The Menopause trivialised
Rosemary Goring shone a light on the menopause recently (‘HRT isn’t only answer – being a woman is not a medical issue’, Herald, 18th May 2022) pointing out that since time immemorial women have been regarded as intrinsically weaker, our occasional irrationality stemming from our role as childbearers with all the adverse physical effects that brought. It became a way of viewing women as inferior. For a long time, medicine taught its practitioners that women were men with some of the bits missing.
Davina McCall has also pointed out the extreme health effects of the menopause, making her at times believe she was developing Alzheimer’s or had a brain tumour, experiencing brain fog and memory loss, or flustered, even suicidal. Hot flushes are the butt of jokes, and crockery can have a short lifespan in the hands of a sufferer.
But less of a joke are the 330,000 women in the UK who have had to give up work altogether as a result of the extreme effects of the menopause. No doubt part of the dismissal of this condition is because it affects only older women, and our society has little respect for older people of either sex.
Not every female suffers. Some sail through the menopause or have relatively minor symptoms, but for those who do not, the effects not only on the woman but on those around her can be devastating. Women are sometimes advised to start ‘treatment’ when they are pre- or perimenopausal. At least society is gradually taking the menopause seriously.
Women appear to get worse treatment than men for heart problems, according to Rachel Ellis (‘Women are still suffering needlessly due to heart care health gap’, Daily Mail, 16th May 2022). Heart attacks and disease are more common in men than women, but studies show that women are less likely to receive the correct treatment and heart disease kills twice as many women in the UK as breast cancer. Women are 50% more likely to be misdiagnosed than men, and 34% less likely than men to receive a timely coronary angiography within 72 hours of first symptoms and slightly less likely than men to get a reperfusion, drugs and stents to clear blocked arteries.
A Leeds University study filed in 2018 found that 8,200 women in England and Wales died between 2002 and 2013 due to having inferior treatment to men. The study, funded by the British Heart Foundation and Wellcome Trust, found women were also less likely to be prescribed statins or beta-blockers on leaving hospital, which lower the risk of a second attack.
Professor of Cardiovascular Medicine at Leeds University, Chris Gale, who led the study, went as far as to say women are dying from unequal heart attack care.
Dr Vijay Kunadian, consultant cardiologist at the Freeman Hospital in Newcastle-upon-Tyne, said women tend to be under-represented in clinical trials and male results seem to be just transposed onto women. The first inkling of a gender gap in heart care appeared in the early 1980s. Women may need lower doses of drugs or other treatments. Maybe it is an unconscious bias, the belief that heart disease and attacks are a men’s issue, and that women are protected by the female hormone oestrogen. Women tend to have heart attacks seven to ten years later than men, but numbers increase after the menopause.
Women tend to delay seeking treatment and may mistake symptoms, which can be as varied as pain between the shoulder blades, tiredness, dizziness, nausea and vomiting, or a choking feeling.
It is complicated by poorer treatment of ethnic minority heart patients, including longer waiting times for treatment, and different reactions to drugs, as revealed in a Keele University study in 2021 (‘Racial differences in management and outcomes of acute myocardial infarction during COVID-19 pandemic’, BMJ Heart journal).
The 2019 Scottish study by the British Heart Foundation (‘Women in Scotland under- estimate heart attack risk’, Clare Shaw, 30th September 2019) painted an equally grim picture for Scotland. Ischaemic heart disease kills three times as many women as breast cancer in Scotland, 2,600 women annually or 7 per day, but heart disease is overlooked, including by women. After a heart attack, the protein troponin is released into the blood stream, but women may release lower levels of troponin, leading to them being diagnosed as not having had a heart attack at all.
In ‘The deadly truth about a world built for men – from stab vests to car crashes’ 23/02/2019, the Guardian highlighted the work of Caroline Criado Perez (Invisible Women: Exposing Data Bias in a World Designed for Men) that showed the many ways in which women are covertly disadvantaged.
Take research into vehicle safety features using car crash dummies. Men are more likely than women to be involved in a car crash, but if involved, a woman is almost half as likely again to be seriously injured, 17% more likely to die, and if not killed, is twice as likely to be trapped, and less likely to be able to extract herself. Because many women pull themselves forward in the car, they are no longer in the standard seating position, so at greater risk of internal injury on frontal collisions. Our legs are more vulnerable to injury, partly due to having to reach further for the pedals, and we are at greater risk of whiplash and pelvic injuries.
Car crash-test dummies are based on the average male. The ‘female’ prototype is a scaled-down male. The EU is planning legislation to make these measurements more accurate, but the UK appears reluctant to follow suit.
Why women are colder in the office
The formula to determine standard office temperature was developed in the 1960s and measured against the metabolic resting rate of the average man. The female metabolic rate appears to have been overestimated by possibly 35%, making offices on average five degrees too cold for women. So it’s not poor circulation (with the added implication women are less healthy than men), it’s poor measurements.
Other examples include chemical exposure. Women’s thinner skin may make them more likely to be adversely exposed to toxins at work, including chemicals such as polishes, removers, gels, disinfectants and cleaning products.
Female police officers are disadvantaged by body armour such as stab vests which can cause long-term injury (they are not built for anyone not flat-chested!), and can ride up leading to safety being compromised. Most personal protective equipment (PPE) is based on average male dimensions.