Breakthroughs in Women's Health

For too many years, medical researchers neglected women’s health. The problem grew partly from practical considerations: Researchers were scared to test new drugs on women who might get pregnant midtrial. But it also came from false assumptions and ignorance: Until recently, most doctors didn’t realize that men and women experience many diseases differently. Women are more prone to osteoporosis, immune disorders, eating disorders, breast cancer, and depression. In women, the tiny arteries are more likely to clog; in men, the big arteries clog more often. Women report more incidents of pain, and their bodies are less able to tolerate alcohol.

“When we think of women’s health, we often think about childbirth,” says Dr. Teresa Woodruff, an obstetrician-gynecologist who is the founder and director of the Institute for Women’s Health Research at Northwestern University’s Feinberg School of Medicine. “That’s not negative. Birthing is a major part of women’s lives, and it is a major health risk, even in 2010.”

But without giving maternal health short shrift, she says, it’s critical to appreciate how the biology of sex differences exists outside of reproduction. Nearly two years ago, Woodruff started the Illinois Women’s Health Registry, designed for women to self-report medical data. Using the registry, investigators can recruit women who are good matches for clinical studies. So far 5,000 women have signed up.

The Institute for Women’s Health Research is just one of the projects and studies under way in Chicago to help bring new treatments and preventive care to women.

In the links below, based on interviews with dozens of doctors, researchers, patients, and others involved in women’s health care, we examine some of the most common ailments afflicting women and discuss some of the initiatives taking place here.

“Chicago is really the epicenter of the new wave of women’s health research,” says Woodruff.

Photograph: Caroline Mollov/Moodboard/Corbis

HEART DISEASE

Dr. Annabelle Volgman Heart disease is the number one cause of death in women. Typically the problem arises from blockages that impede blood flow in the arteries, sometimes leading to a heart attack. Men and women share the same risk factors for heart disease: age, family history, high blood pressure, high cholesterol, diabetes, smoking, physical inactivity, obesity. But women’s arteries are smaller than men’s, and younger women tend to get dangerous blockages in their tiny arteries. “I equate that to a tree,” says Dr. Vera Rigolin, a cardiologist at Northwestern University’s Feinberg School of Medicine. Younger women more often get their arterial clogs out in the little twigs. Unfortunately, “most tests are designed to look for blockages in the big arteries, like the trunks [where the problem tends to occur in men]. We’re not very good at looking at the teeny tiny blood vessels,” says Rigolin. “If you don’t diagnose the problem, you don’t treat it.”

Symptoms can differ between men and women, too. Typically when people experience angina (chest pain that occurs when part of the heart is deprived of oxygen), they feel pressure that radiates to the left arm or to the neck. Women are much more likely than men to feel atypical symptoms, such as fatigue and shortness of breath. Because of these vague signs, sometimes women and their doctors don’t recognize the trouble. “I always tell patients the most important thing is: Does something feel different to you?” says Dr. Rupa Mehta, the medical director for the cardiac rehabilitation program at the University of Chicago Medical Center.

As women age, their coronary problems come to more closely resemble those of men. That’s partly because after menopause (12 consecutive months without a menstrual period, which a typical American experiences at age 52), women lose estrogen and their blood vessels become less elastic and don’t accommodate the surge of blood as well. “Estrogen does nice things for vasculature, makes it more supple,” says Dr. Elizabeth McNally, the director of the University of Chicago’s Institute for Cardiovascular Research. Also, cholesterol—particularly “bad” LDL cholesterol—rises in older women. Weight gain and physical inactivity can play a significant role, too, says Rigolin.

As a general rule, women fare worse when it comes to surgery to treat blockages in arteries. One reason is that they tend to be older when they get the operation; another is that their arteries—always smaller than men’s—are trickier to work with.

Some of the new findings are particularly, well, disheartening. In the past decade, the number of men with diabetes who die of heart disease has started to decline. But the number of women has not. “We usually say if somebody has diabetes that they basically have heart disease. The risk of a heart attack is the same,” says Dr. Annabelle Volgman, the medical director of the Rush Heart Center for Women. She talks to her female patients about losing weight—and about being careful to take calcium (which women often use for bone health) only with vitamin D. “If you take calcium without vitamin D, you have a 30 percent more increased risk of heart attack,” she says. One theory holds that calcium, like plaque, may build up in the arteries, and vitamin D apparently reduces the risk.

