The Fundamentals of Women’s Health

Both women and men suffer from many of the same illnesses and diseases. However, some conditions affect women more than men, such as osteoporosis, strokes and Alzheimer’s disease. While hormonal factors and longer life expectancies can play a role, there are also unique traits within the female body that require specialized healthcare and medical treatment.

“Women tend to live longer than men, largely because younger men have higher rates of death from accidents and injuries,” says Rachel Franklin, M.D., an OU Health family medicine physician and Regents Professor at the OU College of Medicine in Oklahoma City. “As people age, they also become more susceptible to conditions like osteoporosis, strokes and Alzheimer’s disease. That said, women’s bodies are quite different from men’s bodies, and often in unexpected ways. It’s more than a matter of hormones. Women have higher fat-to-lean muscle ratios, less stomach acid and less activity of some body processes.”

Franklin says these differences cause a number of issues. For example, women have higher blood alcohol levels after drinking the same amount as men – independent of their body weight – and a woman’s blood alcohol levels stay higher longer. 

“The same is true for medicines that affect the brain: we are more easily affected by anxiety medicines, sleep aids and other substances that cross the boundary between our blood and brain,” she says. “Women have more side effects to medicines, including higher risks of dementia, breast, colon and esophageal cancers, and irregular heartbeats due to medications.”

In addition to these cancers, there are several female-specific cancers such as cervical, uterine and ovarian. The American Cancer Society estimates that in 2025 there will be approximately 69,000 new cases of uterine cancer, 21,000 new cases of ovarian cancer and 13,000 new cases of cervical cancer. 

“Cancer is a scary word, but we should always remember that the number one killer of women continues to be heart disease,” says Franklin. “Heart disease kills more women than the next five causes of death combined, including all forms of cancer. One in three women die from heart disease, and women are less likely than men to survive a year after their first heart attack.”

According to the U.S. Centers for Disease Control and Prevention, in 2021, heart disease was responsible for the deaths of more than 310,000 women – or about 1 in every 5 female deaths. Other leading causes of death for that year included cancer, COVID-19, stroke and Alzheimer’s disease. 

“Throughout medical history, most research has focused on male bodies, and only now are we beginning to understand women’s unique health needs,” says Allen. “For example, standard heart attack risk calculators still don’t account for the impact of pregnancy. Conditions like pre-eclampsia and gestational diabetes can double, or even quadruple, a woman’s risk of heart disease, yet they remain overlooked in many assessments.”

According to the Gates Foundation, while women make up half of the world’s population, only one percent of healthcare research spending goes toward female-specific conditions not related to cancer. In addition, women were historically excluded from participating in clinical research trials until the subject was revisited in the 1980s, resulting in the U.S. Congress passing a law in 1993 requiring the inclusion of women and minorities in clinical research. As more women are included in clinical trials and medical research, the hope is to achieve greater equity in positive health outcomes. 

According to the 2024 Health of Women and Children Report by the United Health Foundation, the rate of maternal mortality in the United States is the highest among high-income countries and Oklahoma recently ranked 47th in the nation for maternal and child health. 

“Oklahoma is not unique in the challenges we face in maternal health care,” says Candice Meyer, D. O., medical director of women’s services for Warren Clinic in Tulsa. “As women in the U.S. expand their childbearing years longer, the average age of first-time mothers has risen. This means we are also seeing more chronic and pre-existing health issues in pregnancy, such as high blood pressure, diabetes and obesity.”

However, she says while there’s been an increase in maternal death rates in recent years, there’s also been a shift in awareness. 

“There has been a large push for more research and education,” says Meyer. “This recognition has driven the development of new protocols and safety measures – specifically work in tighter control of hypertension and faster response times to postpartum hemorrhage. Hopefully, we see this impact with maternal measures improving in the upcoming months and years.”

Challenges within maternal healthcare include racial/ethnic disparities, complicated health conditions, financial constraints, a lack of access to maternal health care in rural areas and a lack of postpartum support.  

“Reducing racial disparities and strengthening health equity must be a top priority,” says Meyer. “For so long, this was not included in the curriculum or managed by individual institutions, but now we are seeing more training in these areas, even at the medical school and residency levels. At Saint Francis, we have implemented educational training for OB/GYN physicians and maternal nursing staff on implicit bias and health equity which has helped improve care. We were recently recognized as High Performing by U.S. News & World Report for excellent Black maternal patient outcomes.”

