Women’s bodies are structured differently than men’s. They show different symptoms when they have illnesses such as a heart attack and they also process medication differently. However, this has so far been given little consideration in everyday medical practice. We speak to heart specialist Sandra Eifert about why so-called gender medicine is important and what differences there are between men and women (in medicine).

by Editor Business and Advice

Why is it important to distinguish between men and women in medicine?

Professor Sandra Eifert: Gender medicine deals with gender differences in health and illness. We differentiate between social and biological gender. Social gender is referred to as “gender” in English – that’s where the term comes from. It includes access to the health care system, gender roles, but also the perception of illness. The biological factors, summarized in English under “sex”, are the genetic determination of being a man or a woman. It is the hormones that play a major role, and of course our organic/physical side.

What diseases can the physical differences between men and women affect?

Across many diseases: Cardiovascular diseases are the focus. About 15 years ago, the mortality rate among women after a heart attack was about twice as high as among men. According to the German Heart Report 2022, this has improved significantly in the last ten years. Mortality among women has fallen by 34 percent and among men by 26 percent. This is mainly due to improved diagnostics and therapy.

Other examples are neurological and psychiatric illnesses. Depression manifests itself very differently in men and women.

In addition, there are infectious diseases. The immune system and the body’s own defenses differ between men and women. Autoimmune diseases correspond to an excessive defense reaction to a certain stimulus and occur primarily in women. Osteoporosis is an example that is often attributed to women and also occurs in men.

Professor Sandra Eifert is a heart specialist and expert in gender medicine.
Image rights: MDR

Does it make more sense for women to be treated by a female doctor?

In principle, it is right and good for women to go to a specialist with additional qualifications in gender medicine.

A lot has changed in Germany in this regard over the last 20 years. Gender medicine is to become part of the new, upcoming licensing regulations.

Today, gender medicine is already part of the medical curriculum at all major German universities. And so it is finding its way into medicine, which actually reaches patients.

Women also show different symptoms than men. What does this mean for treatment?

The gender differences range from risk factors to symptoms to diagnosis and the resulting therapy. It is very complex and also depends on social behavior and communication. That makes the whole thing complex. In Germany, the patient is male and until recently, everyone was treated that way. That is what makes it so complex.

There is no distinction made between men and women when it comes to medication. Does this mean that women have to expect more side effects?

It is true that a standard dosage is recommended for most medications, and in some cases it is weight-dependent. Women absorb medication differently than men. They metabolize it differently and excrete it differently – due to our different body composition compared to men. We women have more water and fat. Men have more muscle due to testosterone. In addition, certain medications are hormone-dependent. This can lead to us as women storing certain medications more or excreting them later, so that we reach a higher dose and the rate of side effects can also be higher.

Women absorb medications differently than men.

Professor Sandra Eifert, heart specialist

For ten years now, the European Medicines Agency has been recommending that gender, and especially women, be taken into account in drug therapy. This begins with drug testing. This recommendation is not binding for manufacturers.

Are there special active ingredients that work differently in women?

Aspirin is a very good example because it offers a big difference between men and women in primary prevention. For men, aspirin is very suitable for primary prevention to prevent a heart attack when there are already risks but no manifest disease has yet occurred. For women, aspirin is better suited to protect them from a stroke.

Side effects from medications for cardiac arrhythmias or heart failure are much more common in women.

What is the difference between the female and the male heart?

On the one hand, the female heart is somewhat smaller overall, in proportion to the body size. All structures are somewhat more delicate. On the other hand, certain diseases occur with different frequencies. Men generally have more coronary heart disease because women are well protected by hormones for many years. But as women get older, especially after 45, their hormone levels decrease and this protection is lost, meaning that certain risk factors develop and heart disease can occur.

It is particularly important for women that the examination takes place under stress, for example on a bicycle or treadmill. The disease is often not so easy to detect when the patient is at rest. In addition, the symptoms vary.

Angina pectoris and co.: symptoms, effects and examination of individual diseases

What is angina pectoris?

Angina pectoris is the Latin term for chest pain. Typically, when it originates from the coronary arteries, the pain extends behind the breastbone and in men tends to radiate to the left arm. This can also be the case in women, but it does not have to be. In them, non-specific symptoms such as exhaustion, tiredness and reduced resilience as well as nausea are the main symptoms. In women, the pain tends to go to the lower jaw or back.

What is broken heart syndrome?

Broken heart syndrome is a serious illness that often occurs after a particularly stressful situation, such as heartbreak, being abandoned, the death of a relative or a similar serious situation. This means that patients, 95 percent of whom are women and 90 percent of whom are women over 50, experience symptoms similar to those of a heart attack – even the typical male symptoms: pressure behind the breastbone radiating to the arm. They also have changes in their ECG similar to those of a heart attack.

A cardiac catheter is used to assess the coronary arteries, particularly in the case of a heart attack. In the case of broken heart syndrome, the coronary arteries in those affected are usually unremarkable. However, a very typical shape of the left ventricle is seen, with a balloon-like swelling of the apex of the left ventricle and a restriction of the left heart’s pumping ability, a cardiac insufficiency.

Do women who have diabetes have a higher risk of cardiovascular disease than men?

That’s actually true. Diabetes is one of the classic risk factors for the development of arteriosclerosis, a calcification of the coronary arteries, but also of other vessels in principle. And for women, this risk factor is far more serious than for men.

Heart attack: What symptoms do women show?

In principle, these can be the same symptoms that men also express. That is, the strong pressure behind the breastbone, often radiating to the arm. However, women very often have non-specific symptoms such as nausea, exhaustion, tiredness. This is often attributed to age and a lack of hormones and is therefore sometimes misinterpreted.

And patients don’t take it too seriously either: resilience decreases and nausea is a symptom that can occur with many illnesses, for example. It is always important – and we always tell patients this – that if these symptoms increase, if they occur repeatedly, then they should consult a doctor and, ideally, a cardiologist to determine whether the heart is suffering from a disease.

Is there a difference in how high blood pressure should be for men and women?

It is true that the blood pressure limits for men and women are set differently. For women, the upper limit should be less than 130 millimeters Hg and for men, less than 140 millimeters Hg.

What effect does an underactive thyroid have on heart health?

The thyroid is a very important organ for all organ systems and especially for the heart. An underactive thyroid can lead to the pulse or blood pressure being too low. Normal thyroid function is always ideal. This also protects the heart.

More on gender medicine

This topic in the program:MDR TELEVISION | MDR at 4 | May 28, 2024 | 4:00 p.m.