1. Introduction to Women’s Health PPS 946 3/2/15 Dr. Piascik

2. Following this session, students should be able to: Discuss why there is a specific focus on women’s health issues Discuss societal and physiologic differences between the sexes that affect women’s health Identify U.S. leading causes of death for women Discuss recommendations for screening Discuss the progress and pitfalls of women’s health research

3. The Problem MAN ≠ WOMAN 1985 Public Health Service Task Force on Women’s Health Issues concluded: ◦ “the historical lack of research focus on women’s health concerns has compromised the quality of health information available to women as well as the health care they receive.” Alder N., Adashi E., Aguilar-Gaxiola S., et al. Women’s health research: progress, pitfalls, and promise. Washington, D.C., The National Academies Press. 2010. pg 1-15.

4. Sex vs Gender Sex – the chromosomal structure determined at conception; most appropriately reserved for biologic characteristics differentiating female from male. ◦ Ex – girls develop breasts and have periods; boys develop testes and have greater musculature Gender – socially constructed roles and expectations deemed appropriate based entirely on biological sex ◦ Ex – girls wear pink, play with dolls; boys wear blue, play with toy guns

5. Historical View Women have been “the other” in health care Research data collected on male subjects has been assumed to apply to women also Women, children, ethnic minorities, and the elderly have been excluded from research protocols based on “lack of data” Research on women’s health issues has emphasized childbearing concerns

6. AMA Statement on Gender Disparities in Clinical Decisions “Medical treatments for women are based on a male model, regardless of the fact that women may react differently to treatments than men or that some diseases manifest themselves differently in women than men. The results of medical research on men are generalized to women without sufficient evidence of applicability to women.” Council on Ethical and Judicial Affairs, AMA. Gender disparities in clinical decision making. JAMA 1991;266:599-62.

7. Reasons for a male focus in health- related research 1. Lack of understanding of the health importance of male-female differences 2. Cost issues 3. Eliminates the confounding variables of hormonal changes during a study 4. Childbearing issues – ethics of studies on pregnant/lactating women

8. Definition of women’s health Traditional View focused on reproductive and maternal aspects only Contemporary Women’s Health focuses on: Promoting wellness through self care Preventing illness through screening, diagnosing, and managing conditions that are… unique to women more common in women more serious in women with manifestations, risk factors or interventions that are different for women than men

9. Diseases/conditions affecting women in the U.S. Heart Disease (306,246) Cancer (270,018) Cerebrovascular Diseases (81,841) Chronic Lower Respiratory Diseases (66,689) Alzheimer’s Disease (52,832) Accidents (43,879) Diabetes (35,904) Influenza and Pneumonia (28,646) Nephritis (23,832) Septicemia (18,989) Baby girl born in 2007 – life expectancy = 80.4 yr (5 yr more than male)

10. Current health issues for women Breast cancer – affected ~208,000 and killed ~40,000 in 2010 COPD (chronic bronchitis and emphysema) – killed more women than men for past 7 years (ALA) Fibromyalgia – chronic pain syndrome; 90% of the 3- 6 million patients Lupus – affect 90% of the 1.5 million Americans Depression and Anxiety – twice as many women Alzheimer’s Disease – 5.4 million Americans (2/3 women) * From Medicines in Development for Women 2011, PhRMA, May 2011 - See more at: http://www.phrma.org/research/backgrounder-selected-medicines- development-women#sthash.Y9Ot3hMX.dpuf

11. Current health issues for women Migraine – 80% of the 26 million Americans Multiple Sclerosis - 2-3X as many women affected (400,000) Ovarian Cancer – ~14,000 women died from this disease in 2010 Rheumatoid Arthritis – affects ~1.3 million Americans; 2.5X as many women * From Medicines in Development for Women 2011, PhRMA, May 2011 - See more at: http://www.phrma.org/research/backgrounder-selected- medicines-development-women#sthash.Y9Ot3hMX.dpuf

12. Societal Differences that affect health Caregiving Insurance Poverty/Living circumstances Aging Tobacco use Domestic Violence

13. Differences go beyond predisposition to disease Symptoms present may be different ◦ Example - Men having heart attacks typically report chest pain radiating down the arm; women may feel indigestion, extreme fatigue, nausea Differences in metabolism of certain substances ◦ Example - women metabolize nicotine more quickly than men, lower-dose nicotine patch for smoking cessation may not be as effective for women as for men

14. Why do women react differently to medication? Body size and composition Immunology Reproductive issues ◦ Menstrual cycle, contraception, pregnancy, menopause Pharmacokinetic differences ◦ Longer gastric emptying time and less gastric acid (higher, fast availability of alcohol ) ◦ % body fat and  total body water – ADRs from antidepressant occur at lower doses ◦ serum creatinine levels and creatinine clearance; require  doses of renally eliminated drugs

15. Suggested screenings Blood pressure – every 2 yrs if normal BMD – at 65 yrs Mammogram – from 50-74 every 2 yrs Cervical cancer – Pap test every 3 yrs at 21; Pap and HPV test every 5 yrs at 30 Colorectal cancer – at 50 every 10 yrs Pregnant – HIV, syphilis, chlamydia (yearly till 24), gonorrhea – also if at increased risk

16. Women’s health moduletopics: Dysmenorrhea, PMS, PMDD Menopause and HRT Osteoporosis Urinary incontinence Endometriosis, fibroids Contraception Infertility Cervical cancer Drugs in pregnancy and lactation