How A Woman's Exam Would Differ

By CHRISTOPHER HALLOWELL

When I told my wife, who is also 52, about my day-long physical, she wondered if she would have had the same experience. Not exactly. A mammogram, pelvic exam and Pap smear are obvious differences. The effects of hormonal changes associated with menopause, like hot flashes or bone loss, would also be tested. Beyond these, says Dr. Richard Lang, "the issues are the same, but modified by gender."

She too would have gone through the same blood work-up, basic tests and measurements that I encountered. She would have had a sigmoidoscopy, because the frequency of colorectal cancer after 50 in both men and women "just takes off," says Dr. Edgar Achkar, Cleveland Clinic gastroenterologist.

Lang would probably have had an easier time with my wife--or any woman--than with me or most men during the initial consultation. "Women come into my office with a list of concerns," he says. "I have to prod men to tell me what is worrying them about their health." As a result, a woman's physical tends to be more tailored to her worries. Women, for example, "recognize stress issues more readily than men," says Lang, allowing stress evaluation and counseling to be scheduled into the day, if needed.

The first stage at which my wife's exam would differ from mine would be at the cardiac-function lab. While she would have been given an electrocardiogram at rest, a stress test might have been ruled out. EKGs of women on the treadmill are notoriously inaccurate, frequently showing abnormalities where none exist. Instead, women are carefully questioned about family history that might reveal a disposition toward heart disease. Only if heart disease runs in the family would the clinic be tempted to run a stress test.

Another difference: every woman, pre- or postmenopausal, has a bone scan to determine evidence of osteoporosis, because of hormonal changes a very real threat to those in their 50s. Most men don't go to the bone-densitometry lab. I did so only because of the association between kidney stones and bone loss. Mild bone loss in both men and women begins in the late 20s. But with the onset of menopause, women begin losing 1% to 5% of bone mass each year.

Appropriate treatment is the big question. Estrogen replacement to stem the loss can increase the risk of breast cancer and, unless progestin is added in, endometrial cancer. A new medication, raloxifene, appears to stabilize bone loss while reducing the risk of breast cancer. Unlike traditional hormone-replacement therapy, however, raloxifene doesn't ease other menopausal symptoms, like hot flashes.

Proper diet and exercise are the most effective ways of avoiding or alleviating osteoporosis. So women taking the clinic's physical receive more focused advice from registered dietitian Cindy Moore than do men. First, she would want to know if any factors other than hormonal changes have contributed to bone loss. An eating disorder during adolescence, for instance, or chronic inadequate calcium intake diminishes total bone mass. Steroids taken for asthma and immunosuppressants reduce bone density. Even a lack of vitamin D, which is most easily acquired through exposure to half an hour of sunlight a day, diminishes the ability of bones to absorb calcium, a main building block. Moore would recommend an increase in the daily intake of calcium to about 1,500 mg, the equivalent of five 8-oz. glasses of milk. If calcium needs cannot be met through diet only, supplementation with calcium citrate or carbonate should be considered.

Moore, aware of increased risk of postmenopausal heart disease, would worry if a patient was overweight. Excess body fat tends to negate estrogen's protective effect on the heart. She would point out that foods rich in folate, beta carotene and vitamins A, B6, C and E offer protection against heart disease and cancer. Eating a balanced diet consisting of fruits and vegetables, whole grains, protein sources such as poultry and fish, along with nuts and olive, peanut and canola oils can supply these nutrients.

Donald Lu, in the sports clinic, would especially stress the importance of weight-bearing exercises--walking, dancing, tennis and weight lifting--that work muscles against gravity as a way to maintain bone strength for women. --C.H.