Welcome to Hygeia!

Named for the Greek Goddess of Health , Hygeia is dedicated to educating the public about Women's Health.

This page is under construction by Debra R. Judelson, MD

Hygeia will allow you to access many different areas of women's health. For the topic of women's health from the public's point of view, access the Public Directory . For the topic of women's health from the health professional's point of view, access the Professional Directory . If you would like to know about organizations dedicated to women's health, access AMWA, the American Medical Women's Organization , under the Professional Directory . If you're interested in seeing what's out there, check out both.

Public Directory

basic information

current concepts

what's new

and did you know that...

Professional Directory

Medical Professionals that deal with women's health may be interested in an organization dedicated to women's health, the American Medical Women's Association (AMWA) or specialized research areas such as CVRI. Several health topics are described in:

AMWA

CVRI

Disclaimer

The material presented in Hygeia is for general information and entertainment only. It is not intended to provide individual medical advice or to be a substitute for a relationship with your physician, a medical examination, or appropriate tests and treatment. If you have any questions or suggestions, please send comments to: judelsondr@ajdj.com


Basic Information

Why Women's Health

Women's Health covers medical topics that we hear about every day, but from the perspective of the woman as the patient. Physicians are traditionally taught in medical school using a male model of disease and an "ideal" patient, the 70 kilogram (154 pound) male. It's time to shift that focus to the woman.

Women make up a majority of the population and require more health care throughout their lives. Men die more often from violence and accidents, while women suffer throughout their lifetimes from complications of childbirth, more diabetes, more hypertension, and finally, more heart disease and strokes. Because we live longer, the conditions associated with aging occur more often, and their prevention or treatment take on greater importance.

Many physicians have dealt with the bias towards the male model of disease with open eyes and a sense of humor, but there have been too many missed opportunities: in medical research , treatment recommendations , and patient lives . Fortunately, the word has spread and a growing number of physicians approach medical care of patients taking gender into account. We dedicate Hygeia to those physicians, hoping to open the eyes of all physicians for the benefit of their patients' health.

What's an "ideal" patient?

An "ideal" patient is a figment of medical imagination, the classic white rat that is used in experiments so that everything is standardized. While this may have bearing on traffic flow at rush hour, the standardized patient hurts, not helps, medical evaluations. Illnesses, conditions, or diseases are presented by describing this "ideal" patient's complaints, physical examination, and test results. Medications are recommended and therapy ordered while we see the response to treatment.

The basic research on complaints, proper medication doses, and therapy was done on these "ideal" patients, young healthy men. They are average height, average weight, usually 20 to 30 years old, and without other medical problems. Researchers felt that it was easier to study healthy men. They could ignore all those hormones, cycles, and other illnesses that get in the way and they didn't have to worry about babies that may come in the future. In fact, research on drugs universally EXCLUDES women that have the potential to have children (that is, excluding women who are not post-menopause or surgically sterilized). It didn't matter if the drug being investigated was for infections in pregnancy, the medications were still tested and the dosages given based on studies done in men!

The advantage of using the idealized patient is that drug dosing and side effect measurements are reproducible and could be done easily in people who were not likely to have long-term complications. Published data on how quickly a drug is absorbed when taken by mouth and the resultant blood levels came from these studies. The disadvantage of using idealized patients is that there is a great deal of variation in side effects or how much drug is absorbed based on the patient's age and other medical conditions or medications. The data derived in healthy young men is worthless, except for use on healthy young men. Even the protection again damage to future babies is not clear; after all, researchers do not require the men to be surgically sterilized and no one studies babies conceived by men after they've been in drug studies.##

Medical Research

Missed opportunities in medical research occur when groups of people or their diseases are systematically excluded from research studies. This can occur because studies that include women or minorities are not approved or not funded. Congress, which controls funding for medical research in the United States, has traditionally been interested in medical research on diseases which its members feared. Since Congress is overwhelmingly made up of white males, funding for medical research has always emphasized their diseases. The rest of the funding went to media-driven, high profile diseases such as AIDS. It wasn't until then-President Ford's wife and Vice-President Rockefeller's wife both suffered from breast cancer that funding increased for that disease.

Medical research did not study heart disease in adequate numbers of women patients, thinking that women didn't get the disease or that it wasn't very serious for them. Imagine the surprise when statistics showed that women died more often than men from heart disease, and still no major studies were being done. A long-term study in male physicians on the use of aspirin and vitamins to prevent heart disease was launched decades ago; women physicians were not even allowed to participate. This study gave us the reliable proof that aspirin prevents heart disease. No long-term prospective study of women has ever been done. The history of the lack of funding for breast cancer research is legendary, even though it is the most feared disease among women. Women were not included in early studies in AIDS, even though HIV infected women were available. We may never know the natural history of AIDS in women because the opportunity to follow these patients was missed.

