Although hard-to-read heart attacks happen to both men and women, they are more common in women. One reason for this is that men's symptoms initially set the standard for recognizing heart trouble. Now a growing body of research shows that women can experience heart attacks differently than men.

Understanding sex differences in heart disease is important. Heart disease is the leading cause of death for women. Although it mostly affects older women, it isn't rare in younger women. One in 10 of all women who die from heart disease or a stroke are under age 65, and this age group accounts for one-third of heart- or stroke-related hospitalizations. Even so, younger women and their doctors don't necessarily suspect a heart attack even when all the signs are there.

New Guidelines for Managing Women with Abnormal Pap Smears

Each year 3.5 million women have some degree of abnormality on their Pap smear — the test most commonly used to screen for cervical cancer — and require additional attention. But until 2001 there were no national guidelines on the best way for clinicians to treat these women.

The American Society of Colposcopy and Cervical Pathology brought together experts in cervical cancer prevention to develop comprehensive specifications. The guidelines they created could make things easier for women who have inconclusive Pap smear results.

Oral contraceptives and breast cancer risk

Researchers continue to unravel the web concerning the use of oral contraceptives and the risk of breast cancer. A study published in June 2002 indicated that birth control pills don't increase the risk of breast cancer for women in the general population (see August update). But a new study published in the December 4, 2002, issue of the Journal of the National Cancer Institute shows oral contraceptives can increase the risk of breast cancer in women with a particular genetic mutation.

The study examined whether the use of oral contraceptives increased the risk of breast cancer in women with a mutation in the BRCA1 or BRCA2 gene. Women who have such a mutation are already known to have a high risk of developing breast cancer and ovarian cancer. A person inherits these types of gene mutations.

New IUD

Women have a new choice for birth control. Late last year the FDA approved the intrauterine device (IUD) Mirena. Mirena is a T-shaped plastic device placed in the uterus by a physician that releases small amounts of the hormone levonorgesterel to block conception. Although not the first hormonal IUD, Mirena only needs to be replaced once every five years. The others, in contrast, must be changed yearly. The manufacturer, Berlex Laboratories, reports less than 1% of women become pregnant while using Mirena.
Physicians can easily remove the IUD. And once it’s extracted, a woman can again become pregnant. According to Berlex, eight out of ten women who are trying to conceive will become pregnant within the first year after Mirena is removed.

Mirena is not for everyone, however. Women with a history of pelvic inflammatory disease or a previous ectopic pregnancy (when the embryo grows outside the uterus) should not use IUDs. Furthermore, they don’t protect against sexually transmitted diseases. Possible side effects include spotting or missed periods.
June 2001 Update

Warfarin and Vaginal Cream Drug Interaction Warning

The Food and Drug Administration (FDA) has issued a warning stating that women taking the prescription blood thinner warfarin (Coumadin) should consult their doctor or pharmacist before using over-the-counter vaginal creams containing the antifungal drug miconazole because of an increased risk of bleeding or bruising. Miconazole is an active ingredient in many over-the-counter creams and suppositories used to treat vaginal yeast infections.

Doctors were already aware of adverse reactions between warfarin and systemically administered miconazole. This warning urges women to beware of creams and suppositories as well.

The warning was issued in response to two reports of abnormal blood clotting tests in women taking the anticoagulant warfarin who used vaginal miconazole. In addition to the abnormal blood-clotting test, one of the two women also developed bruises, bleeding gums, and a nosebleed. Two journal articles also warned of a possible interaction between warfarin and vaginal miconazole.

The FDA warning will appear on miconazole-containing product labels and consumer brochures.

April 2001 Update

The benefits of multivitamins are looking doubtful. Can we do without them?

The answer is a qualified yes – we can do without them, as long as you eat a well-balanced diet rich in fruits and vegetables.

In the past, doctors often suggested a standard multivitamin with minerals each day. They don't cost much, and earlier studies had shown some benefits. For example, it appeared that folic acid and other B vitamins might lower the risk of heart disease, stroke and possibly cancer. But more recent studies have shown no added benefit of multivitamins for healthy people that eat a balanced diet.

Hot flashes are well known to most menopausal women—and to many who are in perimenopause, the transition to menopause. Hot flashes tend to come on suddenly and last from one to five minutes; they can range in severity from fleeting warmth to a feeling of being on fire.

Why do women experience this symptom differently, and why some don't experience it at all?

Q. I love to soak in the sun and get a nice tan, which makes me look healthier. However, over the years I've acquired a few wrinkles, which I'm not so crazy about. Is there anything I can do to minimize them?

A. As you know, prolonged exposure to the sun can result in premature wrinkles. In addition, age, sex, skin type, geographic location, skin pigmentation, genetics, and total duration of sun exposure throughout life all play a role in how our skin ages. Studies have shown sun exposure induces skin aging in up to 80% to 90% of Europeans and North Americans.

Q. My daughter, who just moved to Atlanta with her husband, is pregnant. I'm worried that she will be exposed to Zika virus once mosquito season gears up. What can she do to minimize the risk that her baby will have microcephaly?

A. You can relax. Although the mosquito that transmits Zika virus, Aedes aegypti, is occasionally found in the southeastern United States, so far, there has been no mosquito-borne Zika transmission in the United States. However, your daughter may want to check the website of the CDC (www.cdc.gov) for updates, especially if she or her husband expects to travel to Latin America or the Caribbean. There have been reports that, rarely, Zika can be transmitted sexually from men to women. Therefore, men should use condoms if they have been exposed to the virus and their partner is pregnant. And since Atlanta has quite a few types of mosquitoes, she may want to know that insect repellents containing ingredients such as DEET, picaridin, and IR3535 are safe to use during pregnancy.

A dozen yoga poses, performed daily, may increase bone density.

 Image: tetmc/Thinkstock

Like most of us, you may have become accustomed to thinking that only common weight-bearing exercises—walking, running, jumping, and lifting—provide enough stress on your bones to maintain or increase their density. So a scientific paper titled "Twelve-Minute Daily Yoga Routine Reverses Osteoporotic Bone Loss" came as a surprise. And it appeared to offer women another option to build bone.

What the study found

The researchers who designed the study noted that yoga's established benefits—including better balance and coordination—protect against falling, a major cause of osteoporotic fractures. They wanted to determine whether the yoga poses they selected might also increase bone density by imposing force on the spine and hips.