Symptoms May Vary – Mpls.St.Paul Magazine

When it comes to diagnosing women, the details matter. While women face many of the same illnesses as men, a historical lack of research around certain conditions has meant they’re not as well understood in the female body. It’s a gap that’s left countless women overlooked—and their symptoms misunderstood. Meanwhile, conditions that predominantly affect women have not always been given the attention they deserve, leading to years of missed or delayed care.

“There has been a paternalism in how we approach women’s health, and more women are being told that what they are experiencing isn’t real or it’s in their heads,” says Dr. Laura France, OB-GYN and VP of medical practice for the Women’s and Children’s Service Line at M Health Fairview. “But as more research has happened, we’re better recognizing the difference in how conditions present in women, and I’m hopeful this will lead to better care.”

Ahead, four health concerns that deserve our attention now.

“As more research has happened, we’re better recognizing the difference in how conditions present in women, and I’m hopeful this will lead to better care.”

—Dr. Laura France

How We Got Heart Health Wrong

Heart disease is the leading cause of death for women—responsible for one in three deaths each year. That’s far more than the one in 43 women who die from breast cancer annually. But women might clutch a painful left arm instead of their chest, like men do. 

Medical researchers didn’t start exploring how heart disease uniquely affects women until the 1980s. Symptoms, guidelines, and treatment approaches were based on evidence from studies of men, reports the American Heart Association. 

However, heart disease presents quite differently in women, says Dr. Kimberly DeRoche, a family medicine physician and president and chief of primary care at M Health Fairview. Women often feel pain in their left shoulder, arm, or jaw. They might never experience the crushing weight on their chest that’s common in men. 

To catch a woman’s heart attack in progress, identify heart disease, and prevent delays in life-saving treatment, it’s critical for everyone to know women’s specific symptoms. Take note if you aren’t able to do your normal vigorous activity, feel new nausea, or experience shortness of breath or lightheadedness, DeRoche says. Everyone should be checked periodically for high blood pressure and cholesterol, but especially women with a family history of heart disease. Pregnancy, postpartum, perimenopause, and menopause are times to be on high alert for heart trouble.

1 in 4

women are affected by insomnia, and are twice as likely as men to report that they rarely or never feel well-rested after waking up.

Things That Go Bump in the Night

We’ve all been there: wide awake at 2 am, tossing and turning, and growing more frustrated by the minute. Whether it’s trouble falling asleep, waking too early, or struggling to drift back off, insomnia wears many disguises. 

Hormonal shifts during the menstrual cycle, pregnancy, perimenopause, and menopause all contribute to women’s higher rates of insomnia, says DeRoche. Add to that bladder changes (causing frequent bathroom trips!); the fact that women tend to get up more in the night for caregiving; and the interplay between insomnia and stress, anxiety, and depression—conditions that affect women disproportionately—and we’ve got a perfect storm of sleep disruption.

No matter the cause, insomnia does a number on your daily well-being and long-term health alike. Not getting enough sleep affects your energy and stress levels, mood, and focus. Chronic insomnia can contribute to bigger-picture health concerns like heart disease, depression, weight gain, and dementia. 

Hormone replacement therapy and a range of other therapies often ease hot flashes and night sweats. Some also help reduce nighttime waking. But managing insomnia isn’t just about symptoms—it’s about stress, too. With myriad responsibilities on women’s plates, it’s no wonder it’s difficult to wind down at night. DeRoche recommends mentally decompressing before bed by calmly thinking through any worries or lingering thoughts.

Pay Attention to This

Despite widespread belief, females have about the same rate of ADHD as males. It just tends to look different, which makes it fly under the radar. That’s been changing in recent years, thanks to deeper understanding and awareness, says Kelsey Scampoli, a clinical psychologist with M Health Fairview.  

Boys get diagnosed sooner—at a rate of three to one—because their symptoms are typically disruptive, including being impulsive, interrupting, and being unable to sit still. Girls with ADHD tend to struggle with paying attention and staying on task, Scampoli says. “Girls are socialized to be prim and proper and good listeners and sit quietly in their chair. They might be struggling with inattention, but nobody knows it.” 

In women, ADHD leads to difficulties with time management, organization, and staying focused. Many also struggle with low self-esteem, anxiety, and depression. If you suspect you may have ADHD, Scampoli recommends getting evaluated and talking with your health care provider about treatment options. This new understanding—paired with options for medication, therapy, mindfulness, and support—helps many women manage their ADHD. 

33%

of deaths among new mothers are linked to heart disease, the leading threat to maternal health.

Breaking the Bladder Taboo

It’s one of those hush-hush topics nobody likes to bring up—but so many women quietly deal with. In the U.S., a staggering 78 million women—roughly 62 percent—experience some form of incontinence. About a third say it happens at least once a month.

Incontinence can happen for a variety of different reasons and shows up in different ways. The good news? There’s a host of treatment options out there, France says. The key is talking to your primary care physician, OB-GYN, urologist, or urogynecologist about what is happening. 

France makes it easier by opening the door herself. She brings up related concerns like menopause symptoms, sleep, and incontinence, creating space for honesty. From there, IDing the types of incontinence is the first step—for some, it’s stress incontinence:  Laughing, sneezing, or jumping triggers a leak. Others face urge incontinence, where bladder spasms create a sudden, “must go now” urgency—often before reaching the bathroom. And some women experience both.

Treatment depends on what’s behind the leaks. For some, it’s the aftermath of pregnancy and years of regularly lifting heavy objects—both of which can lead to weakened pelvic floor muscles and struggles with control. For others, menopause, chronic coughing, or constipation are the culprits. Pelvic floor physical therapy, surgery, devices called pessaries, and hormone replacement therapy can help.

Dr. Kim DeRoche

Family Physician, President and Chief of Primary Care

Dr. Laura France

OB-GYN, VP of Medical Practice for Women’s and Children’s Service Line

At M Health Fairview, wellness for women is well within reach. To learn more, visit mhealthfairview.org/womenshealth.