Women in Medicine: Sex Matters Too
There are many medications, medical trials, methods, symptoms, etc. that are different in both men and women. As we get older and as we start to learn about our bodies better, we must make sure that we are putting ourselves first and making sure we are receiving the best care from medical practices just like men do. After completing Sex Matters: How Male-centric Medicine Endangers Women's Health and What We Can Do About It (2021) by Dr. Alyson J. McGregor, I wanted to share some of the information and tools that I’ve learned regarding being a woman, how to identify signs in distress, the difference between men and women bodies, how to listen to signs of change in my body, and even to understand why, as a woman, our bodies react differently than men.
In the medical field, many methods, strategies, and information are still male-centric. Treatments and symptoms that are looked for in patients are created from male models. This creates false diagnoses for women, hurting them in the short and long term. Women present different reactions and symptoms that are usual for men. Medications that would work for men do not always work for or apply to women.
“We are not simply men with breasts and ovaries-” (11)
Heart attacks and other cardiovascular events present themselves very differently in women than they do in men. Women’s symptoms are described as “atypical” and “unusual” in medical literature. Signs for women are usually mild pains, and discomfort, with a possible combination of fatigue, shortness of breath, and “not feeling right” (McGregor 5). When women go into the emergency department for a heart attack, they are mainly dismissed and misdiagnosed because students, residents, and doctors are looking for male-centric signs of a cardiovascular issue (i.e., sharp pain in the left arm, severe chest pain/discomfort). And if the patient is being taken care of, they are given inappropriate doses of common medications taken by men that DO NOT account for the female metabolism and hormonal cycles. Women’s cardiovascular symptoms also mimic other diseases and events that are classified as more “female”, such as panic attacks or anxiety.
Women’s health deals with the overall health and well-being of women. It should not have to be compared to men, when in fact, both are different. Every cell in the human body contains sex chromosomes. Those same chromosomes influence every biological, chemical, sensory, and psychological function in that body (12). Sex hormones include estrogen, progestin, testosterone, and androgens. Each cell is affected by these hormones.
1. Women are more likely to receive a “psychiatric diagnosis” for conditions not limited to stroke, cardiac events, autoimmune disorders, etc.
“Understudied, underdiagnosed, and undertreated” (31)
New drugs and research for medications come out continuously and impact thousands of people. One thing that continues to be lacking in trials and medical research is the addition of women. Women have many things that cost researchers more money than they would like for new drugs to be put on the market. This includes but is not limited to, menstrual cycles, pregnancies, birth control use, other medications, pre- and post-menopause, and hormonal imbalances. Women also present many different side effects than men while testing drugs. Age differences also impact different outcomes.
In 1974, protection laws were put in place for research concluding that pregnant women and women of childbearing age were considered “protected”. This then made researchers opt out of adding these subjects to their trials. This would allow them to save money and time, but this excluded women's research from their findings. Researchers need to prove that their drugs will provide minimal to no harm to people, excluding women would help results. In 2011, a federally funded randomized clinical trial found only 37 percent of women participants in overall trials; 64 percent of the findings concluded that they did not specify sex influence (24).
1. Enrolling women in research trials includes extra costs that researchers don’t want so they opt out of using women. Therefore, research trials continue to be male-centric studies.
2. Male bias occurs when journals/research are sent to publishers. Publishers, who may mainly be men, lean towards research, and trials that cater to them.
3. Information in studies makes it seem as if the research applies to both men and women.
4. Our male-centric medical system doesn’t address any of women’s issues. All women’s “issues” are sugar-coated and belittled.
5. For teaching purposes and testing, mannequins are all males.
6. The elderly and women of color are overlooked in research. Elderly patients take too many other prescriptions that might counteract the drug being tested, other diseases like dementia also play a part in consent. In 2017, “the Center for Drug Evaluation and Research approved over forty-five new drugs. Only 7 percent of both genders were black or African American, 14 percent Hispanic” (29).
Broken Heart Syndrome
Takotsubo cardiomyopathy, also known as “stress cardiomyopathy” or “broken heart syndrome” primarily affects women (40). After a traumatic or stressful event, the body’s “fight or flight” hormones rise. Women sometimes do not talk about what is bothering them causing the cause of the stress not to be addressed. This also increases other cardiac failures.
There is an overlap between heart disease and anxiety diagnoses in women. Takotsubo cardiomyopathy affects women with anxiety heavily. Patients with Takotsubo report less well-being, more depression, and more anxiety. According to the American Heart Association, women are more likely to die from a serious heart attack than men (42). The Centers for Disease Control and Prevention reported that 64 percent of women who die from sudden heart attacks, presented no symptoms prior (42). Women do not present “male-like” symptoms, so they are overlooked and dismissed when admitted to the emergency departments with milder symptoms. They are misdiagnosed with psychiatric reasoning.
1. “Some women with microvascular disease who complain of angina feel they must be crazy and should see a psychiatrist because their doctor says there is nothing wrong with them. It reaches a point where they’re not just undertreated but under-believed” (43).
2. The Barbra Streisand Women’s Heart Center has research that focuses on creating in-clinic solutions for patients who experience chest pains but no visible blockage, examining the relationship between estrogen levels and heart disease.
3. Encourage others and even yourself to take part in clinical trials.
4. Factors such as hormone levels, fat distribution, and metabolism affect women’s heart disease, but we don’t know exactly how.
