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Update in Women's Health: Evidence Published in 2012

Megan McNamara, MD, MSc*; and Judith M.E. Walsh, MD, MPH*
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 11 April 2013.

* Drs. McNamara and Walsh contributed equally to this work.

From Case Western Reserve University, Cleveland, Ohio, and Women's Health Clinical Research Center, University of California, San Francisco, San Francisco, California.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0263.

Requests for Single Reprints: Megan McNamara, MD, MSc, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106; e-mail, mxm700@case.edu.

Current Author Addresses: Dr. McNamara: Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106.

Dr. Walsh: Women's Health Clinical Research Center, University of California, San Francisco, 1635 Divisadero Street, Suite 600, San Francisco, CA 94115.

Author Contributions: Conception and design: M. McNamara, J.M.E. Walsh.

Analysis and interpretation of the data: M. McNamara, J.M.E. Walsh.

Drafting of the article: M. McNamara, J.M.E. Walsh.

Critical revision of the article for important intellectual content: M. McNamara, J.M.E. Walsh.

Final approval of the article: M. McNamara, J.M.E. Walsh.

Ann Intern Med. 2013;159(3):203-209. doi:10.7326/0003-4819-159-1-201307020-00104
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This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of women's health. Topics include reproductive health, menopause, prevention and screening, and osteoporosis and bone health.

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Women’s Health: Moving Beyond Reproduction
Posted on September 4, 2013
Marjorie Jenkins, MD, FACP, Tedd L. Mitchell, MD, Steven L. Berk, MD
Texas Tech University Health Sciences Center
Conflict of Interest: None Declared

Upon reading the recent article by McNamara and Walsh, Update on Women’s Health: Evidence Published in 2012,1 we recognized the prevailing approach of this review in categorizing women’s health (WH) to the standard topics of breast health, bone health, and reproductive health and screening. By focusing on customary WH topics, the current ideology is reinforced, with the implication that human organ systems function similarly without regard to whether the patient is male or female. This view in some respects fails to include the emerging body of knowledge surrounding sex and gender differences in health and disease, as explicated in evidence-based guidelines.2,3 As such, approaching WH through the lens of gender‐specific medicine is defined as the science of how normal human biology differs between men and women and how the manifestations, mechanisms and treatment of disease vary as a function of gender. 2 We recognize the value and important breakthroughs that have been made by women’s health researchers in the fields of osteoporosis, breast and gynecologic malignancies. However, a broader approach through sex and gender medicine will further improve WH outcomes by defining differences between men and women in all biologic systems, thereby better addressing diagnosis and treatment of a wider range of disease processes.
The emergence of the WH movement in the 1970s and funding of DHHS Centers of Excellence in Women’s Health, the establishment of the National Institutes of Health Office of Research on Women’s Health, and the publication of the Institute of Medicine’s Exploring the Biological Contributions to Human Health: Does Sex Matter? 4 expanded the body of knowledge of WH beyond specific body parts. This approach has already yielded breakthroughs, e.g., aspirin prophylaxis for heart disease. 4 The healthcare industry took note that women are the majority healthcare consumers and WH Centers cropped up across the nation. Perhaps thinking the pendulum had swung too far towards WH, clinical programs and scientific journals focusing on Men’s Health (MH) began to emerge, further entrenching the disparities and constraining men and women’s health into narrow, mutually exclusive definitions. In order to tear down this silo-based approach, an integrated gender-specific medicine approach in medical education 5, research, and clinical care would benefit one and all.


1. McNamara M., Walsh J.; Update in Women's Health: Evidence Published in 2012. Annals of Internal Medicine. 2013 Aug;159(3):203-209.
2. Legato M. Principles of Gender-Specific Medicine. 2nd ed. Elsevier, 2011. Print.
3. Mosca L, Benjamin EJ, Berra K, Bezanson JL, et al. Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women-2011 Update. Circulation. 2011;123:1243-1262
4. Wizemann TM, Pardue M-L. Exploring the Biological Contributions to Human Health: Does Sex Matter?. Washington, DC: National Academy Press. 2001.
5. TTUHSC Sex and Gender-Based Medicine http://www.ttuhsc.edu/som/curriculum/sgbm_curriculum.aspx

Author's Response
Posted on September 18, 2013
Megan C. McNamara, MD, MS, Judith M.E. Walsh, MD, MPH
Case Western Reserve University
Conflict of Interest: None Declared
We appreciate the comments that Dr. Jenkins and colleagues provided regarding our manuscript. As practicing women’s health physicians and internists, we agree that a broad approach to gender-based differences in disease is essential for providing comprehensive primary care. In performing our review, we searched multiple journal articles to identify studies which were relevant to women’s health primary care and had the potential to be practice-changing. Notably, we did not approach the review process with pre-defined categories in mind. Rather, we let the selected articles themselves define the groupings which we used to outline the article. We have performed several updates in women’s health in prior years (1,2) using this approach, and had previously identified practice-changing articles which focused on migraines and cardiovascular disease, as well as breast arterial calcification and coronary heart disease (3,4). For our current update, we did not identify any articles which met the above criteria in the areas of cardiovascular disease, diabetes, or cancer. In our opinion, primary care for women should never be broken down into the silos of “breast and gynecologic care” and “everything else.” Women’s health providers should seek to understand the complex interactions between gender and health, both in regards to chronic disease as well as gender-specific diseases, and use a comprehensive and holistic approach in clinical, educational, and research activities.
Megan C. McNamara, M.D., M.S.
Judith M.E. Walsh, M.D., M.P.H.
1. Schwarz EB, McNamara M, Miller RG, Walsh JME. Update in Women’s Health for the General Internist. J Gen Intern Med 2011; 26(2): 207-13.
2. Walsh JME, McNamara M, Miller RG, Schwarz EB. Update in Women’s Health for the General Internist. J Gen Intern Med 2012; 27(2): 232-7.
3. Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009; 339:b3914.
4. Schnatz P, Marakovitz K, O'Sullivan D. The association of breast arterial calcification and coronary heart disease. Obstet Gynecol 2011;117(2):233–41

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