It's Time to Treat Women Differently: The Case for Sex-based Medicine
By Sharon GreenWomen's Health September 15, 2014
Since the passage of NIH Revitalization Act of 1993, which mandated the inclusion of women in federally funded clinical trials, there has been a growing body of evidence that sex differences are found in all body systems beyond reproductive health. Sex differences can have significant and underestimated consequences in clinical medicine.
The Women’s Health Research Institute at Northwestern University Feinberg School of Medicine has partnered with five clinical services at Northwestern Medicine, and encouraged the establishment of women-centric clinics that address the special needs of women outside of the traditional women-only conditions such as female cancers. The intent is to integrate new knowledge to complex chronic diseases and overall health. These clinics are not intended to be primary care centers but rather authoritative consulting services where physicians can refer their patients for complicated conditions.
For example, conditions that affect the brain can be more complicated to treat in women, and Northwestern Medicine neurologists have joined together to create a unique Women’s Neurology Center. Women with neurologic conditions such as epilepsy, multiple sclerosis. stroke, migraines and sleep disorders have extra challenges when it comes to contraception, pregnancy and menopause.
“Brain differences between men and women complicate the response of targeted therapies for neurological conditions,” said Elizabeth Gerard, MD, co-director of the Women’s Neurology Center and an expert on epilepsy in women. “Dealing with hormonal fluctuations during the menstrual cycle and menopause, choosing appropriate contraception, planning pregnancy, and addressing infertility issues are among the unique challenges faced by females with neurological disease.” These challenges are best approached with the help of physicians with neurological expertise in caring for female patients.
Research has identified many sex differences in heart disease symptoms, diagnoses and treatments. The Program for Women's Cardiovascular Health at Northwestern’s Bluhm Cardiovascular Institute provides a standard of care that recognizes women as unique individuals and tailors treatment strategies to their specific cardiovascular needs. The staff conducts clinical research and educates physicians and the public about sex differences. The Heart Disease and Pregnancy Program under the direction ofMarla Mendelson, MD, working closely with specialists in maternal-fetal medicine, has helped many women with cardiovascular disease undergo a safe pregnancy for both mother and baby.
Women with a history of depression and other mood disorders fear taking medication to control their illness during pregnancy. Without intervention, though, they put both their pregnancy and themselves at risk. According to Katherine L. Wisner, MD, MS, director, Asher Center for the Study and Treatment of Depressive Disorders at Northwestern Medicine, “Very few doctors feel comfortable treating their pregnant patients with drugs, since medications have rarely been studied in pregnant or lactating women.” Physicians rely on instinct and experience in difficult cases, but also hesitate because of concern about the fetus and the potential for litigation should something go wrong. “A severely depressed pregnant woman may need medication to prevent harm to herself or her baby, and litigation is also possible for failing to treat with medication,” says Wisner.
Pelvic Floor Disorders
The Women’s Integrated Pelvic Health Program at Northwestern Medicine, led by Kimberly Kenton, MD, MS, brings a multidisciplinary approach and includes a team of experts in female pelvic medicine and reconstructive surgery, urogynecology, colon and rectal surgery and physical therapy. One in four women will experience a pelvic floor disorder; yet, despite increasing high quality medical research showing treatments are safe and effective, myths continue to discourage women from seeking treatment. Kenton and her team participate in clinical and translational research aimed at improving treatment outcomes, advancing understanding of neuromuscular injury in pelvic floor disorders, and identifying strategies to prevent women from developing pelvic floor disorders after childbirth.
The Women’s Skin Program under the direction of Bethanee Schlosser, MD, PhD, in the Department of Dermatology in the Feinberg School of Medicine provides medical treatment and education regarding common skin disorders as well as surgical and cosmetic consultation. Participating dermatologists have a strong interest in vulvar diseases and infections and skin conditions that occur in pregnancy. While most are not life threatening, these conditions can seriously impact a woman’s quality of life. Ironically, most skin research in the laboratory is done on cells grown from male foreskin, establishing an understanding of skin cell function that has never been tested in female skin cells. However, Amy S. Paller, MS, MD, director of the Skin Disease Research Center and chair, Department of Dermatology at the Feinberg School of Medicine, is generating a skin cell and tissue bank that includes both male and female cells enabling sex variables in function and response to medication to be studied in conditions including eczema and psoriasis that impact tens of millions of individuals, both male and female.
Specialty Clinics to Address Complex Cases
Women’s specialty clinics beyond the discipline of Obstetrics and Gynecology are an important resource for family practitioners, internists, and even, in certain cases, specialists. An endocrinologist with a diabetic patient who becomes pregnant may need advice on glucose/hormonal interactions. An obstetrician may have a postpartum patient with complicated pelvic injury. As the research community moves to a greater inclusion and understanding of sex differences, health care providers need to be alert to these ongoing changes and seek counsel for their more complex cases.
Want to learn more?
Treating Women Differently: the Case for Sex-Based Medicine
Friday, November 21, 2014 1-5 p.m.
Prentice Women’s Hospital, Chicago
Sharon Green is executive director, Women’s Health Research Institute at Northwestern University Feinberg School of Medicine.