1 / 77

Women’s Health Issues– myths and mysteries

Women’s Health Issues– myths and mysteries. Barb Bancroft, RN, MSN www.barbbancroft.com. Myth #1. All men are created equal. TRUE BUT, all men AND all women are NOT…. Mother nature favors her own when it comes to longevity….

tarika
Download Presentation

Women’s Health Issues– myths and mysteries

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Women’s Health Issues– myths and mysteries Barb Bancroft, RN, MSN www.barbbancroft.com

  2. Myth #1 • All men are created equal. TRUE • BUT, all men AND all women are NOT…

  3. Mother nature favors her own when it comes to longevity… • Women live longer than men (but the gap has been closing over the past few decades) • 85 for women, 79 for men (on average)

  4. Men die earlier because of increased… • Cardiovascular disease (108.9 males/55.6 females) • Homicides (1/30 AA males; 1/132 AA females; 1/179 C males; 1/ 495 C females) • Accidents (gap is closing in teenagers) • Cancer rates • www.menshealthnetwork.org

  5. Why cancer? • Men live life in the “faster” lane • Male embryos divide faster than female embryos • Male metabolic rates are faster with 5.6 times greater rate of DNA mutations and increased proliferation • Cancer is a “disease” of DNA mutations

  6. Myth #2—the Federal government has studied men and women equally • Wrong. The Federal government didn’t know there were women to study until 1991. • Most studies prior to 1991 were done in VA hospitals in • 45 –year–old Caucasian males weighing 175 pounds • Why didn’t they include women?

  7. We were either pregnant Premenstrual OR Menstrual Because…

  8. If they had studied women they would have realized that there are distinct differences in diseases • Chronic fatigue syndrome 9:1 • Fibromyalgia 9:1 • Lupus erythematosus 9:1 • Hashimoto’s thyroiditis 10:1 to 25:1 • Grave’s disease 7:1 • Multiple sclerosis 3:1 • Rheumatoid arthritis 6:1 • Gall bladder disease 4:1 (Pre) 2:1 (Post) • Depression 3:1 (post puberty) • Migraine headaches 3:1 (post puberty)

  9. If they had studied women they would have realized distinct differences in drug side effects • ACE inhibitors (“prils”) and the cough • DIGOXIN and women

  10. ACE inhibitors and the cough in women • Research on ACE inhibitors—extract from the venom of the Brazilian Pit Viper • All clinical trials were in VA Hospitals-- in 45-year-old Caucasian men, 175 pounds • Captopril released in 1981; enalapril in 1983 • 1 to 6% of the subjects had a cough • Women started coughing throughout the U.S. • 30-50% still have a cough 

  11. ACE inhibitors… • Block angiotensin converting enzyme (ACE)… • The theory: ACE normally opposes bradykinin; block ACE? Bradykinin is unopposed and goes UP…bradykinin is a potent bronchospastic agent • Women have more bradykinin to begin with, therefore the gender disparity in the cough

  12. Digression…women are just more spastic than men… • Bronchospasm and asthma after 18--In children, asthma is more prevalent in boys than in girls, with male:female ratios reported as high as 4:1. The ratio inverts after puberty so that in adult years, the disease is more common in women. • Why? Testosterone and estrogen’s effects on T regulatory cells during puberty • The theory: Testosterone ramps them UP, which in turn decreases the production of IgE, and estrogen decreases the T-reg function, which increases IgE production • So boys tend to “grow out” of their asthma at puberty and girls “grow into” their asthma

  13. Digression…women are more spastic than men…continued… • Migraine headaches—(CAUTION: the use of triptans and SSRIs at the same time may cause serotonin syndrome—this becomes a problem in women w/ migraines AND depression) • Irritable bowel syndrome • Esophageal spasms • Prinzmetal’s angina—small vessel disease vs. large vessel disease (estrogen receptors on penetrating arteries off the large vessels—as the ovaries start to cough and sputter during perimenopause—chest pain with clean conduit arteries on cardiac cath) • Raynaud’s phenomenon (primary or secondary?)

  14. Women and digoxin • The good news is: we’re rarely using dig anymore for CHF unless the cardiac muscle needs an inotropic boost • The bad news is that when we use it, women have a higher mortality rate • Dig in women? The DIG study showed that in women with an LVEF ≤ 45%, dig significantly increased the risk of death by 23% (absolute increase 4.2%, NNTT=24); Another subgroup study from all 1926 women in DIG study with a reduced or normal LVEF showed that dig increased mortality by 20% • Rathore SS, Wang Y, Krumholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med. 2002 Oct 31;347(18):1403-11.

