Is Your Doctor Treating You Like a Man?
Too many well-meaning MDs are looking for symptoms and tracking signs of illness that are telltale for male patients—but not necessarily female ones. That can mean missed diagnoses and wrong treatments. Here’s how to close yet another gender gap and get the health care you deserve.
Lilly Rocha’s job with an events management firm took her all over the world—but also had her stuck in a state of stress. “I started notic-ing things that didn’t feel quite right,” she says. She was slow to respond when people talked to her. “The words were right there, but I couldn’t speak,” she says. The then 37-year-old also noticed a strange tingling in her left chest area, but her PCP wasn’t alarmed. “My doctor told me I was fine—I was just under a lot of pressure,” she says.
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The tingling continued for three months, growing steadily stronger, until Lilly went to the ER. She complained of pain in her left arm, an ache in her jaw and nausea. Despite describing her symptoms to the staff, she sat in the waiting area for hours before receiving care. When a doctor finally saw her, she was diagnosed with a heart attack.
This kind of misdiagnosis happens all the time: Women’s symptoms are often overlooked, dismissed as anxiety or not acknowledged as problems in the first place—all because diseases often manifest differently in women than they do in men...and doctors don’t spot those differences. The fact is, of course, that women are unique physiologically, hormonally and genetically. We are smaller in stature and have a different ratio of body fat to lean mass compared to guys. Our hormones also fluctuate throughout the month thanks to our periods. Behaviorally there’s a divide too, since we tend to describe our symptoms in distinct ways. All those things can uniquely affect how we react to medications, experience symptoms of medical issues like heart attacks and strokes, and are diagnosed and treated at the doctor’s. Lilly found this out the hard way, but now, as a volunteer with the American Heart Association’s Go Red for Women campaign, she wants to make sure women aren’t ignored by their doctors or ER physicians.
“Most of our health knowledge is based on research in men,” says Alyson McGregor, MD, director for the Division of Sex and Gender in Emergency Medicine at Brown University. Until recently, women had not been included in studies because their (ahem, pesky) hormones are difficult to account for. Researchers also extrapolated that analysis of men in studies would pertain to women too. But McGregor points out that in a sampling of 200 clinical trials, two-thirds of them didn’t include women and 75% of cardiology trials didn’t report gender-specific results. That’s a problem because it affects how you get treated from the moment you arrive at your physician’s office or a walk-in clinic. “Research shows that due to lack of education, only a small percentage of health care practitioners consider gender differences in their practice,” says McGregor. “Doctors look for signs and symptoms based on how men have diseases, and they prescribe drugs based on doses that work for men,” she explains.
Despite this frustrating (and, let’s be honest, outrageous) state of affairs, you have more control than you think. Women make up a little more than half the U.S. population, and they’re responsible for 70% of the health care decisions for their families, says Deborah Bartz, MD, MPH, a physician in the department of obstetrics and gynecology at Brigham and Women’s Hospital in Boston. “There’s a huge opportunity to take charge of their own health and that of their loved ones,” she says.
Try these four steps the next time you go to the MD:
1. Name what physically ails you. Lead with your bodily symptoms (dizziness, fatigue, shortness of breath), then move into how they make you feel (you’re anxious or having trouble coping), Bartz says. Talking about your emotions can stand in the way of an accurate diagnosis.
2. Talk about your pregnancy. It doesn’t matter if your “baby” now has a driver’s permit; your doc still needs to know about even minor complications. Preeclampsia and gestational diabetes back then put you at higher risk for hypertension or type 2 diabetes now.
3. Ask Rx questions. No matter what you’re prescribed, McGregor recommends that you ask your doctor “Am I taking the right dose for a woman?” and “Are there certain things I should know about the drug because I’m a woman?”
4. Shop for a great doc. And that doesn’t necessarily mean a woman. Bartz says the most important factor is that you feel like you can speak freely, openly and honestly with your MD, regardless of their gender. You also want to know that your doctor is truly listening. If you don’t have this positive relationship or you feel dismissed, it’s time to move on.
Stroke Signs by Sex
“I think I’m having a stroke” is exactly what you should tell 911 if you notice any of these red flags.
