Women's Health

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Introduction to women's health

Women and men share many similar health problems, but women also have their own health issues, which deserve special consideration.

Women's lives have changed over the centuries. Historically, life was particularly difficult for most women. Aside from the numerous dangers and diseases, women became wives and mothers often when they were just emerging from their own childhood. Many women had a large number of pregnancies which may or may not have been wanted. In the past, childbirth itself was risky and not infrequently, led to the death of the mother. Most women in the past did not live long enough to be concerned about menopause or old age.

In 1900, a woman's life span was about 50 years. Now, in the new millennium, average life expectancy for American women is 82 years of age, and it is continuing to rise. Not only are women living longer, but they also can anticipate the possibility of enjoying a better quality of life throughout their span of years. In order to accomplish this, it is essential that women take charge of their own bodies and that they comprehend how they can maximize their personal health and fitness. It is also helpful that men understand and are supportive of the health concerns of the women.

Gynecology is the primary branch of medical science concerned with women's health issues. The word "gynecology" is a word consisting of "gyneco," meaning "woman," and "logic," meaning "knowledge." Taken together, it is "woman knowledge."

It is important that every woman has access to knowledge related to the spectrum of women's health issues, not only about her reproductive system, but about all aspects of her body.

Women's general health and wellness

There is credible information available to women not only on such problems as eating disorders, stress, alcoholism, addictions, and depression, but also on basic topics such as good nutrition, heart health, and exercise. For example, it is beneficial that a woman maintain her optimum weight. If a woman's waist size measures more than 35 inches (89 cm), she is more likely to develop heart disease, high blood pressure, and diabetes. Eating sensible meals, eliminating after- dinner snacks, and making physical activity a part of daily life are significant ways to help control weight and lower the risk of a long list of health problems.

Smoking is detrimental to anyone's health, as well as the health of those around them. Unfortunately, women continue to smoke despite the known health risks. Even though the number of female smokers is declining, still about 16% of women in the U.S. continue to smoke. Women are smoking in spite of the well-publicized risks including cancer, heart disease, and innumerable other health issues.

Drinking an excessive amount of alcohol is also harmful to health. Although women typically begin drinking at a later age than men and tend to drink somewhat less, lower doses of alcohol are required for women to develop alcohol-related medical problems including alcohol toxicity, cirrhosis, and hepatitis.

Women should be aware that they metabolize a number of drugs differently than men. In some cases and for some medications, the rate of metabolism may be slower, and in other cases, faster. It is, therefore, essential that women are well informed about the kinds and correct dosages of any drugs they are taking.

Quick GuideWomen's Health: Nutrition and Health Care Reform

Women's Health: Nutrition and Health Care Reform

What is Bacterial Vaginosis?

Bacterial vaginosis is a mild infection of the vagina. This condition is caused by an imbalance in the growth of the bacteria that are normally populate the vagina. It is not known exactly why this imbalance in bacterial growth occurs.

Unlike sexually transmitted infections, this infection results from bacteria that are normally found in the vagina.

Female anatomy

There are major differences in anatomy between males and females that require consideration. As more women are now participating in sports, many anatomic differences are being identified, often because men and women athletes sustain different types of injuries. In females, the hamstrings (muscles behind the leg) are not as strong as in males. Women also have a wider hip-to-knee ratio than men. A woman's legs are relatively longer and her torso shorter than a man of comparable size. She has a lower center of gravity, less muscle mass, less dense bones, and higher percentage of body fat.

Anatomic differences between men and women go well beyond the reproductive and skeletal systems. For example, they involve the brain and the heart. In fact, heart disease is the leading cause of death among women in the United States. It is now described as an "equal opportunity killer." Over one in three adult women in the US has some form of cardiovascular disease.

