By Dr Mary Angela O'Neal
Image credit: Silhouette Woman by PixelwunderByRebecca. Public Domain via Unsplash.
The concerns around what is best practice in caring for a woman with neurologic disease are a common clinical scenario. Therefore, knowledge about women’s health issues and their intersection with neurologic disorders is imperative, as there is an emerging science about differences in medical evaluation, diagnosis, implementation of treatment and care.
Neurological disorders affect women during all stages of their lives, and Women’s Neurology aims to raise awareness and disseminate knowledge about medical problems that afflict both sexes, but which may have different risk, prevalence, presentation, response to treatment, or outcomes in women.
The gender - specific neurologic issues clearly vary at different portions of a woman’s life. For example, these issues might include questions about reproductive health and pregnancy or menopause and healthy aging. Further, one needs to consider how hormonal and reproductive changes throughout a woman's lifespan, as well as use of oral contraceptives and assisted reproduction, impact neurological health and disease.
Nearly every neurological disorder has gender- based concerns. To explore this further, let’s briefly examine some of the gender- based issues in the common disorder, migraine. Migraine is three times more prevalent in women than men (read this freely available chapter). The differences in prevalence begin at the time of menarche and continue until menopause due to the strong influence of estrogen on the disorder. For many women, there is a menstrual exacerbation. Combined hormonal contraceptives may influence migraine frequency and contribute to stroke risk in migraineurs with aura.
Therefore, it is important that providers understand how medication used for migraine treatment may interact with hormonal contraception, reproductive, and bone health and can contribute to teratogenic risk during pregnancy.
Mary Angela O'Neal, MD is an Instructor in Neurology at Harvard Medicial School and the Director of the Women's Neurology Program at Brigham and Women's Hospital in Boston, Massachusetts. There she has organized a multidisciplinary program in Women's Neurology which includes collaborations with obstetrics, obstetrical anesthesia, neurosurgery, women's mental health, medicine and multiple subspecialties in neurology.
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