The life cycle of a woman is totally different from that of a man, so are the health and diseases between men and women. While the life of a man is grossly correlated to his age, beginning in infancy, childhood, adolescence, adulthood and old age, a woman’s is a play of hormones, beginning in infancy, childhood, adolescence starting the reproductive age group towards adulthood ending the reproductive period & post menopausal stage.
The health issues women face are unique and include anemia – Iron Loss and nutritional, thyroid disorders, pregnancy related illnesses, polycystic ovarian disorder, sexually transmitted disorders (common with that of men) and cancers specific to women like ovary, uterus and breast.
Women live 8-9 years longer than men which is good but increasing survival brings room for age related chronic diseases like hypertension, degenerative valve disease, coronary artery disease, complications of diabetes mellitus and heart failure.
Despite improvement in early detection and treatment of chronic diseases, there is considerable delay in diagnosing chronic health disease in women primarily because of prioritization of ‘care taking’ in a woman’s life rather than ‘self-care’. The other downsides in women healthcare are being labelled as ‘multiple somatic complaints’, ‘somatization’, ‘fibromyalgia’ and reluctance to aggressively manage acute coronary syndrome and optimisation of heart failure medications.
The scenario worsens gradually and is expected to deteriorate further with children working and living overseas with only the woman of the house taking care of the man of the house with inadequate physical and emotional support.
There is a definite need to improve the healthcare infrastructure and resources tailored to meet the specific health requirements of women as ‘Woman’s health is the key for family’s health’
Life stages of a woman and specific diseases
- Infancy and Childhood:
- Gender Discriminated treatment and related mental health disorders
- Psychological impact of same (more common in rural than in urban settings)
- Nutritional deficiencies
- Congenital heart diseases., Ex: Atrial septal defect
- Adolescence:
- Body Morphology related psychological disorders
- Anorexia nervosa, bulimia
- Iron deficiency anemia
- Sexually transmitted diseases
- Pulmonary arterial hypertension
- Mitral valve prolapse syndrome
- Thyroid disease
- Migraines
- Adulthood – Reproductive age group:
- Pregnancy related ailments
- Gestational Diabetes mellitus, hypertension, pre-eclampsia, eclampsia, anaemia
- Sub fertility, polycystic ovarian syndrome
- Sexually transmitted diseases
- First manifestation of rheumatic heart disease particularly mitral stenosis
- Spontaneous coronary artery dissection
- Deep venous thrombosis and cortical venous thrombosis
- Post partum psychosis and encephalopathy syndrome
- Connective tissue disorder: e.g.: systemic lupus erythematosus, rheumatoid arthritis,
pulmonary artery hypertension, Raynaud’s phenomenon
- Cancer cervix, cancer breast
- Aortoarteritis
- Need for advice on Contraceptive usage is an important healthcare dimension
- Postmenopausal:
- Post menopausal syndrome of hot flushes, irritability
- Osteoporosis, fractures
- Hypertension
- Coronary artery disease and heart failure
- Interstitial lung disease
- Stroke
- Malignancies: breast, ovaries, uterus
- Uterine prolapse
- Fragility, falls, injuries
- Deformities of rheumatoid arthritis
- Osteoarthritis and degenerative spine disease
- Giant cell arthritis, poly myalgia rheumatic
- Throughout life:
- Depression
- Anxiety
- Schizophrenia
“Health Care Gap to Minority”
A specific note on coronary artery disease in women, a disease more common in men than in women, is often underdiagnosed primarily because of atypical presentation and high threshold to diagnose coronary artery disease with undue advantage given to the protective role of menstruation.
Heart diseases in women are treated with suboptimal medications and dosages fearing intolerance to same.
Thus, health care for women need to cater holistically to all aspects of women’s lifestyle including, not only the physical health, but comprise mental, social & occupational health of a woman.
Thus, women’s health care is to be structured as a separate specialty and should include the following faculties.
- Fitness assessment & Nutritional assessment and advice
- Screening of children for genetic disorders and congenital heart diseases from birth
- Periodic nutritional assessment of children and advice to correct deficiencies
- Vaccination including HPV vaccine for girls from 9 years of age and women in reproductive age group
- Awareness on sexually transmitted diseases including HIV, Hepatitis B, Hepatitis C, HPV, Gonococci, Chlamydial infections and education on safe sex practices
- Education on advantages and disadvantages of various contraceptive options
- Specialized migraine clinics, helping identify triggers, education on avoidance of triggers and effective control of migraine
- Mother health clinics facilitated with diabetologists and physicians coordinating with obstetrician for diagnosis and effective management of medical illness related to pregnancy.
- Actively look for evidence of connective tissue disorder, aorta arteritis in all possible clinic visits
- Mandatory screening for cancer breast with educational meets on self-breast-examination, periodic mammogram, genetic screening for index patient and same for family members if positive in index patient
- Education on post-menopausal symptoms and awareness on treatment options
- Evaluation of need for hormone replacement therapy in early post menopausal stage for treatment of post menopausal syndrome and prevention of osteoporotic fracture
- Muscle strengthening exercises, Vitamin D and calcium replacement, periodic Dexa Scan and identifying risk of fractures
- Diet advice for inclusion of fibre, low fat diary and appropriate protein intake
- Advice on physical activity for prevention of atherosclerotic artery disease, physiotherapy and rehabilitation for independent living and good quality of life
- Periodic PAP smear examination and endometrial thickness monitoring
- Education of health are staff at all levels faculties on diseases specific for women
- Organizing the “women health team” which cadres primordial to tertiary prevention of women health with dedicated multi-faceted team of doctors and paramedical staff.
(Dr. Booma Soundararajan is Senior Registrar, Department of Cardiology, Kauvery Hospital, Chennai)
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