Introduction to Total Health for Women

A woman feels a lump in her breast. Doctors say it's nothing. She insists on a closer look. They find cancer. She survives.

A woman with fibroid tumors is told she needs a hysterectomy. But she wants children, so she searches for a less invasive treatment. She finds it. A few years later, she gives birth to a healthy baby.

Two different women with one important connection: Both took control of their health. They trusted their instincts and invested time and energy to get the health care they wanted. So can you.

How? By being informed about how your body functions and what your health-care options are.

"Women need to become more aware," says Judith LaRosa, Ph.D., clinical professor of public health at the Tulane University School of Public Health and Tropical Medicine and former deputy director of the Office of Research on Women's Health at the National Institutes of Health. "They need to gather information. To ask questions of their doctors. To be assertive."

Separate and Unequal

But there aren't always answers to our questions. For decades, in fact, there has been a deep and dangerous silence surrounding some of women's physical and emotional health needs.

The silence has meant unequal, and some say inadequate, health care for many of the 127 million American women who make up more than 51 percent of the population.

"Women's health has never been taken seriously in medicine," says Karen Johnson, M.D., clinical scholar in women's health at Stanford University, author of the book Trusting Ourselves and a sponsor of the movement to develop a women's health specialty in medical education. "And that has led to the unnecessary death and disability of hundreds of thousands of women." It's an issue that requires women to be vigilant about what they believe they need, says Dr. LaRosa.

"Because we don't always understand what is going on medically in women," Dr. LaRosa says, "a woman sometimes has to be very insistent that, yes, her symptoms are real and not just in her head."

A Void of Information

Sometimes it seems that the only people talking about women's health are women themselves: mothers and daughters, friends and co-workers. But even then, communication can break down. For some of us, menstruation was marked by an embarrassed visit from Mom, a small pink pamphlet and a box of sanitary pads. Menopause got barely a comment from older relatives and friends.

But even when women take the leap to discuss their bodies and their health, hard facts are often difficult to come by.

"My impression is, women talk a lot to each other about what's going on," notes Dr. Johnson. "But our institutions are not providing us with scientifically grounded information so that we can make informed decisions."

What are the major questions about women's health that cry out for answers?

"The area that's been neglected the most is how the menstrual cycle and pregnancy affect diseases, drugs, drug absorption and alcohol absorption." says Janice Werbinski, M.D., medical director of the Center for Women's Health of Bronson Methodist Hospital in Kalamazoo, Michigan, and clinical professor of obstetrics and gynecology at the College of Human Medicine at Michigan State University in Ann Arbor. "Just about every chronic disease, for example, can get worse right before menstruation begins. But nobody knows why."

In fact, doctors and researchers are just beginning to suspect the full impact of sex hormones--and we're not just talking PMS. Chronic diseases like asthma and lupus--and even minor ailments like laryngitis--may intensify the week or so before menstruation begins. The hormones estrogen and progesterone may contribute to a problem that many women know all too well--the pain and unsightliness of varicose veins. And after menopause, research has shown, lower estrogen levels rob calcium from our bones.

Even the medications we take may need to be stronger, or weaker, at different points in the menstrual cycle.

Until the medical profession has answers, Dr. Werbinski says, it's up to women to read as much as they can, ask questions, demand answers from their doctors--and take part in decision-making about their own care.

The Female Difference

If you're going to be an active participant in your health care, it helps to know something about women's health. Here are some facts that may surprise you:

* The number-one killer of American women is heart disease, not breast cancer. A woman's lifetime risk of heart disease is one in two; for breast cancer, it's one in eight.

* Nine out of ten people with eating disorders are women. Among the many reasons are low self-esteem and intense social pressure to be thin.

* Women are twice as likely as men to become depressed. (But they're also twice as likely to recover, because they are willing to seek treatment.)

* Women are infected more readily than men with certain sexually transmitted diseases. In fact, the soaring death rate has made AIDS the fourth-leading killer of women ages 25 to 44 in the United States.

* Alcohol hits us harder, and it can contribute to osteoporosis, breast cancer and diminished fertility. Yet doctors are less likely to diagnose alcoholism in women than in men.

* Smoking also hits us hard, increasing the risk of developing some kinds of cervical cancer and bringing on early menopause in some women.

* Ninety percent of women in their childbearing years do not get enough folic acid, a deficiency that can lead to neural tube defects in a fetus. Birth control pills, cigarettes and dieting can rob our bodies of folic acid.

Taking Care of Yourself

Our bodies are different. So are our lives.

More of us may be working outside the home, but we're still carrying most of the burdens inside it as well. In one survey, women in dual-income families said they did 81 percent of the shopping and cooking and 71 percent of the child care.

Many women are so busy they haven't found time to take care of themselves. Consider this: 40 percent of women have not had a Pap smear, which is the first line of defense against cervical cancer, in the past three years. And while HIV infections are spreading fastest among women, 70 percent of women surveyed were not concerned about contracting this fatal disease.

Did you know your annual gynecological exam does not include screening for STDs, which can cause infertility, among other problems? Or that if your doctor doesn't know the difference between "good" cholesterol levels in women and men, she may be interpreting your cholesterol test incorrectly?

A doctor/patient checklist developed by the National Women's Health Network starts off with this advice: "Your doctor provides medical knowledge, but it's your body. You're responsible for getting and staying healthy."

As the editors of Total Health for Women, we have taken that responsibility seriously to bring you an informed, commonsense guide to women's health. This book is designed to help you understand how your body works, to guard it from disease and to help you make decisions about your own care.

The Editors

Notice

This book is intended as a reference volume only, not as a medical manual. The information given here is designed to help you make informed decisions about your health. It is not intended as a substitute for any treatment that may have been prescribed by your doctor. If you suspect that you have a medical problem, we urge you to seek competent medical help.