When it comes to your health, it’s your right to fight for it because you are your biggest advocate. In Shondaland’s Women’s Health series this month, we’re offering insight and advice on how women can take their physical and mental well-being into their own hands so they can lead happy, healthy lives.
It’s become a well-known fact that women’s health has been under-researched and underreported. Numerous studies have shown gender bias to be prevalent in health care with respect to both treatment and research in everything from mental health treatments to childbirth to breast cancer. Women’s health has suffered overall. “This is where we, as health-care providers, have failed,” says Francine I. Hippolyte, MD, an attending physician and vice chair of clinical operations in the department of obstetrics and gynecology at Northwell Health in Manhasset, New York. “Women are often marginalized in the health-care system in general. When it comes to research, they’re not just marginalized but are actually excluded.”
This kind of medical sidelining can make women less than eager to seek medical care when suffering from symptoms that are, on the surface, relatively easy to live with. It’s also why — as daunting and as much work as it can be — it’s in a woman’s best interest to be her own health advocate.
“As women, we’re accustomed to just pull up our pants, deal with our issues, and keep on moving,” says Hippolyte. “By the time a female patient comes to you, very often her health issues have been going on for a while. It takes a lot for a woman to seek medical attention. It’s important for women to have a voice and to be proactive when it comes to their health. Women are central to their family, and oftentimes, it is through a woman’s diagnosis of conditions that other family members know how it impacts them and can seek health care.”
Being your own health advocate doesn’t just mean staying on top of yearly screenings when they’re available — it also means getting seen if you suspect something is off despite passing those tests. In order to do that, however, ensuring your best health means having the knowledge about which health issues are most crucial for women to understand today. Here are five health conditions or issues you should become and stay aware of.
Breast, uterine, cervical, and ovarian cancers
According to Memorial Sloan Kettering hospital in New York, uterine (endometrial) cancer is the most common cancer of the female reproductive system, with just shy of 50,000 Americans diagnosed each year. Ovarian cancer, the second most common type, affects one in 70 American women across their lifetime. Cervical cancer, which most women are screened for yearly with a pap smear, is diagnosed approximately 12,000 times per year. And a glance at the National Breast Cancer Foundation’s website reveals that as many as one in eight women will be diagnosed with breast cancer in their lifetime, which is why women over the age of 40 are strongly advised to schedule yearly mammograms to screen for breast cancer.
Hippolyte says a woman’s risk for breast, uterine, cervical, and ovarian cancers rises along with her age. Yet women in their 40s and 50s — who are often responsible for bringing up their own children and for the care of their aging parents — are often so busy caring for others that they can easily miss some signs or let regular screenings lapse. “It’s important to pay attention to any subtle changes you may feel,” says Hippolyte. “There are limitations to any screening tests. Sometimes a woman says, ‘I don’t feel right; something is different,’ and we must trust she knows her body better than we do, better than science does.” If your breasts feel different, or you experience breast discharge or skin changes, bring it to your doctor’s attention as soon as possible — even if your mammogram checked out. Also, be sure to discuss any menstrual irregularities with your gynecologist, as those can easily be brushed off as perimenopause but can also indicate uterine, cervical, or ovarian cancers.
According to the Mayo Clinic, fibroids (also known as leiomyomas) are very common noncancerous growths of the uterus that can appear during your childbearing years. You can have more than one, and they can vary in size from tiny growths to large masses that cause you to actually gain weight. Fibroids are usually discovered during routine pelvic exams or ultrasounds and can appear without symptoms. But larger fibroids can cause very heavy bleeding that can be painful and disruptive to your daily life, sometimes requiring removal, and depending on their size and location, could impact fertility. Hippolyte says symptoms of and a history of fibroids can also shroud more urgent medical issues. “A patient might come in and say, ‘I’m bleeding more heavily,’ and because of that fibroid history, the doctor may not investigate further and miss pre-cancer or cancer of the uterus,” she says. Be sure to discuss any abnormal bleeding or abdominal discomfort with your doctor.
