For more than a decade, VA has made women's gender-specific health care needs a major priority. VA researchers are looking at a broad range of health issues related to women Veterans, including chronic diseases, reproductive health, cancer, mental health disorders, military occupational hazards, and amputations.
Today, there are more than 1.9 million women Veterans, and the percentage of the total number of America's Veterans that they represent is increasing. VA's research on women's health issues helps improve the department's ability to care for women Veterans of all eras.
Among the goals of VA's ongoing research initiatives in women's health are to develop improved therapeutic strategies for health issues important to women; enhance the specialized skills of primary care providers who treat women Veterans; and create the best possible health care strategies to deal with family and reproductive issues.
The presence of women in the U.S. armed forces has increased greatly in recent years. In turn, the number of women Veterans seeking VA health care has also significantly increased.
The 1.9 million living women Veterans currently make up more than 8 percent of the total Veteran population. By 2018, women are expected to account for 10 percent of all Veterans.
VA has a longstanding commitment to women's health research. In the early 1990s, women's health issues were declared a research priority, and VA took steps to increase the participation of women Veterans in its studies.
In 2005, VA Research formed a Women's Health Research Planning Group and tasked the group to develop a research agenda for women Veterans and to establish VA as a national leader in investigating women's health. Their 2006 report was published in a special VA-funded supplement to the Journal of General Internal Medicine.
Today, more VA-based women's health research is being funded than ever before. A 2011 review of research on women Veterans revealed that more information was published by VA researchers in the five years from 2004 through 2008 than in the 25 years before that.
Recent research in women Veterans' health care has focused on such areas as the quality of care provided to women at VA facilities and the effectiveness of treatments they receive for PTSD and other conditions; military deployment-related health care needs; and risks, treatment, and outcomes that are related to military traumas, including military sexual trauma (MST).
In a large study of women Veterans and active-duty personnel, VA researchers learned that prolonged-exposure therapy—a type of cognitive behavioral therapy in which therapists help patients recall their traumas under safe, controlled conditions—was more effective in reducing posttraumatic stress disorder (PTSD) symptoms than a supportive intervention called present-centered therapy.
Partly as a result of this study, the largest clinical trial to date involving women Veterans with PTSD, VA launched a nationwide effort to train more clinicians in this type of therapy.
In 2011, a Miami VA team learned that taking soy tablets doesn't boost bone density or help ease menopause symptoms. In the study, which evaluated a natural alternative to hormone replacement therapy, older women who had recently reached menopause took either 200 milligrams of a soy tablet or a placebo each day.
After two years, there were no differences in bone density in the spines, hips, or femurs of women in the study. More women taking soy said they had hot flashes and constipation, compared with those taking placebos.
VA researchers are learning about how women and men respond to combat and other traumas. Some findings suggest that they respond similarly to these situations, while other research points to possible gender differences.
Recently, a study team found that in the first year following deployment, women who served in Iraq and Afghanistan were able to handle combat-related stress as well as men. Researchers in another study of Veterans who served in those areas, however, learned that women were more likely than men to report depression symptoms after deployment.
Although there were no gender differences with respect to PTSD symptoms themselves, the researchers found a stronger association between injury and PTSD symptoms for women than for men.
In a study published in 2014, VA researchers found that PTSD symptoms were more severe in women who served in combat zones compared to men, and women also had had higher rates of probable PTSD.
The authors believe that these differences were not simply explained by gender differences or risk factors related to their deployment—and that combat stress, concerns about life and family disruption, and prior victimization, such as sexual abuse, were all associated with greater post-deployment PTSD symptoms for women.
Since the late 1990s, VA research has been at the forefront of advancing knowledge about the prevalence and impact of military sexual trauma (MST), which includes both sexual harassment and sexual assault, on the health and functioning of women Veterans.
In women Veterans who had experienced military sexual trauma, study researchers found a greater than fourfold increase in PTSD compared to women Veterans who had not experienced such trauma. (In men, the study found a nearly threefold increase in PTSD after MST.)
Among women Veterans with PTSD, those with MST were much more likely than other women to have additional mental health diagnoses such as depression, anxiety, and eating disorders.
A 2013 study led by a VA investigator involving more than 934,000 women found that women aged 50 to 75 face no extra risk of breast cancer if they get a screening mammogram every two years instead of every year. The new evidence also indicated that the less frequent screening meant less overall risk of false positives.
Not every health provider abides by the recommendations of this research. VA itself encourages all women between ages 50 and 75 to get mammograms every two years. Women ages 40 to 50 and those older than 75 should talk with their providers about the risks and benefits of having mammograms and make a decision based on their individual risk factors.
VA researchers have launched the most comprehensive examination to date of the health outcomes of Vietnam-era women Veterans. A team is conducting a five-year cooperative study (CSP 579), which began in 2011 and is expected to include 10,000 participants, to examine the prevalence of PTSD and other mental and physical conditions in these Veterans, and the relationship of PTSD to their experiences while deployed.
