Women's Health: Taking Care

What our mothers couldn’t tell us . . . and our daughters need to know.

 
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I was 14 when my mother went to visit Aunt Millie in the hospital. “What’s wrong with her?” I asked. Mom frowned. “Female trouble,” she said, as if that explained everything.

Years later, I came to learn that “female trouble” was code for a hysterectomy. Looking back, I don’t know why my mother’s euphemism surprised me. To be sure, assuming most women’s ailments had to do with menstruation, pregnancy or menopause, nice people just didn’t talk about them back in the day.

What’s worse, when women did get seriously ill—when they had heart attacks or got cancer—they were treated like men, by men, who learned everything they knew from clinical research done on—you guessed it: men. Rarely did anyone take into consideration a woman’s biological makeup and how it might affect the onset, development, treatment or outcome of disease.

Thankfully, that’s changed. It was in 1990 that a group of physicians, medical researchers and health advocates founded the Society for Women’s Health Research (SWHR) to call attention to the lack of inclusion of women in medical research. They dedicated themselves to improving women’s health by studying how the differences between women and men play out when women get sick. Since then, the medical community has come to see things differently.

“[Twenty years ago], everyone—researchers, physicians and the public—thought of women’s health in terms of reproduction only,” says Linda “Jo” Parrish, vice president for institutional advancement for the SWHR. Now, she says, more and more women are included in major clinical trials, and health care providers and policy makers are changing the way they think.

As a result, we now know more about women’s health than our mothers ever imagined. “We’ve learned that women are very different biologically, which affects everything—from symptoms to outcome,” says Parrish. “We now know that hormones affect how medications work, that women suffer disproportionately from autoimmune diseases, and that heart disease symptoms are not the same in women as they are in men.” The research continues, “but we still have a long way to go,” she adds. “We know there are a lot of differences . . . we don’t always know why.”

HEART DISEASE

Heart attacks were long believed to be life-altering catastrophes that pretty much happened only to men. But the fact is that more than one in three female adults has some form of cardiovascular disease, and heart disease kills more women than all forms of cancer combined.

“A lot has happened in the last 20 years, but I’d say that the most important change has been an understanding that heart disease is as much a killer of women as it is of men,” says Basmah Safdar, M.D., medical director of the Women’s Heart Program and director of the Chest Center at Yale-New Haven Hospital. Statistics bear this out, and yet, says Safdar, many women still think you have to experience chest pain in order to have a heart attack.

“Our mothers and grandmothers grew up in a culture where all heart attacks were associated with chest pains,” says Safdar, “but this is not true, especially in women. Very often, women will present with atypical symptoms, so they may be having a heart attack but not know it. Consequently, they don’t go to the hospital, and they delay necessary care.” According to Safdar, atypical symptoms may include trouble breathing, weakness and fatigue, gastrointestinal pain, nausea and vomiting.

Recognizing risk factors is another cause of concern. “Conventional risk factors include smoking, obesity, diabetes, high cholesterol and high blood pressure,” says Safdar, “but some of these—especially obesity and diabetes—pose a much higher risk in women than they do in men.” Awareness is not enough, stresses Safdar. “A woman who has high blood pressure or cholesterol needs to know her values and numbers, so they can be controlled.”

Some risk factors, such as family history or age, cannot be changed, but there are preventive measures a woman can take to significantly reduce her chances of developing heart disease. The top five, according to the Mayo Clinic, are:

1. Don’t smoke, especially if you take birth control pills.
2. Get active. Guidelines recommend at least 30 to 60 minutes of moderately intense physical activity most days of the week.
3. Eat a heart-healthy diet, one rich in fruits, vegetables, whole grains and low-fat dairy products.
4. Maintain a healthy weight.
5. Get regular health screenings.

It’s also important to note that heart disease progresses differently in women than it does in men and that rehabilitation after treatment is critical, says Safdar. “Too often women rush to get back on their feet. They don’t follow through because they are often the primary caregivers for children,” and this has an impact on outcome.

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