  15. If they had studied women they would also have realized distinct differences in disease presentations Classic signs of an ACS in men Substernal crushing chest pain, radiating down left arm, up to jaw Diaphoresis Nausea Impending doom Sudden cardiac death

  16. Women? • Unusual fatigue or weakness (70% in the month preceding the heart attack) • Difficulty sleeping (50%) • Indigestion or mild heartburn (40%) • STOP HERE…if we diagnosed an ACS based on the above sx? • New, unusual shortness of breath during everyday activities or at rest (40%) • Dizziness or nausea • Discomfort between shoulder blades, elbow, jaw • Sense of doom or anxiety (30%) • Palpitations or a feeling of extra heartbeats • Flu-like symptoms, including chills and cold sweats

  17. PEARL: • A 63-year old woman presenting with nausea, abdominal pain and dizziness may be having an acute coronary event… • Have a high-index of suspicion

  18. Myth #3 • Diamond’s are a girl’s best friend. • Bling. • Wrong. Estrogen is.

  19. Think about it. • Estrogen has over 300 functions. • Where should I start? • Brain? Acetylcholine production and memory storage • Heart? Boosts HDL (?), potent anti-oxidant, vasodilator • Bones? Stimulates osteoblastic function; inhibits PTH (osteoclastic function); builds bone • Skin? Maintains the health of collagen, less wrinkles (Premarin vaginal cream)

  20. Think about it. • Bladder? Tightens sphincter, keeps E. Coli and other rectal flora OUT, maintains an acid pH-4 • Vagina? Lubrication, acid pH 4.5, keeps all sorts of bugs OUT, including yeast • Teeth? Women on ET have more natural teeth; estrogen prevents osteoporosis of maxilla and mandible • Keeps waistline smaller than hips (opposes testosterone)

  21. Think about it. • Since we lose our ovaries at 51.3 +/- 2.7 (not to be exact) and on average, we will be living another 30+ years…should you consider hormone replacement therapy? • OF COURSE…and you ONLY need the progesterone component if you still have a uterus… • My first question is: why can’t our uterus JUST fall out after we have had all of our children? • MY 2nd QUESTION IS…why are we all so bent out of shape about taking estrogen? • If men lost their testicles at 51.3 +/- 2.7 years, would they be willing to live another 25.4 years without testosterone?

  22. Hormone therapy • IS an individual decision based on many factors… • However, don’t summarily dismiss it • If you have had breast cancer, the answer is NO; if you have clotted on a previous hormone regimen, the answer is no; if you have a clotting predisposition, the answer is no…BUT… • If professionals you know are still quoting the Women’s Health Initiative as the reason to not take HT they need to update their research on HT

  23. Myth #4 • “The sperm is the aggressor…” • The egg is the “damsel in distress”…

  24. NOT TRUE… • …the egg is 1000x bigger than the sperm—how in the world can she be passive? • She sends a signal down the Fallopian tube that tells the sperm where to swim and when…

  25. “Which way do we go, George?” • The sperm waits for a signal from the egg to swim up the 5” Fallopian tube • While waiting for the signal it’s swimming around in circles…”which way do we go George?”

  26. Fertility issues • Waiting too long to get pregnant? • the egg is most eager to meet a sperm between the ages of 18 and 30 with peak fertility between 24 and 27 • She has a BULLHORN for a signal • By the time the egg is 35 it’s more like a whistle • By 50 the egg barely puckers…

  27. Speaking of…fertility issues • Digression: Calcium channel blockers and fertility problems

  28. A major reproductive difference… • Women get all the eggs they are ever going to have prior to birth

  29. HOW MANY EGGS/FOLLICLES DO WE GET? • At 6 months gestation ________________ • At birth _____________ • At age 30 ___________ • At age 50 __ • The age of an egg is YOUR age! • Could you possibly get pregnant at 50? • How do eggs meet their demise? Apoptosis and primary ovarian failure—as the follicles drop out, the FSH rises—trying to stimulate the ovary to produce more eggs…rising FSH levels signal impending doom of the ovary

  30. Do guys get all the sperm they’re going to get at birth? • Nooooooooooo… • Men produce sperm PRN until the day they die • Sperm is only 75-90 days old when freshly ejaculated • Can old men father children? • It’s much easier now because of the…

  31. Pfizer riser…(and friends) • Sildenafil • Vardenafil • Tadalafil • What is the problem with old dads?

  32. Multiple births are increasing—why? • Ovary has quantity control prior to age 35-ish • Only allows 1 egg to mature • After 35-ish… • Loss of quantity control—3 eggs, 5 eggs, 7 eggs

  33. Myth #5—Puberty is fun… • When does puberty start? • Breast development at 10 in Caucasians and before 9 in African-Americans • Pubic hair one year later • 27% of AA girls have breasts at 7; 7% C • Precocious puberty is under 7 in C girls and under 6 in AA girls • Diet? Fat, Fat tissue? • Environmental estrogens? PCBs, PBBs, DDE, phthalates, BPA

  34. Girls vs. boys—fat tissue and puberty • Girls—fat = early puberty • Aromatase in fat tissue converts testosterone to estradiol and triggers early development • Leptin from fat sends a signal to the hypothalamus to produce GnRH and says…she’s READY! • OPPOSITE problem--Female Athlete Triad—thin with disordered eating, amenorrhea (oligo), osteopenia/porosis • Boys – fat = delayed puberty • Aromatase in fat tissue converts testosterone to estradiol and delays their development