Women tend to suffer their first heart attack 10 years later than men. For reasons that remain unclear (and require more research), the likelihood for a younger woman dying from a heart attack is significantly greater than that of a man. Moreover, the symptoms of an impending heart attack may be somewhat different in a woman than in a man. A woman may more often ignore the symptoms and fail to seek medical attention. Every woman needs to develop her own healthy heart program.

The female reproductive System

Since the female reproductive system plays such an important role throughout the life of a woman, it receives special consideration. A woman's reproductive system includes her uterus, Fallopian tubes, ovaries, cervix, and external genitalia. The breasts can also be included, even though, technically speaking, they are not part of the reproductive system. The breasts do play a major role in pregnancy and motherhood.

Picture of the female reproductive system
Picture of the female reproductive system

Although the primary function of the reproductive system is to conceive and bear children, a female's reproductive system makes a major contribution to her being a woman. Due to the complexity of her reproductive system, she can experience a number of problems ranging from yeast infections of the vagina to fibroids of the uterus or cysts of the ovary.

If a woman is to make informed choices about her health care, she must understand her reproductive system. In the U.S., a common major surgery performed on women who are not pregnant is a hysterectomy. A hysterectomy, the surgical removal of the uterus, ends menstruation and a woman's ability to become pregnant. A woman needs to comprehend her options before she can decide if a hysterectomy is the best solution for her particular medical condition.

Female hormones

A hormone is a chemical substance secreted by one tissue that travels by way of body fluids to affect another tissue in the body. In essence, hormones are "chemical messengers." Many hormones, especially those affecting growth and behavior, are present in both men and women. Nevertheless, women are more often portrayed as being under the influence of their hormones, as being subject to hormonal "tides" or "storms."

Some hormones are of special concern to women. The sex hormones produced by the ovaries are not only involved in the growth, maintenance, and the repair of the reproductive tissues, but they also influence other body tissues, including bone mass as well. This can be a problem for women who strive for lower body fat (for example, athletes, models, and ballerinas) and for women with eating disorders. Women with low body fat often do not produce sufficient amounts of sex hormones. They can, therefore, experience a cessation of menstruation, osteoporosis (thinning of the bones), fractures, and other conditions similar to those faced by many post- menopausal women.

After menopause, a woman's body produces less of the female hormones, estrogen and progesterone. Symptoms of the menopausal transition can be troubling for some women. Many doctors prescribe hormone therapy (HT, HRT, ERT, ET) to ease menopausal symptoms, although this therapy should be administered for a short duration due to increases in heart attack and slightly increased risk of breast cancer associated with hormone therapy.

Hormonal problems for women are not confined to those involving the sex hormones. For example, thyroid disease, including hyperthyroidism (over-activity of the thyroid gland) and hypothyroidism (under- activity of the thyroid), is far more common in women than in men.

Quick GuideWomen's Health: Nutrition and Health Care Reform

Women's Health: Nutrition and Health Care Reform

Diseases more common in women

Many diseases affect both women and men alike, but some diseases occur at a higher frequency in women. For example, gallstones are three to four times more common in women than in men. About 18% of women in the U.S. suffer migraine headaches compared with only 6% of men, a ratio of three females to one male. Other conditions seen more often in women than in men include irritable bowel syndrome and urinary tract infections.

Urinary tract infections, including cystitis (bladder infection) and kidney infection (pyelonephritis) are significant health problems that especially affect women. Kidney disease is a leading cause of high blood pressure (hypertension). And, after age 50, hypertension is more common in women than in men.

Also more common in women than men are the autoimmune disorders (for example, multiple sclerosis, Sjögren's syndrome, and lupus). In these diseases, the immune system attacks the body's own tissue. Autoimmune disorders afflict at least 12 million Americans and 3/4 of them are women. One autoimmune disorder, rheumatoid arthritis, affects approximately 1.3 million Americans, with 2/3 of the sufferers being women.