Meyer believes that improving Oklahoma’s maternal mortality rates starts with improving access to care. 

“This requires a multidisciplinary approach, incorporating both the primary physician and obstetrical team and increasing the availability of specialty services such as cardiology and maternal fetal medicine through outreach and virtual services,” she says. “The Saint Francis perinatal education team performs outreach teaching to rural and community sites regardless of health system affiliation so that no matter the patient’s location, they still receive the latest and highest standards of care. I see expanding virtual services and outreach programs such as these making huge improvements to access.”

She also notes that insurance and Medicaid providers have begun to expand coverage for postpartum care and doula services. 

“These types of changes should continue to bring awareness to the state of maternal care and help us continue to improve outcomes and provide high-level care to our Oklahoma mothers,” says Meyers. 

Each year, preventative healthcare helps reduce the risk of diseases and disabilities, and saves lives. For women, there are several health screenings recommended at various ages that support a proactive approach in maintaining one’s health. Estacia Cooper, APRN-CNP, MSN, WHNP-BC, with Ascension St. John Women’s Health in Owasso, shares that it’s encouraged for visits with a women’s healthcare provider to begin during the teen years. 

“These appointments are great opportunities for [teenagers] to learn about their health and healthy lifestyles, the menstrual cycle, healthy relationships and sexually transmitted infections,” says Cooper. “It’s also important to have a safe place to come and be able to ask questions regarding changes in the body with puberty and find out what is normal. These appointments do not require an exam, but if a concern or issue needs to be addressed, an exam may be recommended.”

For adult women, Cooper says yearly wellness exams are recommended. However, cervical cancer screening guidelines have changed to extend the time between Pap tests, also called a Pap smear. 

“Today, there is more known about how cervical cancer develops and that there are certain types of HPV (human papillomavirus) that lead to cancer,” she says, adding that Pap testing or cervical cancer screening should begin at the age of 21. “The new guidelines prefer a Pap test only every three years for women between the ages of 21 to 29. For women aged 30 to 65, there are three options for cervical cancer screenings. The first option is a Pap test and an HPV test, also called co-testing every five years. The second option is a Pap test only every three years or, finally, HPV testing only every three years. If women over the age of 65 do not have a history of abnormal cervical cells or a history of cervical cancer and have had adequate testing prior to the age of 65, they may stop having Pap tests.”

Regarding breast cancer screenings, Cooper says women with an average risk of breast cancer should begin screening at age 40. 

“Mammograms are safe and an important tool that can help identify breast cancer, even in women that do not have symptoms,” she says. “While the clinical breast exam and patient self-breast exams may miss cancer too small to feel, mammograms can detect breast cancer early. When cancer is found in the early stages it can be successfully treated. Women are encouraged to become familiar with their breasts, as sometimes there are signs that they may see and not always feel. If changes or concerns arise, they should notify their healthcare provider.”

Yearly exams with a primary care physician also serve as a critical touch point of healthcare. 

“For adult women, the wellness appointment serves to assess general wellbeing and health risks and may include screening for infectious diseases, family planning, counseling and immunizations,” says Cooper. “What you know about your family history can help your healthcare provider individualize your health screenings and preventative care. Your family history gives us clues to potential risk factors to disease.”

She says identifying your risks for certain health conditions, such as high blood pressure, high cholesterol, diabetes or even cancer, can help you take steps toward potentially reducing your chances for disease. In addition, knowing your family history and risk factors helps your healthcare provider tailor your health plan – which could include early monitoring or screenings as needed. 

“As women move to the menopause years, routine annual visits are still important,” she says. “Being able to discuss concerns or ask questions regarding your health as you age can help you continue to make healthy lifestyle choices, increasing the opportunity for optimal health in the later years. Colon cancer screening and bone density tests are other evaluations that can be offered and should be discussed with your healthcare provider regarding when to begin. Our bones change over time and go through processes of building and breaking down, and with age, this process of building bone slows, and break down occurs faster which weakens bones, increasing the risk of fractures. The bone density test screens for this weakening called osteoporosis.”

Despite one’s age, taking the time and energy to regularly evaluate one’s health and follow recommended screening guidelines can help foster a better quality of life and possibly avoid long-term healthcare costs.