Top Women’s Health Concerns

by DEBBE GEIGER, Duke University Medical Center
October 2009

There are a lot of differences between the sexes, but one of the biggest is how chronic conditions impact health. More and more, research is showing where those differences between men and women lie, but it doesn’t change the underlying message: if you want to lower your risk for chronic disease, you’ve got to eat right, exercise regularly and follow a healthy lifestyle.

Here, we’ve outlined some of the common health concerns that plague women, along with the advances being made, and advice on how to incorporate preventive measures into your life. It’s never been a better time to start living healthier and wiser.

Menopause — Nearly 6,000 women reach menopause every day, and as the baby boomer generation reaches mid-life, the number of women living through menopause and beyond is expected to grow by the millions. Menopause, a woman’s final menstrual period, usually doesn’t happen overnight. Rather, as hormone levels of estrogen and progesterone fluctuate, noticeable changes sometimes occur. These changes usually start somewhere between the ages of 45 and 55, says Anne Ford, MD, a gynecologist at Duke University Medical Center in Durham, and that period of time leading up to menopause is called peri-menopause.

"The most common sign of perim-enopause is a change in your menstrual cycle," Dr. Ford says. "It’s also common to experience intermittent hot flashes and mood swings, to see changes in your hair, and to experience weight gain around your middle. Vaginal dryness and urinary problems, including leakage when sneezing, coughing or laughing, are also typical."

Treating these symptoms varies by individual. In the past, most women took hormone replacement therapy for relief, but Dr. Ford says treatment should be individualized. To determine if it’s right for you, she suggests reviewing with your doctor your personal risk for chronic conditions including cancer and heart disease.

Natural and plant-based therapies like soy and black cohosh are often touted as being able to provide symptomatic relief, but Dr. Ford says there’s no good scientific evidence to prove they are safer or more effective than prescription hormone therapy.

"The best way to weather the menopausal years is to take care of yourself," she advises. Follow a healthy diet that includes plenty of fiber and calcium, limit your alcohol intake, quit smoking and maintain an appropriate body weight for your size. Also, see your doctor for regular mammograms, bone density screenings, and to monitor your blood pressure, blood sugar and cholesterol.

Another Reason Why You Shouldn’t Pack on the Pounds — Women may live longer than men, but that doesn’t mean they are living better. In a recent study conducted at Duke University Medical Center, researchers found that women over the age of 65 reported nearly 2.5 times more disabilities then men of the same age, and nearly half of the gender gap was explained by higher rates of obesity and arthritis which take root in middle age.

According to Heather Whitson, MD, a geriatrician and assistant professor of medicine at Duke, the study "suggests that women’s tendency to pack on extra pounds in their child-bearing and peri-menopausal years translates into loss of independence in their old age."

There’s a Reason More Women Die from Heart Disease — Heart disease doesn’t play favorites with women. It’s is the number one leading killer of women, they’re more likely to die at younger ages, and it’s the leading cause of disability. Now a large study finds women are twice as likely as men to die within 30 days following a heart attack. Duke researchers also figured out why.

"We’ve learned that there is not some mysterious black cloud following women around," said Pamela Douglas, MD, professor of medicine with the Duke Clinical Research Institute and the study’s senior author. "This study shows the cause can be attributed to the fundamentally different cardiovascular physiology of the sexes."

Douglas says the difference in death rates is easy to explain. "When women have a heart attack they are sicker, older, and have more risk factors." Other factors that appeared to have the largest impact on the higher mortality rates among women included age, smoking, high blood pressure, heart rate and height.

Having a better understanding of gender differences in cardiovascular disease may help physicians to more effectively tailor prevention or treatment strategies to specific patients.

"Care needs to be personalized because a woman with a heart attack is different than a man," Douglas said. "Risk factors affect men and women at different rates and severity which needs to be taken into account."

To prevent a heart attack from occurring in your future, eat a well-balanced diet, exercise regularly, quit smoking and monitor your cholesterol and blood pressure.

