Women's health: challenges and opportunities

Despite significant advances that have been made in women’s health care over the past few decades, important challenges remain. In the United States, heart disease is still the leading cause of death for women, followed closely by cancer. Among women of reproductive age, over 10% are affected by the painful inflammatory disease of endometriosis, while miscarriage and stillbirth are also common occurrences, ending more than 1 million confirmed pregnancies in the United States each year.

For insights into women’s health—the focus of this issue’s special report—Yale Medicine Magazine spoke with Nancy J. Brown, MD, the Jean and David W. Wallace Dean of Yale School of Medicine and C.N.H. Long Professor of Internal Medicine, about the challenges and opportunities before us.

Where do you see the greatest opportunities for future advancements in women’s health in the United States? There are many. We have opportunities in our understanding of the basic biology of sex differences. We’ve moved on from thinking that women are simply men with higher levels of estradiol, or men without testosterone. And that is helping us understand different presentations of disease in men and women.

What are the most pressing challenges that remain in women’s health? Access is a pressing challenge—making sure that those of [a] lower socioeconomic class who are underserved can both be diagnosed earlier and receive treatment. We have terrific therapies today for breast cancer, for example. Yet women of color are likely to be diagnosed at later stages, have less access to care, and have poorer outcomes. That’s true across many diseases.

We have opportunities and challenges in understanding aging in women. So many diseases of aging disproportionately affect women because we live longer. That includes neurodegenerative diseases, and diseases of the bone and joints that can lead to significant impact on quality of life. There’s also a need for greater understanding of the differences in presentation of common diseases in women, such as heart disease and stroke.

How is Yale School of Medicine improving women’s health? Yale School of Medicine is doing a lot in the arena of women’s health. We are engaged in the search for a new director of our Women’s Health Research at Yale, which is a 25-year-old center aimed at providing resources for investigators who are looking at the biological basis of sex differences in diseases.

We have one of the strongest departments of obstetrics and gynecology, ranked fourth in the country. That has an impact on health related to women’s reproduction. Our cancer center is committed to making the diagnosis and treatment of cancer that is common in women, such as breast cancer, more accessible across our community. Our cardiologists are defining how women present differently with heart disease and how mechanisms of heart disease may differ in men and women.