Osteoporosis, a condition in which bone density decreases, occurs in both men and women. Overall, however, it is more of a major health concern for women. Some studies have reported that as many as one of every two women over 50 will suffer a fracture related to osteoporosis in her lifetime. By age 65, some women have lost half of their skeletal mass. A woman's doctor can assess her bone density and make recommendations as to how to prevent further bone loss.

Cancer in women

Certain cancers are of specific concern to women. These include not only cancer of the female organs, such as the breast, cervix, womb (uterus), and ovary but also of the pancreas, large bowel (colorectal cancer), and lung.

Breast cancer is the second leading cause of cancer deaths among women. In the U.S., a woman has a 12.4% chance of developing breast cancer in her lifetime. Research studies show that the smaller the breast cancer is when it is detected, the greater the chance of survival. Currently, mammography and breast examinations serve as the recommended screening tests for breast cancer. The discovery of inherited gene mutations permits the identification of at least some women at increased risk for developing breast cancer.

Cancer involving the ovaries is also referred to as ovarian cancer. Because ovarian cancer is very difficult to detect in its early stages, it is often referred to as the "silent killer." Although ovarian cancer can occur at any age, a woman's risk gradually increases over time, and it is much higher if there is a history of ovarian cancer in the family. One in every 70 females in the U.S. develops ovarian cancer.

Colorectal cancer is cancer of the large intestine. Most cases of colorectal cancer occur in people over 50 years of age. A woman with a history of cancer of the breast, uterus, or ovary has an increased risk for colorectal cancer. Regular screening is recommended for all women over 50 years old. Research studies show that eating a diet rich in fruits and vegetables and supplementing the diet with antioxidants may help reduce a woman's risk of developing not only colorectal cancer, but a number of other cancers as well.

Lung cancer is the leading cause of cancer deaths among women. As smoking is the primary cause of lung cancer, it should be obvious that abstinence from smoking is a significant way to avoid this dreaded disease. Smoking cessation is essential in minimizing the damage already caused by smoking and optimizing long-term health.

Quick GuideWomen's Health: Nutrition and Health Care Reform

Women's Health: Nutrition and Health Care Reform

Women's cosmetic concerns

To many women, "cosmetic" means a make-up preparation for external use, such as lipstick or eye-shadow. "Cosmetic" can also mean a medical procedure done to correct defects or for the sake of appearance. It is probably an underestimate that more than 600,000 cosmetic procedures are performed each year. The variety of procedures and the number of women undergoing cosmetic surgery is continuing to increase.

There are very few areas of the body for which a cosmetic procedure has not been developed. There are processes to improve the texture and tone of skin such as dermabrasion and chemical peels. Collagen and Botox injections can modify unwanted wrinkles and creases. Birthmarks, moles, and varicose veins can be treated with a variety of techniques. Lasers can eliminate unwanted hair, whereas lack of hair (baldness or alopecia) can often be remedied with drugs or surgical implants.

Liposuction is the removal of fat under the skin. Body contouring to reshape or "sculpt" the body is done with ultrasonic and tumescent liposuction techniques. Various "lifts" and plastic surgery remove skin and fat and reposition skin and tissue.

Millions of women have undergone breast augmentation or reduction over the years. These procedures remain both popular and controversial. Breast reconstruction, especially following breast cancer, is usually viewed in a different light. Because all of these cosmetic procedures are also medical in nature, it is important that a woman understand their risks and benefits.

Menstruation

For about 40 years of her life, a woman experiences a normal phenomenon called the menstrual cycle. Regular loss of blood and tissue from normal sloughing of the inner lining of the uterus (menstruation) occurs every 26 to 35 days (more or less monthly) in every normal non-pregnant woman prior to menopause. Each monthly cycle can be divided into a follicular phase (an egg develops), ovulation (egg release) at mid-month, and a luteal phase (during which the uterine lining readies itself to receive a fertilized egg). If the egg is not fertilized, the uterine lining is shed, and a woman has her menstrual period. Then, the entire sequence of events is repeated.

