I was just about to recommend that! Great episode. (The TL;DR: the Thalidomide disaster made medical researchers, and Congress, very skittish about testing drugs on women of reproductive age.)
But there are data points. The one I’m still having trouble with is the average four hour additional delay for women with heart attacks to go to the ER. If only 15% of women fail to get the same “classic” signs as men, does that mean this 15% is taking 27 hours longer?
I hate the idea of going to the doctor/ER for a non-emergency.
I tolerated several sleepless nights due to abdominal pain, calling my doctor’s office only when I became jaundiced. My gallbladder was a mess.
Years later I assumed the crushing chest pain was non-cardiac because it went away. After a month of increasingly frequent events, I called my PCP and ended up having angioplasty/stent.
Your Mom’s story was scary for me, especially since I have a menopausal, diabetic and family history of heart disease having Mother.:eek: (And by family history, I mean Uncles who dropped dead of Heart Attacks at in their fifties).
I do think that expectation plays a role. Men of a certain age are always told to be careful over heart disease, while women all experience menopause. So men who feel “off” always have the heart attack on their mind.
here is a link to a poster I saw in an airport once about women and heart attacks.
Although it is true that heart attack may manifest as “fatigue” or “nausea”, how helpful is that really? Can you imagine the impact on people’s lives (and on ER utilization) if they popped into the ER every time they felt fatigue or nausea?
I see your point. As a collection of symptoms, it’s helpful; but the text clearly says “if you feel any ONE of these symptoms…” and that’s just not tenable.
True, but people having a heart attack tend to be pretty sick even if not having chest pain. It usually isn’t similar to mild fatigue or nausea they have had before. A more usual thing is a few days of severe heartburn.
I have seen two MIs in people who presented with severe hiccups!
What I will never for sure but I have no choice but to view as an SD sad cautionary tale: chiroptera.
Her op in that thread included:
Did any of us immediately think that she was having heart attacks? No. Oh we all said see your doctor but this active 57 year old female relatively recently ex-smoker had me thinking on it half a day until possible MIs pinged. She made a doctor’s appointment for 2 weeks out. And the day before that appointment date was the last she ever posted here. Obviously it could have just been that a regular poster suddenly got bored with the board … but …
In any case, to the op, some data and some speculation:
So yes, women in general are more likely than men to complain about what bothers them, and to seek medical care; perimenopausal there are lots of physical complaints that they bring to their doctors most of which are not heart attacks. And signs of heart attacks are often more subtle in them compared to men. And their providers are statistically less likely to screen them for heart disease as aggressively and are more likely to treat it less aggressively.
Putting it together into a speculation is not hard. Perimenopausal and postmenopausal women have lots of complaints and are used to being told that their problems are not a sign of life-threatening disease which is usually true. The presentation of life-threatening disease in that population looks not much different from their usual feeling crappy. As a result both they and their providers (and probably their loved ones) are more likely to ignore the signs of life-threatening disease. For some even to themselves they are akin to the boy who cried wolf … the volume of less serious complaints makes ignoring the one that really matters most more probable.
If chiroptera had been a 57 year old male ex-smoker tradesperson calling his doctor (an internist or FP) complaining of heart pounding and some slight dizziness with minimal activity would the appointment had still been two weeks out? Or told to go to the ED now?
Great data in the rest of your post. So the upshot may be that women go much more frequently for “routine” medical care or make appointments to see their primary care physician about health complaints; but they are less likely to head to the ER when they need to. Fascinating…and troubling.
As I entered menopause, I had much trouble with heart palpitations and some weird chestular sensations that I can’t even describe well, not even to the doctor. Nobody suggested I ought to have these looked into more deeply, and as they all eventually went away, this was fine. But as I pass the sixty year old mark, I’m more liable to hand-wave away any chest sensations because of the memory of having bugged the doctor back then. It would make me feel like a fussy, nervous old lady rushing off to the doctor for every little irregularity, wasting his time and mine on nothing.
