Women Are Different

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By Mary Carpenter

“WOMEN are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack,” according to the Harvard Health blog. Differences in specific health issues—stroke, STDs, adult acne, sleep apnea, osteoporosisa and autoimmune diseases like rheumatoid arthritis (RA)—require women to keep informed, ask questions about treatment, as well as call for greater efforts by researchers and personal physicians.

Pain may be the most prominent problem area: “Women in pain are much more likely than men to receive prescriptions for sedatives, rather than pain medication, for their ailments,” according to the Harvard blog. And “one study even showed women who received coronary bypass surgery were only half as likely to be prescribed painkillers, as compared to men who had undergone the same procedure.” “70% of the people [chronic pain] impacts are women…80% of pain studies are conducted on male mice or human men.”

“Gender biases in our medical system can have serious and sometimes fatal repercussions,” writes the Harvard Health blog author. In her own experience, inattention by doctors to her pain led to endometriosis “strangling my large intestine and adhering my ovaries and fallopian tubes to my colon.”

Also notable, many women suffer unnecessarily from hormone-related conditions —since a flawed 2002 study on Hormone Replacement Therapy (HRT) led to a dramatic drop in HRT prescriptions, despite its well-established benefits, such as reduced risk of heart disease and several cancers, including breast and colon; and help with menopause-related issues, especially osteoporosis. (While the optimal time for starting HRT is ages 45-55, during menopause, many of the 16,608 women in the 2002 study were in their mid-60s—as well as overweight and already at risk for heart disease.)

“Our generation got screwed,” 60-something DC lawyer B.J. said, referring to doctors’ ongoing refusal to prescribe oral HRT for symptoms affected by hormones like estrogen, ranging from painful sex to brain fog. According to johnshopkinsmedicine, “Doctors are increasingly aware of how managing osteoporosis, urinary conditions…and diabetes in female patients may call for different approaches that take into account women’s physiological differences.” But for many women, “increasingly” is not fast enough.

For Pittsburgh-based health writer T.C, RA symptoms first diagnosed after her physician took her off HRT after 28 years began to resolve when another doctor re-prescribed HRT.  Said T.C., “I am thrilled to report that within a month, my pain had almost vanished.” According to University College London rheumatologist Charles Raine, “declining estrogen and/or progesterone levels…appear to increase the risk and severity of RA.”

Research on the connection between hormone levels and autoimmunity is, however, contradictory and varies with the different conditions—for example, small studies show lupus symptoms diminish after menopause. Because arthritis and menopause “can cause similar symptoms”—fatigue, GI issues, bone loss and sleep problems—untangling cause and effect can be  “challenging,” according to the Arthritis Foundation. A 2020 study of more than 1.3 million women found no association between RA and hormones that are affected by menopause—but found a small increase in RA with HRT.

“The medical concepts of most diseases are based on understandings of male physiology,” according to the Harvard blog. As a result, writes Forbes business council member Tlalit Bussi Tel Tzure, “when it comes to certain ‘gender-neutral’ diseases such as sleep apnea or heart attacks, women can go undiagnosed because they don’t have similar ‘textbook symptoms’ to men.”  Women are less likely to receive an initial diagnosis of heart failure and are more likely to suffer long-term health problems related to medical conditions such as diabetes. Among the blog’s explanations of dysfunctional healthcare for women: “glaring disparity in research funding.”

“The first stop is awareness,” San Francisco VA medical center’s Calvin Chou contends on Duke Health. Chou describes implicit bias, especially among office-based physicians who “interact with our patients one by one without much outside observation.” Biases can lead, for example, to the greater likelihood of asking young male patients about substance use, or assumptions that female patients have an ample support system—in addition to “areas where disparities have been documented such as rates of cardiac consultations [that are lower for women].”

“The telltale heart attack sign of feeling like there’s an elephant sitting on your chest isn’t as common in women, [who] feel upper back pressure, jaw pain and are short of breath,” according to WebMD. “Or they may feel nauseated and dizzy instead. Though heart disease is the leading cause of death for both genders in the U.S., women are more likely to die after they have a heart attack.”

For stroke, common symptoms are sudden weakness on one side, loss of speech and balance, and confusion—but women can also have fainting, agitation, hallucinations, hiccups and other symptoms. STDs are less likely to cause symptoms in women, but can lead to chronic pelvic inflammatory disease that causes fertility issues, which is not the case for men. Also, women are more prone to adult acne than men, while osteoporosis is often missed in men, who are more likely to die folllowing a broken hip than women with osteoporosis who break their hip.

For sleep apneas, men often report “snoring, waking up gasping for air or snorting…[while] “fatigue, anxiety and depression…telltale signs of sleep apnea in females may not be as obvious,” according to the Eos Sleep Center in New York.  The two times more likely diagnosis of men with sleep apnea “may be partially attributed to how women describe their symptoms…commonly mistaken for depression, hypertension, hypochondria…”

UTIs—which occur in women 30 times more often than in men, and are suspected to be more common in areas where water is polluted by E.coli—may be a good example of failure to direct health research dollars toward women’s issues. According to researchers in Berkeley, California and Guatemala: “No studies have measured whether [E.coli] presence in water may increase…the risk of UTIs in humans. Given the prevalence of drinking water supplies contaminated with E.Coli…efforts should be made [to do this research].”

—Mary Carpenter regularly reports on topical subjects in health and medicine.