Today doctors are still trying to figure out how best to help women. For the past 15 years, Dr. Mary McGrae McDermott and her colleagues at the Feinberg School have followed men and women with peripheral arterial disease (PAD)—a condition in which cholesterol-caused plaque blocks arteries in the lower extremities. PAD patients also tend to have blockages in heart and cerebral arteries. Because of the blocked leg arteries, victims experience trouble walking even before they’ve had a heart attack. The doctors’ new data show that the mobility of female PAD patients declines faster than that of male PAD patients. This means it’s important for women to exercise and do strength training, says McDermott. “Women live longer than men, and, probably for this reason, they live longer with chronic diseases than men.”

The best preventive advice: “Stay as slim as possible,” says Volgman.

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FERTILITY

Dr. Humberto ScocciaA diagnosis of cancer in a woman used to mean she often couldn’t have kids. “Women would go through treatment without any fertility advice or options,” says Northwestern’s Woodruff. But today oncofertility is an active area of research in Chicago. The National Institutes of Health (NIH) has funded a large oncofertility consortium, led by Northwestern University, with the goal of using an interdisciplinary team to try to solve complex problems related to fertility and cancer treatments. (For more information, see myonco fertility.org.) Today most women with cancer can go through in-vitro fertilization (IVF) to create an embryo—a fertilized egg—to freeze. (The national percentage of cases of frozen embryos resulting in live births is 35.6 percent for women under 35 and 29.5 percent for women 35 to 37, according to the Society for Assisted Reproductive Technologies, the trade group for fertility doctors.)

The advances in IVF techniques have led to some curious situations. Two years ago, when she was 39, Noelle Freeland, a mortgage broker, learned she had a rapidly growing cancer in her left ovary. In just four weeks, the cancer increased from half a centimeter to 13 centimeters, wrapping around the back of her uterus and attaching itself to her pelvis. She wanted to preserve her ability to give birth, but her cancer was estrogen-positive, which meant fertility drugs could accelerate the disease. Her doctor at Northwestern told Freeland that he would allow her to do only one cycle of IVF.

At the time, only 3 percent of frozen eggs that were later fertilized resulted in live births, and the success rate with frozen embryos for women of Freeland’s age was 26 percent—statistics that affected her decision. She took the fertility drug, underwent one IVF cycle, and was able to freeze four embryos fertilized using sperm donated by a friend’s husband. “I had 48 hours to decide who I wanted to be the father of my children,” she says.

For about 20 percent of patients (those who are too young or whose cancer is too advanced), the IVF option is not available. Northwestern researchers—led by Woodruff—are trying another approach. Girls are born with ovaries that contain about a million follicles, each with a single egg inside. By age 20, half a million are left, sitting in a dormant state; by menopause, they are all gone. Normally, one egg matures inside the ovary each month. But chemotherapy and radiation can damage eggs and lead to infertility. To preserve the option of pregnancy, the Northwestern team is trying to remove healthy ovaries before treatment starts, isolate immature follicles, and mature the enclosed eggs. The hope is to have this technology available for patients after their recovery from cancer treatment.

Noelle Freeland donated her good ovary to Woodruff’s group to work on growing more follicles. “It’s not going to work for me, but it’s going to work for other people,” Freeland says. “I didn’t need that organ.”

Many cancer-free women who can’t easily get pregnant worry that infertility treatments could increase their risk of ovarian cancer. (The actress Gilda Radner speculated that fertility drugs may have caused her to get the disease.) But Humberto Scoccia, the director of reproductive endocrinology and infertility at the University of Illinois Medical Center, says there’s no evidence of a link. “We have not seen any increased risk in breast, ovarian, or uterine cancer,” he says. To find out more definitely, the NIH has just started a 30-year follow-up of 12,000 women who went through infertility treatment.

