Wonder Woman
More than 30 years as a leading women's health specialist haven't dimmed this M.D.'s wonder at the wisdom and purpose of a woman's body.
entered medical school 35 years ago, in 1971. It was the year Simon and Garfunkel's "Bridge Over Troubled Water" won the Grammy for the best song, Archie Bunker, the character America still loves to hate, made his debut in "All in the Family" on CBS—and women began to change the face and feel and even the factual underpinnings of medicine in this country. It was exhilarating.
Before 1971, nearly every med school in the nation had just seven or eight women in a class of 100. But soon after the year I first set foot in Yale's grand old Sterling Hall of Medicine, the numbers of women in med schools across the country more than doubled, to 20 in every 100 students. From there, the percentage quickly climbed to 30 percent, and in the past few years, it's reached almost 50. This flood of women physicians activated its own natural interest in women's bodies and women's health, formerly a field that had long been shaped not only by men but also by research solely on men.
For years, medical researchers were concerned that if they included women in their studies, they might inadvertently harm the fetuses of study participants who were pregnant. So women were largely excluded from clinical trials of any type. And physicians typically worked from the erroneous assumption that women and men were physiologically the same, beliving that gender didn't matter.
Men and women were thought to be the same on a cellular level—when, in actuality, every cell in the human body has a sex, an XX or an XY chromosome assigned to it. Men and women were assumed to share the same metabolism—when, in fact, they metabolize some drugs very differently. And men and women were treated as though they experience heart disease the same way—when, in actuality, heart attack symptoms and survival rates vary greatly between the sexes. But these are all relatively new discoveries.
New Thinking in a New Era
It wasn't until 1991 that Bernadine Healy, M.D., newly appointed as the first woman director of the National Institutes of Health (NIH), proved that sex does indeed matter by helping launch the Women's Health Initiative (WHI), a $625 million effort to study the causes, prevention and treatment of diseases that affect postmenopausal women. The WHI was the largest single research study ever funded by the NIH, and as its results rolled in, women were shown, at long last, to be unique. And also, as I've always thought, phenomenal.
Consider estrogen—the most maligned of all the hormones. We gripe about it, blame it for pesky PMS. But estrogen is an amazing substance that affects the body in many more ways than most people realize. Yes, estrogen governs the entire reproductive cycle, so women can have children; yes, it helps to build breast tissue and moisten the vagina. But estrogen receptors exist in nearly every organ in the body—in your heart, your bones, your brain and your blood vessels, too. Estrogen stimulates the liver to produce high-density lipoprotein (HDL), or good cholesterol, which protects against heart disease. It helps blood vessels to dilate, decreasing blood pressure.
Estrogen stops you from losing bone (by keeping the parathyroid hormone, which speeds the breakdown of bone, in check). And in the brain, estrogen acts as an antidepressant. In fact, I would argue that estrogen is the most remarkable substance in the body—any body. Male or female.
That's right: Men have estrogen, too. A man in midlife actually has much more estrogen than a postmenopausal woman—and he should be grateful that he does. Some scientists theorize that women develop Alzheimer's disease more frequently than men because the latter are more protected by estrogen later in life than women are. Again, sex matters—in many magical ways.
Libido naturally increases midcycle, around ovulation, to up the odds that a woman will get pregnant and perpetuate the species. When a woman is breast-feeding, she's less fertile, decreasing the risk that she'll conceive and be forced to shift her focus when her first child still desperately needs her undivided attention. Women go through menopause, I believe, because it's an evolutionary advantage to have younger, more vital mothers to bear and care for children. Finally, women worldwide generally have higher life expectancies than men—again, I believe, because it's of evolutionary interest to the species to have the nurturing sex around as long as possible.
My undergraduate degree is in biology, so I tend to look at medicine—and, specifically, my specialty, women's health care—through its lens. And what I see still gives me pause, because it's nothing short of amazing.
Dr. Mary Jane Minkin
Mary Jane Minkin, M.D., is a clinical professor of obstetrics and gynecology at Yale University School of Medicine in New Haven, Conn. She is the author of several books including A Woman's Guide to Sexual Health (Yale University Press, 2003) and A Woman's Guide to Menopause and Perimenopause (Yale University Press, 2005). She is also the woman's health medical advisor for Prevention magazine and medical advisor to the Red Hot Mamas, the nation's largest organization dedicated to educating women about menopause.
Did You Know?
* EGGS 'R' US. Even before a baby girl is born, she has almost a million egg cells in her ovaries—her full complement for life. By the time of puberty, only about 300,000 eggs remain. Of these, just 300 to 400 will be ovulated during her reproductive lifetime. The others degenerate at some point in their development, and at menopause, only a few remain.
* CYCLE OF LIFE. The term "hormone" comes from a Greek verb meaning to "urge on" or to "rouse." And that's what hormones do. For instance, they precipitate all the different actions that occur to create a woman's menstrual cycle. The average woman will have 400 cycles in her lifetime.
* RITES OF PASSAGE. The average age of natural menopause in America is 51. This is a statistic that has remained remarkably constant over the years, while the average age at which American girls first get their periods has dropped, probably due to better nutrition. (Menstruation doesn't usually begin until a girl weighs 95 to 100 pounds. Because children in financially comfortable families nowadays are likely to be optimally nourished, girls probably reach their adult weight sooner than their mothers did.)