Treatment Recommendations

Recommendations can't be made, even today, about some of the most basic treatments for women that are well known for men. The diagnosis and treatment of AIDS in women is different from that in men, because the secondary infections that women get are different. The routine treadmill done in men to diagnose coronary artery disease gives a false result in up to 40% of women, seriously impacting the treatment recommendations that can be made to a woman with chest pain. Research on drug therapy in women during pregnancy is completely lacking; the pregnant woman and her physician have little information on the use of medications needed for other medical problems. In fact, research on the absorption and effect of almost all drugs has been done in "ideal" patients , healthy young men. Physicians are giving amounts of medications without really knowing whether they are optimal for their women patients.##

Patient Lives

The quality and duration of a woman's life is impacted by the missed opportunities. Women aren't screened for heart disease as men are, and when they are routinely diagnosed, they get referred half as often as men do for coronary artery bypass surgery, suffering and dying needlessly. Women who present with elevated blood pressure are frequently told "it's just a little high" and not followed or treated aggressively to prevent its complications. Women are the primary victims of domestic violence, yet when they present to an emergency room with trauma, they are routinely released to the care of the person that hurt them. Women often neglect their own health care when they have symptoms because they are busy caring for their family. This impacts the lives of the women and the families they care for.

Differences between Women and Men

An alien observing the human race might come to the conclusion that there are not one, but two distinct kinds of human beings on this planet, women and men. Each has different physical structures or anatomy, different normal function or physiology, and different emotional/behavioral responses or psychology While these differences can be genetic, acquired, or learned, and can vary greatly between individuals regardless of gender, the effect by gender is overwhelming. These differences influence the way women and men recognize, develop, and respond to diseases and current treatments.

The physical structures are different:

The normal functions of the bodies are different:

The emotional and behavioral responses are different:

Important Diseases affecting Women

  • These are some (not all) of the important conditions that affect women. We will try to discuss each condition, describing aspects that are unique or more common in women, or manifestations that are different in women.
  • Cardiac (Heart Disease)
  • Hypertension (High Blood Pressure)
  • Stroke
  • Diabetes
  • Cancer: Breast, Lung, Uterine, Ovary
  • Osteoporosis
  • Arthritis
  • Thyroid
  • Inflammatory/Collagen Vascular
  • Common infections: Urinary Tract, Vaginal
  • Depression/Anxiety

  • Skin: Aging, Adult Acne, Rashes
  • HIV/AIDS
  • Current Concepts

    Heart Disease

    This section is under construction.

    The number one killer of American women is heart disease, accounting for more than half a million deaths in women a year. Coronary heart disease is the most common cause of death and disability, and it impacts more women than men each year. A knowledge gap exists, because women have a greater fear of cancer (especially breast cancer), worry more about AIDS, read more about domestic violence, and do more to prevent osteoporosis, yet more women die from coronary heart disease than from all these other causes COMBINED. Information is available to dramatically reduce the likelihood of developing coronary heart disease and that needs to be spread to patients and physicians so lives can be spared.

    Types of heart disease

    Coronary Heart Disease

    Hypertensive Heart Disease

    Valvular Heart Disease

    Congenital Heart Disease

    Congestive Heart Failure

    Coronary Heart Disease

    The most common type of heart disease is coronary heart disease. The heart is a muscle that receives its blood supply from vessels called the coronary arteries. When these vessels become narrowed because of the build up of atherosclerotic deposits or plaques, the heart muscle downstream does not receive enough oxygen and nutrients from the blood. Patients who suffer from this condition complain of angina or chest pain, usually coming on with physical activity.

    The usual risk factors for heart disease are well known, though their impact in women is frequently different than in men. The strongest risk factors for heart disease are advancing age, tobacco use, diabetes mellitus, hypertension, and lipid abnormalities. However, many risk factors are stronger in women, and some are unique for women. For example, most women develop symptomatic heart disease after they go through menopause, about 10 to 15 years later than men do. The loss of protection from heart disease with the loss of estrogen is a risk factor that is unique for women. Diabetes mellitus is a condition that occurs more frequently in women, especially in the older age group. Diabetes negates the 10 to 15 year lag in development of heart disease for women compared to men, so that diabetic women develop heart disease at the same age as non-diabetic men. Hypertension occurs more often in women than men, especially in the the age group where heart disease is more common.

    Lipid abnormalities are a major risk factor for heart disease, however the importance of lipid abnormalities varies by gender. In men, LDL or low density lipoproteins are the most important risk factor. The elevation of LDL is associated with increased plaque in the coronary arteries and increased risk for heart disease. In women, LDL is an important risk factor, however the level of HDL or high density lipoprotein is even more important. HDL acts to remove LDL from the coronary plaque; high levels are protective and low levels are a risk. Women tend to have higher HDL than men, though this drops gradually with age and dramatically after menopause. Triglycerides are another risk that is stronger in women than in men. High triglyceride levels are associated with LDL that are more likely to develop coronary plaque. Lp(a) helps LDL get into vessels plaque; it is strongly associated with heart disease in women but only recently is thought to be associated with heart disease in men.

    Knowledge of risk factors is important in trying to reduce their impact for the development of heart disease. Some risk factors can be minimized, some can be prevented, and some can be avoided. The changes and recommendations made for women are critical to reducing the deaths and disability from heart disease.