Author: Dr Ajith Medical Director,
Clinical and Imaging Services,
Anand Diagnostic Laboratory
Sex is biological. It’s based on the genetic makeup. Males have one X and one Y chromosome in every cell of the body. Females have two X chromosomes in every cell. Gender is a social or cultural concept. It refers to the roles, behaviors, and identities that society assigns to girls and boys, women and men, and gender-diverse people. Sex and gender play a role in how health and disease affect individuals.
Women often spend so much time helping others that they don’t have time for themselves. Most often, women experience unique health issues and conditions, from pregnancy and menopause to gynecological conditions, such as uterine fibroids and pelvic floor disorders. Some of the health issues that affect both men and women can affect women differently.
Although the symptoms may be similar, the effects of the condition and the care necessary can differ significantly for women. In addition, some of these conditions might affect women primarily or more severely than men. For example: younger women with Myocardial Infarction are more likely to die than are men of similar age.
The disease burden:
The leading causes of death are the same in women and men: (1) heart disease, and (2) cancer. The leading cause of cancer death, lung cancer, is the same in both sexes. Breast cancer is the second leading cause of cancer death in women. Women’s risk for many diseases increases at menopause, which occurs at a median age of 52 years.
Estrogen levels fall abruptly at menopause, resulting in a variety of physiologic and metabolic responses. Rates of cardiovascular disease (CVD) increase and bone density begins to decrease rapidly after menopause.
Sex differences in health & disease: Heart disease:
Coronary heart disease (CHD) presents differently in women, who are usually 10–15 years older than their male counterparts and are more likely to have comorbidities such as hypertension, congestive heart failure, and diabetes mellitus (DM). They more often have atypical symptoms such as nausea, vomiting, indigestion, and upper back pain. Although awareness that heart disease is the leading cause of death in women has nearly doubled over the last 15 years, women remain less aware that its symptoms are often atypical!
There is also a striking increase in CHD after both natural and surgical menopause, suggesting that endogenous estrogens are cardio protective.
Cancer is the second most dangerous threat to a woman’s health, accounts for 22 percent of female deaths. However even in this category breast cancer is not the most deadly threat. Rather, lung cancer claims the most lives each year – mostly due to smoking; breast cancer is the second leading cause of cancer deaths.
Fortunately, lifestyle choices can help prevent at least one-third of all cancers, so one can reduce the risk by adopting healthier habits.
Breast cancer is the most common cancer that women may face in their lifetime.
It can occur at any age, but the risk goes up as you get older. Because of certain factors, some women may have a greater chance of having breast cancer than others. But every woman should know about breast cancer and what can be done about it.
Cervical cancer can affect any woman who is or has been sexually active. It occurs in women who have had the human papilloma virus (HPV). This virus is passed on during sex. Cervical cancer is also more likely in women who smoke, have HIV or AIDS, have poor nutrition, and who do not get regular Pap tests.
Ovarian cancer :
Ovarian cancer is more likely to occur as women get older. Women who have never had children, who have unexplained infertility, or who had their first child after age 30 may be at increased risk for this cancer. Women who have used estrogen alone as hormone replacement therapy are also at increased risk.
Women are more sensitive to insulin than men are. Despite this, the prevalence of type 2 DM is similar in men and women. There is a sex difference in the relationship between endogenous androgen levels and DM risk. Higher bioavailable testosterone levels are associated with increased risk in women, whereas lower bioavailable testosterone levels are associated with increased risk in men. Polycystic ovary syndrome and gestational DM—common conditions in premenopausal women—are associated with a significantly increased risk for type 2 DM. Premenopausal women with DM lose the cardio protective effect of female sex and have rates of CHD identical to those in males.
The prevalence of both obesity (body mass index ≥30 kg/m2) and abdominal obesity (waist circumference ≥88 cm in women) is higher in women than in men. More than 80% of patients who undergo bariatric surgery are women. Pregnancy and menopause are risk factors for obesity.
There are major sex differences in body fat distribution. Women characteristically have gluteal and femoral or gynoid pattern of fat distribution, whereas men typically have a central or android pattern. Women have more subcutaneous fat than men.
Abdominal obesity characterized by increased visceral fat is associated with an increased risk for Cardio vascular diseases and Diabetes. Obesity increases a woman’s risk for certain cancers, in particular postmenopausal breast and endometrial cancer
Osteoporosis is about five times more common in postmenopausal women than in age-matched men, and osteoporotic hip fractures are a major cause of morbidity in elderly women. Men accumulate more bone mass and lose bone more slowly than do women. Sex differences in bone mass are found as early as infancy.
Calcium intake, vitamin D, and estrogen all play important roles in bone formation and bone loss. Particularly during adolescence, calcium intake is an important determinant of peak bone mass. Vitamin D deficiency is surprisingly common in elderly women.
Most autoimmune disorders occur more commonly in women than in men; they include autoimmune thyroid diseases, lupus, rheumatoid arthritis (RA), scleroderma, multiple sclerosis (MS), and idiopathic thrombocytopenic purpura.
Unique issues in women:
Primary dysmenorrhea is by far the most common gynecologic problem in menstruating women. It is so common that many women fail to report it in medical interviews, even when their daily activities are restricted. It is usually defined as cramping pain in the lower abdomen occurring at the onset of menstruation in the absence of any identifiable pelvic disease. It is distinguished from secondary dysmenorrhea, which refers to painful menses resulting from pelvic pathology such as endometriosis.
PCOD (Polycystic ovarian Disease):
PCOD is the most common hormonal reproductive problem in women of childbearing age. An estimated five to 10 percent of women of childbearing age have PCOD.
Endometriosis, sometimes called “endo,” is a common health problem in women. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. Endometriosis happens when this tissue grows outside of your uterus and on other areas in your body where it doesn’t belong.
Urinary tract infections (UTIs):
Urinary tract infections (UTIs) are caused by bacteria and are 10 times more common among women than men. More than 50% of women will have at least one UTI during their lifetime. About 30 – 40% of UTIs recur within 6 months after the initial episode.
Depression, anxiety, and affective and eating disorders (bulimia and anorexia nervosa) are more common in women than in men. Depression in women appears to have a worse prognosis than does depression in men; episodes last longer, and there is a lower rate of spontaneous remission.
Alzheimer’s disease (AD) affects approximately twice as many women as men. Because the risk for AD increases with age, part of this sex difference is accounted for by the fact that women live longer than men.
Substance abuse & tobacco:
Substance abuse is more common in men than in women. Women alcoholics are less likely to be diagnosed than men. A greater proportion of men than women seek help for alcohol and drug abuse. Men are more likely to go to an alcohol or drug treatment facility, whereas women tend to approach a primary care physician or mental health professional for help under the guise of a psychosocial problem. Late-life alcoholism is more common in women than in men.
Women have a much larger burden of smoking related disease. Smoking markedly increases the risk of CVD in premenopausal women and is also associated with a decrease in the age of menopause. Women who smoke are more likely to develop chronic obstructive pulmonary disease and lung cancer than men and at lower levels of tobacco exposure. Postmenopausal women who smoke have lower bone density than women who never smoked. Smoking during pregnancy increases the risk of preterm deliveries and low birth weight infants.
Women’s health is a unique discipline, and the importance of sex differences in biologic processes is well recognized. There has been a striking reduction in the excess mortality rate from heart disease in younger women. Nevertheless, ongoing misperceptions about disease risk, not only among women but also among their physicians, result in inadequate attention to modifiable risk factors.