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PREGNANCY

Dr. Patricia Garcia Despite being seven months pregnant with her second child, Rebecca Horrighs, 38, has put on only five pounds. On purpose. That’s because the 240-pound mom is enrolled in Northwestern University’s Healthy for You, Healthy for 2 program, for women who are overweight already or who gained too much during previous pregnancies. Horrighs falls into both categories. With her first child, now three, she packed on 40 pounds, even though she had recently undergone gastric bypass surgery. This time around, she walks 10,000 steps a day and cuts her meal in half if she dines out. (She immediately puts the rest in a to-go box.) “You want to see them grow up,” she says. “It’s good for the baby, too.”

Healthy for You, Healthy for 2 is designed to help the 45 percent of women who enter pregnancy overweight. Those extra pounds can lead to diabetes, high blood pressure, heart disease, and some cancers. And excessive gain during pregnancy appears to increase a baby’s risk of being overweight later. One theory is that fetuses exposed to higher levels of weight-related nutrients (such as glucose) produce more insulin, which promotes weight gain later in life. The new thinking is that doctors need to move more aggressively to prevent pregnant women from eating for two. “Previous studies have shown that minimal intervention is minimally effective,” says Dr. Lisa Neff, the endocrinologist who heads Healthy for You, Healthy for 2. Participants meet with experts in nutrition, exercise, and weight management.

Local doctors are also trying to figure out why more than 10 percent of American women deliver their babies three or more weeks early. This past fall, Northwestern started enrolling 1,200 first-time mothers-to-be in the 18-month, eight-center NuMom2B study, funded by the NIH and designed to predict which moms will deliver early. (To enroll, call 312-926-5952.) Rather than look only at traditional risk factors, such as smoking or weight, researchers are tracking sleep, diet, exercise, and proteins in the blood.

“It has the potential to completely revolutionize what we understand about pregnancy,” says Dr. William Grobman, a study investigator and an ob-gyn at Northwestern’s Feinberg School. “It’s unbelievably exciting what it could do for women’s health and obstetrics care.” The results of the study should personalize medicine, save money, and promote good health: Premature delivery causes half of all cerebral palsy cases and a third of all visual impairments, and it increases the long-term risk of death from heart disease. Researchers should know the results in a fast (for science) three to five years.

Grobman is also enrolling pregnant women in an NIH study that is using 3-D technology to follow fetal growth. With better measurements, doctors will know if an infant stops growing robustly and needs heightened surveillance or an early delivery. (To enroll, call 312-926-8624.) At Feinberg, Dr. Francesca Facco, an ob-gyn, has published research showing that pregnant women who slept fewer than seven hours a night or who reported frequent snoring were more likely to develop gestational diabetes. Now she is looking at whether abnormal sleep affects fetal growth and premature birth.

Access to rapid HIV testing at local hospitals has dramatically reduced the number of newborns infected by the virus. If women with HIV aren’t treated, about one in four will transmit the disease to their infants. Prentice Women’s Hospital at Northwestern hasn’t had a case of HIV transmission from mom to baby since 1996, and rates are also low across the state. The reason: As part of the PRTII (Perinatal Rapid Testing Implementation in Illinois) initiative, doctors at Prentice have helped train every labor-and-delivery unit in the state to do rapid HIV testing when patients in labor don’t know their status. “The notion here is that it’s never too late to intervene,” says Dr. Patricia Garcia, the ob-gyn who codirects the women’s HIV clinic at Northwestern Memorial Hospital.

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BREAST AND OVARIAN CANCER

Dr. Melody Cobleigh Six years ago, when she was 24, Elizabeth Esposito learned she had breast cancer when a lump that she had felt but ignored became so enlarged that it broke through her skin. “I didn’t do anything about it for a long time because I didn’t think anything was wrong with me,” she says. “I didn’t feel sick.” Since then, she has had chemotherapy and radiation for breast and ovarian cancer and now takes several drugs (Tykerb, Herceptin, and Zometa). “You name it, I’ve had it,” she says. And, obviously, she is still alive, even though a physician in 2004 warned her that she had only two years to live.

Like one in five women with breast cancer, Esposito has the form of the disease that comes from a nonhereditary gene mutation. The mutation leads to the overproduction of a protein called human epidermal growth factor receptor 2 (HER2), which in turn promotes the growth of malignant cells.

