Hello, His and Her Healthcare
Medicine now recognizes that women are different
It's certain that women should insist on being heard. "I had symptoms of heart palpitations for between six months and a year," says Jean Horgan, 63, of Wilmington, Del. "I'd seen an internist and had a stress test, and all they kept saying was that there's nothing there. They'd get this look on their faces like 'Here comes another one.'" When she saw Columbia's Legato, though, she was diagnosed with a faulty heart valve that was allowing blood to leak back into the heart, a condition less common in men. Medication, Horgan says, has made "a world of difference."
The reasons for all these variations are still being teased out. Hormonal changes--specifically, a loss of estrogen--were long the chief suspect in heart disease, since problems in women tend to show up with greater frequency after menopause. Yet Merz thinks microvascular dysfunction may have more to do with some intrinsic difference in the way male and female blood vessels behave--which might also explain why migraine and the pale hands and feet that result from blood vessel constrictions are more common in women. Researchers are looking into whether ACE inhibitors and statins, now used in people with blockages in big vessels, might be effective treatments.
Likewise, estrogen loss does not seem to be the chief culprit behind older women's rise in blood pressure. Hypertension is more of a male issue through middle age, but women a decade past menopause have pulled into the lead. That slow ramp-up is too gradual to implicate estrogen loss by itself, says Jane Reckelhoff, a physiologist at the University of Mississippi Medical Center. The male sex hormone testosterone, which women also produce, drops at menopause but then rises and could be more to blame: It may increase "oxidative stress," in which certain molecules damage cells, and which can lead to high blood pressure.
Because men and women have different sex chromosomes, genetic differences are thought to play a role in many illnesses, too. Autoimmune diseases, in which the body's immune system attacks its own tissues, affect mostly women: Lupus, which can damage the joints and multiple organs, afflicts nine times as many women as men, for example; twice as many women as men get multiple sclerosis. Because females receive an X chromosome from each parent but need just one to develop normally, one is randomly inactivated during early embryonic development. However, "genes can escape the inactivation," says Michael Lockshin, director of the Barbara Volcker Center for Women and Rheumatic Diseases at the Hospital for Special Surgery in New York. When a gene is expressed twice, the body may fight resulting proteins it perceives as alien.
Triggers. Another theory holds that stray fetal cells circulate in a woman's body long after childbirth and might trigger the body to attack itself. It's likely that other factors, including environmental causes, are also involved since women and men tend to be exposed to toxins differently, says Lockshin. He recalls an outbreak of an autoimmune disease in Spain that affected mostly women. The culprit was contaminated cooking oil; women were the ones stirring and tasting before the contaminants were destroyed by heat.