Mind the GENDER HEALTH GAP

Think medicine treats both sexes equally? Wrong. Women get a raw deal in a whole range of ailments, from Alzheimer’s to heart disease. And even the new ‘female Viagra’ was chiefly tested on MEN!

When it comes to our health, it seems there is still a gender gap in what we know and how we treat men and women. Research suggests that women are missing out on potentially life- saving treatments and tests because doctors and researchers have failed to take fundamental biological differences between the sexes into account.

Certain behavioural or social factors mean that women are less likely to be diagnosed with particular conditions, or get treatment, too.

For example, a study concluded women in the early stages of Alzheimer’s are going undiagnosed because they tend to have superior verbal memories — the type that helps them remember words from stories or lists, for example.

In the study by the University of Illinois, presented to the Alzheimer’s Association International Conference earlier this year, women managed to sustain their performance in memory tests even when scans showed Alzheimer’s was beginning to damage key parts of the brain.

The scientists concluded that ‘while the female advantage may be functionally beneficial, it could mask the early stages of Alzheimer’s, resulting in a more severe burden of disease at the time of diagnosis, with more rapid deterioration thereafter’.

Also, for years, heart attacks have been thought of as a ‘man’s disease’, mainly because men have traditionally tended to be more likely to smoke, have unhealthy lifestyles or succumb to stress.

The symptoms of a heart attack in women are also often thought of as less typical, so tend to be missed. As a result, cases in women are also missed. Women are more likely to die following an attack, partly due to misdiagnosis.

WOMEN’S BREASTS CAN AFFECT HEART SCANS

‘Women with heart attacks are more likely to be taken to hospital and discharged with an irrelevant diagnosis such as panic attacks or indigestion,’ says Georgios Kararigas, a professor of translational gender research at Charité University hospital in Berlin, Germany.

‘This means they are not properly treated, which is detrimental to their health and can lead to unnecessary deaths,’ he adds.

A further complicating factor is that ‘typical’ symptoms of a heart attack — such as chest pain, rapid heartbeat and shortness of breath — are more common in men.

Women, instead, are more likely to experience fatigue, anxiety, light- headedness and sleep disturbances over a period of several days or weeks, rather than a sudden pain. These problems can be easily mistaken for other, less serious conditions.

even if a heart attack is suspected, getting a diagnosis in women is tricky because breast tissue creates confusing shadows on the scan commonly used to detect coronary heart disease, known as Spect (single-photon emission computerised tomography).

‘male and female hearts share the same physiology and function, but the response to disease differs significantly,’ says Professor Kararigas. That’s partly because hormones play a role.

most women have a regular hormonal cycle after puberty, driven by the sex hormone oestrogen. This hormone has a protective effect against heart disease, though it’s not clear why.

however, once oestrogen levels drop after the menopause, this protection is lost and the risk of developing heart problems rises dramatically.

heart disease even looks different in men and women. men tend to have larger fatty blockages in their arteries which trigger an attack. These can be treated with a small tube, called a stent, to open up arteries and restore blood flow.

By contrast, women’s arteries tend to get ‘furred up’ with a layer of fatty material over a larger area. Stents or similar surgical approaches don’t work, and treatment tends to focus on lifestyle changes and drugs such as bloodthinning aspirin or beta blockers to reduce strain on the heart.

These gender differences extend into doctors’ perceptions of illnesses affecting men and women. Alarmingly, a study of A& e admissions in Florida, published in the Proceedings of the national Academy of Sciences earlier this year, showed that women are more likely to die if they are treated by male rather than female doctors.

This is likely due to stereotyped views about how a ‘typical’ (male) heart attack patient should be treated.

RESEARCH STUDIES MISS OUT WOMEN...

one of the main reasons for the lack of knowledge about the impact of female hormones and biology on a whole range of conditions is a historical focus on using males for research.

‘In laboratory studies, we have to use animal models to look at what’s going on — for example, in the brain — so to use as few animals as possible most studies