Excerpt, 'The Savvy Woman Patient'

by Phyllis Greenberger

(CBS)  Chapter 1

Women’s Wellness through the Life Span

Over the past 20 years, society has worked hard to eliminate gender differences in the workplace, at home, and in sports. Yet there’s one area we need to keep separate, one area in which recognizing sex and gender differences is critical: health.

During most of modern times, the medical profession has used the white, male patient as a typical prototype, assuming that if we knew how a disease manifested itself in a man, how a drug worked in a man, why a procedure was successful in a man, we would know the same in terms of a woman.

But today, thanks to groundbreaking work by sex-based biological researchers, we know that sex does matter—and not just when it comes to reproductive health. Sex matters in nearly every avenue of mental, physical, and emotional health, from the different symptoms men and women exhibit during a heart attack to the ways in which they cope with pain. Sex differences are responsible for variations in bone composition, in drug metabolism, and in the rate at which the brain synthesizes neurotransmitters, chemicals important to mood and functioning.

Just consider these top 10 differences:
1. Heart disease. Heart disease kills 500,000 American women each year, over 50,000 more women than men, and strikes women, on average, 10 years later than it does men. Women are more likely than men to have a second heart attack within a year of the first one.
2. Depression. Women are two to three times more likely than are men to suffer from depression. In part, that is because women’s brains make less of the neurotransmitter, serotonin.
3. Osteoporosis. At least 65 percent of those diagnosed with osteoporosis, or loss of bone mass, are women.
4. Smoking. Cigarette smoking is more harmful to women than it is to men. Women also have a harder time quitting smoking and have more severe nicotine withdrawal symptoms.
5. Sexually transmitted diseases. Women are twice as likely as men to contract a sexually transmitted disease and more likely to experience significant drops in body weight if they have AIDS, which can lead to wasting syndrome.
6. Anesthesia. Women tend to wake up from anesthesia more quickly than do men, an average of three to four minutes faster.
7. Drug reactions. Even common medications like antihistamines and antibiotics can cause different reactions and side effects in women and men.
8. Autoimmune disease. Three of four people suffering from autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and lupus are women.
9. Alcohol. Women produce less of the gastric enzyme that breaks down ethanol in the stomach. Therefore, after consuming the same amount of alcohol as men, women have higher blood alcohol levels, even allowing for size differences.
10. Pain. Morphine-like pain medications known as kappa-opiates are far more effective in relieving pain in women than they are in men. An example is meperidine, which is used to treat moderate-to-severe pain and for intravenous regional anesthesia and peripheral nerve blocks.

As Mary-Lou Pardue, PhD, chair of an Institute of Medicine (IOM) report on sex differences in health, said: “Sex does matter. It matters in ways that we did not expect. Undoubtedly, it also matters in ways we have not begun to imagine.”

Unfortunately, our medical model is still a male-based one. Fifty years of clinical studies that focused mainly on men has left us with a lack of female-based data on everything from the best medication to treat hypertension in women to why women are more likely to develop an autoimmune disease. We are thankful that is beginning to change. Clinical trials for new medications must now include women. With more women scientists and doctors in the scientific workforce, new topics and new questions are being explored, even those that were often taken for granted.

The challenge, now, is to parlay this growing knowledge into actionable steps, to disseminate it to health care providers and consumers, and to ensure that the small momentum we have going does not buckle under the weight of politics and funding.

Sex Matters to Wellness

So what, you ask, does all this have to do with wellness through the life span? To answer that, consider an Institute of Medicine report published in 2001, Exploring the Biological Contributions to Human Health: Does Sex Matter? The report, initiated and supported by the Society for Women’s Health Research, underscored the need to better understand the importance of sex differences and how to translate that knowledge into improved medical practice and therapies.

Among its key findings:

Every cell has a sex. Some of the reason for the sex of a cell is related to whether you have XX or XY chromosomes, some is related to the affects of hormones on cellular structure and growth, and some is related to whether you got your X chromosome from your mother or your father (recall that sperm carries X and Y chromosomes, while an egg only has X chromosomes). The result: “multiple, ubiquitous differences in the basic cellular biochemistries of males and females that can affect an individual’s health.”

Sex differences begin in the womb and continue through the life span. It seems obvious, but these differences go far beyond the egg and sperm meeting. Some research indicates that differences in the intrauterine environment triggered by a fetus’s sex may lay the groundwork for later health. These differences continue throughout life and lay the groundwork for biological differences in health and disease.

Sex affects behavior and perception. Basic biological differences in the male and female brain help explain some of the different play behavior we see in boys and girls; boys tend to focus on objects and choose gross motor activities, and girls tend to focus on people and relationships and choose activities that use discreet, finer motor skills. While early play behavior can be strongly influenced by society as well, some of the distinctions are based on the genetic makeup of each individual. And these differences in both perception and the behavior it influences manifest throughout the life span, such as in how women handle stress.

Sex affects health. In fact, sex should be considered a “biological variable” in all biomedical and health-related research, the IOM report notes, much as ethnicity, preexisting conditions, and current health status are.