Loss of consciousness/fainting, general weakness, shortness of breath, disorientation, sudden behavioral changes, agitation, hallucination, nausea/vomiting, pain, seizures, hiccups, fever
Face drooping, arm weakness, speech difficulty, sudden confusion, sudden trouble seeing, sudden dizziness, sudden severe headache
Loss of senses, loss of control of body movements, double vision, repetitive uncontrolled eye movements
Ignore The Scale (Sort Of)
The bathroom scale is not the most friendly gadget in your house, but still. “I wish more women would come and talk to me about their weight,” says Wendy Bennett, MD, MPH, codirector of the Johns Hopkins Center for Women’s Health, Sex and Gender Differences. And yet, nearly half of women say they’ve put off going to the doctor until they lost weight. “We know that being overweight and obese can increase your risk for heart disease, diabetes and osteoporosis,” Bennett says. Being in your 30s and 40s means you have an ideal opportunity to get to a healthy number to head off future health issues. Don’t wait to make that appointment.
The CPR Gap
A man who needs CPR in public is more likely to receive resuscitation from any bystander—male or female—than a woman, says research from the University of Pennsylvania. CPR requires chest compressions, something people may not be OK with giving a woman since we have breasts, the study authors note. But here’s the deal: CPR saves lives. If a person collapses and their heart stops, don’t hesitate to help (as long as you know what you’re doing) and have someone call 911. For training, find a class through the Red Cross or the American Heart Association.
Eye exam: Ages 18 to 64, every two years; 65 and older, annually
Blood pressure: Every two years
Diabetes: Every three years if you have high blood pressure
Pap smear: Ages 21 to 65, every three years, so long as you test negative
Cholesterol: Age 45 and older, every five years if you’re at risk for heart disease
Mammogram: Ages 50 to 74, every two years
Colonoscopy: Ages 50 to 75, every 10 years
DEXA to screen for osteoporosis: Age 65
Mind Your Meds
Six common drugs proven to work very differently in women.
In women, it’s more effective at preventing strokes. In men, it’s better at preventing heart disease. Also, men are told to pop one daily, but women should take a low-dose aspirin (which contains 81 mg as opposed to 325 mg).
When women take this insomnia medication, it remains in their bloodstream longer, leaving them less alert for activities like driving when they wake up the next morning (yikes). Women are now advised to
take half the amount (usually an initial dose of 5 mg) men do, says Bartz.
These cholesterol-lowering drugs “really haven’t been studied as extensively in women as they have in men,” says Susan Steinbaum, DO, director of women’s cardiovascular prevention, health and wellness at Mt. Sinai Heart in New York City. Side effects, such as muscle pain, may be particularly prevalent in women but can be managed by decreasing the dose.
Welbutrin (which treats depression, seasonal affective disorder, and nicotine withdrawal and cravings) may be especially good for post-menopausal women, as it also reduces hot flashes, says Heather P. Whitley, PharmD, associate clinical professor at Auburn University Harrison School of Pharmacy. Obviously, that’s a perk men just don’t need.
Women’s kidneys filter out some meds just a bit more slowly than men’s. As a result, you need a 15% lower dose of some antibiotics. Sometimes this will be calculated on a pharmacist’s computer automatically. If you know your kidneys are impaired, check with your doctor to get the correct dose.
Opioids typically remain in women’s systems longer than in men’s. If you decide to take them, you may need a longer gap between doses, says Whitley. It’s also smart to start with a lower dose and then work with your provider to monitor your reaction.
It Can Happen to You
Being a woman doesn’t exempt you from these “man problems,” so don’t let any doc tell you otherwise.
Compared to women, men are only three to five times more likely to have obstructive sleep apnea—but they’re up to nine times more likely to be diagnosed with it. Pregnancy and menopause increase your risk for apnea, a disorder in which you briefly and repeatedly stop breathing during sleep. If your partner tells you you snore, get it checked out. Other signs: insomnia, restless legs, depression and nightmares.
Knee and shoulder injuries
Traditionally, docs view men as the sports guys and don’t see women as athletes (he must’ve missed that 5K you crushed last spring). “Doctor’s don’t often realize that women are vulnerable to these injuries,” says Bennett. What’s more, she says women are more apt to be told “Just stop running!” rather than being offered treatment so they can stay active.
Women make up 48% of those with type 2 diabetes, which can as much as quadruple your chances of dying from heart disease. And yet, “women aren’t treated as aggressively for it to reduce the risk of heart disease,” Bennett says.
It’s the third leading cause of cancer-related death in both genders, but women are less likely to be screened. Scarier still, when women’s cancers are missed, they’re more likely to die from the disease, according to research from Massachusetts General Hospital.
It’s the number one killer of women, but women are less likely than men to be told by their doctors that they’re at risk for having a heart attack—and often don’t get advice on how to lower their odds either, research shows. Women are also less likely to receive prevention meds. “It takes decades for heart disease to develop,” says Steinbaum, a Go Red For Women spokesperson. That means doing what you can now, when you’re young, can save your heart in the future. “Heart disease is preventable 80% of the time,” Steinbaum says.