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Women’s Health Across the Lifespan: A Pharmacotherapeutic Approach

Second Edition

Janine Clayton, MD

Director, Office of Research on Women’s Health

The National Institutes of Health

 

We are at a critical juncture in the examination of sex and gender differences in the etiology, treatment, and prevention of disease in the United States. Compared to 21 high-income countries, women in the United States are less likely to survive to the age of 50.1,2 Women’s life expectancy has plateaued or decreased in many US counties, even as it has continued to increase for men.3 Reasons for these differences are not well understood. The etiology and manifestation of disease varies widely among men and women and can be affected by a host of factors that can have far-reaching consequences many years later. For example, conditions emerging during young adulthood and pregnancy can affect women’s health across the lifespan. Women who experience gestational diabetes during pregnancy are more likely to develop type 2 diabetes,4 while those diagnosed with preeclampsia are at greater risk for hypertension, renal, and cardiovascular diseases.5 Infection with persistent human papillomavirus in adolescence or young adulthood is associated with greater risk of cervical cancer later in life.6 There are also profound differences in how men and women experience some of the largest drivers of morbidity and mortality in the Unites States. Although cardiovascular disease and lung cancer rates have declined among both men and women, rates among men have declined more rapidly.7 With women living longer than men, they are more likely to be diagnosed with Alzheimer’s disease8 and stroke9 and yet have reduced gains in quality of life and functionality following stroke when compared to men.9 Significant life events, such as divorce, place women at greater risk for cardiovascular disease when compared to men.10 Caretaking responsibilities within families and communities differentially impact women’s health, while their health status during pregnancy can have far-reaching consequences for their offspring and subsequent generations.

To better understand these gender differences requires widening the aperture through which we view women’s health to consider women’s experiences across the lifespan. Greater participation of women in clinical trials, particularly adolescents, pregnant or nursing women, and the elderly, is leading to more evidence-based information to guide treatment decisions. The mission of the Office for Research on Women’s Health (ORWH) of the National Institutes of Health is to continue to expand women’s health research, including women’s full participation in NIH-sponsored clinical trials across the age continuum.

The latest edition of Women’s Health Across the Lifespan: A Pharmacotherapeutic Approach advances this conversation. It provides pharmacists, students, and health practitioners with an expansive review of health conditions disproportionately affecting women at each stage of life. The text presents recent advances in pharmacotherapeutic approaches to eating and sexual disorders, health care for transgendered individuals, and reproductive cancers. It is among the first textbooks to present pharmacological approaches to address these conditions, focusing on sex and gender influences. This revised edition brings fresh attention to the cultural, socioeconomic, and psychosocial factors that affect women’s health, not only at one point in time, but throughout each stage of life. The editors and coauthors discuss women’s use of complementary health approaches to treat conditions that conventional medicine has failed to adequately address. This well-researched text calls upon health care professionals to consider all these issues when treating their patients. Additionally, case studies and measurable learning objectives are included in each chapter to facilitate critical thinking and enhance learning.

Women’s Health Across the Lifespan: A Pharmacotherapeutic Approach will prove to be an invaluable resource for health care practitioners. It serves as a comprehensive reference on sex and gender influences on medication response and presents the newest pharmacologic technologies to advance women’s health. We are indebted to the contributions of the editors and their coauthors, who challenge health care professionals to consider changes to their clinical practices, including what questions to ask and what treatment decisions to make.

References

1. +
National Research Council, and Committee on Population. Explaining Divergent Levels of Longevity in High-Income Countries. Washington, DC: National Academies Press; 2011.
2. +
National Academies of Sciences, Engineering, and Medicine, and Committee on Population. Improving the Health of Women in the United States: Workshop Summary. Washington, DC: National Academies Press; 2016.
3. +
Wang H, Schumacher AE, Levitz CE, Mokdad AH, Murray CJL. Left behind: widening disparities for males and females in US county life expectancy, 1985–2010. Popul Health Metr. 2013;11:8.
4. +
Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol. 2012;8(11):639-649.
5. +
Chen CW, Jaffe IZ, Karumanchi SA. Pre-eclampsia and cardiovascular disease. Cardiovasc Res. 2014;101:579-586.
6. +
Koshiol J, Lindsay L, Pimenta JM, Poole C, Jenkins D, Smith JS. Persistent human papillomavirus infection and cervical neoplasia: a systematic review and meta-analysis. Am J Epidemiol. 2008;168(2):123-137.
7. +
Merz CNB, Shaw LJ, Reis SE, et al. Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J. Am Coll Cardiol. 2006;47:S21-S29.
8. +
Mielke MM, Vemuri P, Rocca WA. Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences. Clin Epidemiol. 2014;6:37-48.
9. +
Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008;7(10):915-926.
10. +
Zhang Z, Hayward MD. Gender, the marital life course, and cardiovascular disease in late midlife. J Marriage Fam. 2006;68:639-657.

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