been viewed as one of menopause's troubling side effects. But Waetjen's published research debunks that conclusion, showing that the transition from pre- or peri-menopause to postmenopause has, at most, a weak negative, and, perhaps, even positive effect on incontinence in midlife women.

Impact of weight gain

Instead, her work shows that factors such as weight gain are more likely to explain incontinence during this phase of life. Waetjen found that women who gain weight in the transition period are more likely to develop and have worsening incontinence, while those who lose weight are less likely to develop incontinence and more apt to see it improve.

"Studies show that obesity is a big risk factor for incontinence in women during this time frame," Waetjen says. "Here we've been blaming menopause when it's actually weight gain – which is good news, because it is something that is preventable and treatable."

In related research, Waetjen has contributed to a growing body of evidence rejecting estrogen as a treatment for incontinence. Until fairly recently, women suffering leakage were commonly given vaginal or oral estrogen. Waetjen has co-authored studies that suggest estrogen either has no effect on incontinence or actually increases the occurrence of incontinence in previously continent women and may aggravate incontinence in those experiencing it.

Medical missions to Africa

While most of Waetjen's time is spent immersed in the medical troubles of middle-aged American women, she also volunteers her services in a country where many women never reach menopause – Tanzania.

As a board member of the group Medicine in Action, Waetjen travels once a year to Tanzania to perform surgeries and provide other gynecological care to women in need. Most of the patients are under 40 and many have never seen a gynecologist. They typically undergo treatment for pelvic inflammatory disease, other sexually transmitted infections or conditions requiring hysterectomies or other gynecological surgery.

"I guess I'm torn between working on the understudied Western issues of older women, like menopause, and the basic problems that affect women in the developing world," says Waetjen, who lived in Kenya and South Africa as a child.

At UC Davis, Waetjen's colleagues praise her as a passionate clinician and accomplished researcher. Ellen Gold, chair of the Department of Public Health Sciences, has worked with Waetjen on the Study of Women's Health Across the Nation, known as SWAN. Citing Waetjen's "meticulous" research, she predicts the urogynecologist eventually will earn national and international recognition for her work.

"In the years to come," Gold says, "I expect further important contributions from Dr. Waetjen as she continues her outstanding clinical work and her investigations into the factors … affecting women as they mature from middle age to older life."

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  "Here we've been blaming menopause (for incontinence) when it's actually weight gain, which is good news, because it is something that is preventable and treatable." — L . Elaine Waetjen, Urogynecologist  
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