In Barcelona in 2018, The Esteve Foundation held a panel discussion with 24 professionals from many disciplines. They presented“over 700 diseases where gender differences in the manifestation of diseases result in poorer diagnosis and treatment for women“. This has long been recognized in women where traditionally studies included more men than women, therefore they did not recognize that coronary artery disease presents differently in women. Women were underdiagnosed which resulted in delay treatment of significant disease.

There are differences as well in the way women metabolize drugs, leading to higher rates of adverse effects. Women have a more acidic stomach, slower stomach emptying, so drugs stay in their intestine longer, they have higher percentage of body fat, and lower kidney filtration rate. All this can lead to variations in the way drugs affect their bodies.

The only disease that is underdiagnosed in men is osteoporosis, which has long been considered a disease in post-menopausal women.

In Denmark, using complicated analysis of 7 million admissions over 21 years, they were able to assess occurrences of disease and disease progression to identify significant differences between men and women.

The following areas of medicine are some that affect men and women differently.

CARDIOVASCULAR DISEASE

Treatment guidelines regulate how physicians manage hypertension. A study published in“Circulation” looked at 27,500 patients over 21 years, 54% of whom were women. The study assessed differences in blood pressure that are associated with heart attacks, heart failure, and stroke. It found that cardiovascular disease was associated with lower blood pressure levels in women than in men. For instance, the risk of a heart attack for women with BP of 110-119 was equivalent to the risk for men with BP over 160! For heart failure, it was 110-119 vs.120-129; for stroke, women 120-129 vs men 140-149. Yet for years, we have used the same values for men and women to initiate treatment for high blood pressure.

STROKE

Most of us know the symptoms of stroke:

• F – facial drooping

• A – arm weakness

• S – speech difficulty

• T – time to call 911.

Of course, symptoms depend on what area of the brain is affected. Although both sexes complain of numbness or weakness, confusion, difficulty talking, difficulty walking, dizziness or loss of balance, or severe headache, women may also report hiccups, nausea, chest pain, shortness of breath, or a racing heartbeat. Because these are non-specific, they could lead to delay in diagnosis. With stroke, early treatment is essential to achieve a better outcome. Women have a greater risk of stroke during pregnancy, with preeclampsia in pregnancy, when using certain birth control pills, having migraines with aura and atrial fibrillation.

MENTAL HEALTH

Although depression and anxiety occur more frequently in women, doctors are more likely to diagnose depression in women even though men may present with the same symptoms or score the same on standardized measures of depression. Women are more likely to seek help from their primary caregiver, while men are more likely to seek specialized help and more likely to get inpatient care. Women disproportionally experience violence and sexual abuse, financial insecurity, primary care of children.

BLEEDING DISORDERS

Hemophilia was originally thought to occur only in men, although their mothers were carriers. These carrier women may have low clotting factors as well, but they are underdiagnosed, with delays in their diagnosis up to 39 months even though they have first bleed and similar symptoms as their male counterparts.

In Von Willebrand’s disease, only 50% of females are not diagnosed by 12 years of age. When they begin menstruating and have heavy periods, the diagnosis still is not made. On average, they experience a 16 year delay with six bleeding symptoms before diagnosis.

As you can see, this could go on and on with 700 diseases showing differences between the sexes. By recognizing the perspective of gender bias, delays from unequal diagnostic access can be eliminated, preventing delay in investigations, and therapeutic strategies can be more quickly implemented.

It is encouraging that as this evidence comes to light, the awareness is beginning to bring about improvement in recognizing the deficiencies in the system. Unfortunately, we have a long way to go!

Dr. Vicki Holmes is a Saskatoon retired family physician who has a special interest in Palliative Care and Women’s Health. She is passionate about sharing medical information with the public!

(Vicki’s Photo: Memories by Mandy)

• Dr Vicki Holmes