A major NIH study of health and fitness (with the ironically apt name of MRFIT), evaluating exercise, nutrition, blood-pressure control and cholesterol, consciously excluded women on the premise that men were the human norm. What is a “normal” cholesterol level? It was based on an all-male population–despite the reality that women’s cholesterol patterns are different. Only men were admitted to the study to see if the many health benefits of daily low-dose aspirin would lengthen life in healthy people. Stunningly, even a clinical trial of estrogen administered after heart attacks was conducted solely in men.
This bleak state of affairs did have a bright side. Emboldened by women’s growing outrage, we at NIH managed to launch the largest clinical study ever undertaken anywhere. Designed in 1991 and enrolling its first participant in October of 1993, the Women’s Health Initiative (WHI) spans a minimum of 14 years and has a budget of $625 million. The participants are a cross section of American women, drawn from scores of medical centers across the country. At first, critics objected that WHI was too ambitious and that women, notoriously less willing than men to join studies, simply would not participate. The very magnitude of the study, however, sent a signal to the best institutions in the country that women’s health was the place to be, with both money and academic acclaim in the offing. Researchers flocked to the field, and a virtual army of women–161,135 at last count–stepped forward to make the initiative work.
These women, drawn from all walks of life and from varied ethnic and racial backgrounds, are sharing their health experiences and donating blood samples to be stored for future use. Together they are already broadening our understanding of women’s well-being–and they will continue to expand our knowledge as scientists link their medical histories with our ever-growing insights into the genetic and environmental basis of disease.
The WHI tackles ways to prevent many of the devastating diseases affecting women–from depression and Alzheimer’s to heart disease, stroke, cancer and osteoporosis. It puts hormone-replacement therapy under the microscope, tests nutritional theories and chronicles the health effects of smoking, exercise and overall quality of life. And it has inspired a vast expansion of clinical research in virtually all fields of medicine, bringing tremendous payoffs already for the better care of women. Studies showing that women’s immune systems are more reactive than men’s, varying especially during pregnancy, have given us new insights into arthritis, systemic lupus erythematosus and multiple sclerosis. New research on sexually transmitted disease, and its devastating impact on female fertility and offspring, has shown that “safe sex” is not the same thing for a woman as it is for a man.
This is just the beginning. Menopause, out of the closet, is no longer the “dire time” for women. New information pouring out of clinics and research labs has told us about estrogen’s benefits to bone strength, heart health and brain function and possible protection from colon cancer and cataracts. One of the hottest fields of pharmaceutical research is developing new designer estrogens that bring women some of the benefits of estrogen while eliminating the risk of breast cancer that comes with long-term estrogen exposure. We’ve seen the development of a new formulation of estrogen-plus-testosterone for increasing libido, which sometimes wanes after menopause. And in contrast to years past–when the “natural” approach to menopause was silent suffering–we now see that “natural” includes soy-based foods filled with plant estrogens, and even progesterone from yams.
Scientists have identified new breast-cancer genes, developed the novel drug Herceptin to tame the most aggressive forms of breast cancer and shown that the hormone tamoxifen can help prevent the disease in high-risk women. More than a tenfold increase in NIH funds for this disease since the early ’90s made these and other discoveries possible.
Meanwhile we’ve come to understand that heart disease is the No. 1 killer of women. Estrogen, we now know, helps shield premenopausal women from heart disease by raising the level of HDL (the good cholesterol) and maintaining healthy blood vessels throughout the body. As a result, women’s heart attacks tend to occur 10 years later than men’s and come with more complications than men’s, and a greater risk of death.
Physicians used to think of osteoporosis–the condition that turns bones into eggshells, causing spines to curve and collapse–as an inevitable symptom of female aging. Now, thanks to better techniques for measuring bone calcium, we know that strength training can help keep the condition at bay. And in the past several years, new drugs have become available to protect and preserve bone.
Though the Women’s Health Initiative is still gathering data, it has helped focus both researchers’ and policymakers’ attention on women’s nutritional needs. Studies have now established that when women of reproductive age consume an extra 400 micrograms of folic acid each day, they reduce the risk of spina bifida and similar birth defects by half. And health officials now agree that women of all ages need far more calcium than anyone previously suspected.
The boom in women’s health research will ultimately affect our minds as well as our bodies, yielding new weapons against everything from dementia to depression. Women have long suffered disproportionately from Alzheimer’s disease–and though the reasons are partly demographic (the elderly population is predominantly female), new research suggests there are hormonal reasons as well. Small studies have found that supplemental estrogen can improve short-term memory in normal, postmenopausal women, and some experts suspect the hormone might also help elderly women ward off Alzheimer’s.
Depression is very much a woman’s disease. We’re more likely to experience it at any given age, and more likely to experience it as a crushing physical torpor. And unlike depressed men, who are more prone to alcohol abuse and suicide, we often suffer silently. Researchers are now linking these differences to subtle differences in men’s and women’s brains.
This flowering of knowledge is part of a larger shift in our society. I think of it as the third wave of the women’s movement. Early in this century women secured a political voice, winning the right to vote through the efforts of marching suffragists and liberated “Bloomers.” Fifty years later, in the second wave, bra-burning activists and feminist baby boomers won the right of personal advancement through newfound educational and economic opportunities. A revolution in women’s health was bound to follow. Like those who preceded them, the women of the ’90s have spoken out, prodded, pressed, participated, marched and raced to claim what is rightfully ours. The “revolutionaries”–people from every walk of life and every corner of the land–share a passion to make life better for their daughters and granddaughters as well as themselves. And they’re succeeding. In less than a decade, they have shattered the medical glass ceiling.
