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Epidemiology Study


1994 - Present








Midlife; midlife women Cohort Multiethnic Community-based Multicenter Women’s health Female Stress Aging Menopausal transition Minority health/disparities/SES Epidemiology depressive symptom trajectories risk factors exercise physical performance Chronic Discrimination, Bodily Pain BONE MODELING; BONE QCT DXA Age at menopause Duration intensity menopausal symptomatology Hormone change menopausal transition Obesity body composition lean mass Body topology hip circumferences change in body composition and topology carbohydrate metabolism, diabetes metabolic syndrome Bone mineral density Lipids Depressive symptomatology depression Race/Ethnicity African-American Blacks Chinese-American Hispanic Japanese-American Caucasian Whites Menopause Women’s Health Womens Women Woman Biospecimens biomarkers markers


The goal of SWAN’s research is to help scientists, health care providers and women learn the relationship of mid-life experiences to health and quality of life during aging. The study is co-sponsored by the following components of the National Institutes of Health (NIH): National Institute on Aging (NIA), National Institute of Nursing Research (NINR), Office of Research on Women’s Health (ORWH), and the National Center for Complementary and Alternative Medicine (NCCIH).


Menopause is a universal phenomenon of women, yet it is incompletely understood. In 1994, the estimate was that about 40 million American women would experience menopause through 2014, and it was estimated that $3-5 billion would be spent annually for menopausal hormone therapy (HT) and the physician monitoring of that HT use through between 1994 and 2005. Additionally, the study of the menopause poses special methodological challenges because of its transitional nature, the potential for involving multiple organ systems (e.g., bone, lipids, mental health), and the potential contribution of varied social, behavioral, and cultural factors. Thus, study of the menopausal transition is both important and complex.

Study Design

The Study of Women’s Health Across the Nation (SWAN) is a multi-site longitudinal, epidemiologic study designed to examine the health of women during their middle years. The study examines physical, biological, psychological and social changes that occur during this transitional period. The study began in 1994 and is in its twenty-fifth year. Between 1996 and 1997, 3,302 participants joined SWAN through seven designated research centers. The research centers are located in the following communities: Ann Arbor, MI (University of Michigan), Boston, MA (Massachusetts General Hospital), Chicago, IL (Rush University Medical Center), Alameda and Contra Costa County, CA (University of California Davis and Kaiser Permanente in Oakland, CA), Los Angeles, CA (University of California at Los Angeles), Jersey City, NJ (Albert Einstein College of Medicine), and Pittsburgh, PA (University of Pittsburgh). SWAN participants represent five racial/ethnic groups (Black, Chinese, Hispanic, Japanese, and White) and a variety of backgrounds and cultures. The study design was developed using a collaborative process. SWAN consisted of a cross-sectional study and a longitudinal cohort study, both of which employed common protocols across the seven research centers. Focus groups were conducted to inform the development of the study design and the protocols and to ensure the relevance and the appropriateness of the protocols to the multiethnic cohort.


SWAN has operated under five funding periods and has completed the screening, baseline and 16 follow-up visits. Visits have taken place approximately every year. The annual visit has included the following core components: physical measures (weight, height, hip, waist, and blood pressure), fasting morning blood draw (used to measure sex steroid hormones and cardiovascular risk markers), interviewer-administered and self-administered questionnaires (used to measure socio-demographic characteristics, menopausal symptoms, lifestyle and psychosocial factors, and cognitive, physical, and sexual function). A subset of women was also given menstrual calendars to complete monthly over the next year. All questionnaires were translated into Spanish, Cantonese, and Japanese and could be administered by bilingual interviewers. SWAN is now in its fifth funding period which included a single in-person visit (visit 15) for the entire cohort, as well as two bone mineral density (BMD) visits for women participating in the BMD protocol, at three sites. In addition to the annual visit core components listed above, new measures of physical function, physical activity, sleep, cognition, and vaginal, urogenital, and sexual health have been completed by SWAN participants at visit 15, which has been completed.


SWAN is providing many valuable findings about the health and aging of mid-life women from diverse communities and racial and ethnic backgrounds. By collecting, analyzing, and publishing information on health status, physical measures, symptoms, lifestyles, attitudes, and health care use by women during mid-life, SWAN has begun to describe the timing of, and the normal variation in, the biologic and psychological characteristics of the menopausal transition and normal aging.

Resources Available
Biospecimens and Study Datasets
Materials Available


Immortalized Cell Lines

Plasma Citrate

Plasma EDTA