She died of a heart attack in the parking lot outside the emergency room—after the ER physician sent her away with a prescription for tranquilizers and a referral for gastrointestinal tests. The doctor had seen that she was sweaty and short of breath, and she had told him she felt tired, weak, achy and nauseous, so he considered it an obvious case of nerves. None of her complaints had sounded like classic heart attack symptoms—a feeling of crushing pressure on the chest and/or pain radiating down the left arm.

Fact: Fatigue, nausea, upper-body aches, perspiring and shortness of breath are indeed symptoms of a heart attack-in about 20% of women who have heart attacks.

The "classic" signs are typical primarily among men. I hear about case after case like the one above. The medical community still struggles, if not with actual gender bias, at least with persistent ignorance about women's unique health concerns.

Here are specific diseases that doctors most often overlook in women...the warning signs to watch for.. and the steps you can take to protect yourself.

Heart Disease

Heart disease is the number one killer of women in the US. The incidence of the disease is on the rise even among women in their 20s and 30s, though this increase may be due to our improved diagnostic abilities. Still, test results are too often misinterpreted.

New finding: A common test for heart disease is coronary angiography, in which a doctor injects dye into the arteries and then takes an angiogram (X-ray) that reveals blockages of fatty plaque inside blood vessels.

A recent study shows that for many women, this test is not accurate-because instead of forming large blockages (as plaque does in men), in women the plaque is spread more evenly throughout the artery walls.

Consequence: As many as 3 million American women who are at high risk for heart attack may be incorrectly told that they're at low risk—so they go untreated.

Self-defense: Other warning signs of heart attack include insomnia, irregular heartbeat, jaw pain, or pain in the upper abdomen or back during physical activity or intense emotion.

If you experience any such symptoms-especially if you smoke, have diabetes or have a family history of heart attack before age 55—it is vital to be tested for heart disease.

Initial tests may include an electrocardiogram (a recording of the heart's electrical activity)... echocardiogram (ultrasound of the heart)...exercise (treadmill stress test...and/or noninvasive nuclear scan (in which an injection of radioactive liquid produces three-dimensional images of the heart).

Important: Memorize the warning signs of heart attack in women mentioned above. If you experience several of the severe symptoms, call 911 immediately. If you suffer from a less worrisome symptom like insomnia, contact your doctor instead.

Ovarian Cancer

Ovarian cancer strikes about 22,000 women in the US yearly, most of them over age 50. It is the second most common gynecologic cancer—and the deadliest.

If the cancer is caught before it spreads beyond the ovary, a woman has a 90% chance of living at least five years. Unfortunately, only 20% of ovarian cancers are discovered at this early stage because the disease exhibits only vague symptoms.

Recent study: Up to a year before being diagnosed, women with ovarian cancer were more likely than cancer-free women to experience abdominal pain and swelling, pelvic pain, gas, constipation or diarrhea and/or frequent urination.

Self-defense: If any of the above symptoms persist for more than a month, see a gastroenterologist. If no digestive problem is found, ask your gynecologist about ovarian cancer screening tests-ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) and a blood test for CA-125, a protein produced by ovarian cancer cells.


One of the most commonly missed autoimmune diseases is Hasbimoto's thyroiditis. This disease impairs the thyroid gland's ability to produce proper amounts of the thyroid hormones T3 and 14, which affect the body's metabolic rate (speed at which calories are burned) and other biological processes.

Symptoms of Hashimoto's thyroiditis vary according to the progression of the disease. They may include fast heart rate, anxiety, swollen neck, brittle nails, thinning hair, heavy or frequent periods, muscle cramps or weakness, weight gain, constipation, chills, fatigue and/or depression.

Some people experience no symptoms at all. Untreated, Hashimoto's can lead to high cholesterol, heart disease, birth defects and other problems.

Self-defense: If you have several of the symptoms above, ask your doctor about blood tests that measure levels of hormones and antibodies associated with the disease. Low levels of T3 and T4 and/or high levels of thyroid stimulating hormone (which the pituitary gland produces more of when the thyroid gland is underactive) indicate Hashimoto's.

Treatment: Thyroid hormone therapy—generally, for life.

Sleep Apnea

Many doctors describe a typical sleep apnea patient as a fat man who snores and gasps in his sleep." Yet this sleep disorder-in which a sleeping person repeatedly stops breathing because the tongue blocks the airway or the brain fails to signal muscles that control respiration-is just as common in postmenopausal women not on hormone replacement therapy as it is in men.

Symptoms include morning headaches, weight gain, lethargy and memory loss. Without treatment, sleep apnea can contribute to high blood pressure, heart disease and accidents brought on by sleep deprivation.

Self-defense: Before bed, set a tape recorder to "voice activation." If the playback is a cacophony of snorts and gasps, ask your doctor for a referral to a sleep disorder center. Sleep apnea may be relieved by weight oral appliance that positions the jaw and tongue...or a continuous positive airway pressure (CPAP) machine, which gently blows air through a face mask to keep your airway open.

Get the Care You Deserve

To make sure your doctor takes your health concerns to heart…

  • Be assertive. Arrive at appointments with a written list of questions, and don't leave until you've gotten clear, complete answers.
  • Keep track of all medical tests performed, and phone the doctor if you are not notified about results within the expected time frame.
  • Go elsewhere for your health care if your physician rushes through exams or brushes off your questions.

Women Less Likely to Control Cholesterol

In an analysis of 194 health care plans, researchers found that women were significantly less likely than men to maintain their LDL "bad" cholesterol at the recommended levels (below 100 mg/dL for healthy women and below 70 mg/dL for women with heart disease or risk factors).

Theory: Women and their health care providers underestimate risk for high cholesterol in women. If you are a woman, ask your doctor to check your cholesterol. If it's high, ask how you can lower LDL levels through diet, exercise and/or medication.

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