Invisible Women by Caroline Criado Perez;

Author:Caroline Criado Perez;
Language: eng
Format: epub
Publisher: Vearsa
Published: 2019-03-06T16:00:00+00:00

CHAPTER 11

Yentl Syndrome

In the 1983 film Yentl, Barbra Streisand plays a young Jewish woman in Poland who pretends to be a man in order to receive an education. The film’s premise has made its way into medical lore as ‘Yentl syndrome’, which describes the phenomenon whereby women are misdiagnosed and poorly treated unless their symptoms or diseases conform to that of men. Sometimes, Yentl syndrome can prove fatal.

If I were to ask you to picture someone in the throes of a heart attack, you most likely would think of a man in his late middle age, possibly overweight, clutching at his heart in agony. That’s certainly what a Google image search offers up. You’re unlikely to think of a woman: heart disease is a male thing. But this stereotype is misleading. A recent analysis of data from 22 million people from North America, Europe, Asia and Australasia found that women from lower socio-economic backgrounds are 25% more likely to suffer a heart attack than men in the same income bracket.1

Since 1989, cardiovascular disease has been the leading cause of death in US women and, following a heart attack, women are more likely to die than men.2 This disparity in deaths has been the case since 1984, and young women appear to be particularly at risk: in 2016 the British Medical Journal reported that young women were almost twice as likely as men to die in hospital.3 This may be in part because doctors aren’t spotting at-risk women: in 2016, the American Heart Association also raised concerns about a number of risk-prediction models ‘commonly used’ in patients with acute coronary syndrome, because they were developed in patient populations that were at least two-thirds male.4 The performance of these risk-prediction models in women ‘is not well established’.

Common preventative methods may also not work as well in women. Acetylsalicylic acid (aspirin) has been found to be effective in preventing a first heart attack in men, but a 2005 paper found that it had a ‘nonsignificant’ effect in women aged between forty-five and sixty-five.5 Prior to this study, the authors noted, there had been ‘few similar data in women’. A more recent study from 2011 found that not only was aspirin ineffective for women, it was potentially harmful ‘in the majority of patients’.6 Similarly, a 2015 study found that taking a low dose of aspirin every other day ‘is ineffective or harmful in the majority of women in primary prevention’ of cancer or heart disease.7

Perhaps the greatest contributor to the numbers of women dying following a heart attack, however, is that their heart attacks are simply being missed by their doctors. Research from the UK has found that women are 50% more likely to be misdiagnosed following a heart attack (rising to almost 60% for some types of heart attack8). This is partly because women often don’t have the ‘Hollywood heart attack’ as it’s known in medical circles (chest and left-arm pains).9 Women (particularly young women) may in fact present without any chest pain at all, but rather with stomach pain, breathlessness, nausea and fatigue.

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