Despite all the pink ribbon campaigns, breast cancer continues to be the second leading cause of cancer deaths in women (after lung cancer). When younger women, such as Esposito, get the disease, they tend to get more aggressive forms. “Breast cancer is not just one disease any more,” says Dr. Melody Cobleigh, an oncologist who is the medical director of the breast cancer clinic at Rush University Medical Center. And breast cancer does not have only one treatment. Cobleigh is studying a drug called T-DM1, an antibody made by Genentech/ Roche, that may help with HER2-positive breast cancer. (The Food and Drug Administration (FDA) recently turned down early approval of the drug for this use.)

About 50 to 80 percent of women born with the hereditary BRCA1 and BRCA2 gene mutations get breast cancer. Their bodies “can’t repair DNA damage very well,” says Cobleigh. They can take steps such as getting mammography or magnetic resonance imaging (MRI) screenings; they can even get prophylactic mastectomies, like the actress Christina Applegate. Some BRCA-positive women also choose to get ovariectomies—removal of the ovaries. Without ovaries, estrogen levels drop—along with the risk of both breast and ovarian cancer, says Dr. Virginia Kaklamani, an oncologist and codirector of the cancer genetics program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Short of resorting to such drastic measures, all women can reduce the risk of getting breast cancer by drinking less alcohol and losing weight. “Patients want to know what they can do,” says Cobleigh. “It used to be you could say, ‘There really isn’t anything.’ Now you can say, ‘If you control your weight after a diagnosis of breast cancer, you’ll be less likely to die.’”

Weight control is important for young and otherwise healthy girls, too. Obesity makes menstruation occur earlier and last longer. “It’s called the estrogen window,” says Cobleigh. “And the wider that window is, the higher the risk of breast cancer.” That’s why the obesity epidemic among young girls worries cancer researchers. At Northwestern’s Feinberg School, Kaklamani is working with a team trying to identify new genes associated with obesity-related breast cancer.

Though in general white women are more likely to get breast cancer in their lifetimes, Chicago researchers are trying to figure out why women of color (both African Americans and Latinas) appear to be at greater risk of getting the more lethal early-onset form of the disease. One theory: Many live in challenging environments, and the accompanying stress can interfere with their immune systems. In fact, University of Chicago researchers have found that women who have been sexually abused or who feel lonely and depressed are more likely to get breast cancer at a younger age. At UIC’s Center for Population Health and Health Disparities, researchers are studying how to make community health centers better able to identify and treat young women at risk of the disease. “[The young women] don’t expect to get it,” says Richard Warnecke, the UIC professor who codirects the center. “They don’t necessarily establish relationships [with doctors or hospitals].” To better treat women after diagnosis, community health centers also need to be able to work more in tandem with big research hospitals, he says.

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CERVICAL AND ENDOMETRIAL CANCER

Each year, about 12,000 American women get cervical cancer—a small-sounding number that nevertheless frustrates doctors. After all, most women can avoid getting the disease—caused by the sexually transmitted humanpapilloma virus (HPV)—if they practice safe sex and get the HPV vaccine. Yet nationwide, only about 25 percent of 9- to 26-year-olds—the recommended age group—even start getting the three doses of the vaccine.

Doctors can catch most cervical abnormalities before they progress to cancer if their patients get regular Pap smears. Enter Dr. Yvonne Collins, a gynecologic oncologist at Advocate Christ Medical Center in Oak Lawn. “I don’t think we stress enough early detection and prevention,” says Collins, who researches prevention and treatment of gynecologic cancers. In 2010, she and the actress Mandy Moore did a media tour sponsored by the Gynecologic Cancer Foundation to raise awareness of cervical cancer.

Collins would like to get funding for free HPV vaccines since the full course of immunization now costs more than $360 for adult women. Advocate is still signing up patients for several studies that look at cervical, endometrial, and ovarian cancers. Among other things, Collins and her colleagues are looking at genetic markers to help them figure out which endometrial cancer patients fare better with different treatments, as well as determining which drugs are most effective and least toxic. In the meantime, to get out the word about the HPV vaccine and Pap smears, Collins continues to show up at beauty shops, churches, and schools—“wherever anybody will listen,” she says.