Same drug, different bodies
As we age into adulthood, our bodies change, especially our medical health. We can take anywhere from four or more medications. Women are more likely to be prescribed medication than men (70). Women have unique attributes in areas including bone structure and composition, body fat, and tissue elasticity. These attributes cause pharmaceuticals to digest and metabolize differently in women than men. There are differences in how drugs are absorbed into the body and distributed throughout the body. This means that dosages are supposed to be different. What works for a man doesn’t always work for a woman.
Aldehyde dehydrogenase is an enzyme that metabolizes alcohol. Men have a lot of this enzyme, and it is in the stomach lining and the liver. It is very active in the male body. In women, this enzyme is little to none in the stomach lining and less active in the liver. Therefore, women tend to stay drunk longer and be less functional, while men start to metabolize alcohol as soon as it enters the body. It is not until alcohol gets into the bloodstream that alcohol in women begins to digest.
Drugs that are said to be lifesaving, can be destroying for women. Researchers tested a drug called naltrexone in a rehabilitation center for cocaine and alcohol users. The drug increased the opioid receptor in women and decreased it in men. This led to an increase in overdoses, drug-related injuries, and other complications.
1. Be careful with generic brands (over-the-counter medicine) because the “active ingredient” from the name-brand drug was already approved but the other ingredients were not. These brands only go through “bioequivalence testing” to prove their version is like their name-brand counterparts.
2. These generic brands are only tested on YOUNG HEALTHY MALES.
Pain is only measured on a scale
Women have both lower pain tolerance and thresholds than men. There are no tools to measure how much pain a patient is in. There is only a scale on which providers would ask “How is the pain on a scale of 1-10?”
Women have more sensitivity to pain based on how and where the sensations are being triggered. The brains make the connection to see how much that pain may or may not be damaging. Sensation for women can also contribute to the fact that we bear children. Pain is processed differently physiologically, biologically, psychologically, cellular, and on.
Sex hormones are everywhere in our bodies (including nerve cells and the central nervous system). These hormones are receptors in the brain, spine, and peripherally throughout the body. They help to deal with the response to pain and to help to control the pain response.
1. “Women of color are more likely to have their pain minimalized. One study found that African American and Hispanic women were less likely than white women to receive any pain medication or lower doses, despite high pain scores” (32).
2. Women have different responses and reactions to pain than men. They have a lower tolerance for pain where they would report discomfort before a man would. This “complaint” would be dismissed by providers, all while prescribing inaccurate pain medications.
3. Once the menstrual cycle begins, the reproductive and nonreproductive tissues begin to change allowing women to experience different feelings causing migraines, irritable bowel syndrome, chronic constipation, chronic tensions, and other issues described by women.
4. Fallen estrogen levels in the premenstrual period are associated with “flares” and can be like disorders such as chronic pain, migraine, and autoimmune diseases.
5. Providers who are aware of the link between menstrual cycles and pain are less likely to offer treatment during flares and brush them off.
6. PMS is a part of life as a biological female, but for some females, these flares are creating chronic pain disorders, and being uncomfortable and unbarring should be receiving treatment. It should be a valid complaint and a genuine way of seeking help.
“Which organs do you have?” (148)
And just like that, we are coming to the end of the article, but before I leave you, we are going to revisit the ideas of birth control, including hormonal use in women and why women should be careful with what they use and how they use it.
Blood clotting is common. 100, 000 people and more die from forms of blood clots each year. Did you know that birth control is one of the leading causes? Hormonal birth control which includes pills, patches, IUDs, and implants, releases a small dosage of hormones into your body that can cause women a four times higher risk of experiencing blood clots than women who do not use hormonal birth control methods. Don’t get me wrong, everyone has their reasons, wants, and needs to use birth control for a variety of reasons but please ask questions especially when you have side effects that ARE NOT common or experience new side effects not listed.
When you are a cigarette smoker, occasionally or daily, please tell your doctor. Nicotine accelerates the heart rate and narrows the diameter of blood vessels. This makes it easier for clots to form. Smoking allows the platelets to develop a “stickiness” (140). Hormonal birth control is an independent risk factor but continuing to smoke increases the chances of clotting.
Women’s hormones such as estrogen, progestins, and other female hormones affect their function throughout the body from immunity to their response systems (141). When adding synthetic hormones into our bodies, risk factors are altered and compounded.
1. Exogenous hormones bring the body into balance after surgery or menopause. It relieved painful symptoms associated with PMS and menopause. It also helps women to increase overall well-being (i.e., improving sleep, mood, vaginal dryness) but, side effects include clotting, phenomena, mood swings, weight gain, swelling, “brain fog” and risk of certain cancers.
2. Younger women’s bodies are NOT the same as older women’s.
3. High doses of exogenous hormonal use increase the chances of blood clotting, deep vein thrombosis, gallbladder disease, and stroke.
4. Drops in estrogen levels are associated with an increase in pain.
5. The use of hormones gives relief to younger women (for PMS symptoms, skin conditions, and pain by taking birth control).
6. Always tell your doctor if you take birth control. IT IS a form of medication. Also, inform them about over-the-counter medications such as Tylenol, allergy medications, and even vitamins that you take.
7. Other persons including transgender persons who were born female, must take into account the hormones they are taking. It is important to tell the doctor that you were assigned female at birth and how far along in your transition you are so that you can be properly dosed. You still have certain organs that are still catering to the (XX) chromosomes that will continue to stay the same inside your body.