Most women do not have difficulties during the first half of their menstrual cycle, but once the egg has been released, there may be problems such as pelvic pain. During the second half of the cycle, a woman may experience premenstrual syndrome (PMS) and she may have menstrual cramps at the onset of her menstrual flow.

Approximately 70%-90% of women suffer from premenstrual syndrome. PMS symptoms include irritability, nervousness, cramps, bloating, and headaches. A particularly severe condition, premenstrual dysphoric disorder (PMDD) is even more troublesome than PMS.

Every step of a woman's menstrual cycle is controlled by hormones. The production of these hormones is dependent on the general good health of the woman. The loss of too much body weight can result in the cessation of menstruation. There are a number of disorders marked either by absent periods or by periods that are too long, heavy, irregular, or painful. Underlying conditions, which may include polycystic ovary syndrome and endometriosis, need to be medically evaluated.

Ironically, there is a medical condition in which affected women benefit from menstruation. The disease is hemochromatosis, which is characterized by too much iron in the blood. Menstruating women with hemochromatosis can lose enough blood during their menstrual periods that they may not need further treatment to remove the excess iron.

Sexuality

Sexuality deals with a woman's sexual attitudes and practices. During her lifetime, a woman goes through many changes, not only in her body, but perhaps also in attitude and lifestyle.

The sex hormones, such as estrogen and progesterone, have a profound influence on a woman's sex life. Women also produce testosterone, as it is required for sexual arousal. In humans, the sexual impulse is not tied to reproduction and women will engage in sexual activity even when they are not fertile.

Little is known about what facilitates or inhibits feminine sexual arousal. It is estimated that 50 million American women have difficulty with sexual arousal. Problems include low sexual desire, sexual aversion, difficulty with sexual arousal (like impotence in men) and pain during intercourse (dyspareunia).

Physical exercise may increase sexual arousal whereas chronic illness, arthritis, cancer, diabetes, cardiovascular disease, mental illness, and depression can inhibit sexual arousal. Alcohol and certain drugs such as tranquilizers can also inhibit the sexual response.

Following the success of sildenafil (Viagra) and other male impotence drugs, there is considerable research now being conducted on drugs that improve blood flow to the vagina and the vaginal region which may assist female sexual arousal.

Fertility, birth control, and infertility

Fertility is the ability to bear children. Most women wish to restrict when and by whom they conceive. In the U.S., 94% of women age 15-44 use some method of birth control in order to prevent unwanted pregnancies.

Ideally, the use of birth control is the responsibility of both sexual partners. The choice of a birth control method should be a joint decision. In reality, the ultimate responsibility for birth control more often than not rests with the woman. Her choices include oral contraceptives, spermicides, diaphragms, cervical caps, rhythm methods, contraceptive implants, and intrauterine devices (IUDs). In general, longer-term protection (for example, oral contraceptives, implants, or IUDs) not requiring last minute decision-making provides better protection (a 0.1-3% "failure rate") than methods (for example, condoms or spermicides) used just before intercourse (5%-15% "failure rate").

Every woman who wishes to use birth control needs to decide which method is best suited for her. She must also determine which methods offer her the most protection against sexually transmitted diseases, including HIV infection and AIDS.

The opposite of fertility is, of course, infertility or the inability to bear children. Infertility affects one in five couples in the U.S. Female infertility tends to become more of a problem as a woman ages, especially after age 35. Regardless of age, a woman and her partner need to be medically evaluated by an infertility specialist to determine the cause for the infertility and, if possible, to correct the problem. The options currently available to infertile couples have been expanded. These include the advanced reproductive technologies, such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or utilization of donor eggs and/or sperm. Adoption, as always, is another option for childless couples.

Pregnancy

Optimally, all pregnancies would be planned well before conception. In the United States, it is currently estimated that 40% of all pregnancies are unplanned. This means that many women become pregnant before they are prepared.

