How did the last decade shape women's health?
The 1970s was a decade in which women became more aware of their bodies and how they worked. The 1980s was a decade of advocacy for diseases like breast cancer. What characterizes this last decade of the century in terms of health care for women?
"In the 1990s we finally recognized that women's health is more than just reproductive health care, and that we need to evaluate, through a gender-specific lens, the other diseases to which women are prone," says Nancy Milliken, MD, director of the Women's Health Center at the University of California at San Francisco.
Heart disease, for example, is the number one killer of women. But for a variety of reasons, women were virtually excluded from studies on heart disease until late in this decade. Researchers assumed that whatever they learned about heart disease in men would be just as true for women. They were wrong. Symptoms of a heart attack can be quite different for women, and the outcome can be far more serious.
The Women's Health Initiative -- a major research study of women and their health -- was launched in 1991 to fill the gaps left by excluding women from so many medical studies. The study's findings on heart conditions in women will be available in 2005.
The Estrogen Factor
"The most interesting thing we've seen in the nineties has been some of the very basic science work that lets us begin to understand just how women are different from men," says Janet Pregler, MD, director of the Iris Cantor UCLA Women's Health Center.
Estrogen, it seems, may play a far greater role in women's health than was previously suspected. According to Pregler, estrogen may ultimately be implicated in autoimmune disease, depression, and dementia -- all of which afflict women at a greater rate than men.
A fuller understanding of estrogen's role in the body will have to wait until the next decade, but the nineties saw its share of important breakthroughs. Pregler, Milliken, and Elizabeth Kennard, MD, associate professor of Medicine at Ohio State University in Columbus, contributed to this list of the most important developments for women's health in the past decade:
- Genetic testing was developed that can identify women who are at high risk for hereditary breast cancer.
- The drug tamoxifen was found to prevent breast cancer in certain high-risk women, while trials of the drug Herceptin showed it is effective at treating advanced breast cancer.
Advances Against Breast Cancer
- Breast cancer surgery became less invasive. More lumpectomies and fewer mastectomies were performed on women, and surgeons found a way to tell if cancer has spread by inspecting only one lymph node instead of removing many.
- For women who need to protect their bones from osteoporosis but cannot take estrogen, raloxifene was found to offer many of the same benefits without raising the odds for breast cancer.
- Two medical procedures, ultrasound and endoscopy, advanced significantly. Ultrasound became far more accurate and useful in pregnancy and diagnosis of breast and pelvic abnormalities. Endoscopy -- which involves inserting a camera and surgical instruments through several small incisions -- allows doctors to repair damage from ectopic pregnancies and remove fibroid tumors and ovarian cysts in a far less invasive procedure.
- A breakthrough in in vitro fertilization techniques allowed doctors to drill a tiny hole in the wall of an egg and inject a single sperm. This enables fertilization in couples where the sperm is unable to penetrate the egg.
From Antidepressants to the Internet
- The development of new antidepressants -- the SSRIs -- expanded treatment options for depression, a disease that is more prevalent in women than men. (According to the National Institute of Mental Health, depression affects twice as many women as men.)
- At least a dozen new ways to treat incontinence were developed in the last decade. Today a woman's options include estrogen rings, biofeedback, electrical stimulation, new drugs, and new surgical techniques.
- Emergency room doctors, primary care physicians, obstetrician-gynecologists, and ophthalmologists -- among other health professionals -- are wiser and more sensitive to domestic violence, a health problem which is more common than most people realize. According to the Centers for Disease Control and Prevention, up to 30% of women treated in emergency rooms have injuries or symptoms related to physical abuse.
- The Internet has transformed the relationship between women and their doctors. "My patients routinely come in for their visits with printouts from the Internet," says Kennard. "They have access to information they would never have been able to find 10 years ago. It's really improved women's education and information."
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