Osteoporosis occurs when your bone tissue doesn’t regenerate fast enough, thus causing bones to become so brittle and weak, they can break under the stress of something as small as a cough. Osteoporosis commonly occurs in the hip, wrist, or spine, according to the Mayo Clinic. Hippolyte says risk factors for osteoporosis are age, race, body mass index, family history, and smoking. The problem is, it’s a silent condition. “The No. 1 symptom of osteoporosis is no symptom. Zero,” she says, adding that it can easily sneak up on women with chronic conditions requiring steroid use or medications that increase their risk of osteoporosis. “Unfortunately, what often happens is a woman has a fracture, and in hindsight, her doctor realizes her risk of fracture was increased because she has osteoporosis. Prevention is very important.” Osteoporosis has a precondition called osteopenia, for which there are oftentimes no symptoms outside of localized bone pain and weakness in the area of a broken bone. However, a bone-density test, which women should get starting at age 65, can determine signs of loss of bone density, which can be counteracted by surveillance and preventative measures like exercise, Hippolyte says.
Hippolyte says heart disease is a strong example of how, historically, the medical establishment has overlooked women. And it’s not just older women: Approximately one in 16 women over the age of 20 (6.2 percent) has coronary heart disease, the most common type of heart disease, which affects Black and white women almost equally. Though it’s the leading cause of death for women in the United States — killing approximately one in every five women — medical research and training have largely ignored the fact that women present very differently than men while having a heart attack. “Heart disease can impact a woman just as much as a man, but symptoms and how it’s recognized are a lot different, therefore putting a woman in danger of her condition going unnoticed,” explains Hippolyte. “We mostly look at data from male patients and studies done on men, from presenting symptoms to medications that could be used. But a woman’s heart attack is not that crushing chest sternal pain that we see in the movies. It’s definitely a lot different. Nausea and upset stomach might be the indication and are oftentimes overlooked.” Heart disease can be insidious because many women don’t have symptoms. Others feel dull or heavy chest pain (also known as angina); pain in the neck, jaw, and throat, and/or pain in the upper abdomen or back; fatigue, nausea, or vomiting.
Your primary-care physician preliminarily screens for basic heart-disease indicators at your yearly well visit by taking your blood pressure, discussing your diet, monitoring your weight, and ordering blood tests to check your cholesterol and glucose levels. Hippolyte says when you’re evaluated for heart disease, your doctor or cardiologist should also consider your obstetrical history. “You might have a woman who gave birth 20 or 30 years ago and perhaps had preeclampsia, or a growth-restricted baby, or an elevation in blood pressure that everybody said was nothing. These risk factors alone contribute to an increased link with cardiovascular disease later in life. A woman who didn’t really seem to have high blood pressure or smoke might suddenly be at risk for congestive heart failure. You have to really know a woman’s personal medical history and see how it could impact her health many decades later,” says Hippolyte. Among other factors that can contribute to heart disease risk are diabetes, alcohol use, a lack of exercise, an unhealthy diet, and obesity.
Complications in pregnancy
Prenatal care is extremely important for your health and your baby’s health. In 2020, the average U.S. maternal mortality rate was 23.8 deaths per 100,000 live births compared with a rate of 20.1 in 2019. Horrific but true: The maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births — 2.9 times the rate for non-Hispanic white women, according to the CDC. These are the highest maternal mortality rates of any high-resource country.
When you’re pregnant, your body goes through so many changes, it can be hard to tell which discomforts are normal and which are signs of something serious. According to the CDC, approximately 50,000 or more American women will experience severe maternal morbidity (SMM), or pregnancy conditions that can adversely affect a woman’s health or even life. Though it’s difficult in a mere paragraph to provide a full guide to which complications warrant exploration, Hippolyte says the following signs and symptoms warrant an immediate call to your doctor:
- A headache that will not go away with acetaminophen, the main ingredient found in Tylenol
- Visual changes at rest (e.g., floaters, or bright spots in your field of vision)
- Vaginal bleeding in any trimester
- Epigastric (or gastrointestinal) pain not relieved with antacid
- Right upper abdominal pain at rest
- Decreased or absent fetal movement in the mid-second trimester and later
In the meantime, be sure to keep up with your prenatal visits, testing, and screenings to carefully monitor your pregnancy throughout.
Vivian Manning-Schaffel is a multifaceted storyteller whose work has been featured in The Cut, NBC News Better, Time Out New York, Medium, and The Week. Follow her on Twitter @soapboxdirty.
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