Foreword

Today, more than at any time in recent history, women’s health care—and even the evidence needed to provide the best possible health care—are under duress. As a result, books such as this one are vitally important if we are to continue making progress in understanding women’s health across the lifespan. Taking sex and gender influences into consideration—at all levels of society, not just research and clinical care—should be as automatic as looking both ways before crossing the street.

Beginning with the founding of the Office of Research on Women’s Health in 1990, followed in 1993 by the Revitalization Act, which added underrepresented racial and ethnic groups to research studies, and then the Sex as a Biological Variable policy in 2016, which required preclinical studies to account for sex-based considerations in vertebrate animals, and most recently the 21st Century Cures Act, which sets forth the Inclusion Across the Lifespan policy, the National Institutes of Health has continuously strengthened the requirements for researchers to understand the health needs of women, particularly as they differ from those of men. After the research has been completed, the findings must be made available to those who can apply them. Hence, after researchers determine sex and gender influences by disaggregating their data, it is crucial that they follow practices such as the Sex and Gender Equity in Research (SAGER) guidelines,^1,2 which recommend how such data should be reported in medical journals. As a result of those and many more efforts, books such as this one can comprehensively summarize sex- and gender-based findings from many researchers around the world. If any part of that continuum of evidence is broken, care for all people is put at risk.

When clinical trials have greater participation of women of all ages, particularly adolescents, pregnant or lactating women, and the elderly, we have better information about how physiologic processes, such as metabolism,³ immunity,⁴ and even microbiome colonization,^5,6 change as we mature. Hence, we have more evidence-based information to guide treatment decisions during different phases of life. We also better understand how medications are metabolized differently at different stages of life, sometimes leading to more adverse reactions in women⁷ or even have differing efficacy in men and women, such as tegaserod, which is FDA-approved only for women with irritable bowel syndrome with constipation.

Despite such advances in understanding sex and gender influences in the etiology, treatment, and prevention of disease, the rates of maternal mortality in the United States have increased since 2018, especially among Black and Hispanic women.⁸ During the opioid crisis, we learned that women are likely to become addicted more quickly than men.⁹ And with the increasing use of social media among girls, there has been a concomitant increase in body image disorders and depression.^10,11 Although the COVID-19 pandemic reduced life expectancy more in men overall, COVID-19 took its toll on women of all ages, with higher mortality among seniors,¹² stress and burnout among those in midlife, and educational and mental health issues among younger women. There was a 5.2% decrease in live births during the pandemic along with an increase in maternal deaths during delivery hospitalization (5.17-8.69 deaths per 100,000).¹³ Long COVID affects women to a greater degree, both in terms of the time it takes to recover and the severity of the symptoms.¹⁴ Reasons for these differences are not well understood.

This book makes clear that the etiology and manifestation of disease varies widely among men and women and can be affected by a host of factors that could have far-reaching consequences many years later. For example, women who experience gestational diabetes during pregnancy have lifetime risks of cardiovascular disease as well as obesity, pre-diabetes, and diabetes,¹⁵ while those diagnosed with preeclampsia are at greater risk for hypertension, renal and cardiovascular diseases.¹⁶ Infection with persistent human papillomavirus in adolescence or young adulthood is associated with greater risk of cervical cancer later in life.¹⁷ With women living longer than men, they are more likely to be diagnosed with Alzheimer’s disease¹⁸ and stroke¹⁹ and yet have reduced gains in quality of life and functionality following stroke when compared to men.¹⁹ As people age, they often develop co- or multimorbidities. Because medications can affect multiple organ systems, not just the affected one, it is imperative to understand the effects of medications on systems outside of one’s area of specialty. Polypharmacy increases in older individuals²⁰; given what is known now and will be determined in future studies, the interactive effects of medications must be considered thoughtfully. By chronicling sex and gender influences in a wide variety of conditions in many different organ systems, this book can help clinicians make informed therapeutic choices.

This third edition of Women’s Health Across the Lifespan: A Pharmacotherapeutic Approach advances the conversation by providing physicians, pharmacists, nurses, students, and other health practitioners with an expansive review of health conditions disproportionately affecting women throughout life. It also presents recent advances in pharmacotherapeutic approaches to reproductive health, mental health, and reproductive cancers. It has become a classic textbook on pharmacological approaches to conditions of great concern to women. Clinicians, however, do not simply treat diseases; they treat human beings, and that requires understanding cultural sensitivities, social and environmental contributors to the health-disease continuum, and understanding when pharmacotherapeutic approaches need to be supplemented by integrative health modalities for full-spectrum health care. This edition brings fresh attention to the cultural, socioeconomic, and psychosocial factors that affect women’s health throughout each stage of life. This well-researched text calls upon health care professionals to consider all these issues when treating their patients.

Women’s Health Across the Lifespan: A Pharmacotherapeutic Approach serves as a comprehensive reference on sex and gender influences on medication response and presents the newest pharmacologic technologies to advance women’s health. We are grateful to the editors and coauthors for providing health care professionals with immediately useful information, including what questions to ask and what treatment decisions to make, so they can provide comprehensive, evidence-based clinical care to women of all ages.