Five medical conditions most overlooked by young women—and their doctors.
Four months into a solo bike tour of Australia, Susie Stephens' knees, hips and ankles had become so stiff and swollen that she could barely stand up to get in and out of her tent. For weeks she had attributed her symptoms to overtraining; after all, she'd been cycling eight to 10 hours a day. By the time she came home, she couldn't straighten her elbows. Her fingers had swollen up as if they were broken. "In five months," says Stephens, 35, a nonprofit consultant in Winthrop, Wash., "I went from being very athletic to not being able to turn on the shower by myself."
A physical therapist prescribed stretching and strengthening exercises, but the pain worsened. It wasn't until two months later that a doctor stunned Stephens with a definitive diagnosis: rheumatoid arthritis, a progressive disease in which the body's immune cells attack the membranes surrounding the joints.
Stephens is lucky. She began treatment before the disease permanently damaged her joints -- and lucky, she says, that her pain was severe enough to demand medical attention. "Otherwise, I might have played the stoic forever," says Stephens, whose symptoms are now under control with twice-weekly injections of a cutting-edge drug called Enbrel (which interrupts the physiological process that damages the joint lining). "When you're young and athletic, you don't think anything serious could be wrong with you."
That's a common -- and understandable -- attitude, physicians say. "People think they ate something wrong or they have a virus or they're exercising too hard," says rheumatologist Scott Baumgartner, M.D., an assistant clinical professor of medicine at the University of Washington in Spokane. That's why it's crucial for women to recognize their symptoms because many chronic conditions (rheumatoid arthritis, lupus and thyroid disease) are not emphasized in medical school, and thus physicians may not put all your symptoms together. You are your own best advocate. So if any of the symptoms on the following pages are familiar to you, contact your doctor immediately (and bring this article with you).
Left untreated, it can erode the bone, causing loss of motion. With treatment, it is not the devastating diagnosis it was a few years ago.
The disease in a nutshell: Rheumatoid arthritis is a disorder in which the body overproduces cells and proteins that inflame joint linings and damage bone and cartilage. This autoimmune disease also can affect the heart, lungs and eyes. "There may be a window of opportunity within the first two years," says rheumatologist Scott Baumgartner. "If the disease is caught and aggressively treated, it may be less crippling and devastating overall." Left untreated, "the classic deformity is big knuckles and fingers that drift off toward the pinkie," Baumgartner says.
The symptoms: The first sign tends to be soreness and stiffness in the morning, typically in both hands and both feet. As the day goes on, the symptoms may subside, only to return again at night. Eventually, the disease may attack the shoulders, hips, knees and ankles.
Who's at risk: Onset typically occurs between age 20 and 50, often around age 35. Of the estimated 2.1 million Americans with rheumatoid arthritis, about 71 percent are women. Heredity may account for one-third to one-half of the cases; other causes are unknown.
The treatments: Depending on the severity and nature of the case, patients are treated with anti-inflammatory medications and a variety of more-aggressive drugs like Enbrel that help prevent damage rather than treat it after the fact. "It's absolutely amazing the strides that have been made just in the last two years," says Scott Baumgartner.
Contact: The Arthritis Foundation; www.arthritis.org
Considered fatal until the 1950s, it can now be controlled with anti-inflammatory drugs.
The disease in a nutshell: Like rheumatoid arthritis, lupus is an autoimmune disease, meaning that the body harms its own healthy tissues. The disease can affect the joints, skin, kidneys, heart, lungs, blood vessels and brain. If not treated early, the disease can cause irreversible organ damage. For instance, knots of capillaries can form in the kidneys, preventing them from filtering waste products out of the blood. Lupus is one of the major causes of kidney failure.
The symptoms: Lupus is particularly difficult to diagnose because the list of symptoms is so long and varied. "Lupus can look like rheumatoid arthritis, gastrointestinal problems, kidney or lung problems, just to name a few," says Noel Rose, M.D., Ph.D., chairman of the American Autoimmune Related Diseases Association's Scientific Advisory Board and a professor of pathology and immunology at Johns Hopkins University. One telltale symptom is a smooth, reddish "butterfly rash" across the bridge of the nose and on either cheek. Still, less than half of lupus patients develop this rash. Other symptoms include fever, exhaustion, muscle and joint aches and blood clotting problems.
Who's at risk: Lupus usually strikes between ages 15 and 45. It's nine times more common in women than men; three times more common in black women than white women.
The treatments: "Anti-inflammatory drugs have changed the picture completely," Noel Rose says. A healthy lifestyle—including exercise, a nutritious diet and managed stress—also can help control flare-ups of the disease.
Contact: The Lupus Foundation of America; www.lupus.org
About 15 percent of women will experience clinical depression this year, but most do not seek treatment, which has proved to be effective in as little as two weeks.
The disease in a nutshell: More serious than simply having "the blues," depression is an illness related to chemical imbalances in the brain. Depression interferes with basic daily activities, such as working, eating and sleeping.
The symptoms: The key symptoms are at least two consecutive weeks of sadness, lack of motivation and the inability to enjoy favorite activities. "You have to make an active effort to do normal, everyday things, like do the dishes or call your friends to make plans," says Joshua Freedman, M.D., an assistant clinical professor of psychiatry and medical director for neuroscience at UCLA. Other symptoms: fatigue, appetite decrease or increase, feelings of guilt or worthlessness, crying over trivial situations and sleeping more or less than usual, especially waking up very early. In extreme cases, thoughts of death or suicide.