In another first-of-its-kind mental health study in women VA care users, researchers with the VA Women's Overall Mental Health Assessment of Needs (WOMAN) study are surveying 4,000 women to learn more about the prevalence of various mental health conditions in women Veterans, and about their use of VA care and their primary health care needs.
VA's Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) program is a new type of framework for VA studies. Under the CREATE initiative, VA funds sets of related studies around a high priority topic. The investigators work closely with each other and with other VA partners, with the goal of rapidly putting research results into practice.
The goal of the Women's Health CREATE, established in 2013, is to use research to accelerate the implementation of comprehensive care for women Veterans, and to focus on fundamental issues in how VA delivers care to women Veterans in the context of national VHA policy.
Studies linked to this effort will focus on the following topics:
Video: Women's Health
Micromanager gene helps prevent breast cancer, VA Research news feature
Gene may alter women's PTSD risk, VA Research Currents, Winter 2013-14
Study backs less frequent mammograms for most women, VA Research Currents, May 2013
Study adds to evidence on cognitive processing therapy for sexual trauma, VA Research Currents, February 2013
Spotlight on Research into Women Veterans' Health, VA Health Services Research and Development
Fact Sheet: Women's Health
Toward a VA Women's Health Research Agenda: Setting Evidence-based Priorities to Improve the Health and Health Care of Women Veterans . Yano EM, Bastian LA, Frayne SM, Howell AL, Lipson LR, McGlynn G, Schnurr PP, Seaver MR, Spungen AM, Fihn SD. A paper summarizing the process and outcomes of the first national VA Women's Health Research Agenda setting conference, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research. J Gen Intern Med. 2006 March;21(Suppl 3): S93-S101.
Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial . Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, Resick PA, Thurston V, Orsillo SM, Haug R, Turner C, Bernardy N. Prolonged exposure is an effective treatment for PTSD in female Veterans and active-duty military personnel. It is feasible to implement prolonged exposure across a range of clinical settings. JAMA, 2007 Feb 28;297(8):820-30
Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF Veterans . Vogt D, Vaughn R, Glickman ME, Schultz M, Drainoni ML, Elwy R, Eisen S. Female Iraq and Afghanistan service members may be as resilient to combat stress as men. Future research is needed to evaluate gender differences in the longer-term effects of combat exposure. J Abnorm Psychol. 2011 Nov;120(4):797-806.
Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan . Maguen S, Luxton DD, Skopp NA, Madden E. Findings of significant gender differences in demographic variables, exposure to combat, and military sexual trauma. J Psychiatr Res. 2012 Mar; 46(3):311-6.
Outcomes of screening mammography by frequency, breast density, and postmenopausal hormone therapy , Kerilkowske K, Zhu W, Hubbard R, Geller B, Dittus K, Braithwaite D, Wemli K, Miglioretti D, O'Meara ES. Women aged 50 to 74 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of false-positive results than those who undergo annual mammography. JAMA Intern Med. 2013;173(9);807-816.
Sexual activity in midlife women: importance of sex matters . Thomas HN, Chang CH, Dillon S, Hess R. The most sexually active midlife women remain sexually active. In contrast, sexual function is not associated with maintenance of sexual activity. A more nuanced understanding of female sexuality is essential. JAMA Intern Med. Published online February 10, 2014
Gender differences in the effects of deployment-related stressors and pre-deployment risk factors on the development of PTSD symptoms in National Guard Soldiers deployed to Iraq and Afghanistan . Polusny MA, Kumpula MJ, Meis LA, Erbes CR, Arbisi PA, Murdoch M, Thuras P, Kehle-Forbes SM, Johnson AK. Elevated PTSD symptoms among female service members were not explained simply by gender differences in pre-deployment or deployment-related risk factors. J Psychiatr Res, 2014 Feb;49:1-9
Middle age doesn't stop women from having sex; why valuing sex may increase old ladies' libido. Medical Daily, Feb. 12, 2014
Military affairs beat: Needs of women veterans surveyed, Minneapolis Star-Tribune, January 28, 2014
'Prolonged exposure' therapy may help vets with PTSD , Reuters, July 17, 2013
Daily care needed in last years, study finds, SFGate, July 16, 2013
Sleep study finds important gender differences among heart patients , University of California San Francisco news release, June 5, 2013
New evidence that aspirin may prevent cancer, Forbes Magazine, April 23, 2013
Sourcebook: Women Veterans in the Veterans Health Administration, Department of Veterans Affairs
Proceedings of the 2011 National Training Summit on Women Veterans, Center for Women Veterans, Department of Veterans Affairs
Women's Health, Centers for Disease Control and Prevention
Womenshealth.gov, U.S. Department of Health and Human Services
For Women, U.S. Food and Drug Administration
Women's Health, Health Resources and Services Administration, U.S. Department of Health and Human Services