New Advance in Breast Cancer Surgery — Nobody knows exactly why breast cancer occurs but they do know who’s at risk. Your age — most breast cancers occur in women over 50 — your ethnic background (breast cancer occurs more in white women than African Americans or Asians), and your family history all add up to increase your risk.

While there’s nothing you can do about those risk factors there’s a lot that can be done about others. For example, controlling your weight, exercising regularly, undergoing routine screenings, and talking to your doctor about your personal risk for breast cancer can go a long way toward prevention and obtaining an early diagnosis.

If you require surgery to remove a tumor, a new experimental device may one day reduce the need to undergo more than one surgery. That’s what happens every year to tens of thousands of American women who must endure more than one lumpectomy to ensure complete removal of their breast cancer. In many hospitals, up to 40 percent of women return to the operating room for a second surgery, says Lee Wilke, MD, a breast surgeon at Duke. Her research may change that.

Dr. Wilke is using a special imaging technique in the operating room that can differentiate between normal breast tissue and cancerous tissue. It lets surgeons know when they’ve removed the whole tumor so they don’t have to go back for another surgery one week later.

The researchers think it will take another two years of testing on many patients before the technique is completely refined.

Bone up: Osteoporosis Can be Prevented — More than 44 million Americans have osteoporosis, and more than half of them are women, according to the National Osteoporosis Foundation.

When the damage is done, weak, brittle bones means even the simplest movement, like bending over or coughing can cause a fracture. The older you get, the higher your risk becomes. Fortunately, it’s never too late to do something about try to keep your bones strong and avoid fractures.

Getting adequate amounts of calcium and vitamin D are important whether your doctor has already seen evidence of osteoporosis in your bones or not. That’s because it may help your bones from becoming even weaker. It’s best to get your calcium through foods like dairy products, but they’re not your only source. Almonds, broccoli, cooked kale and canned salmon are also rich in calcium. Many products are fortified with vitamin D, although many people get adequate amounts simply by being exposed to sunlight. If you want to make sure you’re getting enough calcium and vitamin D, consider taking a daily dietary supplement too.

Exercise programs, including regular walking, will help maintain the bone you’ve got. But to minimize your risk, quit smoking, avoid drinking too much alcohol, and limit your intake of caffeine.

Once diagnosed, a new medication appears to be making a difference, according to researcher at Duke. In 2007, Duke researchers reported a 28 percent reduction in death among patients who received zoledronic acid (Reclast) within 90 days of surgery for a hip fracture. But they didn’t know why.

Now they believe that drug may save lives after hip fractures may do so by strengthening the body’s immune system.

"People assumed it was due to a reduction in secondary fractures," says Cathleen Colon-Emeric, MD, an associate professor of medicine at Duke. "We wanted to know if that was the reason or were other conditions being affected by the medication."

Colon-Emeric and her colleagues report that the reduction in additional broken bones accounts for only eight percent of the mortality benefit. "Even after adjusting for secondary fractures and other risk factors, we found the risk of mortality was still 23 percent lower in the zoledronic acid-treated participants. That suggests the drug must work in other ways."

The link between osteoporosis and an increased risk of death has been observed for some time. Up to 25 percent of the 345,000 Americans hospitalized annually with hip fractures die within a year of their fracture. Typically, most patients die from cardiovascular problems like heart attacks, arrhythmias and strokes, infections such as pneumonia, and cancer.

"People who received the drug experienced common complications at the same rate as those who didn’t," says Colon-Emeric. But the people in the zoledronic acid group were better able to survive these events. "In particular, people with certain cardiac problems such as arrhythmias and pneumonias were much less likely to die from those conditions."

It still remains unclear what role zoledronic acid plays. "We know it affects the immune system and inflammation, and both of those are important in fighting infection and cardiovascular disease," Colon-Emeric says. "It may be that the drug is changing the body’s ability to fight off and recover from those illnesses." That idea will require confirmation in new studies.

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