WE HAVE FEMALE HORMONES:
Our hormones influence how our bodies process medications. Factors like oral contraceptives, the menopause, and postmenopausal hormone treatment could also affect how we respond to drugs.
Painkillers and anaesthetic drugs are absorbed and metabolized in a unique way by women, who have a 30 per cent higher sensitivity to neuromuscular blockers and in turn need smaller doses than men. Research has shown that males and females do not respond in similar ways to opioids like OxyContin, Percocet, and Vicodin. Some medications, like Valium, exit our bodies faster than they do men’s bodies. Others linger longer. In animal studies, males and females also react to withdrawal in different ways. It is crucial for us to be aware of these differences, because as a nation we are currently experiencing what the NIH has termed an “epidemic” of women overdosing on painkillers, with a dramatic rise in the number of women dying every year. And the highest risk of death from an overdose of prescription painkillers isn’t found among the young – it is found among women between the ages of forty-five to fifty-four.
But all this information is relatively new, and that’s because for a long time, pharmaceutical companies tested their drugs only on male cells, male animals, and male humans. This practice has led to a mountain of data that isn’t very accurate when it comes to prescribing drugs for women. Many of the studies we rely on today faithfully and obsessively record variables like time and temperature, but overlook the small detail of sex. Even when it comes to animal testing for drugs being developed to treat illnesses that predominantly affect women, sex isn’t always taken into consideration. That goes for human female subjects, too. Since hormones fluctuate over the course of a month, tests that use females can be a lot more complicated to analyze than tests that use males. Without taking hormonal shifts into account, it is impossible to determine how treatments might affect a woman over the course of a month. Pregnancy is a concern in medical testing as well. In the 1960s, thousands of pregnant women who participated in a study and took the drug thalidomide gave birth to babies with serious defects. That tragedy has had a lingering effect on the scientific community, making researchers wary of including women in drug trials at all. By not creating safer trials and including women, however, we’ve also lost the chance to gather important information.
Luckily, things are changing.
Since 2014, the NIH has required applicants for federally funded research grants to address how sex relates to the way experiments are designed and analyzed. This research is critically needed, because as you’ve read in this chapter, medications affect women uniquely – even everyday ones, like the flu vaccine. A woman requires half as much flu vaccine as a man to potentially produce the same amount of antibodies.
Women need appropriate doses of everyday and life-saving medicines that have been developed to be effective for our bodies. We need research that supports our sex, our cells, and our lives. The more knowledge we have of our female biology, the more we can advocate for quality care for ourselves as we age.
Over the course of my lifetime, women’s healthcare has improved dramatically. When I was a girl, the medical community was evolving in ways that would profoundly affect my life as a woman. I may not have been aware of the social changes that were swirling around me – and I certainly wouldn’t have understood that the advances being made in women’s rights were so closely tied to advances in women’s healthcare. Now I understand that, ladies, we have been living through history.
As we are writing this book, there are more than thirty million women between the ages of thirty-five and fifty living in the United States. Whatever health challenges you might be going through, anywhere in the world, you are not alone. We’re millions strong. We’re standing in the middle of a conversation that has been going on for hundreds of years, with hard-won rights and knowledge bestowed on us by previous generations of women (and men).
And the changes are still coming.
WANT THE FACTS? ASK.
Whether you’re choosing a phone plan, buying new clothes, or ordering from a dinner menu – chances are you probably ask a lot of questions before making a decision. How many minutes will I get? Do these jeans come in petite? Is the pasta homemade?
Asking questions helps you make sure you’re getting what you want and need. So do you bring those same sleuthing skills to your GP visits? Unlimited texting, the perfect pair of jeans, and an amazing meal are totally worth the time it takes you to assess your options – and so is your healthcare.
When we were at the NIH we met with its director, Dr Francis Collins, and asked him what he thought the public needed to do when it comes to healthcare. He said that the most crucial thing we can all do is pay attention. Ageing research (and other medical knowledge) is constantly evolving. We can’t rely on medicine developed twenty years ago for our treatment today.
The only way to stay informed is to ask your doctor lots of questions, and to keep on asking if you still aren’t sure of the answer. We talked to doctors who said they were amazed by the LACK of questions they receive from patients. They told us their patients don’t always ask about the medications they’re prescribed – what they’re for, what they do, what the benefits and risks and side effects may be. They all encouraged us to encourage you to ask more questions.
Everyone deserves to have a GP who listens to their questions and takes the time to answer them, who will discuss alternatives and options, and who respects and takes seriously their symptoms.
Dr Seth Uretsky, a cardiovascular specialist and medical director of cardiovascular imaging at Morristown Medical Center in New Jersey, often sees patients who feel their symptoms have been overlooked by physicians. He believes that it’s important to trust and feel comfortable with your GP, and that finding one who listens, gives you time, and explains his or her thought process is crucial. And the data underscores his point: when patients feel understood by their GP, outcomes are better.
If your GP doesn’t seem to have the time to listen to your concerns, or if you feel that he or she doesn’t take your questions or symptoms seriously, it’s time to find a new GP.
WHEN I WAS A child, I loved to spend as much time as I could with my grandparents. My grandmother was my hero. She was seven years older than my grandfather, and she was a powerhouse.
My grandmother was my ideal of strength and ability. She basically maintained a full working farm at her house, raising her own livestock and tending a thriving garden. She didn’t drive, so when she needed more feed for her chickens and rabbits she would set out on foot. She would walk to the feed store, about a mile away, and carry two ten-pound sacks of feed, one in each hand, on the walk back, even in the heat of the summer. If she wanted to haul more, she would bring a wagon. As a child, I remember asking her why she carried such heavy bags so far in the scorching heat. She would say, “Because I like it, and because it keeps me strong.” Her answer was so awesome to me, and I think of it every time I am pushing myself to go farther, to work harder, to try