Smidt Heart Institute Experts Address Women's Health Inequities

Worldwide, more than 328 million working women are in or entering menopause, coping with symptoms that can cause professional setbacks and job loss and create financial instability. At the same time, women of all ages are more likely than men to suffer from cultural, political, and socioeconomic disparities that increase their risk for cardiovascular disease, which kills 8 million women every year.

Two physician leaders from the Barbra Streisand Women's Heart Center in the Smidt Heart Institute at Cedars-Sinai are calling attention to these inequities and advocating for change.

Chrisandra Shufelt, MD, MS, associate director of the center, director of the Women's Hormone and Menopause Program, and professor of Cardiology, was the only U.S. physician to take part in crafting new global recommendations for addressing menopause in the workplace. The recommendations were released in September by the European Menopause and Andropause Society (EMAS).

And earlier this year, Noel Bairey Merz, MD, director of the Barbra Streisand Women's Heart Center and professor of Cardiology, was among the authors of the first global report on cardiovascular disease in women. The report, by The Lancet Women and Cardiovascular Disease Commission, concluded heart disease in women remains understudied, underrecognized, underdiagnosed and undertreated despite the fact that it is the No. 1 killer of women worldwide.

"Women are, in general, less valued," said Bairey Merz, the Irwin and Sheila Allen Chair in Women's Heart Research. "They typically have less opportunity for education, and thus fewer economic resources, than men do, and this contributes to health disparities that increase their risk for cardiovascular disease and other health problems."

For instance, some social or religious norms around the globe—such as restrictions on female participation in sports and physical activities of daily living—can increase women's cardiovascular disease risk. And women on a budget put the health of other family members first and tend to ignore their own symptoms, putting off doctor visits where routine screenings of blood pressure and blood sugar could help prevent cardiovascular disease.

At the same time, women experiencing severe symptoms of menopause—including fatigue, insomnia and hot flashes—are more likely to take a back seat in their jobs, skipping promotions, reducing their hours, or even leaving the workforce early. This threatens their immediate and long-term financial security but is rarely discussed in the workplace.

"When it comes to the workplace, we treat menopause the way we treated pregnancy 50 years ago," said Shufelt, the Anita Dann Friedman Chair in Women's Cardiovascular Medicine and Research. "We should be talking about every aspect of a woman's life, from reproductive years to midlife and beyond, and what those different phases of a woman's life mean to their productivity and success."

Shufelt and other experts on the panel recommended measures to destigmatize menopause in the workplace. Their suggestions included increasing manager awareness of the problems this medical condition can cause for some women, addressing discrimination to prevent women from being marginalized or dismissed because of menopause symptoms, and collaborating to address workplace issues that affect menopausal women.

"Menopausal symptoms can affect women at all professional levels," said Shufelt. "I have had patients who experienced such severe hot flashes their glasses fogged up or they began to sweat heavily during important meetings. This distracted them and kept them from fully participating. We need to do better and make everyone aware that women whose menopausal symptoms are making it difficult for them to work have many treatment options available."

Bairey Merz and female colleagues from 11 countries on The Lancet Women and Cardiovascular Disease Commission, meanwhile, outlined recommendations for reducing the global burden of women's cardiovascular disease, including educating healthcare providers and patients on early detection and prevention, scaling up heart health programs, and prioritizing gender-specific research on cardiovascular disease in women.

"We've done quite a lot of research in cardiovascular disease in women during the past 30 years, but there is so much yet to do," said Bairey Merz. "We're 50 years behind our understanding of male cardiovascular disease, so maybe it'll take another 20 years for us to get where we need to be."

Read more on the Cedars-Sinai Blog: Menopause Matters