Women’s Health: Issues that Matter
It seems women are naturally programmed to nurture those around them, but it’s important to remember that self care is the foundation of good family health. It’s difficult to take care of others if your own body isn’t up to the task! Female health providers have a personal perspective on the care needs of women, so we’ve asked local experts to weigh in on important issues.
what to eat
Nutrition plays a pivotal role in women’s well-being, especially with bone and heart health. According to registered dietitian Amy Knoblock-Hahn, Ph.D., owner of Whole Food Is Medicine, plant-based foods and fish form the ideal basis of a heart-healthy diet. “Particularly good choices are ground flaxseed, unprocessed soy, edamame, tofu and tempeh, a fermented soy cake made with grains that you can stir-fry or use in salads in place of chicken,” she says. “Navy, garbanzo and kidney beans also are good. They offer a lot of protein and fiber, and you can put them in light dishes like salads and soups. Flaxseed, fish and nuts also contain heart-healthy fats.”
Your bones also need vitamin D for good health, Knoblock-Hahn says, but it’s difficult to get it from food. “Getting some sun to help your body produce vitamin D can be a good idea, but not too much,” she advises. “Your doctor can test to see if your blood level of the vitamin is normal and may recommend you take supplements.”
what to leave out
A healthy diet is also about what you don’t consume. For the sake of your bones, it’s important to avoid soft drinks and foods that are processed, packaged or high in sodium, Knoblock-Hahn explains. “Both regular and diet soda are acidic and high in phosphorus, so they tend to pull calcium from the bones,” she says. “Processed foods usually contain a lot of sodium, which also is damaging to bones.” Dr. Stephanie White, a cardiologist with SSM Health St. Mary’s Hospital, agrees that processed items like crackers, cookies and cake should be avoided because they are high in carbohydrates and offer only empty calories.
“The American College of Cardiology recommends the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, which include very limited amounts of meats like chicken, no red meat, and lots of fruits, vegetables and whole grains,” White says. She advises women to give animal products only a small share of the plate and focus instead on fresh, plant-based foods.
A woman’s metabolism slows down with time, and the combination of age and hormonal changes can make it difficult to lose weight, Knoblock-Hahn says. So it’s important to be realistic in your expectations. “If you are trying to return to a weight you haven’t seen in 20 or 30 years, that may not be reasonable,” she notes. “If you are significantly overweight, even a 10- or 15-pound reduction can benefit your body. It may improve your blood pressure, blood sugar and cholesterol levels. Don’t get discouraged by thinking there’s no point unless you lose all of the weight.”
Knoblock-Hahn advises speaking with a health professional about why you want to lose weight and whether you can sustain it through diet, physical activity and lifestyle changes. “The yo-yo cycle of losing and gaining weight is actually more harmful than carrying a few extra pounds,” she says.
listen to your heart
According to White of SSM Health, both sexes have the same cardiovascular disease processes, but a few issues are unique to women. “Modifiable risk factors like diet, exercise and lifestyle, and nonmodifiable ones like family history, are basically the same in everyone,” she explains. “But women can experience some things that put them at higher risk for cardiovascular disease, like HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome and preeclampsia, both of which can happen during pregnancy.” HELLP is a life-threatening condition in which the mother’s red blood cells break down, and preeclampsia is a related problem involving high blood pressure and organ damage.
White says if you have a first-degree relative (parent or sibling) who has had an early cardiovascular event, you are at higher risk for heart disease—for example, if mom had a stroke under age 65, or dad had a heart attack before age 55. “Smoking is the biggest modifiable risk factor in both women and men,” she adds. “Quitting is the best thing you can do for your heart health.”
talk it out
White says instead of scolding patients about eating habits and lifestyle choices, doctors should have a more positive tone. “Adults can be a lot like kids,” she notes. “If a doctor tries to forbid you from doing something, you may want to do it even more!” She says your physician should suggest exercising and eating colorful, nutritionally dense foods that are enjoyable to cook and eat. Many health systems have dietitians on staff to provide more detailed help with healthful menus.
Dr. Basima Williams, a family medicine physician at PALM Health, says women should remember that cardiovascular health is closely tied to emotional and psychological well-being. “Love, stress and faith definitely have an effect on heart health,” she notes. “Knowing yourself, communicating well and paying attention to what makes you happy are important factors in preventing stress and disease.” And it’s important to connect with your doctor often as you age because post-menopausal women may have a higher risk for cardiovascular problems, she notes.
Williams says PALM Health uses the Boston Heart Lab Evaluation to get a thorough picture of patients’ cardiovascular health and risk factors. “First, we do a physical exam, get a clear family history and look at any environmental risks,” she explains. “Then, we use the Boston Heart tool to evaluate factors like the patient’s lipid levels and conditions like diabetes.”
Another helpful procedure is the Method Test, which analyzes the patient’s heart rate and fat-burning capacity during physical activity. “It tells you what heart rate to strive for during exercise so your body can burn the most fat for better cardiovascular health,” Williams says.
know your heart!
Check out the American Heart Association’s Interactive Cardiovascular Library website, watchlearnlive.heart.org. It explains common conditions, treatments and procedures related to heart disease and stroke.
signs of a heart attack in women
Heart attack symptoms can look different in women than in men. Both may feel chest pain and shortness of breath, but women also can experience:
>> A feeling of pressure, fullness or squeezing in the chest
>> Pain in one or both arms, the back, neck, jaw or stomach
>> Heartburn-like discomfort
>> A cold sweat, nausea or lightheadedness
>> Extreme fatigue
looking at options
Dr. Gigi Maminta-Streiff of Women’s Care Consultants says modern birth control may seem like a perplexing subject, but honest communication with a gynecologist can help clear the air. She says a detailed doctor-patient conversation is the first step toward finding the right method.
“When a woman first comes in for birth control, we talk about family history, medical conditions and treatments, and what her periods have been like,” she says. “Have they been painful, irregular or heavy? Are there blood clotting disorders in the family? Has the patient had children, or does she plan to? Is she able to take a daily pill? Is she on other medications like heart or seizure drugs?” The answers to these questions and others can help the doctor determine if a hormonal or nonhormonal birth control method is best.
pill or no pill
Many women opt for a daily oral contraceptive tablet, says Dr. Gillian Schivone, a Washington University gynecologist. “The combined estrogen/progesterone pill that many patients take has potential benefits outside birth control as well,” she says. “It may decrease the risk of endometrial or ovarian cancer, and it can help control acne.”
If the patient can’t commit to a daily pill, there are other options including Nexplanon, a hormone-releasing implant placed under the skin; Paragard, a hormone-free IUD (intrauterine device); and Nuvaring, a hormone-releasing vaginal ring. Women looking for permanent birth control may choose a method such as Essure, a flexible insert placed in the fallopian tubes, though there have been safety questions surrounding it. (Maminta-Streiff notes that all medications and procedures come with some risk of side effects, so it’s important to stay informed.)
on the horizon
According to Schivone, new steroid hormones are being studied that may reduce side effects like unwanted hair growth, blood clots and liver problems. “There’s also a new nitinol IUD that is more flexible and may cause less cramping,” she notes. “It’s in clinical trials now.”
Schivone says researchers also are working on a new form of male contraception, a hormone gel that is absorbed through the skin to inhibit sperm production. “Trials are being done, but no one has invested in creating the product yet,” she notes. “Another important area of study is better birth control counseling. The family planning community is creating new practice recommendations to help doctors educate patients on this subject.”