Who's at risk: Depression occurs twice as often in women as in men -- and many do not seek treatment. "People know to go to the doctor or do strength exercises if their backs hurt," says Freedman. "But when someone's mind hurts, people blame themselves." Depression affects up to 10 percent of new mothers.
The treatments: Treatment involves therapy, anti-depressant medication or both. Medication tends to help within two to six weeks, although patients who take the drugs for four to six months are less likely to become depressed again. With therapy, 10-14 sessions may suffice. The therapist can be a psychiatrist, psychologist, social worker or other professional.
Contact: The American Psychological Association; www.apa.org.
Type 2 Diabetes
About 16 million people have diabetes, but more than 5 million of them don't know it. Sometimes weight loss is enough to keep it at bay.
The disease in a nutshell: People with Type 2 diabetes, also called non-insulin-dependent diabetes, are either unable to produce enough insulin or unable to make use of the insulin their pancreas does produce. (Insulin is the hormone that enables your cells to accept glucose, the substance that is converted from food and used for energy.) As a result, glucose builds up in the bloodstream, starving the cells of energy and, over time, damaging the eyes, kidneys, nerves, heart and circulation.
The symptoms: These can be so subtle that they often go ignored for 10-15 years. "But some very frightening things can already be going on," says Chris Driscoll, R.N., coordinator of the Diabetes Care Center at the Tarzana Regional Medical Center in Tarzana, Calif. Complications include nerve damage, heart and kidney problems and irreversible vision damage. Key symptoms include fatigue, numbness in the feet and hands, frequent urination, extreme thirst, frequent bladder infections, vaginal dryness, cuts that are slow to heal and blurry vision. "Tiny blood vessels in the back of the eye can leak blood without the person knowing it," Driscoll says. "The bleeding can be so significant that it detaches the retina."
Who's at risk: Those over age 45 are most prone, but "the age of onset is getting younger because of our lifestyle," says Driscoll. "We tend to be heavy and inactive, and we have a terrible diet. All those things increase our risk." Other risk factors: gestational diabetes (i.e., giving birth to a baby over 9 pounds), low HDL cholesterol, high triglycerides and family history.
The treatments: For many diabetics, regular exercise and dietary improvements (cutting down on simple sugars, increasing complex carbohydrates and protein, and controlling portions) can control blood glucose levels. Weight loss helps, too; sometimes, a loss of 10 or 20 pounds is enough to keep the disease at bay. If diet and exercise don't work, the next step is one of the many glucose-lowering oral medications. Insulin injections are a last resort.
Contact: The American Diabetes Association; www.diabetes.org
Ten percent to 15 percent of American women have an underactive thyroid; 3-5 percent of women have an overactive thyroid. Both are easy to treat.
The disease in a nutshellThyroid disease occurs when the thyroid gland, located just below the Adam's apple, produces either too much or not enough metabolism-regulating hormone called thyroxin. If the thyroid produces too much hormone (hyperthyroidism), the body uses energy faster than it should. The most common form of hyperthyroidism is Graves' disease, in which the immune system causes the thyroid to think it needs to produce more hormone. In extreme cases, hyperthyroidism can cause respiratory failure and paralysis of the arms and legs.
If the thyroid doesn't produce enough hormone (hypothyroidism), the body uses energy more slowly than it should. Hypothyroidism is a common yet overlooked cause of high LDL cholesterol (interfering with the body's ability to clear cholesterol from the bloodstream) which can increase the risk for heart disease. Other long-term consequences of untreated hypothyroidism problems include osteoporosis, infertility, depression and weight gain.
The symptoms: People with hyperthyroidism tend to be nervous and irritable. They may lose weight despite an increased appetite. "They're on edge and think it's just stress," says Richard Dickey, M.D., president of the American Association of Clinical Endocrinologists and a clinical instructor of endocrinology at Wake Forest University School of Medicine in Winston-Salem, N.C. Other symptoms of an overactive thyroid include hair loss, trembling hands, increased perspiration, swollen fingertips, goiter (swelling in the neck caused by an enlarged thyroid gland), increased frequency of bowel movements, eyes that seem to be popping out of their sockets, decreased and less-frequent menstrual flow. Symptoms rarely occur all at once.
The symptoms of an underactive thyroid tend to be more subtle: stiff and achy joints, dry skin, fatigue and weight gain. "I've had patients who sleep 20 hours a day," Dickey says. This condition also can be caused by immune-system problems, producing proteins that damage the thyroid and make it inefficient. Other symptoms include feeling cold, slow heart rate, difficulty concentrating, poor memory, thinning hair, heavy menstrual flow and milky discharge from the breasts.
Who's at risk: Underactive thyroid is five to eight times more common in women than in men. Thyroid dysfunction complicates 5-9 percent of all pregnancies. Postpartum thyroid problems are often misdiagnosed as postpartum depression.
The treatment: The treatment for an overactive thyroid is usually radioactive iodine in pill form. However, this treatment often causes the thyroid to swing the other direction and not produce enough hormone. So patients end up taking the same hormone-replacement pills used to treat those with an underactive thyroid.
Contact: The Thyroid Society for Education; www.the-thyroid-society.org