  35. Puberty is fun… • Migraine headaches • Prior to puberty boys > girls • As adolescence approaches females > males • Between the ages of 15-18 migraines are 3x greater in females • Family history • Celiac disease? Gluten allergy? Perhaps 1 in 5 women with migraines have a gluten sensitivity, undiagnosed celiac • Try a 3-month gluten free diet and observe migraine trends

  36. Depression and puberty • Prior to puberty boys and girls have equal rates of depression • Increased incidence of classic depression emerges between 15-18 in teenage girls • 3:1 female to male ratio • Women tend to eat to treat their DEPRESSION… • CARBs for COMFORT

  37. Low carb diets…ineffective in women; dieters feel psychologically hungry • Another problem w/ low carb diets—low folate levels (higher risk of neural tube defects) ( MMWR January 2007) • Not to mention the halitosis, depression, and constipation

  38. Digression on depression • Genetic influences • Nature vs. nurture? • Mirror neurons

  39. Digression on depression • Treating depression during pregnancy and postpartum—what’s more dangerous? • Untreated depression (and associated poor health habits) during pregnancy is associated with negative clinical outcomes—pre-term, low birth weight, respiratory problems (worse outcomes than non-depressed women) (Oberlander et al., Arch Gen Psychiatry 2006;63:898-906) • High anxiety levels during pregnancy CAN influence negative outcomes (The Carlat Psychiatry Report, February 2009)

  40. So, do the benefits of treating depression during pregnancy outweigh the risks of effects on the fetus? • Risks of what? Teratogenic effects, future depression • Simple answer YES, the benefits outweigh risks • Some antidepressants and mood stabilizers have a higher risk of teratogenic effects and should be avoided—one jumps right out as the leader of teratogenesis—valproate (Depakote)—6.2—20% rate of congenital malformations, with NTD most prominent; dose-related w/ >1000 mg/day

  41. Mood stabilizers during pregnancy • Lithium (Eskalith, Lithobid)—rate of major malformations reported to be 4 – 12%; Cardiovascular malformation, Ebstein’s anomaly; increased maternal risk of diabetes, thyroid dysfunction during pregnancy • Carbamazepine (Tegretol)—rate of major malformation reported to be 2.2 to 7.9%; NTD, craniofacial defects, CV malformations, hypospadias • Lamotrigine (Lamictal)—rate of major malformations reported to be 1 to 5.6%; increased risk of oral clefts

  42. Antidepressants during pregnancy • TCAs—recent meta-analysis of 300,000 live births; no increased risk of malformations • SSRIs—controversial data regarding paroxetine (Paxil) and cardiac defects; odds ratio of ~1.5 for risk of heart defect (Cole JA et al. Pharm Drug Saf2007;16(10):1075-1085); Conflicting reports on decreased gestational age, low birth weight, low APGAR; use in latter pregnancy with conflicting reports on persistent pulmonary HTN

  43. Antidepressants during pregnancy • Duloxetine (Cymbalta)—little data • Mirtazapine (Remeron)—sparse data but one small study suggests no increased risk of major malformations • Venlafaxine (Effexor); desvenlafaxine (Pristiq)—no major malformations; increased maternal blood pressure during pregnancy, especially at higher doses • Bupropion (Wellbutrin)—no increased risk • (The Carlat Psychiatry Report, November 2010; Adrienne Einarson, Assistant Director, Motherrisk Program, Hospital for Sick Children, Toronto, ON)

  44. Say NO to St. John’s wort • Too many drug interactions • Reduces the effectiveness of combined oral contraceptives • SIDE EFFECT?

  45. I’m pregnant. • Old Chinese proverb • “It take many nail to build crib…only one screw to fill it…”

  46. Adolescents and polycystic ovary disease (PCOS)(a form of metabolic syndrome) • 1922 article by two French physicians • Anovulation • Hirsutism • Metabolic Syndrome • young women present to fertility clinics • Treatment? OCs, metformin • Word to the wise about metformin—it jump starts ovulation, so if your patient NOT in the mood or mode to get pregnant discuss the use of a birth control method!

  47. OCs • First oral contraceptive? 1960--Enovid • Old OCs (80 to 100 mcg per pill) vs. today’s OCs (20-35 mcg per pill)… • Old days? SE were MIs and Strokes…miss a pill? No big deal • Today’s pills? Miss a pill AND…

  48. Latest info on contraceptive methods and pregnancy • May 24, 2012 N Engl J Med • Long-acting devices ( Depo-provera and IUDs) are nearly 22 times as effective as oral contraceptives, diaphragms, or patches • Failure rate of long-term devices less than 1% • Failure rate of OCs, patches, diaphragms was 4.8% after the first year and 9.4% after the 3rd year

  49. Myth #6: COCs are dangerous in women over 40 • FACT: the benefits of COC for women over 40 are numerous…11% of the 40-44 y.o. population use COCs • Women over 40? Increased risk for heavy menstrual bleeding secondary to uterine fibroids or adenomyosis—dysfunctional uterine bleeding

  50. Dysfunctional uterine bleeding • Use of COCs restores cyclic, predictable bleeding—greater than 80% have improvement in bleeding patterns (The levonorgestrel IUD will also decrease bleeding)

More Related