OSTEOPOROSIS

Seven years ago, when she was 60, Susan Schaalman Youdovin was jogging in Germany and “tripped over a piece of air,” as she puts it. She broke her left arm—but didn’t even realize what had happened until she visited her doctor several months later. “This [osteoporosis] is a completely asymptomatic disease,” explains Youdovin’s doctor, Beatrice Edwards, a geriatrician who directs the bone health and osteoporosis program at Northwestern’s Feinberg School. Youdovin went on the treatment drugs Actonel and Forteo, and she is now taking Reclast. Today, at 67 years old, 95 pounds, and four feet 11 inches (three inches shorter than when she was younger), Youdovin wears a brace to stay erect. But she feels lucky that modern medicine is paying attention to her ailment.

Bone loss is a major female health issue. Three-quarters of all fractures occur in women, and more than 40 percent of women will suffer at least one fracture at some point in their lives. From age 30 on, both genders lose about 1 percent of bone mass per year, but the rate speeds up for women when they go through menopause. At that point, “the breakdown of bone far exceeds what the bone replacement process can keep up with,” says Murray Favus, the director of the bone program at the U. of C. Medical Center. In all, women typically lose 15 to 20 percent of their bone mass in the decade following menopause—and the loss might even be greater if left untreated.

The consequences can be serious. About a quarter of all postmenopausal women suffer fractures in their vertebrae (though only a third receive medical attention). Hip fractures also pose a big, expensive problem. But breaks in tiny bones can be equally disabling. In a study published this year in the British Medical Journal, Edwards reported that even a simple wrist fracture contributes to functional decline in older women, who run into trouble cooking and cleaning. “Even such a small fracture has an impact on the ability to stay in the community,” says Edwards.

Though medications are available, one problem with osteoporosis is that it often goes undiagnosed. “Bone loss is as common as hypertension,” says Edwards. “But unlike hypertension, it’s only identified in 15 percent of cases.”

Bone density is the standard clinical measure for assessing bone strength, but it only predicts 70 percent of fracture risk. (Women whose mothers had osteoporosis or who have a history of anorexia nervosa, and, as a result, formed less bone mass as teens, are considered particularly susceptible.) At the U. of C. Medical Center, Dr. Tamara Vokes, an endocrinologist, is studying another measure—called radiographic texture analysis—that looks at the pattern of bones. Coarse bone patterns—that is, bones exhibiting a more textured surface—seem to be more durable. “You could think of it as having a scaffolding that’s strong,” says Vokes. She wants to find out if coarseness is dominant and if it varies between genders and among races. “The goal would be to define people who have the greatest fragility and treat them more aggressively,” she says.

HEADACHES, MULTIPLE SCLEROSIS, AND OTHER NEUROLOGIC DISORDERS

No one should tell women who complain about headaches or trouble moving that it’s all in their head. It turns out that women are more susceptible than men to some neurological conditions, including multiple sclerosis (MS) and migraines. In fact, they are twice as likely to suffer from MS (a degenerative disease of the nervous system that impairs vision, strength, and coordination) and three times as likely to suffer from migraines (which cause headaches, nausea, vomiting, and sensitivity to light and sound).

The probable source of the trouble: hormones. Interestingly, though pregnancy can exacerbate many health problems, it actually decreases relapse of MS symptoms, says Dr. Susan Rubin, a neurologist at the NorthShore Neurological Institute, part of the NorthShore University HealthSystem. Pregnancy, she explains, is a quieter time when hormones are steady, not fluctuating. To try to mimic this state, which is without the hormonal ups and downs that women normally experience during and after ovulation each month, Rubin and her colleagues are giving extra estriol (the type of estrogen that rises in pregnancy) to patients in their ongoing two-year study on the hormone’s effect. (For more information, visit northshore.org.)

To fight headaches, Rubin often gives women continuous contraceptives that prevent menstruation and keep hormone levels even throughout the month.

NorthShore doctors are not specifically studying women with epilepsy, another neurologic disease, but they are treating them. Though epilepsy hits both genders equally, it’s a bigger deal for women of childbearing years since medications that treat it can hurt fetal development.

DEPRESSION

Depression is twice as common in women as in men, and the impact of the untreated disease reverberates—it’s linked to an increased risk of cardiovascular disease and perhaps even cancer. “Depression doesn’t just affect the brain,” says Dr. John Zajecka, a psychiatrist and the director of the Woman’s Board Depression Treatment & Research Center at Rush.