More than 30 years as a leading women's health specialist haven't dimmed this M.D.'s wonder at the wisdom and purpose of a woman's body.
entered medical school 35 years ago, in 1971. It was the year Simon and Garfunkel's "Bridge Over Troubled Water" won the Grammy for the best song, Archie Bunker, the character America still loves to hate, made his debut in "All in the Family" on CBS—and women began to change the face and feel and even the factual underpinnings of medicine in this country. It was exhilarating.
Before 1971, nearly every med school in the nation had just seven or eight women in a class of 100. But soon after the year I first set foot in Yale's grand old Sterling Hall of Medicine, the numbers of women in med schools across the country more than doubled, to 20 in every 100 students. From there, the percentage quickly climbed to 30 percent, and in the past few years, it's reached almost 50. This flood of women physicians activated its own natural interest in women's bodies and women's health, formerly a field that had long been shaped not only by men but also by research solely on men.
For years, medical researchers were concerned that if they included women in their studies, they might inadvertently harm the fetuses of study participants who were pregnant. So women were largely excluded from clinical trials of any type. And physicians typically worked from the erroneous assumption that women and men were physiologically the same, beliving that gender didn't matter.
Men and women were thought to be the same on a cellular level—when, in actuality, every cell in the human body has a sex, an XX or an XY chromosome assigned to it. Men and women were assumed to share the same metabolism—when, in fact, they metabolize some drugs very differently. And men and women were treated as though they experience heart disease the same way—when, in actuality, heart attack symptoms and survival rates vary greatly between the sexes. But these are all relatively new discoveries.
New Thinking in a New Era
It wasn't until 1991 that Bernadine Healy, M.D., newly appointed as the first woman director of the National Institutes of Health (NIH), proved that sex does indeed matter by helping launch the Women's Health Initiative (WHI), a $625 million effort to study the causes, prevention and treatment of diseases that affect postmenopausal women. The WHI was the largest single research study ever funded by the NIH, and as its results rolled in, women were shown, at long last, to be unique. And also, as I've always thought, phenomenal.
Consider estrogen—the most maligned of all the hormones. We gripe about it, blame it for pesky PMS. But estrogen is an amazing substance that affects the body in many more ways than most people realize. Yes, estrogen governs the entire reproductive cycle, so women can have children; yes, it helps to build breast tissue and moisten the vagina. But estrogen receptors exist in nearly every organ in the body—in your heart, your bones, your brain and your blood vessels, too. Estrogen stimulates the liver to produce high-density lipoprotein (HDL), or good cholesterol, which protects against heart disease. It helps blood vessels to dilate, decreasing blood pressure.
Estrogen stops you from losing bone (by keeping the parathyroid hormone, which speeds the breakdown of bone, in check). And in the brain, estrogen acts as an antidepressant. In fact, I would argue that estrogen is the most remarkable substance in the body—any body. Male or female.
That's right: Men have estrogen, too. A man in midlife actually has much more estrogen than a postmenopausal woman—and he should be grateful that he does. Some scientists theorize that women develop Alzheimer's disease more frequently than men because the latter are more protected by estrogen later in life than women are. Again, sex matters—in many magical ways.
Libido naturally increases midcycle, around ovulation, to up the odds that a woman will get pregnant and perpetuate the species. When a woman is breast-feeding, she's less fertile, decreasing the risk that she'll conceive and be forced to shift her focus when her first child still desperately needs her undivided attention. Women go through menopause, I believe, because it's an evolutionary advantage to have younger, more vital mothers to bear and care for children. Finally, women worldwide generally have higher life expectancies than men—again, I believe, because it's of evolutionary interest to the species to have the nurturing sex around as long as possible.
My undergraduate degree is in biology, so I tend to look at medicine—and, specifically, my specialty, women's health care—through its lens. And what I see still gives me pause, because it's nothing short of amazing.
Dr. Mary Jane Minkin
Mary Jane Minkin, M.D., is a clinical professor of obstetrics and gynecology at Yale University School of Medicine in New Haven, Conn. She is the author of several books including A Woman's Guide to Sexual Health (Yale University Press, 2003) and A Woman's Guide to Menopause and Perimenopause (Yale University Press, 2005). She is also the woman's health medical advisor for Prevention magazine and medical advisor to the Red Hot Mamas, the nation's largest organization dedicated to educating women about menopause.
Did You Know?
* EGGS 'R' US. Even before a baby girl is born, she has almost a million egg cells in her ovaries—her full complement for life. By the time of puberty, only about 300,000 eggs remain. Of these, just 300 to 400 will be ovulated during her reproductive lifetime. The others degenerate at some point in their development, and at menopause, only a few remain.
* CYCLE OF LIFE. The term "hormone" comes from a Greek verb meaning to "urge on" or to "rouse." And that's what hormones do. For instance, they precipitate all the different actions that occur to create a woman's menstrual cycle. The average woman will have 400 cycles in her lifetime.
* RITES OF PASSAGE. The average age of natural menopause in America is 51. This is a statistic that has remained remarkably constant over the years, while the average age at which American girls first get their periods has dropped, probably due to better nutrition. (Menstruation doesn't usually begin until a girl weighs 95 to 100 pounds. Because children in financially comfortable families nowadays are likely to be optimally nourished, girls probably reach their adult weight sooner than their mothers did.)
source : www.merck.com
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