The ideal time to start learning about pregnancy is not when a woman is already pregnant. In order for a future mother to maximize her chances of having a healthy baby, she should to know what she can do before she conceives and then what to do after she learns she is pregnant.

For a woman, pregnancy planning means learning everything she can about how her own health and that of her baby can be optimized. For example:

  • The expectant mother needs to know about those diseases that can complicate a pregnancy by their existence or their treatment, such as depression, epilepsy, thyroid disease, asthma, lupus, or diabetes.
  • If the mother smokes, she must stop, because women who smoke have a higher incidence of miscarriages and stillbirths.
  • She needs to be aware of the dangers of alcohol consumption during pregnancy.
  • She must also know which drugs and medications she can continue to use safely and which ones she must avoid.
  • There are also a number of prenatal tests that can monitor the health and development of her baby.
  • Finally, she needs to plan ahead for the labor and delivery. Although pregnancy itself lasts only nine months, it is a period of time in which the maintenance of a woman's health is especially critical.

Motherhood

A woman who has children devotes a large proportion of her life to motherhood. Although a woman's fertility is limited roughly to a 40 year period, her maternal responsibilities may last considerably longer -- 60 years or so. And most mothers never cease being concerned about the health and welfare of their children (and grandchildren), no matter what their ages. In other words, a mother is a mother forever.

During the time of motherhood, a woman is responsible not only for the maintenance of her own health, but also that of her family. Roughly one-third of all children in this country (19 million) live apart from their fathers, which means that society still relies on mothers to protect and nurture their children.

Menopause

The term menopause is used to describe an event or a period of time in a woman's life. In some contexts, it is used to designate a period of a number of years, typically the time when a woman is in her 40's through the decade of her 50's and beyond. Strictly speaking, a woman is said to have experienced menopause when she has had 12 consecutive months without a menstrual period. On average, menopause occurs around 51 years of age. The premenopausal process, however, usually begins in the early 40's. Diminishing sex hormone levels can be measured in a woman in her mid-30's.

"Menopausal" women represent a major component of the population. An estimated 50 million women in the US have reached menopause. Most women can expect to spend around 1/3 of their lives after menopause has occurred.

Menopause has often been referred to as "the change of life" because it is a time in a woman's life when menstruation stops and she can no longer conceive. Symptoms of menopause may include:

Until the 1950's, society's attitude was that menopause is a woman's destiny and she should simply accept her destiny. Now there are many medical strategies to cope with the symptoms of menopause. Women are encouraged to think of menopause not as a cataclysmic event in life, but merely as a time of transition.

The mature woman - post menopause

Before the 20th century, the average woman didn't live long enough to worry about the quality of her life after cessation of menses. Now, most women live for several decades beyond menopause.

This is not necessarily good news. 50% of U.S. women over age 75 are living alone in relative social isolation. Ninety percent of residents in nursing homes are women. Not only does the mature woman often have to deal with osteoporosis, cancer, and heart disease, but she is also confronted with other health problems including hearing loss, diminished vison, incontinence, arthritis, insomnia, memory loss, and sexual dysfunction.

The problems of a sedentary, isolated life style can be compounded by poor diet, smoking, and alcohol or drug abuse. Studies show that it is never too late to benefit from an improved diet, moderate exercise, cessation of cigarette smoking and drug usage, not abusing drugs, and decreasing alcohol consumption.

Disease, rather than normal aging, usually accounts for loss of function in the mature woman. Nothing can be done about the passage of years, but a great deal can be done throughout a woman's life to prevent and treat the diseases that keep her from being in the best possible health.

Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology

REFERENCES:

CDC.gov. Adult Cigarette Smoking in the United States: Current Estimates.

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

National Cancer Institute. Breast Cancer Risk in American Women.

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Reviewed on 11/12/2015
References
Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology

REFERENCES:

CDC.gov. Adult Cigarette Smoking in the United States: Current Estimates.

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

National Cancer Institute. Breast Cancer Risk in American Women.

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