Researchers aren’t certain why women are more likely to be depressed than men, but the disparity seems to reflect hormone differences and social pressures, says clinical psychologist Jackie Gollan, the director of the translational stress and affective disorders laboratory at Northwestern’s Feinberg School. Around puberty, “girls begin to overthink [and] pull negative information from the environment,” especially about body image, she says. She and her team are collecting information on the differences between women’s and men’s brains—and on the risk of depression over a woman’s reproductive lifespan. Times of change—such as puberty and menopause—are associated with increased rates of depression. But even elderly women, removed from those periods of hormonal change, may experience more depression because of loneliness and loss of social support.

Gollan’s team is enrolling women for several studies designed to solve the mystery of female depression. One will use MRI to measure the differences in emotion and attention between healthy and depressed women. The group expects to discover reduced activation in the front part of the brain, which is involved in planning, thinking, expressing personality, and making decisions; and in the amygdala, the “emotion center” deep in the brain. Another study will focus on women’s mental health during and after pregnancy to create a predictive index for postpartum depression. “Untreated maternal depression is very serious,” says Gollan.

In addition, she and her team have written a screening protocol for all outpatient clinics affiliated with Northwestern’s Prentice Women’s Hospital. Pregnant women will be asked about their moods twice while they are pregnant and once after delivery. “It represents good clinical care because perinatal depression risk increases in the second trimester,” says Gollan.

She points out the profound social consequences of untreated depression in new mothers. Depressed moms have trouble identifying positive elements in their surroundings, she says. “If you think about the translation of that to their environment, they appear to pay more attention to negative [things].”

EATING DISORDERS

On one hand, two-thirds of American women are overweight. On the other, many are struggling with eating disorders, such as anorexia, bulimia, and binge eating. In their lifetimes, women are three times more likely to experience anorexia and bulimia than men and 75 percent more likely to suffer from a binge-eating disorder.

“Men are more likely to have issues with alcohol,” says the psychologist Joyce Corsica, the director of outpatient psychotherapy at Rush, who recently published a review in Current Opinion and Gastroenterology about the biological and behavioral underpinnings of food addiction. She theorizes that some women have food addictions—especially related to sweets, carbohydrates, and fats—that come from alterations in neurochemistry. “Women are more likely to have issues with food,” she says. “Women report having more food cravings for sure.” (The top craved food: chocolate.)

Eating disorders affect women so disproportionately that Eunice Chen, a psychologist at the U. of C. Medical Center, says that her Adult Eating and Weight Disorders Clinic studies only women. Binging women (who are often in their 40s) feel a loss of control and eat a lot of food in a short time. Bulimics (who are often in their late 20s) compensate for binge eating with diuretics, laxatives, and vomiting. Researchers at the U. of C. are working on a five-year study of treatments but cannot look at the data or say anything about the results until it ends in 2012. (To enroll, call 773-834-9120.) In the meantime, Chen and her colleagues teach women skills and strategies to manage their eating.

On the anorexia front, researchers are figuring out how best to treat teens suffering from the affliction. Those who weigh less than 75 percent of what is considered normal need to get stabilized at a hospital. But recently, a University of Chicago and Stanford study reported that anorexic teens fare better in the long run if they’re at home with their parents. “The idea is to keep them out of the hospital,” says Daniel Le Grange, the director of the eating disorders clinic at the U. of C. Medical Center, a senior author of the study, and the coauthor of Help Your Teenager Beat an Eating Disorder. “With few exceptions, being medically unstable—at less than 75 percent of ideal body weight—should be the only reason for inpatient eating disorder treatment.” Traditionally parents were kept out of the picture, he says, because moms were wrongly seen as part of the problem.

INCONTINENCE

Dr. Linda BrubakerFor two decades, Nancy Brandau, now 68, suffered from incontinence. She tried everything, including surgery, with no success. Finally she got an injection of collagen in her urethra, which eased the problem by compressing the area by the urethra’s outlet. “I just don’t want to be wet,” she says. But even now, she adds, “it’s not unusual for me to have to go four times in the morning.”

Older men sometimes face an incontinence problem as their prostate gland grows and pushes against the bladder. But early in life, women are at greater risk, largely because of childbirth, which puts pressure on the pelvic floor and the nerves. “A third of women will become [permanently] incontinent after a single normal vaginal delivery,” says Dr. Linda Brubaker, a professor of ob-gyn and urology at Loyola University Health System. Though the problem may start with a small leakage, often it gets progressively worse as women age and their muscles and nerve fibers weaken. “Incontinence is the number one reason women go to the nursing home,” says Dr. Sheila Dugan, an associate professor of physical medicine and rehabilitation at Rush.

One promising area of research: Botox. Preliminary studies at Loyola indicate that administering the muscle relaxer straight into the bladder can decrease the spilling of urine. Loyola researchers are comparing Botox to typical overactive bladder medications, such as Toviaz and Vesicare. (To enroll, call 708-216-4188.) They are also getting ready to enroll women for a rehabilitation study for first-time mothers.

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IMMUNE DISORDERS

Women’s immune systems are different from men’s. “Women have a stronger antibody response than men,” says Dr. Tammy Utset, a rheumatologist at the U. of C. Medical Center. Sometimes, though, something goes awry and women produce antibodies against their own tissue—a development that can lead to lupus, a chronic immune disorder that can cause severe fatigue, rashes, sores, hair loss, and organ damage. Victims are typically in their 20s and 30s. (A researcher named Patrick Wilson originally suggested that the ability to develop superantibodies was once an evolutionary advantage—comparable to the way the sickle cell gave Africans resistance to malaria.)

Lupus is nine times more common in women than in men. Researchers aren’t completely sure why. “Women in general do tend to respond immunologically with antibodies rather than cellular defenses when faced with germs or vaccines,” says Utset. Hormones may be a culprit—especially because the onset of lupus tends to come before and during pregnancy, when estrogen levels are high. (The disease rarely starts after menopause, when estrogen levels are low.) “Sex hormones modulate the immune response,” says Dr. Rosalind Ramsey-Goldman, a rheumatologist at Northwestern’s Feinberg School. She is trying to find biomarkers that indicate who might get immune disorders such as lupus.

So far researchers have largely focused on treatments for lupus. But at Rush, they are developing a survey tool to measure quality of life and are working on better medications. “The medicine list [for treating lupus] hasn’t changed in the last 50 years,” says Dr. Meenakshi Jolly, the rheumatologist who directs Rush’s lupus clinic. Frequently used corticosteroids cause weight gain and weakness. Her lab was part of a phase two trial for a new medicine, Benlysta (not yet approved by the FDA), that may decrease the need for steroids. At this point, the drug has been administered to about 400 patients who are participating in a clinical trial.

SLEEP DISORDERS

Women are twice as likely as men to suffer from insomnia, which is often associated with depression. They are less likely to get sleep apnea—but that changes once they hit menopause. When estrogen levels go down, sleep apnea levels go up. When women receive hormone replacement therapy (either estrogen or estrogen plus progesterone), they sleep better.

In a study published in the October issue of Sleep Medicine, Northwestern University researchers found that aerobic exercise caused the most dramatic nondrug improvement in the quality of sleep of insomnia patients (primarily women). Participants also reported fewer depressive symptoms, more vitality, and less daytime sleepiness.

Sleep-deprived adults also risk gaining weight. “Most studies have shown that sleep deprivation is associated with increased appetite and a craving for carbohydrates,” says Dr. Eve Van Cauter, the director of the sleep research center at the U. of C. Medical Center. “Sleep is the window of opportunity to release growth hormone, which partly controls the relative amount of muscle versus fat.”

Sleep problems are nothing to yawn about. Among other things, they can be a sign of thyroid disorder or anemia. “Certainly trouble sleeping at night can be the canary in the coal mine for a variety of reasons,” says Dr. James Wyatt, the director of the Sleep Disorders Service and Research Center at Rush University Medical Center.

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HEART DISEASE

FERTILITY

PREGNANCY

BREAST AND OVARIAN CANCER

CERVICAL AND ENDOMETRIAL CANCER

OSTEOPOROSIS

HEADACHES, MULTIPLE SCLEROSIS, AND OTHER NEUROLOGIC DISORDERS

DEPRESSION

EATING DISORDERS

INCONTINENCE

IMMUNE DISORDERS

SLEEP DISORDERS

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